Relationship of trust with medication adherence among African American men with hypertension: The Alabama Collaboration for Cardiovascular Equality Project

Background: African American (AA) men's health is considerably worse than other groups, with African American men disproportionately suffering from preventable diseases. Notably, hypertension among AA men demonstrates a disproportionate incidence and adverse clinical course such as greater stroke, heart disease, and end stage renal disease mortality relative to Whites. Even though AA men are more likely than other groups to know they are hypertensive; they are less likely than other groups to achieve control of hypertension. AAs are more prone than Whites to distrust the health care establishment. Lack of trust is associated with poorer medical adherence and delays in seeking health care, however this is an understudied area in AA men.

Objective: To examine the relationship of trust in the healthcare system and providers with medication adherence and blood pressure among AA men seeking care at a large safety-net, urban clinical center.

METHOD: A cross-sectional study was designed to measure trust and medication adherence in diagnosed hypertension AA male patients ≥19 years old in 2008. Trained study personnel used computer assisted protocols to conduct in-person interviews and abstract medical records. Medication adherence was assessed by the Morisky scale, and patients were considered adherent if they reported missing no medication. Trust scales scores were divided into tertiles. We performed descriptive and bivariate analyses with t-tests or chi square as appropriate.

RESULTS: 229 AA men participated in the study. Overall, 86% were ≥ 45 years of age; 67% were not married; and 77% reported an annual household income of ≤ $16,000. Almost 67% trust doctors in general; 83% trust their personal doctors; and 80% believe hospitals experiment on people without telling them. Those with Hall trust scores in the upper tertile, compared to those in the lower tertile, were more likely to report missing no medication doses (69%, 46%, p = 0.037). However, systolic and diastolic blood pressure were not significantly different for those with lower compared to higher tertile trust scores.

Results: Trust is associated with medication adherence in AA men. Implementing relevant interventions to increase trust in physicians might enhance adherence to hypertension medication in AA men.