The Knowledge Levels of Hypertension among Faith-Based African-American Men
Submitted by
Ethel Johnson
Direct Practice Improvement Project Proposal
Doctorate of Nursing Practice
Grand Canyon University
Phoenix, Arizona
June 27, 2018
, 2
Chapter 1: Introduction to the Project
A growing number of disease burdens and disparities are affecting the Black
population in regard to the hypertension (HTN) epidemic (Center for Disease Control and
Prevention [CDC], 2018). In African-American (AA) men, the prevalence of HTN is
more severe with an earlier onset linked to stroke, cardiac, and renal disease attributing to
30% of the causes of death (Flack, Ferdinand, & Nasser, 2003). Several factors affect the
ability of AA men to control their HTN efficiently such as mistrust in physicians, stress,
perceived stress, dietary/physical habits, and mental health (Parker, Hunte, Ohmit, &
Thorpe, 2017).
Numerous hypotheses are offered to explain the increased vulnerability of AA
men regarding the surge in HTN. Researchers continue to discover underlying causes for
the disparities related to the disease process in AA males. AA males have limited contact
with the healthcare system, thus placing them at risk for missing key health information
(Parker et al., 2017). In the AA community barbershops, hair salons, and churches are
some of the venues used in providing health education and strategies (Lumpkins, Greiner,
Daley, Mabachi, & Neuhaus, 2013). The use of these sites is designed to target common
places that Black men visit in efforts to provide them with details about health screening
and other useful information (Parker et al., 2017). Lumpkins et al. (2013) supported prior
research and the linkage between religion, spirituality, and health decision making as
consequential in health communication. The factors comprising this linkage should be
considered when targeting the AA population (Lumpkins et al., 2013; Saunders et al.,
2015; Woods, King, & Murray, 2012).
, 3
Patient education provided in an environment where one is comfortable and
receptive is an essential approach to addressing non-adherence lifestyle changes and
medication compliance in patients (Woods et al., 2012). According to Thomas and
Stoeckel (2016), higher adherence rate is vital to improving the individual’s knowledge
about medications and side effects. Furthermore, for a greater understanding of the
diseases, educators, physicians, and other providers must use the language of Black
people (Woods et al., 2012). Medical diagnosis and treatment involve communication
between the provider and patient speaking the same language for effective two-way
transfer of information (Woods, et al., 2012). All cultures utilize their own meanings of
verbal expressions, to get individuals comfortable in asking questions (Burgess, Ding,
Hargreaves, Van Ryn, & Phelan, 2008).
The combination of providing a comfortable venue and speaking in one’s
language is crucial to AAs achieving greater health outcomes. Regardless of the AA age
group, many believe providers do not listen to their health-related issues or concerns
(Woods, et al., 2012). The AA community internalizes the lack of listening by health care
providers as a lack of interest in them and their families ((Woods et al., 2012). The
primary investigator will describe the outcomes of using a comfortable venue (church)
and the Black language on impacting knowledge of hypertension and changing behaviors
of AA men for a higher quality of life.
In this evidence-based project, the language referring to Blacks and African-
Americans will be used interchangeably throughout, as many AAs refer to themselves
this way, via journals, statistics, and government reports (Woods et al., 2012). African-
, 4
Americans are individuals from a wide range of countries, such as the Caribbean,
African, and anyone of African descent.
This DPI project will assess the pre and post intervention knowledge of AA men
using the Hill-Bone Blood Pressure Therapy Scale. Within this project, the primary
investigator seeks to determine if providing culturally appropriate education using Black
language promotes behavior changes in AA men. The behavior changes will be evidenced
by self-monitoring of medication adherence and lifestyle modifications’ (such as
improved nutritional intake, increased physical activity, medication adherence, and lower
blood-pressure readings).
The remainder of this chapter builds on the DPI project by providing the
background for the project and identifying the problem statement, objectives,
significance, purpose of the project, and clinical questions. The chapter will discuss how
the project will advance population health outcomes, describes the research methodology,
and nature of the project. This chapter will also offer the definition of terms, assumptions,
limitations, and delimitations; and indicate the structure for the remainder of the project.
Background of the Project
Hypertension is described by the new guidelines set by the American Heart
Association and the American College of Radiology as a systolic blood pressure [SBP] >
130 mm Hg or diastolic blood pressure [DBP] > 80 mm Hg. The old guidelines were an
SBP >130 and a DBP>80. The new guidelines reflect that complications of HTN occur
at lower numbers. Hypertension affects Blacks at higher rates than any other racial
groups (Haile, Magalhaes, & Rudman, 2017). Further studies illuminated not only does
Submitted by
Ethel Johnson
Direct Practice Improvement Project Proposal
Doctorate of Nursing Practice
Grand Canyon University
Phoenix, Arizona
June 27, 2018
, 2
Chapter 1: Introduction to the Project
A growing number of disease burdens and disparities are affecting the Black
population in regard to the hypertension (HTN) epidemic (Center for Disease Control and
Prevention [CDC], 2018). In African-American (AA) men, the prevalence of HTN is
more severe with an earlier onset linked to stroke, cardiac, and renal disease attributing to
30% of the causes of death (Flack, Ferdinand, & Nasser, 2003). Several factors affect the
ability of AA men to control their HTN efficiently such as mistrust in physicians, stress,
perceived stress, dietary/physical habits, and mental health (Parker, Hunte, Ohmit, &
Thorpe, 2017).
Numerous hypotheses are offered to explain the increased vulnerability of AA
men regarding the surge in HTN. Researchers continue to discover underlying causes for
the disparities related to the disease process in AA males. AA males have limited contact
with the healthcare system, thus placing them at risk for missing key health information
(Parker et al., 2017). In the AA community barbershops, hair salons, and churches are
some of the venues used in providing health education and strategies (Lumpkins, Greiner,
Daley, Mabachi, & Neuhaus, 2013). The use of these sites is designed to target common
places that Black men visit in efforts to provide them with details about health screening
and other useful information (Parker et al., 2017). Lumpkins et al. (2013) supported prior
research and the linkage between religion, spirituality, and health decision making as
consequential in health communication. The factors comprising this linkage should be
considered when targeting the AA population (Lumpkins et al., 2013; Saunders et al.,
2015; Woods, King, & Murray, 2012).
, 3
Patient education provided in an environment where one is comfortable and
receptive is an essential approach to addressing non-adherence lifestyle changes and
medication compliance in patients (Woods et al., 2012). According to Thomas and
Stoeckel (2016), higher adherence rate is vital to improving the individual’s knowledge
about medications and side effects. Furthermore, for a greater understanding of the
diseases, educators, physicians, and other providers must use the language of Black
people (Woods et al., 2012). Medical diagnosis and treatment involve communication
between the provider and patient speaking the same language for effective two-way
transfer of information (Woods, et al., 2012). All cultures utilize their own meanings of
verbal expressions, to get individuals comfortable in asking questions (Burgess, Ding,
Hargreaves, Van Ryn, & Phelan, 2008).
The combination of providing a comfortable venue and speaking in one’s
language is crucial to AAs achieving greater health outcomes. Regardless of the AA age
group, many believe providers do not listen to their health-related issues or concerns
(Woods, et al., 2012). The AA community internalizes the lack of listening by health care
providers as a lack of interest in them and their families ((Woods et al., 2012). The
primary investigator will describe the outcomes of using a comfortable venue (church)
and the Black language on impacting knowledge of hypertension and changing behaviors
of AA men for a higher quality of life.
In this evidence-based project, the language referring to Blacks and African-
Americans will be used interchangeably throughout, as many AAs refer to themselves
this way, via journals, statistics, and government reports (Woods et al., 2012). African-
, 4
Americans are individuals from a wide range of countries, such as the Caribbean,
African, and anyone of African descent.
This DPI project will assess the pre and post intervention knowledge of AA men
using the Hill-Bone Blood Pressure Therapy Scale. Within this project, the primary
investigator seeks to determine if providing culturally appropriate education using Black
language promotes behavior changes in AA men. The behavior changes will be evidenced
by self-monitoring of medication adherence and lifestyle modifications’ (such as
improved nutritional intake, increased physical activity, medication adherence, and lower
blood-pressure readings).
The remainder of this chapter builds on the DPI project by providing the
background for the project and identifying the problem statement, objectives,
significance, purpose of the project, and clinical questions. The chapter will discuss how
the project will advance population health outcomes, describes the research methodology,
and nature of the project. This chapter will also offer the definition of terms, assumptions,
limitations, and delimitations; and indicate the structure for the remainder of the project.
Background of the Project
Hypertension is described by the new guidelines set by the American Heart
Association and the American College of Radiology as a systolic blood pressure [SBP] >
130 mm Hg or diastolic blood pressure [DBP] > 80 mm Hg. The old guidelines were an
SBP >130 and a DBP>80. The new guidelines reflect that complications of HTN occur
at lower numbers. Hypertension affects Blacks at higher rates than any other racial
groups (Haile, Magalhaes, & Rudman, 2017). Further studies illuminated not only does
