Illness beliefs in African Americans with hypertension

Illness perceptions and blood pressure control among hypertensive Filipino Americans: A cross-sectional study

BACKGROUND

Among Asian Americans, Filipino Americans (FAs)-who constitute the fourth largest US immigrant group and who fill in health care workforce shortages-experience high prevalence but low control rates of high blood pressure (HBP). Research reveals that patients' illness perceptions, their common-sense model (CSM) of the illness, influence treatment behaviors, and management outcomes. However, scarce information exists about FAs' perceptions about HBP.

PURPOSE

To address this gap, we conducted a cross-sectional study to (a) identify the illness perceptions of hypertensive FAs, (b) classify these perceptions into clusters, and (c) determine the association between illness perceptions and BP control.

METHODOLOGY

The responses of 248 FAs with HBP to the Brief Illness Perception Questionnaire were analyzed using JMP Pro version 17 to discover their CSMs or illness perceptions. We used iterative K means cluster analysis to classify variations in CSMs and analysis of means chart to determine the association of illness perceptions and BP control.

RESULTS

Hypertensive FAs expressed threatening (negative) views of HBP through their emotional perceptions of the illness and its chronic time line, whereas their positive views centered on their cognitive beliefs about understanding HBP and its controllability. Based on the biomedical model of HBP, the overall illness perceptions or CSMs encompassed three clusters. Generally, threatening illness perceptions were associated with stage 2 HBP.

CONCLUSIONS/IMPLICATIONS

The findings underscore the need for nurse practitioners to elicit, listen, discern, and understand the illness perceptions or CSMs of hypertensive FAs to improve BP treatment and control with scientifically and culturally tailored interventions.

Group Medical Visits Versus Usual Care for Illness Perception and Hypertension: A Randomized Pilot Study

ABSTRACT

Despite separate evidence regarding illness perception (IP) and group medical visits (GMVs) for hypertension, research on both is limited. Here, we have assessed and compared the effectiveness of GMVs and usual care (UC) on IP and blood pressure (BP) in patients with hypertension. This was a two-group parallel randomized controlled study with 1:1 allocation. Patients with essential hypertension on antihypertensive medication and no cognitive impairments were screened for BP control status and eligibility. A web-based program randomly assigned them to the GMV and UC groups. Group medical visits were held once a month for 3 months. Primary and secondary outcome measures included improvements in IP and BP control. Among 152 participants, 40 and 43 were assigned to the GMV and UC groups, respectively. The control group had a 9.3% dropout rate. The chronic timeline and illness coherence improved significantly in the intervention group ( p < .01). Systolic BP in the intervention group decreased significantly compared with that of the control group (Δ: -18.8 ± 18.4 mm Hg vs. Δ: -10.6 ± 12.5 mm Hg, p = .025). The participation in GMVs had a significant association with the odds of an increase in BP regulation (OR 3.8, 95% confidence interval 1.4-10.3, p = .007). Therefore, GMVs may be feasible for BP control in hypertensive patients with similar characteristics.

Experiences of stress among West Africa-born immigrant women with hypertension in Washington DC area

OBJECTIVE

To report a study that explored hypertension (HTN) stress and coping experiences of West-Africa-born immigrant (WABI) women in Washington DC Metropolitan area of the United States.

DESIGN AND SAMPLE

This qualitative study conducted from December 2017 to May 2018 involved WABI women (n = 15) in Washington Metropolitan area that self-reported diagnosis of HTN. The transactional model of stress and coping (TMSC) provided the conceptual framework. Data collection was through semi-structured one-on-one interviews.  Data analysis was done through manual open-hand coding of themes.

RESULTS

Three themes emerged from the analysis: Perceived Stressors, Sources of Stress, and Coping Measures. Participants perceived that their HTN diagnosis contributed to their stress; reported other financial, school, work, trauma, household and marriage-related stressors, and coping measures that include faith-based and other recreational leisure activities.

CONCLUSION

Participants mentioned stressors related to lack of support with domestic house chores and described various religious practices as coping strategies. These findings provide additional insights relevant to several ongoing public health nursing conversations on acute and chronic stress management in different parts of the globe. Public health nurses need to utilize these findings when assessing stressors and considering safe coping measures that appeal to WABI women experiencing HTN or chronic illness.

Psychometric evaluation of a culturally adapted illness perception questionnaire for African Americans with type 2 diabetes

Background

Diabetes is burdensome to African Americans, who are twice as likely to be diagnosed, more likely to develop complications and are at a greater risk for death and disability than non-Hispanic whites. Medication adherence interventions are sometimes ineffective for African Americans because their unique illness perceptions are not adequately addressed. The Illness Perception Questionnaire-Revised (IPQ-R) that assesses illness perceptions has shown reliability and validity problems when used with African Americans. Thus, the study objective was to adapt the IPQ-R for African Americans and assess the validity and reliability of the culturally adapted questionnaire.

Methods

The parent study used an exploratory sequential mixed methods design, to explore African Americans’ illness perceptions qualitatively, used the results to adapt the IPQ-R, and tested the culturally adapted IPQ-R items quantitatively. In this paper, a preliminary culturally adapted IPQ-R refined based on the qualitative study, was administered to 170 middle-aged United States-based African Americans with type 2 diabetes in a face-to-face survey. Content, construct, convergent, and predictive validity, including reliability was examined. Pearson and item-total correlations, item analysis, exploratory factor analysis, multiple linear regression analysis, and test-retest were conducted.

Results

A revised culturally adapted IPQ-R was identified with a 9-factor structure and was distinct from the old factor structure of the original IPQ-R. The ‘consequences’ domain from the IPQ-R occurred as two factors (external and internal consequences) while the ‘emotional representations’ domain in the IPQ-R emerged as separate ‘present’ and ‘future’ emotional representation factors. Illness coherence’ was differently conceptualized as ‘illness interpretations’ to capture additional culturally adapted items within this domain. Most items had factor loadings greater than 0.4, with moderate factor score correlations. Necessity and concern beliefs in medicines significantly correlated with domains of the culturally adapted IPQ-R. Pearson’s correlation values were not greater than 0.7, indicating good convergent validity. The culturally adapted IPQ-R significantly predicted medication adherence. None of the correlation values were higher than 0.7 for the test-retest, indicating moderate reliability. Most domains of the culturally adapted IPQ-R had Cronbach’s alpha values higher than 0.7, indicating good internal consistency.

Conclusions

The results provide preliminary support for the validity of the culturally adapted IPQ-R in African Americans with diabetes, showing good construct, convergent and predictive validity, as well as reliability.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13172-2.

Statin-use and perceptions of high cholesterol as predictors of healthy lifestyle behaviours in Nigerians

It is unclear how statin-use influences the adoption of healthy lifestyle choices. It is important to understand the nature of this relationship as this could facilitate targeted public health interventions which could help promote a healthy lifestyle, curb the rise of non-communicable diseases, and facilitate overall health. This study aimed to explore whether statin-use influenced the adoption of healthy lifestyle choices by changing the way urban and semi-urban Nigerians thought about their high cholesterol and their future risk of cardiovascular disease. Structured questionnaires were used to compare the lifestyle behaviours, perceptions of high cholesterol and future risk of cardiovascular disease of statin users and non-statin users recruited in urban and a semi-urban Nigeria. In-depth, face-to-face interviews were used to further explore the relationship between statin-use and the adoption of healthy lifestyle choices, and explore the influence of personal and social factors on this relationship. The odds of adopting a low-fat diet increased as perceived statin-effectiveness increased (OR = 2.33, p<0.05), demonstrating a synergistic relationship between statin-use and the adoption of healthy of lifestyle choices. In addition to this synergistic association, at interview, two other relationships were found between statin use and the adoption of healthy lifestyle choices: an antagonistic relationship fuelled by a strong perception of statin effectiveness and a perceived inability to make healthy lifestyle changes, which favoured statin-use, and an antagonistic relationship fuelled by congruous cause-control beliefs and concerns about medication-use which favoured the adoption of healthy lifestyle choices. The odds of adopting a low-fat diet was 5 times greater in urban dwellers than in semi-urban dwellers (p<0.01). Statin-use influenced the adoption of healthy lifestyle choices in three different ways, which require exploration at clinical consultation. Gender, social obligations, and physical environment also influenced statin-use and the adoption of healthy lifestyle choices.

Co-created health education intervention among older African American women living with hypertension

INTRODUCTION

African Americans over the age of 60 years face disproportionate risk of developing hypertension, which can be mitigated with lifestyle changes. This study examines the acceptability and cost of a patient-centered, co-created health education intervention with older African Americans living with hypertension.

METHODS

Twenty women participated in this study that included four weekly, two-hour group sessions centered on hypertension knowledge and calibration of home blood pressure monitors, stress and interpersonal relationship management, sleep and pain management, and healthy eating. The study took place in the Midwest United States.

RESULTS

Descriptive statistics were used to analyze acceptability data that included attendance and a brief investigator-generated questionnaire. Twenty women were enrolled. Sixteen participants attended all four sessions, all reported they intended to continue using the intervention and felt it fit within their culture, routine, and self-care practices. The estimated cost of conducting the intervention was $227.00 (U.S. dollars) per participant.

CONCLUSIONS

The co-created health education intervention was acceptable. Given the dire need for cost-effective interventions to improve the adoption of health promoting self-care management behavior, to reduce the prevalence of hypertension in African Americans, the results of this study have implications for future research and practice.

Study on illness perceptions of Chinese rural-dwelling adults with hypertension: A descriptive study

OBJECTIVE

The aim of this study was to describe the levels of illness perception and identify interrelations among the variables of illness perception, demographic, and health-related characteristics in a sample of rural Chinese adults with hypertension (HTN).

DESIGN

This is a cross-sectional descriptive study using descriptive and correlation analysis.

SAMPLE

It included 163 people diagnosed with HTN for at least 3 years who lived in two rural villages in Zhejiang Province of mainland China during 2014-2015.

MEASUREMENTS

Illness perception was measured by the Chinese Illness Perception Questionnaire-Revised. Demographic and illness characteristics were collected by the researcher. Weight, height, and blood pressure (BP) were, respectively, measured by calibrated scale and digital sphygmomanometers.

RESULTS

The findings showed that the BP control rate was 28.80% in the village. The highest average item score found in timeline (3.98 ± 0.76) and control (3.29 ± 0.67) subscales indicated that rural Chinese adults believe in the chronicity and controllability of HTN. Negative illness representation presented the lowest mean item score (2.64) suggesting that the participants neither perceive symptom variation of the illness nor their illness as serious. Interrelations existed among the illness perception variables with variation from that in other previous study. The cause of HTN was attributed to balance factors, psychological factors, risk factors, and cultural factors in sequence. Age, education, body mass index, and household annual income were correlated with illness perception.

CONCLUSION

These findings suggested that misconceptions about HTN perception existed among rural adults in the villages. Comprehensive health education program is needed to increase rural adults' knowledge and management of HTN.

Practice and predictors of self-care behaviors among ambulatory patients with hypertension in Ethiopia

BACKGROUND

Despite the benefits of evidence-based self-care behaviors in the management of hypertension, hypertensive patients have low rate of adherence to the recommended self-care behaviors. Studies related to self-care behaviors among hypertensive patients are limited in Ethiopia.

OBJECTIVE

To assess the rate of adherence to self-care behaviors and associated factors among hypertensive patients.

METHOD

A cross-sectional study was conducted at the cardiac clinic of Ayder comprehensive specialized hospital among ambulatory hypertensive patients. Self-care behaviors were assessed using an adopted Hypertension Self-Care Activity Level Effects (H-SCALE). Data were collected through patient interview and review of medical records. Binary logistic regression analysis was performed to identify predictors of self-care behaviors.

RESULT

A total of 276 patients were included in the study. The majority of the participants were nonsmokers (89.9%) and alcohol abstainers (68.8%). Less than half of the participants were adherent to the prescribed antihypertensive medications (48.2%) and recommended physical activity level (44.9%). Moreover, only 21.45% and 29% were adherent to weight management and low salt diet recommendations, respectively. Our finding indicated that rural resident (adjusted odds ratio [AOR]: 0.45, 95% confidence interval [CI]: 0.21-0.97), comorbidity (AOR: 0.16, 95% CI: 0.08-0.31), and negative medication belief (AOR: 0.25, 95% CI: 0.14-0.46) were significantly associated with medication adherence. Female sex (AOR: 0.46, 95% CI: 0.23-0.92), old age (AOR: 0.19, 95% CI: 0.06-0.60) and lack of knowledge on self-care behaviors (AOR: 0.13, 95% CI: 0.03-0.57) were significantly associated with adherence to weight management. Female sex (AOR: 1.97, 95% CI: 1.03-3.75) and lack of knowledge on self-care (AOR: 0.07, 95% CI: 0.03-0.16) were significantly associated with adherence to alcohol abstinence. Female sex (AOR: 6.33, 95% CI: 1.80-22.31) and khat chewing (AOR: 0.08, 95% CI: 0.03-0.24) were significantly associated with non-smoking behavior. There was also a significant association between female sex and physical activity (AOR: 0.22, 95% CI: 0.12-0.40).

CONCLUSION

The rate of adherence to self-care behaviors particularly weight management, low salt intake, physical exercise, and medication intake was low in our study. Elders, females, khat chewers, rural residents, and patients with negative medication belief, comorbidity, and inadequate knowledge of SCBs were less adherent to self-care behaviors compared to their counterparts. Therefore, health care providers should pay more emphasis to patients at risk of having low self-care behaviors.

Promoting Health Equity And Eliminating Disparities Through Performance Measurement And Payment

Current approaches to health care quality have failed to reduce health care disparities. Despite dramatic increases in the use of quality measurement and associated payment policies, there has been no notable implementation of measurement strategies to reduce health disparities. The National Quality Forum developed a road map to demonstrate how measurement and associated policies can contribute to eliminating disparities and promote health equity. Specifically, the road map presents a four-part strategy whose components are identifying and prioritizing areas to reduce health disparities, implementing evidence-based interventions to reduce disparities, investing in the development and use of health equity performance measures, and incentivizing the reduction of health disparities and achievement of health equity. To demonstrate how the road map can be applied, we present an example of how measurement and value-based payment can be used to reduce racial disparities in hypertension among African Americans.

Utilizing the common sense model to explore African Americans' perception of type 2 diabetes: A qualitative study

Illness perceptions, which are likely influenced by patients' cultural contexts, are associated with disease self-management and adherence. African American patients perceptions of type 2 diabetes is not well understood and no known studies has used a comprehensive evidence-based theoretical framework to explore what AAs with type 2 diabetes know, believe, and think about type 2 diabetes. Understanding perceptions of an illness shared by a group of people will be useful in developing culturally-appropriate interventions targeted to the needs of the community. The purpose of this study is to explore African Americans' perceptions of type 2 diabetes based on the common sense model of illness and self-regulation. Using a phenomenology qualitative approach and purposive sampling, 40 African American men and women, age 45-60 years old with diagnosed type 2 diabetes at least one year prior, and who took at least one prescription diabetes medication, participated in six semi-structured 90-minute focus groups conducted in a private space. Qualitative content analysis was conducted to explore African Americans beliefs about type 2 diabetes. Participants expressed that historical issues, e.g., slavery, healthcare providers, the government, and God influenced how they developed diabetes. Participants reported a loss of autonomy, a change of their identity as an employee, a social individual and sexual person, as well as anger and frustration due to having diabetes. Diabetes made the African American family bonding experience of eating difficult, and the disease diminished their cultural experiences. Concerns about diabetes ranged from fear of death and amputations to the inability to prevent the disease among their children/grandchildren. Participants perceived that medications, faith in God, and positive thinking about survival helped control diabetes. Conclusions: Improved diabetes self-management and medication adherence may depend on the meaning African Americans attach to diabetes, available psychosocial support for managing diabetes, and African Americans experience with diabetes.

Illness Representation and Self-Care Ability in Older Adults with Chronic Disease

Chronic illness affects >50% of adults in the United States and accounts for >80% of healthcare spending. The purpose of this study was to determine whether beliefs about one’s chronic disease (illness representation) are associated with self-care activation, emergency department (ED) visits, or hospitalizations. Using a cross-sectional design, we recruited older adults with heart failure, chronic obstructive pulmonary disease (COPD), and chronic kidney disease. The Revised Illness Perception Questionnaire (IPQ-R) measured perceptions about disease. The Patient Activation Measure measured self-care activation. ED visits and hospitalizations were measured by self-report. IPQ-R scores were analyzed using latent profile analysis to identify subgroups. Participants included 187 adults (mean age 65 years, 54% female, 74% Black). We found three subgroups (stable, overwhelmed, and confident). Groups did not differ demographically or by disease. The stable group (few consequences, non-fluctuating pattern) had the fewest hospitalizations. The overwhelmed group (many consequences, fluctuating pattern, high negative emotion) had high hospitalizations and low self-care ability. The confident group (high disease control, well-understood) had the highest self-care ability, but also high hospitalizations. ED visits did not differ by group. We found three subgroups that differ in their illness representation and health outcomes. Findings suggest that assessing patients’ illness representations may have important implications for subgroup-specific interventions.

Factors associated with physical activity in African Americans with hypertension

BACKGROUND

Pharmacological management only controls 58% of those with hypertension. Combining pharmacological therapy with physical activity is important in controlling hypertension.

AIM

To examine factors associated with physical activity (PA) adherence in African Americans (AAs) with hypertension and antihypertensive medication adherence.

METHODS

A cross-sectional descriptive correlational design was used to examine if systolic BP, co-morbidities, serum creatinine and potassium, education, depression, locus of control, and social support explained PA adherence in a convenience sample of AAs (N = 77) aged 55 to 84. All completed: demographic data, PA visual analog scale (VAS-PA); Multidimensional Health Locus of Control Scale; Patient Health Question-9 Depression Instrument. Physiological data and co-morbidities were also collected.

RESULTS

A third (n = 26) had systolic BP over 140 mm/Hg. The model explained 26% variance in adherence to PA (F = 3.378 [8, 68]; p = .003) with creatinine (p < .05), depression (p < .01), and social support (p < .05) as significant. Differences in VAS-PA scores between levels of depression were significant (F = 4.707 [269], p = .012; Eta² = 0.12). Those with no depression had significantly higher PA adherence (M = 88.26, SD = 18.97) compared to mildly depressed (M = 70.24, SD 27.71) and moderately depressed (M = 66.83, SD = 23.31).

CONCLUSIONS

Clinicians should promote PA as an adjunct to medications for effective control of hypertension in AAs. Screening and intervening for depression are important when examining adherence to PA in AAs with hypertension.

Elevated blood pressure and illness beliefs: a cross-sectional study of emergency department patients in Jamaica

BACKGROUND

Elevated blood pressure (BP) is common among emergency department (ED) patients. While some data exist on the association between ED BP and hypertension (HTN) in the USA, little is known about this relationship in Afro-Caribbean nations. The aim of the study was to evaluate the relationship between elevated systolic BP in the ED and a previous diagnosis of HTN, accounting for potential factors that could contribute to poor HTN control among those with a previous diagnosis: socioeconomic status, health-seeking behavior, underlying HTN illness beliefs, medication adherence, and perceived adherence self-efficacy.

METHODS

This was a cross-sectional survey over 6 weeks, from November 19 through December 30, 2014. Those surveyed were non-critically ill or injured adult ED patients (≥ 18 years) presenting to an Afro-Caribbean hospital. Descriptive statistics were derived for study patients as a whole, by HTN history and by presenting BP subgroup (with systolic BP ≥ 140 mmHg considered elevated). Data between groups were compared using chi-square and t tests, where appropriate.

RESULTS

A total of 307 patients were included: 145 (47.2%) had a prior history of HTN, 126 (41.4%) had elevated BP, and 89 (61.4%) of those presenting with elevated blood pressure had a previous diagnosis of HTN. Those with less formal education were significantly more likely to present with elevated BP (52.1 vs. 28.8% for those with some high school and 19.2% for those with a college education; p = 0.001). Among those with a history of HTN, only 56 (30.9%) had a normal presenting BP. Those with a history of HTN and normal ED presenting BP were no different from patients with elevated BP when comparing the in duration of HTN, medication compliance, location of usual follow-up care, and HTN-specific illness beliefs.

CONCLUSIONS

In this single-center study, two out of every five Jamaican ED patients had elevated presenting BP, the majority of whom had a previous diagnosis of HTN. Among those with a history of HTN, 60% had an elevated presenting BP. The ED can be an important location to identify patients with chronic disease in need of greater disease-specific education. Further studies should evaluate if brief interventions provided by ED medical staff improve HTN control in this patient population.

Health perception and adherence with blood pressure control among rural Chinese adults with hypertension

AIM

The aim of this study was to examine associations among blood pressure, personal and illness characteristics, illness perception and medication and self-management adherence among adults with hypertension in rural mainland China.

BACKGROUND

Despite the high prevalence of hypertension in China, the control rate is only 20%. Identifying factors associated with blood pressure control is critical.

DESIGN

Cross-sectional survey.

METHODS

Data were collected from 163 hypertensive adults in two rural villages in mainland China. Measures included a demographic questionnaire, the Chinese Illness-Perception Questionnaire-Revised, Medication Adherence Inventory and the Inventory of Adherence to Self-management. Height, weight, and blood pressure were also measured using standard approaches. Hierarchical linear regression was used to assess the association between blood pressure and significant variables identified in bivariate analysis.

FINDINGS

The mean systolic pressure observed in this sample was 147 mmHg and the diastolic mean was 81 mmHg. None of the variables analysed were associated with systolic blood pressure. Gender, age, and household annual income were associated with diastolic blood pressure, explaining 23% of the variance in the regression model. Illness coherence contributed an additional 2%.

CONCLUSION

These findings suggest: (a) healthcare providers should focus on educating rural hypertensive adults about healthful diets and behaviours to manage hypertension, especially for those with high household income; (b) knowledge-based health education alone is not adequate; (c) illness perception may not be directly associated with blood pressure; and (d) the Chinese Illness-Perception Questionnaire-Revised and the Inventory of Adherence to Self-management require validation and potential revision for use with rural Chinese populations.

Sociocultural Influences on African Americans' Representations of Type 2 Diabetes: A Qualitative Study

Objective

Illness representations, known as patients' beliefs and expectations about an illness, may be influenced by cultural beliefs and personal experiences. This study explored African Americans' perceptions of the sociocultural factors that influence their representations of diabetes.

Design

Six semi-structured focus groups.

Setting

Private space at a convenient site.

Participants

Forty African Americans, aged 45-60 years with type 2 diabetes for at least one year prior.

Results

Participants perceived that there was a race-mediated effect of how they developed diabetes because of poverty due to past slavery, racial discrimination by health care providers, and the stigma associated with diabetes within the African American community. Participants perceived that poverty influenced African Americans' unhealthy eating habits, which led to diabetes diagnosis among their ancestors and their development of the disease since it was hereditary. Participants also perceived that there was provider ill intention, ie, providers were purposefully making people sick, and their lack of education on diabetes from providers was done on purpose, as information on diabetes was withheld and not shared due to racial discrimination. Perceived stigma by the community led to African Americans' avoidance and denial of the disease, and subsequently the development of diabetes.

Conclusions

To enhance disease management for African Americans with diabetes, it is important to focus on the sociocultural context of how African Americans view their world that may be influenced by their knowledge of negative historical circumstances and their current provider relationship, which, in turn, may be reflected in their perceptions of diabetes.

Development and Validation of the Beliefs About Personal Weight Survey Among African American Women

The purpose of this study was to develop the Beliefs about Personal Weight Survey among African American women. Sixty-five items were developed from literature and sample participants to characterize beliefs about personal weight in 3 domains: descriptors, causes, and consequences. The items were administered to 150 community-dwelling African American women, 18 to 40 years old, recruited from 5 sites. Factor analysis supported a 4-factor solution with the following dimensions: overweight acceptance, overweight concern, conventional weight regulation, and circumstantial weight regulation. These factors were significantly associated with weight management behaviors and body mass index. Profile analysis indicated distinct factor belief profiles by 3 weight categories.

Illness Perceptions and Health Behaviors of Black Women

The Common Sense Model of Illness Representations proposes that representations or perceptions of illness drive health behaviors. The purpose of this study was to explore the relationships between hypertension representations, exercise, and dietary behaviors in hypertensive black women (N = 204, aged 18-65 years). Regression results revealed that perceiving hypertension as chronic and perceiving it a result of environmental causes were inversely related to moderate-intensity physical activity (β = -.15 [P = .05] and β = -.25 [P = .05], respectively). Having more emotional responses to hypertension (β = .23, P = .05) was related to moderate-intensity physical activity and more fruit and vegetable consumption (β = .28, P = .05). These findings suggest that hypertension representations can interfere with recommended lifestyle changes among black women. Assessing hypertension representations and implementing measures to clarify misperceptions of hypertension among black women may lead to better blood pressure control and health outcomes.

Common Sense Model Factors Affecting African Americans' Willingness to Consult a Healthcare Provider Regarding Symptoms of Mild Cognitive Impairment

OBJECTIVE

Although at increased risk for developing dementia compared with white patients, older African Americans are diagnosed later in the course of dementia. Using the common sense model (CSM) of illness perception, we sought to clarify processes promoting timely diagnosis of mild cognitive impairment (MCI) for African American patients.

DESIGN, SETTING, PARTICIPANTS

In-person, cross-sectional survey data were obtained from 187 African American (mean age: 60.44 years). Data were collected at social and health-focused community events in three southern Wisconsin cities.

MEASUREMENTS

The survey represented a compilation of published surveys querying CSM constructs focused on early detection of memory disorders, and willingness to discuss concerns about memory loss with healthcare providers. Derived CSM variables measuring perceived causes, consequences, and controllability of MCI were included in a structural equation model predicting the primary outcome: Willingness to discuss symptoms of MCI with a provider.

RESULTS

Two CSM factors influenced willingness to discuss symptoms of MCI with providers: Anticipation of beneficial consequences and perception of low harm associated with an MCI diagnosis predicted participants' willingness to discuss concerns about cognitive changes. No association was found between perceived controllability and causes of MCI, and willingness to discuss symptoms with providers.

CONCLUSIONS

These data suggest that allaying concerns about the deleterious effects of a diagnosis, and raising awareness of potential benefits, couldinfluence an African American patient's willingness to discuss symptoms of MCI with a provider. The findings offer guidance to designers of culturally congruent MCI education materials, and healthcare providers caring for older African Americans. .

Model development of healthy-lifestyle behaviors for rural Muslim Indonesians with hypertension: A qualitative study

Hypertension is a significant health issue in Indonesia. Health professionals in a rural district of West Java identified hypertension as a priority health issue. In this study, we describe healthy-lifestyle behaviors as perceived by the district's middle-aged Muslims with hypertension. A qualitative case-study design was used. Twelve married couples, directly or indirectly impacted by hypertension, and who visited community health centers, were purposively recruited. Semistructured interviews provided data that were systematically analyzed for categories and subcategories. Categories of healthy-lifestyle behaviors currently practiced were eating behavior, physical activity, resting, not smoking, managing stress, seeking health information, seeking health care, caring other people, and fulfilling an obligation to God. Categories of reasons for practicing healthy-lifestyle behaviors were behavioral beliefs, competence, religious support, prior experience, social support, and health system support. Categories for not practicing healthy-lifestyle behaviors were personal, social, and environmental barriers. To achieve healthy-lifestyle behavior changes, it is essential for rural middle-aged Muslim individuals to be supported by reinforcing their positive reasons and to address their negative reasons to practice healthy-lifestyle behaviors.