African American Spouses with Hypertension (AASH): Co-Construction of Liminal Health Spaces in Dyadic Communication

Theoretical Background and research questions/hypothesis: Onset of health problems requires a re-integration of the new health information into a person's identity as well as in their family identity. One of the ways this is done is through family communication. This idea of health-related identity is especially salient in African-American women, whose health status may be related to their social environment and identity. In fact, research findings show that early onset of hypertension in African-American women is related to social, environmental, economic, and family-related stressors. Since it is not uncommon for African American partners to both have hypertension, this issue of family health identity is especially crucial in this population. Our research involves an interdisciplinary approach with scholars from health communication, public health, and psychology, to examine how diagnosis of early onset hypertension affects this personal and family identity and thus influences health behaviors.  This is a pilot qualitative study to examine how married African-American couples discuss hypertension and its affect on their relationship and identity.  

Methods:  We conducted qualitative interviews with African American older adult couples where both partners have hypertension. Participants reflected on their conceptions of health in individual, couples, and family contexts; ways the hypertension diagnosis has affected their lifestyle, identity, and spousal relationship; and how having hypertension relates to their sense of self and approach to life.

Results:  Emergent themes included normalization of hypertension; lack of worry or urgency toward a hypertension diagnosis; inclusion of dietary changes in everyday lifestyle; and the role of spousal partners in minimizing a spouse’s denial toward health concerns.

Conclusions:  Our research suggests that couples use a combination of dietary changes, negative and positive comparison (with others with hypertension diagnoses), and rationalization to normalize the diagnosis of hypertension. We also discovered how in spousal communication, spouses gloss over health concerns while “calling each other out” on health claims, and how a hypertension diagnosis does not reach the threshhold of a “health story” until complications such as stroke develop. In this presentation, we will discuss how African-American couples construct ideas of health liminality (not quite healthy and not quite unhealthy) in the context of a hypertension diagnosis.

Implications for research and/or practice:  This research has implications for healthcare practitioners to assist African-American patients in their management of their hypertension, and suggests ways providers can use health communication to move patients toward developing a more serious understanding of the diagnosis.