John T. Billimek, Ph.D. - US grants

PROJECT SUMMARY/ABSTRACT In the past decade, the prevalence of uncontrolled hypertension has remained substantially higher in Latino Americans compared to other groups, even as access to health insurance has increased. This rise can be explained in part by high rates of medication nonadherence in this population. Many existing approaches to improve medication adherence, such as cell phone reminders, mail order refills and cost-lowering programs, can be effective in patients who are motivated to take a prescribed medication. However, these approaches will not help the over 40% of Latino patients who engage in ?intentional nonadherence??choosing not to take medications because of serious concerns that the drugs are not needed, or will cause side effects. Culturally- bound, negative beliefs about medications, and a preference to replace medications with natural remedies, are common in disadvantaged Latino communities, but are rarely discussed with health providers due to language barriers, low health literacy and cultural distance. Interventions supporting direct and vicarious experiences with a medication may dispel myths about medications and promote more positive beliefs and motivation to adhere. The proposed study is a RCT testing a culturally appropriate and novel intervention to improve adherence to antihypertensive medications in low-income Latino Americans with uncontrolled hypertension. The intervention aims to address negative beliefs over four group medical visit (GMV) sessions by incorporating culturally-bound perspectives on lifestyle and natural remedies alongside medications in discussions of blood pressure lowering strategies, and engaging patients in three brief periods of home monitoring with mHealth devices to support discussion of patients? actual individual experiences with a regimen. The investigators have many years of experience researching contributors to nonadherence in low- income Latino communities, developing mHealth applications and delivering health interventions in safety net clinics. The aims of the study are (1) to evaluate the efficacy of a theory-based intervention to modify negative medication beliefs and promote medication adherence through direct and vicarious experiences with a medication, and (2) to test a theoretical model by which beliefs about medication at baseline predict subsequent use of behavioral strategies to improve adherence. If successful, the intervention may serve as a model approach to reduce intentional nonadherence due to negative beliefs about medications, and address an important contributor to health disparities.