Glaucoma is the leading cause of irreversible blindness among African Americans (AA) who are more than three times more likely to develop glaucoma when compared to Caucasians. Changes associated with the progression of glaucoma can have a serious negative impact on an individual's quality of life, independence, and everyday functioning. Accumulating research indicates that pressure-reducing eye drops can significantly delay or prevent the onset of disease; however, such preventative efforts have been found to be limited due to problems with poor medication adherence. Lacking are available health promotion interventions that minimize this important health disparity. Thus, in our research program, we demonstrated this health disparity for glaucoma medication adherence (Dreer et al., 2012). Next, we conducted several follow-up studies in order to develop a culturally relevant and informed, health promotion-based intervention to improve glaucoma medication adherence among AA's. As part of the intervention development process, we conducted several focus groups with AA glaucoma patients to elicit the salient barriers and facilitators related to glaucoma medication adherence, and then formed a community-based participatory research team comprised of AA's with glaucoma (Dreer et al., 2013). The resulting intervention was based on a multi-component empowerment framework that includes glaucoma education, motivational interviewing, and problem-solving training to improve glaucoma medication adherence. We recently pilot tested the feasibility and preliminary efficacy of the intervention among AA's. Findings revealed significant improvements in objective medication adherence (Dreer et al., under review). Therefore, we now propose to further evaluate the efficacy of this intervention for improving glaucoma medication adherence among AA patients in a large-scale randomized clinical trial (RCT). The patient population for the RCT will consist of 240 adult AA's with glaucoma and who are aged = 21 years who seek services at the University of Alabama at Birmingham's Glaucoma Clinic within the Department of Ophthalmology. The RCT will have two treatment arms; patients will be randomized following eligibility determination and written informed consent. The usual care only arm will consist of the standard medical care for glaucoma (medicine, laser trabeculoplasty, conventional surgery, or a combination of any of these). The second arm will consist of usual care as just described plus the culturally relevant, health promotion-based intervention. The primary outcome (objective glaucoma medication adherence) and secondary outcomes will be assessed at baseline before intervention initiation and at 3, 7, and 12-month in-clinic follow-up visits by a research interviewer masked to subjects' randomization. The practical question to be addressed is does a culturally relevant, health promotion-based intervention improve glaucoma medication adherence among a high-risk segment of the population? Information from this project will be particularly useful for AA's with glaucoma, their families, and eye care providers.
Poor adherence to glaucoma therapy is a significant healthcare issue that may result in unwarranted changes in medications, increased healthcare expenditure, risk to the patient if surgical intervention is required and further deterioration of vision, all of which can be prevented. This can subsequently have a negative impact on an individual's quality life, independence, and everyday living. The multifaceted and culturally relevant, health promotion-based intervention, lacking in this area, is designed to take critical steps toward addressing this problem by motivating change for healthy lifestyle behaviors and improving problem-solving strategies to better manage barriers related to glaucoma medication adherence, particularly among African American patients who are at greater risk for glaucoma and poor adherence compared to Caucasians.
