African American Adult Males with Hypertension - Research Paper Example

A Research study in African American adult males with hypertension, is there a difference in quality of life Table of Contents …………………………………………………………………………………2 List of Tables ……………………………………………………………………………………. 3 List of Figures …………………………………………………………………………………… 4 Abstract ………………………………………………………………………………………….. 5 Introduction ………………………….………………………………………………………….. 6 Purpose ………………………………………………………………………………………….. 7 Research Question ………………………………………………………………………………. 8 Hypotheses ……………………………………………………………………………………… 8 Literature Review ………………………………….…………………………………………… 8 Conceptual Framework ……………………………………………………………………..…. 10 Summary ………………………………………………………………………………………. 11 Methodology …….. ……………………………………………………………………………. 12 Study design ...………………………………………………………………………………….. 12 Sampling ……………………………………………………………………………………….. 12 Instrument ……………………………………………………………………………………… 12 Data Collection Procedures ……………………………………………………………….…… 13 Reliability and Validity of Instrument …………………………………………………………. 14 Data Analysis and results ….……………………………..……………………………………. 14 Ethical Considerations …………………………………………………………………………. 15 References ……………………………………………………………………………………… 16 Appendices …………………………………………………………………………………….. 19 Consent Form …………………………………………………………………………………... 19 Instrument ……………………………………………………………………………………… 22 Table 1: Percentage of Persons with High Blood Pressure by Race/Ethnicity and Sex, 18 Years Old and Over, 2002–2006 …………………………………………………………………… 7 Figure 1: Conceptual framework of factors associated with quality of life in hypertensive patients ……………………………………………………………………………………………….. 10 Abstract Hypertension is one of the critical health conditions that have exerted pressure on the government resources in recent years, and resulted in multiple disabilities and deaths. This research is aimed at comparing the quality of life between African American adults male who are part of a support groups and those who are not. The number of subjects to be used in this study will be 351. The dependent variables will be measured based on the scores of eight domains of the Medical Outcomes Study:  36-Item Short Form Survey. After data collection, the results will be presented using descriptive and inferential statistics. Introduction Stroke and heart diseases have a great impact on the general US population. As revealed by the American Heart Association, stroke and other heart diseases have both a direct and indirect impact on the American economy, with their costs amounting to over $475 billion in 2009 (Appel, Wright, & Greene, 2010). Heart diseases and stroke are ranked as the first and third major causative of death and other disabilities, with experts on both national and international levels agreeing that this is the right moment to take action towards addressing the conditions together with the associated risk factors. The disease burden as well as the constant disparities in some populations is indications of stroke and heart disease epidemic. Among the populations that have been affected greatly by this is that of African American men. The African American men are found to suffer disproportionately from cases related to high blood pressure, which is a prime risk factor for stroke and heart disease. Due to these high rates of hypertension among the African Americans, the rate of stroke mortality is at least 80 percent higher, with the mortality rate for CAD being 50 percent higher than the White population. On the other hand, the rates of the hypertension-related end-stage renal disease are 320 percent higher in the African Americans than in the general American population. Reports indicate that the high-CVD-risk population, the hypertensive African American population, currently stands at over 9 million adults in the US. With the increase in age, the disparities in health, as well as the general weight of the society, the numbers are expected to increase in the successive years. Therefore, hypertension is more common among the African American men, and is equally more severe; it develops earlier in their developmental age compared to other ethnic and racial groups. African American males suffer disproportionately from hypertension. 29% of African American males had developed high blood pressure by 2006. From 1999 to 2004, there was a 4.5% increase in deaths related to hypertension amongst the African American males (CDC, 2010). Table 1 below gives a comparison amongst African American men, white men, Hispanic men and African American women with high blood pressure from 2002 to 2006. Race/Sex 2002 2003 2004 2005 2006 Percentage Point Change 2002–2006 African American men 26.4 29.1 27.7 28.1 28.6 +2.2 White men 21.2 21.1 22.0 21.5 23.5 +2.3 Hispanic men 16.7 16.2 16.6 17.1 19.2 +2.5 African American women 32.5 33.9 31.0 34.0 34.1 +1.6 Table 1: Percentage of Persons with High Blood Pressure by Race/Ethnicity and Sex, 18 Years Old and Over, 2002–2006 (CDC, 2010). Purpose of Study This study is aimed at critically evaluating the prevalence of hypertension in the African American male population. The study also intends to establish whether being part of a support group impacts on the quality of life led by the individuals suffering from hypertension. The findings from the study would be ideal towards the efforts to curb hypertension cases among the African American men as well as improving their life qualities and enhancing their health status. Research Questions The research study will seek to answer the following questions: 1. How do hypertension prevalence rates compare across the American population based on their race and ethnicity? 2. What are the predisposing factors for African American men to increased hypertension cases? 3. What health impacts does hypertension have on the individuals having the condition? Hypotheses The null hypothesis is that no difference in the quality of life will be reported by African American adult males with hypertension who are part of support groups and those who are not part of support groups. The directional hypothesis of the study is that there will be a difference in the quality of life reported by African American adult males with hypertension who are part of support groups and those who are not part of support groups. Literature Review Numerous studies have been conducted in relation to how different health conditions impact on different racial and ethnic groups, as well as their ages. Such studies have demonstrated that there exists a variation in the manner and mode in which different health conditions affect the different groups of human population. For instance, African American men have been found to have a higher likelihood of having high blood pressure compared to their white, Mexican, or Hispanic American men counterparts (Murray, Varnell, & Blitstein, 2004). Similarly, the African American men have a higher likelihood of being identified by their physicians when they have high blood pressure. These differences have been consistently observed for a long time, dating back to 1988. For instance, it has been established that the prevalence of hypertension among African American is 45,2 percent while among the white American, the prevalence is at 29.1 percent (Warren-Findlow, Seymour, & Huber, 2012). Hypertension is among the most prevalent and more severe health conditions that result in deaths and disabilities caused by stroke, myocardial infarction, as well as the end-stage renal disease among African Americans compared to other ethnic and racial groups in the United States(Appel et al., 2010; Rigsby, 2011). Appel, et al., (2010) observe that among the men of African American race who have been identified as having high blood pressure, the awareness about their hypertensive condition, the related treatment for the condition, as well as the control of the hypertensive condition, has been on the increase in the recent years. For instance, between 1999 and 2004, whereas at least a half of the group was aware of their hypertensive condition, there was an approximate 56 percent of this population receiving medication, while only 30 percent was under blood pressure control. Health-related quality of life is defined as “the measurement of perceived functional status, impact, restrictions, conditions and treatment point of view that patients with chronic diseases and heart disease have a cultural context and value system” (George, Duran, & Norris, 2014). Measuring Health-related quality of life helps to verify the burden of avoidable disease, hurt, and disabilities (Shanableh, Abdulkarem, Shamssain, & Sarhan, 2014). Health-related quality of life can provide priceless novel insights into the associations between health-related quality of life and risk factors. Blood pressure is a physiological parameter (Fábregas et al., 2013). Blood pressure fluctuates extensively among populations, among diverse persons. Blood pressure also varies in the same individual in different situations (Brennan T  Villagra V, Ofili E, McMahill-Walraven C, Lowy EJ, Daniels P, Quarshie A, Mayberry R, 2010). Blood pressure is established physiologically by “the ratio between cardiac output and peripheral resistance” (Ha, Duy, Le, Khanal, & Moorin, 2014). Genetics has a role in the spread of high blood pressure. If there was there was an individual in the family history suffering from hypertension, it is possible for the traits to be passed down the lineage. The risk to develop hypertension increases as people grow old (Mansyur, Pavlik, Hyman, Taylor, & Goodrick, 2013). Marital status is a significant independent factor affecting all domains of quality of life. One study established that there was an appreciably higher quality of life across the domains investigated. The higher quality of life was registered among participants who were married in contrast to the participants who were not married (Ha et al., 2014). Conceptual Framework The conceptual framework consists of disease status, socio-economic status, behavioral variables, symptom status, role-specific functional status and health-related quality of life (Ha et al., 2014). The framework proposes the health-related variables plummet in a series. The disease status is at the summit. The generic health-related quality of life lies at the bottom. Additionally, the conceptual framework postulates that socio-economic status and behavioral factors exercise considerable effects along this continuum. As a result, the socio-economic status and behavioral factors ought to be carefully considered in examination and interpretation of health-related quality of life data. The framework is essential for the recognition of intricate relationships between variables related to health-related quality of life outcomes (Ha et al., 2014). In addition, the framework is vital to the development of interventions intended to improve health-related quality of life. Figure 1: Conceptual framework associated with quality of life (Ha et al., 2014). The disease status, socio-economic status and behavioral factors have been identified as fundamental factors in the prevalence of high blood pressure in African American population. According to the framework, the domains of general health fall at the distal end of a continuum. The general health perceptions start with physiologic variables that in turn foretell symptom status. The symptom status includes bodily pain. The bodily pain corresponds with one of the variables in this study. The symptom status forecast the functional status that includes psychological, social and physical functioning. The mental health and role emotional variables are attributable to the psychological functioning. The role physical and physical functioning domains as well as the social functioning domain are variable due to the functional status. Summary A high incidence of hypertension amongst African American adult males is a documented fact. A number of interventions are used to mitigate the impact of high blood pressure. One of the recommended interventions is the social support groups. Social groups have been an effective intervention mechanism in a number of diseases. However, with regards to high blood pressure no explicit evidence exists. High blood pressure has composite risk factors. Consequently, it is critical to establish how the various risk factors affect the social support group intervention. Methodology Study Design The study will make use of a cross-sectional randomized design. The sample required for the study is the African American adult males with hypertension based on whether they are either part of support groups or not. Convenience sampling, therefore, is needed to ensure that only African American adult males with hypertension are sampled out of the target population. The cross-sectional randomized design will ensure that data collected is representative of the target population. The African American adult males are spread over large areas with numerous diversities amongst themselves. The diversities include economical, social, political, environmental, and even psychological. Sampling Power analysis will be the sampling technique to be used. Power analysis depends on three aspects. The three aspects are size of the sample, size of the effect and the level of significance desired in the study. Power analysis will aid in determining the size of the sample required to attain the desired level of significance. The sample to be used for this study will be recruited from Baltimore, Maryland. The sampling criteria to be used will be: 1. The person should be with hypertension 2. The person should be an African American male 3. The person must be 18yrs or old 4. The person must have been aware of their status for at least one year. 5. Anyone diagnosed with any other disease or medical conditions alongside hypertension with adverse health effects shall be excluded. The quality of life of such individuals will influence to a great extent by the other disease(s) or condition(s). The information obtained out of the persons shall be misleading. 351 subjects will be recruited for this study. The CHAMP program reaches about 3000 to 4000 people. If 4000 is the size of the population, 95% as the confidence level with 5% as the margin of error; power analysis gives 351 as the recommended sample size. Instrument The instrument that will be used to collect the data will be the Medical Outcomes Study:  36-Item Short Form Survey Instrument. The instrument has 36 questions which can be grouped into eight domains: physical functioning, social functioning, mental health, role-physical, general health, role-emotional, bodily pain and vitality(Shanableh et al., 2014). The scoring in the instrument varies between two, three, five and six scales. Data Collection Procedure The procedure for collecting the data will be as follows. First, the potential participant will be identified as per the sampling criteria. The identification will be followed by explanation of the terms of engagement after which willing participants will be issued with consent forms. Upon getting back the consent forms, the interviewer will personally take the questionnaires to the participants. The participants will subsequently fill in the questionnaires and hand them back to the interviewer. Reliability and validity The reliability of the instrument of study will be tested in each new sample. Cronbach’s alpha will be used to estimate the reliability of the 36-Item Short Form. Cronbach’s alpha values of at least 0.70 have been considered acceptable from other studies (Ha et al., 2014). Pearson’s correlation coefficient will be used to evaluate the level of concurrence between the eight domains of the 36-Item Short Form. Data Analysis and results Descriptive and inferential statistics for the demographic data will be produced. Similarly, descriptive and inferential statistics will be availed for the data collected on the study variables. A demographic table will be used to present number and percentage for all categorical variables. In addition, the demographic table will include the mean, standard deviation, and range for all interval/ratio level data. ANOVA (Analysis of Variance) tests and Independent t- test will be utilized to examine the relationship between participants’ characteristics and mean 36-Item Short Form domain scores (Shanableh et al., 2014). All factors established to be related will be further scrutinized by multivariate linear regression. A stepwise backward elimination procedure will be used for the multivariate linear regression. The cut off for the backward elimination procedure will be set at 0.05. In this study, the level of significance will be set at p < 0.05. The p-value will apply for all the analyses to be done including the evaluation of the hypothesis. Ethical Considerations The proposal will be reviewed and approval will be given from the Institutional Review Board of the University of Manitoba. The details of the study will be explained to all participants. The participants will be given the freedom to choose whether they wish to participate or not. After which they will be given a consent form to sign. The participants will be free to withdraw from the study at any point. In addition, the participants will be explained for that withdrawing from the study will not make them be victimized in any manner. More importantly, all the potential participants will be to understand that failure to participate in the study will not cause them to miss the care they receive. The data collected will be held in confidence. No piece of information received from the participants will be divulged to any unauthorized entity. The data will be accessible to the people who will be collected the data at the point of data collection. The interviewers will subsequently handover the questionnaires to the group that will analyze the data. The questionnaires will be stored for one year after the study after which they will be destroyed. References Center for Disease Control and Prevention, CDC (2010). A Closer Look at African American Men and High Blood Pressure Control: A Review of psychosocial Factors and System-level Interventions. Atlanta: U.S. Department of Health and Human Services. Appel, L. J., Wright, J. T., Greene, T., Agodoa, L. Y., Astor, B. C., Bakris, G. L., … Wang, X. (2010). Intensive blood-pressure control in hypertensive chronic kidney disease. The New England Journal of Medicine, 363, 918–929. doi:10.1056/NEJMoa0910975 Brennan T  Villagra V, Ofili E, McMahill-Walraven C, Lowy EJ, Daniels P, Quarshie A, Mayberry R, S. C. (2010). Disease management to promote blood pressure control among African Americans. Population Health Management, 13(2), 65. Retrieved from http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=cctr&NEWS=N&AN=CN-00748367 Fábregas, B. C., De Ávila, R. E., Faria, M. N., Moura, A. S., Carmo, R. A., & Teixeira, A. L. (2013). Health related quality of life among patients with chronic hepatitis C: a cross-sectional study of sociodemographic, psychopathological and psychiatric determinants. The Brazilian Journal of Infectious Diseases : An Official Publication of the Brazilian Society of Infectious Diseases, 17(6), 633–9. doi:10.1016/j.bjid.2013.03.008 George, S., Duran, N., & Norris, K. (2014). A systematic review of barriers and facilitators to minority research participation among African Americans, Latinos, Asian Americans, and Pacific Islanders. American Journal of Public Health, 104(2), 16–32. doi:10.2105/AJPH.2013.301706 Ha, N. T., Duy, H. T., Le, N. H., Khanal, V., & Moorin, R. (2014). Quality of life among people living with hypertension in a rural Vietnam community. BMC Public Health, 14(1), 833. doi:10.1186/1471-2458-14-833 Mansyur, C. L., Pavlik, V. N., Hyman, D. J., Taylor, W. C., & Goodrick, G. K. (2013). Self-efficacy and barriers to multiple behavior change in low-income African Americans with hypertension. Journal of Behavioral Medicine, 36, 75–85. doi:10.1007/s10865-012-9403-7 Rigsby, B. D. (2011). Hypertension Improvement through Healthy Lifestyle Modifications. Official Journal of the Association of Black Nursing Faculty in Higher Education, 22(2), 41–43. Shanableh, S., Abdulkarem, A., Shamssain, M., & Sarhan, F. (2014). Quality Of Life of Hypertensive Patients on Different Types of Antihypertensive Medications, 4(5), 23–28. Warren-Findlow, J., Seymour, R. B., & Huber, L. R. B. (2012). The association between self-efficacy and hypertension self-care activities among African American adults. Journal of Community Health, 37, 15–24. doi:10.1007/s10900-011-9410-6 Appendices Appendix 1: Informed Consent This informed consent form is for African American adult males in Baltimore who are invited to participate in the research titled “Quality of Life Reported by African American Adult Males with Hypertension". [Name of Principle Investigator] [Name of Organization] [Name of Sponsor] [Name of Project and Version] Introduction I am …, a nursing student at …. I am doing research on hypertension amongst African American adult males. I invite you to be part of this research. You do not have to decide today whether or not you will participate in the research. Before you decide, you can talk to anyone you feel comfortable with about the research. Purpose of the research Hypertension affects the quality of life of the people with high blood pressure. Support groups are one of the ways that are being used to help victims of hypertension. I want to know whether it is of value for an individual with high blood pressure to be part of a support group. I trust you will be helpful by giving me the details concerning yourself. The information you give will aid us in establishing concrete results. Type of Research Intervention This research will require you to fill a questionnaire of 36 short questions and it will take you about one and a half hour to complete. Participant Selection You are requested to participate in this research because you had indicated to us that you have high blood pressure. We believe you will bring on board relevant information to help us understand our topic. Voluntary Participation You are free to choose whether want to participate or not. You are free to withdraw from this research at any point. Choosing to withdraw from the research will not make you be victimized in any manner. More importantly, choosing not to participate will not stop you from receiving the services you get at this center. Procedures You will be required fill out a questionnaire which will be provided by [name of distributor] and collected by [name of collector]. You may skip any of the questions in the questionnaires if you do not wish to answer them. Kindly do not include your name on the forms. The information captured in the forms will be confidential. Duration This research will be done over a three month period. Certificate of consent I have read the abovementioned information. I have had the opportunity to ask questions about it. All concerns I had have been answered to my contentment. I consent of my own accord to be a contributor in this study Print Name of Participant__________________ Signature of Participant ___________________ Date ___________________________ Day/month/year I substantiate that the participant was accorded a chance to ask questions about the research, and all the concerns raised by the participant have been answered in the approved manner to the best of my aptitude. I affirm that the person has not been pressurized into giving consent, and the consent has been given without restraint and of his/ her own free will. Print Name of Researcher/person taking the consent________________________ Signature of Researcher /person taking the consent__________________________ Date ___________________________ Day/month/year Appendix 2: Instrument Top of Form Bottom of Form Medical Outcomes Study:  36-Item Short Form Survey Instrument 1. In general, would you say your health is? Excellent Very good Good Fair Poor 1 2 3 4 5 2. Compared to one year ago, how would you rate your health in general now? Much better now than one year ago 1 Somewhat better now than one year ago 2 About the same 3 Somewhat worse now than one year ago 4 Much worse now than one year ago 5 The following items are about activities you might do during a typical day. Does your health now limit you in these activities? If so, how much? Yes, Limited a Lot Yes, Limited a Little No, Not limited at All [1] [2] [3] 3. Vigorous activities, such as running, lifting heavy objects, participating in strenuous sports [1] [2] [3] 4. Moderate activities, such as moving a table, pushing a vacuum cleaner, bowling, or playing golf [1] [2] [3] 5. Lifting or carrying groceries [1] [2] [3] 6. Climbing several flights of stairs [1] [2] [3] 7. Climbing one flight of stairs [1] [2] [3] 8. Bending, kneeling, or stooping [1] [2] [3] 9. Walking more than a mile [1] [2] [3] 10. Walking several blocks [1] [2] [3] 11. Walking one block [1] [2] [3] 12. Bathing or dressing yourself [1] [2] [3] During the past 4 weeks, have you had any of the following problems with your work or other regular daily activities as a result of your physical health? Yes No 13. Cut down the amount of time you spent on work or other activities 1 2 14. Accomplished less than you would like 1 2 15. Were limited in the kind of work or other activities 1 2 16. Had difficulty performing the work or other activities (for example, it took extra effort) 1 2 During the past 4 weeks, have you had any of the following problems with your work or other regular daily activities as a result of any emotional problems (such as feeling depressed or anxious)? Yes No 17. Cut down the amount of time you spent on work or other activities 1 2 18. Accomplished less than you would like 1 2 19. Didnt do work or other activities as carefully as usual 1 2 20. During the past 4 weeks, to what extent has your physical health or emotional problems interfered with your normal social activities with family, friends, neighbors, or groups? Not at all Slightly Moderately Quite a bit Extremely 21. How much bodily pain have you had during the past 4 weeks? None Very mild Mild Moderate Severe Very severe 22. During the past 4 weeks, how much did pain interfere with your normal work (including both work outside the home and housework)? Not at all A little bit Moderately Quite a bit Extremely These questions are about how you feel and how things have been with you during the past 4 weeks. For each question, please give the one answer that comes closest to the way you have been feeling. How much of the time during the past 4 weeks . . . All of the Time 1 Most of the Time 2 A Good Bit of the Time 3 Some of the Time 4 A Little of the Time 5 None of the Time 6 23. Did you feel full of pep? 1 2 3 4 5 6 24. Have you been a very nervous person? 1 2 3 4 5 6 25. Have you felt so down in the dumps that nothing could cheer you up? 1 2 3 4 5 6 26. Have you felt calm and peaceful? 1 2 3 4 5 6 27. Did you have a lot of energy? 1 2 3 4 5 6 28. Have you felt downhearted and blue? 1 2 3 4 5 6 29. Did you feel worn out? 1 2 3 4 5 6 30. Have you been a happy person? 1 2 3 4 5 6 31. Did you feel tired? 1 2 3 4 5 6 32. During the past 4 weeks, how much of the time has your physical health or emotional problems interfered with your social activities (like visiting with friends, relatives, etc.)? All of the time 1 Most of the time 2 Some of the time 3 A little of the time 4 None of the time 5 How TRUE or FALSE is each of the following statements for you. Definitely True Mostly True Dont Know Mostly False Definitely False 1 2 3 4 5 33. I seem to get sick a little easier than other people 1 2 3 4 5 34. I am as healthy as anybody I know 1 2 3 4 5 35. I expect my health to get worse 1 2 3 4 5 36. My health is excellent 1 2 3 4 5 Read More