Spirituality and Medication Adherence in Older African American Women with Hypertension: Partnering with God

1. 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

2. 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

3. Acknowledgements • Pheobie Askie, University of Pennsylvania School of Nursing BSN Candidate • Research Assistant

4. Support • Hartford Center of Geriatric Nursing Excellence, University of Pennsylvania • Frank Morgan Jones Pilot Funding • Minority Post-Doctoral Research Supplement (MPDS) to R01 HL 067439 from the National Heart, Lung and Blood Institute of the National Institutes of Health

5. 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.

6. 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

7. 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

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

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

10. 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

11. Methods • Recruitment • Presentation, presentation, presentation  • PACE staff • PACE members x 2 • Remuneration for acknowledgement of time and contribution to study

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

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

14. Results • Sample Characteristics (N = 21)

15. Results • Sample Characteristics (N = 21)

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

17. “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

18. “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

19. “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

20. “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

21. “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

22. “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

23. 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

24. 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

25. 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.” Results

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

27. 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.

28. Thank you • Questions?

29. Contact Information Lisa M. Lewis, PhD, RN School of Nursing University of Pennsylvania 418 Curie Boulevard Philadelphia, PA 19104-6096 LISAML@nursing.upenn.edu 215-898-0828