Factors Affecting Hypertension Treatment Adherence among African Americans

心血管疾病（CVD）每年杀死更多的美国人比任何其他死亡原因，CVD死亡率最高的是该国最贫困的地区。非裔美国人（AA）死于CVD的风险比白人高4.6倍，主要是由于不受控制的高血压（HTN）和可能的遗传影响。AA对HTN治疗的依从率低于白人，但原因尚不清楚。了解AA对坚持HTN治疗和遗传风险因素的看法可能有助于制定量身定制的文化敏感的干预措施，以提高对治疗的依从性并减少CVD的破坏性并发症。然而，很少有研究关注AA对HTN治疗依从性的看法。因此，本研究的目的是更好地了解贫困AA对HTN的看法，对治疗的依从性，以及治疗的促进者和障碍。具体目标是：1）检查男性和女性AA对HTN的看法以及他们的看法影响依从性决定的方式，2）检查AA文化和家族史对HTN依从性决定的影响，3）检查在初级保健中为AA开发CVD基因图的可行性。重点民族志将被用来检查AA的坚持治疗HTN和周围的问题的看法。将从阿肯色州普拉斯基县的一家提供免费药物的诊所招募30名参与者（男女各15名）。将从受试者的医疗记录中获得有关当前药物和临床医生建议的生活方式改变的信息。将获得人口统计学数据以及自我报告的家族史，并对所有参与者进行个人半结构化访谈。此外，将为每位参与者制定CVD基因图。内容分析和持续比较将用于检查HTN周围的问题，以及影响AA男性和女性坚持HTN治疗的因素。这项研究将为制定文化敏感的定制干预措施以减少这一高危人群的CVD提供基础。 公共卫生相关性：这项研究将帮助医疗保健专业人员了解贫困的非洲裔美国人接受高血压治疗的情况。研究结果将帮助我们制定文化敏感的干预措施，以更有效地治疗非洲裔美国人的高血压，从而减少心血管疾病。

DESCRIPTION (provided by applicant): Cardiovascular disease (CVD) kills more Americans every year than any other cause of death and the highest rates of mortality from CVD are in the poorest areas of the country. African- Americans (AAs) have a 4.6-fold higher risk of death from CVD than Whites, largely due to uncontrolled hypertension (HTN) and possibly genetic influences. AAs have lower rates of adherence than Whites to HTN treatment but the reasons for this are unknown. An understanding of AAs' perceptions of adherence to HTN treatment and genetic risk factors could be useful in developing tailored, culturally sensitive interventions to improve adherence to treatments and reduce the devastating complications of CVD. Few studies, however, have focused on AAs' perceptions of adherence to HTN treatment. The objective of this study therefore is to gain a better understanding of poor AAs' perceptions of HTN, adherence to treatment, and facilitators and barriers to treatment. Specific aims are to: 1) examine male and female AAs' perceptions of HTN and the ways in which their perceptions influence adherence decisions, 2) examine the influences of AA culture and family history on HTN adherence decisions, and 3) examine the feasibility of developing a CVD genogram for AAs in primary care. Focused ethnography will be used to examine AAs' perceptions of adherence to treatment for HTN and surrounding issues. Thirty participants (15 of each gender) will be recruited from a clinic that provides free medications in Pulaski County, Arkansas. Information on current medications and clinician recommended lifestyle changes will be obtained from participants' medical records. Demographic data will be obtained as well as a self-reported family history, and individual, semi-structured interviews will be conducted with all participants. Also, a CVD genogram will be developed for each participant. Content analysis and constant comparison will be used to examine issues surrounding HTN, and factors influencing adherence to HTN treatment in AA males and females. This study will provide the foundation for the development of culturally sensitive tailored interventions to reduce CVD in this high-risk group. PUBLIC HEALTH RELEVANCE: This research will help health care professionals learn what it is like for poor African-Americans to be treated for high blood pressure. Findings will help us develop culturally sensitive interventions to treat high blood pressure more effectively in African-Americans and thus reduce cardiovascular disease.