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Despite the advances in the treatment of hypertension, this chronic disease continues as a major health problem in rural southeastern United States. Although, the area of the target area is called the “Bible Belt” and “the stroke belt”. The purpose of this study was to explore the relationship of cognitive, behavioral, and cultural (particularly spirituality), and medication adherence to blood pressure, body mass index, and cholesterol. After jointly planning the study conceptual framework and protocols with Iwate Prefecture Faculty of Nursing colleagues, data collection was conducted at primary care offices in southeastern United States. Using English versions of surveys a sample of 200 patients with hypertension will participate in the U.S. cohort. The findings from the initial 40 patients of the outpatient clinic are currently being analyzed. Findings, conclusions, and discussions from the total sample (200) will be presented at the conference.

Preliminary analysis reveals that 60% are women (24) and 40% (16) men aged 45-78 with the majority (90%) being protestant. The majority (47%) is African American and 17% Caucasians. Preliminary data analysis reveals a mean Health Promoting Lifestyle Profile II (HPLPII) of 3.0 (SD 0.28). The Belief in a Higher Being is 3.10(SD 3.5). For the North Carolina cohort, the knowledge of hypertension is high (18.5) and reported medication adherence shows trends toward good adherence. The presentation will include correlations between the demographic variables, spirituality, belief in a higher being, knowledge of hypertension, medication adherence, the HPLP II total score and subscales, systolic and diastolic blood pressure, cholesterol, waist circumference, and body mass index.

Understanding the relationships between spirituality, knowledge of hypertension, belief of a higher being in healing, and medication adherence can assist nurses design culturally tailored interventions to reduce blood pressure levels for rural clients with hypertension.