Implementation of Community-Based Stress Management Interventions forAfrican-American Women M. Webb, M. Evans, J. Beckstead University of South Florida College of Nursing C. Yucha, University of Florida College of Nursing J. Meininger, University of Texas School of Nursing, Houston
Study Funding K01 Mentored Scientist Award National Institute of Nursing Research National Institute of Health Bethesda, MD
Purpose of Study • To estimate the treatment effect size of two stress management interventions designed to assist African American women in modifying their cognitive and behavioral responses to the stress process.
Perspective of Study • Cardiovascular mortality rates in African Americans, ages 35-64, are more than twice that in Caucasians. • Hypertension is the single initiating factor, independent of socioeconomic status, that contributes the most to this disparity. • National Heart, Lung, and Blood Institute, 2003
Perspective of Study • Clinical trial data has shown that cardiovascular benefit attributable to a given decline in blood pressure is similar in African Americans and Caucasians. • The 1999-2000 NHANES data revealed low rates of hypertension control in African American women and men as well as high prevalence of hypertension. • National Heart, Lung, and Blood Institute, 2003
Stress and Hypertension • Long term stress is thought to sensitize arterioles to catecholamines resulting in over constriction of the vessels and endothelial damage.
Stress and African American Women • African American women are frequently exposed to stressors within the Westernized culture. • Stressors may include low occupational status, lack of resources and social support, and exposure to racism and prejudice. • Anderson, N. N. et al. (1994). Autonomic reactivity and hypertension in Blacks. Ethnicity & Disease,1, 154-170.
Significance of Study • African American patients have reported less satisfaction with care, perceived racial biases, stereotyping, and prejudice from health professionals. • A need exists for culturally acceptable and effective methods of delivering hypertension care.
Study Design • Factorial design with subjects randomized to 1 of 3 groups. • Group 1. Cognitive Mediation • Group 2. Arousal Reduction (Relaxation) • 3. Control (Delayed Treatment)
Blood Pressure Weight Height BMI Waist/Hip Ratios Health history State-Trait Anger Expression Inventory-2 (Spielberger, 1999) Personal Strain Questionnaire (Osipow, 1999) Personal Resources Questionnaire (Osipow, 1999) Sleep Survey Study Variables
“Sisterhood of Caring” • African American women were recruited from the University campus and nearby community worksites. • Eligibility criteria included (a) self-report of hypertension meds, or (b) systolic blood pressure >130 mmHg, or (c) diastolic blood pressure > 80 mmHg.
Baseline Measures • Blood pressure measures (three consecutive weeks). • Completion of STAXI, PSQ, PRQ, health history, sleep survey, informed consent. • Randomization to one of 3 treatment groups.
Treatment Design • Cognitive mediation, relaxation, or delayed treatment control group. • Groups 1 and 2 had six weekly classes; Control group had blood pressure monitoring. • Repeated measures at conclusion of classes (6 weeks) and 10 weeks. • Subjects received $50.00 at completion of study.
Cognitive Mediation Group • Self-assessment of stressors, effects of stress on body and BP. • Anger Management: Coping and Diffusing • Thought Stopping • Taking Time Out for Self • Assertiveness • Enhancing Self-Esteem • Meditation
Relaxation Group • Self-assessment of stressors, effects of stress on body and BP. • Guided Imagery • Meditation • Breathing Exercises • Progressive Relaxation • Autogenic Training
Study Sample • Sample=47 enrolled, 34 women completed study • Age= 45 y. (SD=7.89) • Weight=205 lb (SD=43.16) • BMI=34 (SD=6.85) • Waist/Hip=0.86 (SD=.05) • Smokers=8/34 (24%)
Attrition of Subjects (n=13) • 2 women ineligible due to uncontrolled hypertension • 1 woman withdrew after assignment to group • 10 women withdrew pre-assignment to group. • 2 women lost interest • 8 women unable to meet time requirements
Baseline Measures of Blood Pressure • An ANOVA showed a significant time effect (F[1, 33] =11.38, p = .002) for blood pressure decrease in the subjects on medications v. those not on therapy. • The women on medication therapy had a mean decrease in SBP of 12.85 mmHg, while those not on medication had a 2. 25 mmHg decrease.
Determining Differences in Groups • ANOVA analyses showed no significant differences among the three groups in demographic variables, BP, and psychological measures at baseline. • Ҳ2 showed no significant difference among the three groups in the proportion of smokers.
Positive Group Sessions Designed For AA Women Worksite Setting Fun, Relaxed Environment Increased Knowledge Negative Too Many Questionnaires Long Study For Control Group Lack Of Privacy for Some Issues Nominal Reimbursement Lacked Information On Diet And Weight Control Perceptions of Study
Implications for Future Research • Content focus: Diet, exercise, and stress control • Biological variables: BP, BMI, lipids, salivary cortisol, glucose levels. • Individual monitoring plus group sessions. • Compare effectiveness of nurse monitoring, electronic monitoring, and traditional method.