Purpose: The purposes of this study were to examine: a) male and female African Americans' (AAs') perceptions of hypertension (HTN) and the ways in which their perceptions influence adherence decisions, b) the influences of AA culture and family history on HTN adherence decisions, and c) the feasibility of developing a cardiovascular disease (CVD) pedigree for AAs in primary care. Background: African Americans have a 4.6-fold higher risk of death from CVD than Whites, largely due to uncontrolled HTN and possibly genetic influences. Increased adherence to treatment, pedigree development, family history, and genetic testing may be useful in improving HTN treatment outcomes. Methods: Purposive sampling was used in this ethnographic study to recruit AAs with HTN from a free clinic who were ≥ 21 years of age. Demographic data were obtained and one hour individual in-person interviews were recorded. Verbatim transcripts were analyzed using content analysis and constant comparison. Medical record audits were conducted for the previous year. A three-generation pedigree was developed for each participant using the My Family Health Portrait tool. Descriptive statistics were used to examine demographic, medical record, and pedigree data. Results: Twenty-nine AAs with HTN completed data collection (15 females, 14 males; mean age 49 years; 52% had taken anti-HTN medication for ≥ 5 years). Audits indicated 65% had uncontrolled HTN but medication treatment changes were prescribed only 25% of the time. Perceptions of the causes of HTN influenced adherence decisions. Perceived causes included diet, stress, and unhealthy actions while treatments included altering diet, reducing stress, and avoiding unhealthy actions. Many described cultural treatments "passed down," including drinking pickle juice. Family history motivated the majority to adhere to treatment. Twenty-six (90%) reported their family history in sufficient detail to develop a CVD pedigree. The majority stated they would participate in a genetic study of HTN and provide DNA. Conclusion: Perceptions of HTN, culture, and family history influenced adherence decisions. Clinicians have the opportunity to explore culturally-based treatments used by patients and discover perceptions of adherence. These studies demonstrated that this sample of poor AAs could develop a pedigree and are willing to participate in genetic research.
|Advisor:||McSweeney, Jean C.|
|Commitee:||Cleves, Mario A., Heo, Seongkum, Price, Elvin T., Souder, Elaine, Stewart, Katharine E.|
|School:||University of Arkansas for Medical Sciences|
|School Location:||United States -- Arkansas|
|Source:||DAI-B 75/05(E), Dissertation Abstracts International|
|Subjects:||African American Studies, Nursing|
|Keywords:||Adherence, African American, Black, Hypertension, Qualitative|
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