Date of Award


Document Type


Selected Creative Commons License

Creative Commons Attribution 4.0 International License
This work is licensed under a Creative Commons Attribution 4.0 International License.

Degree Name

Doctor of Philosophy (Ph.D.) Nursing





Millions of Caribbean women have migrated to the United States, and a sizeable number of these women and Black American women suffer from hypertension and other cardiovascular health problems. This research showed the comparison of health behaviors of both groups of women and the difference in their health outcomes. Today, there are more migrants in the world than ever before; an estimated 272 million international migrants in 2019, which is an increase in 51 million since 2010 (United Nations, 2019) and Caribbean migrants are a substantial portion of this pool. Approximately 4.4 million Caribbean immigrants reside in the U.S. and this represents 10 percent of the 44.5 million immigrants who live here (Zong & Batalova, 2016). Hypertension has been recognized as a major health burden both nationally and globally and is a leading cause of cardiovascular morbidity and mortality. According to the National Health and Nutrition Survey, 85.7 million adults have hypertension and more than half of these are women. Cardiovascular disease is attributed to one in three deaths of women in the U.S. (Abramson, Srivaratharajah, Davis & Parapiuid, 2018).


The purpose of this study is to explore and compare health beliefs, health-promotion activities, and reported health quality among women with hypertension from different cultures, focusing on Black Caribbean immigrant women and Black American women living in the New York Tri-State area. Pender’s (1987) Health Promotion Model (HPM) serves as the comprehensive theoretical framework to understand the full range of health perceptions and health behaviors of the women in this study.


The sample was recruited from the offices of two internal medicine doctors who were located in the New York Tri-State area. A six-page survey was delivered to all female subjects who met the criteria in these two offices. All questionnaires and surveys were coded and distributed in packets with sealable envelopes for confidentiality. The Quality of Life Instruments for Chronic Diseases – Hypertension Scale (QLICD – HY) for self-reported health quality and the health locus of control scales were used. QLICD- HY scale is a five-level Likert- type scoring system, consisting of 47 questions, which measures the physical, psychological, social and specific self-reported symptoms related to hypertension of the subjects.

The Multidimensional Health Locus of Control (MHLC), including the God Locus of Health Control (GLHC) scales, were used to determine the individual’s belief in what determines health outcomes. These beliefs were combined with questions that focus on the cultural lifestyles of these women from the other scales, which involved diet, exercise and their spiritual beliefs.

Other measures of health promotion behaviors were included with the demographic

questions, and self-reported health quality related to hypertension was measured via a questionnaire. This research helped to provide culturally appropriate and equitable care that has been a challenge for nurses, as social and cultural boundaries become complex, and as nurses see more patients from backgrounds that are different from their own.


Quantitative analysis was used for this research study. A non-experimental, comparative and correlational design was used to examine the association among the variables of interest.

Descriptive statistics was used to describe the entire sample. Demographic data described that the sample was using frequencies and appropriate descriptive statistical techniques (percentage, mean, standard deviation and variance).

Analysis of variance (ANOVA) was used to test differences among the cultural groups (as defined) and for four selected subscales of the MHLC Scale, four subscales of the self- reported health quality, and eight questions related to health-promotion behaviors. Pearson Product Moment correlations were computed to explore possible relationships between health locus of control and health behaviors.


The findings from this study showed that there is a difference between groups within select demographic variables, the self-reported health locus of control, self-reported health quality, and self-reported health-promoting behaviors. The findings did show there is a difference between Black Non-Caribbean and Black Caribbean women’s self-reported health quality and that there is not a statistically mean significant difference between Black Caribbean women and Black Non-Caribbean women’s health locus of control, with the exception of the “Powerful Other” measure.

Related Pillar(s)


Included in

Nursing Commons