Hypertensive Medication Adherence in Young Adult African American Women 18-45 Years of Age Restricted; Files Only

Spikes, Telisa (Spring 2019)

Permanent URL: https://etd.library.emory.edu/concern/etds/z029p5945?locale=zh
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Abstract

Background:Hypertension (HTN), a modifiable contributor of cardiovascular disease (CVD) maintains its presence as a significant public health threat in the United States and worldwide. African American (AA) women age 20 years and older have the highest prevalence of HTN compared to white women (44% vs. 28%). AAs 18-49 years are twice as likely to die from heart disease as whites and AAs aged 35-64 years are 50% more likely to have HTN compared to whites. Additionally, poor adherence and non-adherence to hypertensive medications have been strongly indicated as a primary contributor to the early onset of disparity in CVD morbidity and mortality that is experienced by AAs. 

 

Purpose:The purpose of this dissertation was to examine blood pressure medication adherence in AA women relative to sociodemographic, clinical, cultural context, psychosocial, cognitive and behavioral processes factors. 

 

Sample and Design:This was a cross-sectional dissertation study with prospective data collection of hypertensive AA women 18-45 years of age (N=85, mean age 39±5.4 years). Variables and measures included: sociodemographic characteristics (age, education, income, health insurance), clinical (blood pressure & comorbidities), exposure to lifetime gender and racial stressors (SSE_SRE), depressive symptoms (PHQ-8), social support (ENRICH-D), HTN illness perceptions (BIPQ), resilient coping (CDRISC-10), and medication adherence (ARMS-7). Analysis included descriptive statistics, correlations, and multiple regressions. 

 

Results:81% of the sample were categorized as non-adherent. SBP was the only clinical covariate associated with HTN medication adherence. None of the predictor variables, overall HTN illness perceptions composite score, resilient coping, depressive symptoms, exposure to lifetime gender and racial stressors, or social support were associated with HTN medication adherence. There were group differences, adherent vs. non-adherent, on the ‘Consequence’ (OR=0.78, p=.01) and ‘Identity’ (OR=0.76, p=.02) dimensions associated with HTN medication adherence and higher income was a significant predictor of HTN medication adherence (OR=1.80, p=0.02). 

 

Conclusions:The findings of this study suggest that components of HTN illness beliefs and sociodemographics, specifically income, are two important contributors to medication adherence in this population. This finding demonstrates the need and importance for clinicians to have open and honest communication regarding HTN and its treatment in facilitating adherence.

Table of Contents

TABLE OF CONTENTS

                                                    

Chapter 1 ................................................................................................................1

            Introduction..................................................................................................1

            Specific Aims.................................................................................................8

            Theoretical Framework ………………………………………………………….………..9

            Research Design and Methods…………………………………………………………10

Study Protocol………………………………………………………………………………..12                    

            Data Analysis………………………………………………………………………………….15

            Protection of Human Subjects………………………………………………………….16

            Innovation of the Proposed Study……………………………………………………..21

            Summary……………………………………………………………………………………….24

Chapter 2  Literature Review…………....................................................................25

            Introduction...............................................................................................25

            Purpose………………………………………………………………………………………….26

            Review of Literature………………………………………………………………………..27

            Conceptual framework…………………………………………………………………….35

            Discussion/Conclusions…………………………………………………………………..37

Chapter 3 Manuscript 2.........................................................................................40

            Introduction...............................................................................................40

            Purpose.......................................................................................................41

            Literature Review.......................................................................................42

            Methods......................................................................................................48

            Measures.....................................................................................................48

            Data Analysis.............................................................................................51

            Results.......................................................................................................52            

            Discussion.................................................................................................56

Chapter 4 Manuscript 3.......................................................................................67

            Introduction..............................................................................................67

            Conceptual Model ....................................................................................71

            Purpose.....................................................................................................73

            Methods....................................................................................................73

            Measures...................................................................................................74

            Data Analysis............................................................................................76

            Results.......................................................................................................77

            Discussion.................................................................................................80

            Conclusion.................................................................................................84

Chapter 5: Discussion and Conclusion................................................................99

            Summary of Research Findings...............................................................101

            Chapter 2 Summary.................................................................................102

Chapter 3 Summary.................................................................................103

Chapter 4 Summary.................................................................................106

Discussion................................................................................................109

Strengths and Limitations……………………………………………….……….….…111

Implications of Model...............................................................................113

Implications of Future Research..............................................................113

Future Next Steps....................................................................................115

References ..........................................................................................................117 

Appendices..........................................................................................................127

            Appendix A: Permission to use instruments……………………….……………127

            Appendix B: Instruments.........................................................................133

            Appendix C: IRB approvals......................................................................144

            Appendix D: Consent Forms....................................................................150

            Appendix E: Instruments..........................................................................171

List of Tables and Figures

                                                                                                                                    Pages

Table 1.1 Overview of variables and Measures .............................................................13

Figure 1.1 Conceptual Model.........................................................................................23

Table 2.1 Barriers to Adherence....................................................................................38

Table 2.2 Table of Potential Research Questions..........................................................39

Table 3.1 Demographic Table.........................................................................................61

Table 3.2 T-test for Adherent status..............................................................................62

Table 3.3 Correlation Matrix..........................................................................................63

Table 3.4 Multiple variable logistic regression and predictors of Adherence….………..64

Table 3.5 Multiple linear regression and predictors for HTN illness perceptions….....65

Table 3.6 Multiple linear regression and predictors for Resilient Coping…….…..……..66

Table 4.1 Simple logistic regression predictors of Adherence……………………….………..86

Table 4.2 Demographic and Physiological Characteristics…………………………….……….87

Table 4.3 HTN beliefs mean scores between adherent and non-adherent groups…….88

Table 4.4 Bivariate Correlation with Adherence and predictors……………….……………..89

Table 4.5 Logistic Regression table with predictors of adherence………………….………..90

Table 4.6 Regression results for Adherence…………………………………………….…………….91

Figure 4.1 Predictive Margins and Systolic Blood Pressure………………………….…….……92

Figure 4.2 Graph Adherence and ‘Consequence’ Dimension…………………………..…….…93

Figure 4.3 Graph Adherence and ‘Identity; Dimension……………………………….…….…...94

Figure 4.4 Slopes Analysis between resilient coping and adverse stressors…………….…95

Figure 4.5 Slopes Analysis between resilient coping and HTN beliefs………………………96

Figure 4.6 Slopes Analysis between resilient coping and ‘Consequence’.....................97

Figure 4.7 Slopes Analysis between resilient coping and ‘Identity’…………………………98

Figure 5.1 Common Sense Model of Illness Representations………………………………..116

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