Hypertensive Medication Adherence in Young Adult African American Women 18-45 Years of Age Restricted; Files Only
Spikes, Telisa (Spring 2019)
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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