Interventions Incorporating Therapeutic Alliance to Improve Medication Adherence in Black Patients with Diabetes, Hypertension and Kidney Disease: A Systematic Review Patient Preference

Background: Black Americans have a disproportionately increased risk of diabetes, hypertension, and kidney disease, and higher associated morbidity, mortality, and hospitalization rates than their White peers. Structural racism amplifies these disparities, and negatively impacts self-care including medication adherence, critical to chronic disease management. Systematic evidence of successful interventions to improve medication adherence in Black patients with diabetes, hypertension, and kidney disease is lacking. Knowledge of the impact of therapeutic alliance, ie, the unique relationship between patients and providers, which optimizes outcomes especially for minority populations, is unclear. The role and application of behavioral theories in successful development of medication adherence interventions specific to this context also remains unclear. Objective: To evaluate the existing evidence on the salience of a therapeutic alliance in effective interventions to improve medication adherence in Black patients with diabetes, hypertension, or kidney disease. Data Sources: Medline (via PubMed), EMBASE (OvidSP), Cumulative Index of Nursing and Allied Health Literature (CINAHL) (EBSCOhost), and PsycINFO (ProQuest) databases. Review Methods: Only randomized clinical trials and pre/post intervention studies published in English between 2009 and 2022 with a proportion of Black patients greater than 25% were included. Narrative synthesis was done. Results: Eleven intervention studies met the study criteria and eight of those studies had all-Black samples. Medication adherence outcome measures were heterogenous. Five out of six studies which effectively improved medication adherence, incorporated therapeutic alliance. Seven studies informed by behavioral theories led to significant improvement in medication adherence. Discussion/Conclusion: Study findings suggest that therapeutic alliance-based interventions are effective in improving medication adherence in Black patients with diabetes and hypertension. Further research to test the efficacy of therapeutic alliance-based interventions to improve medication adherence in Black patients should ideally incorporate cultural adaptation, theoretical framework, face-to-face delivery mode, and convenient locations.

[1]  O. Shiyanbola,et al.  Preliminary engagement of a patient advisory board of African American community members with type 2 diabetes in a peer-led medication adherence intervention , 2021, Research Involvement and Engagement.

[2]  C. Arenson,et al.  Critical Race Theory as a Lens for Examining Primary Care Provider Responses to Persistently-Elevated HbA1c. , 2020, Journal of the National Medical Association.

[3]  G. L. Hall,et al.  Poor Medication Adherence in African Americans Is a Matter of Trust , 2020, Journal of Racial and Ethnic Health Disparities.

[4]  K. Steinhaeuser,et al.  Development and Evaluation of a Tailored Mobile Health Intervention to Improve Medication Adherence in Black Patients With Uncontrolled Hypertension and Type 2 Diabetes: Pilot Randomized Feasibility Trial , 2020, JMIR mHealth and uHealth.

[5]  E. Grochans,et al.  Diabetes Mellitus Versus Hypertension—Does Disease Affect Pharmacological Adherence? , 2020, Frontiers in Pharmacology.

[6]  K. Norris,et al.  Interventions Incorporating Therapeutic Alliance to Improve Hemodialysis Treatment Adherence in Black Patients with End-Stage Kidney Disease (ESKD) in the United States: A Systematic Review , 2020, Patient preference and adherence.

[7]  H. Bosworth,et al.  Racial Disparities in Medication Adherence between African American and Caucasian Patients With Systemic Lupus Erythematosus and Their Associated Factors , 2020, ACR open rheumatology.

[8]  C. T. Yeam,et al.  Factors affecting medication adherence among pre-dialysis chronic kidney disease patients: a systematic review and meta-analysis of literature , 2020, International Urology and Nephrology.

[9]  S. Chase,et al.  Utilizing a Mobile Health Intervention to Manage Hypertension in an Underserved Community , 2020, Western journal of nursing research.

[10]  K. Wallston,et al.  Provider Attitudes and Support of Patients’ Autonomy for Phosphate Binder Medication Adherence in ESRD , 2019, Journal of patient experience.

[11]  Natalie S Blencowe,et al.  RoB 2: a revised tool for assessing risk of bias in randomised trials , 2019, BMJ.

[12]  B. Appelhans,et al.  Randomized Trial of a Lifestyle Intervention for Urban Low-Income African Americans with Type 2 Diabetes , 2019, Journal of General Internal Medicine.

[13]  R. Oprean,et al.  An overview of the common methods used to measure treatment adherence , 2019, Medicine and pharmacy reports.

[14]  Dana P Goldman,et al.  Racial and ethnic disparities in medication adherence among privately insured patients in the United States , 2019, PloS one.

[15]  Y. Kwan,et al.  A systematic review of factors affecting medication adherence among patients with osteoporosis , 2018, Osteoporosis International.

[16]  Jenny I. Shen,et al.  Kidney Disease Among African Americans: A Population Perspective. , 2018, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[17]  S. Santarossa,et al.  Exploring the role of in-person components for online health behavior change interventions: Can a digital person-to-person component suffice? , 2021 .

[18]  R. Elashoff,et al.  A Cluster‐Randomized Trial of Blood‐Pressure Reduction in Black Barbershops , 2018, The New England journal of medicine.

[19]  M. Sharma,et al.  Using Social Cognitive Theory to Predict Medication Compliance Behavior in Patients with Depression in Southern United States in 2016 in a Cross-Sectional Study , 2018, Journal of caring sciences.

[20]  M. Hernán,et al.  ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions , 2016, British Medical Journal.

[21]  W. Polonsky,et al.  Poor medication adherence in type 2 diabetes: recognizing the scope of the problem and its key contributors , 2016, Patient preference and adherence.

[22]  Jenna M. Norton,et al.  Social Determinants of Racial Disparities in CKD. , 2016, Journal of the American Society of Nephrology : JASN.

[23]  K. Wallston,et al.  Health care providers’ support of patients’ autonomy, phosphate medication adherence, race and gender in end stage renal disease , 2016, Journal of Behavioral Medicine.

[24]  M. Cleves,et al.  African Americans’ Perceptions of Adherence to Medications and Lifestyle Changes Prescribed to Treat Hypertension , 2016, SAGE open.

[25]  Richard Cooke,et al.  A Theory-Based Approach for Developing Interventions to Change Patient Behaviours: A Medication Adherence Example from Paediatric Secondary Care , 2015, Healthcare.

[26]  M. Mete,et al.  THE SYNERGY TO ENABLE GLYCEMIC CONTROL FOLLOWING EMERGENCY DEPARTMENT DISCHARGE PROGRAM FOR ADULTS WITH TYPE 2 DIABETES: STEP-DIABETES. , 2015, Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists.

[27]  J. Schwartz,et al.  Counseling African Americans to Control Hypertension: Cluster-Randomized Clinical Trial Main Effects , 2014, Circulation.

[28]  L. Mayberry,et al.  Empirical Validation of the Information–Motivation–Behavioral Skills Model of Diabetes Medication Adherence: A Framework for Intervention , 2014, Diabetes Care.

[29]  Sherita Hill Golden,et al.  Race/Ethnic Difference in Diabetes and Diabetic Complications , 2013, Current Diabetes Reports.

[30]  Roger L. Brown,et al.  Improving refill adherence and hypertension control in black patients: Wisconsin TEAM trial. , 2013, Journal of the American Pharmacists Association : JAPhA.

[31]  K. Kalantar-Zadeh,et al.  Racial differences in estimated GFR decline, ESRD, and mortality in an integrated health system. , 2013, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[32]  Bryan C. Batch,et al.  A culturally targeted self-management program for African Americans with type 2 diabetes mellitus. , 2012, The Canadian journal of nursing research = Revue canadienne de recherche en sciences infirmieres.

[33]  Papatya Karakurt,et al.  Factors affecting medication adherence in patients with hypertension. , 2012, Journal of vascular nursing : official publication of the Society for Peripheral Vascular Nursing.

[34]  Martin T. Wells,et al.  A randomized controlled trial of positive-affect intervention and medication adherence in hypertensive African Americans. , 2012, Archives of internal medicine.

[35]  Peter Rudd,et al.  A Culturally Adapted Telecommunication System to Improve Physical Activity, Diet Quality, and Medication Adherence Among Hypertensive African–Americans: A Randomized Controlled Trial , 2012, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[36]  P. Llorca,et al.  The influence of therapeutic alliance and insight on medication adherence in schizophrenia , 2012, Nordic journal of psychiatry.

[37]  H. Bogner,et al.  Integrating Type 2 Diabetes Mellitus and Depression Treatment Among African Americans , 2010, The Diabetes educator.

[38]  W. Cushman,et al.  Antihypertensive Medication Adherence, Ambulatory Visits, and Risk of Stroke and Death , 2010, Journal of General Internal Medicine.

[39]  J. Ioannidis,et al.  The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration , 2009, BMJ : British Medical Journal.

[40]  P. Bacchetti,et al.  White/black racial differences in risk of end-stage renal disease and death. , 2009, The American journal of medicine.

[41]  B. Hartmann,et al.  Adherence to prescribed oral medication in adult patients undergoing chronic hemodialysis: A critical review of the literature , 2009, European journal of medical research.

[42]  L. Wishart,et al.  The role of theory in increasing adherence to prescribed practice. , 2009, Physiotherapy Canada. Physiotherapie Canada.

[43]  G. Elwyn,et al.  Advocating Mandatory Patient ‘Autonomy’ in Healthcare: Adverse Reactions and Side Effects , 2008, Health Care Analysis.

[44]  D. Roblin,et al.  Racial/ethnic disparities and consumer activation in health. , 2008, Health affairs.

[45]  M. Charlson,et al.  Multiple health-risk behavior in a chronic disease population: what behaviors do people choose to change? , 2008, Preventive medicine.

[46]  P. Muntner,et al.  Prevalence and Predictors of Poor Antihypertensive Medication Adherence in an Urban Health Clinic Setting , 2007, Journal of clinical hypertension.

[47]  A. Farmer,et al.  Designing and evaluating complex interventions to improve health care , 2007, BMJ : British Medical Journal.

[48]  K Rivet Amico,et al.  An information-motivation-behavioral skills model of adherence to antiretroviral therapy. , 2006, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[49]  N. Langer.  Culturally Competent Professionals in Therapeutic Alliances Enhance Patient Compliance , 1999, Journal of health care for the poor and underserved.

[50]  Abpp Elizabeth L. McQuaid PhD,et al.  Cultural Issues in Medication Adherence: Disparities and Directions , 2017, Journal of General Internal Medicine.

[51]  M. Rosal,et al.  A Virtual World Versus Face-to-Face Intervention Format to Promote Diabetes Self-Management Among African American Women: A Pilot Randomized Clinical Trial , 2021 .