Impact of socio-environmental barriers on adoption of therapeutic lifestyle change among low-income hypertensive black men

Background: Black men have the greatest burden of premature death from hypertension (HTN). Clinical trials support the efficacy of interventions targeting therapeutic lifestyle change (TLC) to reduce HTN, but these interventions rarely address socio-environmental factors that likely pose a significant barrier to adoption of TLC among low-income urban Black men. This study examined barriers to adoption of TLC among men participating in a community-based intervention targeting HTN reduction. Methods: To identify salient themes related to socio-environmental barriers, a focus group was conducted with 6 interventionists who completed one-on-one Motivational Interviewing (MI) sessions with 623 participants in two randomized controlled trials of a church and barbershop-based MI intervention targeting TLC to promote HTN reduction among low-income, older (≥ 50 years old) Black men in New York City. Interventionists identified barriers to the adoption of TLC reported by participants during MI sessions. Identified categories were further defined through group discussion, followed by a final voting and ranking process. Results: 17 barriers to successful adoption of TLC were identified. The most consistently reported barriers were financial constraints, unstable housing, and long-term unemployment. Combined with lack of access to affordable healthy options and social networks that supported unhealthy behaviors (e.g., consumption of fatty, salty foods; smoking), these factors prevented men from engaging in health-promoting activities. Conclusions: Low-income urban Black hypertensive men may experience socio-environmental factors as fundamental barriers to the adoption of TLC. The impact of behavioral interventions in this high-risk population could be improved by addressing the influence of socio-environmental barriers on TLC.