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Hypertension Education and
Screening In Urban African
American Churches
Dawn M. Aycock, PhD, RN, ANP-BC
Assistant Professor
Overview
 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?
Hypertension in the Unites States
• Hypertension is a major health problem
• Hypertension is the “silent killer”
• Uncontrolled blood pressure contributes to chronic
diseases
Hypertension among African Americans - Disparities
 Prevalence
 Development
 Control
 Hospitalizations
 Chronic diseases
 Mortality
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
 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
(Howard, G. 2013. Stroke Epidemiology and Primary
Prevention. 39th 10-day Seminar Epidemiology and
Prevention of Cardiovascular Disease. Tahoe City, CA.)
Family History of Stroke and Hypertension
 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 prehypertension.
(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.)
Potential Triggers for Hypertension in
African Americans
 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)
Urban Environment and Hypertension
 Urbanization 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
Blood Pressure Screening and Monitoring
Recommendations
 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)
**African Americans/Blacks need more frequent
blood pressure screening and monitoring and
more aggressive strategies to prevent or manage
hypertension **
Barriers to Hypertension Diagnosis and
Management among African Americans
 Lack of time
 Transportation problems
 Poor access to health care
 Lack of health insurance
 Lack of knowledge
 Distrust of the healthcare system/medical professionals
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).
Barriers to Hypertension Diagnosis and
Management among African Americans
 Lack of time
 Transportation problems
 Poor access to health care
 Lack of health insurance
 Lack of knowledge
 Distrust of the healthcare system/medical professionals
Hypertension Self-Management
 Hypertension self-efficacy
associated with adherence to
self-care activities (WarrenFindlow 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
Study Purpose
 To 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 Survey
 50 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
30310 - 4
30312 - 4
30318 - 3

30314 - 2
30313 - 1
30317 - 1
30331 - 1
Church Characteristics (n=45)
Blood Pressure Activities
Activity

Total Sample -45
N(%)

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

Health Ministry /Nurses Guild

Total Sample
N=45

Urban Churches Other Churches
n=22
n=23

33 (73%)

18 (82%)

15 (65%)

28 (85%)

14 (78%)

14 (93%)

17 +14.1

13 + 10.8

21 + 16.8

N(%)

Ministry Director – Healthcare
Background
N(%)

Ministry Members
M+SD
Work with Outside Organizations
Characteristic

Total Sample
N=45

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

3.5 +2.6

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

Urban Churches Other Churches
n=22
n=23

3.6 +2.9

3.5 +2.5
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
Blood Pressure Activity Challenges
 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
Incentives for Study Participation
 Health ministry resource packs:
- Speakers and blood pressure screeners
- Educational materials and resource sites
- Healthcare and prescription drug assistance programs
- Program ideas
Conclusions
 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
Recommendations – Public Health
 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 – Future Research
 What more can be done to reduce disparities in hypertension among
AA?

- Identify barriers and facilitators to implementing churchbased programs
- Examine effectiveness of church-based programs for
hypertension
Thank You – Questions?
 Semere Araya (University Scholar – Pre-Nursing Student)
 Paula Gordon, MS, RN
 Kenya Kirkendoll, MS, MPH, RN

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Hypertension Education and Screening In Urban African American Churches

  • 1. Hypertension Education and Screening In Urban African American Churches Dawn M. Aycock, PhD, RN, ANP-BC Assistant Professor
  • 2. Overview  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?
  • 3. Hypertension in the Unites States • Hypertension is a major health problem • Hypertension is the “silent killer” • Uncontrolled blood pressure contributes to chronic diseases
  • 4. Hypertension among African Americans - Disparities  Prevalence  Development  Control  Hospitalizations  Chronic diseases  Mortality
  • 5.
  • 6. 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.)
  • 7. Hypertension and Stroke – Findings from the ReGARDS study  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 (Howard, G. 2013. Stroke Epidemiology and Primary Prevention. 39th 10-day Seminar Epidemiology and Prevention of Cardiovascular Disease. Tahoe City, CA.)
  • 8. Family History of Stroke and Hypertension  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 prehypertension. (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.)
  • 9. Potential Triggers for Hypertension in African Americans  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)
  • 10. Urban Environment and Hypertension  Urbanization 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
  • 11.
  • 12. Blood Pressure Screening and Monitoring Recommendations  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)
  • 13. **African Americans/Blacks need more frequent blood pressure screening and monitoring and more aggressive strategies to prevent or manage hypertension **
  • 14. Barriers to Hypertension Diagnosis and Management among African Americans  Lack of time  Transportation problems  Poor access to health care  Lack of health insurance  Lack of knowledge  Distrust of the healthcare system/medical professionals
  • 15. 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).
  • 16. Barriers to Hypertension Diagnosis and Management among African Americans  Lack of time  Transportation problems  Poor access to health care  Lack of health insurance  Lack of knowledge  Distrust of the healthcare system/medical professionals
  • 17. Hypertension Self-Management  Hypertension self-efficacy associated with adherence to self-care activities (WarrenFindlow et al., 2012)  Churches can help to empower individuals
  • 18. The Role of the Church in Promoting Health & Disease Prevention  Education sessions  Health screenings  Health Fairs  Nutrition and exercise programs  Health care research
  • 19. 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
  • 20. Study Purpose  To 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.
  • 21. 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.
  • 22. Telephone Survey  50 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
  • 23. Churches (N=45) Distance from Atlanta, GA 0-5 miles 5-10 miles 10-15 miles 15-20 miles 20+ miles
  • 24. 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 30310 - 4 30312 - 4 30318 - 3 30314 - 2 30313 - 1 30317 - 1 30331 - 1
  • 26. Blood Pressure Activities Activity Total Sample -45 N(%) 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%)
  • 27. Group Providing Health Activities Characteristic Health Ministry /Nurses Guild Total Sample N=45 Urban Churches Other Churches n=22 n=23 33 (73%) 18 (82%) 15 (65%) 28 (85%) 14 (78%) 14 (93%) 17 +14.1 13 + 10.8 21 + 16.8 N(%) Ministry Director – Healthcare Background N(%) Ministry Members M+SD
  • 28. Work with Outside Organizations Characteristic Total Sample N=45 Work with Outside Organizations M+SD (possible range 0-10) 3.5 +2.6  AHA (59%)  ABC (41%)  Colleges/Universities (36%)  Health Departments (33%) Urban Churches Other Churches n=22 n=23 3.6 +2.9 3.5 +2.5
  • 29. 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
  • 30. Blood Pressure Activity Challenges  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
  • 31. Incentives for Study Participation  Health ministry resource packs: - Speakers and blood pressure screeners - Educational materials and resource sites - Healthcare and prescription drug assistance programs - Program ideas
  • 32. Conclusions  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
  • 33. 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
  • 34. Recommendations – Public Health  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)
  • 35. Recommendations – Future Research  What more can be done to reduce disparities in hypertension among AA? - Identify barriers and facilitators to implementing churchbased programs - Examine effectiveness of church-based programs for hypertension
  • 36. Thank You – Questions?  Semere Araya (University Scholar – Pre-Nursing Student)  Paula Gordon, MS, RN  Kenya Kirkendoll, MS, MPH, RN

Editor's Notes

  1. Research Interest is
  2. Earlier I mentioned that AA have more preventable hospitalizations for hypertension and this graph shows us just that with AA here in blue, it also shows a higher rate of admissions to urban hospitals. Actually from the massachusetts community health information profile.