In the past decade, the prevalence of uncontrolled hypertension has risen substantially in Latino Americans with diabetes 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 diabetes and uncontrolled hypertension. The intervention aims to address negative beliefs over three 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 two 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 culturally bound negative beliefs about medications, and address an important contributor to health disparities.
The proposed research is relevant to public health because poor adherence to prescribed treatments is common for individuals with one or more chronic health conditions, and contributes to significant preventable morbidity in the population. Results from this study will provide evidence for the effectiveness of an intervention that focuses on addressing negative beliefs about medication in a large, high risk population, Latino adults with diabetes and uncontrolled hypertension, and test a conceptual framework that will inform future development of novel interventions tailored for other at-risk populations. Thus, the proposed research is relevant to the priority area of improving adherence, as identified by multiple NIH Institutes and Centers participating in the NIH Adherence Network.