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The contexts of adherence for African Americans with high blood pressure
L E Rose1, M T Kim, C R Dennison
1Johns Hopkins University School of Nursing, Baltimore, Maryland 21205, USA.
Insights
Adherence to high blood pressure treatment is complex for young African American men. Social, economic, and personal factors, along with provider relationships, significantly impact medication adherence and appointment keeping.
Area of Science:
- Public Health
- Sociology
- Health Disparities
Background:
- African American men aged 18-49 exhibit the lowest rates of high blood pressure (HBP) awareness, treatment, and control in the U.S.
- Understanding the lived experiences of urban Black males with HBP is crucial for improving health outcomes.
Purpose of the Study:
- To explore the multifaceted contexts influencing adherence to high blood pressure treatment among urban African American men.
- To identify key social, personal, and cultural factors affecting medication-taking and appointment keeping.
Main Methods:
- Qualitative study employing in-depth, semi-structured interviews with 19 urban African American men diagnosed with HBP.
- Interviews explored perceptions of health, HBP, treatment, and daily life concerns impacting adherence.
- Participants were a subset of a larger clinical trial focused on HBP control in an inner-city African American population.
Main Results:
- Content analysis revealed key themes: personal contexts (meaning of health/treatment), social contexts (urban Black male experience), and cultural contexts (patient-provider relationship).
- Factors influencing adherence included symptom interpretation, medication adjustment, privacy concerns, resource allocation, addiction, and perceived provider empathy.
- Adherence was found to be dynamic, influenced by social, economic, and personal circumstances, provider interactions, financial stability, and substance use.
Conclusions:
- High blood pressure adherence among young African American men is complex and influenced by a range of individual and systemic factors.
- Empathetic, non-judgmental patient-provider relationships are vital for improving adherence.
- Findings can inform the development of more effective and culturally sensitive HBP interventions for this population.
Abstract:
The contexts of adherence for African Americans with high blood pressure African American men between the ages of 18 and 49 years have the lowest rates of awareness, treatment and control of high blood pressure (HBP) of all age/race/gender groups in the United States. A qualitative study was done to gain an understanding of urban black males' experiences of living with HBP. In-depth semi-structured interviews were conducted with 19 black males. The interviews explored perceptions of health, health problems and priorities, and concerns of daily living that influenced appointment keeping and medication taking. The sample was a subset of 309 men participating in a 3-year clinical trial to improve HBP control in an inner city African-American population. Content analysis of transcribed interviews identified the following themes and related concerns: (a) personal contexts: meaning of health, high blood pressure and treatments; (b) social context: living as a young black male in an urban environment; and (c) cultural context of relating: patient-provider relationship can make a difference. Influencing participants' responses were: interpreting symptoms; adjusting medication taking; protecting personal privacy; allocating limited resources; dealing with addiction; and feeling cared for by a health care provider. Adherence appeared to be multifaceted and changing depending upon: the men's social, economic and personal circumstances; empathetic and non-judgemental assistance from providers; financial concerns and employment; and drug addiction. Findings are useful in refining high blood pressure interventions.