Psychosocial Factors Affecting Blood Pressure Outcomes among Young African American Men
Hypertension (HTN) is devastating to African American (AA) men who have a greater prevalence of HTN than any other US population. In 2010, the death rate attributable to cardiovascular (CVD) disease for White females was 192.2/100 000, for White males 278.4/100,000, for AA females 260.5/100 000, and for AA males 369.2/100 000. As a result, CVD associated renal dysfunction, and stroke place AA men as having the highest HTN-induced target organ damage-related death rate than any other race in the nation. HTN control rates for AA men are currently estimated at 36%, well below the national average. Although lifestyle modifications are essential to HTN control, psychosocial factors affecting medication adherence (MA) and blood pressure (BP) outcomes among young AA men who are currently in treatment are not well understood. This descriptive, cross-sectional dissertation study, guided by the PRECEDE-PROCEDE planning model and the Public Health Critical Race praxis model, explores psychosocial factors affecting BP outcomes among 152 hypertensive young AA men age 22 to 50. These factors included sociodemographic characteristics, HTN knowledge, mental and physical health-related quality of life (HRQOL) measured as Mental and Physical Health Composite Scores (MHCS & PHCS), health literacy, medication adherence self-efficacy (MASE), provider communication style (PCS), personal discrimination in healthcare (PDHC), and medication adherence (MA) on systolic blood pressure (SBP) and diastolic blood pressure (DBP) outcomes. Using Bonferroni corrections, nine significant correlations were found, one of which included a strong positive correlation with SBP and DBP. Three psychosocial factors held positive correlations with MASE, these were: MA, PCS, and MHCS, indicating that improvements in MASE are related to improvements in MA, PCS, and MHCS. Three additional factors held significant negative correlations with PDHC these were: MASES, MHCS, and MA, suggesting that as perceptions of PDHC increased, MASE, MHCS and MA declined. Finally, MA was positively associated with MHCS and PCS, indicating that as MA increased, MHCS and PCS also increased.
Positive linear regressions found predictors of SBP outcomes were HTN knowledge and MHCS. Thus as HTN knowledge and MHCS increased, SBP also increased, creating important areas for further study. Additionally, a significant negative predictor of SBP outcome was MA, indicating that as MA increased, SBP declined; this correlation is favorably conducive to HTN control. Finally, mediation process analysis found that MA negatively indirectly mediated MASE, thus inversely affecting SBP outcomes. This is an important finding for future health program planning. Further analysis using Bonferroni corrected correlations of aged-related differences among men aged 22-44 (N = 56) and 45-50 (N = 96) was discussed, the findings of which aid in the development of targeted approaches for HTN control among this population of varying age. Implications for clinical practice include routine assessments of HTN control self-management, MASE and MA behaviors aligned with interventions to promote mutual HTN control goals. Future interventions studies among hypertensive young AA men that address provider communication style, perceived discrimination in healthcare, and enhancing MASE are recommended.