Journal of Racial and Ethnic Health Disparities

, Volume 6, Issue 1, pp 197–206 | Cite as

Qualitative Study of Knowledge, Perception, and Behavior Related to Hypertension and Cardiovascular Disease Risk Reduction Among Hypertensive African-Americans in Urban Inner City of South Bronx, New York

  • Maria EspejoEmail author
  • Shirley Magabo
  • Angel Rivera-Castro
  • Mohammed Faiz
  • Leandro Ramirez
  • Cristabel Robles
  • Tarek Shabarek
  • Masood A. Shariff
  • Balavenkatesh Kanna



To study the knowledge, perception, and behaviors among hypertensive African-Americans in South Bronx, New York, to elucidate any gaps that could explain their poor blood pressure control.


Cross-sectional qualitative study on African-American participants with essential hypertension, on single or combined oral antihypertensive regimen. Three focus groups were presented with open-ended questions on topics including cardiovascular disease knowledge, perception, and behaviors. A total of 18 data collection tools were used. Concepts formulated were categorized into dominant themes. A sample size of 21 participants was attained based on the saturation point related to emerging common themes.


Six dominant themes identified were unhealthy diet, stress, patient-physician relationship, medication non-compliance, decreased physical activity, and hypertension complications. The most dominant was unhealthy diet with self-identified barriers such as poor food selection, family tradition, economical cost, will-power, food taste, and accessibility to healthier food. Regarding medication adherence, participants recognized trust was a determining factor that has been negatively reinforced by previous experiences with their healthcare providers especially when they were not perceived as knowledgeable. Participants have also felt they have been influenced by historic events in their health decision-making process.


The South Bronx African-American population has some feelings that are valid and not simply misconceptions. Some of them are historically related, gaps in knowledge influenced by culture and traditions, and barriers to healthy behaviors enhanced by economic status, lack of will-power, physical limitations, and stress from daily living. A physician partnership with this African-American community to improve trust, raise awareness, facilitate, and change in behavior that could help address blood pressure control and prevent cardiovascular disease.


African American Cardiovascular diseases Decision making Hypertension Patient adherence Patient medication knowledge 



Our thanks to the following individuals who assisted in various aspects of the grant-funded study: Maryanne Guerrero BHSA MA (Research Manager for Administrative Support) and Drs. Namita Tiwari and Lashuan Trimble for initial protocol design and support. In addition, we thank all the Research Associates who have assisted with data collection and regulatory support. Thank You! This study is part of a group of studies originating from the Center for Health Evaluation, Education, Research and Engagement (CHEVERE)-Phase I, Hypertension Study, with the Purpose is to explore the cultural, social and psychological factors that either facilitate or serve as barriers to behavioral or engagement changes in each setting, within the South Bronx African American and Latinx minority populations.


This research was supported by a grant from the New York State Department of Health, Empire Clinical Research Investigator Program (ECRIP) Grant Number: 7000008.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Statement of Human Rights

In accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards, this study was approved by the institutional review board of Lincoln Medical Center-NYC H+H.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Statement on the Welfare of Animals

This article does not contain any studies with animals performed by any of the authors.


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Copyright information

© W. Montague Cobb-NMA Health Institute 2018

Authors and Affiliations

  • Maria Espejo
    • 1
    • 2
    • 3
    Email author
  • Shirley Magabo
    • 3
    • 4
    • 5
  • Angel Rivera-Castro
    • 2
    • 3
  • Mohammed Faiz
    • 2
    • 3
    • 4
  • Leandro Ramirez
    • 3
  • Cristabel Robles
    • 2
    • 3
  • Tarek Shabarek
    • 2
    • 3
  • Masood A. Shariff
    • 3
    • 5
  • Balavenkatesh Kanna
    • 2
    • 3
    • 5
  1. 1.Department of Ambulatory CareLincoln Medical Center-NYC H+HBronxUSA
  2. 2.Department of Internal MedicineLincoln Medical Center-NYC H+HBronxUSA
  3. 3.Center for Clinical and Community ResearchLincoln Medical Center-NYC H+HBronxUSA
  4. 4.Department of Physical Medicine and RehabilitationTufts Medical CenterBostonUSA
  5. 5.ECRIP Fellowship of Graduate Medical EducationLincoln Medical Center-NYC H+HBronxUSA

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