Qualitative Study of Knowledge, Perception, and Behavior Related to Hypertension and Cardiovascular Disease Risk Reduction Among Hypertensive African-Americans in Urban Inner City of South Bronx, New York.

OBJECTIVE: To study the knowledge, perception, and behaviors among hypertensive African-Americans in South Bronx, New York, to elucidate any gaps that could explain their poor blood pressure control.

METHODS: Cross-sectional qualitative study on African-American participants with essential hypertension, on single or combined oral antihypertensive regimen. Three focus groups were presented with open-ended questions on topics including cardiovascular disease knowledge, perception, and behaviors. A total of 18 data collection tools were used. Concepts formulated were categorized into dominant themes. A sample size of 21 participants was attained based on the saturation point related to emerging common themes.

RESULTS: Six dominant themes identified were unhealthy diet, stress, patient-physician relationship, medication non-compliance, decreased physical activity, and hypertension complications. The most dominant was unhealthy diet with self-identified barriers such as poor food selection, family tradition, economical cost, will-power, food taste, and accessibility to healthier food. Regarding medication adherence, participants recognized trust was a determining factor that has been negatively reinforced by previous experiences with their healthcare providers especially when they were not perceived as knowledgeable. Participants have also felt they have been influenced by historic events in their health decision-making process.

CONCLUSIONS: The South Bronx African-American population has some feelings that are valid and not simply misconceptions. Some of them are historically related, gaps in knowledge influenced by culture and traditions, and barriers to healthy behaviors enhanced by economic status, lack of will-power, physical limitations, and stress from daily living. A physician partnership with this African-American community to improve trust, raise awareness, facilitate, and change in behavior that could help address blood pressure control and prevent cardiovascular disease.