Dawn M. Aycock, PhD, RN, ANP-BCAssistant Professor

Hypertension Education and Screening In Urban African

American Churches

What are the disparities in hypertension among African Americans (AA)?

Is there an association between urban environments and hypertension?

What are Atlanta churches doing to address hypertension among AA?

Are there differences between churches located in urban versus non-urban Atlanta?

What more can be done to reduce disparities in hypertension among AA?

Overview

Hypertension in the Unites States

•Hypertension is a major health problem

•Hypertension is the “silent killer”

•Uncontrolled blood pressure contributes to chronic diseases

Prevalence

Development

Control

Hospitalizations

Chronic diseases

Mortality

Hypertension among African Americans - Disparities

Hypertension and Stroke – Findings from the ReGARDS study

(Howard, G. 2013. Stroke Epidemiology and Primary Prevention. 39th 10-day Seminar Epidemiology and Prevention of Cardiovascular Disease. Tahoe City, CA.)

Hypertension and Stroke – Findings from the ReGARDS study

(Howard, G. 2013. Stroke Epidemiology and Primary Prevention. 39th 10-day Seminar Epidemiology and Prevention of Cardiovascular Disease. Tahoe City, CA.)

AA more likely to be hypertensive (71% versus 51%)

AA are less likely to be controlled (odds ratio = 0.70)

Uncontrolled blood pressure worse for AA

Family history of stroke associated with history of hypertension (67% versus 39%; p <.05) and

9 of 11 with a family history of stroke and no history of hypertension, had blood pressure readings indicating pre-hypertension.

(Aycock, DM, Kirkendoll, KD, Coleman, KC, Clark, PC, Albright, KC & Alexandrov, AW (in press). Family history of stroke among African Americans and its association with stroke risk factors, knowledge, perceptions and exercise. Journal of Cardiovascular Nursing.)

Family History of Stroke and Hypertension

Genetics (Fuchs, 2011)

Sensitivity to salt/sodium intake

Abnormal vasoreactivity

Excess adiposity (CDC, 2009)

Racial bias and discrimination (Chae et al., 2012)

Low socioeconomic position (James et al., 2006)

Potential Triggers for Hypertension in African Americans

Urban Environment and HypertensionUrbanization has been correlated with hypertension.

Air pollution (Fuks et al., 2011)

Traffic noise (Babisch, 2006; Bluhm et al., 2007)

Overcrowding and crime

Disadvantaged neighborhoods

Safety and resources to promote physical activity

Adults without diagnosis – twice a year (AHA, 2011)

Adults with pre-hypertension – yearly (AHA, 2011)

Adults receiving treatment – monthly until goal reached then every 3-6 months (USDHHS, 2004)

Children – yearly (AHA, 2011)

Blood Pressure Screening and Monitoring Recommendations

**African Americans/Blacks need more frequent blood pressure screening and monitoring and more aggressive strategies to prevent or manage hypertension **

Lack of time

Transportation problems

Poor access to health care

Lack of health insurance

Lack of knowledge

Distrust of the healthcare system/medical professionals

Barriers to Hypertension Diagnosis and Management among African Americans

Health and the Church

•The church is a trusted and influential establishment

•Guidance and social and emotional support

•Church-based health promotion and disease prevention activities have a positive impact on health (Frank & Grubbs, 2008;Boltri et al., 2008; Oexmann et al., 2001;Yanek et al., 2001).

Lack of time

Transportation problems

Poor access to health care

Lack of health insurance

Lack of knowledge

Distrust of the healthcare system/medical professionals

Barriers to Hypertension Diagnosis and Management among African Americans

Hypertension Self-Management

Hypertension self-efficacy associated with adherence to self-care activities (Warren-Findlow et al., 2012)

Churches can help to empower individuals

The Role of the Church in Promoting Health & Disease Prevention

Education sessions

Health screenings

Health Fairs

Nutrition and exercise programs

Health care research

Strategies that Enhance Program Support

Culturally targeted information (Resnicow et al., 2005; Whitt-Glover et al., 2008)

Prayer and gospel music with activities

Scriptures in promotional materials (Butler-Ajibade, 2012)

Pastors to promote program participation (Butler-Ajibade, 2012 Cowart et al., 2010; Winett et al, 2007)

Collaborating community agencies (Cowart et al, 2010; Resnicow et al., 2005)

Study PurposeTo determine if hypertension education and blood pressure screenings are being offered in African American churches in Atlanta and to identify the types of activities most frequently offered.

(Aycock, D.M., Kirkendoll, K.D., Gordon, P.L. ,2013. Hypertension education and screening

in African American churches. Journal of Community Health Nursing, 30, 16-27)

To compare findings of churches located in urban versus non-urban areas.

Sample

Non-random

95 AA churches in or within a 35 mile radius of Atlanta, GA identified through word of mouth, internet search, sorority group, drive by and church directories.

Recruitment efforts - in person, telephone and email.

Church members (N=45) with knowledge of health activities of the church were surveyed.

Telephone Survey50 questions: - Church characteristics

- Health ministry/nurses’ guild - Frequency of blood pressure activities - 2yrs - Health education needs of the church - Challenges to providing health promotion activities

Content validity Verbal telephone consent

Telephone interviews lasted 20-30 minutes

Churches (N=45)Distance from

Atlanta, GA

0-5 miles

5-10 miles

10-15 miles

15-20 miles

20+ miles

Urban Atlanta Churches (n=22) Criteria: minimum of 50,000 residents and > 1

connecting block with population density no less than 1,000 people per square mile (US Bureau of the Census, 2013)

City = Atlanta

Zip codes: 30311 - 6 30314 - 2 30310 - 4 30313 - 1 30312 - 4 30317 - 1 30318 - 3 30331 - 1

Church Characteristics (n=45)

Blood Pressure Activities Activity Total Sample

-45N(%)

Urban Churches-22

n(%)

Other Churches-23

n(%)

Offered BP Activity 39 (87%) 20(91%) 19(83%)

BP Screening 38 (84%) 19 (95%) 19 (100%)

Distribution of BP brochures or pamphlets

36 (80%) 17 (85%) 19 (100%)

BP Educational Talk/Seminar

30 (67%) 14 (70%) 16 (84%)

Health Fairs 29 (64%) 15 (75%) 14 (74%)

Group Providing Health Activities

Characteristic Total Sample

N=45

Urban Churches

n=22

Other Churches

n=23

Health Ministry /Nurses Guild N(%)

33 (73%) 18 (82%) 15 (65%)

Ministry Director – Healthcare Background N(%)

28 (85%) 14 (78%) 14 (93%)

Ministry Members M+SD

17 +14.1 13 + 10.8 21 + 16.8

Work with Outside Organizations

Characteristic Total Sample

N=45

Urban Churches

n=22

Other Churches

n=23

Work with Outside Organizations M+SD (possible range 0-10)

3.5 +2.6 3.6 +2.9 3.5 +2.5

AHA (59%)ABC (41%)Colleges/Universities (36%)Health Departments (33%)

Additional Findings:34% identified high blood pressure as most important health need

33% Go Red for Women Campaign, 51% Body & Soul Health Program and 27% Exercise Programs

One church reported blood pressure programs targeting youth

42% kept records for tracking

Most church representatives (72%) were “somewhat knowledgeable” of community resources

Lack of individual/group to initiate or maintain active health program

Lack of interest among church members

Blood Pressure Activity Challenges

Health ministry resource packs:

- Speakers and blood pressure screeners

- Educational materials and resource sites

- Healthcare and prescription drug assistance programs

- Program ideas

Incentives for Study Participation

What are the health disparities in hypertension among AA?

- Incidence & prevalence; control/management;

outcomes; access to care resulting from barriers

Is there an association between urban environments and hypertension?

- Possible - more research needed in US

Conclusions

What are Atlanta churches doing to address hypertension among AA?

- Recognized hypertension as a problem

- The majority offered at least one activity

- Some community resources and programs were used

- Seeking more information and resources

Are there differences between churches located in urban versus suburban Atlanta?

- No significant differences found

Conclusions

What more can be done to reduce disparities in hypertension among AA?

- Establish health ministries/nurses’ guilds - Establish/enhance hypertension activities

- Identify and develop hypertension resources

- Link smaller churches with larger churches, developing health

consortiums

- Develop programs for youth

- Promote family-focused activities

- Initiate collaborations (e.g. organizations, health departments

colleges/universities)

Recommendations – Public Health

What more can be done to reduce disparities in hypertension among AA?

- Identify barriers and facilitators to implementing church-

based programs

- Examine effectiveness of church-based programs for

hypertension

Recommendations – Future Research

Semere Araya (University Scholar – Pre-Nursing Student)

Paula Gordon, MS, RNKenya Kirkendoll, MS, MPH, RN

Thank You – Questions?