Intergenerational Transmission of Chronic Illness Self-care: Results From the Caring for Hypertension in African American Families Study

Research suggests that family members can be highly influential on chronic disease self-care of older adults (Gallant, Spitze, & Prohaska, 2007; Warren-Findlow & Prohaska, 2008). Most of the studies examining social support and chronic illness self-care focus on diabetes (Gallant, 2003), despite the fact that hypertension is more prevalent and requires similar self-care activities. Social support for chronic illness can take many forms. Family members provide instrumental support such as filling prescriptions or driving an older adult to the physician, behavioral support for diet and exercise regimens, informational support such as reminders to take medications, and emotional support to cope with the uncertainties of chronic illness (Gallant, Spitze, & Grove, 2010). However, not all family support for chronic illness self-care is positive, particularly in relation to diet (Gallant et al., 2007; Warren-Findlow & Prohaska). Studies examining family social support for chronic illness self-care among older adults do not differentiate between support from spouses versus adult children or other family members (Gallant, 2003). Research with older African Americans who have chronic disease indicates that family members and extended family provide the same types of support for chronic illness self-care as occurs in White families and other ethnic groups (Gallant et al., 2010). However, among African Americans, there may be a greater expectation for older adults to provide reciprocal support of some kind, such as caring for small children (Ruiz, 2000). Having a large family to provide support may entail increased burden on older adults to give support (Sarkisian & Gerstel, 2004). Older African Americans also gain support from their social networks in less direct ways, such as using experiential knowledge gained from family members with shared health conditions as a method of assessing their own chronic disease risk (Warren-Findlow & Issel, 2010). As family members’ health status changes, individuals with a similar condition may reevaluate their own health and health practices. This vicarious experiential learning becomes a form of passive informational support. In the gerontology literature, provision of social support for health issues is usually viewed within the context of caregiving with the implication that the care recipient is frail or impaired. Support in this situation typically flows from adult children to older adults or from one spouse to another (Litwak, 1985). We have found no studies that have examined how older adults’ health and health knowledge may influence the health self-care of an adult child when the parties are not impaired. Within African American families, the family structure is frequently highly interdependent with multiple generations coresident (Peek, Koropeckyj-Cox, Zsembik, & Coward, 2004). These living arrangements are not necessarily the result of impairment or lack of resources but rather cultural practice and avoidance of institutional living (Gallant et al., 2010; Hays & George, 2002). Intergenerational relationships may be particularly important to study among African Americans as they are less likely to be married than White Americans (hereafter Whites; Dixon, 2009) and therefore may rely more heavily on other family members for social support. Older adults may have an important influence on adult children when both the older parent and the adult child share a chronic health condition, such as hypertension. African Americans often experience early onset of hypertension causing both younger and older adults to be managing high blood pressure (Stewart, Johnson, & Saunders, 2007). A shared health concern in conjunction with an interdependent family structure may create an opportunity for intergenerational sharing of self-care practices and knowledge. The potential for transmission of health knowledge and health beliefs as a form of informational support from one generation to another is of interest to public health gerontologists who are searching for effective ways to intervene to improve hypertension self-care among African Americans. This study examines whether African American older parents and adult children who share a common chronic illness provide informational and behavioral support to each other that influences their hypertension self-care. We use a conceptual model based on the Theory of Interdependence (Lewis, DeVellis, & Sleath, 2002; Lewis et al., 2006; Rusbult & Van Lange, 1995) to guide our analyses of the influence of older parents on adult children’s hypertension self-care and, conversely, adult children’s influence on older parents’ self-care. This study extends the literature on dyadic relations between older parents and adult children within a chronic illness context. It also contributes to the research on intergenerational transmission of health knowledge and beliefs among older parents and adult children.