Study highlights Barriers and Facilitators to Adherence

Literature Update 3, July 2004

A recent study published in the journal Ethnicity and Disease explored the perspectives of 106 hypertensive African-American patients in two urban primary care practices regarding the factors they perceived as barriers or facilitators of adherence to prescribed antihypertensive medications. Through open-ended interviews the investigators explored patients' experiences taking antihypertensive medications and their perceptions of the challenges they face in adhering to their medications as prescribed. They also asked patients 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 them to adhere to their medical regimen. The study highlighted four categories of barriers: 1) patient-specific barriers such as skepticism about treatment or different understanding of hypertension; 2) medication-specific barriers such as side effects, size or frequency of pills; 3) logistic barriers such as obtaining or paying for the medication; and 4) disease-specific barriers such as the lack of symptoms associated with hypertension. Five categories of facilitators were identified and included the use of reminders, having a routine, knowledge about hypertension, its treatment and complications, having social support and good doctor-patient communication. The ESFT model is a useful screen and approach to addressing adherence in cross-cultural populations.