Neighborhood and social influences on blood pressure: An exploration of causation in the explanatory models of hypertension among African Americans

Objective: African Americans are at the highest risk of having hypertension compared to all other races and ethnicities in the United States. This disparity is compounded by lower rates of medication adherence and blood pressure control among African Americans. Divergence in African American patients' views of their hypertension from the biomedical model may be an important driver in shaping adherence behaviors and outcomes. Our study sought to identify African American explanatory models (EMs) of hypertension with a focus on disease etiology, in order to increase provider understanding of how African American patients conceptualize their hypertension and how this information can be used to foster provider-patient trust and engagement. Methods: The study utilized 12 in-depth and semi-structured interviews with hypertensive African American patients living in Philadelphia. Interview questions solicited participants' EMs of hypertension with a focus on etiology, including what they thought caused their hypertension, environmental factors that influence blood pressure, and barriers to managing hypertension in their neighborhood and social environment. Interview transcripts were analyzed using a modifiedgrounded theory approach to identify emergent themes. Results: We identified five themes from participants' EMs of hypertension: (1) stress causes high blood pressure; (2) unsafe neighborhoods lead to stress and can raise blood pressure; (3) the financial stressors of everyday living can make hypertension worse; (4) emotional distress from strained social relationships can exacerbate high blood pressure; and (5) lack of access to health care and healthy food in the community contributes to hypertension.