Willie M. Abel

The Association between Trust in Health Care Providers and Medication Adherence among Black Women with Hypertension

Background: Black women have the highest prevalence of hypertension in the world. Reasons for this disparity are poorly understood. The historical legacy of medical maltreatment of Blacks in the U.S. provides some insight into distrust in the medical profession, refusal of treatment, and poor adherence to treatment regimens. Methods: Black women (N = 80) who were prescribed antihypertensive medications were recruited from urban communities in North Carolina. Study participants completed the Trust in Physician and Hill-Bone Compliance to High Blood Pressure Therapy questionnaires. An exact discrete-event model was used to examine the relationship between trust and medication adherence. Results: Mean age of study participants was 48 ± 9.2 years. The majority of participants (67%) were actively employed and 30% had incomes at or below the federal poverty level. Increasing levels of trust in the health care provider was independently associated with greater medication adherence (PTrend = 0.015). Conclusion: Black women with hypertension who trusted their health care providers were more likely to be adherent with their prescribed antihypertensive medications than those who did not trust their health care providers. Findings suggest that trusting relationships between Black women and health care providers are important to decreasing disparate rates of hypertension.

Predictors of Depression in Black Women with Hypertension

Black women have the highest prevalence of hypertension in the world, and depression is associated with both hypertension and lack of health promoting behaviors. Thus, it is important to identify factors that may contribute to depression in hypertensive women. This cross-sectional study was conducted with a convenience sample of 80 black women ages 18–60 who were prescribed anti-hypertensive medication. Data were collected using self-report instruments. The study showed that lower income level, greater number of comorbidities, lower active coping scores, and poorer medication adherence were significantly associated with higher depression scores. These findings have important implications for the development of screening protocols and interventions for black women.

Fatigue and Physical Activity After Myocardial Infarction

Background: Fatigue is prevalent after myocardial infarction (MI) and is a barrier to physical activity (PA). Because PA is an important health behavior in preventing or delaying recurrent MIs, examining the influence of biophysical markers and fatigue on PA is important as a prerequisite to developing effective interventions. Objective: This study compared PA in 34 men and 38 women, aged 65 and older, 6–8 months post MI, and examined the influence of biophysiological measures and fatigue on PA in this sample. Methods: Using a cross-sectional descriptive correlational design, adults completed a demographic form that included documentation of blood pressure, heart rate, height and weight; the Revised Piper Fatigue Scale (RPFS), and the Community Healthy Activities Model Program for Seniors Physical Activity Questionnaire for Older Adults, and blood collection for measurement of hemoglobin (Hgb), interleukin-6, and B-natriuretic peptide. Results: There were no differences in frequency of PA between older men and older women; however, men reported a higher intensity of PA (p = .011). When controlling for sex, age, and biophysiological measures, the RPFS significantly explained 16% of the variance in the frequency of PA (p = .03), with no individual subscale serving as a significant predictor. The RPFS behavior/severity subscale explained 31% of the variance in energy expended on all PA (p < .001) and 40% of the variance in energy expended on moderate-intensity PA (p < .001). Conclusion: The older adults participating in this study did not participate in the recommended levels of PA, and fatigue significantly influenced PA post MI.

Predicting Heart Failure Readmissions.

Objectives:In this study, the effects of sociodemographic and clinical factors on heart failure (HF) readmission risk were examined. Background:Hospitals now incur financial penalties for excessive HF readmission rates; therefore, identifying factors associated with risk is essential for designing risk-reduction strategies. Methods:A retrospective cohort study using chart reviews compared HF inpatients (N = 245) who were readmitted with those who were not readmitted. Results:The sample included mostly white (64%) elderly (mean [SD] age, 69.8 [15.1] years) men (49%) and women (51%). Using Cox regression, the number of comorbidities (3–4 or 5–8) and type of comorbidities, specifically renal insufficiency (readmission ratio [RR], 1.7; P = .003), atrial fibrillation (RR, 1.7; P = .005), cardiomyopathy (RR, 1.5; P = .020), followed by a history of myocardial infarction/coronary artery disease (RR, 1.4; P = .055), were the predictors of HF readmission. Conclusions:Targeting those with high-risk comorbidities is important in designing measures to prevent or delay readmission of HF patients.

Psychometric Testing of the Self-care of Hypertension Inventory.

Background: Hypertension (HTN) is a global public health issue. Self-care is an essential component of HTN treatment, but no instruments are available with which to measure self-care of HTN. Objectives: The purpose of this study is to test the psychometric properties of the Self-care of Hypertension Inventory (SC-HI). Methods: Using the Self-care of Chronic Illness theory, we developed a 24-item measure of maintenance, monitoring, and management appropriate for persons with chronic HTN, tested it for content validity, and then tested it in a convenience sample of 193 adults. Exploratory factor analysis was used to identify measure structure. Cronbachs &agr; and factor determinacy scores and were used to assess reliability. Validity was tested with the Medical Outcomes Study General Adherence Scale and the Decision Making Competency Inventory. Results: Seventy percent of the sample was female; mean age was 56.4 ± 13 years; mean duration of HTN was 11 ± 9 years. Removal of 1 item on alcohol consumption resulted in a unidimensional self-care maintenance factor with acceptable structure and internal consistency (&agr; = .83). A multidimensional self-care management factor included “consultative” and “autonomous” factors (factor determinacy score = 0.75). A unidimensional confidence factor captured confidence in and persistence with each aspect of self-care (&agr; = .83). All the self-care dimensions in the final 23-item instrument were associated with treatment adherence and several with decision making. Conclusion: These findings support the conceptual basis of self-care in patients with HTN as a process of maintenance, monitoring, and management. The SC-HI confidence scale is promising as a measure of self-efficacy in self-care.

Fatigue in Older Adults Postmyocardial Infarction.

Objective The purpose of this study was to comprehensively examine putative factors that may independently contribute to fatigue and subsequent persistence of fatigue in elderly adults 6–8 months post-myocardial infarction (MI). Studies suggest cardiac function, comorbidities, daytime sleepiness, depression, anemia, interleukins, and social support are correlates of fatigue; however, no studies have systematically examined these factors 6 months post-MI in an aging population. Methods Study participants included 49 women and men (N = 98) ages 65–91 who were 6–8 months post-MI. Data collection included the demographic health status questionnaire (heart rate, blood pressure, body mass index, and medications), fatigue-related comorbidity scale, revised Piper fatigue scale, Epworth sleepiness scale, geriatric depression scale, social provisions scale, and venous blood tests (B-natriuretic peptide, hemoglobin, and interleukin-6). Results Fatigue persisted after MI in 76% of older men and women with no difference by sex. Only depression scores (Ptrend = 0.0004) and mean arterial pressure (Ptrend = 0.015) were found to be linearly independent predictors for fatigue, controlling for age, Il-6 levels, and body mass index. Conclusion Post-MI depression and mean arterial blood pressure are important to assess when examining fatigue post-MI in older populations.

Self-care management strategies used by Black women who self-report consistent adherence to antihypertensive medication

Background Black women in the USA have the highest prevalence rate of hypertension (HTN) contributing to a higher risk of organ damage and death. Research has focused primarily on poorly controlled HTN, negative belief systems, and nonadherence factors that hinder blood pressure control. No known research studies underscore predominantly Black women who report consistent adherence to their antihypertensive medication-taking. The purpose of this study was to describe self-care management strategies used by Black women who self-report consistent adherence to their antihypertensive medication and to determine the existence of further participation in lifestyle modifications, such as eating a healthy diet and increasing physical activity. Methods Using a qualitative descriptive design, four focus groups with a total of 20 Black women aged 25–71 years were audio-taped. Transcripts were analyzed using qualitative content analysis. Participants were included in the study if they scored perfect adherence on the medication subscale of the Hill–Bone Compliance to High Blood Pressure Therapy Scale. Results Medication adherence was predicated on three themes: HTN experience, involvement with treatment regimen, and a strong motivated mentality. Black women would benefit from treatment approaches that are sensitive to 1) diverse emotional responses, knowledge levels, and life experiences; 2) two-way communication and trusting, collaborative relationships with active involvement in the treatment regimen; 3) lifestyle modifications that focus on health benefits and individual preferences; and 4) spiritual/religious influences on adherence. Conclusion The use of self-care management strategies to enhance antihypertensive medication adherence is key to adequate blood pressure control and the reduction of cardiovascular events. This study provides preliminary insight for future research to develop interventions to aid those Black women who struggle with medication adherence and are disproportionately impacted by HTN.

Spiritual/religious Beliefs and Medication Adherence in Black Women with Hypertension.

ABSTRACT: Black women have the highest rate of hypertension (HTN) in the U.S. and perhaps the world. Because they are deemed the most religiously devout group in the U.S., it is plausible that faithfulness to spiritual/religious practices may yield more adherence to HTN medication regimens. This study examined spiritual/religious beliefs in relation to antihypertensive medication adherence in Black women with HTN. Although results showed no association between beliefs and adherence, women who developed trusting relationships with their healthcare provider were more likely to be adherent to their medications.

Exploring the “Obesity Paradox” as a Correlate of Cognitive and Physical Function in Community-Dwelling Black and White Older Adults

Objective The obesity paradox has been documented in aged populations, yet it remains unclear if this paradox persists for physical and cognitive outcomes in community-dwelling older adult populations. Our study examines associations between body mass index (BMI) classification, cognitive function, and physical function. We also investigate whether these associations are modified by race or age. Design Cross-sectional study. Setting Senior residential sites and community centers in Saint Louis, Missouri. Participants Study participants included 331 adults, aged >55 years. Age was stratified into young-old (aged 55-74 years) and older (aged ≥75 years). Outcome Measures Physical function was measured using the mini-Physical Performance Test (mini-PPT) and grip strength. Cognitive function was assessed with the Short Blessed Test (SBT) and the Trail Making Tests (TMT-A and TMT-B) performance. Results Older adults who were obese had significantly better cognitive flexibility (TMT-B) performance than normal weight older adults (P=.02), and this association was not influenced by age or race. Adiposity was not associated with psychomotor speed (TMT-A), general cognition (SBT), or measures of physical function (Ps>.05). Conclusion In a diverse sample of community-dwelling older adults, we found partial support for the controversial obesity paradox. Our results suggest excess adiposity may be protective for executive function processes. Future research is needed to examine the underlying physiological processes linking adiposity to executive function in older adults.

Our Community of Practice—Advancing Nursing Research: Message from the President

Our mission is reflected in every decision made by our Board of Directors. While it is very appealing for organizations to try to be all things to all people, keeping the organizational mission in the forefront is essential to grow as an organization and claim our space in the broader nursing community. Our engagement with other specialty organizations is also driven by our mission—to advance nursing research. Therefore all activities and engagement of the organization—now and in the future—will be reflective of this mission. Jean Lave and Etienne Wenger described the concept of community of practice (Wenger, 1998), in which individuals engage in learning together to address shared concerns or passions. This concept is useful in reflecting on our organization. Belonging, participation, and collaboration are central to the development, function and sustainability of a community of practice. A community of practice is much more than a network of people; it connotes a sharing of values, ideas, and activity. SNRS members have a shared competence and interest that distinguishes the SNRS mission from other specialty organizations. In pursuing the development of nursing science, our members collaborate in activities, discussions, and conferences. Through SNRS, expert and novice researchers are able to learn from each other. The collegiality of members explicitly united in the common purpose of advancing nursing research and supporting each others strengths and abilities is gratifying to experience. The fact that we come together with a shared vision gives our members a sense of joint enterprise and identity. Wenger (1998) also described membership during community development as fluid. Members are more active at different times within their career. As students and new researchers join the SNRS they have the opportunity to observe our senior scientist experts and gain knowledge on how to hone their own research knowledge and skills. The benefits of hearing current research and exchange of ideas can only strengthen our abilities as nurse scientists. Joining SNRS is one step toward engaging in our community of practice, but it is not enough. As members become familiar with SNRS, they can become more involved by serving on committees such as the Student Network, Program Planning, Awards, Bylaws, Policy and Procedures, Communications, Development, Grants, Membership, and the Succession Planning and Nominations. All members can become involved with one of the Research Interest Groups to network with other members interested in their research focus. Emerging leaders in the organization are encouraged to run for one of the eleven Board of Director positions. Becoming involved in SNRS provides exposure to other researchers who are passionate about their work and research agendas.