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Health Care Issues, Research Paper Example

Pages: 1

Words: 2905

Research Paper

Outline

Introduction

Literature Review

  • Table
  • Study 1
  • Study 11
  • Study 111
  • Study 1V
  • Study V

Analysis

Conclusion

  • Implications
  • Recommendations

Abstract

Health beliefs, practices, barriers and facilitators in the control of hypertension in African Americans are the focus of this literature review. It will embrace five research studies linking these concepts of interest in evaluating hypertension as a disease and phenomenon among this high risk population.

Health Care: Health Issues

Integrated Literature Review

Hypertension in African Americans

Introduction

In 2006 it was discovered that 76 million US Adults are hypertensive. African Americans accounted for 44% of all cases, which is the highest number of Africans affected with hypertension in the world (Ostchega et.al, 2007). Studies conducted by P D Curtin (1992) challenged the notion that the emergence of hypertension among African Americans is related to the sociology of slavery (Curtin, 1992).

Three assumptions were made regarding this traditional theory; firstly dietary salt deficiencies in the African geographic locations from which slaves were recruited for the Americas was responsible; secondly, the traumatic elements whereby the slave trade was conducted influenced it and thirdly rigors of slavery itself in America had an impact (Curtin, 1992).

However, Curtin’s research proved that there were no salt dietary deficiencies among the African territories from which slaves were recruited. Besides, even today there is a very low incidence of hypertension among West Africans. Similarly deaths and treatment during transportation to the Americas on slave ships was also disputed. A limitation in this research was that much of the data related to West Indies and not United States of America. Enough evidence did not exist to show where dietary changes influenced hypertension among slaves either if actual conditions did (Curtin, 1992).

Importantly, research studies have revealed that hypertension has affected African Americans uniquely. Primarily, it becomes obvious at a comparatively younger age than other ethnic groups and is more likely to develop into complications such as stroke, heart disease; kidney failure and blindness. Scientists and researchers alike are inconclusive regarding the causes of hypertension, generally and more so among African Americans if there is no predisposing kidney or heart disease. This is classified as secondary hypertension (Ostchega et.al, 2007).Consequently, this literature review seeks to find answers to the question how health beliefs/practices create barriers or facilitate control of hypertension in African Americans?

Literature Review

In selecting studies for this literature review PubMed; American Heart Association and PMC data bases were researched utilizing  key words, African Americans hypertension, African Americans health beliefs; African Americans health practices, hypertension control in African Americans. The inclusion criteria were hypertension and African Americans while the exclusion    were other races and health conditions. The following are results of this search:-

Project title: Review of Evidence

Article Citation Study

Design

Sample size

and statis-

tical

methods

Purpose/ results/ findings Limita-

tions

Conclusions/ Recommen-

dations/

Nursing Implications

 

Quality of evidence
 

1. Warren-Findlow, J., & Seymour, R. (2011). Prevalence Rates of Hypertension Self-

Care Activities among African Americans. J Natl Med Assoc. 103(6): 503–512.

 

Quali-

tative

186

No statisti-

cal methods were used

1.To evaluate the extent to which African Ameri-

cans comply with self- care against those who did not.

2. Half of the sample were compl-

iant

Small sample size cannot

generalize

African Americans need to more education in this regard Evi-

dence level

V1

 

Evid

ence grade:-

A

            Evidence Level

 

Evidence Grade.

 

 

2. Fernandez, S. Tobin, J. Cassells, A. Diaz-Gloster, M. Kalida C., & Ogedegbe, G.

(2011).The counseling African Americans to control hypertension (caatch) trial: baseline

Demographic, clinical, psychosocial, and behavioral characteristics. Implement Sci, 6,

100.

Quan-

tative and quali-

tative

Mixed

– 1,039 hyperten-

sive African Ameri-

cans were recruited for this study. Mean and median statis-

-tical methods

1.Counseling African American to Control Hyperten-

sion (CAATCH) was used by researchers to evaluate ‘the effective-

ness of a multi-level, multi-component, evidence-based interven-

tion compared with usual care (UC). 90% were resistant to

CAATCH

2.  The program

needs further refinement to be effective.

Groups were not compa-

tibile in every respect.

The African American needs to more education in this regard Evidence Level:-

1V

 

Evidence Grade. A

3.Scisney-Matlock, M. Bosworth, H.  Newman Giger, J. (2009). Strategies for

Implementing and Sustaining Therapeutic Lifestyle Changes as Part of Hypertension

Management in African Americans. Postgrad Med. 121(3): 147–159.

Quali-

tative

Syste-

mic review

20 studies

Mean and median statisti

cal methods

1.To eval-

uate the effect-

iveness of thera

peutic

Life Style

Chan-

ges  in

hyper-

tention control among

African Americans

2.There were obvious limita-

tions regarding integra-

tion of the Dietary Approa-

ches to Stop Hyperten-

sion (DASH) eating plan

Literature

Reviews are

Limited

to the studied

viewed.

African Americans need culturally

appropriated education in this regard

Evid

ence

Level:- V

Evid-

ence

Grade:- A

 

4. Konerman, M. Weeks, K., & Shands, J. (2011). Short Form (SF-36) Health Survey

Measures are Associated with Decreased Adherence among Urban African-Americans with

Severe, Poorly Controlled Hypertension. J Clin Hypertens (Greenwich), 13(5): 385–390.

Quali-

tative

158

Mean and median calcu-

lations

1. The purpose of this study was to identify whether there is an association between SF-36 measures and nonadherence among urban African-Americans with poorly controlled hypertension.

2.Beliefs about disease and its treatment influences compliance with hypertensive medication therapy.

Small sample size difficult to genera-

lize

 Approaches

to hyperten-

sion control in African

Americans

Need to be culturally relevant

Evid-

ence level: VI

Evid-

ence grade:- A

5. Peters, R. Aroian, K., & Flack, J. (2006). African American Culture and

Hypertension Prevention. West J Nurs Res, 28(7), 831–863.

Quali

-tative

Focus groups

34 adults

Mean

And median

Calcu-

lations

1. The purpose of this study was to apply the theory of planned behavior (TPB) in explaining African Americans’ noncompliance to hypertensive medication management/ therapies.

2. Culturally defined foods appeared to be a major factor in non-compliance.

Partici-

pants

could hide the truth due to

group

interact-

tion.

There needs

to be more

specific

research in

control of

hyperten-

tion among

African Americans

Evid-

ence level 1V

Evid-

enced grade:-B

Study 1:- Warren-Findlow, J., & Seymour, R. (2011). Prevalence Rates of Hypertension Self-Care Activities among African Americans. J Natl Med Assoc. 103(6): 503–512.

Purpose: – This study explored self-care prevalent activities among African Americans with hypertension examining differences between those who comply with self-care and non-compliant subjects.

Methodology:- Researchers employed interviews as the data collection technique. Administered questionnaries were applied as instruments to a sample of 186 African Americans.  H-SCALE (Hypertension Self-Care Activity Level Effects) was established as the measurement in evaluating behavioral activities recommended for optimal management of high blood pressure during self-care.

Results: – 58.6% – 52% respectively, of participants reported to have been compliant with recommended medication and prescribed physical activity levels. Practices included weight management, to which 30.1% of the sample was in adherence and low-salt diet showed less compliance, 22.0%. 75% did not smoke and 65% abstained from alcohol. The greatest adherence was among elderly women and majority of noncompliant participants were uninsured.

Conclusion: – Hypertension self-care among African Americans is still a challenge, especially, in relation weight control and reduced salt intake. Ultimately, researchers confirmed that the H-SCALE authentic in accurately evaluating hypertension self-care activities since the instruments were pretested and proven valid and reliable. Further they recommended that health care providers measure patients’ hypertension self-care activities response by applying the H-SCALE.

Study 11:- Fernandez, S. Tobin, J. Cassells, A. Diaz-Gloster, M. Kalida C., & Ogedegbe, G. (2011).The counseling African Americans to control hypertension (caatch) trial: baseline Demographic, clinical, psychosocial, and behavioral characteristics. Implement Sci, 6: 100.

Purpose: – Counseling African American to Control Hypertension (CAATCH) was used by researchers to evaluate ‘the effectiveness of a multi-level, multi-component, evidence-based intervention compared with usual care (UC) in improving BP control among poorly controlled hypertensive African Americans who receive primary care in Community Health Centers (CHCs)’ (Fernandez et.al, 2011, abstract).

Methodology: – 1,039 hypertensive African Americans were recruited for this study. They were being offered care at 30 CHCs within the New York Metropolitan area. Chart reviews and interviews were the instruments used to collect baseline data. These included blood pressure readings; medications for controlling hypertension, psychosocial influences; depression; adherence to medication management; effectiveness of self-care; exercise and diet.

Results: – 71.6% of the sample was female of an average age of 59 years old; 62.4% acquired a high school education; 72.4% earned less than %20,000 annually; 35.9% received Medicaid; 12.6% Medicare; 25.6% were resistant to anti-hypertensive medication;16% were diagnosed with moderate or severe depression; 35.8% were diabetics and 59.7% obese. The sample’s mean BP was 150/91. ‘54.8% were poor global physical health, poor eating habits, high health literacy, and good overall mental health’ (Fernandez et.al, 2011, abstract).

Conclusion: – Lifestyle behaviors which were considered adverse have been identified a president variable in 90% of the CAATCH trial sample. Significantly, evidence of medical and psychosocial barriers was also observed which influenced blood pressure control. Consequently, there were multiple co-morbid conditions among the low income African Americans (Fernandez et.al, 2011)

Study 111:- Scisney-Matlock, M. Bosworth, H.  Newman Giger, J. (2009). Strategies for Implementing and Sustaining Therapeutic Lifestyle Changes as Part of Hypertension Management in African Americans. Postgrad Med. 121(3): 147–159.

Purpose: – 1. To synthesize current scientific evidence related to therapeutic lifestyle changes (TLC) in hypertension management among African Americans. 2. To identify strategies that health care providers can incorporate in TLC management plan for controlling hypertension in African Americans.

Methodology: – Scientific data pertaining to TLC application among African Americans was synthesized by a multidiscipline panel. Data retrieved was used to assess TLC application strategies for improving blood pressure management; removing barriers to behavioral change, and measures to overcome them. Researchers began with the assumption that therapeutic lifestyle change (TLC) interventions should focus on patient self-management as well as providers, family, and community support. TLC must also be consistent with the individual’s cultural heritage, beliefs, and behavioral norms since targeting multiple factors which impede blood pressure control can enhance success in TLC. Precisely, 20 studies from Davis et.al compilation were relevant for the literature review.

Results: – There were obvious limitations regarding integration of the Dietary Approaches to Stop Hypertension (DASH) eating plan. African Americans were highly non-compliant with diet.  Barriers to life style changes included African Americans do not trust the health care system and do not believe the diagnoses. Reaction to the message depends on the source from which it emerges. Government sources receive the least response. African Americans do not acknowledge dietary guidelines which depart from their traditional diet since they believe that it may be a way of exterminating Africans form the society.

From the provider perspective some of them do not believe in the hypertension management guidelines suggested in TLC for African Americans because their hypertension is peculiar to other races. Providers preferred the easier route of prescribing medications. Limited access to health care through lack of insurance coverage is a major source of non-compliance especially, in cases where one-to-one counseling is necessary Complex therapy related factors proved a barrier to TLC also. Therefore, interventions could be considered unsuccessful.

Conclusions/Recommendations:-Many forms TLC interventions have been useful scientific evidence towards improving hypertension management. Numerous factors however can produce barriers. These include accessibility and nature relationships among patient, provider, suggested therapy, and personal environment. Reconstructing tools for patients and providers is recommended.

Study 1V: – Konerman, M. Weeks, K., & Shands, J. (2011). Short Form (SF-36) Health Survey Measures are Associated with Decreased Adherence among Urban African-Americans with Severe, Poorly Controlled Hypertension. J Clin Hypertens (Greenwich), 13(5): 385–390.

Purpose:  The purpose of this study was to identify whether there is an association between SF-36 measures and nonadherence among urban African-Americans with poorly controlled hypertension.

Methodology: – Researchers evaluated 158 African-Americans admitted to an urban hospital. They were diagnosed with severe, uncontrolled hypertension. The Physical Component Summary (PCS) was used to measure compliance with treatment among the sample. Specifically, the instrument measured ‘self-reported nonadherence to antihypertensive medications’ (Konerman et.al, 2011).

Results: – 70% reported missing medication prior to admission. Perceived improvement in physical health was responsible for non-adherence.

Conclusion: – Beliefs about disease and its treatment influences compliance with hypertensive medication therapy. Socio-economic pressures have been identified as a barrier to compliance, especially, when depression develops.

Study V: – Peters, R. Aroian, K., & Flack, J. (2006). African American Culture and Hypertension Prevention. West J Nurs Res, 28(7), 831–863.

Purpose: – This purpose of this study was to apply the theory of planned behavior (TPB) in explaining African Americans’ noncompliance to hypertensive medication management/ therapies. Specifically, researchers hoped to explore their behavioral, normative, and control beliefs.

Methodology: – Through a purposive sampling method researchers recruited 34 adult African American participants between the ages of 25-60 years old. Data was collected through focus group interaction by a primary investigator; a group moderator, data collector, and doctoral prepared nurse expert in qualitative methods.

Results: – Culturally defined foods appeared to be a major factor in non-compliance. They were careless regarding weight control since it was not perceived to be ill health, but rather a sign of great health. The theory of planed behavior (TPB) was limited in explaining African American’s response to hypertension management since there was no extensive assumption related to culture, which appears to be the foundation of noncompliance among African Americans.

Conclusions: – Culture plays a very important role in compliance. Therefore, providers and health promotion specialists ought to embrace culturally appropriate interventions I the control of hypertension among African Americans.

Analysis

The research question asked how health beliefs/practices create barriers or facilitate control of hypertension in African Americans. The foregoing literature clearly identified that culture plays a great role in non-compliance among African Americans’ response to both medication and therapy. A common belief is that they do not trust the American health care system since it is felt that they are placed at risk of being subtly drafted into an experiment which can prove detrimental to their health later.

With regard to practices it is very difficult changing dietary practices, especially, those inculcated as tradition. These are the obvious barriers to compliance. Redesigning appropriate cultural education and programs, that would build their confidence in American health care system can act as facilitators if they are truly hypertensive.

Conclusion

Implications: – The implication emerging from this literature review is that if more in-depth research regarding the peculiarity of African American hypertension is not conducted it could converge into an epidemic crisis.

Recommendations: – Culturally applicable self-management hypertension programs ought to be designed catering specifically to African American peculiarity. The myths concerning relationship to slavery and salt intake ought to be reviewed and discarded from research as evidence. Perhaps, the African American normal blood pressure is not consistent with the standard. Hence, studies should embrace reviewing the 140/90 to determine whether this is true for African Americans. Maybe this is normal for them. Really, they may not be hypertensive and when placed on antihypertensive drugs the side effects bring on illnesses.

References

Curtin, P. (1992). The slavery hypothesis for hypertension among African Americans: the historical evidence. Am J Public Health. 82(12): 1681–1686.

Fernandez, S. Tobin, J. Cassells, A. Diaz-Gloster, M. Kalida C., & Ogedegbe, G.  (2011).The counseling African Americans to control hypertension (caatch) trial: baseline

Demographic, clinical, psychosocial, and behavioral characteristics. Implement Sci, 6:100.

Konerman, M. Weeks, K., & Shands, J. (2011). Short Form (SF-36) Health Survey Measures are Associated with Decreased Adherence among Urban African-Americans with Severe, Poorly Controlled Hypertension. J Clin Hypertens (Greenwich), 13(5): 385–390.

Ostchega, Y. Dillon, C. Hughes, J. Carroll, M., & Yoon, S. (2007). Trends in hypertension prevalence, awareness, treatment, and control in older U.S. adults: data from the National Health and Nutrition Examination Survey 1988 to 2004. Journal of the American Geriatrics Society 55 (7), 1056–65.

Peters, R. Aroian, K., & Flack, J. (2006). African American Culture and Hypertension Prevention. West J Nurs Res, 28(7), 831–863.

Scisney-Matlock, M. Bosworth, H.  Newman Giger, J. (2009). Strategies for Implementing and Sustaining Therapeutic Lifestyle Changes as Part of Hypertension Management in African Americans. Postgrad Med. 121(3): 147–159.

Warren-Findlow, J., & Seymour, R. (2011). Prevalence Rates of Hypertension Self-Care Activities among African Americans. J Natl Med Assoc. 103(6): 503–512.

Links to research studies

  1. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2694441/
  2. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3390197/
  3. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2790525/
  4. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3090746/
  5. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3179927/

Explanation of Research

 Why I choose this topic?

Hypertension among African Americans has reached epidemic proportions. There have been myths associating it with slavery. For example, in 2006 it was discovered that 76 million US Adults are hypertensive. African Americans accounted for 44% of all cases, which is the highest number of Africans affected with hypertension in the world (Ostchega et.al, 2007). Studies conducted by P D Curtin (1992)  however, challenged the theory that the emergence of hypertension among African Americans is related to the sociology of slavery (Curtin, 1992).

Three assumptions were made regarding this traditional theory; firstly dietary salt deficiencies in the African geographic locations from which slaves were recruited for the Americas was responsible; secondly, the traumatic elements whereby the slave trade was conducted influenced it and thirdly rigors of slavery itself in America had an impact (Curtin, 1992).

However, Curtin’s research proved that there were no salt dietary deficiencies among the African territories from which slaves were recruited. Besides, even today there is a very low incidence of hypertension among West Africans. Similarly deaths and treatment during transportation to the Americas on slave ships was also disputed. A limitation in this research was that much of the data related to West Indies and not United States of America. Enough evidence did not exist to show where dietary changes influenced hypertension among slaves either if actual conditions did (Curtin, 1992).

Importantly, research studies have revealed that hypertension has affected African Americans uniquely. Primarily, it becomes obvious at a comparatively younger age than other ethnic groups and is more likely to develop into complications such as stroke, heart disease; kidney failure and blindness. Scientists and researchers alike are inconclusive regarding the causes of hypertension, generally and more so among African Americans if there is no predisposing kidney or heart disease. This is classified as secondary hypertension (Ostchega et.al, 2007).

Consequently, researcher seeks to find answers to the question how health beliefs/practices create barriers or facilitate control of hypertension in African Americans. It is my opinion that perhaps, African Americans who are classified hypertensive are not really hypertensive. Maybe, research should be conducted regarding a mean as well as normal blood pressure range for them since their blood pressure phenomenon is unique. This could be the reason for them being non-compliant with scientific medicine’s classification of hypertension..

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