Chronic disease management requires the individual to perform varying forms of self-care behaviors. Self-efficacy, a widely used psychosocial concept, is associated with the ability to manage chronic disease. In this study, we examine the association between self-efficacy to manage hypertension and six clinically prescribed hypertension self-care behaviors. We interviewed 190 African Americans with hypertension who resided in the greater metropolitan Charlotte area about their self-efficacy and their hypertension self-care activities. Logistic regression for correlated observations was used to model the relationship between self-efficacy and adherence to hypertension self-care behaviors. Since the hypertension self-care behavior outcomes were not rare occurrences, an odds ratio correction method was used to provide a more reliable measure of the prevalence ratio (PR). Over half (59%) of participants reported having good self-efficacy to manage their hypertension. Good self-efficacy was statistically significantly associated with increased prevalence of adherence to medication (PR = 1.23, 95% CI: 1.08, 1.32), eating a low-salt diet (PR = 1.64, 95% CI: 1.07–2.20), engaging in physical activity (PR = 1.27, 95% CI: 1.08–1.39), not smoking (PR = 1.10, 95% CI: 1.01–1.15), and practicing weight management techniques (PR = 1.63, 95% CI: 1.30–1.87). Hypertension self-efficacy is strongly associated with adherence to five of six prescribed self-care activities among African Americans with hypertension. Ensuring that African Americans feel confident that hypertension is a manageable condition and that they are knowledgeable about appropriate self-care behaviors are important factors in improving hypertension self-care and blood pressure control. Health practitioners should assess individuals’ self-care activities and direct them toward practical techniques to help boost their confidence in managing their blood pressure.

Background A comprehensive understanding of the self-care activities that contribute to blood pressure control may explain health disparities experienced by African Americans with hypertension. This study assessed the prevalence of self-care activities among African Americans with high blood pressure and examined differences between adherers and nonadherers to self-care activities. Methods Interviews were conducted with 186 African Americans. Self-care activities were measured using the H-SCALE (Hypertension Self-Care Activity Level Effects), which was developed to assess the behavioral activities recommended for optimal management of high blood pressure. Results More than half of participants reported adhering to medication recommendations and prescribed physical activity levels (58.6% and 52.2%, respectively). Following practices related to weight management was less frequent, (30.1%) and adherence to low-salt diet recommendations was also low (22.0%). Three-fourths were nonsmokers and 65% abstained from alcohol. Across the self-care activities, adherers were more likely to be older and female. Nonadherers were more likely to be uninsured. Conclusions Many African Americans still face challenges related to hypertension self-care, particularly with weight management and salt reduction. The H-SCALE was a valid and reliable measure of hypertension self-care activities. In addition to monitoring blood pressure, health care providers should assess patients’ hypertension self-care activities using the H-SCALE.

This study establishes preliminary validation of a measure that assesses hypertension self-care activities with clinical blood pressure (BP). The Hypertension Self-Care Activity Level Effects (H-SCALE) was administered to patients with hypertension to assess levels of self-care. Patients (n=154) were predominantly female (68.6%) and black (79.2%). Greater adherence to self-care was associated with lower systolic and diastolic BP for 5 of the 6 self-care behaviors. Hypertension is one of the most prevalent chronic diseases among US adults, affecting one third of the adult population older than 20 years 1 and approximately 70% of adults older than 65 years.2 African Americans experience hypertension at rates of 43.0% for men and 45.7% for women, while rates for white men and women are 33.9% and 31.3%, respectively, and Mexican American men and women have prevalence rates of 27.8% and 28.9%, respectively.1 Despite some estimates that show modest declines in blood pressure (BP) prevalence, 3 clinicians will be actively engaged in chronic disease management with patients diagnosed with hypertension for the foreseeable future. While trends suggest increased awareness of hypertension among the population and higher treatment rates in the past decade, less than half of hypertensive adults have controlled hypertension regardless of race/ethnicity or sex.

Program design decisions can significantly influence the participation of underrepresented populations in exercise health promotion programs for older adults. In particular, group-specific efforts targeted to recruiting and retaining African Americans can be successful.

Researchers have suggested that lifelong chronic and cumulative exposure to social and economic stressors is associated with early onset of chronic illness in African American women. Recent literature has demonstrated that socioeconomic aspects of neighborhoods contribute to health disparities in heart disease morbidity and mortality. In this article, the author analyzes the stories of older African American women concerning stress and other events related to heart disease, triangulated with individual- and neighborhood-level socioeconomic and environmental data, from the perspective of the weathering conceptual framework. She conducted in-depth qualitative interviews with urban, older Black women with early-stage heart disease. Women described lifelong and recent incidents of stress that they perceived as contributing to their "bad heart." The episodes described were a mixture of chronic social, environmental, and family-related challenges. Findings reveal substantial evidence supporting the weathering conceptual framework and the Sojourner syndrome in this sample of older, chronically ill Black women.