Predictors of Medication Adherence Among African Americans With Hypertension

描述(由申请人提供)：我的首要目标是阐明非裔美国人高血压控制不佳的根本原因。在阿拉巴马州伯明翰的库珀绿色健康系统(CGHS)工作时，我们发现，大约80%被诊断患有高血压的非裔美国人没有充分控制他们的血压。感知到的歧视和对医疗系统的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担忧的健康差距。这些因素还影响非裔美国人如何应对压力，并与依赖家庭补救措施而不是适当的药物管理有关。这项横断面研究将利用由国家心肺和血液研究所资助的信托项目的现有数据(2007-2008年)，研究社会文化因素与非裔美国人用药依从性的关系。TRUST首席调查员Jeroan Allison博士和Sandral Hullett博士将担任这项研究的导师。Hullett博士的实习将提供一个与CGHS患者合作的机会，这些患者就是招募信托参与者的同一批人。本论文的具体目的是：(1)评估自我报告的歧视与服药依从性的关系，并确定对医疗系统的信任是否中介了这种联系；(2)考察应对逆境与服药依从性的关系；(3)确定家庭补救措施的使用是否与较低的依从性相关。这项研究支持了AHRQ的使命，即改善优先人群的卫生保健的质量、安全、效率和有效性。我们的分析将使用中介分析和结构方程建模等先进的统计技术。因此，我们将产生新的知识和实用的见解，这些将很容易转化为创新的缩小差距的干预措施。除了我提议的实质性工作外，我还与艾利森博士和胡利特博士制定了一项坚实的指导计划。我的学位论文咨询委员会在先进的量化方法、社会文化结构在卫生服务研究中的应用以及为减少健康差距而开发文化敏感干预措施方面带来了额外的专业知识。完成论文后，我将申请职业发展奖，该奖项利用定量和定性技术来开发和试点干预措施，促进非裔美国人的用药依从性。我致力于卫生服务研究的事业，重点是健康差距。除了从事自己的独立研究外，我的长期目标是成为一股积极的力量，吸引新的人才进入卫生服务研究，指导少数族裔学生在学术医学方面取得成功，并建立牢固的社区-学术合作伙伴关系。 公共卫生相关性：该项目将产生关于心血管健康差距根本原因的新知识，这是一个迫切需要公共卫生的主题。此外，这项工作将为新的研究奠定基础，这些研究将提供新的与文化相关的干预措施，以改善非裔美国人的健康结果。这种干预措施可以在患者、临床接触、卫生系统、当地社区和其他层面上进行。

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.