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Cooper LA, Marsteller JA, Carson KA, Dietz KB, Boonyasai RT, Alvarez C, Crews DC, Himmelfarb CRD, Ibe CA, Lubomski L, Miller ER, Wang NY, Avornu GD, Brown D, Hickman D, Simmons M, Stein AA, Yeh HC. Equitable Care for Hypertension: Blood Pressure and Patient-Reported Outcomes of the RICH LIFE Cluster Randomized Trial. Circulation 2024; 150:230-242. [PMID: 39008556 PMCID: PMC11254328 DOI: 10.1161/circulationaha.124.069622] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 06/03/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND Disparities in hypertension control are well documented but underaddressed. METHODS RICH LIFE (Reducing Inequities in Care of Hypertension: Lifestyle Improvement for Everyone) was a 2-arm, cluster randomized trial comparing the effect on blood pressure (BP) control (systolic BP ≤140 mm Hg, diastolic BP ≤90 mm Hg), patient activation, and disparities in BP control of 2 multilevel interventions, standard of care plus (SCP) and collaborative care/stepped care (CC/SC). SCP included BP measurement standardization, audit and feedback, and equity-leadership training. CC/SC added roles to address social or medical needs. Primary outcomes were BP control and patient activation at 12 months. Generalized estimating equations and mixed-effects regression models with fixed effects of time, intervention, and their interaction compared change in outcomes at 12 months from baseline. RESULTS A total of 1820 adults with uncontrolled BP and ≥1 other risk factors enrolled in the study. Their mean age was 60.3 years, and baseline BP was 152.3/85.5 mm Hg; 59.4% were women; 57.4% were Black, 33.2% were White, and 9.4% were Hispanic; 74% had hyperlipidemia; and 45.1% had type 2 diabetes. CC/SC did not improve BP control rates more than SCP. Both groups achieved statistically and clinically significant BP control rates at 12 months (CC/SC: 57.3% [95% CI, 52.7%-62.0%]; SCP: 56.7% [95% CI, 51.9%-61.5%]). Pairwise comparisons between racial and ethnic groups showed overall no significant differences in BP control at 12 months. Patients with coronary heart disease showed greater achievement of BP control in CC/SC than in SCP (64.0% [95% CI, 54.1%-73.9%] versus 50.8% [95% CI, 42.6%-59.0%]; P=0.04), as did patients in rural areas (67.3% [95% CI, 49.8%-84.8%] versus 47.8% [95% CI, 32.4%-63.2%]; P=0.01). Individuals in both arms experienced statistically and clinically significant reductions in mean systolic BP (CC/SC: -13.8 mm Hg [95% CI, -15.2 to -12.5]; SCP: -14.6 mm Hg [95% CI, -15.9 to -13.2]) and diastolic BP (CC/SC: -6.9 mm Hg [95% CI, -7.8 to -6.1]; SCP: -5.5 mm Hg [95% CI, -6.4 to -4.6]) over time. The difference in diastolic BP reduction between CC/SC and SCP over time was statistically significant (-1.4 mm Hg [95% CI, -2.6 to -0.2). Patient activation did not differ between arms. CC/SC showed greater improvements in patient ratings of chronic illness care (Patient Assessment of Chronic Illness Care score) over 12 months (0.12 [95% CI, 0.02-0.22]). CONCLUSIONS Adding a collaborative care team to enhanced standard of care did not improve BP control but did improve patient ratings of chronic illness care.
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Affiliation(s)
- Lisa A. Cooper
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, Maryland
- The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jill A. Marsteller
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, Maryland
- The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Kathryn A. Carson
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, Maryland
- The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Katherine B. Dietz
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, Maryland
| | - Romsai T. Boonyasai
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Agency for Healthcare Research and Quality, Rockville, Maryland
| | - Carmen Alvarez
- Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, Maryland
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | - Deidra C. Crews
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Cheryl R. Dennison Himmelfarb
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, Maryland
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Johns Hopkins School of Nursing, Baltimore, Maryland
| | - Chidinma A. Ibe
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, Maryland
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Lisa Lubomski
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, Maryland
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Edgar R. Miller
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, Maryland
- The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Nae-Yuh Wang
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Gideon D. Avornu
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Deven Brown
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, Maryland
| | - Debra Hickman
- Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, Maryland
- Sisters Together and Reaching, Inc., Baltimore, MD
| | - Michelle Simmons
- Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, Maryland
| | - Ariella Apfel Stein
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, Maryland
| | - Hsin-Chieh Yeh
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, Maryland
- The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Jean-Louis G, Jin P, Moise R, Blanc J, Rogers A, Bubu OM, Chung D, Zizi F, Seixas AA. Effectiveness of peer-delivered sleep health education and social support in increasing OSA evaluation among at-risk blacks. J Sleep Res 2024:e14213. [PMID: 38773705 DOI: 10.1111/jsr.14213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 03/16/2024] [Accepted: 04/02/2024] [Indexed: 05/24/2024]
Abstract
To assess the effectiveness of culturally and linguistically tailored, peer-delivered obstructive sleep apnea education and of social support to increase adherence to physician-recommended obstructive sleep apnea evaluation among blacks. In a two-arm randomised controlled trial, we ascertained the effectiveness of peer-delivered obstructive sleep apnea education in increasing obstructive sleep apnea evaluation among 319 blacks at risk of obstructive sleep apnea (intervention = 159 and control = 160); their average age was 47 ± 12.9 years, and 41% were male. Obstructive sleep apnea risk was assessed with the Apnea Risk Evaluation System questionnaire, administered in community venues. Participants in the intervention arm received tailored obstructive sleep apnea education during a 6 month period; those in the control arm received standard sleep and healthy lifestyle information. Analysis focussed on the effectiveness of peer-delivered obstructive sleep apnea education on adherence to obstructive sleep apnea evaluation, but also considered the role of psychosocial factors. The results showed no significant differences in baseline demographic and clinical measures when contrasting participants in the study arms. The adherence rates for home-based obstructive sleep apnea evaluation in the intervention and control arms were 45.9% and 45.6%, respectively. Overall, participants in both study arms (adherers) who underwent obstructive sleep apnea evaluations were likely to experience a greater level of social support (8.2 ± 2.4 vs. 7.3 ± 2.4; p = 0.06). Moreover, adherers showed greater psychosocial scores (i.e., Dysfunctional Beliefs and Attitudes about Sleep scale, Apnea Beliefs Scale (ABS) (and Apnea Knowledge) compared with non-adherers (6.0 ± 1.8 vs. 4.9 ± 2.2; p = 0.02; 77.0 ± 7.1 vs. 73.2 ± 7.4; p = 0.04, and 6.4 ± 3.1 vs. 7.6 ± 2.4; p = 0.06, respectively). The results of the present randomised controlled trial favoured a potential role of peer-based social support and psychosocial factors, associated with obstructive sleep apnea adherence behaviour.
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Affiliation(s)
- Girardin Jean-Louis
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Miami, Florida, USA
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - P Jin
- Department of Population Health, NYU Grossman School of Medicine, New York City, New York, USA
| | - R Moise
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - J Blanc
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - A Rogers
- Department of Health and Human Services, St John's University, Jamaica, New York, USA
| | - O M Bubu
- Department of Population Health, NYU Grossman School of Medicine, New York City, New York, USA
| | - D Chung
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - F Zizi
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - A A Seixas
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Miami, Florida, USA
- Department of Informatics and Health Data Science, Miller School of Medicine, University of Miami, Miami, Florida, USA
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Mukhopadhyay A, Blecker S, Li X, Kronish IM, Chunara R, Zheng Y, Lawrence S, Dodson JA, Kozloff S, Adhikari S. Neighborhood-Level Socioeconomic Status and Prescription Fill Patterns Among Patients With Heart Failure. JAMA Netw Open 2023; 6:e2347519. [PMID: 38095897 PMCID: PMC10722333 DOI: 10.1001/jamanetworkopen.2023.47519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/30/2023] [Indexed: 12/17/2023] Open
Abstract
Importance Medication nonadherence is common among patients with heart failure with reduced ejection fraction (HFrEF) and can lead to increased hospitalization and mortality. Patients living in socioeconomically disadvantaged areas may be at greater risk for medication nonadherence due to barriers such as lower access to transportation or pharmacies. Objective To examine the association between neighborhood-level socioeconomic status (nSES) and medication nonadherence among patients with HFrEF and to assess the mediating roles of access to transportation, walkability, and pharmacy density. Design, Setting, and Participants This retrospective cohort study was conducted between June 30, 2020, and December 31, 2021, at a large health system based primarily in New York City and surrounding areas. Adult patients with a diagnosis of HF, reduced EF on echocardiogram, and a prescription of at least 1 guideline-directed medical therapy (GDMT) for HFrEF were included. Exposure Patient addresses were geocoded, and nSES was calculated using the Agency for Healthcare Research and Quality SES index, which combines census-tract level measures of poverty, rent burden, unemployment, crowding, home value, and education, with higher values indicating higher nSES. Main Outcomes and Measures Medication nonadherence was obtained through linkage of health record prescription data with pharmacy fill data and was defined as proportion of days covered (PDC) of less than 80% over 6 months, averaged across GDMT medications. Results Among 6247 patients, the mean (SD) age was 73 (14) years, and majority were male (4340 [69.5%]). There were 1011 (16.2%) Black participants, 735 (11.8%) Hispanic/Latinx participants, and 3929 (62.9%) White participants. Patients in lower nSES areas had higher rates of nonadherence, ranging from 51.7% in the lowest quartile (731 of 1086 participants) to 40.0% in the highest quartile (563 of 1086 participants) (P < .001). In adjusted analysis, patients living in the lower 2 nSES quartiles had significantly higher odds of nonadherence when compared with patients living in the highest nSES quartile (quartile 1: odds ratio [OR], 1.57 [95% CI, 1.35-1.83]; quartile 2: OR, 1.35 [95% CI, 1.16-1.56]). No mediation by access to transportation and pharmacy density was found, but a small amount of mediation by neighborhood walkability was observed. Conclusions and Relevance In this retrospective cohort study of patients with HFrEF, living in a lower nSES area was associated with higher rates of GDMT nonadherence. These findings highlight the importance of considering neighborhood-level disparities when developing approaches to improve medication adherence.
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Affiliation(s)
- Amrita Mukhopadhyay
- Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York
| | - Saul Blecker
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
- Department of Medicine, NYU Grossman School of Medicine, New York, New York
| | - Xiyue Li
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
| | - Ian M. Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, New York
| | - Rumi Chunara
- Department of Biostatistics, NYU School of Global Public Health, New York, New York
- Department of Computer Science & Engineering, Tandon School of Engineering, New York, New York
| | - Yaguang Zheng
- NYU Rory Meyers College of Nursing, New York, New York
| | - Steven Lawrence
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
| | - John A. Dodson
- Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York
| | - Sam Kozloff
- Department of Medicine, University of Utah, Salt Lake City
| | - Samrachana Adhikari
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
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Shiyanbola OO, Maurer M, Mott M, Schwerer L, Sarkarati N, Sharp LK, Ward E. A feasibility pilot trial of a peer-support educational behavioral intervention to improve diabetes medication adherence in African Americans. Pilot Feasibility Stud 2022; 8:240. [PMID: 36376960 PMCID: PMC9660113 DOI: 10.1186/s40814-022-01198-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 10/31/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND African Americans are twice as likely to die from diabetes, compared to other racial and ethnic groups in the USA. Poor adherence to diabetes medications is common among African Americans and contributes to these disproportionally worse outcomes. A pilot study was conducted to determine the feasibility and acceptability of a peer-supported intervention targeting diabetes and medication beliefs, communication, and self-efficacy skills to enhance medication adherence among African Americans with type 2 diabetes. METHODS Based on the extended self-regulatory model and information-motivation-behavioral skills model, this intervention was piloted using a single group pre/post-intervention study design at two sites. Seventeen African Americans who self-reported as adherent to diabetes medicines (ambassadors) were paired with 22 African Americans with self-reported poor medication adherence (buddies). Feasibility outcomes evaluated recruitment, retention, and intervention adherence. Measures assessed at baseline and 1-month post-intervention included glycemic control (hemoglobin A1c), self-reported medication adherence, diabetes beliefs, concerns about diabetes medicines, and diabetes self-efficacy. Wilcoxon signed-rank tests assessed for differences in mean scores of outcome variables at baseline compared with a 3-month follow-up. Semi-structured 60-min interviews were conducted with each buddy to explore their acceptability of the intervention. To ensure the rigor of the qualitative data, we focused on analytic criteria such as credibility, confirmability, and transferability. RESULTS Most buddies and ambassadors were female and about 56 years old. Feasibility outcomes included recruitment success rates of 73% for buddies and 85% for ambassadors relative to our goals. Retention rate for hemoglobin A1c and medication adherence outcome assessment was 95% for buddies. Both buddies and ambassadors had excellent intervention adherence, with buddies having a mean attendance of 7.76 out of 8 sessions/phone calls and ambassadors completing > 99% of the 105 intervention calls with Buddies. Results showed a signal of change in hemoglobin A1c (effect size = 0.14) and medication adherence (effect size = 0.35) among buddies, reduction in buddies' negative beliefs about diabetes and an increase in necessity beliefs of diabetes medicines. Summative interviews with buddies showed they valued ambassador's encouragement of self-management behaviors. CONCLUSIONS Results support conduct of an efficacy trial to address medication adherence for African Americans with type 2 diabetes using a peer-supported tailored intervention. TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT04028076 .
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Affiliation(s)
- Olayinka O Shiyanbola
- Division of Social and Administrative Sciences, University of Wisconsin-Madison School of Pharmacy, Madison, WI, USA.
| | - Martha Maurer
- Sonderegger Research Center, School of Pharmacy, University of Wisconsin-Madison School of Pharmacy, Madison, WI, USA
| | - Mattigan Mott
- School of Nursing, University of Wisconsin-Madison, Madison, WI, USA
| | - Luke Schwerer
- School of Pharmacy, University of Wisconsin-Madison, Madison, WI, 53705, USA
| | - Nassim Sarkarati
- School of Pharmacy, University of Wisconsin-Madison, Madison, WI, 53705, USA
| | - Lisa K Sharp
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois, Chicago, IL, USA
| | - Earlise Ward
- School of Nursing, University of Wisconsin-Madison, Madison, WI, USA
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Sarfo FS, Ovbiagele B. Utilizing Implementation Science to Bridge Cerebrovascular Health Disparities: a Local to Global Perspective. Curr Neurol Neurosci Rep 2022; 22:293-303. [PMID: 35381952 PMCID: PMC9081275 DOI: 10.1007/s11910-022-01193-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2022] [Indexed: 01/15/2023]
Abstract
PURPOSE OF REVIEW Stroke is a prime example of a medical disorder whose incidence, prevalence, and outcomes are strongly characterized by health disparities across the globe. This scoping literature review seeks to depict how implementation science could be utilized to advance health equity in the prevention, acute treatment, and post-acute management of stroke in the underserved regions of high-income countries as well as in all low-income countries. RECENT FINDINGS A major reason for the persisting and widening cerebrovascular disease disparities is that evidence-based stroke prevention and treatment interventions have been differentially translated (if at all) to various populations and settings. The field of implementation science is endowed with frameworks, theories, methodological approaches, and outcome measures, including equity indices, which could be harnessed to facilitate the translation of evidence-based interventions into clinical practice for underserved and vulnerable communities. Encouragingly, there are several novel frameworks, which eminently merge implementation science constructs with health equity determinants, thereby opening up key opportunities to bridge burgeoning worldwide gaps in cerebrovascular health equity.
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Affiliation(s)
- Fred Stephen Sarfo
- Department of Medicine, Kwame Nkrumah University of Science & Technology, Private Mail Bag, Kumasi, Ghana.
- Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
| | - Bruce Ovbiagele
- Department of Neurology, University of California, San Francisco, USA
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Bond J, Julion WA, Reed M. Racial Discrimination and Race-Based Biases on Orthopedic-Related Outcomes: An Integrative Review. Orthop Nurs 2022; 41:103-115. [PMID: 35358128 DOI: 10.1097/nor.0000000000000830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Musculoskeletal diseases often lead to functional limitations and debility. The burden of these debilitating diseases is not balanced across race and ethnicity. The Institute of Medicine (now referred to as the National Academy of Medicine) identified racial discrimination as a substantive cause of race-based health disparities for racial and ethnic minority groups. The purpose of this integrative review is to summarize the evidence on the relationship among racial discrimination, race-based implicit biases and other types of biases (e.g., gender and appearance), and orthopaedic-related outcomes. Nine studies met inclusion criteria and were included in this review. The orthopaedic outcomes addressed across the nine studies were osteoarthritis, rheumatoid arthritis, low back pain, pain tolerance, disability, and likelihood of being recommended for a total knee arthroplasty. The results reveal that experiences of racial discrimination, race-based implicit biases, and other types of biases contribute to unsatisfactory orthopaedic-related outcomes for minority groups. Orthopaedic nurses can leverage their expertise to address these disparities in orthopaedic-related outcomes across minority groups.
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Affiliation(s)
- Jerenda Bond
- Jerenda Bond, PT, DPT, Graduate College, Rush University, Chicago, IL
- Wrenetha A. Julion, PhD, MPH, RN, CNL, FAAN, Associate Dean for Equity and Inclusion, Professor, Department of Women, Children and Family Nursing, College of Nursing, Rush University, Chicago, IL
- Monique Reed, PhD, MS, RN, FAAN, Associate Professor, Department of Community, Systems and Mental Health Nursing, College of Nursing, Rush University, Chicago, IL
| | - Wrenetha A Julion
- Jerenda Bond, PT, DPT, Graduate College, Rush University, Chicago, IL
- Wrenetha A. Julion, PhD, MPH, RN, CNL, FAAN, Associate Dean for Equity and Inclusion, Professor, Department of Women, Children and Family Nursing, College of Nursing, Rush University, Chicago, IL
- Monique Reed, PhD, MS, RN, FAAN, Associate Professor, Department of Community, Systems and Mental Health Nursing, College of Nursing, Rush University, Chicago, IL
| | - Monique Reed
- Jerenda Bond, PT, DPT, Graduate College, Rush University, Chicago, IL
- Wrenetha A. Julion, PhD, MPH, RN, CNL, FAAN, Associate Dean for Equity and Inclusion, Professor, Department of Women, Children and Family Nursing, College of Nursing, Rush University, Chicago, IL
- Monique Reed, PhD, MS, RN, FAAN, Associate Professor, Department of Community, Systems and Mental Health Nursing, College of Nursing, Rush University, Chicago, IL
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Psychometric Analysis of Hypertension Self-Management Behaviors Questionnaire; an Application of Intervention Mapping Approach in Questionnaire Development. JOURNAL OF EDUCATION AND COMMUNITY HEALTH 2021. [DOI: 10.52547/jech.8.4.237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Determinants of Hypertension Self-management Behaviors: An Application of the Intervention Mapping Approach. HEALTH SCOPE 2021. [DOI: 10.5812/jhealthscope.112994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Hypertension is one of the key risk factors for several diseases. Objectives: The aim of this study was to determine the determinants of hypertension self-management behaviors (HSBs) based on intervention mapping approach. Methods: A cross-sectional study was conducted among 800 hypertensive patients in southwestern Iran in 2018. A structured questionnaire was applied for data collection. Data were analyzed using SPSS version 16. Results: The mean age of respondents was 58.25 years (SD: 12.10; age range: 30 - 74 years). The best predictors for HSBs were perceived barriers, outcome expectations, and self-efficacy. Conclusions: Our findings have implications for the evidence-based design of HSBs promotion interventions.
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Dong X, Tsang CCS, Wan JY, Shih YCT, Chisholm-Burns MA, Dagogo-Jack S, Cushman WC, Hines LE, Wang J. Exploring racial and ethnic disparities in medication adherence among Medicare comprehensive medication review recipients. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2021; 3. [PMID: 35434697 PMCID: PMC9009823 DOI: 10.1016/j.rcsop.2021.100041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background There has been a lack of evidence on whether there are racial and ethnic disparities in medication nonadherence among individuals receiving comprehensive medication review (CMR), a required component of the Medicare Part D medication therapy management (MTM) services. Objectives To explore racial/ethnic disparities in medication nonadherence among older MTM enrollees who received a CMR and to determine how much the identified disparities can be explained by observed characteristics. Methods The retrospective study used 100% of the 2017 Medicare claims, including MTM data. Linked Area Health Resources Files provided community characteristics. Nonadherence was defined as proportion of days covered <80%, and was measured for diabetes, hypertension, and hyperlipidemia medications. Racial/ethnic disparities were examined by logistic regressions that included racial/ethnic minority dummy variables. A nonlinear Blinder-Oaxaca decomposition method was applied to decompose the identified disparities. Results Compared with non-Hispanic Whites (Whites), Blacks were respectively 39% (odds ratio [OR] = 1.39, 95% confidence interval [CI] = 1.33–1.45), 27% (OR = 1.27, 95% CI = 1.22–1.32), and 43% (OR = 1.43, 95% CI = 1.39–1.47) more likely to be nonadherent to diabetes, hypertension, and hyperlipidemia medications; Hispanics were 20% (OR = 1.20, 95% CI = 1.14–1.27) more likely to be nonadherent to hyperlipidemia medications. The total portion of disparity explained was 13.42%, 7.66%, 14.87%, and 10.69% respectively for disparities in Black-White (B–W) diabetes, B–W hypertension, B–W hyperlipidemia, and Hispanic-White hyperlipidemia. The top three contributors were the proportion of married-couple families, census region, and male gender. Conclusions A lower level of community affluence and social support, regional variations, and a lower proportion of males in Blacks and Hispanics may contribute to the disparities in medication nonadherence. The large unexplained portion of the disparity attests that nonadherence is a complex issue. The Medicare MTM program needs to implement measures to reduce disparities in medication adherence. This retrospective study used 100% of the 2017 Medicare claims including MTM data. Racial/ethnic disparity in medication adherence was identified among CMR recipients. Blacks were more likely than Whites to be nonadherent to all medications studied. Hispanics were more likely than Whites to be hyperlipidemia medication nonadherent. Observed characteristics explained close to 15% of the identified disparity.
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Affiliation(s)
- Xiaobei Dong
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Room 214, Memphis, TN 38163, United States of America
| | - Chi Chun Steve Tsang
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Room 212, Memphis, TN 38163, United States of America
| | - Jim Y. Wan
- Department of Preventive Medicine, University of Tennessee Health Science Center College of Medicine, 66 N. Pauline, Suite 633, Memphis, TN 38163, United States of America
| | - Ya-Chen Tina Shih
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1444, Houston, TX 77030, United States of America
| | - Marie A. Chisholm-Burns
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Room 264, Memphis, TN 38163, United States of America
| | - Samuel Dagogo-Jack
- Division of Endocrinology, Diabetes & Metabolism, Clinical Research Center, University of Tennessee Health Science Center College of Medicine, 920 Madison Avenue, Suite 300A, Memphis, TN 38163, United States of America
| | - William C. Cushman
- Department of Preventive Medicine, University of Tennessee Health Science Center College of Medicine, 66 North Pauline Street, Suite 651, Memphis, TN 38163, United States of America
| | - Lisa E. Hines
- Pharmacy Quality Alliance, 5911 Kingstowne Village Parkway, Suite 130, Alexandria, VA 22315, United States of America
| | - Junling Wang
- Department of Clinical Pharmacy & Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Room 221, Memphis, TN 38163, United States of America
- Corresponding author.
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10
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Nakata C, Sharp LK, Spanjol J, Cui AS, Izberk-Bilgin E, Crawford SY, Xiao Y. Narrative arcs and shaping influences in long-term medication adherence. Soc Sci Med 2021; 285:114264. [PMID: 34329922 DOI: 10.1016/j.socscimed.2021.114264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 07/11/2021] [Accepted: 07/22/2021] [Indexed: 11/30/2022]
Abstract
Long-term adherence to medications is not well understood and poses a significant challenge for many chronically ill persons. Past research provides insights on adherence in short durations such as a day or several weeks, even though chronically ill patients are required to take medications for periods as long as a lifetime. To fill this important knowledge gap, we study the temporal unfolding of prolonged medication-taking experiences among thirty adults, mostly African American, with chronic hypertension in the U.S. Specifically, we take an extended, experience-centered, narrative approach to examine retrospective patient accounts of adherence efforts over spans of one year to more than four decades. Applying Gergen and Gergen's concept of narrative forms (1983), we find four distinct narrative arcs, or patterned sequences of medication consumption, that we term Out of the Gate, Existential Turn, Fits and Starts, and Slow Climb, along with individual and social elements that shape and shift practices in the context of time.
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Affiliation(s)
- Cheryl Nakata
- Department of Marketing, Entrepreneurship, Hospitality, & Tourism, Bryan School of Business and Economics, University of North Carolina at Greensboro, 516 Stirling Street, 348 Bryan Building, Greensboro, NC, 27402, USA.
| | - Lisa K Sharp
- Institute for Health Research and Policy, 463 Westside Research Office Building, 1747 West Roosevelt Road, Chicago, IL, 60608, USA; Department of Pharmacy Systems, Outcomes, and Policy in the College of Pharmacy, University of Illinois at Chicago, 833 S. Wood Street (MC 871), Chicago, IL, 60612, USA.
| | - Jelena Spanjol
- Ludwig-Maximilians-Universität (LMU) München, LMU Munich School of Management, Geschwister-Scholl-Platz 1, 80539 München, Germany.
| | - Anna Shaojie Cui
- Department of Marketing, College of Business Administration, University of Illinois at Chicago, 601 S. Morgan (MC 243), Chicago, IL, 60607, USA.
| | - Elif Izberk-Bilgin
- Department of Management Studies, College of Business, University of Michigan-Dearborn, 151 FCS, Dearborn, MI, 48126, USA.
| | - Stephanie Y Crawford
- Department of Pharmacy Systems, Outcomes, and Policy in the College of Pharmacy, University of Illinois at Chicago, 833 S. Wood Street (MC 871), Chicago, IL, 60612, USA.
| | - Yazhen Xiao
- Department of Marketing, University of Tennessee, 321 Stokely Management Center, 916 Volunteer Boulevard, Knoxville, TN, 37996-0530, USA.
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11
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Engmann L, Sun F, Legro RS, Diamond MP, Zhang H, Santoro N. Factors associated with study protocol adherence and bio banking participation in reproductive medicine clinical trials and their relationship to live birth. Hum Reprod 2021; 35:2819-2831. [PMID: 33190149 DOI: 10.1093/humrep/deaa232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 07/14/2020] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION What demographic and baseline characteristics are predictive of adherence to reproductive medicine clinical trial protocols, live birth or participation in genetic studies? SUMMARY ANSWER Race, BMI and lower income are associated with likelihood of non-adherent to reproductive medicine clinical trial protocols, while race influences collection of biological samples and non-adherent to study protocols is associated with lower probability of live birth. WHAT IS KNOWN ALREADY Although aspects of adherence to study protocol have previously been evaluated as individual factors in infertile women, the factors that affect overall non-adherent to study protocol have not been previously evaluated. STUDY DESIGN, SIZE, DURATION A secondary data analysis of 1650 participants from two prospective multicenter, double-blind controlled studies was carried out: Pregnancy in Polycystic Ovary Syndrome II (PPCOS II) and Assessment of Multiple Intrauterine Gestations from Ovarian Stimulation (AMIGOS). PARTICIPANTS/MATERIALS, SETTING, METHODS The participants were women aged 18-40 years old with either polycystic ovary syndrome (PCOS) with ovulatory dysfunction in combination with either hyperandrogenemia and/or polycystic ovarian morphology (PPCOS II), or regular ovulatory cycles with unexplained infertility (AMIGOS). The study was carried out in 14 clinical sites in the USA. Non-adherence to clinical trial protocol was chosen as the primary outcome for this analysis. To evaluate whether demographic and baseline characteristics were predictive of adherence to study protocols, live birth or participation in blood sampling for DNA and repository, and pregnancy registry, these putative factors were compared between the outcome measures. Logistic regression was used to establish a prediction model using the putative predictors introduced above. MAIN RESULTS AND THE ROLE OF CHANCE Women who self-identified as African American or Asian and those with higher BMI and lower household income were less likely to adhere to protocol. Non-adherence to the study protocol was associated with a lower probability of live birth (odds ratio: 0.180, 95% CI: 0.120, 0.272, P < 0.001). African Americans or Asians were less likely to participate in optional study DNA collection compared to Whites. Participants who were African American or with high annual income or from the Southwest sites or had PCOS were less likely to participate in the blood repository studies. LIMITATIONS, REASONS FOR CAUTION Race and ethnicity were self-reported and such self-classification to strict race and ethnicity may not always be representative of a whole racial or ethnic group. This study included two US multicenter trials and therefore the findings may not be extrapolated to international trials. WIDER IMPLICATIONS OF THE FINDINGS Identification of populations with low participation is an important initial step, as further investigation can develop specific measures to improve adherence to study protocols and participation in biospecimen banking and thereby extend the representativeness of reproductive medicine clinical trial findings. STUDY FUNDING/COMPETING INTEREST(S) Supported by NIH Eunice Kennedy Shriver NICHD Grants: U10 HD39005, U10 HD38992, U10 HD27049, U10 HD38998, U10 HD055942, HD055944, U10 HD055936, U10HD055925, PPCOSII: U10 HD27049, U10 HD38992, U10 HD055925, U10 HD39005, U10 HD38998, U10 HD055936, U10 HD055942, U10 HD055944; Clinical Reproductive Endocrine Scientist Training Program (CREST): R25HD075737. Outside this study, M.P.D. received NIH/NIHCD research grant and R.S.L. received research grant from Ferring and was consultant for Bayer, Kindex, Odega, Millendo and AbbVie. TRIAL REGISTRATION NUMBER ClinicalTrials.gov number: NCT00719186; NCT01044862.
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Affiliation(s)
- Lawrence Engmann
- Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Fangbai Sun
- Department of Biostatistics, Yale University School of Public Health, New Haven, CT, USA
| | - Richard S Legro
- Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey, PA, USA
| | - Michael P Diamond
- Department of Obstetrics and Gynecology, Augusta University, Augusta, GA, USA
| | - Heping Zhang
- Department of Biostatistics, Yale University School of Public Health, New Haven, CT, USA
| | - Nanette Santoro
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO, USA
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12
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Alvarez C, Hines AL, Carson KA, Andrade N, Ibe CA, Marsteller JA, Cooper LA. Association of Perceived Stress and Discrimination on Medication Adherence among Diverse Patients with Uncontrolled Hypertension. Ethn Dis 2021; 31:97-108. [PMID: 33519160 PMCID: PMC7843046 DOI: 10.18865/ed.31.1.97] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Uncontrolled hypertension is a significant risk factor for cardiovascular morbidity and mortality. In the United States, many patients remain uncontrolled, in part, due to poor medication adherence. Efforts to improve hypertension control include not only attending to medical management of the disease but also the social determinants of health, which impact medication adherence, and ultimately blood pressure control. Purpose To determine which social determinants - health care access or community and social stressors - explain medication adherence. Methods In this cross-sectional analysis, we used baseline data (N=1820, collected August 2017 to October 2019) from a pragmatic trial, which compares the effectiveness of a multi-level intervention including collaborative care and a stepped approach with enhanced standard of care for improving blood pressure. We used logistic regression analyses to examine the association between patient experiences of care and community and social stressors with medication adherence. Results The participants represented a diverse sample: mean age of 60 years; 59% female; 57.3% Black, 9.6% Hispanic, and 33.2% White. All participants had a blood pressure reading ≥140/90 mm Hg (mean blood pressure - 152/85 mm Hg). Half of the participants reported some level of non-adherence to medication. Regression analysis showed that, compared with Whites, Blacks (AOR .47; 95% CIs: .37-.60, P<.001) and Hispanics (AOR .48; 95% CIs: .32- .73, P<.001) were less likely to report medication adherence. Also part-time workers (AOR .57; 95% CIs: .38-.86, P<.05), and those who reported greater perceived stress (AOR .94; 95% CIs: .91 - .98, P<.001) and everyday discrimination (AOR .73; 95% CIs: .59 - .89; P<.001) had lower odds of medication adherence. Among Blacks, greater perceived stress (AOR .93; 95% CIs: .88-.98, P<.001) and everyday discrimination (AOR .63; 95% CIs: .49 - .82, P<.005) were negatively associated with medication adherence. Among Hispanics, greater report of everyday discrimination (AOR .36; 95% CIs: .14 - .89, P<.005) was associated with lower odds of medication adherence. Among Whites, the negative effect of perceived stress on medication adherence was attenuated by emotional support. Conclusions Using the social determinants of health framework, we identified associations between stress, everyday discrimination and medication adherence among non-Hispanic Blacks and Hispanics that were independent of health status and other social determinants. Programs to enhance self-management for African American and Hispanic patients with uncontrolled blood pressure should include a specific focus on addressing social stressors.
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Affiliation(s)
- Carmen Alvarez
- Johns Hopkins University School of Nursing, Baltimore, MD.,Johns Hopkins Center for Health Equity, Baltimore, MD
| | - Anika L Hines
- Virginia Commonwealth University School of Medicine, Department of Health Behavior and Policy, Richmond, VA
| | - Kathryn A Carson
- Johns Hopkins Center for Health Equity, Baltimore, MD.,Johns Hopkins University School of Medicine, Department of Medicine, Division of General Internal Medicine, Baltimore, MD
| | - Nadia Andrade
- Johns Hopkins University School of Nursing, Baltimore, MD
| | - Chidinma A Ibe
- Johns Hopkins Center for Health Equity, Baltimore, MD.,Johns Hopkins University School of Medicine, Department of Medicine, Division of General Internal Medicine, Baltimore, MD
| | - Jill A Marsteller
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, MD
| | - Lisa A Cooper
- Johns Hopkins University School of Nursing, Baltimore, MD.,Johns Hopkins Center for Health Equity, Baltimore, MD.,Johns Hopkins University School of Medicine, Department of Medicine, Division of General Internal Medicine, Baltimore, MD.,Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, Baltimore, MD
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13
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Abdul Wahab NA, Makmor Bakry M, Ahmad M, Mohamad Noor Z, Mhd Ali A. Exploring Culture, Religiosity and Spirituality Influence on Antihypertensive Medication Adherence Among Specialised Population: A Qualitative Ethnographic Approach. Patient Prefer Adherence 2021; 15:2249-2265. [PMID: 34675490 PMCID: PMC8502050 DOI: 10.2147/ppa.s319469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 08/21/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Hypertension is one of the major risk factors of stroke and leading risk factors for global death. Inadequate control of blood pressure due to medication non-adherence remains a challenge and identifying the underlying causes will provide useful information to formulate suitable interventions. PURPOSE This study aimed to explore the roles of culture, religiosity, and spirituality on adherence to anti-hypertensive medications. METHODOLOGY A semi-structured qualitative interview was used to explore promoters and barriers to medication adherence among hypertensive individuals residing in urban and rural areas of Perak State, West Malaysia. Study participants were individuals who are able to comprehend either in Malay or English, above 18 years old and on antihypertensive medications. Interview transcriptions from 23 participants were coded inductively and analyzed thematically. Codes generated were verified by three co-investigators who were not involved in transcribing process. The codes were matched with quotations and categorized using three levels of themes named as organizing, classifying and general themes. RESULTS Cultural aspects categorized as societal and communication norms were related to non-adherence. The societal norms related to ignorance, belief in testimony and anything "natural is safe" affected medication adherence negatively. Communication norms manifested as superficiality, indirectness and non-confrontational were also linked to medication non-adherence. Internal and organizational religiosity was linked to increased motivation to take medication. In contrast, religious misconception about healing and treatment contributed towards medication non-adherence. The role of spirituality remains unclear and seemed to be understood as related to religiosity. CONCLUSION Culture and religiosity (C/R) are highly regarded in many societies and shaped people's health belief and behaviour. Identifying the elements and mechanism through which C/R impacted adherence would be useful to provide essential information for linking adherence assessment to the interventions that specifically address causes of medication non-adherence.
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Affiliation(s)
- Noor Azizah Abdul Wahab
- Centre of Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, 50300, Malaysia
- Faculty of Pharmacy and Health Sciences, Universiti Kuala Lumpur Royal College of Medicine Perak, Perak, 30450, Malaysia
| | - Mohd Makmor Bakry
- Centre of Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, 50300, Malaysia
| | - Mahadir Ahmad
- Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, 50300, Malaysia
| | - Zaswiza Mohamad Noor
- Faculty of Pharmacy and Health Sciences, Universiti Kuala Lumpur Royal College of Medicine Perak, Perak, 30450, Malaysia
| | - Adliah Mhd Ali
- Centre of Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, 50300, Malaysia
- Correspondence: Adliah Mhd Ali Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, 50300, MalaysiaTel +603-9289 7964Fax +603-2698 3271 Email
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The RICH LIFE Project: A cluster randomized pragmatic trial comparing the effectiveness of health system only vs. health system Plus a collaborative/stepped care intervention to reduce hypertension disparities. Am Heart J 2020; 226:94-113. [PMID: 32526534 DOI: 10.1016/j.ahj.2020.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 05/04/2020] [Indexed: 01/08/2023]
Abstract
Disparities in the control of hypertension and other cardiovascular disease risk factors are well-documented in the United States, even among patients seen regularly in the healthcare system. Few existing approaches explicitly address disparities in hypertension care and control. This paper describes the RICH LIFE Project (Reducing Inequities in Care of Hypertension: Lifestyle Improvement for Everyone) design. METHODS RICH LIFE is a two-arm, cluster-randomized trial, comparing the effectiveness of enhanced standard of care, "Standard of Care Plus" (SCP), to a multi-level intervention, "Collaborative Care/Stepped Care" (CC/SC), for improving blood pressure (BP) control and patient activation and reducing disparities in BP control among 1890 adults with uncontrolled hypertension and at least one other cardiovascular disease risk factor treated at 30 primary care practices in Maryland and Pennsylvania. Fifteen practices randomized to the SCP arm receive standardized BP measurement training; race/ethnicity-specific audit and feedback of BP control rates; and quarterly webinars in management practices, quality improvement and disparities reduction. Fifteen practices in the CC/SC arm receive the SCP interventions plus implementation of the collaborative care model with stepped-care components (community health worker referrals and virtual specialist-panel consults). The primary clinical outcome is BP control (<140/90 mm Hg) at 12 months. The primary patient-reported outcome is change from baseline in self-reported patient activation at 12 months. DISCUSSION This study will provide knowledge about the feasibility of leveraging existing resources in routine primary care and potential benefits of adding supportive community-facing roles to improve hypertension care and reduce disparities. TRIAL REGISTRATION Clinicaltrials.govNCT02674464.
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15
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Medication adherence in the older adults with chronic multimorbidity: a systematic review of qualitative studies on patient's experience. Eur Geriatr Med 2020; 11:369-381. [PMID: 32297271 DOI: 10.1007/s41999-020-00313-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 03/17/2020] [Indexed: 01/04/2023]
Abstract
PURPOSE Medication non-adherence represents a socially relevant challenge, particularly when interlinked to multiple chronic diseases and polypharmacy. Non-adherence rates affect treatment efficacy and increase health care costs. The aim of the study was to identify factors influencing medication adherence in the older adults through a systematic review of qualitative studies on patients' experience. METHODS Two electronic databases were searched for qualitative studies on medication adherence in chronic diseases (hypertension, heart disease, COPD, asthma) involving people aged 65 + . The systematic review was performed according to the PRISMA statement guidelines, employing theoretical frameworks of the ABC Taxonomy of patient adherence and Three Factor model of determinants of behaviour. RESULTS The initial database search identified 1234 records, of which 39 studies were considered eligible. Most of the studies focused on hypertension and were conducted in English-speaking countries. According to the ABC Taxonomy, Persistence and Implementation were the most often considered phases. Considering the Three Factor model, the most often reported themes were Information and Strategies upon being adherent. Stemming from the review findings and the patients' narratives, a new integrated model was proposed. It reports the patient's decisional flowchart describing barriers and facilitators (personal, social and environmental) to adherence. CONCLUSION Medication adherence is a complex and multifaceted process. The implementation of theoretical frameworks along with a patient-centred perspective may provide clinicians with useful suggestions for clinical practice, enhancing the patient's ability to adhere.
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Spikes T, Higgins M, Clark P, Quyyumi A, Reilly C, Pemu P, Dunbar S. The Relationship Among Health Beliefs, Depressive Symptoms, Medication Adherence, and Social Support in African Americans With Hypertension. J Cardiovasc Nurs 2020; 34:44-51. [PMID: 30273259 PMCID: PMC6752722 DOI: 10.1097/jcn.0000000000000519] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND African Americans are disproportionately affected by hypertension and have lower medication adherence when compared to other racial groups. Antecedent factors such as beliefs surrounding hypertension, the presence or absence of social support, and depressive symptoms have not been extensively studied collectively in relation to hypertension medication adherence in African Americans. OBJECTIVE To determine the associations among demographic and clinical factors, depressive symptoms, hypertension beliefs, and social support with blood pressure medication adherence in middle-aged African American adults with a diagnosis of hypertension. METHODS A cross-sectional study of (N = 120) African Americans (mean age, 49 years; 22.5% men) with a current diagnosis of metabolic syndrome, including hypertension, who reported having and taking a prescribed blood pressure-lowering medication were included. Descriptive statistics, bivariate correlation analysis, and logistic regression using odds ratio were used to examine the effects of high blood pressure beliefs, social support, and depression on medication adherence. RESULTS A small but significant relationship was found between medication adherence and number of comorbidities (r = 0.19, P = .04). In a multivariate regression model, after controlling for gender, comorbidities remained associated with medication adherence (β = 0. 77, P = .04). Depressive symptoms, high blood pressure beliefs, and social support did not have a significant relationship with medication adherence. CONCLUSIONS Multiple comorbidities may have a positive impact upon medication adherence. Further study is needed in a larger sample of African Americans who have a diagnosis of hypertension in addition to other comorbidities requiring medication management.
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Affiliation(s)
- Telisa Spikes
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Rd. NE Atlanta, GA 30322-4027 , 404-493-1161
| | - Melinda Higgins
- Nell Hodgson Woodruff, School of Nursing, Emory University, 1520 Clifton Rd, NE Atlanta, GA 30322-4027, office# 260 ; (office): 404-727-5180
| | - Patricia Clark
- Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, 140 Decatur St, SE Atlanta, GA 30303, , (office): 404-413-1180 & (fax): 404-413-1205
| | - Arshed Quyyumi
- Emory Clinical Cardiovascular Research Institute, Emory University, 1462 Clifton Rd. NE, Atlanta, GA 30322-4027, Suite 507, ; (office): 404-727-3655 & (fax): 404-712-8785
| | - Carolyn Reilly
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Rd, NE Atlanta, GA office# 366 30322-4027, ; (office): 404-727-9658
| | - Pricilla Pemu
- Morehouse School of Medicine, 720 Westview Drive, Atlanta, GA 30310, ; (office): 404-616-8201
| | - Sandra Dunbar
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Rd, NE office 402B Atlanta, GA 30322-4027, ; (office): 404-727-6939
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Nyaaba GN, Agyemang C, Masana L, de-Graft Aikins A, Beune E, Larrea-Killinger C, Stronks K. Illness representations and coping practices for self-managing hypertension among sub-Saharan Africans: A comparative study among Ghanaian migrants and non-migrant Ghanaians. PATIENT EDUCATION AND COUNSELING 2019; 102:1711-1721. [PMID: 30992171 DOI: 10.1016/j.pec.2019.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 04/02/2019] [Accepted: 04/05/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Hypertension (HTN) control is a major obstacle among sub-Saharan African populations partly due to poor self-management. We explored and compared how persons' social and physical context shapes their illness representations regarding HTN and the coping strategies they develop and adapt to mitigate challenges in self-managing HTN. METHODS A cross sectional multisite qualitative study using semi-structured interviews among 55 Ghanaians with HTN living in The Netherlands and urban and rural Ghana. A thematic approach was used in data analysis. RESULTS Family HTN history, personal experiences with HTN and outcomes of using biomedical and traditional treatments shaped participants' illness representations and coping strategies. Migrants and urban non-migrants modified medication schedules and integrated taking medication into daily routine activities to cope with experienced side effects of taking antihypertensive medication while rural non-migrants used traditional remedies and medicines to mitigate experienced medication side effects and/or in search for a cure for HTN. CONCLUSION Contextual factors within participants' social and physical environments shape their illness representations and coping strategies for HTN though interactive phrases. PRACTICE IMPLICATIONS Health professionals should harness the relationships within peoples' social and physical environments, encourage implementation of family-wide behavioural changes and involve family and communities in HTN treatment to enhance patients' self-management of HTN.
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Affiliation(s)
- Gertrude Nsorma Nyaaba
- Department of Public Health, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam University Medical Centres, Amsterdam, The Netherlands; Barcelona Institute for Global Health (IS Global), University of Barcelona, Barcelona, Spain.
| | - Charles Agyemang
- Department of Public Health, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Lina Masana
- Barcelona Institute for Global Health (IS Global), University of Barcelona, Barcelona, Spain; Medical Anthropology Research Centre-URV Tarragona, Spain
| | - Ama de-Graft Aikins
- Regional Institute for Population Studies, University of Ghana, Legon, Ghana
| | - Erik Beune
- Department of Public Health, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | | | - Karien Stronks
- Department of Public Health, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam University Medical Centres, Amsterdam, The Netherlands
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Fongwa MN, dela Cruz FA, Hays RD. African American women's perceptions of the meaning of support groups for improving adherence to hypertension treatment: a conceptual model. Nurs Open 2019; 6:860-870. [PMID: 31367409 PMCID: PMC6650675 DOI: 10.1002/nop2.266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 02/18/2019] [Indexed: 11/07/2022] Open
Abstract
AIM To investigate the meaning of support groups and the features of these groups that African American (AA) women view as improving adherence to high blood pressure (HBP) treatment. The study generated a conceptual model to illuminate features of these groups that influence adherence of AA women to HBP treatment. DESIGN Qualitative research. METHODS Used focus groups and open-ended questions to obtain the views of 26 eligible AA women, recruited from South Los Angeles. Line-by-line review and coding of interview transcripts were done. The feedback was used to specify a conceptual model depicting the meaning of support groups. The Consolidated Criteria for the Reporting of Qualitative Research guidelines were used. RESULTS The conceptual model depicts the meaning of support groups as information giving/knowledge sharing, emotional or psychological support, instrumental support and coaching, and facilitators and barriers to joining support groups and factors for consideration in forming these groups.
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Affiliation(s)
| | | | - Ron D. Hays
- Department of MedicineUCLALos AngelesCalifornia
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19
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Kang AW, Dulin A, Nadimpalli S, Risica PM. Stress, adherence, and blood pressure control: A baseline examination of Black women with hypertension participating in the SisterTalk II intervention. Prev Med Rep 2018; 12:25-32. [PMID: 30128268 PMCID: PMC6098218 DOI: 10.1016/j.pmedr.2018.08.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 07/31/2018] [Accepted: 08/02/2018] [Indexed: 01/13/2023] Open
Abstract
The prevalence of hypertension is highest among Black women, but treatment adherence is reportedly low. Stress unique to the experiences of Black Americans may be associated with low adherence and poor blood pressure control, but few studies have examined the relationships between stress, adherence, and blood pressure control among hypertensive Black women. This study seeks to fill gaps in research by examining the association between stress, adherence, and blood pressure control. The baseline sample (n = 571) of at-risk or hypertensive Black women from the SisterTalk II RCT (Northeastern USA, 2004-2006) to improve adherence to recommendations for hypertension was analyzed. Participants self-reported stress, pharmacological adherence, non-pharmacological adherence (i.e. lifestyle management such as diet and exercise), and demographics. Blood pressure and anthropometrics (BMI and waist circumference) were measured. Statistical analysis included ANOVA, t-tests, linear regression. Tests of mediation examined if adherence mediated the relationship between stress and blood pressure control. This study found that stress was associated with lower age (p < .001) and being a single parent (p < .001). Stress was also associated with higher systolic blood pressure (p = .029), and poor blood pressure control (p = .043). Participants who reported higher stress also reported lower non-pharmacological adherence (p = .042). Non-pharmacological adherence was found to mediate the association between stress and blood pressure control. Hence, results document a relationship between stress with non-pharmacological adherence and blood pressure control among Black American women. More research is necessary to examine the relationship between stress and treatment adherence.
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Affiliation(s)
- Augustine W. Kang
- Center for Health Equity Research, Brown University School of Public Health, Providence, RI, USA
| | - Akilah Dulin
- Center for Health Equity Research, Brown University School of Public Health, Providence, RI, USA
- Department of Behavioral and Social Sciences, Brown School of Public Health, Providence, RI, USA
| | - Sarah Nadimpalli
- Center for Health Equity Research, Brown University School of Public Health, Providence, RI, USA
| | - Patricia M. Risica
- Center for Health Equity Research, Brown University School of Public Health, Providence, RI, USA
- Department of Behavioral and Social Sciences, Brown School of Public Health, Providence, RI, USA
- Department of Epidemiology, Brown School of Public Health, Providence, RI, USA
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Seixas AA, Trinh-Shevrin C, Ravenell J, Ogedegbe G, Zizi F, Jean-Louis G. Culturally tailored, peer-based sleep health education and social support to increase obstructive sleep apnea assessment and treatment adherence among a community sample of blacks: study protocol for a randomized controlled trial. Trials 2018; 19:519. [PMID: 30249293 PMCID: PMC6154893 DOI: 10.1186/s13063-018-2835-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 08/02/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Compared to whites, blacks are at increased risk for obstructive sleep apnea (OSA) yet less likely to adhere to physician-recommended sleep assessment and treatment. Poor OSA health literacy and lack of social support to navigate the current healthcare system are two potential barriers to adequate OSA care. This study is designed to address these barriers by evaluating the effectiveness of a peer-based sleep health education program on adherence to OSA assessment and treatment among blacks at risk for OSA. METHOD/DESIGN In a two-arm, randomized controlled trial, we will ascertain the effectiveness of peer-based sleep health education and social support in increasing OSA evaluation and treatment rates among 398 blacks at low to high OSA risk. Participants at risk of OSA will receive quality controlled, culturally, and linguistically tailored peer education based on Motivational Enhancement principles over a period of 12 months. During this 12-month period, participants are encouraged to participate in a sleep home study to determine risk of OSA and, if found to be at risk, they are invited to undergo a diagnostic sleep assessment at a clinic. Participants who are diagnosed with OSA and who are prescribed continuous positive airway pressure treatment will be encouraged, through peer-based education, to adhere to recommended treatment. Recruitment for the project is ongoing. DISCUSSION The use of a culturally tailored sleep health education program, peer health educators trained in sleep health, and home-based sleep assessment are novel approaches in improving OSA assessment and treatment adherence in blacks who are significantly at risk for OSA. Empirical evidence from this trial will provide clinical and population level solutions on how to improve and increase assessment and treatment of OSA among blacks. TRIAL REGISTRATION NCT02427815 . Registered on 20 April 2015. ClinicalTrials.gov title: Sleep Health Education and Social Support Among Blacks With OSA.
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Affiliation(s)
- Azizi A. Seixas
- Department of Population Health, New York School of Medicine, New York, NY USA
- Department of Psychiatry, NYU Langone Health, New York, NY 10016 USA
| | - Chau Trinh-Shevrin
- Department of Population Health, New York School of Medicine, New York, NY USA
| | - Joseph Ravenell
- Department of Population Health, New York School of Medicine, New York, NY USA
| | - Gbenga Ogedegbe
- Department of Population Health, New York School of Medicine, New York, NY USA
| | - Ferdinand Zizi
- Department of Population Health, New York School of Medicine, New York, NY USA
| | - Girardin Jean-Louis
- Department of Population Health, New York School of Medicine, New York, NY USA
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A Systematic Review of Beliefs About Hypertension and its Treatment Among African Americans. Curr Hypertens Rep 2017; 18:52. [PMID: 27193774 DOI: 10.1007/s11906-016-0662-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW The prevalence of hypertension and uncontrolled hypertension is higher among African Americans than any other ethnicity in the USA. Certain patient medical beliefs may lead to adverse health behaviors. The aim of this study was to systematically review and narratively synthesize beliefs about hypertension among African Americans. RECENT FINDINGS In a narrative review of 22 studies, many participants attributed hypertension to stress and fatty foods. Hypertension was perceived to be an episodic, symptomatic disease. Many patients exhibited a strong faith in the efficacy of medications, but used them as needed to treat perceived intermittent hypertensive episodes or infrequently to avoid addiction and dependence. Home remedies were often reported to be used concurrently to treat the folk disease "high blood" or in place of medications associated with unwanted effects. Nevertheless, participants were invested in treatment of hypertension to prevent long-term complications. Trends over time suggest that beliefs about hypertension among African Americans have change significantly and now reflect the currently accepted biomedical model. African American beliefs about hypertension may frequently differ from those of healthcare professionals. These results suggest that reconciliation of differences between patient and provider expectations for disease management may improve adherence to and acceptance of medical treatments among African Americans with hypertension. Nevertheless, discordant health beliefs are common among all patients and additional work to elucidate beliefs of other patient subgroups such as age and gender is warranted.
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Johnson LA. Factors influencing oral adherence: qualitative metasummary and triangulation with quantitative evidence. Clin J Oncol Nurs 2017; 19:6-30. [PMID: 26030389 DOI: 10.1188/15.s1.cjon.6-30] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Concern about adherence to oral agents among patients with cancer has grown as more oral agents are being used for cancer treatment. Knowledge of common factors that facilitate or inhibit adherence to oral medication regimens can be beneficial to clinicians in identifying patients at risk for nonadherence, in planning care to address barriers to adherence, and in educating patients about ways to improve adherence. OBJECTIVES The focus of this review is to synthesize the evidence about factors that influence adherence and identify implications for practice. METHODS Literature was searched via PubMed and CINAHL®. Evidence regarding factors influencing adherence was synthesized using a metasummary of qualitative research and triangulated with findings from quantitative research. FINDINGS Forty-four factors influencing adherence were identified from 159 research studies of patients with and without cancer. Factors associated with adherence in oncology and non-oncology cases included provider relations, side effects, forgetfulness, beliefs about medication necessity, establishing routines for taking medication, social support, ability to fit medications in lifestyle, cost, and medication knowledge. Among patients with cancer, depression and negative expectations of results also were shown to have a negative relationship to adherence.
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Williams NJ, Robbins R, Rapoport D, Allegrante JP, Cohall A, Ogedgebe G, Jean-Louis G. Tailored approach to sleep health education (TASHE): study protocol for a web-based randomized controlled trial. Trials 2016; 17:585. [PMID: 27931249 PMCID: PMC5146895 DOI: 10.1186/s13063-016-1701-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 11/14/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is a sleep disorder that disproportionately affects African Americans (hereafter referred to as blacks). Moreover, blacks may underutilize sleep services including overnight polysomnography. Thus, OSA among blacks may go undiagnosed and untreated, which has significant health consequences, including hypertension, diabetes, cognitive impairment, and daytime sleepiness. DESIGN AND METHODS This two-arm randomized controlled trial will assign 200 participants to a culturally and linguistically tailored web-based sleep educational platform. The website will be developed to ensure that the content is user friendly and that it is readable and acceptable by the target community. Participants will receive login information to a password-protected website and will have access to the website for 2 months. Study assessments will be collected at baseline, 2 months (post-enrollment) and at 6 months (follow-up). We will use qualitative and quantitative methods to develop tailored materials and to ascertain whether tailored materials will increase OSA knowledge and OSA health literacy by comparing blacks exposed to tailored materials versus those exposed to standard sleep health literature. We hypothesize that exposure to tailored OSA information will improve OSA health literacy. DISCUSSION Few studies have investigated the racial/ethnic disparities in relation to OSA screening and treatment comparing blacks and whites. Moreover, we know of no interventions designed to increase OSA knowledge and health literacy among blacks. Use of the Internet to disseminate health information is growing in this population. Thus, the Internet may be an effective means to increase OSA health literacy, thereby potentially increasing utilization of sleep-related services in this population. TRIAL REGISTRATION The study is registered at clinicaltrials.gov, reference number NCT02507089 . Registered on 21 July 2015.
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Affiliation(s)
- Natasha J. Williams
- Department of Population Health, Division of Health and Behavior, Center for Healthful Behavior Change, NYU Medical Center, New York, NY 10016 USA
| | - Rebecca Robbins
- Department of Population Health, Division of Health and Behavior, Center for Healthful Behavior Change, NYU Medical Center, New York, NY 10016 USA
| | - David Rapoport
- Ichan School of Medicine at Mount Sinai, Pulmonary, Critical Care and Sleep Medicine, New York, NY 10029 USA
| | - John P. Allegrante
- Department of Health and Behavior Studies, Teachers College, Columbia University, New York, NY 10027 USA
| | - Alwyn Cohall
- Harlem Health Promotion Center, Columbia University, New York, NY 10032 USA
| | - Gbenga Ogedgebe
- Department of Population Health, Division of Health and Behavior, Center for Healthful Behavior Change, NYU Medical Center, New York, NY 10016 USA
| | - Girardin Jean-Louis
- Department of Population Health, Division of Health and Behavior, Center for Healthful Behavior Change, NYU Medical Center, New York, NY 10016 USA
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Grant AB, Seixas A, Frederickson K, Butler M, Tobin JN, Jean-Louis G, Ogedegbe G. Effect of Expectation of Care on Adherence to Antihypertensive Medications Among Hypertensive Blacks: Analysis of the Counseling African Americans to Control Hypertension (CAATCH) Trial. J Clin Hypertens (Greenwich) 2016; 18:690-6. [PMID: 26593105 PMCID: PMC5357563 DOI: 10.1111/jch.12736] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 09/16/2015] [Accepted: 09/22/2015] [Indexed: 12/31/2022]
Abstract
Novel ideas are needed to increase adherence to antihypertensive medication. The current study used data from the Counseling African Americans to Control Hypertension (CAATCH) study, a sample of 442 hypertensive African Americans, to investigate the mediating effects of expectation of hypertension care, social support, hypertension knowledge, and medication adherence, adjusting for age, sex, number of medications, diabetes, education, income, employment, insurance status, and intervention. Sixty-six percent of patients had an income of $20,000 or less and 56% had a high school education or less, with a mean age of 57 years. Greater expectation of care was associated with greater medication adherence (P=.007), and greater social support was also associated with greater medication adherence (P=.046). Analysis also showed that expectation of care mediated the relationship between hypertension knowledge and medication adherence (P<.05). Expectation of care and social support are important factors for developing interventions to increase medication adherence among blacks.
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Affiliation(s)
- Andrea Barnes Grant
- Department of Nursing, Graduate Center, City University of New York, New York, NY
- Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY
| | - Azizi Seixas
- Department of Population Health, Division of Health and Behavior, Center for Healthful Behavior Change, New York University Medical Center, New York, NY
| | - Keville Frederickson
- Department of Nursing, Graduate Center, City University of New York, New York, NY
- Pace University, College of Health Professions, Lienhard School of Nursing, Pleasantville, NY
| | - Mark Butler
- Department of Population Health, Division of Health and Behavior, Center for Healthful Behavior Change, New York University Medical Center, New York, NY
| | - Jonathan N Tobin
- Clinical Directors Network, New York, NY
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine of Yeshiva University, Bronx, NY
- Center for Clinical and Translational Science, the Rockefeller University, New York, NY
| | - Girardin Jean-Louis
- Department of Population Health, Division of Health and Behavior, Center for Healthful Behavior Change, New York University Medical Center, New York, NY
| | - Gbenga Ogedegbe
- Department of Population Health, Division of Health and Behavior, Center for Healthful Behavior Change, New York University Medical Center, New York, NY
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Lambert-Kerzner A, Havranek EP, Plomondon ME, Fagan KM, McCreight MS, Fehling KB, Williams DJ, Hamilton AB, Albright K, Blatchford PJ, Mihalko-Corbitt R, Bryson CL, Bosworth HB, Kirshner MA, Giacco EJD, Ho PM. Perspectives of patients on factors relating to adherence to post-acute coronary syndrome medical regimens. Patient Prefer Adherence 2015; 9:1053-9. [PMID: 26244013 PMCID: PMC4521673 DOI: 10.2147/ppa.s84546] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
PURPOSE Poor adherence to cardioprotective medications after acute coronary syndrome (ACS) hospitalization is associated with increased risk of rehospitalization and mortality. Clinical trials of multifaceted interventions have improved medication adherence with varying results. Patients' perspectives on interventions could help researchers interpret inconsistent outcomes. Identifying factors that patients believe would improve adherence might inform the design of future interventions and make them more parsimonious and sustainable. The objective of this study was to obtain patients' perspectives on adherence to medical regimens after experiencing an ACS event and their participation in a medication adherence randomized control trial following their hospitalization. PATIENTS AND METHODS Sixty-four in-depth interviews were conducted with ACS patients who participated in an efficacious, multifaceted, medication adherence randomized control trial. Interview transcripts were analyzed using the constant comparative approach. RESULTS Participants described their post-ACS event experiences and how they affected their adherence behaviors. Patients reported that adherence decisions were facilitated by mutually respectful and collaborative provider-patient treatment planning. Frequent interactions with providers and medication refill reminder calls supported improved adherence. Additional facilitators included having social support, adherence routines, and positive attitudes toward an ACS event. The majority of patients expressed that being active participants in health care decision-making contributed to their health. CONCLUSION Our findings demonstrate that respectful collaborative communication can contribute to medication adherence after ACS hospitalization. These results suggest a potential role for training health-care providers, including pharmacists, social workers, registered nurses, etc, to elicit and acknowledge the patients' views regarding medication treatment in order to improve adherence. Future research is needed with providers to understand how they elicit and acknowledge patients' views, particularly in the face of nonadherence, and with patients to understand how to empower them to share their opinions with their providers.
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Affiliation(s)
- Anne Lambert-Kerzner
- Department of Crdiology, Veterans Health Administration (VA) Eastern Colorado Health Care System, Denver, CO, USA
- School of Public Health or School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Edward P Havranek
- School of Public Health or School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
- Cardiology, Denver Health Medical Center, Denver, CO, USA
| | - Mary E Plomondon
- Department of Crdiology, Veterans Health Administration (VA) Eastern Colorado Health Care System, Denver, CO, USA
- School of Public Health or School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Katherine M Fagan
- Department of Crdiology, Veterans Health Administration (VA) Eastern Colorado Health Care System, Denver, CO, USA
| | - Marina S McCreight
- Department of Crdiology, Veterans Health Administration (VA) Eastern Colorado Health Care System, Denver, CO, USA
| | - Kelty B Fehling
- Department of Crdiology, Veterans Health Administration (VA) Eastern Colorado Health Care System, Denver, CO, USA
| | - David J Williams
- School of Public Health or School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Alison B Hamilton
- Health Services Research, Veterans Health Administration (VA) Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Karen Albright
- School of Public Health or School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Patrick J Blatchford
- School of Public Health or School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Renee Mihalko-Corbitt
- Internal Medicine, John L. McClellan Memorial Veterans Hospital, Little Rock, AR, USA
| | - Chris L Bryson
- Health Services Research, Veterans Health Administration (VA) Puget Sound Health Care System, Seattle, WA, USA
| | - Hayden B Bosworth
- Health Services Research, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Miriam A Kirshner
- Health Services Research, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Eric J Del Giacco
- Internal Medicine, John L. McClellan Memorial Veterans Hospital, Little Rock, AR, USA
| | - P Michael Ho
- Department of Crdiology, Veterans Health Administration (VA) Eastern Colorado Health Care System, Denver, CO, USA
- School of Public Health or School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
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August KJ, Billimek J. A theoretical model of how neighborhood factors contribute to medication nonadherence among disadvantaged chronically ill adults. J Health Psychol 2015; 21:2923-2933. [PMID: 26089191 DOI: 10.1177/1359105315589391] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In addition to individual-level socioeconomic and psychological factors, the neighborhood environment has been found to be related to medication nonadherence, particularly among low-income, minority populations managing a chronic disease. In this article, we synthesize the relevant literature on how neighborhood factors contribute to engagement in health behaviors and reasons for medication nonadherence among this population. We propose a theoretical framework for understanding the mediating and moderating mechanisms whereby the neighborhood environment may impact medication nonadherence among individuals most at risk for adverse disease outcomes. Guided by this model, we provide recommendations for future research, practice, and policy.
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Mueller M, Purnell TS, Mensah GA, Cooper LA. Reducing racial and ethnic disparities in hypertension prevention and control: what will it take to translate research into practice and policy? Am J Hypertens 2015; 28:699-716. [PMID: 25498998 DOI: 10.1093/ajh/hpu233] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Accepted: 10/30/2014] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Despite available, effective therapies, racial and ethnic disparities in care and outcomes of hypertension persist. Several interventions have been tested to reduce disparities; however, their translation into practice and policy is hampered by knowledge gaps and limited collaboration among stakeholders. METHODS We characterized factors influencing disparities in blood pressure (BP) control by levels of an ecological model. We then conducted a literature search using PubMed, Scopus, and CINAHL databases to identify interventions targeted toward reducing disparities in BP control, categorized them by the levels of the model at which they were primarily targeted, and summarized the evidence regarding their effectiveness. RESULTS We identified 39 interventions and several state and national policy initiatives targeted toward reducing racial and ethnic disparities in BP control, 5 of which are ongoing. Most had patient populations that were majority African-American. Of completed interventions, 27 demonstrated some improvement in BP control or related process measures, and 7 did not; of the 6 studies examining disparities, 3 reduced, 2 increased, and 1 had no effect on disparities. CONCLUSIONS Several effective interventions exist to improve BP in racial and ethnic minorities; however, evidence that they reduce disparities is limited, and many groups are understudied. To strengthen the evidence and translate it into practice and policy, we recommend rigorous evaluation of pragmatic, sustainable, multilevel interventions; institutional support for training implementation researchers and creating broad partnerships among payers, patients, providers, researchers, policymakers, and community-based organizations; and balance and alignment in the priorities and incentives of each stakeholder group.
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Affiliation(s)
- Michael Mueller
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | - George A Mensah
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - Lisa A Cooper
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Baltimore, Maryland, USA; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
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Newlin Lew K, Arbauh N, Banach P, Melkus G. Diabetes: Christian worldview, medical distrust and self-management. JOURNAL OF RELIGION AND HEALTH 2015; 54:1157-1172. [PMID: 25735754 PMCID: PMC4673985 DOI: 10.1007/s10943-015-0022-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
To inform the development of a combined diabetes prevention and self-management intervention in partnership with church communities, this study sampled African American church leaders and members (N = 44) to qualitatively study religious beliefs and practices, diabetes prevention and self-management behaviors, and related community actions. Prior to commencing the study, internal review board approval was obtained. Although not required, community consent was officially provided by the church pastors. Individual consent was subsequently obtained from eligible community members who expressed an interest in participating in the study. Following a participatory action research approach, the inquiry group method was used. Qualitative data were analyzed with content analysis. Findings revealed Christian worldview, medical distrust and self-management as prominent themes. Findings suggest that diabetes providers address religious orientation in the provision of care with attention to rebuilding trust with the African-American community to improve health outcomes.
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Knowledge, attitudes and beliefs of patients and carers regarding medication adherence: a review of qualitative literature. Eur J Clin Pharmacol 2014; 70:1423-31. [PMID: 25277162 DOI: 10.1007/s00228-014-1761-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 09/21/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE The aim of this review is to cohere evidence on the knowledge, attitudes and beliefs of patients and carers regarding medication adherence. Medication adherence refers to "the extent to which the patient's action matches the agreed recommendations". Medication adherence is vital in preventing, managing and curing illnesses and, hence, is linked with positive health outcomes. METHODS A search was conducted using the following databases: CINAHL, Embase, PubMed and Web of Knowledge from inception to November 2013. Titles and abstracts were screened for inclusion in the review according to pre-defined inclusion and exclusion criteria. Studies were assessed for quality, and data were extracted into a data extraction form. Results were analysed thematically. RESULTS The final results included 34 articles. Eight analytical themes were identified: (i) beliefs and experiences of medicines, (ii) family support and culture, (iii) role of and relationship with health-care practitioners, (iv) factors related to the disease, (v) self-regulation, (vi) communication, (vii) cost and (viii) access. The theme, "beliefs and experiences of medicines", was present in 33 studies, with many discussing the influence that side effects have on medication adherence. CONCLUSIONS There are a number of variables that impact upon the knowledge, attitudes and beliefs of patients and carers regarding medication adherence. This review presents an overview of the analytical themes which offers the opportunity to examine interventions and their relative efficacies to increase medication adherence.
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Cho SJ, Kim J. Factors associated with nonadherence to antihypertensive medication. Nurs Health Sci 2014; 16:461-7. [DOI: 10.1111/nhs.12145] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 03/17/2014] [Accepted: 03/19/2014] [Indexed: 12/13/2022]
Affiliation(s)
- Su-Jin Cho
- College of Nursing; Seoul National University; Seoul Korea
| | - Jinhyun Kim
- College of Nursing; Seoul National University; Seoul Korea
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Thomas NF, Dunn KS. Self-transcendence and medication adherence in older adults with hypertension. J Holist Nurs 2014; 32:316-26. [PMID: 24692160 DOI: 10.1177/0898010114528379] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE The purpose of this study was to examine the relationship between self-transcendence and medication adherence among older adults prescribed antihypertensive medication. DESIGN Descriptive, correlational research design. METHOD Forty-six older adults who were prescribed antihypertensive medications from an independent living facility participated in this study. Participants were given a survey that included a demographic questionnaire, the Morisky Medication Adherence Scale, and Reed's Self-Transcendence Scale. FINDINGS No significant relationship was found between medication adherence and self-transcendence (r = -.20, p = .18). Ninety percent of the participants however, admitted to cutting back or stopping their medication without notifying their providers. CONCLUSION Continued investigation is needed to identify reasons why older adults fail to adhere to taking prescribed hypertension medications in order to improve health outcomes in this population.
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Perceived discrimination and medication adherence in black hypertensive patients: the role of stress and depression. Psychosom Med 2014; 76:229-36. [PMID: 24677163 DOI: 10.1097/psy.0000000000000043] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To examine the relationship between perceived discrimination and medication adherence among black people with hypertension and the role of stress and depressive symptoms in this relationship. Perceived racial discrimination has been associated with poor health outcomes in blacks; its relationship to medication adherence among hypertensive patients remains untested. METHODS We measured perceived racial discrimination at baseline, stress and depressive symptoms at 6 months, and medication adherence at 12 months among patients enrolled in a 30-site cluster-randomized controlled trial testing a patient and physician-targeted intervention to improve blood pressure. A mediational method with bootstrapping (stratified by site) confidence intervals was used to estimate the indirect association between perceived discrimination and medication adherence through stress and depression. RESULTS Of 1056 patients from 30 sites enrolled in the trial, 463 had complete data on all four measures at 6 and 12 months and were included in the analyses. Adjusting for clustering, perceived discrimination was associated with poor medication adherence (B = 0.138, p = .011) at 12 months, and with stress (B = 2.24, p = .001) and depression (B = 1.47, p = .001) at 6 months. When stress and depression were included in the model, there was a 65% reduction in the total association of perceived discrimination with medication adherence, and the relationship was no longer significant (B = 0.049, p = .35). CONCLUSIONS Perceived discrimination is associated with poor medication adherence among hypertensive blacks, and stress and depressive symptoms may account for this relationship. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00233220.
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Holt EW, Rung AL, Leon KA, Firestein C, Krousel-Wood MA. Medication Adherence in Older Adults: A Qualitative Study. EDUCATIONAL GERONTOLOGY 2014; 40:198-211. [PMID: 25214707 PMCID: PMC4157658 DOI: 10.1080/03601277.2013.802186] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
To effectively address medication adherence and improve cardiovascular health among older adults, a deeper understanding is needed of the barriers that this age group faces and approaches that would be most effective and feasible for improving adherence. We conducted a focus group study (n=25) in a diverse population of older adults with hypertension recruited from the Cohort Study of Medication Adherence in Older Adults (CoSMO). A structured guide was used to collect feedback on barriers to adherence and acceptability and feasibility of intervention strategies. The final coding framework outlines factors at the individual, relationship, health care system, and environmental or policy level which affect adherence in older adults, including memory, knowledge, attitudes and beliefs, side effects, social support, interaction with health care providers, and cost and convenience of medication filling. Patient responses highlighted the varied nature of barriers and the need for interventions which are both multi-faceted and tailored.
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Affiliation(s)
- Elizabeth W Holt
- Center for Health Research, Ochsner Clinic Foundation, New Orleans, LA ; Dept. of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
| | - Ariane L Rung
- Epidemiology Program, Louisiana State University Health Sciences Center, School of Public Health, New Orleans, LA
| | - Kyla A Leon
- College of Pharmacy, Xavier University of Louisiana, New Orleans, LA
| | - Catherine Firestein
- Dept. of Internal Medicine, Tulane University School of Medicine, New Orleans, LA
| | - Marie A Krousel-Wood
- Center for Health Research, Ochsner Clinic Foundation, New Orleans, LA ; Dept. of Internal Medicine, Tulane University School of Medicine, New Orleans, LA ; Dept. of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
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Borges JWP, Moreira TMM, Rodrigues MTP, de Souza ACC, da Silva DB. [Content validation of the dimensions constituting non-adherence to treatment of arterial hypertension]. Rev Esc Enferm USP 2013; 47:1077-83. [PMID: 24346446 DOI: 10.1590/s0080-623420130000500010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 04/01/2013] [Indexed: 11/21/2022] Open
Abstract
The objective of the study was to validate the content of the dimensions that constituted nonadherence to treatment of arterial systemic hypertension. It was a methodological study of content validation. Initially an integrative review was conducted that demonstrated four dimensions of nonadherence: person, disease/treatment, health service, and environment. Definitions of these dimensions were evaluated by 17 professionals, who were specialists in the area, including: nurses, pharmacists and physicians. The Content Validity Index was calculated for each dimension (IVCi) and the set of the dimensions (IVCt), and the binomial test was conducted. The results permitted the validation of the dimensions with an IVCt of 0.88, demonstrating reasonable systematic comprehension of the phenomena of nonadherence.
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Nurse care coordination and technology effects on health status of frail older adults via enhanced self-management of medication: randomized clinical trial to test efficacy. Nurs Res 2013; 62:269-78. [PMID: 23817284 DOI: 10.1097/nnr.0b013e318298aa55] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Self-management of complex medication regimens for chronic illness is challenging for many older adults. OBJECTIVES The purpose of this study was to evaluate health status outcomes of frail older adults receiving a home-based support program that emphasized self-management of medications using both care coordination and technology. DESIGN This study used a randomized controlled trial with three arms and longitudinal outcome measurement. SETTING Older adults having difficulty in self-managing medications (n = 414) were recruited at discharge from three Medicare-certified home healthcare agencies in a Midwestern urban area. METHODS All participants received baseline pharmacy screens. The control group received no further intervention. A team of advanced practice nurses and registered nurses coordinated care for 12 months to two intervention groups who also received either an MD.2 medication-dispensing machine or a medplanner. Health status outcomes (the Geriatric Depression Scale, Mini Mental Status Examination, Physical Performance Test, and SF-36 Physical Component Summary and Mental Component Summary) were measured at baseline and at 3, 6, 9, and 12 months. RESULTS After covariate and baseline health status adjustment, time × group interactions for the MD.2 and medplanner groups on health status outcomes were not significant. Time × group interactions were significant for the medplanner and control group comparisons. DISCUSSION Participants with care coordination had significantly better health status outcomes over time than those in the control group, but addition of the MD.2 machine to nurse care coordination did not result in better health status outcomes.
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Lewis LM, Ogedegbe C, Ogedegbe G. Enhancing adherence of antihypertensive regimens in hypertensive African-Americans: current and future prospects. Expert Rev Cardiovasc Ther 2013; 10:1375-80. [PMID: 23244358 DOI: 10.1586/erc.12.138] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Patient adherence to antihypertensive medication is an important strategy for blood pressure control in hypertensive patients. However, rates of antihypertensive medication adherence among hypertensive African-Americans are unacceptably low. This article examines the current understanding of patient, clinical, provider and healthcare system factors associated with medication adherence in hypertensive African-Americans. Studies demonstrated that patient and clinical factors, such as self-efficacy and depression, are consistently associated with medication adherence in hypertensive African-Americans patients. Provider communication shows promise as a correlate of medication adherence, but more research on provider and healthcare system factors are still needed. The authors recommend that interventions targeted at increasing medication adherence among hypertensive African-Americans focus on self-efficacy. It is also imperative that clinicians screen hypertensive patients for depression and treat, if necessary.
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Affiliation(s)
- Lisa M Lewis
- School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Philadelphia, PA 19104-4217, USA.
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Brown WV, Jacobson TA, Braun LT. Achieving adherence to lipid-lowering regimens. J Clin Lipidol 2013; 7:4-13. [PMID: 23351577 DOI: 10.1016/j.jacl.2012.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 11/28/2012] [Indexed: 11/30/2022]
Affiliation(s)
- W Virgil Brown
- Emory University School of Medicine, Atlanta, GA 30033, USA.
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Cené CW, Dennison CR, Powell Hammond W, Levine D, Bone LR, Hill MN. Antihypertensive medication nonadherence in black men: direct and mediating effects of depressive symptoms, psychosocial stressors, and substance use. J Clin Hypertens (Greenwich) 2012; 15:201-9. [PMID: 23458593 DOI: 10.1111/jch.12056] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Black men suffer disproportionately from hypertension. Antihypertensive medication nonadherence is a major contributor to poor blood pressure control, yet few studies consider how psychosocial functioning may impact black men's medication adherence. The authors examined the direct and mediating pathways between depressive symptoms, psychosocial stressors, and substance use on antihypertensive medication nonadherence in 196 black men enrolled in a clinical trial to improve hypertension care and control. The authors found that greater depressive symptoms were associated with more medication nonadherence (β=0.05; standard error [SE], 0.01; P<.001). None of the psychosocial stressor variables were associated with antihypertensive medication nonadherence. Alcohol misuse was associated with increased medication nonadherence (β=0.81; SE, 0.26; P<.01), but it did not mediate the association between depressive symptoms and medication nonadherence. Clinicians should consider screening for depressive symptoms and alcohol misuse if patients are found to be nonadherent and should treat or refer patients to appropriate resources to address those issues.
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Affiliation(s)
- Crystal W Cené
- Division of General Internal Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7110, USA.
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Freedom of choice and adherence to the health regimen for African Americans with hypertension. ANS Adv Nurs Sci 2012; 35:E1-8. [PMID: 22918261 DOI: 10.1097/ans.0b013e31826b842f] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The prevalence of hypertension in African Americans exceeds that of all other racial/ethnic groups in the world. Hypertension in African Americans is less likely to be controlled and this problem is further complicated by failure to adhere to prescribed hypertension management regimens. Oftentimes, health care providers give African American patients with hypertension multiple health "rules" to follow that may arouse reactance behaviors: that is, patients may choose to do the opposite of what they are told to do. The theory of psychological reactance offers a framework for understanding the relationship between freedom of choice and adherence to hypertension regimens in African Americans.
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Thames AD, Moizel J, Panos SE, Patel SM, Byrd DA, Myers HF, Wyatt GE, Hinkin CH. Differential predictors of medication adherence in HIV: findings from a sample of African American and Caucasian HIV-positive drug-using adults. AIDS Patient Care STDS 2012; 26:621-30. [PMID: 22889235 DOI: 10.1089/apc.2012.0157] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Modest or even occasional nonadherence to combined antiretroviral therapy (cART) can result in adverse clinical outcomes. African Americans demonstrate lower rates of adherence than Caucasians or Latinos. Identifying factors that influence medication adherence among African Americans is a critical step toward reducing HIV/AIDS disease progression and mortality. In a sample of 181 African American (n=144) and Caucasian (n=37) HIV-positive drug-using individuals [age (M=42.31; SD=6.6) education (M=13.41; SD=2.1)], we examined the influence of baseline drug use, literacy, neurocognition, depression, treatment-specific social support, and patient satisfaction with health care provider on medication adherence averaged over the course of 6 months (study dates 2002-2006). Our findings suggest differential baseline predictors of medication adherence for African Americans and Caucasians, such that patient satisfaction with provider was the strongest predictor of follow-up medication adherence for African Americans whereas for Caucasians depressive symptoms and treatment-specific social support were predictive of medication adherence (after controlling for duration of drug use).
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Affiliation(s)
- April D. Thames
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, California
- Greater Los Angeles VA Healthcare System, Los Angeles, California
| | - Jennifer Moizel
- Department of Clinical Psychology, Alliant International University Los Angeles, Los Angeles, California
| | - Stella E. Panos
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, California
- Greater Los Angeles VA Healthcare System, Los Angeles, California
| | - Sapna M. Patel
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, California
- Greater Los Angeles VA Healthcare System, Los Angeles, California
| | - Desiree A. Byrd
- Department of Neurology, Mount Sinai School of Medicine, New York, New York
| | - Hector F. Myers
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, California
- Department of Psychology, University of California Los Angeles, Los Angeles, California
| | - Gail E. Wyatt
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, California
| | - Charles H. Hinkin
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, California
- Greater Los Angeles VA Healthcare System, Los Angeles, California
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Abstract
BACKGROUND Rates of medication adherence are low among hypertensive blacks despite numerous interventions to increase their adherence. PURPOSE The aim of the study was to conduct a systematic review of the literature to understand the factors associated with medication adherence in hypertensive blacks. METHODS A systematic computer search of qualitative and quantitative studies that examined factors associated with medication adherence in hypertensive blacks from 1966 to 2010 was performed. Studies were excluded if medication adherence was not either the primary or secondary outcome variable. RESULTS Studies (n = 18) were cross-sectional or qualitative, measured adherence via self-report, and conducted in low-income blacks. Factors that were associated with medication adherence were self-efficacy, depression, patient-provider communication, and healthcare system related. CONCLUSIONS Findings from existing studies should be interpreted with caution because of their methodological limitations. Longitudinal studies with heterogeneous samples of hypertensive blacks are imperative so that targeted interventions can be developed for this vulnerable population. CLINICAL IMPLICATIONS Even though there are methodological limitations associated with existing studies, clinicians may want to consider some of the factors that were associated with medication adherence in this systematic review as they provide care for hypertensive blacks. Given that self-efficacy and patient-provider communication are modifiable factors, they can be the focus of interventions to increase medication adherence. Finally, clinicians may want to screen their hypertensive patients for depression and treat, if necessary.
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Marshall IJ, Wolfe CDA, McKevitt C. Lay perspectives on hypertension and drug adherence: systematic review of qualitative research. BMJ 2012; 345:e3953. [PMID: 22777025 PMCID: PMC3392078 DOI: 10.1136/bmj.e3953] [Citation(s) in RCA: 213] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/23/2012] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To synthesise the findings from individual qualitative studies on patients' understanding and experiences of hypertension and drug taking; to investigate whether views differ internationally by culture or ethnic group and whether the research could inform interventions to improve adherence. DESIGN Systematic review and narrative synthesis of qualitative research using the 2006 UK Economic and Social Research Council research methods programme guidance. DATA SOURCES Medline, Embase, the British Nursing Index, Social Policy and Practice, and PsycInfo from inception to October 2011. STUDY SELECTION Qualitative interviews or focus groups among people with uncomplicated hypertension (studies principally in people with diabetes, established cardiovascular disease, or pregnancy related hypertension were excluded). RESULTS 59 papers reporting on 53 qualitative studies were included in the synthesis. These studies came from 16 countries (United States, United Kingdom, Brazil, Sweden, Canada, New Zealand, Denmark, Finland, Ghana, Iran, Israel, Netherlands, South Korea, Spain, Tanzania, and Thailand). A large proportion of participants thought hypertension was principally caused by stress and produced symptoms, particularly headache, dizziness, and sweating. Participants widely intentionally reduced or stopped treatment without consulting their doctor. Participants commonly perceived that their blood pressure improved when symptoms abated or when they were not stressed, and that treatment was not needed at these times. Participants disliked treatment and its side effects and feared addiction. These findings were consistent across countries and ethnic groups. Participants also reported various external factors that prevented adherence, including being unable to find time to take the drugs or to see the doctor; having insufficient money to pay for treatment; the cost of appointments and healthy food; a lack of health insurance; and forgetfulness. CONCLUSIONS Non-adherence to hypertension treatment often resulted from patients' understanding of the causes and effects of hypertension; particularly relying on the presence of stress or symptoms to determine if blood pressure was raised. These beliefs were remarkably similar across ethnic and geographical groups; calls for culturally specific education for individual ethnic groups may therefore not be justified. To improve adherence, clinicians and educational interventions must better understand and engage with patients' ideas about causality, experiences of symptoms, and concerns about drug side effects.
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Affiliation(s)
- Iain J Marshall
- King's College London, Division of Health and Social Care Research, London SE1 3QD, UK.
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Ruppar TM, Dobbels F, De Geest S. Medication beliefs and antihypertensive adherence among older adults: a pilot study. Geriatr Nurs 2012; 33:89-95. [PMID: 22387190 DOI: 10.1016/j.gerinurse.2012.01.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Revised: 01/17/2012] [Accepted: 01/20/2012] [Indexed: 11/20/2022]
Abstract
Older adults with hypertension are dependent on medication to control blood pressure and reduce risk for cardiovascular disease and renal impairment. Unfortunately, adherence to antihypertensive regimens remains low. This pilot study examines the relation among medication beliefs, demographic variables, and antihypertensive medication adherence in a sample of older adults (median age = 74 years). Medication beliefs were measured using the Beliefs About Medicines Questionnaire (BMQ), and medication adherence was measured by electronic monitoring. Among study participants (n = 33), concerns about medications were found to be related to poorer antihypertensive adherence. In particular, older adults with lower medication adherence were concerned about dependency and long-term effects from their medications. When controlling for other factors that may influence antihypertensive adherence, beliefs about medication necessity were related to adherence (odds ratio: 2.027, 95% confidence interval: 1.10-3.75).
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Affiliation(s)
- Todd M Ruppar
- University of Missouri, Sinclair School of Nursing, Columbia, MO, USA
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Lewis LM, Schoenthaler AM, Ogedegbe G. Patient factors, but not provider and health care system factors, predict medication adherence in hypertensive black men. J Clin Hypertens (Greenwich) 2012; 14:250-5. [PMID: 22458747 DOI: 10.1111/j.1751-7176.2012.00591.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The problem of medication adherence is pronounced in hypertensive black men. However, factors influencing their adherence are not well understood. This secondary analysis of the ongoing Counseling African Americans to Control Hypertension (CAATCH) randomized clinical trial investigated the patient, provider, and health care system factors associated with medication adherence among hypertensive black men. Participants (N=253) were aged 56.6±11.6 years, earned <$20,000 yearly (72.7%), and almost one half were on Medicaid (44%). Mean systolic blood pressure was 148.7±15.8 mm Hg and mean diastolic blood pressure was 92.7±9.8 mm Hg. Over one half of participants (54.9%) were nonadherent. In a hierarchical regression analysis, the patient factors that predicted medication adherence were age, self-efficacy, and depression. The final model accounted for 32.1% of the variance (F=7.80, df 10, 165, P<.001). In conclusion, age, self-efficacy, and depression were associated with antihypertensive medication adherence in black men followed in Community/Migrant Health Centers. Age is a characteristic that may allow clinicians to predict who may be at risk for poor medication adherence. Depression can be screened for and treated. Self-efficacy is modifiable and its implications for practice would be the development of interventions to increase self-efficacy in black men with hypertension.
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Affiliation(s)
- Lisa M Lewis
- School of Nursing, University of Pennsylvania, Philadelphia, PA 19104-4217, USA.
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Russell E, Robinson DHZ, Thompson NJ, Perryman JP, Arriola KRJ. Distrust in the healthcare system and organ donation intentions among African Americans. J Community Health 2012; 37:40-7. [PMID: 21626439 PMCID: PMC3489022 DOI: 10.1007/s10900-011-9413-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purpose of this study is to further understanding of the association between distrust in the healthcare system and written and verbal expressions of donation intentions among African Americans. We hypothesize that distrust in the healthcare system will be significantly, positively associated with both verbal and written donation intentions. Five hundred and eighty five participants completed a 98-item survey that included scales on distrust in the healthcare system and donation intentions. Bivariate analyses (t-tests, ANOVA, chi-square tests and odds ratios) were used to explore the extent to which donation intentions and distrust in the healthcare system varied by demographic characteristics and the association between the distrust in the healthcare system scale and verbal and written donation intentions. Separate logistic regressions were performed with each of the dependent variables to see if significant associations remained while controlling for confounders. Findings based on the multiple regression indicate that when controlling the participant's education level, distrust in the healthcare system was not significantly related to written donation intentions (OR = 1.04; P = .12). When controlling for education level, health insurance status, Community Health Advocates group and marital status, distrust in the healthcare system was significantly associated with verbal donation intentions (OR = 1.08; P < 0.05). Our results suggest that distrust in the healthcare system varies in the way that it is associated with donation intentions. Future organ donation studies should be conducted to determine the pathways through which distrust in the healthcare system impacts different types of organ donation intentions.
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Affiliation(s)
- Emily Russell
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health of Emory University, Atlanta, GA 30322, USA.
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Li CY, Han HR, Kim J, Kim MT. Factors related to risk of cardiovascular disease among older korean chinese with hypertension. Asian Nurs Res (Korean Soc Nurs Sci) 2011; 5:164-9. [PMID: 25030365 DOI: 10.1016/j.anr.2011.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Revised: 08/24/2011] [Accepted: 08/29/2011] [Indexed: 10/17/2022] Open
Abstract
PURPOSE The purpose of this study was to assess the prevalence of cardiovascular disease (CVD) risk factors among older Korean Chinese with hypertension-one of the most underserved and understudied ethnic minority groups in China. In addition, factors underlying the risk of CVD were examined. METHODS A total of 334 participants were recruited at the Community Health Service Center in Yanji, China. Data regarding socioeconomic, health-related, psychosocial, and other CVD risk factors were collected between June and October 2009. In this cross-sectional study, factors related to the risk of CVD were assessed by multivariate logistic regression; the Framingham Risk Score was used to measure the risk of CVD. RESULTS The prevalence of dyslipidemia, diabetes, and current smoking were 75.4%, 6.6%, and 23.1% respectively. Participants who lived alone were twice as likely to have a high risk of CVD (10-year risk of CVD ≥15%; odds ratio [OR], 2.00; 95% confidence interval [CI], 1.13-3.54). Those with a higher education level and greater knowledge about hypertension were at 57% and 62% reduced risk for CVD (OR, 0.43; 95% CI, 0.21-0.92 and OR, 0.38; 95% CI, 0.15-0.95, respectively). CONCLUSION Future intervention should include strategies to addressing social isolation and also focus on older Korean Chinese with low education. Knowledge enhancement program is warranted for the prevention of CVD in this population.
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Affiliation(s)
- Chun Yu Li
- School of Nursing, Yanbian University, Yanbian, China
| | - Hae-Ra Han
- School of Nursing, Johns Hopkins University, Baltimore, USA
| | - Jiyun Kim
- Department of Nursing, Kyungwon University, Seongnam, Korea
| | - Miyong T Kim
- School of Nursing, Johns Hopkins University, Baltimore, USA
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Ali S, Patel T, Jabeen S, Bailey RK, Khan JA, Shahid M. Drug Noncompliance in Psychiatric Practice: A Review. Psychiatr Ann 2010. [DOI: 10.3928/00485713-20101123-04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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