Perceptions of barriers to medication adherence in hypertensive African-Americans: The stress associated with everyday living

Medication adherence is low among hypertensive patients regardless of ethnic background. However, African-American prevalence is higher when compared to Caucasian-Americans. Recognizing African-American perspectives about their adherence to antihypertensive medications is necessary for the development of successful interventions aimed at improving adherence to prescribed regimens. Thus, the purpose of this qualitative study was to explore community-dwelling hypertensive African-American perspectives regarding adherence to antihypertensive medications. A community and academic partnership was formed to conduct three focus groups with 40 participants at two community centers in a Northeastern urban city. Each focus group was recorded and transcribed verbatim. We analyzed the focus group data using thematic analysis. Participants had a mean age of 57 years, were mostly female (n=27), high school graduates (n=14), unemployed (n=27), and earned an annual income of $20, 000 or less (n=18). In addition, they had a mean hypertension diagnosis of 8 years with most participants reporting adherence to their antihypertensive medication regimens (n=26). Data analysis revealed an overarching theme of “stress associated with everyday living” in which study participants were able to articulate the health benefits associated with adhering to their medications but also described the difficulties associated with adherence in relation to their social contexts. Participants identified three subthemes associated with the “stress associated with everyday living.” The subthemes included: (a) negotiating their limited resources, (b) negotiating their neighborhood violence, and (c) negotiating their feelings of mistrust of doctors. Although these results cannot be generalized, they do provide significant insight into the contextual factors associated with the lives of some community-dwelling hypertensive African-Americans. These findings may be useful for tailoring interventions to increase medication adherence in hypertensive African-Americans.