Stress and Treatment Adherence Among Hypertensive Black Women: A Socio-Cognitive Approach

Abstract

Introduction: The prevalence of hypertension is highest among Black American women compared to Black American men and other racial groups. Treatment adherence is an important health behavior that prevents the future development of hypertension-related chronic diseases, but treatment nonadherence is a widespread problem that undermining treatment effectiveness. Not much is currently known about the correlates of treatment adherence among hypertensive Black women. Psychosocial variables such as stress, self-efficacy and social support are important correlates of adherence, but gaps in research currently exist in terms of how these factors interact among hypertensive Black women. Hence, this study examines the relationship between stress, socio-cognitive variables, and hypertension treatment adherence among hypertensive Black women. Methods: This study examined the cross-sectional, baseline data from the SisterTalk Adhere randomized controlled trial to promote weight management among hypertensive Black women (n = 571). Study variables include: (1) life stress; (2) socio-cognitive variables such as self-efficacy, outcome expectations, and social support (3) adherence (both pharmacological and non-pharmacological, and; (4) demographics and clinical variables, including blood pressure, BMI and waist circumference. Statistical analysis performed included ANOVA, simple linear regression and t-tests. Mediation was conducted to examine if (M) self-efficacy (pharmacological and non-pharmacological) mediated the relationship between (X) stress and (Y) treatment adherence, as well as examine whether social support (M) and outcome expectations (M) mediated the relationship between self-efficacy (X) and treatment adherence (Y). Results: The mean age of the study sample was about 48 years old. Age was found to be associated with significantly lower life stress (p = .002), and single mothers reported significantly higher life stress compared to other household composition subgroups (e.g. dual-parent households and single participants without children) (p < .001). Age was also found to be associated with higher self-efficacy (p = .005). Participants who reported higher self-efficacy also reported higher systolic blood pressure. In terms of outcome variables, stress was associated with (1) non-pharmacological adherence (p < .001), (2) self-efficacy (p = .047), and (3) family social support (p = .049). Self-efficacy was associated with (1) non-pharmacological adherence (p = .001) and social support (p = .037). Mediation analysis revealed that non-pharmacological self-efficacy mediated the relationship between stress and non-pharmacological adherence. Family social support was also found to mediate the relationship between overall self-efficacy and overall adherence. Conclusion: This study documented a relationship between stress, self-efficacy, and non-pharmacological adherence. Results also indicate the importance of family social support among hypertensive Black women. Future health interventions to improve non-pharmacological adherence in this population should identify and target these psychosocial constructs.