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What do elderly blacks know about high blood pressure as compared to elderly whites

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What do elderly blacks know about high blood pressure as compared to elderly whites

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Content WHAT DO ELDERLY BLACKS KNOW ABOUT HIGH
BLOOD PRESSURE AS COMPARED TO
ELDERLY WHITES
h y
Petra J.C . Niles
A T hesis P resented to th e
FACULTY OF THE LEONARD DAVIS SCHOOL OF GERONTOLOGY
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillm ent of the
R equirem ents for th e Degree
MASTER OF SCIENCE IN GERONTOLOGY
D ecem ber 1991
Copyright 1991 P etra J.C . Niles
UMI Number: EP58981
All rights reserved
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UMI EP58981
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UNIVERSITY OF SOUTHERN CALIFORNIA
LEONARD DAVIS SCHOOL OF GERONTOLOGY
UNIVERSITY PARK
LOS ANGELES, CALIFORNIA 90007
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TABLE OF CONTENTS
PAGE
INTRODUCTION............................................................................................... 1
CHAPTER 1 LITERATURE REVIEW................................................................ 3
W hat is High Blood Pressure?................................................................. 3
Why is High Blood Pressure a Problem?............................................. 3
Prevalence of High Blood Pressure........................................................ 4
W hy is High Blood P ressure H igher Among B lack s? ............... 5
High Blood Pressure in the Elderly....................................................... 7
High Blood P ressure D rug T h erap y ............................................... 8
High Blood P ressure N on-D rug T h erap y............... 10
High Blood P ressure T herapy C hallenges.....................................11
Im portance of E d u c a tio n .................................................................... 12
High Blood P ressu re K now ledge......................................................14
CHAPTER 2
M ethodology............................................................................................ 17
S a m p le .......................................................................................................18
CHAPTER 3
R e su lts/D iscu ssio n ................................................................................2 0
CHAPTER 4
D iscussion.............................................................................................. 28
S um m ary/C onclusion ...........................................................................4 0
Recommendations......................................................................................41
BIBLIOGRAPHY...................................................................................................43
APPENDIX............................................................................................................... 4 6
Questionnaire Used in Study........................................... 47
C orrect A nsw ers From Interview .................................................... 51
ii
LIST OF TABLES
TABLE 1: Characteristics of the Sample Population................................ 19
TABLE 2: Q uestions A nsw ered Correctly Pertaining to Knowledge of
High Blood P ressure, By G en d er........................................... 22
TABLE 3: Q uestions Answ ered Correctly Pertaining to Knowledge of
High Blood P ressure, By R a ce................................................ 2 9
TABLE 4: Knowledge of High Blood P ressure Among Physician
D iagnosed H y p erten siv es......................................................... 3 4
I TABLE 5: Knowledge of High Blood P ressure by E ducation................ 3 6
1 1 1
IN TRO DUCTIO N
High blood p ressu re occurs m ore frequently in blacks th a n in
w hites. It is associated w ith the high ra te s of m orbidity and
m ortality in th e U nited S tates annually.
High blood p ressu re is an im portant h ealth issu e for blacks. A
great deal of evidence show s th a t blacks are m ore susceptible to th is
disease and a t a n earlier age th a n th eir w hite co u n terp arts. There
have been considerable efforts m ade to control th is disease, yet
blacks rem ain th e m ost at-risk population for th is disease.
To get a b etter grasp on th e control of high blood p ressu re, a
look a t th e existing knowledge of high blood p ressu re am ong blacks
an d w hites is n ecessary so th a t im proved or new attem p ts can be
m ade to reduce th e m ortality an d m orbidity ra te s associated w ith
high blood p ressu re.
The purpose of th is stu d y were to find o u t w h at elderly blacks
know a b o u t high blood p ressu re as com pared to elderly w hites.
This stu d y is im p o rtan t b ecau se w ith age there is a greater chance
for th e developm ent of high blood p ressu re, as blood p ressu re ten d s
to rise n atu rally w i t h the aging process.
T his stu d y describes th e general knowledge of blacks and
w hites ab o u t high blood p ressu re. V ariables u sed are race,
1
education, and gender. It is of im portance because health,
i knowledge, attitu d e s and beliefs are predictive of h ea lth behaviors of
1
I high blood p ressu re control ranging from th e screening of th e
I disease to drug m ain ten an ce (Katz, 1988).
Chapter 1
LITERATURE REVIEW
The literatu re on high blood p ressu re is plenteous, b u t
specific literatu re regarding th e elderly p o p u latio n ’s know ledge of
high blood p ressu re is lim ited. The chief em phasis in th is review is
race and its relationship w ith high blood p ressu re.
WHAT IS HIG H BLOOD P R E SSU R E ?
The World H ealth O rganization defines high blood p re ssu re or
hypertension as any blood p ressu re in excess of 1 6 0 /9 5 m m Hg
(Cam bert, 1987). H ypertension is classified either as prim ary or
secondary. Prim ary hypertension affects approxim ately ninety
p ercen t of all people w i t h elevated blood p ressu re. It is also
referred to as essential hypertension. Secondary hypertension
includes ten percent of all hypertensive diseases. This type is due
to som e underlying (primary) organic disorder (Kahn, 1983).
WHY IS HIGH BLOOD PR ESSU R E A PROBLEM ?
j High blood p ressu re is one of th e m ajor risk factors for
I p rem atu re d eath and disability because of th e large n u m b er of
I people afflicted an d th e consequences of uncontrolled h y p erten sio n
3
(Kaplan, 1986). High blood p ressu re in itself is a risk factor for
strokes, renal disease an d m yocardial infarction (Fors, Owen, Hall,
M cLaughlin, an d Levinson, 1989).
C ardiovascular disease rem ains the leading cause of d eath
am ong U nited S tates blacks. In 1981 th ere w ere over 40,000
coronary h e a rt disease d eath s an d 19,000 cerebrovascular disease
d eath s in blacks nationw ide (Folsom, Gomez-M arin, Sprefka,
Prineas, E dlairtch an d Gillum, 1987).
A nother reaso n w hy high blood p re ssu re is a problem is m ost
people w ith th e disease are sym ptom less, so no great atten tio n is
paid to blood p ressu re u n til som ething critical h ap p en s.
PREVALENCE OF HIGH BLOOD PR E SSU R E
According to th e 1988 Report of th e J o in t N ational
Com m ittee on D etection, E valuation, an d T reatm en t of High
P ressure, 58 m illion people in th e U nited S tates have elevated blood
p re ssu re or are tak in g anti-hypertensive m edication.
Among th e elderly high blood p re ssu re is a m ajor factor
underlying th e 500,000 stro k es an d 175,000 d ea th s from stroke
th a t occur annually. It is also th e contributing factor in 1,500,000
h e a rt attack s an d 570,000 h e a rt attack d eath s each y ear in the
.j
elderly. R esearch indicates th a t th e prevalence of high blood
p ressu re, including diastolic an d systolic elevations, to be
approxim ately 44% in w hites age 65-74 years an d 60% in b lack s in
th e sam e age group. T hese differences occur depending on w hich
blood p ressu re th resh o ld s are u se d to define high blood p re ssu re
disorder (The W orking G roup in H ypertension in th e Elderly,
1983).
I T rends show th a t high blood p ressu re related d ea th ra te s are
I declining in blacks, an d stroke m ortality rate s in som e com m unities
I
have experienced greater decline in blacks th a n in w hites. T hese
tren d s are due to an increase in control efforts u sed th ro u g h o u t the
countiy. However, high blood p ressu re continues to be th e m ost
serio u s h ealth problem for blacks in the U nited S tates (Joint
I
N ational Com m ittee on D etection E valuation, an d T reatm en t of High |
I
Blood P ressure, 1988).
WHY IS HIGH BLOOD PR E SSU R E HIGHER AMONG BLACK S?
I The prevalence rate of high blood p ressu re in th e U nited
S tates black population is m u ch higher th a n in the w hite population
(Kaplan, 1986). S tudies also show th a t blacks are m ore likely th a n
w hites to develop high blood p ressu re a t a n early age.
A pproxim ately 25% of th e black population h a s uncontrolled
hypertension, com pared w ith only 16% of th e non-black population
1 — ---------------------------------------------------------------------------------------------------------------------------------------------
! (Joint N ational Com m ittee, 1988). Felder (1990) sta te s th a t
I approxim ately 6.8 million black ad u lts have high blood p ressu re
j w hich resu lts in strokes, h e a rt an d kidney disease.
I
The prevalence of high blood p ressu re am ong blacks stem s
from a m ultidim ensional origin. It is n o t clear w h at is th e specific
cau se of this, b u t a n u m b er of predisposing factors have been
I identified. They include diets high in sodium an d fat, obesity,
stress, sed en tary lifestyle, family history of high blood p ressu re,
1
race, econom ics, alcohol, an d biological factors (Felder, 1990;
K aplan, 1986).
In general, people of lower social class and those w ith lower
educational levels tend to have higher blood p ressu res th a n those in
I a higher social class and th o se w ith higher levels of education.
E thnicity as well as socioeconom ic s ta tu s should be
considered in th e trea tm e n t and control of high blood p ressu re
(Francis, 1990). Race is one of th e m ost im p o rtan t factors in
hypertension. Blacks develop high blood p ressu re m ore often th a n
w hites an d are affected m ore severely. It rem ain s difficult, how ever
to assign race to high blood p ressu re, since blacks in rural, n o n
urbanized Africa have virtually no high blood p ressu re. Blacks in
W estern societies have experienced th e process of u rb an izatio n of
w hich m ajor dietary changes occur, a n increase in sodium
j
L ^
consum ption an d a n increase in the level of psychosocial stress
(Editorial: H ypertension in B lacks— Tim e for Action, 1990).
A lthough th e relationship betw een social factors an d high
blood p ressu re levels exists, am ong the elderly biological factors
begin to play a m ore im portant role in th is disease. A dult blacks are
affected despite being located in less stressfu l areas.
A ccording to W ilson an d Grim (1991), th e g reater prevalence
of hypertension in W estern hem isphere blacks is due to survival of
the fittest during the slavery period of history. Slaves who were b est
able in conserving sodium survived an d becam e th e an cesto rs of
p rese n t day sodium sensitive blacks in the W est. Due to extrem e
overcrow dedness, lim ited food an d w ater due to slave trading,
I
j individuals who were m ost efficient a t retain in g sodium w ere b etter
I able to survive, therefore a resu lt of future generations of blacks in
I th e W estern H em isphere have a n in h erited genetic increase in th e
! ability to conserve sodium . There is th e n an increase in the
' developm ent of high blood p ressu re an d the consequences of it.
HIGH BLOOD PR E SSU R E IN TH E ELDERLY
High blood p ressu re is a very im p o rtan t issu e. For the elderly,
high blood p ressu re is one of th eir m ost com m on h ealth problem s
(Hollenberg, 1991). It is a m ajor risk factor for stroke, cardiac
disease, h e a rt failure, renal failure an d other diseases (Francis,
1990).
High blood p ressu re in th e elderly is associated w ith several
psychosocial factors, to w hich h ealth care providers sh o u ld be aw are
of in achieving b etter control of th is disease. They include
tra n sp o rta tio n problem s, déficiences in th eir diet, having low an d
fixed incom es, tak in g care of a sp o u se an d neglecting them selves,
im pedim ents in hearing an d eyesight, m ental confusion th a t m ay
re su lt in neglect or im proper u se of m edications, living alone as well
as opening safety caps m ay also h in d er trea tm en t adherence. The
elderly are m ore likely to tak e over th e co u n ter m edications th a n
younger people, increasing th e risk of d ru g in teractio n (The
W orking G roup on H ypertension in th e Elderly, 1986).
According to Pathy, 1988, age an d high blood p ressu re is a
lethal com bination. T his m akes high blood p ressu re m ore
im p o rtan t w hen considering th e elderly.
HIGH BLOOD P R E SSU R E DRUG TH ERAPY
T reatm en t of high blood p ressu re includes dru g as well as
n o n -drug therapy. D rug th erap y includes:
8
! D iuretics, are the m ost frequently prescribed d ru g u sed to
I
j tre a t high blood p ressu re; i.e., hydrochlorothiazide. They are low in
' cost an d are very effective.
Sym patholytics are also effective, b u t are associated w ith
significant cen tral nervous system side effects.
B eta-blockers have the advamtage of antianginal an d
cardioprotective action, b u t they produce cen tral nervous system
side effects.
C alcium ch an n el blockers ap p ear to w ork well in th e elderly,
b u t have a n u m b er of side effects.
A ngiotension- converting inhibitors (ACE) are being
considered in trea tm en t of high blood p re ssu re in elderly; i.e.,
captopril an d eralapril.
If any trea tm e n t is to be successful, total com pliance m u st be
given. Poor com pliance com es ab o u t a s a resu lt of m edication costs,
long w aiting room tim e, d u ratio n an d com plexity of treatm en t. A
i good relationship betw een p atien t an d physician is necessary. M uch
I
h a s to be considered h er as th e elderly take a n u m b er of
m edications for other problem s. Finally racial as well as individual
differences sh o u ld be considered in tre a tm e n ts, (Katz, 1988;
Levinson, 1988; Tuck, 1988).
HIGH BLOOD PRESSURE NON DRUG THERAPY
N on-drug th erap y is also beneficial to h ypertensives, b u t
th erap y can only be successful if high blood p ressu re levels have an
early diagnosis. It includes:
•The reduction of w eight for those w ho are obese.
•R elaxation/m edication can be u sed for stress reduction.
•The red u ctio n of sodium intake is recom m ended for non-
pharm acological therapy. There should also be lim itations of food
containing sa tu ra te d fats or high cholesterol. For blacks dietary
h ab its consists of "soul food" w hich is generally high in both fat an d
sodium . More fiber and less sa tu ra ted fat are also beneficial.
•R eduction of alcohol consum ption for those who consum e
m ore th a n two d rin k s daily.
•Sm oking should be discouraged as tobacco is a risk factor for
cardiovascular disease.
•A ppropriate aerobic exercise (walking, sw im m ing, biking) is
helpful for th o se w ho can participate. E ach exercise program
should be individualized and approved by a physician, (Gifford,
1987; Langford, et al., 1985; Tom pson, 1985; Levinson, 1988; 1988
J o in t N ational Com m ittee).
10
HIGH BLOOD PRESSURE THERAPY CHALLENGES
In th e elderly population, m anagem ent of high blood p ressu re
I brings ab o u t som e special challenges. M any elderly have other
d iseases along w ith high blood p ressu re. Some com m on ones are
congestive h e a rt failure, diabetes m ellitus, degenerative Joint
disease, angina, and cerebral v ascu lar disease.
1
I A nother challenge th a t often occurs is th a t m an y elderly are
j tak in g m ultiple dru g s to w hich th e response to antihypertensive
I trea tm en t m ay be a fine line betw een efficacy an d toxicity (Katz,
1988).
O ther challenges th a t are evident th ro u g h o u t th is literatu re
are lifestyle factors, w hich vary depending on culture. T hese factors
(cost of therapy, education an d literacy level, language b arriers,
environm ental conditions, cu ltu ral diets and beliefs) m ay be
im p o rtan t co n trib u to rs to hypertension an d its control.
An issu e of im portance here is for m em bers of th e m edical
team to pay special atten tio n to th ese factors (1988 J o in t N ational
Com m ittee). If treatm en t is to be successful, all asp ects of th e
hypertensive p atien t m u st be considered.
11
IMPORTANCE OF EDUCATION
I E ducation is critical in th e control of high blood p ressu re. In
i addition to diet, exercise an d n u tritio n , th ere is also a need for
I
j h ea lth prom otion to reduce high blood p re ssu re levels am ong
I elderly blacks.
I
I
I The prim ary objective of education is to en h an ce th e care and
I control of individuals w ith high blood p ressu re in order to prevent
I m orbidity an d m ortality (Levine, 1990).
E ducation of the public should be continuous, it should
prom ote changes in public knowledge, a ttitu d e s an d consequently
behavior. It should also create an aw areness of available com m unity
reso u rces for high blood p ressu re (Roccella, 1990). E du catio n does
n o t always involve a single organized program , it does n o t always
have its objectives stated an d its beginning an d end m ight n o t be
clear. Instead it reflects the su m of a great n u m b er of personal and
I societal influences an d experiences w hich deliberately or otherw ise,
m ore people in a desired direction (Hodge, et al., 1990).
In a stu d y done to see how a H ealth E ducation Program affects
th e control of hypertension in th e elderly, an elderly population
w as com pared w ith a younger population. The program consisted of
i th ree seq u en tial interventions w hich included a five to te n m in u te
12
counselling interview w ith the p a tie n t im m ediately following th e ir
m edical appointm ent. The next step w as fam ily u n d erstan d in g ;
su p p o rt an d reinforcem ent for th e p atien t; an d th e th ird w as a
series of th ree o n e-h o u r group sessio n s to in crease th e p atien ts'
u n d e rsta n d in g an d feelings of self-confidence a b o u t th eir problem ,
especially in relation to m an ag em en t an d com pliance of
h y p erten sio n .
R esults tak en b o th a t two y ea r an d five y ear follow -ups show ed
th a t th e elderly p atien ts reported higher levels of com pliance th a n
did th e younger p atien ts. T his show ed th a t program s for th e elderly
can be successfully im plem ented an d equally effective (Morisky, et
al, 1982).
In a review of a stu d y done by Inui, Yourtee, an d W illiam son,
(1976), "Improved O utcom es in H ypertension After P hysician
T utorials: A C ontrolled Trial," show ed th a t education w as crucial to
th e m an ag em en t an d control of hypertension.
Sixty-two physicians participated in th e study, 29 w ere in the
experim ental group an d 33 were in th e control group. The
experim ental group w as tu to red to im prove its effectiveness as
m an ag ers an d ed u cato rs of p atien ts w ith essen tial hypertension, and
a g reater p ercen t of th e clinic visit tim e w as devoted to p a tie n t
teachings. R esults show ed th a t th e p atien ts of th e tu to red
13
p h y sic ian s (experim ental group) w ere m ore co m p lian t w ith th e ir
m edical p rescrip tio n s a n d th u s h ad b e tte r control of th e ir blood
p re ssu re th a n th e p a tie n ts in th e control group.
H IG H BLOOD P R E SSU R E KNOW LEDGE
In a stu d y done to identify th e general know ledge of elderly
p erso n s w ho h a d b een diagnosed hypertensive, re su lts show ed th a t
th e p artic ip an ts included in th e stu d y age 65 a n d older, h a d
insufficient know ledge a b o u t hyp erten sio n .
Knowledge w as m e asu red w ith th e u se of a n interview , w hich
included 15 q u estio n s a b o u t general know ledge of h y p erten sio n .
Insufficient know ledge w as d eterm ined th ro u g h th e p a rtic ip a n t’s
p o ssessio n of factu al know ledge a b o u t h y p erten sio n , its tre a tm e n t
an d th e d an g ers th a t are asso ciated w ith th e disease (Baldini, 1981).
In a n o th e r stu d y dealing w ith th e u n d e rsta n d in g of
h y p erten siv es of th e ir condition, th e p a rtic ip a n ts w ho h a d been
tu to re d by p h y sician s (who allocated a g reater percen tag e of clinic-
v isit tim e to p a tie n t teaching) in creased th e ir know ledge on
h y p erten sio n a n d h ad b e tte r control of blood p re ssu re th a n th o se
w ho w ere in th e control group.
14
H ealth knowledge h a s a m o st im p o rtan t role. Not only is
inform ation given, b u t a ttitu d es an d beliefs can be changed (Baldini,
1981). C om m unity education is therefore helpful for th o se w ho are
predisposed to high blood p ressu re. There should be a n increase in
' h ealth education ab o u t the harm ful effects of high sa lt consum ption.
I
They should becom e fam iliar w ith all know n risk factors, su c h as
obesity, sm oking, genetics, alcohol an d high sa lt diet (Katz, 1988).
People need to know th a t som e of the risk factors are m odifiable
an d som e are fixed. W ith th is knowledge, preventive an d control
m easu res can be taken.
Knowledge brings ab o u t aw areness an d u n d erstan d in g . W ith it
changes can occur, therefore if blacks have know ledge of high blood
p ressu re m easu res can be ta k en to reduce the possibility of having
high blood p ressu re or m ain ten an ce of th e individuals blood
p ressu re to th a t w hich is norm al as defined by a physician. Not only
does know ledge allow for a b etter control of high blood p ressu re,
b u t it in tu rn will aid in th e prevention of other diseases, su c h as
cardiovascular disease an d stroke.
H ypertensives need to know th a t th is disease is asym ptom atic,
it ten d s to ru n in fam ilies an d therefore family m em bers sh o u ld be
evaluated. Any m yths ab o u t the disease should also be corrected
(Levy an d W ard, 1979).
15
W ith a b u n d a n t am o u n ts of literatu re pertaining to high blood
p ressu re an d blacks available, it yet rem ains th a t blacks are m ost
likely to have high blood p ressu re. One im plication here is th a t it is
n ecessary for elderly blacks or blacks in general to be m ade aw are of
specific inform ation regarding high blood p ressu re. T his "at risk"
popu latio n will benefit very m u ch from th is inform ation.
A lthough som e of th e literatu re reviewed here is d ated b ack to
1979, it is im p o rtan t to th is study.
From th is L iterature Review, we have th e following
hypotheses:
1. Knowledge of high blood p ressu re is related to
h y p erte n siv en e ss.
2. D ifferences in knowledge of high blood p ressu re am ong
blacks an d w hites depends on education.
16
CHAPTER 2
METHODOLOGY
It is im p o rtan t to identify w h a t knowledge exists or does n o t
exist am ong elderly blacks ab o u t high blood p ressu re. The
advantage w ould be th e achievem ent of g reater efforts in th e control
I of high blood p ressu re.
I
T his stu d y investigated the knowledge of high blood p ressu re
am ong elderly blacks and w hites. W ith a b u n d a n t evidence th a t
blacks are m ore susceptible to hypertension th a n w hites it is of
im portance to know w h at knowledge th ey have of the disease.
D ata for th is stu d y w as collected from a 16 item questionnaire.
E ight q u estio n s m easu red general know ledge of high blood p ressu re
an d eight m easu red personal h ealth history including w h eth er or
n o t fam ily m em bers or p articip an ts them selves h ad ever h ad stroke,
h e a rt disease, or kidney disease. D em ographics w ere included a t
th e beginning of th e questionnaire.
17
SAMPLE
The sam ple population w as tak en from a senior cen ter and
high-rise senior a p a rtm e n t com plex. The two settin g s w ere very
different from each other. The m ajority of th e sam ple w as tak en
from th e senior ap a rtm en t com plex w hich h ad quite a large
population of both blacks an d w hites, b u t b ecau se of insufficient
participation the re st of th e population w as tak en from a senior
ce n ter.
Anyone 51 an d above w ho w as either black or w hite w as
eligible to particip ate in th is study. The selection of th e sam ple w as
b ased on non-random m ethods. Individuals volunteered to
com plete th e questio n n aire for th is study.
The population consisted of 94 p articip an ts. The racial
com position w as 62% black an d 38% w hite an d th e m ajority (60%)
w ere female. Ages ranged from 51 years of age to 88, w ith a m ean
age of 71.
The education level of th is population varied. Tw enty-seven
p ercen t h ad 0-8 y ears 23% com pleted high school, 21% h ad gone
I
' on to do som e college w ork, 10% com pleted four y ears of college
I an d 22% did p o stg rad u ate or professional work, (See Table 1).
I
TABLE 1 CH ARACTERISTICS O F TH E SAM PLE POPULATION
(N = 94)
VARIABLE CODING PERCEN TAG E
O R M EAN
SEX 1 MALE 4 0 %
2 FEMALE 6 0 %
AGE NUMBER OF YEARS 7 1 .3 3
RACE 1 BLACK 6 2 %
2 WHITE 3 8 %
EDUCATION 1 0-8 YEARS 9%
2 SOME H.S. 15%
3 H.S. COMPLETED 23 %
4 1-3 YEARS
COLLEGE
21 %
5 4 YEARS COLLEGE 10%
6 GRAD/PROFES
SIONAL
2 2 %
SELF-RATED 1 GOOD 4 7 %
HEALTH STATUS 2 FAIR 47%
3 POOR 6%
19
CHAPTERS
R E S U L T S /D IS C U S SIO N
A com parison of blacks an d w hites show th a t n eith er group
w as very know ledgeable ab o u t high blood p ressu re. C om parisons
w ere determ ined w ith u se of ch i-sq u are
E ach of th e variables w as analyzed separately. The resu lts
including tables are given in th is section. A list of questions giving
I
I th e correct an sw ers is listed in A ppendix 2.
R esults show th a t 43% of th e blacks an d 31% of th e w hites
know th a t there are no obvious sym ptom s for high blood p ressu re
(Q uestion 8.5). In th e 0-8 years educational level only 4% answ ered
correctly. F our p ercen t of those w ith som e high school answ ered
correctly, 17% of th o se who com pleted high school, 16% of th o se
w ith 1-3 y ears of college, 3% of th o se w ith 4 y ears of college an d in
th e p o st g rad u a te/p ro fe ssio n level, 13% knew th a t th ere w ere no
obvious sym ptom s of high blood p ressu re. Tw enty seven p ercen t
fem ale in c o n tra st to 12% m ales knew th a t th ere were no obvious
sym ptom s of high blood p ressu re (See Table 2).
Only 29% b lack s an d 32% w hites knew th a t h e a rt attac k s
(Q uestion 9.1) com e ab o u t as a re su lt of high blood p ressu re an d
am ong th is population 15% of th e m ales an d 34% of th e fem ales
20
knew th a t h e a rt attac k s com e ab o u t as a re su lt of high blood
p ressu re. Tw enty-eight p ercen t of those who are tak in g
m edications an d 21% w ho are n o t tak in g m edication answ ered
correctly. In the 0-8 years edu catio n level 4% knew , am ong those
w ith high school education 5% knew , in th e high school com pletion
level 13% answ ered correctly w hile 10% of th o se w ho com pleted 1-
3 y ea rs of college 12% answ ered correctly, am ong th e 4 y ear college
5% answ ered correctly, w hile 16% of th e p o st g ra d u a te / professional
level answ ered correctly. Am ong physician diagnosed
hypertensives, 31% answ ered correctly.
In identifying th e risk factors for high blood p re ssu re, 12% of
th e b lack s an d 9% of the w hites believe lower educational s ta tu s
(Q uestion 10.1) to be a risk factor. Only 9% m ales an d 9% fem ales
agreed an d 6% on m edication also agreed.
One p ercen t of th o se in th e 0-8 years educational level
answ ered correctly am ong th o se w ith som e high school 2% knew,
th o se who com pleted high school 6% knew, in th e 1-3 y ears of
college level 1% knew , of th o se w ith 4 y ears of college 2% knew
an d 4% of those in th e p o st g rad u ate/p ro fessio n al level answ ered
correctly th a t education s ta tu s is a risk factor for high blood
p ressu re. Am ong th e hypertensives 10% answ ered correctly.
21
TABLE 2 Q U ESTIO N S ANSW ERED CORRECTLY PERTAINING TO
KNOW LEDGE OP HIGH BLOOD PR E SSU R E . BY G ENDER
Q U E ST IO N MALE n = 3 8 FEM ALE n = 5 6
8.1 31% 29% .006*
8.2 34% 46% .379
8.3 37% 56% .621
8.4 28% 34 % .270
8.5 12% 27% .124
9.1 15% 3 4 % .053
9.2 14% 19% .834
9.3 13% 2 3 % .445
9.4 24% 4 3% .270
10.1 09% 09% .392
10.2 11% 06% .048*
10.3 10% 10% .357
10.4 26% 45 % .218
10.5 10% 14% .958
10.6 24% 30% .315
10.7 02% 0 1 % .347
10.8 23% 46% .052
10.9 26% 33% .451
10.10 29% 4 4 % .818
11.1 17% 21% .532
11.2 15% 19% .637
11.3 30% 53% .048*
11.4 32% 46% .805
12 05% 02% .082
13 14% 13% .169
14 20% 16% .022*
15 37% 53% .648
'significant if is <.05
22
Tw enty p ercen t of th e b lack s an d 20% of th e w hites believe
th a t being overweight is a risk factor for high blood p ressu re
j (Q uestion 10.2). In th e 0-8 y ear education level 0% knew , an o th er
j 0% of th o se w ith som e high school education, 6% of th o se w ho
, com pleted high school knew , 2% of th o se w ith 1-3 y ears of college
I knew , only 1% of those w ith 4 y ears of college knew an d 7% of
those in th e p o st g rad u ate / professional knew . Among physician
diagnosed hypertensives 10% gave th e correct answ er. Seven
p ercen t of th o se tak in g m edication believed being overw eight is a
risk factor an d only 11% of m ales an d 6% of fem ales answ ered
correctly.
A significant finding w as th a t only 12% of th e blacks and 12%
of the w hites identified high sa lt diet as a risk factor (Q uestion
10.3). Ten p ercen t of th e m ales an d 10% of th e fem ales identified a
high sa lt diet a s a factor. Only 1% of those w ith 0-8 years education
gave th e correct answ er, 1% w ith som e high school knew , 4% of
th o se w ith 1-3 y ears of college knew , 1% of those w ith 4 years of
college an d 4% of th o se w ith p o st g rad u ate/p ro fessio n al education
answ ered correctly. Seven p ercen t of those tak in g m edication and
47% n o t taking m edication identified high sa lt diet as a risk factor
for high blood p ressu re. Among th e hypertensives 11% w ere
co rre c t.
23
In identifying heredity a s a risk factor 46% of th e blacks an d
39% of th e w hites answ ered correctly. T hose w ith 0-8 y ears
ed u catio n 1% gave th e right answ er w hile 1% w ith som e high
school, 17% of those w ho com pleted high school, 16% of th o se w ith
1-3 y ears of college, 9% of those w ith 4 y ears of college an d 16% of
th e p o st g rad u ate/p ro fe ssio n al answ ered correctly. T hirty-six
p ercen t of th o se on m edication an d 34% n o t tak in g m edications
answ ered correctly. Am ong hypertensives 45% h a d th e right
answ er.
A nother significant finding is th a t only 2% of th e blacks an d |
2% of th e w hites identified sm oking as a risk factor (Q uestion 10.7). I
Two p ercen t of diagnosed hypertensives knew a s well as 2% of
I th o se tak in g m edications an d 1% of th o se n o t tak in g m edication i
th a t sm oking is a risk factor. Am ong those w ho h ad 0-8 y ears of
ed u catio n 0% knew , 0% of those w ith som e high school and 0% of
th o se w ho h ad com pleted high school. Zero p ercen t w as also th e
score for th o se w ith 4 y ears of education, of th o se w ith som e college
i
! 2% answ ered correctly an d only 1% in th e p o st
g rad u ate/p ro fe ssio n al level answ ered correctly. Am ong th e
hypertensives 2% knew and of th e m ales an d 1% of th e fem ales
answ ered correctly.
T here w ere 48% of th e b lack s an d 34% of th e w hites w ho
identified high cholesterol as a risk factor (Q uestion 10.8). Forty-six
24
[.
p ercen t of th e fem ales an d 23% of th e m ales answ ered correctly. Of
th e diagnosed hypertensives 41% answ ered correctly an d a
p ercentage of 35 of th o se taking m edication answ ered correctly.
T hose w ho h ad 0-8 y ears education 37% knew an d 9% of those w ith
som e high school, 16% of those w ho com pleted high school, 16% of
th o se w ith 1-3 y ears of college, 10% of th o se w ith 4 y ears of college
: an d 16% of th e p o st g rad u a te/ professional level answ ered correctly.
A percentage of 48 blacks an d 39 w hites answ ered th a t having
diabetes is a risk factor for high blood p ressu re (Q uestion 10.10).
Tw enty-nine p ercen t of of the m ales an d 44% of th e fem ales
answ ered correctly. Of those who w ith 0-8 years of edu catio n 4%
knew , 9% of th o se w ith som e high school knew , 18% of th o se
com pleted high school, 14% of those who h a d som e college, 9% of
4 years college an d 19% of p o st g rad u ate/p ro fessio n a l answ ered
correctly. Am ong diagnosed hypertensives 43% gave th e correct
answ er.
The two body organs m ost likely to be affected by high blood
p ressu re w ere identified by 23% of th e blacks an d 11% of the
w hites (Q uestions 11.2 an d 11.4). They identified th e h eart, while
52% blacks a n d 41% w hites identified th e kidneys. Fifteen p ercen t
of th e m ales an d 19% of th e fem ales knew th a t th e h e a rt w as m o st
likely to be affected an d 32% of th e m ales an d 40% of th e fem ales
identified the kidney. Among educational levels, 2% of th o se w ith
25
0-8 y ears of education answ ered correctly w ith 04% of th o se w ith
I som e high school, 09% of th o se w ho com pleted high school, 06% of
! th o se w ith 1-3 years of college, 04% of th o se w ith 4 y ears of college,
an d 09% of those w ith p o st g rad u ate/ professional. Among
hypertensives, 21% identified th e h e a rt a n d 48% identified the
kidneys.
Sm all percentages of th e sam ple knew th a t diabetics have
h y p erten sio n m ore frequently th a n n on-diabetics (Q uestion 12), 3%
of th e blacks answ ered correctly as well as 7% of th e w hites. Only
5% of th e m ales knew, 2% of th e fem ales, an d 2% of th e
hypertensives knew. Among th e educated th o se w ith 0-8 y ears of
ed u catio n 1% knew , along w ith 0% w ith som e high school, 1% of
th o se who com pleted high school, 2% of th o se w ith 1-3 y ears of
college, 2% w ith 4 y ears of college knew an d 1% of th o se in the
p o st g ra d u a te / professional level knew.
Seventeen p ercen t of th e blacks an d 15% of th e w hites
answ ered correctly th a t high blood p ressu re is a controllable disease
(Q uestion 13). F o u rteen p ercen t of th e m ales, 13% of th e fem ales
an d 16% of diagnosed hypertensives gave th e correct answ er.
Am ong th e education levels, 0% of those w ith 0-8 y ears of
education, 3% of th o se w ith som e high school, 9% of th o se who
com pleted high school, 4% of th o se w ith 1-3 y ears college, 2% of |
26
th o se w ith 4 y ears of college an d 9% of those in th e p o st
g rad u ate/p ro fe ssio n a l level answ ered correctly.
Only 23% of the blacks an d 20% of th e w hites know th a t you
can have high blood p ressu re an d n o t feel it (Q uestion 14). Tw enty
p ercen t of th e m ales, 16% of th e fem ales an d 18% of th e diagnosed
hypertensives answ ered correctly. T hree p erce n t of th o se in th e 0-
8 years education level, 1% of th o se w ith som e high school, 9% of
th o se w ho com pleted high school, 9% of th o se w ith som e college,
6% of those w ith 4 y ears of college an d 9% of th e p o st g ra d u a te /
professionals knew th e correct answ er.
T here w ere 59% of th e b lack s who knew th a t high blood
I p re ssu re is m ore com m on am ong th em an d 51% of th e w hites
agreed (Q uestion 15). T hirty-seven p ercen t of th e m ales, 53% of
th e fem ales an d 54% of diagnosed hypertensives gave th e correct
answ er.
The re su lts for those in the v arious education levels show th a t
6% of th o se w ith 0-8 years, 11% of those w ith som e high school,
21% of those w ith 1-3 years of college, 10% of those who
com pleted 4 y ears of college and 19% of th o se in th e p o st
g rad u ate/p ro fessio n al level knew th a t high blood p ressu re is m ost
com m on am ong blacks.
27
CH APTER 4
D ISC U SSIO N
T here w ere very few statistically significant findings th a t
elderly blacks know m ore ab o u t high blood p ressu re th a n elderly
w hites (See T able 3). However, blacks h ad h ig h er percentages m ost
of th e tim e.
O ne explanation is th a t th ere w ere m ore b lack s (62%) th a n
w hites in th is study, therefore p ercen tag es w ere expected to be
slightly higher.
In a fu rth e r d iscu ssio n of knowledge differences by race, less
th a n h alf of th e blacks as well as w hites know th a t th ere are no
obvious sym ptom s for high blood p ressu re. Here blacks as well as
w hites identified h ead ach es, fatigue, an d dizziness as sym ptom s of
j high blood p ressu re. Som e explanations could be th a t oth er
I d iseases along w ith high blood p ressu re m ay produce a n u m b er of
I th ese sym ptom s to w hich th e population believe to be sym ptom s of
high blood p ressu re.
A n u m b e r of people w ith hypertension also have h e a rt disease,
diabetes or kidney disease, all of w hich increase th e ch an ces of
m orbidity an d m ortality (Long, et al., 1976). T herefore it is
^ im p o rtan t th a t everyone is aw are th a t high blood p re ssu re is
1 asym ptom atic an d th a t sym ptom s from oth er diseases can n o t be
28
assu m ed to be sym ptom s of high blood p ressu re. A ccording to Levy
an d W ard, a belief in sym ptom s can lead to a lack of ad h eren ce to
preventive m e asu res or treatm en t. Therefore th o se w ho believe
TABLE 3 Q U ESTIO N S AN SW ERED CORRECTLY PERTAINING TO
KNOW LEDGE OF H IG H BLOOD P R E SSU R E , BY RACE (N = 94)
Q U E ST IO N # BLACKS n = 5 8 W H ITES n = 3 6
8.1 4 0 % 3 1 % .136
8.2 2 9 % 2 6 % .150
8.3 6 0 % 54% .140
8.4 3 8 % 37 % .926
8.5 4 3 % 3 1 % .066
9.1 2 9 % 3 2 % .557
9.2 20% 2 0 % .954
9.3 2 0 % 2 1 % .382
9.4 4 1 % 4 1% .954
10.1 12% 9% .524
10.2 10% 12% .622
10.3 12% 12% .954
10.4 4 6 % 39% .291
10.5 50% 4 3 % .197
10.6 3 4% 3 2 % .821
10.7 0 2 % 0 2 % .857
10.8 4 8 % 3 4 % .025*
10.9 3 6 % 3 6 % .978
10.10 48% 3 9 % .149
11.1 23 % 15% .926
11.2 23 % 11% .313
11.3 53% 3 0 % .290
11.4 52% 41% .044*
12 03% 07% .286
13 17% 15% .783
14 2 3 % 2 0 % .652
15 59% 51% .066
* Significant if is <.05
29
th ese sym ptom s to be associated w ith high blood p ressu re m ay only
seek tre a tm e n t w hen th ey occur.
An im p o rtan t m essage from th e H eart an d Stroke Facts,
A m erican H eart A ssociation, 1991, rem inds u s th a t due to th e fact
th a t th is disease u su ally h a s no early w arning signs or specific
sym ptom s it rem ain s in th e p a st a s well a s today a "silent killer".
E lderly people sh o u ld have th eir blood p re ssu re checked
regularly, especially those w ith relatives who have high blood
p re ssu re or cardiovascular disease. The te s t for getting your blood
p re ssu re m easu red is n eith er expensive or painful, therefore elderly
people can be aw are of th e ir blood p ressu re levels.
The diet of m any U nited S tates b lack s co n sist of a high sa lt
content; since sa lt h a s been identified in literatu re as a risk factor
for high blood p ressu re reduction of sa lt in tak e or total elim ination
of it m ay be n ecessary for som e older ad u lts depending on th e
severity of th e ir disease.
L iterature h a s also identified sm oking as a risk factor for
several d iseases including high blood p ressu re. W hile h ealth
professionals along w ith th e m edia and public billboards have
b ro u g h t ab o u t aw areness of th e dangers of sm oking.
30
Yet a very sm all percentage identified sm oking as a risk factor.
One reaso n m ay be th a t sm oking h as been m ore asso ciated w ith
can cer ra th e r th a n w ith high blood p ressu re therefore it is n o t seen
as a threat.
I A higher percentage of blacks identified high cholesterol as a
j risk factor becau se of th e aw areness th a t is being b ro u g h t ab o u t
th ro u g h th e m edia. Also th ro u g h the m edia, m ore an d m ore people
are becom ing aw are of th e im portance of exercise. M oderate
exercise approved by a physician is beneficial to older ad u lts. It will
im prove th e h ealth s ta tu s of th e individual.
B lacks in com parison to w hites h ad higher scores in
identifying th e h e a rt an d the kidneys as th e two body organs m ost
j likely to be affected by high blood p ressu re. T his aw aren ess m ay be
I due to the fact th a t blacks have m ore cardiovascular diseases th a n
I
j w hites as confirm ed in th e literatu re (Folsom, et al., 1987). It m ay
also be th a t b ecau se blacks have m ore severe consequences from
high blood p ressu re an d have h ad to deal w ith strokes, h e a rt
attac k s, ren al failure, they are m ade m ore aw are of th e organs th a t
are affected.
A lthough a h igher percentage of blacks answ ered correctly
th a t high blood p ressu re is a controllable disease, th e percentage is
som ew hat low.
31
L __
C u rren tly th ere is a lot of inform ation on high blood p ressu re.
Inform ation is located a t m any clinics, h ea lth facilities, senior
cen ters an d even ch u rch es. The A m erican H eart A ssociation is one
of th e reso u rce s from w hich inform ation on high blood p re ssu re can
be h ad yet a sm all percentage know th a t high blood p re ssu re is
controllable. M any of th e risk factors for high blood p ressu re have
b een identified, an d while som e can n o t be modified, th ere are m any
th a t can be changed. One reaso n for the resu lts from th is question
m ay be th a t blacks believe th a t high blood p re ssu re can n o t be
controlled. Im p o rtan t here is w h at people believe v e rsu s th e facts
ab o u t th e disease. M any blacks do n o t associate lifestyle practices
w ith th e disease. High blood p ressu re can be controlled
pharm acologically an d non-pharm acologically. Any m isconceptions
th a t high blood p ressu re is n o t controllable does n o t allow
individuals to seek help in stead they accept the disease. Elderly
people as well as th e public a t large should be aw are th a t high blood
p ressu re is controllable an d th a t individuals m ay continue to live
; norm al lives w ith the disease p resen t.
A n u m b e r of antihypertensives are available to p atien ts for the
low ering of th e ir high blood p ressu re. There are various classes of
antihypertensives th a t can be adm inistered by a physician.
32
W hile m edications do th eir p art, d ietary a n d overall lifestyle
changes are also im p o rtan t in th e control of th is d isease (American
H eart A ssociation, 1991).
Am ong th e physician diagnosed hypertensives, lower scores
w ere recorded as com pared to n o n -h y p erten siv es (See Table 4).
In th e identification of th e consequences of high blood
p ressu re, one explanation of th e low scores could be th a t m any
blacks, w ho are also the m ajority of hypertensives, have in ad eq u ate
access to h ealth care w h eth er it is becau se of th e lack of m oney,
tran sp o rta tio n or som e o th er factor. M edical care m ay only be
so u g h t in cases of em ergencies therefore an y know ledge of th is
disease m ay only be h ad th ro u g h th e ph y sician -p atien t relationship.
A significant re su lt w as th a t less th a n h alf of diagnosed
hypertensives knew th a t high blood p ressu re is controllable, and
th a t a p erson can have high blood p ressu re an d n o t feel anything is
wrong, b u t a large percentage know th a t high p ressu re is m ost
com m on in blacks. An explanation for the low scores m ay be th a t
high blood p ressu re com es w ith age an d therefore ca n n o t be
controlled. They m ay also believe th a t high blood p re ssu re h a s
33
TABLE 4 KNOW LEDGE OF H IG H BLOOD P R E SSU R E AM ONG
PH Y SIC IA N D IA G N O SED H Y PE R T E N SIV E S (N = 94)
QUESTION
NUMBER
NON-HYPERTENSIVES
n=39
HYPERTENSIVES
n=55
8.1 27% 33% .451
8.2 35% 45% .326
8.3 39% 54% .675
8.4 29% 33% .206
8.5 16% 36% .978
9.1 18% 31% .383
9.2 07% 26% .009*
9.3 15% 37% .963
9.4 24% 43% .162
10.1 07% 10% .840
10.2 09% 09% .448
10.3 09% 11% .777
10.4 26% 45% .121
10.5 12% 12% .355
10.6 22% 32% .947
10.7 01% 02% .771
10.8 28% 41% .661
10.9 22% 36% .440
10.10 30% 43% .921
11.1 18% 20% .374
11.2 13% 21% .573
11.3 33% 50% .448
11.4 30% 48% .250
12 05% 02% .095
13 11% 16% .860
14 18% 18% .207
15 36% 54% .368
^Significant if yp * is <.05
sym ptom s an d w hen th ere are no sym ptom s th e disease is n o t
p resen t. However, a large percentage of th e hypertensives know
th a t high blood p ressu re is m ost com m on in blacks b ecau se as
m entioned earlier, th e m ajority of th e hypertensives are them selves
black.
L._
34
Even th o u g h m any of th e hypertensives are on m ed icatio n /s
for th e disease, an d m ay have m ore physician visits becau se of th is
th e ir know ledge of th e disease rem ain s in ad eq u ate.
T he low est scores in each educational level occu rred in th e
identifying of sm oking as a risk factor for high blood p ressu re. An
explanation as m entioned before is th a t sm oking h a s alw ays been
asso ciated to o th er diseases, m ore specifically can cer an d therefore
is n o t associated w ith high blood p ressu re.
The tren d in education show ed th a t th e m ore ed u cated a
p erso n w as, th e less th ey knew of hy p erten sio n (See Table 5).
Those w ho com pleted 0-8 years of ed u catio n h a d th e le a st
know ledge as expected an d th o se w ho com pleted high school ten d
to have the m ost knowledge. One explanation is th a t th o se who
com pleted high school h ad a varied ed u catio n w hich included
h ealth , w hile th o se w ith som e college, 4 y ears of college an d th e
p o st g rad u ate/p ro fessio n al level h ad a m ore specific education
focusing on one specific area ra th e r th a n several.
E ducation m ay influence h ealth sta tu s an d h ealth care
utilization th ro u g h th e know ledge of sym ptom s of illness, th u s being
35
TABLE 5 KNOWLEDGE OF HIGH BLOOD PRESSURE BY EDUCATION
(N = 94)
QUES
TION
NUM
BER
0TO 8
YEARS
n=8
SOME
H.S.
n=14
H.S.
COM
PLETED
n=22
1-3
YEARS
COL
LEGE
n=20
4
YEARS
COL
LEGE
n=9
GRAD/
PRO
FES
SIONAL
n=21
8.1 04% 04% 17% 16% 03% 15% .029*
8.2 07% 15% 16% 16% 06% 19% .194
8.3 09% 14% 21% 19% 10% 21% .853
8.4 06% 13% 10% 13% 04% 16% .074
8.5 02% 03% 06% 10% 04% 13% .214
9.1 04% 05% 13% 12% 05% 10% .846
9.2 02% 03% 05% 07% 05% 10% .397
9.3 05% 10% 06% 05% 03% 06% .088
9.4 03% 06% 18% 16% 09% 15% .064
10.1 01% 02% 06% 01% 02% 04% .534
10.2 00% 00% 06% 02% 01% 07% .051
10.3 01% 01% 07% 04% 01% 04% .521
10.4 03% 10% 17% 16% 09% 16% .294
10.5 03% 07% 22% 16% 09% 19% .002*
10.6 04% 02% 13% 14% 06% 15% .037*
10.7 00% 00% 00% 02% 00% 01% .426
10.8 03% 09% 16% 16% 10% 16% .105
10.9 02% 06% 13% 15% 07% 15% .141
10.10 04% 09% 18% 14% 09% 19% .184
11.1 06% 10% 07% 04% 03% 07% .033*
11.2 02% 04% 09% 06% 04% 09% .939
11.3 05% 14% 20% 14% 10% 20% .056
11.4 03% 11% 20% 19% 09% 16% .041*
12 01% 00% 01% 02% 02% 01% .422
13 00% 03% 09% 04% 02% 09% .295
14 03% 01% 09% 09% 06% 09% .113
15 06% 11% 23% 21% 10% 19% .016*
^Significant if y p is <.05
able to practice preventive h ea lth m easu res. Having a higher
ed u catio n in creases th e ch an ces of getting b e tte r benefits allowing
for m ore u se of h ealth care services.
36
The findings in th is rep o rt do n o t su p p o rt th e hyp o th esis th a t
"lack of know ledge of high blood p ressu re is related to w h eth er or
I n o t individuals are hypertensive." R esults show ed th a t
I hypertensives have sim ilar know ledge to th o se w ho are non-
j hypertensive.
\
T he hy p o th esis th a t th e know ledge of high blood p re ssu re
betw een b lack s an d w hites depend on ed u catio n w as partially
confirm ed. T hose w ho com pleted high school h ad h igher scores
th a n th o se w ith som e high school or 0-8 years education. However,
th o se w ith 1-3 y ears of college h ad higher scores th a n th o se w ho
com pleted 4 y ears of college or those w ho w ere in th e p o st
g ra d u ate/p ro fe ssio n a l level (See Table 5).
The re su lts of th is stu d y can n o t be generalized to th e public as
th is is a lim ited study. B oth blacks an d w hites show ed sim ilar
know ledge of high blood p ressu re.
R esults show th a t th ere is a definite need for m ore public
education of th e disease. T his education should n o t only be
I concerned w ith th e teaching (inform ation) aspect, b u t sh o u ld also
; include behavioral strateg ies th a t w ould lead to m odifying beliefs,
J
I attitu d e s an d behavior an individual m ay have (Hodge, et al., 1990).
37
Im plications from th e se findings include th e n eed for
in creased h e a lth prom otion of high blood p ressu re, its prevention,
m an ag em en t an d control. H ealth prom otions m ay occur th ro u g h
th e u se of public service an n o u n cem en ts in th e m edia, th e
d istrib u tio n of inform ation to "at risk" populations. In th e black
com m unity, becau se of the significant role of th e ch u rch , classes on
hy p erten sio n can be established th ere as well a s in th e com m unity
centers. E m p h asis m u st be placed on the fact th a t th e disease is
j asy m p to m atic, an d if blood p ressu re is n o t m onitored, severe
co nsequences m ay be th e resu lt.
Since th e g reatest prevalence is am ong blacks, priority should
be placed in th e education of th is population. This ed u catio n should j
I
n o t only be for older ad u lts, b u t for children as well. I
i
t
A dditional research w ith a large sam ple rep resen tativ e of th e j
general popu latio n is needed to determ ine how m u ch does th e *
public know ab o u t the disease. V ariables could include access to
h e a lth care, an d p h y sic ian /p a tien t education. C om parisons m ay be
I m ade w ith th e 1978 G allup Study, "W hat Does th e Public Know
A bout High Blood Pressure?" (Levy and W ard, 1979).
A ccording to Haywood (1990), to m ake a significant im p act on
th e ra te of h y p erten sio n -related m orbidity an d m ortality in th e
L _ 38
U nited S tates a n u m b e r of problem s along w ith th e ir solutions have
b een stated .
•Problem: Lack of knowledge about hypertension.
Solution: Greater efforts to educate the populace
through public health education program s specifi
cally tailored to address particular subgroups of the
general population.
• Problem: Presence of undetected hypertension in
the population as a whole and of especially high
rates of undetected high blood pressure in certain
m inorities.
Solution: Increased efforts to screen high-risk
groups, at intervals designed to detect moderately
elevated blood pressure at an early age and early
stage of the disease.
• Problem: Cultural attitudes, especially in minority
groups, th at militate against screening for unde
tected problems and th at fail to recognize the impor
tance of preventive medicine.
Solution: Public, group, and individual education
strategies aimed at reinforcing the importance of
screening and wellness.
• Problem: Socioeconomic statu s as an overriding
determ inant of morbidity and mortality, access to
adequate health care, and longevity.
Solution: Legislation to improve living standards
and raise the minimum wage.
• Problem: Inability to afford direct medical care.
Solution: Provide more comprehensive health
care through a national health insurance program:
fund the cost of high blood pressure medications and
outpatient visits as well as inpatient needs when
indicated.
• Problem: Lack of information about specific com
m unity needs, coupled with lack of knowledge about
the effectiveness of existing high blood pressure
education programs.
Solution: Application of m onitoring methodology
and utilization of a recognized vehicle for com m uni
cating with both the lay public and health care pro
fessionals; health district m onitoring techniques
constitute one approach to this problem (Haywood, 1990).
The above solutions to th e problem s given are all valuable an d play a
g reat role in th e control of high blood p ressu re.
39
SU M M ARY/CO NCLUSIO N
T he an sw er to th e question of th is p ap er is by no m ean s
I
I conclusive. Independent variables su c h as race and edu catio n show
!
a very sm all effect on high blood p ressu re knowledge, b u t th ere are
o th er m easu res, su c h as incom e, access to h ea lth care, an d
p h y sic ia n /n u rse education, th a t have n o t been included.
In th is study, b lack s w hen com pared to w hites do n o t have a
h ig h er know ledge of high blood p ressu re. It how ever show s th e
need for edu catio n of th is su bgroup to w hich high blood p re ssu re is
m o st com m on. There are som e suggestions th a t a lack of
know ledge m ay be due to a lack of education, b u t even th o se w ho
are ed u cated could benefit from additional ed u catio n on high blood
p ressu re.
A m ong th e hypertensives w hen com pared to n o n -h y p erten
sives th ey do n o t have a higher know ledge of high blood p ressu re.
In th e educational levels th o se w ho com pleted high school found to
have th e g reatest know ledge of high blood p ressu re.
j M any of th e q u estio n s th a t w ere answ ered correctly seem to
1
I
I have com e from th e p artic ip an t's ow n experiences w ith high blood
Î p re ssu re an d also th e experiences of th eir friends an d relatives.
Som e of th e p a rticip an ts in com pleting th e q u estio n n aires
^ 40
I m entioned th a t they did n o t know anything ab o u t high blood
I p ressu re, b u t th a t they chose answ ers relying on w h at th e ir friends
! an d relatives h ad said.
It is clear th a t know ledge of high blood p re ssu re is critical to
th e public a t large, b u t m ore specific to th e black population.
In conclusion, th e findings show th a t th ere is a need for
in creased education on high blood p ressu re. W ith th e se resu lts, the
a t risk population can be targeted w ith specific program s to
im prove th e h ealth s ta tu s of those m ost susceptible to th is disease.
REC O M M ENDATIO NS
The delivery of h ea lth care inform ation is critical to the
control of high blood p ressu re. M any elderly black A m ericans will
sp en d the la ter p a rt of th eir lives dealing w ith th e co nsequences of
high blood p ressu re an d o th er diseases, therefore strateg ies for a
b e tte r control of th is d isease should be developed.
A careful consideration of th e needs of th e b lack elderly
I including access to h ealth care, a n aw areness of needed charges in
lifestyles an d how lifestyles affect th eir h ea lth (high blood p ressure)
I an d finally th e im portance of tak in g personal responsibility for one's
own health .
L _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ «
R ecom m endations from th is stu d y include: a rep ea t of th is
stu d y w ith a larger population. A larger population random ly chosen
will allow for generalizations to be m ade from th e resu lts of th e
study.
A nother recom m endation w ould be to include a n u m b e r of
o th er variables in addition to race an d education. As m entioned in
th e S um m ary th ey m ay include incom e, access to h ea lth care an d
p h y sician / p atien t or n u rs e / p atien t education.
A final recom m endation w ould be to im prove th e in stru m e n t
u se d to g ath er d ata. A dditional specific q u estio n s relating to high
blood p ressu re know ledge should be included on questionnaire.
42
B ib lio g ra p h y
T he 1988 J o in t N ational C om m ittee. The 1988 R eport of th e J o in t
N ational Com m ittee on D etection, E valuation, an d T reatm en t of
H igh Blood P ressu re. A rchives of In tern al M edicine
1 9 8 8 ;1 4 8 :1 0 2 3 -1 0 3 8 .
A m erican H eart A ssociation. 1991 H eart an d Stroke F acts. : 1-48.
B aldini J . Knowledge A bout H ypertension in Affected Elderly
P ersons. Jo u rn a l of G erontological N ursing 1981 ;7: 542-551.
E ditorial. H ypertension in B lacks— Time for Action. J o u rn a l of
H u m an H ypertension 1990:4:67-68.
Felder E. Self-care Agency an d Blood P ressure Control. J o u rn a l of
H u m an H ypertension 1990:4:124-126.
Folsom AR; Gom ez-M arin O; S prafka JM ; P rineas RJ; E dlavitch SA;
G illum RF. T rends in C ardiovascular Risk F actors in a n U rban
B lack Population, 1973-74 to 1985: The M innesota H eart
Survey. A m erican H eart J o u rn a l 1987; 114:1199-1205.
Fors SW: Owen S; Hall W; M cLaughlin J; Levinson R. E valuation of a
D iffusion S trategy for School-B ased H ypertension E ducation.
H ealth E d u catio n Q u arterly 1989; 16(2):225-261.
F ran cis CK. H ypertension an d C ardiac D isease in M inorities. The
A m erican J o u rn a l of M edicine 1990;88:3B -8S.
F ran cis CK. M aking a Difference: M anaging H ypertension in
M inority P atients. The A m erican J o u rn a l of M edicine
1990:88(Suppl 3B):1S-2S.
G am bert RS. H ypertension in the Elderly. New York an d London:
P lenum M edical Book Co.; 1987.
Gifford J r. RW. G eriatric H ypertension: C h airm an ’ s C om m ents on
th e NIH W orking G roup Report. G eriatrics 1987;42: 45-50.
Haywood JL . H ypertension in M inority P opulations. The A m erican
J o u rn a l of M edicine 1990:88(Suppl 3B):3B-17S.
Hodge RL; M agnus P; C arroll A; W illiams PM. P atien t E ducation and
Public E ducation: S eparate, O verlapping or C om plem entary?
J o u rn a l of H u m an H ypertension 1990; 4(Suppl l):79-83.
I
43
H ollenberg NK. H ypertension in an Aging Population: Problem s and
O pportunities. T he A m erican Jo u rn a l of M edicine
1990;90(Suppl 4B):1S-2S.
Inui TS; Y ourtee EL; W illiam son JW . Im proved O utcom es in
H ypertension After Physician T utorials: A C ontrolled Trial. A nnals
of In tern al M edicine 1976;84:646-651.
K ahn AP. Help Y ourself to H ealth: High Blood P ressure. Chicago,
Illinois: C ontem porary Books, Inc.; 1983.
S au n d ers E; S hoenberger JA. G uidelines for th e T reatm en t of
H ypertension. A m erican J o u rn a l of H ypertension, Inc. 1989;2:75-
77.
Katz LA. C hallenges in T herapy of H ypertension in th e Elderly. The
A m erican J o u rn a l of H ypertension 1988; 1: 372S -377S .
Langford HG, Langford FPJ, Tyler M. D ietary Profile of Sodium ,
P otassium , an d C alcium in US Blacks. Chicago, Illinois: Yearbook
M edical P ublishers, Inc.; 1985.
Levine D. The Objectives: W hat Do We W ant to Achieve by P atient
E du catio n ? J o u rn a l of H um an H ypertension 1990; 4(Suppl 1):7-
8.
Levison SP. T reating H ypertension in the Elderly. Clinics in
G eriatric M edicine 1988;4:1-10.
Levy RI; W ard GW. W hat Does the Public Know A bout High Blood
P ressu re? A m erican P harm acy 1979;19:39-41.
Long ML; W inslow EH; S cheuhing MA; C allahan JA. H ypertension:
W hat P atien ts Need to Know. A m erican J o u rn a l of N ursing
1 9 7 6 ;7 6 (5 ):7 6 5 -7 7 0 .
M orisky DE; Levine DM; G reen LW; Sm ith CR. H ealth E ducation
Program Effects on th e M anagem ent of H ypertension in th e
Elderly. A rchives of In tern al M edicine 1982; 142: 1835-1838.
P athy S J. H ypertension an d A ssociated D iseases in Elderly P atients.
J o u rn a l of H ypertension 1988;6(Suppl 1): S 37-S 40.
Roccella E J. Add dressing Larger A udiences: C om m unity
Program m es. J o u rn a l of H u m an H ypertension 1990;4(Suppl
l):7 7 -7 8 .
! 44
T hom pson GE. N onpharm acologic T h erapy of H ypertension in
B lacks. Chicago, Illinois: Year Book M edical P ublishers, Inc.;
1985.
T uck ML; Griffiths RF; Jo h n so n LE; S te m N; Morley JE . UCLA
G eriatric G rand R ounds-H ypertension in th e Elderly.
1 9 8 8 ;3 6 :6 3 0 -6 4 3 .
W ilson TW; Grim CE. B iohistory of Slavery an d Blood P ressu re
D ifferences in B lacks Today: A H ypothesis. H ypertension
1991;17(Suppl I):I* 122-1* 128.
T he W orking G roup on H ypertension. S tatem en t on H ypertension in j
th e Elderly. Jo u rn a l of A m erican M edical A ssociation (JAMA) j
1 9 8 6 ;2 5 6 (l):7 0 -7 4 . j
45
APPENDIX
46
Appendixl QUESTIONNAIRE USED IN STUDY
THANK YOU FOR PARTICIPATING IN THIS SHORT
QUESTIONNAIRE ON HIGH BLOOD PRESSURE.
PLEASE TAKE YOUR TIME AND ANSWER THESE QUESHONS AS
BEST AS YOU CAN.
SEX : MALE___________________ FEMALE__
A G E:
i ETHNICITY: BLACK W HITE
YEARS OF EDUCATION:
I
0 - 8 YEARS
SO M E HIG H SCH O O L
HIG H SCH O O L COM PLETED
COLLEGE 1 - 3 Y E A R S _______
COLLEGE 4 YEARS COM PLETED
PO ST G R A D U A T E /PR O FE SSIO N A L
WHAT DO YOU CONSIDER YOUR GENERAL HEALTH TO BE?
CHECK ONE.
GOOD
FAIR
PO O R
DO YOU THINK YOU HAVE HIGH BLOOD PRESSURE? YES NO
47
1. HAVE YOU BEEN DIAGNOSED BY A DOCTOR AS HAVING HIGH
BLOOD PRESSURE? YES NO
2. ARE YOU CURRENTLY TAKING MEDICATION FOR HIGH BLOOD
PRESSU RE? YES NO
3. DOES ANYONE IN YOUR IMMEDIATE FAMILY HAVE HIGH
BLOOD PRESSURE? IF YES WHAT RELATION?
SISTER
BROTHER
MOTHER
YES NO
YES NO
YES NO
SON
DAUGHTER
FATHER
YES NO
YES NO
YES NO
4. HAVE YOU EVERY HAD?
STROKE
HEART DISEASE
DIABETES
KIDNEY DISEASE
YES NO
YES NO
YES NO
YES NO
5. DOES ANYONE IN YOUR IMMEDIATE FAMILY HAVE?
STROKE
HEART DISEASE
DIABETES
KIDNEY DISEASE
YES NO
YES NO
YES NO
YES NO
6. DO YOU THINK YOU ARE OVERWEIGHT? YES NO
7. WOULD YOU SAY THAT YOU EXERCISE (CHECK ONE)
REGULARLY
OCCASSIONALY
NOT AT ALL
8. WHAT ARE SOME OF THE SYMPTOMS OF HIGH BLOOD
PRESSU RE?
LOSS OF APPETITE YES NO
HEADACHES YES NO
FATIGUE YES NO
DIZZINESS YES NO
ALMOST NO OBVIOUS SYMPTOMS YES NO
48
9. WHAT MEDICAL CONDITIONS COME ABOUT AS A RESULT OF
HIGH BLOOD PRESSURE?
HEART ATTACKS YES NO
STROKE YES NO
1 DIABETES YES NO
KIDNEY DISEASE YES NO
10.WHAT ARE THE RISK FACTORS ASSOCIATED WITH HIGH
BLOOD PRESSURE?
EDUCATION STATUS YES NO
BEING OVERWEIGHT YES NO
HIGH SALT DIET YES NO
HEREDITY YES NO 1
H EIG H T YES NO
STR ESS YES NO
SMOKING YES NO
HIGH CHOLESTEROL YES NO
LACK OF EXERCISE YES NO
HAVING DIABETES YES NO
11 .WHICH BODY ORGAN IS MOST LIKELY TO BE AFFECTED BY !
HIGH BLOOD PRESSURE?
1
LIVER YES NO
HEART YES NO
GALL BLADDER YES NO
KIDNEYS YES NO
12.DIABETICS TEND TO HAVE HIGHER BLOOD PRESSURE THAN
NON-DIABETICS? YES NO |
I
13.IS HIGH BLOOD PRESSURE A CONTROLLABLE DISEASE:
YES NO I
14.CAN PEOPLE HAVE HIGH BLOOD PRESSURE AND NOT FEEL
THAT ANYTHING IS WRONG WITH THEM? YES
NO
15.IS HIGH BLOOD PRESSURE MORE COMMON IN BLACKS THAN
ANY OTHER RACIAL GROUP? YES NO
49
16.HAVE YOU READ ANY LDERATURE ON HIGH BLOOD
PRESSU RE?
IN THE LAST 6 MONTHS YES NO
IN THE LAST YEAR YES NO
THANK YOU FOR YOUR COOPERATION!
50
I
Appendix 2 CORRECT ANSWERS FROM INTERVIEW
8. WHAT ARE SOME OF THE SYMPTOMS OF HIGH BLOOD
PRESSU RE?
8.1 LOSS OF APPETITE YES NO*
8 .2 HEADACHES YES NO*
8 .3 FATIGUE YES NO*
8 .4 DIZZINESS YES NO*
8 .5 ALMOST NO OBVIOUS SYMPTOMS YES* NO
9. WHAT MEDICAL CONDITIONS COME ABOUT AS A
RESULT OF HIGH BLOOD PRESSURE?
9.1 HEART ATTACKS YES* NO
9 .2 STROKE YES* NO
9 .3 DIABETES YES NO*
9 .4 KIDNEY DISEASE YES* NO
10. WHAT ARE THE RISK FACTORS ASSOCIATED WITH HIGH
BLOOD PRESSURE?
10.1 EDUCATION STATUS YES* NO
10.2 BEING OVERWEIGHT YES* NO
10.3 HIGH SALT DIET YES* NO
10.4 HEREDITY YES* NO
10.5 H EIG H T YES NO*
10.6 STR ESS YES* NO
10.7 SMOKING YES* NO
10.8 HIGH CHOLESTEROL YES* NO
10.9 LACK OF EXERCISE YES* NO
10.10 HAVING DIABETES YES* NO
11. WHICH BODY ORGAN IS MOST LIKELY TO BE AFFECTED
BY HIGH BLOOD PRESSURE?
11.1 LIVER YES NO*
11.2 HEART YES* NO
11.3 GALL BLADDER YES NO*
11.4 KIDNEYS YES* NO
12. DIABETICS TEND TO HAVE HIGHER BLOOD PRESSURE
THAN NON-DIABETICS? YES* NO
51
13. IS HIGH BLOOD PRESSURE A CONTROLLABLE DISEASE:
YES* NO
14. CAN PEOPLE HAVE HIGH BLOOD PRESSURE AND NOT
FEEL THAT ANYTHING IS WRONG WITH THEM? YES* NO
15. IS HIGH BLOOD PRESSURE MORE COMMON IN BLACKS
THAN ANY OTHER RACIAL GROUP? YES* NO
* CORRECT ANSWER
52

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Creator Niles, Petra J. C. (author)

Core Title What do elderly blacks know about high blood pressure as compared to elderly whites

Degree Master of Science

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

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