Discussion: Medication Adherence in African American Adults

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Discussion: Medication Adherence in African American Adults state_of_knowledge___final_paper.docx Running Head: MEDICATION ADHERENCE IN AFRICAN AMERICAN ADULTS Antihypertensive Medication Adherence in African American Adults State of Knowledge Nympha Charles Florida International University NGR 1178 Scientific and Theoretical Foundation December 3, 2017 MEDICATION ADHERENCE IN AFRICAN AMERICAN ADULTS 1 Abstract Antihypertensive medication non-adherence is a subject of concern to all stakeholders in the management of hypertension in African American adults. Non-adherence to medication has caused often results in uncontrolled hypertension that leads to cardiovascular complications of varying severity. This paper aims to understand the challenges and assess solutions surfacing in the care of hypertensive African American adults through the critical review of the literature. Results of the study suggest that the challenges in the adherence to antihypertensive medication are socioeconomic, psychosocial, and interpersonal factors causing difficulties for both the patient and the healthcare providers. The proposed solution is to adopt a comprehensive health promotion procedure that would ensure both short-term and long-term care to patients. Thereby it will enable healthcare workers to provide holistic and rehabilitative care to patients with the pre-existing condition of hypertension while making sure those healthcare sectors to provide necessary support to institutionalize quality and accessible for all. MEDICATION ADHERENCE IN AFRICAN AMERICAN ADULTS 2 Introduction Hypertension is a universal health crisis that affects people of all races, ethnicities, sex, and walks of life. In the United States, it is considered as one of the major concerns in public health having about 78 million cases for 20 years old and over (Buis et al., 2015). The statistics also contribute to the concern on hypertension as it is known to be one of the leading primary or secondary causes of death in the modern age. Studies of Roger et al., (2012) and Danaei et al., (2010) suggest that cardiovascular mortality is caused predominantly by hypertension and claims to be the primary source of disparities in all-cause mortality (as cited in Young et al., 2015). One of the contributors to this disparity according to previous studies of Egan et al. (2010), Mensah et al., (2005) and Douglas et al., (2003) is the early onset, high prevalence, great severity, and high rate of inadequate treatment of the disease among African Americans (as cited in Young et al., 2015). This is consistent with the study of Wong et al., (2002) that African Americans have been observed to exhibit cardiovascular mortality; half of the cases are attributed to hypertension (as cited in Cené et al., 2012). Discussion: Medication Adherence in African American Adults The National Center for Health Statistics (2009) and the Centers for Disease Control and Prevention (2010) reported that African Americans, especially men, suffer hypertension at a disproportionately higher rate in comparison to any other race or ethnic groups as reported by (as cited in Cené et al., 2012). Inadequate patient education, self-efficacy, and self-management skills also significantly impact the prevalence of uncontrolled hypertension in African American (Buis et al., 2015). While antihypertensive treatments are widely available and sometimes accessible to hypertensive patients, non-adherence to medication and treatment regimens undermines the effectiveness of antihypertensive therapy in African Americans. Improving patient-care provider interaction and promoting self-efficacy in patients have been suggested to be crucial to successfully increase adherence to antihypertensive treatment and reducing hypertensionrelated mortality in African Americans. MEDICATION ADHERENCE IN AFRICAN AMERICAN ADULTS 3 Many studies have researched the prevalence of hypertension in African American communities to determine the driving factors behind non-adherence to antihypertensive treatment among Blacks and identify potential interventions to improve adherence to treatment and reduce the risk of complications. Several factors including cultural perception of hypertension, racial discrimination on the access or lack of health care, and the quality of care provided influences the management of hypertension in African American adults and impacts on the rate of uncontrolled hypertension in this population (Buis et al., 2015). Thus, it can suggest that the rate of prevalence of hypertension in African American adults is a multifactorial consequence that covers vast areas of health concerns from a personal health view to multi-sector provision of care. Discussion: Medication Adherence in African American Adults.3 This paper reviewed existing literature including academic journals and articles on hypertension, antihypertensive medication adherence and the factors that influence these conditions in African American populations. These reviews explore the theoretical framework and health models used in the research of adherence to medication in hypertensive African Americans. It also evaluates for potential practice implication for care providers to address the problem of medication non-adherence in patients. Furthermore, this paper also identified common themes emerging from the results of the reviewed to propose an evidence-based health promotion framework that can be utilized to support the needs of hypertensive African American adults. Component of the Literature Search The student employed database research through CINAHL, Google Scholar, ProQuest, and Ebsco databases. General headings on medication adherence were used for purposes of online database search using keywords such as antihypertensive, drug adherence, medication compliance, and African American patients. Specific headings include keywords such as African American hypertension, African American drug adherence to medication, and MEDICATION ADHERENCE IN AFRICAN AMERICAN ADULTS 4 antihypertensive drug compliance. Other headings used to qualify relevant journal articles that include keywords such as self-efficacy theory, health promotion theory, and health education efficacy. A total of 17,700 academic journals, newspaper articles, and books resulted from the initial database search. Since the focus of the critical review was on antihypertensive medication adherence, only articles cited between 2010 to 2017 considered. Excluded Books, essays, and newspaper articles from the study. There are ten articles annotated and reviewed from the online database research using the inclusion and exclusion criteria. All ten articles were empirical quantitative descriptive studies most of which utilized frameworks to guide the research process. Historical Evolution of the Theory Health Promotion is the process of supporting and empowering people to play active parts in the control and improvement of their health (WHO, 2017). Health promotion focuses on social and environmental interventions rather than individual behaviors as the primary tool for improving health and wellness in any population. O’Donnell (1987) defines it as both science and art where people are assisted towards lifestyle change to achieve optimum health functioning (as cited in Edelman, Mandle, and Kudzma, 2013, p. 11). This definition suggests that the core context of health promotion is the process that enables people to be able to take control of their health to attain optimal functioning. The U.S. Public Health Service commissioned Kreuter and Devore (1980) to formulate a more comprehensive definition of health promotion that is supporting health-related advocacies (as cited in Edelman et al., 2013, p. 11). Discussion: Medication Adherence in African American Adults They intended to encourage positive healthcare practices to be adopted by individuals, businesses, and government institutions towards promoting health consciousness, a norm in the society (Edelman et al., 2013, p. 11). The root of this theory covers various disciplines in social sciences such as the theory of reasoned action by Ajzen and Fishbein (1980), theories of behavior by Albert Bandura (1976, 1999, 2004), the health belief model by Rosenstock (Janz MEDICATION ADHERENCE IN AFRICAN AMERICAN ADULTS 5 et al., 2002), Pender’s health promotion model (Pender et al., 2010), and stages of change theories by Prochaska (Prochaska et al., 2004) (as cited in Edelman, et al., 2013, p. 11). These theories support the idea that health promotion, when aimed towards behavioral change through social rather individual interventions, can result in the attainment of observable behavioral outcomes of health promotion strategies. In addition, health promotion is not limited to providing health education; it also serves as a platform for social change by determining social issues affecting health and provides actual proactive solutions to address these issues (Edelman et al., 2013, p.12). Collaboration among all participants including care workers, community leaders, and patients is crucial in promoting a holistic health care attitude in different communities. Health promotion can either be active or passive depending on how the health care providers view the patients. Passive health promotion views patients as receivers of health information while active health promotion views patients as part of the implementation of a health promotion program making them active collaborators of its goals and purposes (Edelman et al., 2013).Discussion: Medication Adherence in African American Adults The student opted to adopt the integration of both passive and active health promotion through the Transtheoretical model that integrates three concepts of change in health promotion. These include the conceptualization of change as a time-bound perspective that moves on a continuum from readiness to action. Decisional Balance is another concept considers the factors affecting change in behavior by reflecting the individual’s weighing of the pros and cons of changing (Peterson & Bredow, 2017, p.286). Self-efficacy defines a change regarding the intrinsic motivation of a person to change habits or actions while the process of change outlines different mental, emotional, and behavioral actions affecting change (Peterson & Bredow, 2017, p.229). The theory of self-efficacy developed by Bandura claims that expectations and outcomes associated with self-efficacy are not only influenced by the behaviors of individuals but also the expectations influenced by verbal encouragement from MEDICATION ADHERENCE IN AFRICAN AMERICAN ADULTS 6 others such as nurses, doctors, and family (Peterson & Bredow, 2017). The core purpose of using the Transtheoretical framework is to be able to study and provide holistic and viable means for the adherence to antihypertensive medication of African Americans. It also shifts the focus of health promotion from a solely acute, hospital-based approach to a primary and preventive, community-based care (Edelman et al., 2013, p. 15). This entails the active involvement of nurses in making sure that desired changes are achieved and sustained by the patients they serve. The goals of health promotion also require nurses to play various roles such as advocates, care managers, consultants, deliverer of services, educators, healers, and researchers (Edelman et al., 2013). The framework used to explain, understand, and respond to the issues involving the adherence to the antihypertensive medication of African American adults is valuable in the proposing a process that results in possible actions. In turn, would enable healthcare providers and related sectors to develop, implement, and evaluate different protocols to address the increasing prevalence hypertension not only in the African Americans but also to the general population of the country. Conceptual, Theoretical, Methodological Issues Six stages highlight the current conceptual issues that influence medication adherence and non-adherence in hypertensive African Americans. Discussion: Medication Adherence in African American Adults The concept of Transtheoretical model as a basis for health promotion is based on the six stages of change: pre-contemplative stage (where individuals are not considering change); contemplative (where individuals are aware of the problems but not considering change soon); preparation stage (where individuals are planning to act soon); action (where individuals are beginning to show signs of recent behavioral change); maintenance (where individuals are observed to continue exhibiting favorable behavior that can be sustained for long term); and relapse (where individuals revert MEDICATION ADHERENCE IN AFRICAN AMERICAN ADULTS to old behavior) (Peterson & Bredow, 2017). 7 These stages are used to describe the phenomenon of antihypertensive medications adherence in African American. The key to the effective treatment and management of hypertension is the integration of different care models and interventions to achieve maximum effectiveness. Some of the interventions utilized in the management of hypertension in African Americans include lifestyle modifications such as improved physical activity, dietary regimens, and controlled smoking and alcohol intake. Martin et al., (2010) purports that hypertension is a cardiovascular risk factor that is most commonly modifiable. Hypertension can be regulated to make sure it does not progress into cardiovascular complications such as stroke or cardiovascular accidents. The literature surrounding the antihypertensive adherence of the African American adults talked about various issues and contexts, which were valuable in explaining how people in this demography struggle to be adherent to the directives of taking their respective medications. It also raises valuable concerns in the healthcare promotion and healthcare provision of the different healthcare sectors and providers. Thus, in the review of the literature, the student reported three issues discussed in the literature selected. The first issue identified is the factors that contribute to the non-adherence to antihypertensive medication of the African Americans. The pre-contemplative, contemplative and event to some extent the planning stage where various factors explain the readiness of specific population to change toward medication adherence. The second issue is the proposed solutions of the different researchers towards reducing non-adherence to antihypertensive medications in African American adults. Discussion: Medication Adherence in African American Adults This section falls on the preparation, action and maintenance phase of health promotion as it utilizes the available responses of Black American and recommendation to address solutions to medication adherence. The third issue discusses the theoretical frameworks used in the research of antihypertensive medication adherence in African American adults and their limitations that may offer valuable insight for future studies. MEDICATION ADHERENCE IN AFRICAN AMERICAN ADULTS 8 Factors of Medication Non-Adherence for Hypertensive Patients Studies suggest that non-adherence to medication is one of the contributing factors to elevated blood pressure among African Americans, (Young et al., 2015; Schoenthaler et al., 2017; Cené et al., 2012). This may be attributed to three particular issues: socio-economic factors (Young et al., 2015, Richardson et al., 2014), psychosocial status (Schoenthaler et al., 2017; Schoenthaler et al., 2016; Abel & Efird, 2013; Cuffee et al., 2013; Cenè et al., 2012, and Warren-Findlow et al., (2011), and health care provider factors (Schoenthaler et al., 2017; Schoenthaler et al., 2016; Buis et al., 2015; Richardson et al., 2014; Abel & Efird, 2013; Warren-Findlow et al., 2012; and Martin et al., 2010). These factors predispose African American adults to complications of hypertension caused by high and uncontrolled arterial blood pressure. Socio-economic Factors One of the most consistent findings of the literature studies is the prevalence of antihypertensive medication non-adherence in African American adults who belong to lowincome families. The reason for their non-adherence to medication is caused by their relatively weak access to medication and low self-efficacy. The failure of their health care insurance coverages to sustain their access to antihypertensive medications is also a contributing factor (Young et al., 2015). Discussion: Medication Adherence in African American Adults Thus, patients who need and want medications are forced to skip dosages or entirely miss their medications as often recorded before admission to hospitals. In the study of Martin et al., 2010, 60% of the adult participants reported being non-adherent to medications due to limited access to free medications. Factors that influenced this phenomenon also include inadequate patient-provider engagement and communication, forgetting to take medications, and running out of antihypertensive medications. The findings indicated that more individuallevel intention is required to remedy the rates of non-adherence that occur mainly due to individual factors such as negligence. MEDICATION ADHERENCE IN AFRICAN AMERICAN ADULTS 9 Psychosocial Factors The psychosocial factor that contributes to medication non-adherence was comprehensively studied in the research by Schoenthaler et al. (2016). Specifically, the study centers on self-efficacy and depression as a key component of medication adherence among hypertensive patients. Warren-Findlow et al. (2011) describe self-efficacy as a psychosocial concept related to the ability of a person to manage a chronic disease. This self-management practice according to Schoenthaler et al. (2016), has been applied and associated with the adoption of and adherence towards specific health behaviors including consistent intake of medication as a practice for patients with chronic illness. In addition, self-efficacy is also a predictor towards self-management especially with adherence to medication. People who tend to have high self-efficacy are inclined to exhibit confidence, especially in assigned tasks as they tend to exert more effort in accomplishing responsibilities, take up challenging endeavors, and are proven to persist longer in difficulties and obstacles (Schoenthaler et al., 2016). A higher level of self-efficacy is directly found to influence an improvement in medication adherence. The study of Richardson et al., (2014), proposed measuring self-efficacy towards adherence to medication using a 26-item scale known as the Medication Adherence SelfEfficacy Scale with potential scores ranging from 0 to 78. On the contrary, Richardson et al. (2014) claim that low self-efficacy is resulting from experiences of discrimination regarding race or ethnicity and mental status results to adverse effects in medication adherence. Depression is another psychosocial factor that is related to medication adherence (Warren-Findlow et al., 2011). According to Howard et al. (2006), hypertensive patients are associated to have poor adherence to medication, case in point is a study conducted by Bosworth et al., (2008) among hypertensive African Americans with depression symptoms were found out to have difficulty adhering to medications due to low self-efficacy (as cited in Warren-Findlow et al., 2011). Discussion: Medication Adherence in African American Adults The claims of the role of depression to MEDICATION ADHERENCE IN AFRICAN AMERICAN ADULTS 10 non-adherence to medication support the idea that the psychological state of the person affects health-related tasks such as regular intake of medicine. Thus, it can be reasoned that low selfefficacy is directly relational to depression and non-adherence to medications. Measuring depression symptoms in patients who have medication adherence problems can be a challenge. The study of Cené et al., (2012) suggest an instrument to be used to measure depression symptoms through the Center for Epidemiologic Studies Depression (CESD) scale, which is a 20-item questionnaire using a 4-point Likert response format aiming to measure the symptoms of depression pre-existing for one week. Interpersonal Factors Interpersonal factors were also part of the discourse whether it is affecting patient adherence to medication. The relationship between the healthcare provider and the patient is crucial in the delivery of care and communic … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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