Telisa Spikes, RN, PhD Postdoctoral Research Fellow, Rollins School of Public Health, Emory University, Atlanta, Georgia. Melinda Higgins, PhD Associate Research Professor, Biostatistics, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia. Tené Lewis, PhD Associate Professor, Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia. Sandra Dunbar, RN, PhD, FAAN, FAHA, FPCNA Professor, Associate Dean for Academic Advancement, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia.
J Cardiovasc Nurs. 2020 Nov/Dec;35(6):576-587. doi: 10.1097/JCN.0000000000000671.
Poor adherence to hypertensive medication has been suggested to be a major contributor to uncontrolled hypertension (HTN) in African Americans. The impact that social determinants have on the various patient-level factors, including HTN beliefs, mental well-being, and social support, may provide insight into the development and tailoring of culturally targeted interventions, thus improving adherence.
The aim of this study was to examine the relationships of exposures to contextualized racial and gendered stressors, social support, and depressive symptoms with HTN illness perceptions and blood pressure (BP) medication adherence.
Participants (N = 85) were hypertensive African-American women aged 18 to 45 years (mean [SD], 39.2 [5.4] years) recruited from the community setting and outpatient medical clinics in a large metropolitan city. Hypertension illness beliefs were assessed using the 8-item Brief Illness Perception Questionnaire ("How much does your blood pressure affect your life?") and medication adherence was assessed with the 7-item Adherence to Refills and Medication Scale ("How often do you forget to take your BP medicine?"). Logistic regression analyses were performed to examine the associations with medication adherence and linear regression analyses were performed to examine the associations of continuous variables and HTN illness perceptions.
The sample was predominantly nonadherent (81.2%). In the adjusted multivariable regression model, systolic BP (odds ratio, 0.95; P = .05) and the "Consequence" dimension of HTN beliefs (odds ratio, 0.76; P = .02) were associated with medication adherence. In the adjusted linear regression model, systolic BP (β = 0.22, P < .01) and depressive symptoms (β = 1.11, P < .01) were associated with HTN illness beliefs.
Assessing beliefs and the mental well-being before initiating BP medications is essential for adherence and BP control.
研究表明，高血压药物治疗依从性差是导致非裔美国人高血压（HTN）控制不佳的主要原因。社会决定因素对各种患者层面因素的影响，包括 HTN 信念、心理健康和社会支持，可能为制定和调整针对文化的干预措施提供深入了解，从而提高依从性。
本研究旨在探讨接触情境化的种族和性别压力源、社会支持和抑郁症状与 HTN 疾病认知和血压（BP）药物依从性的关系。
参与者（N=85）为来自大城市社区环境和门诊医疗诊所的 18 至 45 岁（平均[SD]，39.2[5.4]岁）的高血压非裔美国女性。使用 8 项简短疾病认知问卷（“您的血压对您的生活有多大影响？”）评估 HTN 疾病认知，使用 7 项“药物续开和服用依从性量表”（“您多久会忘记服用 BP 药物？”）评估药物依从性。采用逻辑回归分析评估与药物依从性的关联，采用线性回归分析评估与 HTN 疾病认知的连续变量的关联。
该样本主要为不依从者（81.2%）。在调整后的多变量回归模型中，收缩压（比值比，0.95；P=0.05）和 HTN 信念的“后果”维度（比值比，0.76；P=0.02）与药物依从性相关。在调整后的线性回归模型中，收缩压（β=0.22，P<0.01）和抑郁症状（β=1.11，P<0.01）与 HTN 疾病认知相关。
在开始服用 BP 药物之前评估信念和心理健康状况对于依从性和 BP 控制至关重要。
