EXAMINING THE INFLUENCE OF EXISTING SOCIAL ROLES ON SICK ROLE ACCEPTANCE ...

150 Pages·2016·1.15 MB·English

EXAMINING THE INFLUENCE OF EXISTING SOCIAL ROLES ON SICK ROLE
ACCEPTANCE AMONG AFRICAN AMERICAN WOMEN WITH HYPERTENSION
Tamara Keondra Hicks
A dissertation submitted to the faculty of the University of North Carolina at Chapel Hill in
partial fulfillment of the requirements for the degree of Doctor of Philosophy in the School of
Social Work.
Chapel Hill
2015
Approved by:
Kathleen Rounds
Sheryl Zimmerman
Debra Barksdale
Trenette Clark-Goings
Chris Wiesen
©2015
Tamara Keondra Hicks
ALL RIGHTS RESERVED
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ABSTRACT
TAMARA K HICKS: Examining the Influence of Exiting Social Roles on Sick Role Acceptance
Among African American Women with Hypertension
(Under the direction of Kathleen Rounds)

This study explored social factors involved in African American women’s acceptance of
the “sick role” defined as a medical diagnosis of hypertension. The primary purpose of this study
was to examine the relationship that an African American woman’s existing social roles play in
sick role acceptance behaviors, utilizing a role theory and stress and coping theoretical
framework. The researcher hypothesized that failure to accept the sick role would be
demonstrated by non-adherence to medical recommendations for treatment of hypertension.
Conversely, evidence of sick role acceptance would be demonstrated by adherence to a
combination of recommended lifestyle modification and prescribed medication. Secondary data
analysis was performed with variables extracted from the National Health and Nutrition
Examination Survey (NHANES) years 2011 and 2012 (CDC, 2013). The study included a
sample of 1476 African American women over the age of 20 years who had been told by a
doctor that they have hypertension. Logistic regression analysis was performed for this
dissertation analysis as there are several dichotomous outcome variables (medication, salt intake
and exercise) as well as multiple categorical independent variables (marital status, parental status
and employment status). The findings of this study indicate that we cannot confidently conclude
that there is a direct or indirect relationship between social roles and sick role acceptance based
on the analysis of the NHANES data and were at best only able to estimate the relationships due
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to limited variance in the data. This research was tasked with examining the influence of social
roles on medical non-adherence in a sample that was nearly fully compliant with medical
recommendations for hypertension.

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For Skylar Addison, everything I do is for you.

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ACKNOWLEDGMENTS
There are no words to fully express how grateful I am to Kathleen Rounds. From my
beginnings as a Masters of Social Work student to the extremely long bumpy road to the PhD in
Social Work, I could never have done this without your patience, encouragement, and wisdom. I
am forever grateful.
I am also grateful to Sheryl Zimmerman for her immeasurable support when I saw no
way to complete this program. You heard my distress call and jumped to my rescue with no
hesitation.
To each of my committee members, Debra Barksdale, Trenette Clark-Goings, and Chris
Wiesen, each of you welcomed my invitation to sit on my committee with warmth and support.
Chris Wiesen, for the multiple phone an office consultations on my data and my SAS coding I
offer a special thanks. Your patience was saintly.
Finally, thank you to my mother, Ronnie Wagoner, and my father, Erskine Hicks. Thank
you for observing my journey with no judgement, as well as loving and supporting Skylar and
me. None of this would have been possible without you. I love you both.

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TABLE OF CONTENTS

LIST OF TABLES ........................................................................................................................ xii

LIST OF FIGURES ..................................................................................................................... xiii
CHAPTER 1. INTRODUCTION ........................................................................................1
Hypertension ..............................................................................................................................2
Causes ........................................................................................................................................3
CHD and Hypertension Interventions ........................................................................................5
Pharmacological treatment and adherence ...........................................................................5
Lifestyle modification interventions ....................................................................................7
Weight loss and physical activity ..................................................................................8
Sodium reduction and dietary charges ........................................................................11
Barriers to adherence in African American women ..........................................................13
The Sick Role ...........................................................................................................................15
African American Women and the Sick Role Behavior in the Literature ...............................17
Purpose of the Dissertation ......................................................................................................18
Research Questions ..................................................................................................................19
CHAPTER 2. LITERATURE REVIEW ...........................................................................20
Social Statuses and Social Roles..............................................................................................21
Role Theory .............................................................................................................................22
Status Roles and Social Value .................................................................................................25
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Status-valued characteristics ..............................................................................................26
Subjective social status ......................................................................................................26
Understanding Social Roles and Health ..................................................................................27
Multiple Social Roles ...............................................................................................................29
Marital status and health outcomes ....................................................................................30
Parental status and health ...................................................................................................32
Employment and health .....................................................................................................34
Social Roles among African American Women ......................................................................36
Marriage .............................................................................................................................36
Cohabitation .......................................................................................................................38
Single motherhood .............................................................................................................39
Employment and head of household ..................................................................................40
CHAPTER 3. CONCEPTUAL FRAMEWORK ...............................................................42
The Transactional Model of Stress and Coping (TMSC) ........................................................42
TMSC Cognitive Appraisal .....................................................................................................44
Primary appraisal ...............................................................................................................44
Commitments and beliefs ............................................................................................45
Secondary appraisal ...........................................................................................................46
Situational appraisal .....................................................................................................46
Reappraisal .........................................................................................................................46
TMSC Coping ..........................................................................................................................47
Coping strategies ................................................................................................................47
Stress Coping and Health Outcomes........................................................................................48
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Stress coping and health outcomes in African American women .....................................49
Racism and Health ...................................................................................................................50
Racism and high blood pressure ........................................................................................50
Explanatory Theories of Stress and Coping Specific to African Americans ...........................53
Weathering hypothesis .......................................................................................................53
Allostatic load ....................................................................................................................53
John Henryism ...................................................................................................................54
Sojourner Syndrome ..........................................................................................................55
Conceptual Model Components ...............................................................................................56
Illness behavior and sick role diagnosis .............................................................................57
Primary appraisal ...............................................................................................................58
Secondary appraisal ...........................................................................................................58
Coping ................................................................................................................................58
Reappraisal .........................................................................................................................60
Sick Role Acceptance ..............................................................................................................61
CHAPTER 4. METHODOLOGY .....................................................................................62
Measurement Model ................................................................................................................62
Data Source ..............................................................................................................................64
Study Sample ...........................................................................................................................66
Outcome Variable ....................................................................................................................67
Independent Variables .............................................................................................................68
Marital status ......................................................................................................................68
Employment status .............................................................................................................68
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Parental status ....................................................................................................................68
Moderating Variables...............................................................................................................69
Health insurance.................................................................................................................69
Usual source of care ...........................................................................................................69
Additional Variables of Interest ...............................................................................................69
Body mass index ................................................................................................................69
Education ...........................................................................................................................70
Age group...........................................................................................................................70
Income to poverty ratio ......................................................................................................70
Data Analysis ...........................................................................................................................71
Multiple logistic regression in SAS ...................................................................................74
Missing Data ............................................................................................................................74
Addressing missing data ....................................................................................................75
CHAPTER 5. RESULTS ...................................................................................................76
Sample Description ..................................................................................................................76
Model Testing ..........................................................................................................................79
Bivariate analysis ...............................................................................................................80
Multivariable analysis ........................................................................................................81
Moderation models ............................................................................................................83
Medication ...............................................................................................................................84
Probability of non-adherence to medication ......................................................................84
Salt Intake ................................................................................................................................85
Probability of non-adherence to salt reduction ..................................................................86
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