Influence of Active-Coping on Medication Adherence in a Low-Income Hypertensive African-American Community: A New Application of John Henryism

Background: In addition to improved dietary habits and increased physical activity, effective blood pressure control often requires high levels of medication adherence (Weir et al. 2000, Oparil et al. 2001). Levels of adherence to antihypertensive medications are lower among African-Americans compared to Whites (Charles et al. 2003). Psychosocial factors, such as active-coping levels, may play a significant role in this disparity.

Methods: Using cross-sectional baseline data from the Community Hypertension Intervention Project (Ward et al. 1998), we examined the association between active-coping and medication adherence. Active-coping was operationalized using a short version of the John Henryism Active Coping Scale (James et al. 1983); the 8-item Morisky Scale was used to measure medication adherence (Morisky et al. 2008). Chi-square statistic and binomial logistic regression analyses were used to test for medication adherence differences and the effect of active-coping levels on medication adherence.

Results: There was a statistically significant difference in medication adherence between high and low active-coping groups (c2=7.14, p=0.008). After adjusting for relevant covariates, African-Americans with higher levels of active-coping had 38% greater odds of medication adherence than African-Americans with lower levels of active-coping (OR=1.38, 95% CI=1.00-1.89).

Conclusion: Several factors influence medication adherence levels among hypertensive African-Americans. As demonstrated by this study, active-coping is one such factor. Understanding how African-Americans actively cope with the demands of a medical regimen, in addition to daily stressors, is important for designing public health interventions aimed at increasing medication adherence in the African-American community, and ultimately eliminating disparities in blood pressure control.