Support group: Model for increasing adherence to treatment in hypertensive black women

Background: Hypertension (HBP) is a major risk factor for cardiovascular disease, including heart and kidney disease and stroke. About 43% of African American (AA) adult men and 47% of women have hypertension. Only 30% of AAs have controlled of blood pressure (BP). Lack of adherence to recommended treatment is a major cause of uncontrolled BP among African/black American (AA) women. There is a paucity of approaches to BP control in inner-city underserved communities that have been found to be effective, but group behavior modification approaches have been shown to reduce BP. Inner-city hypertensive AA women identified support groups as a desirable strategy for enhancing their adherence to treatment, but the specific aspects of support groups that AA women find beneficial are not well understood.

Purpose: Guided by the Orem’s self-care framework, this study explored the perceived value of support groups using focus groups with AA women who are receiving treatment for HBP. Methods: Four focus groups were conducted with 26 hypertensive AA women in South Los Angeles (mean age of 67). Eligibility criteria included (a) self-identified as AA woman, (b) diagnosed with and receiving at least one type of antihypertensive medication, (c) 21 years or older, (d) speaks and writes at least 6^th grade level English, and (e) did not have a serious medical condition, cognitive impairment or psychiatric condition according to their care provider. The focus group interview guide was designed to capture: (a) perceptions of the meaning and content of support groups, (b) how support groups can help in the management of HBP, (c) what facilitates or prevents attending a support group, (d) what motivates one to participate in a support group discussion, and (e) the desired frequency and timing of support group meetings. Socio-demographic information and BP were collected.

Results: Analyses yielded four component categories/themes: (a) information giving or knowledge sharing, (b) emotional or psychological support, (c) instrumental support, and (d) coaching. These themes indicate that support groups aimed at improving adherence to hypertensive treatment for AA women should (a) provide an information resource, (b) provide instrumental support, (c) provides emotional/psychological support, and (d) allow members to coach one another.

Conclusion: Support groups for AA women with hypertension can increase adherence to treatment by encouraging and facilitating behavior modification and lifestyle changes. The support group model provides ground work for testing the effectiveness of support group in increasing adherence to HBP treatment regimens with subsequent BP reduction or improve BP control in AA women.