Date of Award
Doctor of Philosophy (PhD)
Shih-Yu Lee, PhD, RNC
The prevalence of hypertension (HTN) is high in Latinos (Latino/Latina) Americans due to social and ecological factors. Increased migration of Latino migrant/seasonal farmworkers (MSFW) to the U.S. augments the social, economic, environmental, and psychosocial factors associated with health and illness. Bronfenbrenner’s Ecological Systems Theory was used to guide this study. The purposes of this cross-sectional, correlational study were to explore Latino MSFWs’ adherence to HTN treatment (medication adherence, blood pressure [BP] self-care, and BP control) and to examine the influence of BP knowledge, perceived stress, acculturation, health literacy, and health care access (HCA) on adherence to HTN treatment.
A total of 45 Latino (mean age 45 + 9) MSFWs receiving HTN treatment participated in this study. Spanish and English questionnaires were available for participants to measure adherence to HTN treatment and the five independent variables. Analysis included correlations, t-tests, hierarchical multiple regression, and hierarchical logistic regression.
The majority of MSFWs were from Mexico, female (55.6%), had less than a 6th grade education. Most (82%) of the MSFWs had uncontrolled BP, and were not adherent to medications (42%), even with high BP knowledge scores (M = 6.5 ±1.3). MSFWs perceived a high level of stress (M = 16 + 6.9), low acculturation level (Anglo orientation: M = 2.9 + 0.9), and no employer-provided health insurance for personal illnesses or injuries (93%). Blood pressure knowledge, perceived stress, acculturation, health literacy, and HCA accounted for 49% of the variance in the BP self-care; however, only higher BP knowledge was a significant predictor of better BP self-care (p < .001). Furthermore, acculturation was a significant predictor of BP control (p < .01).
This study explored select determinants of adherence to HTN treatment in Latino MSFWs in a culturally informed way. Although BP self-care behaviors appeared to be a consequence of BP knowledge, this study found low medication adherence in Latino MSFWs and uncontrolled BP explained by the two predictors, acculturation and health literacy. Perceived stress and health care access did not influence the adherence to HTN treatment. MSFWs had poor BP control and HTN treatment adherence. A culturally appropriate educational program is needed to help the MSFWs adherence to HTN treatment.
Hall, Eleanor M., "Social Ecology of Adherence to Hypertension Treatment in Latino Migrant and Seasonal Farmworkers." Dissertation, Georgia State University, 2011.