Aim

To investigate the meaning of support groups and the features of these groups that African American (AA) women view as improving adherence to high blood pressure (HBP) treatment. The study generated a conceptual model to illuminate features of these groups that influence adherence of AA women to HBP treatment.

Design

Qualitative research.

Methods

Used focus groups and open-ended questions to obtain the views of 26 eligible AA women, recruited from South Los Angeles. Line-by-line review and coding of interview transcripts were done. The feedback was used to specify a conceptual model depicting the meaning of support groups. The Consolidated Criteria for the Reporting of Qualitative Research guidelines were used.

Results

The conceptual model depicts the meaning of support groups as information giving/knowledge sharing, emotional or psychological support, instrumental support and coaching, and facilitators and barriers to joining support groups and factors for consideration in forming these groups.

Background

Lack of adherence to recommended regimens is a major cause of uncontrolled blood pressure (BP) among African/Black American (AA) women. The national initiative to increase BP control among AAs by 50% makes clear the need for culturally appropriate instruments to assess facilitators of adherence to treatment of hypertension (high BP [HBP]).

Objective

The aim of this study was to develop a culturally sensitive measure of facilitators of and barriers to adherence to hypertension treatment regimens for AA women.

Methods

We developed the Facilitators of and Barriers to Adherence to Hypertension Treatment Scale (FATS) with input from focus groups with 20 AA women. A total of 147 AA women from a federally funded inner-city clinic in Los Angeles were enrolled in the study and 70 (48%) completed the survey. Internal consistency reliability was estimated using Cronbach's α.

Results

Coefficient α for the 18-item FATS was 78. In a multivariate regression model, controlling for BP stage, the FATS was significantly associated with the Hill-Bone High Blood Pressure Compliance Scale (standardized β = .35; P = .0014), the Enhancing Recovery From Coronary Heart Disease Social Support Inventory (β = .42; P = .001), the and CAGE (cut down on your drinking, annoyed by being criticized for your drinking, guilty about drinking, and eye-opener drink in the morning) alcohol screening instrument (β = -.24; P = .05).

Discussion

The FATS is a culturally sensitive measure for assessing adherence to treatment regimens of HBP in AA women. Further study in other samples of AA women is needed to confirm that the FATS adequately assesses facilitators of adherence to regimens for HBP in AA women.

To estimate readability of seven commonly used health-related quality of life instruments: SF-36, HUI, EQ-5D, QWB-SA, HALex, Minnesota Living with Heart Failure Questionnaire (MLHFQ), and the NEI-VFQ-25. The Flesch–Kincaid (F–K) and Flesch Reading Ease (FRE) formulae were used to estimate readability for every item in each measure. The percentage of items that require more than 5 years of formal schooling according to F–K was 50 for the EQ-5D, 53 for the SF-36, 80 for the VFQ-25, 85 for the QWB-SA, 100 for the HUI, HALex, and the MLHFQ. The percentage of items deemed harder than “easy” according to FRE was 50 for the SF-36, 67 for the EQ-5D, 79 for the QWB-SA, 80 for the VFQ-25, 100 for the HUI, HALex, and the MLHFQ. All seven surveys have a substantial number of items with high readability levels that may not be appropriate for the general population.

Background

Hypertension among African American women is of epidemic proportions. Nonadherence to treatment contributes to uncontrolled blood pressure in this population. Factors associated with adherence to treatment in African American women are unknown. The purpose of this study was to identify factors associated with adherence to hypertension treatment in African American women.

Methods

Five audio-taped focus groups were conducted with hypertensive African American women, 35 years and older receiving treatment for hypertension from an inner-city free clinic. All transcripts from the tapes were analyzed for content describing adherence to treatment factors.

Findings

factors associated with adherence to treatment in hypertensive african american women were in three main categories including: beliefs about hypertension, facilitators of adherence to treatment, and barriers to adherence to treatment.

Implications

The study supports the need for education on managing hypertension and medication side effects, early screening for depression in hypertensive African Americans, development of culturally sensitive hypertension educational material, and formation of support groups for promoting adherence to treatment among African American women with hypertension.