hypertension education and screening in urban african american churches
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Hypertension Education and Screening In Urban African American Churches by Dawn M. Aycock, PhD, RN, ANP-BC Assistant Professor at Georgia State University.TRANSCRIPT
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Dawn M. Aycock, PhD, RN, ANP-BCAssistant Professor
Hypertension Education and Screening In Urban African
American Churches
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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
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Hypertension in the Unites States
•Hypertension is a major health problem
•Hypertension is the “silent killer”
•Uncontrolled blood pressure contributes to chronic diseases
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Prevalence
Development
Control
Hospitalizations
Chronic diseases
Mortality
Hypertension among African Americans - Disparities
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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.)
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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
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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
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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
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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
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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
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**African Americans/Blacks need more frequent blood pressure screening and monitoring and more aggressive strategies to prevent or manage hypertension **
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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
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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).
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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
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Hypertension Self-Management
Hypertension self-efficacy associated with adherence to self-care activities (Warren-Findlow et al., 2012)
Churches can help to empower individuals
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The Role of the Church in Promoting Health & Disease Prevention
Education sessions
Health screenings
Health Fairs
Nutrition and exercise programs
Health care research
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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)
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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.
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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.
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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
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Churches (N=45)Distance from
Atlanta, GA
0-5 miles
5-10 miles
10-15 miles
15-20 miles
20+ miles
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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
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Church Characteristics (n=45)
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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%)
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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
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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%)
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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
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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
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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
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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
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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
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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
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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
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Semere Araya (University Scholar – Pre-Nursing Student)
Paula Gordon, MS, RNKenya Kirkendoll, MS, MPH, RN
Thank You – Questions?