African-Americans and Hypertension Prevention, Article Critique Example

Hypertension among African-Americans is a significant health problem, and many studies have been conducted to determine the causative factors of this issue. Because there has been no indication that the cause of hypertension is a genetic predisposition among black people, the conclusions have been that lifestyle and socio-environmental factors are the main contributors to the problem (Peters, Aorian & Flack, 2006.) This paper will discuss a qualitative research study conducted in order to examine the beliefs and attitudes of African-Americans towards behaviors leading to the prevention of hypertension.

The research tradition utilized for this study was a qualitative design, with the research question examining the “behavioral, normative, and control beliefs” of African-Americans pertaining to beginning and maintaining active behaviors that will control blood pressure in order to avoid developing hypertension. Qualitative research designs are considered to be the most flexible method of scientific inquiry, because they involve a wide range of acceptable methods and structures (“Qualitative Research Design,” 2008.) Characteristics of qualitative designs include: combining various data collection methods; maintaining flexibility in order to adapt to new information collected during the study; utilizing the extreme involvement of the researchers to become the research tool; and providing continuous analysis of the data in order to formulate future strategies ((Beck & Polit, 2012.)

The study described in the article at hand matched those criteria, using focus groups to collect results and analyzing descriptive data based on the very rich interactional patterns that are characteristic of group behaviors.

The population sampling for this research was purposive, or deliberate, because the authors wanted to create a sampling that was varied in educational background as well as economic status. In addition, the five focus groups were separated based on gender in order to increase the chances that various viewpoints regarding hypertension and lifestyle behaviors would be represented. Ultimately, five groups were formed comprised of three groups of females, two of males, a total of 34 people who ranged in age from 27 to 60 years of age; in addition, the sample contained representatives of various income levels, as well as educational backgrounds. The researchers intentionally gathered a diverse group to study in order to understand significant differences in health promotion and health seeking behaviors among this African-American population. This deliberate decision was a productive one because it allowed a wide range of data related to the research question to be obtained.

The focus groups were held in a combination of convenient settings such as churches that were able to provide private settings; at the beginning of each meeting, refreshments were served in order to create an informal, open environment. The group sessions, which were 90 minutes, were audiotaped to guarantee accuracy.

The data were collected by a team of researchers, consisting of a primary investigator, a group moderator, data collector, and a doctorally-prepared nurse with expertise in qualitative research. Each group session was led by a moderator as well as a data collector; all of the research teams were made up of African Americans in order to increase the comfort level of the participants. The groups were conducted using a semi-structured interview containing three sets of questions based on Theory of Planned Behavior, or TPB; the purpose of this theory is to explain why people act in certain ways and that they form an intention to behave that is based on a person’s beliefs, social pressure to conform to others wishes, as well as their perceived ability to carry out these actions (Williamson, 2009.) The first set of questions involves significant beliefs about the prevention of hypertension. The next set of questions explored normative beliefs in order to understand the effect of family and friends on the prevention of hypertension behaviors; the final set explored control believes that included the perceived benefits and obstacles to becoming involved in strategies to avoid hypertension.

The method of data analysis involve the transcription of audio tapes that were made at each group session; after each meeting, the moderator summarized the main points of each session, soliciting feedback from the participants about whether or not that summary accurately reflected the contents of the meeting. After the tapes were transcribed, they were reviewed by the primary investigator to make sure that the data was accurate. Data analysis involved two steps: implementing traditional coding to evaluate behavioral, normative, and control beliefs, and “open” coding, performed by the qualitative expert who had not participated in any of the focus groups and was not familiar with TPB. The research team engaged in discussions about themes that emerged during the focus groups, evaluating whether or not the coding method had been able to capture the wide range of responses given by the study participants. The researchers debated both how the data fit the theoretical model, as well as how it contradicted TPB. Ultimately, the team arrived at results that they felt accurately categorized the participants’ answers.

The overall themes that emerged from the research findings included a “circle of culture” which represented the ties that bind members of the African-American community and which determined acceptable and unacceptable behaviors. Another important theme was comprised of three ideas: cognitive beliefs about the causes and results of hypertension, affective beliefs about the pros and cons of participating in hypertension-preventing lifestyle changes, and cognitive beliefs pertaining to making a commitment to engage in actions to prevent hypertension. The population sample mentioned a range of factors affecting hypertension, including diet, stress, obesity, and lack of financial resources to seek medical help.

The researchers followed four procedures to ensure validity of the results. They accomplished credibility by continuing to run the focus groups until saturation was achieved. In addition, debriefing by peers was utilized to evaluate bias by the investigators that might have skewed the results. The researchers also established dependability in various means: using a wide range of subjects, clearly establishing the team members’ role in the process, using uniform data collection methods for each focus group, and by having the investigators evaluate their peers’ analysis and interpretation of the results.

This study was intended to apply the Theory of Planned Behavior to the question of African-Americans attitudes and beliefs regarding hypertension, as well as their willingness to become involved in self-care in order to prevent the condition. The research utilized focus groups to elicit qualitative data from participants by carefully enlisting a team approach consisting of moderators, interviewers, and researchers. Many methods were used to ensure that the data obtained was a fair representation of the belief systems of a wide range of African-American citizens.

Essentially, there were four conclusions contained in the study: the participants largely felt that the causes of hypertension are diet and food preparation, rather than obesity and lack of exercise; that participants cognitively knew that dieting, increasing exercising and minimizing stress would help to prevent hypertension, although this knowledge did not necessarily impact actual behavior; that the “circle of culture” directly impacted the likelihood of African-Americans’ willingness to engage in self-care behaviors to prevent hypertension, and that family and community support can play a tremendous role in supporting healthy practices that discourage hypertension. In addition, the study supported the researchers’ thesis that applying TPB to the issue of health issues in any communities, but in particular minority communities, is a crucial step in understanding the potential success, or lack of, in prevention programs.

This article was aimed at health care providers in an effort to assist them in identifying the factors that contribute to behaviors regarding disease prevention. Its emphasis on cultural factors and the formation of cultural identities has been rare among researchers, according to its authors, leading them to focus on socio-cultural factors in particular. The suggestion that healthcare providers expand their interventions to include families and communities makes much sense given how influential these factors are in the development of attitudes regarding health.

References

Beck, C. T., & Polit, D. F. (2012). Nursing research: generating and assessing evidence, research, practice. (6th ed.). Philadelphia: Wolters Kluwer Heath/Lippincott Williams & Wilkins.

Peters, R., Aorian, K., & Flack, J. (2006). African-American culture and hypertension prevention.Western Journal of Nursing Research, 28(7), 831-863. doi: 10.1177/0193945906289332

Qualitative research design. (2008). Retrieved from http://www.experiment-resources.com/qualitative-research-design.html

Williamson, G. (2009, June 30). Theory of planned behavior. Retrieved from http://www.speech-therapy-information-and-resources.com/theory-of-planned-behavior.html