Health Disparities among African-American Women in Faith-based Organizations: Type II Diabetes and Hypertension

Transcription

1 1 Health Disparities among African-American Women in Faith-based Organizations: Type II Diabetes and Hypertension Vanessa Bland, Natarsha Lindsey, Aundria Range

2 2 Health Disparities among African-American Women in a Rural Faith-based Organization in Mississippi: Type II Diabetes and Hypertension Vanessa Bland, NaTarsha Lindsey and Aundria Range Abstract Objective Health disparities, differences in health status, and mortality among different groups have challenged the public health commitment to health for all (Akers, V.C., Schultz, J.A., Carson, V., Fawcett, S.B. & Ronan, M., 2009). Hypertension, commonly known as high blood pressure, increases the risk of mortality and morbidity among many Americans, particularly African-American women. Diabetes, commonly known as sugar diabetes, is one of the leading causes of medical conditions that results in end stage renal disease such as lower extremity amputations, etc. More than 25 million people in the United States are diagnosed with diabetes. The purpose of this study was to explore the knowledge and awareness of the relationship between diabetes and hypertension among African- American women in a faith-based organization (FBO). Methodology This study used a cross-sectional design utilizing a health disparity questionnaire to obtain the following demographics: age, education, religion, family history, physical lifestyle and diagnosis of disease, specifically diabetes and hypertension. Thirty respondents between the ages of and older were part of the study. Discussion and Results Based on chi-square statistical analysis, 70% of the women were aware of the relationship between diabetes and hypertension. However, women with lower level of education were more aware of the relationship between diabetes and hypertension when compared to women with a higher education. These findings highlight important implications for public health practitioners working with African-American women in faith-based organizations in similar health conditions. Future research studies can focus on integrating women s beliefs and behavioral change interventions to better understand the knowledge and awareness of women with diabetes and hypertension.

3 3 Introduction Hypertension is a comorbidity of diabetes that affects 20-60% of people with diabetes (Arauz-Pacheco, C., Parrott, M. A., & Raskin, P., 2002). Both chronic diseases are closely related. Hypertension affects approximately 50 million people in the U.S. (Moser, M., 2005). It is reported that 29% of Americans are affected by hypertension (Anthony, H., Valinsky, L., Inbar, Z., Gabriel, C. & Varda, S., 2012). According to the Mississippi State Department of Health, 2012, approximately 700,000 Mississippians are affected by hypertension (high blood pressure). It is also estimated that thousands more may be at risk (Mississippi State Department of Health, 2012). There are no common symptoms associated with hypertension, and it often goes untreated because people do not know they have the disease (Moser, M., 2005). Hypertension is a leading cause of both morbidity and mortality in cardiovascular disease (Anthony, et al., 2012). In the United States, diabetes affects 25.8 million children and adults. Approximately 8.3% of the U.S. population has diabetes. In 2011, it was reported that 18.8 million people were diagnosed with diabetes and 7.0 million were undiagnosed. Seventy-nine million people were reported as prediabetics (American Diabetes Association, 2013). In Mississippi, over 270,000 adults are reported as having type 2 diabetes. This is 12% of the state s adult population (Mississippi State Department of Health, 2012). In 2010, 926 Mississippians died as a result diabetes (Mississippi State Department of Health, 2012). Diabetes Mellitus may result in many complications such as lower extremity amputations, end stage renal disease, blindness, loss of protective sensation, heart disease, and premature death (Mississippi State Department of Health, 2012).

4 4 Faith-Based Organizations (FBOs), particularly churches, are considered an important source of support to African Americans. These organizations are also a good setting for the implementation health education and promotion programs to help eliminate racial and ethnical disparities in health (Wilcox, S., Laken, M., Bopp, M., Gethers, O., Huang, P., McClorin, L., Parrott, A.W., Swinton, R. & Yancy, A., 2007). Faith-Based Organizations may consist of churches, YMCA and other religious organizations and affiliations. They serve as partners and collaborators with community-based organizations, local, state and federal government programs and initiatives, and other agencies that address health issues and concerns. Many FBOs provide services such as health education and promotion programs, high blood pressure and diabetes screenings, weight loss and smoking cessation, cancer prevention and awareness, geriatric care, nutritional guidance, and mental health (DeHaven, M. J., Hunter, I.B., Wilder, L., Walton, J.W. & Berry, J., 2004). Faith-based initiatives became popular when President Bush's executive orders came on the scene. This program, created by the White House, mandated the Department of Health and Human Services to fund faith-based initiatives. The executive order was established to help Faith-Based Organizations fund their social and health programs and initiatives. The purpose of the faith-based initiatives was to involve the community, local congregations, and government to generate funding (Kotecki, C.N., 2002). Health disparities frequently refer to disparities in health care, including differential access to screening and/or treatment options, or unequal availability of culturally or linguistically knowledgeable and sensitive health personnel. It is also used in the United States to refer to differences in heath care or health status among different racial and ethnic groups, whereas in the United Kingdom and European nations it move frequently refers to differences associated with

5 5 social class and socioeconomic status (SES) (Adler, N.E. & Stewart, J., 2010). Health disparities can be categorized as racial and ethnic groups, rural and urban, age, and gender based. This also includes socioeconomic status and those who are uninsured (Rust, G. & Cooper, L.A, 2007). Health disparities are known to be caused by "societal issues such as institutional racism, discrimination, socioeconomic status, and poor access to health care and community resources (Plescia, M., Herrick, H., & Chavis, L., 2008). This study uses a cross-sectional research design. The research questions for this study were to determine if women in faith-based organization are aware of the relationship between diabetes and hypertension and does educational levels of women in faith-based organizations have an impact on the awareness of the relationship diabetes and hypertension. The purpose is to determine the knowledge and awareness of the relationship between diabetes and hypertension of African American women in a faithbased organization. Methods Participants The study was conducted between April 01, 2013 and April 30, It was conducted at Mount Helm Missionary Baptist Church. An institutional review board (IRB) approval was obtained from Jackson State University prior to data collection. Primary inclusion criteria included those women between the ages of and older and African-American. The exclusion criteria applied to women who were under the age of 20 and of another ethnic group. The sample size for this study was thirty (n = 30) African-American women ages and older, and non-probability convenience sampling was used. The participants were chosen primarily on their basis their availability.

6 6 Data Collection The women were recruited through print media such as flyers and church bulletins, church announcements, and word of mouth. The participants completed a survey questionnaire instrument of 27 questions administered by the researchers. An identifying code was issued to each questionnaire. An inform consent form was given to the participants prior to administering the survey. Analyses All analyses were performed with SPSS (Statistical Package for the Social Sciences) 18. Descriptive statistics were calculated on the demographic characteristics of age, education, religion, duration of hypertension and diabetes, familial history, exercise, diet, smoking history, alcohol consumption, whether their church facility had a church health and wellness program, and their awareness of the relationship between hypertension and diabetes. To examine the relationship between the knowledge and awareness of the relationship between diabetes and hypertension of African American women in a faith-based organization, a chi-square analysis was conducted to test the significance of the hypotheses. The hypotheses for this study include: H1 Majority of the Women in the observed FBO is aware of the relationship between diabetes and hypertension. H2 Women who have a higher education level is more aware of the relationship between diabetes and hypertension.

7 7 Results Demographic Characteristics The total number of participants included 30 African American females; most of the women diagnosed with hypertension were between the ages of 50 and 64 and those women diagnosed with diabetes were between the ages of (n=11; 36.6%), employed (70%), preferred Baptist as their religious affiliation (76.6%) and over half, approximately 53.3%, of the women had only a high school diploma. All participants were African American women and their age ranged from and older. As noted above, the total number of participants in this study was 30 (n=30). Five participants were diagnosed with diabetes, 16 were diagnosed with hypertension and nine were not diabetic or hypertensive. Significant differences were found between age and hypertension (Pvalue =.026), family history and diabetes (Pvalue =.024), and church health and wellness program and the hypertensive group (Pvalue =.027). Hypertension and Diabetes Questionnaire Participants were asked a series of questions pertaining to the awareness of the relationship between hypertension and diabetes. They were asked questions such as: how often they visited their health care provider; whether they had someone in their family who had been diagnosed with hypertension or diabetes; whether they exercised; if so, for how long they exercised (a day or week, how many hours?); the type of physical activities they engaged in; the kind of diet they followed daily; how often they had a regular serving of fruits and vegetables; whether they had a nutritionist; how often they manually checked their blood pressure; whether they smoked or drank alcohol; whether their church had a health and wellness program; and whether they were aware that a diagnosis of diabetes increased the risk of having high blood

8 8 pressure. Figures 1 and 2: Shows the percentage of women diagnosed with diabetes and hypertension between the ages of and older. The illustrations are representations of African-American women from a local faith-based organization. Figure 1. Percentage of women diagnosed with diabetes Women Diagnosed With Diabetes 20-34, 0% 65-and older, 25.00% 35-49, 27.30% 50-64, 14.30% Figure 2. Percentage of women diagnosed with hypertension

9 9 Figure 1 illustrates that 27.3% of the women were diagnosed with diabetes between the ages of when compared to the other age groups and Figure 2 shows that 85.7% of the women between the ages of were diagnosed with hypertension. Table 1. Characteristics of African American women with and without diabetes and hypertension Diabetes (N=30) p-value+ Hypertension(N=30) p-value+ Characteristics N (%) N (%) Age No Yes.437 No Yes (100%) 0(0%) 8(100.0%) 0(0%) (72.7%) 3(27.3%) 4(36.4%) 7(63.6%) (85.7%) 1(14.3%) 1(14.3%) 6(85.7%) 65 and older 3(75.0%) 1(25.0%) 1(25.0%) 3(75.0%) Education High School Associate Degree Bachelor s Degree Grad/Prof Degree Medical Degree Family History No Yes: grandparent, aunts, uncles Yes: parent, sister brother, child Other Exercise 2 times a week 3 times a week 4 times a week Never Diet Low cholesterol diet Low carbs/sugar diet Low salt diet No diet Other Smoking No Yes Alcohol No Yes Church health and wellness program No Yes 14(87.5%) 2(12.5%) 4(100.0%) 0(0%) 4(66.7%) 2(33.3%) 2(66.7%) 1(33.3%) 1(100.0%) 0(0%) 13(100%) 0(0%) 6(85.7%) 1(14.3%) 4(80.0%) 1(20.0%) 2(40.0%) 3(60.0%) 6(75.0%) 2(25.0%) 7(77.8%) 2(22.2%) 5(100.0%) 0(0.0%) 7(87.5%) 1(12.5%) 1(100.0%) 0(0%) 2(66.7%) 1(33.3%) 3(75.0%) 1(25.0%) 18(85.7%) 3(14.3%) 1(100.0%) 0(0%) 24(82.8%) 5(17.2%) 1(100.0%) 0(0%) 17(85.0%) 3(15.0%) 8(80.0%) 2(20.0%) (56.3%) 7(43.8%) 2(50.0%) 2(50.0%) 2(33.3%) 4(66.7%) 0(0%) 3(100.0%) 1(100.0%) 0(0%) 6(46.2%) 7(53.8%) 5(71.4%) 2(28.6%) 2(40.0%) 3(60.0%) 1(20.0%) 4(80.0%) 5(62.5%) 3(37.5%) 4(44.4%) 5(55.6%) 3(60.0%) 2(40.0%) 2(25.0%) 6(75.0%) 0(0%) 1(100.0%) 1(33.3%) 2(66.7%) 2(50.0%) 2(50.0%) 10(47.6%) 11(53.4%) 1(100.0%) 0(0%) 14(48.3%) 15(51.7%) 0(0%) 1(100.0%) 8(40.0%) 12(60.0%) 6(60.0%) 4(40.0%) 22(84.6%) 4(15.4%) 11(42.3%) 15(57.7%) 3(75.0%) 1(25.0%) 6(75.0%) 1(25.0%) Awareness

10 10 No Yes 9(100.0%) 0(0%) 16(76.2%) 5(23.8%) 4(44.4%) 5(55.6%) 10(47.6%) 11(52.4%) Table 1 shows the characteristics of the African American women with and without diabetes and hypertension. In the age group 20-34, there were no reports of diabetes or hypertension. In the age group 35-49, the majority of the women reported having diabetes (73%) and hypertension (64%). In the same age group, (27%) did not have diabetes and (36%) did not have hypertension. In the age group 50-64, the majority of the women did not have diabetes 6(86%). In contrast, 86% of the women in this age group reported having hypertension. In the age group, 65 and older only 25% of participants were diagnosed with diabetes and, in the same age group for hypertension, 75% was diagnosed. This study found that African American women with only a high school education were less impacted by diabetes (75%) and hypertension (56%). None of the women with an Associate degree reported as having diabetes, and it was evenly divided at 50% among those with and without hypertension. In contrast, the majority of those with a bachelor s degree (66%) did not have diabetes but the majority of them (66%) were diagnosed with hypertension. The participants who had a graduate/professional degree reported 33% with diabetes and 67% with hypertension. Those with a medical degree reported not having (100%) diabetes or hypertension. As it relates to family history, only the group that was non-diabetic reported no family history (100%). Eighty six percent of the non-diabetic group reported that they had grandparents, aunts, and uncles with diabetes, and 14% were reported from the diabetic group. While 80% of the non-diabetic group reported that they had parents, sisters, brothers and children with diabetes, 20% were reported from the diabetic group. The majority of the women

11 11 with hypertension did not have a family history of hypertension (54%), most of the hypertensive group reported that they had a family history of grandparents, aunts, and uncles (60%) as well as other family members (80%). Some life styles and risk behaviors were assessed in this study. We observed that women who were diagnosed with diabetes were less susceptible to eating a healthy diet and exercising on a continual basis. Both the non-diabetics (75%) and non-hypertensive (63%) groups reported that they were less likely to exercise 2 times a week. While most of the participants with diabetes reported that they did not exercise 3 times a week (78%), the majority with hypertension (56%) reported that they did exercise at least 3 times a week. When asked if they exercised 4 times a week, the non-diabetes group (100%) reported they did not, and it was evenly divided at 40% for those with and without hypertension. Whereas 87% of the women who did not have diabetes never excised, 75% of those with hypertension never exercised. As it relates to diet, the non-diabetic highly reported that they did not incorporate a healthy diet lifestyle (86%). Among those with diabetes, 33% reported having a low carbohydrate/sugar diet, 25% a low salt diet, and 14% no diet. A majority of the women in the non-hypertensive (43%) and hypertensive (52%) groups reported that did not have a healthy diet lifestyle. An overwhelming majority of the participants who did not have diabetes reported that they did not smoke (82%), and most of those with hypertension stated that they did not smoke (52%). A 100% of those who smoked did not have diabetes, yet had hypertension. Most women who did not drink alcohol did not have diabetes (85%), and the majority of those who had hypertension did not drink alcohol either. The study found that 80% of those who

12 12 did not have diabetes drank alcohol and 50% of those who did not have hypertension were alcohol drinkers. The diabetic participants reported that 85% of them did not have a church health and wellness program. Fifty-seven percent of those with hypertension reported that they did not have a church health and wellness program. Seventy-five percent of those with a health and wellness program did not have diabetes and 50% did not have hypertension. The study revealed that only 24% of those who were diagnosed with diabetes were aware of the relationship between diabetes and hypertension. Fifty-two percent of the women who were diagnosed with hypertension were aware of the relationship between the two diseases. The study also revealed those who did not have diabetes were not aware of the association between hypertension and diabetes, and 76% of the participants who did not have diabetes were aware of the association. In addition, 57% of the participants with hypertension were not aware of the association between hypertension and diabetes. In addressing the second research question, does educational levels of women in faith-based organizations have an impact on the awareness of the relationship diabetes and hypertension, it was determined that the women who were diagnosed with hypertension were more aware of the relationship between diabetes and hypertension than those who had diabetes. The women of both groups did have some knowledge of the awareness that there is a relationship between hypertension and diabetes. In relations to our study, a study was conducted in 2002 (Dokken, B.B., 2008) in the U.S. in which a survey was administered to a group of patients who were diagnosed with diabetes. The result of this study concluded that 68% of the participants did not considered themselves at risk for heart attack or strokes which are often a result of hypertension ((Dokken, 2008). As diabetics, they were not aware of their risk for hypertension and the

13 13 complications of the disease. As with our study, they were not aware of the close relationship of diabetes and hypertension. The study also revealed that those who did not have diabetes were not aware of the association between hypertension and diabetes, and 76% of the participants who did not have diabetes were aware of the association. In addition, 57% of the participants with hypertension were not aware of the association between hypertension and diabetes while 52% of those with hypertension were aware of the association. Discussion Religion and the importance of a healthy lifestyle are significant factors in the lives of African-American women. Faith-based organizations are a source of support and prayer is a key element in assisting individuals to cope with life stressors. Numerous studies have been conducted on the effect of religion, spirituality and health disparities among African-American women in faith-based organizations. Table 2 describes the general characteristics of women s awareness based on their educational level. Based on chi-square analysis, the table typically indicates that the majority of the women who were aware of the relationship between diabetes and hypertension had only a high school diploma, with a p-value of.572, which determines that the two variables are independent and that there is no relationship between the two variables. Table 2. The relationship between education and awareness AWARE Characteristic NO YES p-value + Education.572 High School

14 14 Associate Degree Bachelor s Degree Graduate/Prof. Degree Medical Degree 5 (31.3%) 1 (25.0%) 3 (50.0%) 0 (0%) 0 (0%) 11(68.8%) 3 (75.0%) 3 (50.0%) 3(100.0%) 1(100.0%) Educational levels were a major factor among women who were diagnosed with diabetes and hypertension. In our study, the more advanced education, the higher was the number of women with diabetes and hypertension. The study was not statistically significantly in terms of the p-value, which was.558 for diabetes and.308 for hypertension. In a study that was conducted by, (Kautzky-Willer, A., Dorner, T., Jensby, A., & Rieder, A. (2012), to determine if there was an association between education level on hypertension and diabetes in Austria. Survey data were collected from the Austrian Health Interview Survey with a representative sample of 770 Austrians 15 years and older. The result of this study indicated association between education, diabetes and hypertension in women with higher education levels suffered less from diabetes or hypertension and more so than the men in the study. A previous study of 34 participants that explored the attitudes and beliefs of African- American women regarding hypertension-preventive self-care behaviors showed the following: one in three (33.5%) African-Americans were hypertensive, which is the highest prevalence of any ethnic group surveyed; African-Americans had difficulty achieving lifestyle modifications; a lack of trust in physicians and reluctance to seek medical care were additional habits passed down in the community. Cultural expectations were so strong that individuals needed a great

15 15 deal of family and community support to be able to implement current recommended health practices (Peters, R.M., Aroian, K.J. & Flack, J.M., 2006). Limitations This report has a few limitations. First, there was a relatively small sample size. Therefore, the findings cannot be generalized as an entire community. Second, limited time to obtain research information was a significant limitation of the study. Third, the research was conducted at a single local faith-based organization in a rural community. Perhaps with a larger number of participants, a considerable amount of time and various faith-based organizations, the statistical and hypothesized findings would have a more thorough correlation between individuals awareness of hypertension and diabetes based on their age and education level. Direction of future research Future research studies may further explore the association between diabetes and hypertension in faith-based organizations, as a community, to promote health education concerning a healthier lifestyle, healthier eating and consultation with one s health care provider. Also, as a faith-based organization, future research may help such organizations understand the importance of health and wellness programs and recognize the risk factors associated with diabetes/hypertension and integrate health and wellness programs in their organization. Implications The findings of this study imply the importance of characteristics that are significant in the association of diabetes and hypertension. Individuals that are more aware and knowledgeable of the resources available in their community may prevent the onset of diseases such as hypertension and diabetes. In addition, the findings also suggest the importance of religion among African-American women diagnosed with diabetes and hypertension. Faith-based

16 16 organizations are an essential source of support for African-American women. It may be helpful to health care providers to consider how they can integrate religion into their profession. Furthermore, incorporating health and wellness programs in the church has major benefits such as: a healthier and happier congregation, more energetic to contribute to the church community and educating people in the community about diet and physical activity. More research is needed to design programs to promote healthy behaviors, including physical activity, diet, healthcare screenings and smoking cessation. Conclusion This study determined the knowledge and awareness of the relationship between diabetes and hypertension of African American women in a faith-based organization has several strengths. First, 70% of the participants were aware of the relationship between hypertension and diabetes, which indicates that they were knowledgeable of their health status as well as the relationship between the two co-morbidities. Second, the women diagnosed with hypertension or diabetes engaged in a healthy lifestyle by incorporating a regular serving of fruits and vegetables in their diet and engaging in physical activities at least 2-4 times per week. The results of this study add to the studies involving African-American women in faith-based organizations regarding hypertension and diabetes. Faith-based organizations are effective resources to enlighten the community about health education to reduce health disparities among African- American women. Faith-based organizations can benefit from church health and wellness programs that may have a positive impact on their congregation members; lifestyle changes. The study proposes further research to examine the relationship between African-American women based on their awareness of hypertension and diabetes and the importance of health and wellness

17 17 programs. Therefore, faith-based organizations should consider community health initiatives that will promote longevity, prevent disease and yield success.

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