Predictors of Changes in Medication Adherence in Blacks with Hypertension: Moving Beyond Cross-Sectional Data

Abstract

Background Many studies have examined the multiple correlates of non-adherence in Blacks. However, they are largely cross-sectional thus; these studies are unable to examine their predictive value on long-term medication adherence. Purpose To examine the predictive role of key psychosocial and interpersonal factors on changes in medication adherence over a one-year period. Methods Data were collected from 815 Black patients with hypertension followed in community health centers. Hypothesized predictor variables included self-efficacy, depressive symptoms, social support, and patient-provider communication measured at baseline, 6- and 12-months. The dependent variable, medication adherence was assessed at baseline, 6- and 12-months. Latent Growth Modeling was used to evaluate the pathways between the latent predictor variables and medication adherence. Results Participants were mostly female, low-income, with high school education or less, and mean age of 57 years. At baseline, high self-efficacy was associated with low depressive symptoms (β=−.22, p=0.05), collaborative patient-provider communication (β=.17, p=0.006), and better medication adherence (β=1.04, p<0.001). More social support and collaborative patient-provider communication were associated with low depressive symptoms (β=−.08, p=0.02; β=−.18, p=0.01). More social support was positively associated with collaborative patient-provider communication (β=.32, p<0.001). In the longitudinal model, increasing self-efficacy over time predicted improvements in medication adherence one year later (β=1.76, p<0.001; CFI=0.95; RMSEA=0.04; SRMR=0.04; Chi-Squared Index of Model Fit=1128.54). Conclusions Self-efficacy is a key predictor of medication adherence over time in Black patients with hypertension. Initial levels of self-efficacy are influenced by the presence of depressive symptoms as well as the perceived quality of patient-provider communication.

Health Behavior Change in Older Adults: Testing the Health Action Process Approach at the Inter‐ and Intraindividual Level

“…In addition, patients with overall higher levels of recovery self-efficacy, that is who believe in their abilities to readopt adherent medication intake after not taking them regularly for some time, and patients who intend to be adherent to medication seem to have fewer problems with medication intake. Hence, this study is in line with a number of previous studies which found self-efficacy to be associated with medication adherence (Barclay et al, 2007;Holmes, Hughes, & Morrison, 2014;Pinheiro, de-Carvalho-Leite, Drachler, Silveira, & Pinheiro, 2002;Schoenthaler, Butler, Chaplin, Tobin, & Ogedegbe, 2016).…”

Development and Evaluation of a Tailored Mobile Health Intervention to Improve Medication Adherence in Black Patients With Uncontrolled Hypertension and Type 2 Diabetes: Pilot Randomized Feasibility Trial

“…Each strategy was socioculturally tailored for Black patients based on feedback from the interviews, the research teams’ expertise, and the existing literature [ 7 , 30 , 43 - 47 ]. For example, the Myth Busters module addressed inaccurate beliefs about medications by including true or false questions about the use of herbal remedies to treat HTN and T2D, the effectiveness of generic medications, and the long-term safety of medications.…”

“…Specifically, questions targeted the most salient informational (eg, how medications work, side effects), motivational (eg, social support, beliefs), and behavioral (eg, self-efficacy, ability to administer medications) barriers and facilitators that may affect adherence behaviors. Interview questions on the most salient barriers to adherence were constructed using the IMB survey items and from the existing adherence literature, including the authors’ research in this patient population [ 28 , 30 , 31 ]. Sample interview questions included, “What, if any, reasons did your doctor give you about why s/he felt that you needed to take blood pressure/diabetes medicines?…”

&ldquo;I did not want to take that medicine&rdquo;: African-Americans&rsquo; reasons for diabetes medication nonadherence and perceived solutions for enhancing adherence

“…Collaborative patient–provider relationships are associated with better medication adherence among AAs with chronic diseases. 54 , 55 AAs want to be involved in partnerships with their health care providers. 47 However, for providers delivering care to AAs with diabetes, as shown in this study’s findings, developing a trusting relationship with the patient, the AA community, and caregivers also requires recognizing the societal barriers to controlling diabetes and adherence that AAs face.…”