Religious/spiritual Coping in Older African American Women

By Greer, Danice B.; Abel, Willie M. | The Qualitative Report, January 2017 | Go to article overview

Religious/spiritual Coping in Older African American Women


Greer, Danice B., Abel, Willie M., The Qualitative Report


The purpose of this study was to identify religious/spiritual coping behaviors of African American women with hypertension (HTN) and explore how religious/spiritual coping influences adherence to high blood pressure (HBP) therapy in older African American women. A mixed-method research design guided this study. Twenty African American women with primary HTN were enrolled in this study using a mixed methods concurrent triangulation design. Data collection included physiologic, descriptive, and sociodemographic data. Adherence was measured using the Hill-Bone Compliance to High Blood Pressure Therapy scale (Kim, Hill, Bone, & Levine, 2000), and religious/spiritual coping was evaluated with the Brief Religious/Spiritual Coping scale. Qualitative data were obtained by audiotaped interviews using a semi-structured interview guide. Descriptive, physiologic data and data from questionnaires were analyzed. Five themes emerged. (a) Feelings of dizziness, lightheadedness, and feeling sick; (b) Belief in God or a Supreme Being, (c) Prayer as the primary coping mechanism, (d) Adherence conceptualized as obedience to God's will, and (e) Need for healthcare providers to pray and provide more health information. This study provided insight into the influence of religious/spiritual coping behaviors on adherence to HTN treatment in older African American women with HTN in a rural medically underserved area. Nurses and other healthcare providers are in a key position to influence positive health outcomes in rural settings with limited resources using culturally appropriate strategies. Keywords: Religious/Spiritual Coping, Adherence/Compliance, Hypertension, Mixed Method, African American Women

An estimated 80 million Americans 20 years of age and older have been diagnosed with hypertension (HTN). Hypertension is conceptually defined as an arterial blood pressure that exceeds 140/90 mm Hg. African American women have the highest prevalence rate of HTN (46.1%), followed by African American men (44.9%; Mozaffarian et al., 2016). Also, African Americans tend to develop HTN earlier in life than Non-Hispanic Whites, and they are at greater risk for stroke, heart disease, and kidney failure leading to higher rates of disability and death (Mozaffrian et al., 2016).

Although the disproportionate burden of HTN and associated diseases contributes to considerable health disparities for African Americans, the sequelae of HTN are largely preventable with lifestyle modifications and antihypertensive medications (Ferdinand & Welch, 2007). Adherence to lifestyle modifications and antihypertensive medication is essential for blood pressure control and prevention of organ damage. However, African American have not readily participated in risk reduction behaviors to manage and prevent HTN and the reasons for not participating are not fully understood.

Literature Review

In a Cochrane review, Schroeder, Fahey, and Ebrahim (2004) identified motivational strategies as a promising intervention for improving adherence to the HTN treatment regimen. As a type of motivation, spiritual inspiration or religious conversion (Center for Substance Abuse Treatment, 1999), has been a major influence in achievement of positive health outcomes.

Adherence is best defined as the extent to which a person's behavior (which includes) taking medication, following a diet, and/or executing lifestyle changes, corresponds with agreed recommendations from a health care provider (Sabate, 2003). For most (clinicians, health care practitioners, and researchers) a cutoff point of [greater than or equal to] 80% is accepted as adherent. Yet, medication adherence rates in patients with HTN are estimated to be between 50 and 70% (Domino, 2005; Sabate, 2003), and several studies (Krousel-Wood et al., 2010; Lewis, Ogedegbe, & Ogedegbe, 2012; Ndumele, Shaykevich, Williams, & Hicks, 2010) have reported that African Americans have lower adherence rates than Whites. …

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