The relationship between perceptions of social support and adherence to dietary recommendations among African-American elders with hypertension

Why Gerontology Needs Anthropology: Toward an Applied Anthropological Gerontology

In this essay, we argue that gerontologists should increase their engagement with anthropologists to increase transdisciplinary collaboration, fulfill the interdisciplinary promise of gerontology as a field, and to ensure the work of anthropologists is formed by, and employed in, situations where meaningful engagement with practitioners and policymakers can lead to social change. Anthropology is the study of human societies in historical, biological, and sociocultural context, comprising a holistic field of study that can contribute unique methods, approaches, and theories to the field of gerontology. Although increasing amounts of anthropological scholarship have focused on older adulthood, this critical work of anthropologists still needs to be utilized by those in positions of power to enact change. Furthermore, the work conducted by anthropologists of aging has not consistently been recognized as anthropological scholarship. Therefore, a notable gap exists between the promise of the anthropology of aging and the utilization of the field, its findings, and engagement with the broader gerontological academy. As such, the contributions of anthropology to aging scholarship and the resulting reduction in inequities in the aging experience are not always adequately recognized. By examining the history of anthropology's engagement with aging and the lifecourse, we argue for a more applied anthropological gerontology. We conclude with a call to action to ensure that anthropological gerontology is seen as a fundamental branch of scholarship, both within anthropology and gerontology, which can be used to improve the lived experiences of older adults globally.

The Comparison of Dietary Behaviors among Rural Controlled and Uncontrolled Hypertensive Patients

Nutrition is a dominant peripheral factor in increasing blood pressure; however, little information is available about the nutritional status of hypertensive patients in Iran. This study aimed to compare nutritional behaviors of the rural controlled and uncontrolled hypertensive patients and to determine the predictive power of nutritional behaviors from blood pressure. This cross-sectional study was conducted on 671 rural hypertensive patients, using multistage random sampling method in Ardabil city in 2013. Data were collected by a 3-day food record questionnaire. Nutritional data were extracted by Nutritionist 4 software and analyzed by the SPSS 18 software using Pearson correlation, multiple linear regression, ANOVA, and independent t-test. A significant difference was observed in the means of fat intake, cholesterol, saturated fat, sodium, energy, calcium, vitamin C, fiber, and nutritional knowledge between controlled and uncontrolled groups. In the controlled group, sodium, saturated fats, vitamin C, calcium, and energy intake explained 30.6% of the variations in blood pressure and, in the uncontrolled group, sodium, carbohydrate, fiber intake, and nutritional knowledge explained 83% of the variations in blood pressure. There was a significant difference in the nutritional behavior between the two groups and changes in blood pressure could be explained significantly by nutritional behaviors.

Social support and adherence to treatment in hypertensive patients: a meta-analysis

BACKGROUND

It is important to examine factors associated with patient adherence to hypertension control strategies.

PURPOSE

A meta-analysis was conducted to examine whether social support was related to adherence to healthy lifestyle and treatment medication in hypertensive patients.

METHODS

Journal articles were searched in medical (CINAHL, MEDLINE), psychological (PsycINFO, PsycARTICLES), and educational (ERIC) electronic databases; in reference lists of selected papers; and in the reference list of a previous review.

RESULTS

Findings of a set of meta-analyses indicated that (a) structural social support was not significantly related to overall adherence, (b) functional social support was significantly and positively related to overall adherence, (c) these findings were further confirmed in meta-analyses conducted on specific types of adherence, and (d) most results were characterized by heterogeneity across studies that was partially explained by moderator analyses.

CONCLUSIONS

Functional social support, but not structural social support, was associated with adherence in hypertensive patients.

Identification of validated questionnaires to measure adherence to pharmacological antihypertensive treatments

BACKGROUND

Low adherence to pharmacological treatments is one of the factors associated with poor blood pressure control. Questionnaires are an indirect measurement method that is both economic and easy to use. However, questionnaires should meet specific criteria, to minimize error and ensure reproducibility of results. Numerous studies have been conducted to design questionnaires that quantify adherence to pharmacological antihypertensive treatments. Nevertheless, it is unknown whether questionnaires fulfil the minimum requirements of validity and reliability. The aim of this study was to compile validated questionnaires measuring adherence to pharmacological antihypertensive treatments that had at least one measure of validity and one measure of reliability.

METHODS

A literature search was undertaken in PubMed, the Excerpta Medica Database (EMBASE), and the Latin American and Caribbean Health Sciences Literature database (Literatura Latino-Americana e do Caribe em Ciências da Saúde [LILACS]). References from included articles were hand-searched. The included papers were all that were published in English, French, Portuguese, and Spanish from the beginning of the database's indexing until July 8, 2013, where a validation of a questionnaire (at least one demonstration of the validity and at least one of reliability) was performed to measure adherence to antihypertensive pharmacological treatments.

RESULTS

A total of 234 potential papers were identified in the electronic database search; of these, 12 met the eligibility criteria. Within these 12 papers, six questionnaires were validated: the Morisky-Green-Levine; Brief Medication Questionnaire; Hill-Bone Compliance to High Blood Pressure Therapy Scale; Morisky Medication Adherence Scale; Treatment Adherence Questionnaire for Patients with Hypertension (TAQPH); and Martín-Bayarre-Grau. Questionnaire length ranged from four to 28 items. Internal consistency, assessed by Cronbach's α, varied from 0.43 to 0.889. Additional statistical techniques utilized to assess the psychometric properties of the questionnaires varied greatly across studies.

CONCLUSION

At this stage, none of the six questionnaires included could be considered a gold standard. However, this revision will assist health professionals in the selection of the most appropriate tool for their individual circumstances.

Facilitators and barriers to hypertension self-management in urban African Americans: perspectives of patients and family members

INTRODUCTION

We aimed to inform the design of behavioral interventions by identifying patients' and their family members' perceived facilitators and barriers to hypertension self-management.

MATERIALS AND METHODS

We conducted focus groups of African American patients with hypertension and their family members to elicit their views about factors influencing patients' hypertension self-management. We recruited African American patients with hypertension (n = 18) and their family members (n = 12) from an urban, community-based clinical practice in Baltimore, Maryland. We conducted four separate 90-minute focus groups among patients with controlled (one group) and uncontrolled (one group) hypertension, as well as their family members (two groups). Trained moderators used open-ended questions to assess participants' perceptions regarding patient, family, clinic, and community-level factors influencing patients' effective hypertension self-management.

RESULTS

Patient participants identified several facilitators (including family members' support and positive relationships with doctors) and barriers (including competing health priorities, lack of knowledge about hypertension, and poor access to community resources) that influence their hypertension self-management. Family members also identified several facilitators (including their participation in patients' doctor's visits and discussions with patients' doctors outside of visits) and barriers (including their own limited health knowledge and patients' lack of motivation to sustain hypertension self-management behaviors) that affect their efforts to support patients' hypertension self-management.

CONCLUSION

African American patients with hypertension and their family members reported numerous patient, family, clinic, and community-level facilitators and barriers to patients' hypertension self-management. Patients' and their family members' views may help guide efforts to tailor behavioral interventions designed to improve hypertension self-management behaviors and hypertension control in minority populations.

Correlates of self-care behaviors for managing hypertension among Korean Americans: a questionnaire survey

BACKGROUND

While self-care behaviors have been documented as one of the main determinant of hypertension control, studies investigating correlates of self-care behaviors have been rare regarding hypertension among minority population.

OBJECTIVES

The purpose of this study was to examine factors associated with self-care behaviors for hypertension using a community sample of Korean Americans.

DESIGN

A descriptive cross-sectional design.

SETTINGS

Community setting in the Baltimore-Washington metropolitan area.

PARTICIPANTS

The sample included 445 middle-aged (40-64 years of age) Korean Americans with hypertension (systolic BP > or = 140 and/or diastolic BP > or = 90 mmHg; or taking antihypertensive medication).

METHODS

Guided by Social Cognitive Theory, a variety of personal (age, gender, marital status, employment status, years in U.S., duration of hypertension, hypertension knowledge, hypertension belief, and hypertension control self-efficacy) and environmental (social support) factors were examined in relation to hypertension self-care behaviors, including medication-taking, exercise, diet, and weight control.

RESULTS

The model explained 18.0% of the total variance in self-care scores. Hierarchical multiple regression revealed that personal factors contributed significantly to the explanatory model, whereas social support did not add much. Examination of individual regression coefficients showed that Korean Americans who were older, who had longer duration of hypertension, and who had higher hypertension control self-efficacy were more likely to have higher self-care scores.

CONCLUSIONS

Hypertension control self-efficacy emerged as the most significant contributing factor to hypertension self-care. Future intervention programs should focus on improving hypertension control self-efficacy as a modifiable personal factor.

Effect of treatment and adherence on ethnic differences in blood pressure control among adults with hypertension

We evaluated whether hypertension control differs by ethnicity after accounting for patient characteristics, treatment, and adherence to treatment using the third National Health and Nutrition Examination Survey (US population estimate, 42,511,379). Outcome measures were prescribed treatment, treatment adherence, hypertension control (blood pressure [BP]<140/90 mm Hg). Multivariate logistic regression was performed with non-Hispanic whites (NHW) as the comparison group. Non-Hispanic blacks (NHB) were more likely to report medication prescription (odds ratio [OR] 1.6, 95% confidence interval [CI] 1.1-2.5) and being advised to restrict salt (OR 1.5, CI: 1.2-2.0). Among those advised, NHB were more likely to report salt restriction (OR 1.5, CI: 1.1-2.1) and weight-loss attempts (OR 1.7, CI: 1.3-2.3). Among persons advised to follow exercise, alcohol restriction, smoking cessation, tension reduction, or diet modification, NHB (OR 2.2, CI: 1.6-3.0) and Mexican Americans (OR 2.0, CI: 1.1-3.9) were more likely to report adherence. The likelihood of uncontrolled hypertension was higher in NHB (OR 1.4, CI: 1.1-1.7) and Mexican Americans (OR 1.5, CI 1.1-2.0) despite medication adherence. Even after adjustment for treatment and adherence, substantial ethnic differences in hypertension control were found. Initiating treatment, while crucial, is not sufficient and future guidelines should emphasize aggressive treatment escalation to achieve hypertension control.

Something old is new again: mutual aid and the Tennessee Office of Minority Health

This article is the result of inquiries and ethnographic encounters over a 15-year period, with the governmental agency known as the Tennessee Office of Minority Health (TOMH), a division of the Tennessee Department of Health. This article concerns the innovative and participatory response of TOMH to support African American health in Tennessee. For the purposes of this article, an innovative and participatory response to alleviate any form of human suffering is defined as mutual aid. How TOMH uses mutual aid will be considered. The intent of this article is to show that mutual aid has historic roots in African American communities and the Black Church. Yet today, government agencies like TOMH use mutual aid to create outputs-altering processes that support health and redress health needs for African American communities.

Predictive validity of a medication adherence measure in an outpatient setting

This study examines the psychometric properties and tests the concurrent and predictive validity of a structured, self-reported medication adherence measure in patients with hypertension. The authors also assessed various psychosocial determinants of adherence, such as knowledge, social support, satisfaction with care, and complexity of the medical regimen. A total of 1367 patients participated in the study; mean age was 52.5 years, 40.8% were male, 76.5% were black, 50.8% graduated from high school, 26% were married, and 54.1% had income <$5,000. The 8-item medication adherence scale was reliable (alpha=.83) and significantly associated with blood pressure control (P<.05). Using a cutpoint of <6, the sensitivity of the measure to identify patients with poor blood pressure control was estimated to be 93%, and the specificity was 53%. The medication adherence measure proved to be reliable, with good concurrent and predictive validity in primarily low-income, minority patients with hypertension and might function as a screening tool in outpatient settings with other patient groups.

Predictive validity of a medication adherence measure in an outpatient setting

This study examines the psychometric properties and tests the concurrent and predictive validity of a structured, self-reported medication adherence measure in patients with hypertension. The authors also assessed various psychosocial determinants of adherence, such as knowledge, social support, satisfaction with care, and complexity of the medical regimen. A total of 1367 patients participated in the study; mean age was 52.5 years, 40.8% were male, 76.5% were black, 50.8% graduated from high school, 26% were married, and 54.1% had income <$5,000. The 8-item medication adherence scale was reliable (alpha=.83) and significantly associated with blood pressure control (P<.05). Using a cutpoint of <6, the sensitivity of the measure to identify patients with poor blood pressure control was estimated to be 93%, and the specificity was 53%. The medication adherence measure proved to be reliable, with good concurrent and predictive validity in primarily low-income, minority patients with hypertension and might function as a screening tool in outpatient settings with other patient groups.

Social Support and Patient Adherence to Medical Treatment: A Meta-Analysis

In a review of the literature from 1948 to 2001, 122 studies were found that correlated structural or functional social support with patient adherence to medical regimens. Meta-analyses establish significant average r-effect sizes between adherence and practical, emotional, and unidimensional social support; family cohesiveness and conflict; marital status; and living arrangement of adults. Substantive and methodological variables moderate these effects. Practical support bears the highest correlation with adherence. Adherence is 1.74 times higher in patients from cohesive families and 1.53 times lower in patients from families in conflict. Marital status and living with another person (for adults) increase adherence modestly. A research agenda is recommended to further examine mediators of the relationship between social support and health.