Barriers and facilitators of medication adherence in hypertensive African Americans: a qualitative study.

OBJECTIVE: This study explored the perspectives of hypertensive African-American patients, in 2 primary care practices, regarding the factors they perceived as barriers or facilitators of adherence to prescribed antihypertensive medications. DESIGN: This qualitative study used a grounded theory methodology with data collection occurring through in-depth individual patient interviews. SETTING AND PARTICIPANTS: One hundred and six hypertensive African-American patients followed at 2 urban primary care practices participated in the open-ended interviews. METHODS: During interviews, patients' experiences taking antihypertensive medications and their perceptions of the challenges they face in adhering to their medications as prescribed were explored. Patients were also asked about the situations that make it easy or difficult for them to take their antihypertensive medications as prescribed and the skills they thought were necessary for patients to adhere to their medications as prescribed. All responses were recorded verbatim and analyzed using grounded theory methodology. RESULTS: Fifty-eight percent of participants were women, mean age was 56 years, and 60% had uncontrolled hypertension. Four categories of barriers and 5 categories of facilitators were identified. The barriers included patient-specific, medication-specific, logistic, and disease-specific barriers. The facilitators included use of reminders, having a routine, knowledge about hypertension, its treatment and complications, having social support and good doctor-patient communication. CONCLUSION: This study provides a framework for investigating issues of medication adherence in hypertensive African Americans by describing a taxonomy of barriers and facilitators of adherence identified by patients.