Predictors of Medication Adherence Among African Americans With Hypertension

描述（由申请人提供）：我的总体目标是阐明非洲裔美国人高血压控制不良的根本原因。我们在库柏绿色健康系统（CGHS）工作，该系统位于阿拉巴马州伯明翰的市中心，我们发现大约80%被诊断为高血压的非裔美国人没有得到适当的血压控制。对医疗系统的歧视和缺乏信任可能是高血压药物依从性的重要决定因素，这在很大程度上导致了这些令人震惊的健康差距。这些因素也影响了非裔美国人如何应对压力，并与依赖家庭疗法而不是适当的药物管理有关。这项横断面研究将利用信托项目的现有数据（2007- 2008）来检验社会文化因素与非裔美国人药物依从性之间的关系，该项目由国家心肺和血液研究所资助。信托基金首席研究员，博士。Jeroan Allison和Sandral Hullett将担任这项研究的导师。与Hullett博士的实习将提供与CGHS患者一起工作的机会，与TRUST参与者招募的人群相同。本论文的具体目的是：(1)评估自我报告歧视与药物依从性的关联，并确定对医疗系统的信任是否介导了这种关联；(2)考察逆境应对与药物依从性的关系；(3)确定使用家庭疗法是否与较低的依从性有关。这项研究支持AHRQ的使命，即为重点人群提高卫生保健的质量、安全、效率和效力。我们的分析将使用中介分析和结构方程建模的先进统计技术。因此，我们将产生新的知识和实际见解，这些知识和见解将很容易转化为创新的减少差距的干预措施。除了我提议的实质性工作之外，我还与Allison博士和Hullett博士制定了一个坚实的指导计划。我的论文顾问委员会带来了额外的专业知识，先进的定量方法，社会文化结构的应用，以卫生服务研究，并为减少健康差距文化敏感的干预措施的发展。完成论文后，我将申请一个职业发展奖，该奖项利用定量和定性技术来开发和试点促进非裔美国人服药依从性的干预措施。我致力于从事卫生服务研究，重点关注健康差距。除了追求我自己的独立研究，这是我的长期目标，作为一个积极的力量吸引新的人才卫生服务研究，指导少数民族学生在学术医学的成功，并建立强大的社区学术伙伴关系。

DESCRIPTION (provided by applicant): My overarching goal is to elucidate the root causes of poor hypertension control in the African American population. Working in the Cooper Green Health System (CGHS), an urban, inner-city setting in Birmingham, Alabama, we found that approximately 80% of African Americans diagnosed with hypertension did not have their blood pressure adequately controlled. Perceived discrimination and lack of trust in the medical system may be important determinants of hypertension medication adherence, greatly contributing to these alarming health disparities. These factors also influence how African Americans cope with stress and are linked to the reliance on home remedies instead of appropriate medication management. This cross-sectional study will examine the association of sociocultural factors with medication adherence among African Americans using existing data (2007-8) from the TRUST project, funded by the National Heart Lung and Blood Institute. The TRUST Principal Investigators, Drs. Jeroan Allison and Sandral Hullett will serve as mentors for this research. An internship with Dr. Hullett will provide an opportunity to work with the patients of CGHS, the same population from which the TRUST participants were recruited. The specific aims of this dissertation are to: (1) evaluate the association of self-reported discrimination with medication adherence, and to determine if trust in the medical system mediates this association; (2) examine the relationship of coping with adversity and medication adherence; and (3) determine if the use of home remedies is associated with lower adherence. This study supports AHRQ's mission to improve the quality, safety, efficiency and effectiveness of health care for priority populations. Our analyses will use the advanced statistical techniques of mediation analysis and structural equation modeling. As such, we will generate new knowledge and practical insights that will be easily translated into innovative disparity-reducing interventions. In addition to the substantive work that I am proposing, I have developed a solid mentorship plan with Drs Allison and Hullett. My dissertation advisory committee brings additional expertise in advanced quantitative methods, the application of sociocultural constructs to health services research, and the development of culturally sensitive interventions for reducing health disparities. After completing my dissertation, I will apply for a career development award that draws on quantitative and qualitative techniques to develop and pilot interventions that promote medication adherence among African Americans. I am committed to a career in health services research, with a focus on health disparities. In addition to pursuing my own line of independent research, it is my long-term goal to serve as a positive force attracting new talent to health services research, mentoring minority students for success in academic medicine, and building strong community-academic partnerships. PUBLIC HEALTH RELEVANCE: This project will generate new knowledge about the root causes of cardiovascular health disparities, which is a topic of urgent public health need. In addition, this work will lay the foundation for new research that will deliver new culturally relevant interventions to improve health outcomes for African Americans. Such interventions may operate at the level of the patient, clinical encounter, health system, local community, and beyond.