High Blood Pressure in African American Women - Article Example

Analysis of a Qualitative Research Study al affiliation How do African American women with hypertension understand their condition and the strategies they employ in managing it? Abstract Background: High blood pressure is the leading cause of coronary heart disease and stroke among African American women compared with other groups despite the advances in HBP management. This paper aims to find out how African American women with hypertension understand their condition and the strategies they use in managing it. Methods: Analysis of a qualitative research report in which five audio taped focus groups of African American women were conducted. They were aged 35 years and older and were receiving treatment from an inner city clinic. All transcripts were analyzed for content. Findings: African American women had blurred ideas on their understanding of their condition and strategies to employ in managing it. There were also considerable factors that promoted or hindered their commitment to treatment. Implications: The study supports need for education on what hypertension is, managing hypertension and medication side effects, early screening for depression in hypertensive African Americans, developing cultural sensitive education material and formation of support groups. Keywords: African American, Hypertension, management Purpose This paper is aimed to determine the ways through which African American women with high blood pressure understand their condition. This paper also finds out the strategies used by the women in managing hypertension through qualitative analysis. Hypertension is the leading cause of coronary heart disease and stroke in African American women. Compared to other groups, African American women have an earlier onset, a higher prevalence, more rapid progression of hypertensive end organ disease as well as mortality related to hypertension. Qualitative analysis should be intensive and non-biased. Qualitative research gives an in depth understanding of how African American women deal with their condition. Method Collection of qualitative data was done by interviews on a focus group of hypertensive African American women who were undergoing treatment for the disease from an ambulatory inner city free clinic in West Los Angeles. Twenty hypertensive women, aged 35 years and older, participated in the five focus group interviews. Attendance ranged from one to eight from the ten to twelve people that were invited. The study was approved by the University of California, Los Angeles Institutional Review Board. A flyer posted in appropriate areas of the clinic and neighboring areas was used to advertise the study. After sampling, participants were selected for the focus group. Sampling The sample collection procedures were clearly defined since the participants went through a series of tests. First, the research assistants screened the potential participants for eligibility using the JNC-7 classification for pre-hypertension, Stages I and Stage II hypertension. The target group was clearly defined and the inclusion criteria were African American women with hypertension, who were receiving treatment for HBP, were at least 35 years old, able to read 6th grade level English and not obviously too ill to attend and participate in a focus group discussion. If a participant met the required characteristics, she was asked to sign a consent form to protect the rights of the participants. The participants were quietly seated in a chair for 5 minutes and blood pressure measured from each arm at an interval of ten minutes. The average systolic and diabolic readings of both arms were calculated to obtain accurate results. After 10-12 participants had been recruited, a focus group invitation was sent out to each woman stating the time, date and room number for the focus group session. Data collection Before participating in the focus group, the participants signed a consent form. All group sessions were audio-taped and in order to protect their privacy, each one of them was asked to choose a pseudo first name for them and to hold information disclosed in the focus group in confidence. The focus group discussions were moderated by the Principal Investigator using a literature generated interview guide that asked questions on factors influencing adherence to treatment such as their knowledge, attitude and beliefs, health care access and health care behaviors and social support. All focus groups tapes were transcribed to verbatim and each transcript was coded before the next focus group session to identify salient issues to be addressed in the next group session. Accuracy of data was ensured by listening to each focus group tape and reading the corresponding transcript and necessary corrections made prior to coding and content analysis of each transcript for the factors associated with adherence to recommendation to hypertension treatment. The interview method collected large amounts of information about the experiences of the women and offered flexibility to the researcher. Detailed personal information could be collected from the individuals using oral questions (Woods, 2011) Data analysis One of the investigators experienced in qualitative data performed content analysis of the data using constant comparative method. The transcribed interviews were analyzed line by line and relevant sentences and phrases were coded into relevant sentences. Concurrent coding and analysis for each transcript was continued until unique categories were no longer identified. The identification of terms used to describe knowledge, attitudes and beliefs about HBP. This analysis is important since valid inferences can be made to make information more reliable. Findings The results from the discussion of the 20 African American women with high blood pressure gave light to how they understand their condition and the strategies they employ in managing it. This information obtained was their beliefs about HBP, adherence factors to their recommended treatment and barriers to their commitment with the recommended treatment regimens. First, the participants gave various explanations that reflected their understanding of the meaning of high blood pressure. The participants gave a variety of explanations and it was clear that they all had a vague idea of what hypertension was. Factors that influenced their commitment to treatment included reasons to follow provider’s orders, positive changes, knowledge about HBP and social support. From the discussion, it was established that the participants felt that knowledge about HBP and its management provides a basis for adhering to treatment orders. Social support included the people they lived with, group interactions from where they learnt from one another and communicating with a higher power. The factors that were hindrances to commitment to treatment recommendations were categorized as individual, provider, and environmental factors and depression. Individual factors to following dietary recommendations stemmed from disbelief that one has HBP, financial problems and side effects of the medication. Environmental factors included lack of a convenient place for physical activity or stress from the social system. Some study participants felt that controlling the stressors in their lives could help them manage their HBP. Presentation The data on the 20 hypertensive African American women demographics and blood pressure were presented on a table. The variables included age, education level, employment status, yearly household income, health insurance status, where they sought treatment, and the rate of own health status and in comparison with age mates. The mean age was 52.02 and most were widowed, had a high school level of education, unemployed and had a yearly income of less than $10,000. In addition, most did not have a health insurance status and they got treatment from the clinic. Most rated their health status as good but compared to their age mates it was poor. Implications In managing high blood pressure in hypertensive African American women, standards should be followed in addition to screen the women for depression, each woman needs to provided for individualized information to adhere to prescribed treatment for high blood pressure, create and test the effectiveness of a local support group in promoting commitment and therefore control of blood pressure among these women and create culturally sensitive health education material on hypertension and its management. It is noted that awareness needs to be created on hypertension on African American women and should be free of charge. The content based from this research should be definition of hypertension, common medication and side effects, how to handle medication side effects, dietary recommendations and foods to avoid, suitable type of physical activity, and stress reduction approaches. Effects of the study From the findings, it can be established that the blood pressure among African American women is poorly controlled regardless to the fact that all the participants were on antihypertensive medications. Therefore there is an urgent need of health care providers to provide different strategies to manage HBP in African American women. Culturally sensitive approaches were recommended with the hypertensive African Americans. The patients’ knowledge on hypertension influenced their adherence to treatment and management of hypertension. It is important that those who do not know about HBP should be educated so that they can care for themselves. There were strong reasons as to why the women were commitment to treatment in regard to their experiences such as living to see their children grow up. The participants also engaged in positive behavioral changes such as healthy ways to shop, cook and eat food. Increased risk for poor outcomes of health such as obesity and hypertension could be alleviated by nutritious eating. These dietary approaches to stop hypertension can significantly reduce blood pressure. It was also established that the side effects of the medication could cause the women alter their medication. Therefore there is need for the African American women to be educated about the side effects. This could be done by educational approaches targeted on the group by health care providers and empower the women by grounding them in their personal responsibility to take care of themselves. This would impart knowledge on the patients on how to improve their health and prevent further complications. Education targeted on African American women will be important in addition to adequate assessment of the patient including physical and psycho-social aspects and using the information as basis for a culturally relevant plan of care. It is important to examine the roles of the patient, provider and system and health care system as factors that influence adherence to treatment to ensure high quality patient care. The women felt the need to self-manage to adhere to their doctor’s treatment plan. Lack of access to medical care was a great issue among the women in the study and they turned to home remedies which are ineffective. It is essential that to achieve adequate HBP control the patients are required to receive and take appropriate medication. Presence of other people in their lives was instrumental aiding the women to be committed to treatment or not. It was evident that support groups for those with HBP enabled them to share information and the interaction affirmatively reinforced desired attitudes and behaviors. This study showed that the patients have ideas and action plans relating to the management of the disease. They had specific concerns about side effects that the providers need to hear and they know what to take and what will not work. The providers needed to listen to the patients and thoroughly checked their through medical records about the patients. It has been established that African American women are exposed to stressors such as racism, poor housing and education unemployment, low status occupation and high rates of poverty. These are environmental stressors that interfere with adherence to treatment. This stressful environment provides an unsuitable environment to participate in physical activity. Therefore, these women could form walking groups in their neighborhoods. A long term solution could be to ensure African American women attain adequate formal education that would enable them to get good paying jobs and be able to live in less stressful environments. Validity and applicability of the study This study is suitable since it helps health care providers understand how hypertensive African American women view their condition and the strategies used in managing it. It also provides insight of factors that would hinder their treatment. This information is useful as it can be used to control hypertension among the targeted group. This study could also provide a framework for management of other chronic conditions affecting other ethnic minority groups. References Fongwa, M., Evangelista, L., Hays, R., Martins, D., Elashoff, D., Cowan, M., & Morisky, D. (2008). Adherence treatment factors in hypertensive African American women. Vascular Health and Risk Management, 4(1), 157-166 Woods, Martin (2011). Interviewing for research and analyzing qualitative data: An overview. School of Health and social sciences. Massey University Read More