Journal
AMERICAN JOURNAL OF PUBLIC HEALTH
Volume 103, Issue 11, Pages E55-E62Publisher
AMER PUBLIC HEALTH ASSOC INC
DOI: 10.2105/AJPH.2013.301554
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Funding
- Agency for Healthcare Research and Quality [R36 HS020755-01]
- National Heart, Lung, and Blood Institute [U01 HL079171-01]
- Center for Health Equality and Intervention Research (CHEIR) at the University of Massachusetts Medical School
- National Institute on Minority Health and Health Disparities [1P60MD006912]
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Objectives. We sought to determine if reported racial discrimination was associated with medication nonadherence among African Americans with hypertension and if distrust of physicians was a contributing factor. Methods. Data were obtained from the TRUST project conducted in Birmingham, Alabama, 2006 to 2008. All participants were African Americans diagnosed with hypertension and receiving care at an inner city, safety net setting. Three categories of increasing adherence were defined based on the Morisky Medication Adherence Scale. Trust in physicians was measured with the Hall General Trust Scale, and discrimination was measured with the Experiences of Discrimination Scale. Associations were quantified by ordinal logistic regression, adjusting for gender, age, education, and income. Results. The analytic sample consisted of 227 African American men and 553 African American women, with a mean age of 53.7 +/- 9.9 years. Mean discrimination scores decreased monotonically across increasing category of medication adherence (4.1, 3.6, 2.9; P = .025), though the opposite was found for trust scores (36.5, 38.5, 40.8; P < .001). Trust mediated 39% (95% confidence interval = 17%, 100%) of the association between discrimination and medication adherence. Conclusions. Within our sample of inner city African Americans with hypertension, racial discrimination was associated with lower medication adherence, and this association was partially mediated by trust in physicians. Patient, physician and system approaches to increase earned trust may enhance existing interventions for promoting medication adherence.
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