Intervention Program for African American Women - Essay Example

What kind of intervention program would best meet the needs of African Americans over the age of 60 with hypertension? Introduction: Hypertension is medically recognized as having a blood pressure of above 140 mm Hg during systole and 90 mm Hg during diastole (Selassie et al., 2011). While normal blood pressure is considered to be 120/80 mm Hg, these values vary greatly in the population. The prevalence of hypertension in America is alarming (Taylor, 2009). Studies have shown that at least one in six Americans is hypertensive (Jones et al., 2009), and that the prevalence of hypertension is even higher among African Americans, one in three (33.5%). Medical professionals consider African Americans to have the highest prevalence of an ethnic group (Hajjar, & Kotchen, 2003). The risk for hypertension also increases with age. Thus, the prevalence of hypertension among African Americans above the age of 60 years is almost 50%. Interventions to help reduce the incidence and prevalence of hypertension among older African Americans have been implemented all over the country by professional bodies and organizations for many years. There is however a great concern over the fact that most of these interventions have not been entirely successful. Literature Review Self-care and hypertension care activities have been identified as a potential intervention in the management of hypertension and other chronic illnesses (Mansyur et al., 2013). These interventions, as practiced by African Americans suffering from hypertension, were studied by Warren-Findlow et al., (2012). In their study, the researchers interviewed 190 African Americans suffering from hypertension and who had also been in a self-care program in Charlotte. The study was aimed at exploring the efficacy of the self-care activities. The study compared self-efficacy and adherence to hypertension self-care behaviors. The results of this comparative research established that self-care efficacy is directly related to adherence to medication, dietary restrictions (low salt diet), and lifestyle modification (physical activity and cessation of smoking) (Warren-Findlow et al, 2012; Warren-Findlow & Seymour, 2011). However, the study did not explore the various barriers to the adherence, such as economic factors. Addressing economic factors as part of their intervention could perhaps have changed the efficacy of the self-care program as a whole, and in turn change the study results. In a different study involving different races in America and their control of blood pressure, the researchers used a cohort study to assess the impact of low health literacy on the control of blood pressure. By using a community based participatory approach, the researchers were able to explore the practice level and patient intervention level of care. The main criteria explored in this study included clinical decision making, home-care and blood pressure monitoring, and medication adherence. The study sample included patient groups from six primary care practices although only five were present during the formative phase of the study. The results from this study indicated that the use of community-based participatory approach in primary care for hypertensive patients allows the patients and the families to be fully engaged in the practice. The major limitation of this study is that it used a small sample to develop a conclusion. Taking just six care centers reports may not be enough to generalize the results. In addition, the use of the proposed approach has not been effectively compared with others in current use and hence it cannot be conclude that it is the best (Halladay et al., 2013). Dietary modification has earlier been identified as part of the self-care interventions for hypertension (Tucker, 1999). The efficiency of this intervention has been widely studied. Rankins et al., (2005) conducted a pilot-test for Dietary Approaches to Stop Hypertension (DASH). The study population consisted of 82 hypertensive, low-income, African American adults. It involved arranged ‘dinner with the nutritionist’ sessions for the participants as their blood pressure was monitored. The results indicated that among the hypertensive participants who missed no more than eight sessions, blood pressure was better controlled. The conclusion of this study establishes that the DASH-Dinner model is an adequate intervention in controlling of hypertension (Rankins et al., 2005). The main limitation of this study is that it fails to consider the variables of patient age, sex, and use of prescription drugs for controlling blood pressure. If considered, these factors could have significantly affected the results. The study also fails to capture the dietary behavior of the patients away from the dinner table which could also have affected the results. The above studies have identified a number of interventions that can effectively help manage and control blood pressure. The interventions, however, have variable levels of success among African Americans (Fuchs, 2011). It has been deduced that perhaps a multi-level approach can be relatively more successful in improving hypertension control among the population (Jones, Tucker & Herman, 2009). Ogedegbe et al., (2009) explores this proposition in depth. Their study sought to evaluate the effectiveness of a multi-level, multicomponent, and research-based intervention for hypertension, in comparison to the usual hypertensive care. The study involved 30 healthcare centers, and 15 of them were selected to provide the multi-level interventions which include client education, home blood pressure monitoring, behavioral counseling, and lifestyle modification. The others were to act as a control group, providing the usual hypertension care which mainly entailed drug therapy. Quarterly assessment of outcomes was conducted by the researchers over the course of a year. The study established that a combination of therapies in a multilevel intervention improves the control of hypertension among the African American (Ogedegbe et al., 2009). These results are however limited by the fact that confounding factors such as health care literacy and access to the healthcare centers have not been addressed. The purpose, research question and hypothesis This study will be focused on creating an intervention program that fills the gaps of previous hypertension prevention programs for African Americans over the age of 60. The general question that will guide this research is: What kind of intervention program would best meet the needs of African Americans over the age of 60 with hypertension? The study will be focused around the hypothesis that a multidisciplinary approach, involving all healthcare professionals, as well as the patient and their family, is the most effective intervention program to meet the needs of hypertensive African Americans over the age of 60. Significance of the study As aforementioned, African Americans have relatively higher rates of hypertension. The problem is worsened by the fact that this also increases their risk for severe complications. The prevalence and hence the risk also increases with age making senior citizens (those above the age of 60 years) more vulnerable to life-threatening illnesses and complications (Choudhary, Jankowich & Wu, 2013;Peters, Aroian, & Flack, 2006). Many of the interventions that have been implemented have failed to address this problem adequately. The multidisciplinary approach has been shown to be effective in the treatment of health conditions, particularly hypertension, and will therefore be studied. References Choudhary, G., Jankowich, M., & Wu, W. C. (2013). Prevalence and clinical characteristics associated with pulmonary hypertension in african-americans.PloS one, 8(12), e84264. Fuchs, F. D. (2011). Why do Black Americans have higher prevalence of hypertension? An enigma still unsolved. Hypertension, 57(3), 379-380. Hajjar, I., & Kotchen, T. A. (2003). Trends in prevalence, awareness, treatment, and control of hypertension in the United States, 1988-2000. JAMA, 290(2), 199-206. Halladay, J. R., Donahue, K. E., Hinderliter, A. L., Cummings, D. M., Cene, C. W., Miller, C. L., … DeWalt, D. (2013). The Heart Healthy Lenoir project--an intervention to reduce disparities in hypertension control: study protocol. BMC Health Services Research, 13, 441. doi:10.1186/1472-6963-13-441 Jones, J. D., Tucker, C. M., & Herman, K. C. (2009). Stress and nutrition among African American women with hypertension. American Journal of Health Behavior, 33(6), 661-672 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(1), 75-85. Ogedegbe, G., Tobin, J. N., Fernandez, S., Gerin, W., Diaz-Gloster, M., Cassells, A., ... & Ravenell, J. (2009). Counseling African Americans to Control Hypertension (CAATCH) Trial A Multi-Level Intervention to Improve Blood Pressure Control in Hypertensive Blacks. Circulation: Cardiovascular Quality and Outcomes, 2(3), 249-256. Peters, R. M., Aroian, K. J., & Flack, J. M. (2006). African American culture and hypertension prevention. Western journal of nursing research, 28(7), 831-854. Rankins, J., Sampson, W., Brown, B., & Jenkins-Salley, T. (2005). Dietary Approaches to Stop Hypertension (DASH) intervention reduces blood pressure among hypertensive African American patients in a neighborhood health care center. Journal of nutrition education and behavior, 37(5), 259-264. Redmond, N., Baer, H. J., & Hicks, L. S. (2011). Health behaviors and racial disparity in blood pressure control in the national health and nutrition examination survey. Hypertension, 57(3), 383-389. Selassie, A., Wagner, C. S., Laken, M. L., Ferguson, M. L., Ferdinand, K. C., & Egan, B. M. (2011). Progression is accelerated from prehypertension to hypertension in blacks. Hypertension, 58(4), 579-587. Taylor, J. Y. (2009). Risks for hypertension among undiagnosed African American mothers and daughters. Journal of Pediatric Health Care, 23(6), 378-387. Tucker, K. (1999). Dietary patterns and blood pressure in African Americans.Nutrition reviews, 57(11), 356-358. Warren-Findlow, J., & Seymour, R. B. (2011). Prevalence rates of hypertension self-care activities among African Americans. Journal of the National Medical Association, 103(6), 503. 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(1), 15-24. Read More