Validity of the Cognitive Representations of Hypertension Scales (CRHTN)1

Migration and cognitive representations of hypertension in african immigrant women

The purpose of this study was to use the Self-Regulation Model on African immigrant women, to determine the association of migration and residence in the United States with cognitive representations and dietary behavior, and also to explore migration stress and blood pressure (BP) in them. Participants included a convenience sample of 91 Nigerian immigrant women (NIW) and 38 African American women (AAW). Data collection instruments were the Acculturative Stress Scale and the Women's and Men's Hypertension Experiences and Emerging Lifestyle Survey of 2008-2009. Descriptive t test and ANOVA statistics were used to analyze study variables comparing groups and NIW duration of residency in the United States. Knowledge of Hypertension and Cognitive Representation of Hypertension were significantly increased in the NIW by years of residency. Migration stress had no significant relationship with BP level. A longitudinal study initiated on immigrants' arrival in the United States is recommended to understand the trajectory of chronic illnesses such as hypertension.

Adherence to anti-hypertensive medication: proposing and testing a conceptual model

OBJECTIVES

A conceptual model of the psychological factors underpinning adherence to anti-hypertensive medication is proposed and tested. The model suggests that adherence is influenced by three sets of variables: demography, health status, and perceived effects of medication; cognitions and motivation; and intention to adhere.

METHODS AND DESIGN

Patients with known hypertension were recruited from three primary care practices in South-East England and were asked to complete a postal questionnaire. A total of 1,070 responses were received. The questionnaire asked about the three sets of predictor variables, and adherence. Eight weeks after the first questionnaire, a second was posted to all respondents, this time asking about adherence over the intervening period.

RESULTS

The three sets of predictor variables were treated as blocks in a hierarchical model, so that each successive block added to the variance in adherence explained by the previous blocks. The data were analysed by hierarchical multiple regression. The predictors accounted for 19% of the variance in adherence at Time 1, and 34% at Time 2. The leading individual predictors at Time 1 were age, gender, conscientiousness, hypertensive identity, perceived behavioural control, and intention. At Time 2, they were the same, except that gender made way for adherence at Time 1.

CONCLUSIONS

The model offers a parsimonious account, and the findings suggest a number of approaches to designing interventions to modify behaviour.

Comparison of quality-of-hypertension-care indicators for groups treated by physician versus groups treated by physician-nurse team

PURPOSE

To determine whether the type of health care provider (i.e., physician versus physician-nurse team) affected the quality of hypertension care given to two groups of randomly selected adult women.

DATA SOURCES

Three indicators measured the quality of hypertension care: blood pressure control level, knowledge of hypertension, and discussion about blood pressure medications with the health care provider(s). Blood pressure readings were taken with a 24-hr ambulatory blood pressure monitor, and demographic data from survey results taken at orientation and researcher-collected data on posttreatment knowledge of hypertension and cognitive representations of hypertension were gathered. Chi-square and t tests were used to analyze the data.

CONCLUSIONS

The group whose care was managed by a physician-nurse team demonstrated lower means for 24-hr systolic blood pressure and diastolic blood pressure (systolic: M = 132, SD = 14.9; diastolic: M = 75, SD = 11.3) than the group whose care was managed only by one or more physicians (systolic: M = 136, SD = 13.4; diastolic: M = 79, SD = 11.24). Also, the group whose care was managed by a physician-nurse team revealed significantly higher scores for discussion of blood pressure medication than the group whose care was managed only by one or more physicians. There were no group differences for knowledge of hypertension.

IMPLICATIONS FOR PRACTICE

Nurses qualified to assist with meeting the needs of hypertension clients in primary care settings can positively affect clients' knowledge about blood pressure medication and--perhaps as a result of this knowledge--how well the clients control their blood pressure.