Dissertations, Theses, and Capstone Projects

Date of Degree

2013

Document Type

Dissertation

Degree Name

Ph.D.

Program

Nursing

Advisor

Keville Frederickson

Committee Members

Margaret Lunney

Martha V. Whetsell

William Ebenstein

Olugbenga Ogedegbe

Lisa Lewis

Subject Categories

Nursing

Abstract

Hypertension (HTN) prevalence in African Americans contribute to higher rates of disabilities and deaths from stroke, myocardial infarction, and end stage renal disease than all other racial groups in the United States. The major reason documented for these poor health outcomes is related to lower HTN control rates among African Americans compared to other racial/ethnic groups. Though overall HTN awareness, pharmacological treatments and control have significantly improved for all populations, studies found that rates of HTN control and adherence with anti-hypertensive medications are lower for African Americans compared to other subgroups.

Study Aims

The primary aim was to determine whether hypertension knowledge, expectation of care, and social support are predictors of adherence to prescribed medications while controlling for socioeconomic factors in the context of hypertension among African Americans.

Methods

A cross sectional quantitative approach was used. A secondary data analysis was conducted with 387 hypertensive African Americans. The Morisky Medication Adherence scale was used to measure adherence, internal consistency was established, (r=.61).

The Roy Adaptation Model (RAM) was used to link HTN knowledge, expectations of care, social support, and socioeconomic factors with adherence to medications to provide an understanding of the process of adaptation. Logistic regressions were used to determine the relationships among the variables.

Results

The sample (N=387) was primarily female (76%) and men (24%). On average, participants scored high in knowledge about hypertension; mean knowledge score was .91 (SD = .09). Controlling for patient covariates, hypertension knowledge was not found to be a predictor of adherence to prescribed medications (p=.469). Expectation of care was found to be a predictor of adherence to prescribed medications (p=.008); social support was found to be a predictor of adherence to medications (p=.006).

Conclusion and Implications

This study supports findings regarding expectations of care, social support, and adherence to medication in African American patients with hypertension. The findings are useful for planning patient management initiatives specific to chronic disease such as hypertension.

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