Spirituality and Medication Adherence in Older African American Women Diagnosed with Hypertension: A Process of Partnering with God Lisa M. Lewis, PhD, RN University of Pennsylvania School of Nursing June,4 2008

Spirituality Helps Older Black Women Beat Hypertension WEDNESDAY, Nov. 7 (HealthDay News) -- Spirituality helps older black American women with high blood pressure stick to the drug regimens that keep the condition under control, new research suggests. –washingtonpost.com

Acknowledgements Pheobie Askie, University of Pennsylvania School of Nursing BSN Candidate –Research Assistant

Support Hartford Center of Geriatric Nursing Excellence, University of Pennsylvania –Frank Morgan Jones Pilot Funding Minority Post-Doctoral Research Supplement (MPDS) to R01 HL from the National Heart, Lung and Blood Institute of the National Institutes of Health

Background Over one-half of all Americans over the age of 60 have been diagnosed with hypertension (HTN). Racial and ethnic disparities exist in BP control and cardiovascular disease mortality. Hypertension contributes to one of the major health disparities found between African and Caucasian Americans in the United States. Older African American adults also have the lowest rates of medication adherence.

Background An individual’s beliefs about his or her HTN and antihypertensive medications are important: –perceptions that medications are harmful –distrust of physicians and pharmaceutical companies

Background Spirituality has been identified as an important cultural belief in the African American community: –increases with age –profoundly influences health practices and beliefs –may enhance health promoting behaviors –historical events, such as slavery, discrimination, and oppression influence spiritual beliefs and practices

Background Literature examining how older African American adult use their spirituality in the management of medication adherence is virtually non-existent.

Purpose Explore the spiritual process associated with medication adherence among a group of older African American adults diagnosed with hypertension.

Methods Research Design –Grounded Theory Sample –Self-identified as African American or Black –Self-reported diagnosis of HTN –Self-reported prescription of at least one antihypertensive medication –Self-identified as spiritual Study Setting –Program of All-Inclusive Care for the Elderly (PACE) –Northeastern USA –Urban

Methods Recruitment –Presentation, presentation, presentation –Presentation, presentation, presentation PACE staff PACE members x 2 –Remuneration for acknowledgement of time and contribution to study

Methods Data Collection –September to November, 2006 –21 individual in-depth interviews –Demographic questionnaire

Methods Data Analysis –Constant comparison –Three levels of coding Open –substantive coding Axial –categorizing Selective –central themes and process

Results Mean Age (range) 73.7 (57-86) GenderFemaleMale N (%) 21 (100%) 0 (0%) Marital Status Married/partneredDivorced/SeparatedWidowed N (%) 5 (23%) 9 (45%) 7 (32%) Educational Attainment Less than high school High school graduate Some college/technical school N (%) 3 (14%) 14 (67%) 4 (19%) Sample Characteristics (N = 21)

Results Mean years diagnosed with HTN (range) 16.7 (8-26) Mean number of prescribed antihypertensives (range) 1.8 (1-3) Religious Affiliation African Methodist Episcopal BaptistCatholic Church of God in Christ Jehovah’s Witness PentecostalOthers N (%) 2 (10%) 9 (43%) 0 (0%) 5 (24%) 0 (0%) 4 (19%) 1 (4%)

Results Partnering with God to Manage My Medications –Describing and defining spirituality –Adopting spiritual practices –Building strength with spirituality

Results “The Lord helps those who help themselves” – Partnering with God: There’s a whole lot you got to do for yourself and that’s why it’s good to be spiritual. Because He [God] can work through the medicine, provide the opportunity for you to help the blood pressure. But you got to have that partnership with him.

Results “It’s more than just going to church” – Describing and defining spirituality Establishing faith in God Developing a relationship with God Developing relationships with other Christians

Results “It’s more than just going to church” – Describing and defining spirituality “God said I will never leave you or forsake you” “God is with me all the time” “I trust Him to take care of me” “Spirituality is your personal relationship with God” “You fellowship every Sunday to get strength”

Results “It’s more than just going to church” – Describing and defining spirituality “Spirituality is your personal relationship with God. Not everyone has this or wants to have this. Going to church is an action but you need to have that relationship with God to take it one step further.”

Results “Staying in the Lord” – Adopting spiritual practices Praying –“Prayer helps me with the side effects of the medication.” –“You got to pray for the doctors and nurses.” Reading Bible scriptures –“The Bible is God’s word. It says that my body is the temple of the Holy Spirit and that means that I am not supposed to do anything that is going to cause it harm. Not taking my medicine is causing it harm.”

Results “God is my rock” - Building strength with spirituality Guiding decisions to remain adherent Coping with medication side effects Increasing self-efficacy to manage barriers

Results Building Strength with Spirituality –Guiding decisions to remain adherent “You need to be directed by the Lord. Yes, you need to pray and ask for guidance. You got to have that direction from our Father above. I live by that.”

Results Building Strength with Spirituality –Coping with medication side effects “In the book of Timothy, it says there…I am not given a spirit of fear but of power and a sound mind. I remind myself all of the time about these words God gave to us. It brings me peace, I can cope.”

Results Results Building Strength with Spirituality –Increasing self-efficacy to manage barriers “He wants to help you with your high blood pressure medicines and how to deal with the problems, such as forgetting and such. When I stay connected to my God, be really spiritual, it just don’t seem so difficult anymore. It’s like I’m in tune to everything and you just feel like you can do just about anything that you set your mind to.”

Limitations Christian sample Self-report of adherence Members of the same PACE program

Discussion Similar findings to other exploratory work of spirituality among older African American adults and chronic illness. –Harvey (2006) Provided insight into how the participants used spirituality to help adhere to their medication regimens. Participant described spirituality as a positive resource for managing barriers associated with medication adherence. Health care providers may consider encouraging individuals who identify as spiritual, or even religious, to capitalize on their spiritual practices to manage their medication adherence. Future studies may examine the role of spirituality as a moderator of self- efficacy among older African American adults diagnosed with hypertension.

Thank you Questions?

Contact Information Lisa M. Lewis, PhD, RN School of Nursing University of Pennsylvania 418 Curie Boulevard Philadelphia, PA