Factors Affecting Hypertension Treatment Adherence among African Americans

描述(申请人提供)：心血管疾病(CVD)每年导致美国人死亡的人数比其他任何死因都多，心血管疾病的死亡率最高的地区是美国最贫穷的地区。非裔美国人(AA)死于心血管疾病的风险是白人的4.6倍，这主要是由于失控的高血压(HTN)和可能的遗传影响。AAS对HTN治疗的依从率低于White，但原因尚不清楚。了解AAS对坚持HTN治疗的看法和遗传风险因素可能有助于开发量身定制的、对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AAS对坚持HTN治疗的看法。因此，这项研究的目的是为了更好地了解贫穷的AA对HTN的看法、对治疗的坚持以及治疗的促进者和障碍。具体目的是：1)调查男性和女性AA对HTN的认知及其影响坚持决策的方式；2)考察AA文化和家族史对HTN坚持决策的影响；3)研究在初级保健中开发AAS心血管疾病基因图谱的可行性。聚焦的人种学将被用来检查协会对HTN和周围问题坚持治疗的看法。30名参与者(每性别15名)将从阿肯色州普拉斯基县一家提供免费药物的诊所招募。有关目前的药物和临床医生建议的生活方式改变的信息将从参与者的医疗记录中获得。将获得人口统计数据以及自我报告的家族史，并将与所有参与者进行单独的、半结构化的访谈。此外，还将为每个参与者开发一份心血管疾病基因图。内容分析和持续比较将被用来检查围绕HTN的问题，以及影响AA男性和女性坚持接受HTN治疗的因素。这项研究将为制定对文化敏感的量身定做的干预措施以减少这一高危群体的心血管疾病提供基础。 公共卫生相关性：这项研究将帮助卫生保健专业人员了解贫穷的非裔美国人接受高血压治疗是什么感觉。这些发现将帮助我们开发对文化敏感的干预措施，以更有效地治疗非裔美国人的高血压，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.