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

项目总结/摘要 在过去的十年中，拉丁美洲人的高血压患病率仍然很高， 美国人与其他群体相比，即使获得医疗保险的机会增加了。这一增长可能是 部分原因是这一人群中药物不依从率高。许多现有的方法 提高药物依从性，如手机提醒，邮购续药和降低成本的计划， 可以有效地用于那些有动机服用处方药的患者。然而，这些方法 将不会帮助超过40%的拉丁美洲患者谁从事“故意不遵守”-选择不采取 因为严重担心药物不需要，或者会引起副作用。文化上- 对药物的束缚，消极的信念，以及用自然疗法取代药物的偏好， 在弱势拉丁裔社区很常见，但由于语言原因，很少与医疗服务提供者讨论 障碍、卫生知识普及率低和文化距离。支持直接和间接体验的干预措施 药物治疗可能会消除关于药物的神话，并促进更积极的信念和动力， 坚持。拟议的研究是一项RCT，测试一种文化上适当的新型干预措施， 高血压未控制的低收入拉美裔美国人的抗高血压药物依从性。 干预的目的是解决消极信念超过四个小组医疗访问（GMV）会议， 结合文化约束的观点，生活方式和自然疗法以及药物， 讨论降低血压的策略，并让患者参与三个简短的家庭治疗 使用mHealth设备进行监测，以支持讨论患者的实际个人体验， 方案.研究人员有多年的经验，研究了低- 拉丁裔社区，开发移动医疗应用程序，并在安全网中提供医疗干预措施 诊所。本研究的目的是：（1）评估基于理论的干预措施对改善负性抑郁的有效性。 药物信念，并通过直接和替代经验，促进药物依从性， （2）测试一个理论模型，通过该模型，基线时关于药物治疗的信念预测 随后使用行为策略来提高依从性。如果成功，干预措施可以作为一种 模型方法，以减少由于对药物的负面信念而故意不依从，并解决 是造成健康差距的重要因素。

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.