Resilience and Self-Management of Hypertension in African American Adults Using a Conceptualized Resilience Framework: An Exploratory Analysis.

BACKGROUND: Hypertension rates have increased worldwide, with the most significant increase in morbidity and mortality observed among African Americans. Resilience is a potential factor influencing how individuals manage health-related challenges or self-management tasks for hypertension. Research is scarce related to resilience and self-management frameworks in African Americans with hypertension. OBJECTIVES: We aimed to describe a conceptualized resilience framework and preliminary findings of the association among resilience precursors, stress response, hypertension self-management behaviors, and health outcomes in African Americans with hypertension. METHODS: This cross-sectional, descriptive-correlational study included African American adults with hypertension, aged 25 years and older, recruited from an academic university and surrounding urban communities in the Midwest. Participants completed standardized, validated questionnaires to examine the association among resilience precursors, stress response, hypertension self-management behaviors, health-related quality of life (HRQOL), and blood pressure at baseline. Descriptive statistics were used to describe the sample demographic characteristics, whereas Pearson's correlational and multiple regression analyses were conducted to determine the associations among the variables. RESULTS: African Americans with hypertension (N = 30) were included in this preliminary study, with a mean age of 59.17 years; 66.7% were female. The mean systolic blood pressure was 136 (SD = 16.8) mmHg; the mean diastolic blood pressure was 78.1 (SD = 13) mmHg. Pearson's correlation analysis revealed significant relationships between resilience precursors, stress response, hypertension self-management behaviors and capability, and health outcome components. Multiple regression analysis showed that poor perceived resilience significantly predicted depression. Low dispositional optimism and low perceived resilience were significant predictors of stress. Higher perceived resilience significantly predicted self-efficacy. Perceived stress was negatively and significantly associated with HRQOL. Finally, higher self-efficacy significantly predicted better HRQOL. DISCUSSION: This study underscores the significant association between resilience, stress, self-management behaviors, and health outcomes in African Americans with hypertension. Further research with larger sample sizes and longitudinal designs is warranted to confirm and expand upon these findings.

Advancing health equity through nursing research.

BACKGROUND: Health inequities are major predictors of poor health and remain a complex and persistent challenge globally and in the United States. Research has documented the underlying causes and mechanisms that give rise to health disparities. However, it lacks adequate attention to the strategies needed to build upon promulgated research to address equity-based challenges to improve health. PURPOSE: This paper describes how building and supporting diverse research teams can play a central role in increasing the research capacity and participation of diverse populations to improve the health of individuals, families, and communities. METHODS: Exemplars from work and discussion of strategies to grow nursing's health equity workforce are presented. DISCUSSION: Actions to build and leverage partnerships to expand capacity, maximize the impact of health equity outcomes, and cultivate a supportive environment to grow the health equity scientific workforce are discussed. CONCLUSION: Nurse scientists can address health equity through the research process.

Medical Mistrust Among Black Women in America.

This qualitative research study highlights medical mistrust as a significant barrier to quality health care for Black women. Unraveling mistrust is essential for reducing health disparities and improving well-being for women and their families. Three research sites were included: Florida, Ohio, and the U.S. Virgin Islands. Three 90-minute focus groups were convened with 10 women in each of them. The discussions were recorded. Five themes will be discussed through the voices of women from each of the sites. Mistrust of healthcare professionals was associated with fears about being rejected, embarrassed, and misunderstood during the clinical encounter. Others reported that providers who were reluctant to make physical contact with them during the clinical visits provoked feelings that the color of their skin might seem "dirty." Finally, this research will help to inform discussions about COVID-19 vaccine hesitancy, which remains a critical health concern among Black women and healthcare providers.

Medication Adherence of Older Adults with Hypertension: A Systematic Review.

Objective: Hypertension (HTN) significantly increases the risk of stroke and heart disease, which are the leading causes of death and disability globally, particularly among older adults. Antihypertensive medication is a proven treatment for blood pressure control and preventing complications. However, medication adherence rates in older adults with HTN are low. In this review, we systematically identified factors influencing medication adherence in older adults with HTN. Methods: We applied the PRISMA guidelines and conducted systematic searches on PubMed, MEDLINE, and Google Scholar in July 2022 to identify preliminary studies reporting factors influencing medication adherence among older adults with HTN. The convergent integrated analysis framework suggested by the Joanna Briggs Institute for systematic reviews was adopted for data synthesis. Results: Initially, 448 articles were identified, and after title and abstract screening, 16 articles qualified for full-text review. During this phase, three articles were excluded for reporting on irrelevant populations or focusing on issues beyond the review's aim, leaving thirteen studies in the final review. After data synthesis, fifteen themes were extracted from the key findings of the included studies. The most prevalent themes included the number of medications used (53.9%, n=7 studies), financial status (38.5%, n=5), sex (38.5%, n=5), age (30.1%, n=4), duration of disease (23.1%, n=3), comorbidities (23.1%, n=3), and health compliance (23.1%, n=3). Other themes, such as education, health literacy, health belief, medication belief, perception of illness, patient-physician relationship, self-efficacy, and social support, were also identified. Conclusion: The findings of this review highlight critical areas for developing innovative, evidence-based programs to improve medication adherence in hypertensive older adults. Insights from this review can contribute to improving medication adherence and preventing future health complications.

Nonpharmacological Interventions for Preventing Rehospitalization Among Patients with Heart Failure: A Systematic Review and Meta-Analysis.

Background: Heart failure (HF) is the most common condition for rehospitalization among people aged ≥65 years in the United States, with 35,197,725 hospitalizations between 2014 and 2017. Hospitalized patients with HF have the highest 30-day readmission rate (25%). Overall, HF management, despite its progress, remains a challenge. Although several studies have evaluated interventions designed to reduce HF-related hospital readmissions, research comparing their effectiveness remains insufficient. Purpose: This systematic review and meta-analysis focused on studies that investigated the effectiveness of nonpharmacological interventions (NPIs) on reducing rehospitalization among patients with HF. Methods: This review conformed to the preferred reporting items for systematic reviews and meta-analyses guidelines, used four databases: Cumulative index to Nursing and Allied Health Literature, PubMed, Cochrane, and Web of Science. Studies were included in the review according to the following criteria: (a) included only randomized control trials (RCTs), (b) included participants with HF who were over 18 years of age, (c) peer-reviewed, (d) written in English, and (e) rehospitalizations occurring within 30-day, 90-day, and 1 year of discharge from the initial hospitalization. Results: Fourteen studies were included, with a total of 2,035 participants. Meta-analysis showed that rehospitalization was different between the intervention and usual care groups. The odds ratio was 0.54 (95% confidence interval [0.36, 0.82, p < 0.01]). Conclusions/Implications for Practice: NPIs designed to increase HF knowledge and self-management may effectively reduce rehospitalization among HF patients. NPIs can be delivered at the patient's home through visits, phone calls, or digital platforms and technologies.

Secondary Stroke Risk Reduction in Black Adults: a Systematic Review.

OBJECTIVE: To address the fact that Black adults (BAs) experience significantly greater stroke burden than the general population, we conducted a systematic literature review which described evidence-based interventions targeting secondary stroke risk reduction in BAs. DATA SOURCE: Publications were selected from PubMed, Ovid, Cochrane, and Web of Science databases. We included peer-reviewed, longitudinal, English-language studies performed in the USA which reported results for BAs separately and had adult participants who had experienced stroke-related events. RESULTS: Six of the 7 studies employed behavioral interventions which promoted education on stroke risk factors, problem-solving skills, and healthy-coping strategies. These studies demonstrated improvements in one or more biologic outcomes including cholesterol control and systolic blood pressure. CONCLUSIONS: Existing interventions on secondary stroke risk reduction approaches are effective in reducing secondary stroke risk among BAs, especially in individuals with poorly controlled blood pressure at baseline. However, additional research is needed because the current approaches may limit generalizability.

Is Medication Adherence Predictive of Cardiovascular Outcomes and Blood Pressure Control? The Systolic Blood Pressure Intervention Trial (SPRINT).

BACKGROUND: Adherence to study medications is crucial to evaluating treatment effects in clinical trials. To assess whether in the SPRINT trial, adherence and cardiovascular outcomes are associated regardless of intervention assignment. METHODS: This study included 9,361 participants aged ≥50 years, recruited from 102 clinics. Participants were randomized to a Standard Treatment Group (targeted systolic blood pressure [SBP] <140 mm Hg) or an Intensive Treatment Group (targeted SBP <120 mm Hg) and followed for incident cardiovascular events until the study was halted early for benefit. The 8-item Morisky Medication Adherence Scale (MMAS-8) was administered at baseline, and at the 12- and 48-month (or close out) visit. RESULTS: Adjusting for covariates, there was no association between the baseline 8-item MMAS-8 and the likelihood of the primary composite endpoint, any of the secondary endpoints, or blood pressure (BP) control. Low adherence was associated with a higher body mass index, SBP, diastolic BP, and Patient Health Questionnaire, and high adherence was associated with a higher Montreal Cognitive Assessment. There was no difference in the MMAS-8 over time by treatment arm assignment. For the primary outcome (a composite of myocardial infarction, other acute coronary syndromes, stroke, heart failure, or death from cardiovascular causes), baseline odds ratios (95% confidence intervals) for the Low vs. Medium and vs. High; and, for Medium vs. High MMAS-8 were 1.02 (0.82-1.28), 1.07 (0.85-1.34), and 1.05 (0.88-1.250). CONCLUSIONS: In SPRINT, medication adherence as measured using the MMAS-8 was not associated with outcomes or BP control.

Effects of the Intensity of Lifestyle Exercise on Changes in Blood Pressure.

The purpose of this study was to investigate whether the amount of time participants exercised in the target heart rate zone (THRZ) influenced change in blood pressure (BP) one year following a cardiac event. Lifestyle exercise (habitual, small exercise opportunities) and intensity were objectively measured using portable heart rate monitors. Linear mixed models were used to analyze change in BP among 331 participants. Mean BP at baseline was 118/70 mmHg, and both systolic and diastolic BP increased from baseline to one year-4.79 mmHg (p <.001) and 2.09 mmHg (p =.002), respectively. Overall, participants had a decrease in levels of lifestyle exercise. After controlling for time, age, gender, and study group, SBP change was inversely associated with amount of time in THRZ. Given suboptimal engagement in recommended exercise, the underlying mechanisms of lifestyle exercise effects on the time spent in THRZ to reduce BP warrants further study in this population.

African American Older Adults' Perceived Use of Technology for Hypertension Self-Management.

With the unprecedented growth of technology for disease prevention and management, little is known about the experience and adoption of such technology in African American older adults with hypertension. A 90-minute focus group session was used to explore African American older adults' (N = 21) experiences with using technology (mobile devices and applications) for hypertension self-management. Twenty participants reported owning smartphones and used this technology to communicate; seek, acquire, and share information; engage in entertainment; and organize and manage time. Participants expressed concerns about not being informed or trained sufficiently to integrate technology for hypertension self-management. There is a need to develop novel hypertension self-management interventions that integrate technology and training programs for this marginalized population that may help improve blood pressure control and address important clinical and public health priorities of uncontrolled hypertension. [Res Gerontol Nurs. 2018; 11(5):249-256.].