Exploring Hypertension Medication Adherence in African Americans Using the Health Belief Model and the Social Determinants of Health.

Background: Medication nonadherence is a significant threat to the treatment of hypertension in African Americans. Nonadherence to medications negatively impacts treatment efficacy, safety, and cost. Purpose: This paper aims to identify potential predictors of medication adherence among African Americans based on the Health Belief Model (HBM). In addition, this analysis provides insight into medication nonadherence, interventions to reduce the risk of nonadherence, and the impact of the Social Determinants of Health (SDOH). Conclusion: African American patients with hypertension continue to have lower hypertension medication adherence, due to factors that health care providers may not understand. Besides modifiable and nonmodifiable risk factors, African Americans also experience both unintentional and intentional adherence barriers that are influenced by SDOH, historical constructs, mistrust of the health care system, myths about medications, potential side effects, and passed-down beliefs. The HBM provides a viable theoretical model for promoting hypertension health promotion and disease prevention in African Americans. Clinical Implications: In addition to considering modifiable and nonmodifiable risk factors, health care providers should understand how intentional and unintentional rationales for taking medications can affect a patient's decision. The HBM can be used as a foundation for education and establishing patient willingness to take prescribed medications. Future studies must examine African Americans' readiness and intention to use medications to treat hypertension.