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Issues Influencing Medication Adherence in Black Women with Hypertension

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Issues Influencing Medication Adherence in Black Women with Hypertension ABEL, WILLIE M., Ph.D. Issues Influencing Medication Adherence in Black Women with Hypertension. (2011) Directed by Dr. Patricia B. Crane. 279 pp. The purposes of this study were to: (a) describe the differences in adherent and nonadherent Black women who have hypertension (HTN), (b) examine issues that influence medication adherence, and (c) explore the relationship of reactant behaviors and medication adherence. Cox’s interaction model of client health behavior was used to guide this study. Client singularity background variables: demographic characteristics (age and education), social influence (religion), previous health care experience (family history of HTN, comorbidities, number of medications, blood pressure [BP], and body mass index), and environmental resources (income and type of health coverage) along with client singularity dynamic variables: intrinsic motivation (reactance), cognitive appraisal (HTN knowledge, self-care of HTN, trust in health care provider, and coping), and affective response (perceived racism and depression) were examined to determine their influence on the health outcome, medication adherence. A cross-sectional, correlational non-experimental study was conducted with a convenience sample of 80 Black women who were taking antihypertensive prescription medications for blood pressure control. Over half of the participants (56%) were single, divorced, or widowed. Ages ranged from 19 to 60 with a mean age of 47.8 (SD ± 9.2). Almost one-third 30% (n=24) of the participants reported household incomes levels at or below the federal poverty level. The majority of the sample was employed (67%), physically inactive (90%), overweight/obese (88%), and had a history of smoking (54%). The study results did not show a difference between those who adhere to antihypertensive medications and those who do not. Also, there was no relationship between reactant behaviors and medication adherence. However, in the optimal predictive model, those aged 40-49 were less likely to be adherent to their antihypertensive medications. In contrast, those who took 5 to 7 medications were more likely to be adherent. Trust in the health care provider was highly associated with adherence to the medication treatment regimen. These results are congruent with the expectation that trust in the health care provider promotes better medication adherence. Future research should continue to identify factors that influence adherence to the treatment regimen among Black women with HTN and develop interventions that facilitate their ability to better manage their HTN and thus, maintain BP control. ISSUES INFLUENCING MEDICATION ADHERENCE IN BLACK WOMEN WITH HYPERTENSION by Willie M. Abel A Dissertation Submitted to the Faculty of The Graduate School at The University of North Carolina at Greensboro in Partial Fulfillment of the Requirements for the Degree Doctor of Philosophy Greensboro 2011 Approved by ____________________________________ Committee Chair © 2011 Willie M. Abel Without God I could do nothing, Without Him I would fail, Without Him my life would be rugged, Like a ship without a sail. Beatrice Brown ... I thank my God through Jesus Christ... Romans 1:8 ii APPROVAL PAGE This dissertation has been approved by the following committee of the Faculty of The Graduate School at The University of North Carolina at Greensboro. Committee Chair _____________________________________ Patricia B. Crane Committee Members _____________________________________ Carolyn Blue _____________________________________ Danielle Bouchard _____________________________________ Susan Letvak ______________________________ Date of Acceptance by Committee ______________________________ Date of Final Oral Examination iii ACKNOWLEDGEMENTS I express heartfelt gratitude to my advisor and dissertation chair, Dr. Patricia Crane, for her support, guidance, and encouragement. With pleasure, I thank my dissertation committee members, Dr. Carolyn Blue, Dr. Danielle Bouchard, and Dr. Susan Letvak for their support and insightful contributions to my dissertation. My sincere appreciation goes to my consultant, Dr. Jimmy Efird, for his biostatistical expertise. To all who helped me in any way, thank you, especially the professors who taught me how to approach my work as a nurse scientist and my cohort/fellow PhD students who knowingly and unknowingly inspired me to work hard to succeed. A loving thank you I give to my husband, Kenneth, for his never ending love, support, encouragement, patience, and prayers during this endeavor. I thank my children, Katrina and Kenny Jr., for their unconditional love and understanding. Special thanks to my mother, Virginia, for believing in me and keeping me lifted up in prayer. I thank all my family (including my church family) and friends for prayers and moral support. To all the women who participated in my study, I offer kind regards and blessings for their willingness to share in the research process. I gratefully acknowledge the following for financial support of my doctorate: Johnson & Johnson Campaign for Nursing’s Future-American Association of Colleges of Nursing (AACN) Minority Nurse Faculty Scholarship, North Carolina Nurse Educators of Tomorrow (NET) Scholarship, Mary Lewis Wyche Fellowship, and the School of Nursing Graduate Research Assistantship Program. iv TABLE OF CONTENTS Page LIST OF TABLES ........................................................................................................... viii LIST OF FIGURES ........................................................................................................... ix CHAPTER I. BACKGROUND ..................................................................................................1 Introduction ..................................................................................................1 Significance..................................................................................................5 Purpose of Study ........................................................................................11 Conceptual Framework ..............................................................................11 Definitions..................................................................................................21 Specific Aims and Research Questions .....................................................25 Assumptions ...............................................................................................26 Summary ....................................................................................................27 II. LITERATURE REVIEW ...................................................................................28 Introduction ................................................................................................28 Conceptual Views on Adherence ...............................................................29 Elements of Client Singularity ...................................................................38 Element of Health Outcome.......................................................................82 Summary ....................................................................................................88 III. METHODS .........................................................................................................90 Introduction ................................................................................................90 Design ........................................................................................................90 Setting ........................................................................................................91 Sample........................................................................................................91 Human Subjects Protection ........................................................................92 Instruments .................................................................................................93 Procedures ................................................................................................103 Data Analyses ..........................................................................................107 Limitations ...............................................................................................111 Summary ..................................................................................................112 v IV. RESULTS .........................................................................................................113 Introduction ..............................................................................................113 Sample......................................................................................................113 Preliminary Examination of Data ............................................................114 Sample Demographics .............................................................................117 Cox’s Interaction Model of Client Health Behavior Variables ...............119 Research Question #1 ..............................................................................124 Research Question #2 ..............................................................................128 Research Question #3 ..............................................................................133 Research Question #4 ..............................................................................139 Additional Analyses .................................................................................140
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