This project will examine behavioral self regulation in elderly African Americans with essential hypertension. According to the self regulation model of illness representation, adherence to antihypertension therapy depends upon the accuracy of the patients' mental model (interpretation) of essential hypertension, the efficacy of the coping procedures generated by that mental model, the specificity and appropriateness of the criteria against which the patient evaluates coping procedures, and the degree of congruence between the patient's mental representation of hypertension and contextual factors including cultural beliefs regarding illness and treatment, family and work-related roles, the clinic setting, and practitioner-patient interaction. The project has three main goals: (1) Generate descriptive information regarding behavioral self regulation in this population; (2) test hypotheses regarding the role of patients' mental models of essential hypertension in guiding their efforts at behavioral self regulation; (3) design and pilot test and intervention aimed at increasing the accuracy of patient's illness models as a means of optimizing behavioral self regulation of essential hypertension. The first three goals will be addressed in a Descriptive Study that will involve interviewing 120 hypertensive patients prior to and following each of two clinic visits, and tape-recording two interactions between each patient and one of 6 resident physicians. Specific goals of the Descriptive Study are to (a) develop for use in an elderly, African American population a set of instruments to assess patients' mental representations of hypertension and of anti-hypertensive therapy; (b) identify aspects of the practitioner-patient interaction that influence the accuracy of patients' representations of hypertension, the efficacy of procedures patients use to cope with (control) hypertension, and the specificity and appropriateness of the criteria patients use to evaluate coping procedures; (c) identify features of the clinic setting that undermine effective self regulation of hypertension. Data from the Descriptive Study will be used to design an intervention aimed at modifying practitioner behavior, patient behavior, and structural features of the clinic setting so as to improve the accuracy of patients' mental representations and the efficacy of their coping behavior. The intervention will be pilot-tested with the goal of evaluating feasibility of implementation and efficacy with respect to the modification of patient cognition and behavior. The long term goal of this project is to refine the pilot-tested intervention program and implement and evaluate it on a larger scale as a means of understanding and optimizing of medical care, adherence to anti-hypertensive regimens, and modification of diet, alcohol intake, exercise, and other behaviors that contribute to the control of hypertension.
| Hekler, Eric B; Lambert, Jennifer; Leventhal, Elaine et al. (2008) Commonsense illness beliefs, adherence behaviors, and hypertension control among African Americans. J Behav Med 31:391-400 |
