Predictors of Medication Adherence Among African Americans With Hypertension

非裔美国人高血压患者服药依从性的预测因素

• 批准号: 8183261
• 负责人: Yendelela Levana Cuffee
• 金额: $ 2.93万
• 依托单位: UNIV OF MASSACHUSETTS MED SCH WORCESTER
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-07-01 至 2012-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8183261
• 关键词: Predictors; Medication; Adherence; Among; African

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.

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。我们在阿拉巴马州伯明翰市中心的库珀绿色医疗系统 (CGHS) 工作，发现大约 80% 被诊断患有高血压的非裔美国人的血压没有得到充分控制。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，极大地导致了这些令人震惊的健康差异。这些因素也影响非裔美国人应对压力的方式，并与依赖家庭疗法而不是适当的药物管理有关。这项横断面研究将使用由国家心肺和血液研究所资助的 TRUST 项目的现有数据 (2007-8) 来检验非裔美国人的社会文化因素与药物依从性之间的关联。 TRUST 首席研究员，博士。 Jeroan Allison 和 Sandral Hullett 将担任这项研究的导师。 Hullett 博士的实习将提供与 CGHS 患者一起工作的机会，TRUST 参与者也是从这些患者中招募的。本论文的具体目的是：（1）评估自我报告的歧视与药物依从性之间的关联，并确定对医疗系统的信任是否介导了这种关联； (2)考察应对逆境与服药依从性的关系； (3) 确定家庭疗法的使用是否与依从性较低有关。这项研究支持 AHRQ 的使命，即提高重点人群医疗保健的质量、安全性、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的先进统计技术。因此，我们将产生新的知识和实践见解，这些知识和见解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休利特博士一起制定了可靠的指导计划。我的论文咨询委员会带来了先进定量方法、社会文化结构在卫生服务研究中的应用以及开发文化敏感干预措施以减少健康差异方面的更多专业知识。完成论文后，我将申请职业发展奖，该奖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。我致力于健康服务研究，重点关注健康差异。除了追求自己的独立研究之外，我的长期目标是成为吸引新人才参与卫生服务研究、指导少数族裔学生在学术医学方面取得成功以及建立强有力的社区学术伙伴关系的积极力量。 公共卫生相关性：该项目将产生有关心血管健康差异根本原因的新知识，这是公共卫生迫切需要的一个主题。此外，这项工作将为新研究奠定基础，从而提供新的文化相关干预措施，以改善非裔美国人的健康状况。此类干预措施可以在患者、临床遭遇、卫生系统、当地社区等层面实施。