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Advisory Committee Chair

Kathleen C Brown

Advisory Committee Members

Diane M Grimley

M Gail Hill

Elizabeth H Maples

Erica R Pryor

Document Type

Dissertation

Date of Award

2010

Degree Name by School

Doctor of Philosophy (PhD) School of Nursing

Abstract

ABSTRACT According to the World Health Organization, hypertension is the leading cause of death in the world and it is one of the primary reasons patients seek health care. Prior to 2010, uncontrolled blood pressure (BP) rates were approximately 18%, despite the fact that prescribed medical treatment is available to adequately control patients' BP. It has been established that medication adherence is a major factor in controlling BP, and self-BP monitoring is highly recommended by the national guideline to improve blood pressure control. However, information related to assessing hypertensive patients' readiness to engage in health care treatment and self-monitoring is limited in the literature. In addition, there is a gap in the literature regarding self-efficacy for medication adherence and BP control among those patients with access to health care, such as municipal workers. The purpose of the study was to examine the relationships among stage of change, medication adherence, and medication adherence self-efficacy, and to determine the best predictors for the odds of BP control and self-blood pressure monitoring in hypertensive municipal workers. The Transtheoretical Model (TTM), highly acclaimed in the field of health behavior, guided this investigation. A convenience sample of 149 hypertensive workers completed self-administered questionnaires including the Stage of Change Questionnaire, Medication Adherence Self-Efficacy Scale, Morisky Medication Adherence Scale, and a Behavioral Risk Factor Surveillance System (BRFSS) based questionnaire. Descriptive statistics, correlations, and multiple logistic regression models were used for data analyses. The participants were primarily well educated, middle aged (M= 47, SD=8.4), African American, male municipal employees in the public safety department of a large southeastern US city. More than three-quarters of the participants had controlled blood pressure (75.70%) and a high proportion (70%) reported self-blood pressure monitoring. Stage of change was a significant independent predictor of self-blood pressure monitoring. Further, there was a significant correlation between stage of change and medication adherence and stage of change and medication adherence self-efficacy. Age was positively associated with medication adherence self-efficacy and with medication adherence. This study may inform development of stage-correlated interventions to achieve improved BP control in hypertensive workers.

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