Religious/Spiritual Coping in Older African American Women

An estimated 80 million Americans 20 years of age and older have been diagnosed with hypertension (HTN). Hypertension is conceptually defined as an arterial blood pressure that exceeds 140/90 mm Hg. African American women have the highest prevalence rate of HTN (46.1%), followed by African American men (44.9%; Mozaffarian et al., 2016). Also, African Americans tend to develop HTN earlier in life than Non-Hispanic Whites, and they are at greater risk for stroke, heart disease, and kidney failure leading to higher rates of disability and death (Mozaffrian et al., 2016). Although the disproportionate burden of HTN and associated diseases contributes to considerable health disparities for African Americans, the sequelae of HTN are largely preventable with lifestyle modifications and antihypertensive medications (Ferdinand & Welch, 2007). Adherence to lifestyle modifications and antihypertensive medication is essential for blood pressure control and prevention of organ damage. However, African American have not readily participated in risk reduction behaviors to manage and prevent HTN and the reasons for not participating are not fully understood.Literature ReviewIn a Cochrane review, Schroeder, Fahey, and Ebrahim (2004) identified motivational strategies as a promising intervention for improving adherence to the HTN treatment regimen. As a type of motivation, spiritual inspiration or religious conversion (Center for Substance Abuse Treatment, 1999), has been a major influence in achievement of positive health outcomes.Adherence is best defined as the extent to which a person's behavior (which includes) taking medication, following a diet, and/or executing lifestyle changes, corresponds with agreed recommendations from a health care provider (Sabate, 2003). For most (clinicians, health care practitioners, and researchers) a cutoff point of > 80% is accepted as adherent. Yet, medication adherence rates in patients with HTN are estimated to be between 50 and 70% (Domino, 2005; Sabate, 2003), and several studies (Krousel-Wood et al., 2010; Lewis, Ogedegbe, & Ogedegbe, 2012; Ndumele, Shaykevich, Williams, & Hicks, 2010) have reported that African Americans have lower adherence rates than Whites. Anti-hypertensive medication has proven efficacy when taken as prescribed (Chobanian et al., 2003). Hence, improving adherence to the HTN treatment regimen is to improve health outcomes in African Americans with hypertension.Religious/Spiritual CopingThe seminal work of Lazarus (1966) and colleagues introduced coping as a means to adjust to stress. Coping theory emphasizes the active role individuals play in interpreting and responding to major life stressors (Lazarus & Folkman, 1984) however, general coping theorists and researchers neglected the religious dimension (Pargament, Feuille, & Burdzy, 2011). Pargament (1997) developed a theory of religious coping and as such defined religious coping as, "efforts to understand and deal with life stressors in ways related to the sacred" (Pargament et al., 2011, p. 52). What is sacred depends on the individual but represents the unique characteristic of spirituality and at its' core are concepts of God, the divine, and transcendent reality (Pargament & Mahoney, 2009). A substantial body of literature has found strong connections between religion, spirituality, and physical health (Hill & Pargament, 2008; Koenig, 2012). Mattis (2000), for example, conducted a qualitative study with African American women that explored the meaning of spirituality and religiosity. The women in the study viewed spirituality as an intimate relationship with transcendent forces such as God and humans that inspired faith, trust, adherence, and they relied on these forces for all things pertaining to life. Women referred to religion as adherence to formal doctrines and practices associated with the worship of Deity, and some women noted that religion was an external act that prepared individuals for the internal experience of spirituality (Mattis, 2000). …