Mi Propio Camino (My Own Way): Addressing negative beliefs about medication to improve adherence among Hispanic adults with hypertension

Mi Propio Camino（我自己的方式）：解决对药物的负面信念，以提高西班牙裔成人高血压患者的依从性

• 批准号: 10554170
• 负责人: JOHN BILLIMEK
• 金额: $ 58.27万
• 依托单位: UNIVERSITY OF CALIFORNIA-IRVINE
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-02-01 至 2025-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10554170
• 关键词: Address; Adherence; Adult; Affect; American; Antihypertensive Agents; Area; Behavioral; Belief; Binding; Black American; Blood Pressure; Cellular Phone; Chronic; Clinic; Clinical; Communities; Cultural Backgrounds; Data; Development; Devices; Disadvantaged; Disparity; Drug Prescriptions; Effectiveness; Effectiveness of Interventions; Failure; Future; Health; Health Insurance; Health Personnel; Health Promotion; Hispanic; Home; Hypertension; Individual; Intervention; Language; Latino; Life Style; Low income; Mail Order; Mediating; Medical; Mexican Americans; Mobile Health Application; Modeling; Monitor; Morbidity - disease rate; Motivation; NIH Program Announcements; Natural Remedy; Not Hispanic or Latino; Outcome; Patients; Persuasive Communication; Pharmaceutical Preparations; Population; Populations at Risk; Prevalence; Prevention; Public Health; Publishing; Recommendation; Regimen; Research; Research Personnel; Safety; Testing; Theoretical model; United States National Institutes of Health; Visit; Work; blood pressure control; blood pressure reduction; compliance behavior; cost; effectiveness evaluation; efficacy evaluation; ethnic disparity; evidence base; experience; follow-up; forgetting; health disparity; high risk population; improved; intervention effect; low health literacy; low socioeconomic status; mHealth; medication compliance; medication nonadherence; novel; patient engagement; patient subsets; peer; preference; programs; prospective test; racial disparity; safety net; side effect; theories

PROJECT SUMMARY/ABSTRACT In the past decade, the prevalence of uncontrolled hypertension has remained substantially higher in Latino Americans compared to other groups, even as access to health insurance has increased. This rise can be explained in part by high rates of medication nonadherence in this population. Many existing approaches to improve medication adherence, such as cell phone reminders, mail order refills and cost-lowering programs, can be effective in patients who are motivated to take a prescribed medication. However, these approaches will not help the over 40% of Latino patients who engage in “intentional nonadherence”—choosing not to take medications because of serious concerns that the drugs are not needed, or will cause side effects. Culturally- bound, negative beliefs about medications, and a preference to replace medications with natural remedies, are common in disadvantaged Latino communities, but are rarely discussed with health providers due to language barriers, low health literacy and cultural distance. Interventions supporting direct and vicarious experiences with a medication may dispel myths about medications and promote more positive beliefs and motivation to adhere. The proposed study is a RCT testing a culturally appropriate and novel intervention to improve adherence to antihypertensive medications in low-income Latino Americans with uncontrolled hypertension. The intervention aims to address negative beliefs over four group medical visit (GMV) sessions by incorporating culturally-bound perspectives on lifestyle and natural remedies alongside medications in discussions of blood pressure lowering strategies, and engaging patients in three brief periods of home monitoring with mHealth devices to support discussion of patients’ actual individual experiences with a regimen. The investigators have many years of experience researching contributors to nonadherence in low- income Latino communities, developing mHealth applications and delivering health interventions in safety net clinics. The aims of the study are (1) to evaluate the efficacy of a theory-based intervention to modify negative medication beliefs and promote medication adherence through direct and vicarious experiences with a medication, and (2) to test a theoretical model by which beliefs about medication at baseline predict subsequent use of behavioral strategies to improve adherence. If successful, the intervention may serve as a model approach to reduce intentional nonadherence due to negative beliefs about medications, and address an important contributor to health disparities.

项目概要/摘要 在过去的十年中，拉丁裔未受控制的高血压患病率仍然较高 与其他群体相比，美国人获得健康保险的机会有所增加。这个涨幅可以 部分原因是该人群不遵守药物治疗的比例很高。许多现有的方法 提高用药依从性，例如手机提醒、邮购补充和降低成本计划， 对于有动机服用处方药的患者可能有效。然而，这些方法 不会帮助超过 40% 的拉丁裔患者“故意不依从”——选择不服用 药物治疗，因为严重担心药物不需要或会引起副作用。文化上—— 对药物的束缚、消极信念以及用自然疗法替代药物的偏好， 在弱势拉丁裔社区中很常见，但由于语言原因很少与医疗服务提供者讨论 障碍、健康素养低和文化距离。支持直接和替代体验的干预措施 服用药物可能会消除有关药物的误解，并促进更积极的信念和动力 坚持。拟议的研究是一项随机对照试验，测试一种文化上适当且新颖的干预措施，以改善 高血压未受控制的低收入拉美裔美国人坚持服用抗高血压药物。 该干预措施旨在通过以下方式解决对四次团体就诊 (GMV) 会议的负面看法： 将文化上对生活方式和自然疗法以及药物的观点纳入其中 讨论降压策略，并让患者参与三个短暂的居家时间 使用移动医疗设备进行监测，以支持讨论患者的实际个人经历 养生法。研究人员拥有多年研究低依从性患者不依从因素的经验。 收入拉丁裔社区，开发移动医疗应用程序并在安全网中提供健康干预措施 诊所。该研究的目的是（1）评估基于理论的干预措施对改变负面影响的有效性。 通过与患者的直接和间接经验来培养用药信念并促进用药依从性 药物治疗，以及（2）测试一个理论模型，通过该模型对基线药物的信念进行预测 随后使用行为策略来提高依从性。如果成功，干预措施可以作为 减少因对药物的负面信念而导致的故意不依从的模型方法，并解决 健康差异的一个重要因素。

项目成果

Latino Health Access: Comparative Effectiveness of a Community-Initiated Promotor/a-Led Diabetes Self-management Education Program.

• DOI: 10.1097/fch.0000000000000311
• 发表时间: 2022-01-01
• 期刊: FAMILY & COMMUNITY HEALTH
• 影响因子: 2.3
• 作者: Slater, Allison;Cantero, Patricia J.;Alvarez, Guillermo;Cervantes, Brett S.;Bracho, America;Billimek, John
• 通讯作者: Billimek, John