This online COVID-19 pandemic era investigation with Black hypertensive adults (N=612) who were 93.6% U.S. born, 54.7% male, 44.3% female with a mean age of 37 years sought to identify predictors of self-ratings for being medication non-adherent and for racism and discrimination impacting engagement with medical providers.
Findings showed over 70% were medication non-adherent on Morisky Medication Adherence Scale, and 49.3% self-classified as medication non-adherent. Regarding behaviors of following provider instructions for taking medication, maintaining appointments, and uninterrupted receipt of medication, these deteriorated during the pandemic, but improved by currently—as resilience; yet, maintaining appointments and uninterrupted receipt of medication were better currently than pre-pandemic. While social support was low and unchanged from before the pandemic to currently, social support with medications deteriorated during the pandemic, but improved currently.
Participants rated providers as follows: having closest to moderate cultural competence; moderate level of discrimination; moderately high for discriminating against their personal demographics, identity, or appearance (e.g. 85.3% for being Black, 80.6% for skin color, 66% for hair); 64.5% exposed them to racism/ discrimination so it impacted engagement with providers for willingness to regularly attend appointments; and, low-moderate frequency of microaggressions related to being Black. Not surprisingly, moderate medical mistrust was found.
Two backward stepwise logistic regression models highlighted recurrent predictors for medication adherence as being 1-less provider discrimination for demographics/ identity/ appearance, and 2-less frequent provider microaggressions for being Black; and, one highlighted higher provider cultural competence. In a third model, greater provider discrimination was a predictor of self-classifying for racism/discrimination impacting engagement with providers. Findings highlight less provider discrimination and less frequent microaggressions by providers as key experiences—such that lower levels of exposure to provider racism, discrimination and microaggressions emerge as powerful determinants of medication adherence. The study has important implications for the urgency of addressing providers’ racism, discrimination and racial microaggressions as factors playing a role in medication non-adherence and patients’ unwillingness to return for medical appointments.
Training in cultural competence is vitally needed with specific attention in training to actually observing, addressing and changing providers’ behavior of enacting racism, discrimination, and microaggressions with Black hypertensive patients.
| Identifer | oai:union.ndltd.org:columbia.edu/oai:academiccommons.columbia.edu:10.7916/dg2g-vq78 |
| Date | January 2023 |
| Creators | Jacob, Julie |
| Source Sets | Columbia University |
| Language | English |
| Detected Language | English |
| Type | Theses |
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