Self-Management and Resilience Trajectories in African American Adults with Hypertension

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PROJECT SUMMARY/ABSTRACT: Although substantial data are available on the treatment and management of hypertension (HTN), lifestyle modification and medication adherence to antihypertensives therapy, self-managing HTN remains suboptimal in African Americans (AA) and has major impacts on health outcomes and patient care cost with direct medical expenditures estimated to cost $42.9 billion annually. Self-managing HTN to a blood pressure (BP) goal of <130/80 mmHg presents challenges such as juggling multiple medications and health care providers, dealing with complex recommendations and treatment regimens, and coping with negative emotional states. Resilience can be an important factor that protects health, well-being, and quality of life in the context of self- managing HTN. However, there has been a paucity of studies that have examined the biopsychosocial mechanisms that foster effective HTN self-management and resilience among AA. Understanding the mechanism that influence HTN self-management and resilience holds the promise of new modifiable targets for behavior change interventions. This R21 application, Self-management and Resilience Trajectories in African Americans with Hypertension, will explore the influence of resilience precursors on self-management behaviors and on stress response, and the effects that these associations have on health outcomes (health- related quality of life and BP) over a 6-month period. Our research is guided by the theoretical underpinnings of both Glass and McAtee’s Society-Behavior-Biology Nexus of nested hierarchical influences on health and the work of Szanton and Gill’s Society-to-Cell framework. Using a descriptive longitudinal cohort design, we will recruit a convenient sample of 125 AA diagnosed with HTN with multiple chronic condition (MCCs). Participants will be administered a battery of instruments to capture potential covariates, study variables, and observe outcomes at baseline and months 3 and 6. The aims of this study are to [1] Assess the association among resilience precursors (dispositional optimism and resilience, emotion regulation); stress response (cortisol, interleukins, depression cognitions, perceived stress); HTN self-management behaviors and capability (self-efficacy for chronic disease mangement, medication adherence to antihypertensives); and health outcomes (HQROL, BP) among AA with HTN and MCCs at baseline and Months 3 and 6; [2] Determine if stress response mediate the relationship between resilience precursors and health outcomes over time when controlling for risk regulators; [3] Determine if self-management behaviors mediate the relationship between resilience precursors and health outcomes over time when controlling for risk regulators; and [4] Identify resilience trajectory patterns and factors that influence HTN self-management behaviors over time. This study will advance self-mangement and resilience science through the identification and understanding of how protective factors and resilience promote self-management behaviors and influence health at the individual level and inform future interventional research intended to reduce CVD risks associated with suboptimal BP.