OBJECTIVE This study aimed to describe the perceptions of Southern, rural, African American women regarding personal and environmental factors that affect their hypertension. METHODS A purposive sample of 25 African American women aged 40-74 years, who lived in rural Alabama, participated in seven Talking Circles for 60 minutes. RESULTS Most felt that hypertension was a "common occurrence" and that it was "typical in the African American community." They associated hypertension with stroke and heart attacks and referred to hypertension as the "silent killer." Barriers to following the treatment plan were low income, high medical expenses, and lack of insurance. Barriers to medication were cost, dislike for taking medication, running out of medication, side effects, forgetting, and being tired; and barriers to exercise were being tired, busy schedule, and safety. Walking paths, fitness centers, or malls to walk around were not available in all communities, and not all sidewalks were well-lit, limiting their walking exercise opportunities after work hours. Healthcare facilities were accessible, but it was easier to get an appointment and receive respect from healthcare providers if the women had money or insurance. Blood pressure monitors were available in their homes, at grocery stores and at Wal-Mart. No church health programs were available, but some churches had nurses on duty who offered blood pressure and cholesterol screening; however, no medication was provided. Grocery stores were accessible, and they had a flea market with fresh fruits and vegetables. Social environment/support by families and friends for persons with hypertension was not always positive. CONCLUSIONS The findings of this study indicate that personal and environmental factors play important roles in hypertensive status. The modified ecological framework used in this study may help us explore perspectives of family members and friends regarding their support for persons with hypertension. More serious efforts and resources need to be made available for preventive measures of hypertension in this population.