The contexts of adherence for African Americans with high blood pressure

African American men between the ages of 18 and 49 years have the lowest ra tes of awareness, treatment and control of high blood pressure (HBP) of all age/race/gender groups in the United States. A qualitative study was done to gain an understanding of urban black males' experiences of living with H BP. In-depth semi-structured interviews were conducted with 19 black males. The interviews explored perceptions of health, health problems and priorit ies, and concerns of daily living that influenced appointment keeping and m edication taking. The sample was a subset of 309 men participating in a 3-y ear clinical trial to improve HBP control in an inner city African-American population. Content analysis of transcribed interviews identified the foll owing themes and related concerns: (a) personal contexts: meaning of health , high blood pressure and treatments; (b) social context: living as a young black male in an urban environment; and (c) cultural context of relating: patient-provider relationship can make a difference. Influencing participan ts' responses were: interpreting symptoms; adjusting medication taking; pro tecting personal privacy; allocating limited resources; dealing with addict ion; and feeling cared for by a health care provider. Adherence appeared to be multifaceted and changing depending upon: the men's social, economic an d personal circumstances; empathetic and non-judgemental assistance from pr oviders; financial concerns and employment; and drug addiction. Findings ar e useful in refining high blood pressure interventions.