Date of Award

2023-01-31

Degree Name

PhD Nursing

Dissertation Committee

Ann M. Mayo, DNSc, RN, FAAN, Chairperson Razel Milo, PhD, DNP, MSN, FNP-C, RN Committe Member Margaret Avila, PhD, PHN, APRN, Committe Member

Keywords

Medication adherence, antihypertensive, hypertension, African Americans, Blacks, uncontrolled blood pressure, health literacy, comorbidities

Abstract

Purpose: To describe adherence to antihypertensive medications among African Americans adults aged 35 to 65 years in south Los Angeles.

Study Aims: Aim 1: Describe patient sociodemographic factors (age, gender, education, insurance, employment, living arrangement and income), clinical factors (history of current depressive symptoms, comorbidities, comorbidity Charlson score and number of comorbidities), health literacy level, and medication adherence to hypertension (HTN) medications. Aim 2: Describe the relationships between sociodemographic factors, clinical factors, health literacy level, and medication adherence. Aim 3: Compare medication adherence between patients with high health literacy level, low possible health literacy, and low health literacy level.

Background: HTN leads to 494,873 deaths per year and costs more than $48 billion annually in medical expenditures. The prevalence of HTN among African Americans is over 41%, compared to only 28% among other non-white groups. In the general population, adherence to prescribed antihypertensive medication regime is the key to controlling HTN.

Conceptual Basis: The Health Believe Model was the theoretical underpinning used for this study.

Method: A community-based descriptive study was conducted to describe adherence to antihypertensive medications among 122 African American adults aged 35-65 years with a diagnosis of HTN.

Findings: The sample (N = 122) was primarily female (n = 82, 67.2%) and in the age group of 55-65 years. The results suggest that having current depression was associated with higher adherence total score. Adherence scores were higher for participants who had a higher likelihood of limited literacy compared to those with possible limited health literacy and those with adequate health literacy. Of note, 61 out of 122 participants (50%) were unable to complete the numeric portion of the health literacy instrument which may help to explain the unusual finding that as health literacy decreased, adherence increased.

Implications for Nursing: Understanding the importance of adhering to an antihypertensive medication regimen is important for African American patients and more research is needed to understand the complicated factors, especially around health literacy among this population.

Document Type

Dissertation: Open Access

Department

Nursing

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