title: Medication adherence among rural, low-income hypertensive adults: a randomized trial of a multimedia community-based intervention.
abstract: OBJECTIVE
  Examine the effectiveness of a community-based, multimedia intervention on medication adherence among hypertensive adults.
  
  
  METHODS
  Randomized controlled trial.
  
  
  METHODS
  Rural south Alabama.
  
  
  METHODS
  Low-income adults (N  =  434) receiving medication at no charge from a public health department or a Federally Qualified Health Center.
  
  
  METHODS
  Both interventions were home-based and delivered via computer by a community health advisor. The adherence promotion (AP) intervention focused on theoretical variables related to adherence (e.g., barriers, decisional balance, and role models). The cancer control condition received general cancer information.
  
  
  METHODS
  Adherence was assessed by pill count. Other adherence-related variables, including barriers, self-efficacy, depression, and sociodemographic variables, were collected via a telephone survey.
  
  
  METHODS
  Chi-square analysis tested the hypothesis that a greater proportion of participants in the AP intervention are ≥80% adherent compared to the control group. General linear modeling examined adherence as a continuous variable.
  
  
  RESULTS
  Participants receiving the intervention did not differ from individuals in the control group (51% vs. 49% adherent, respectively; p  =  .67). Clinic type predicted adherence (p < .0001), as did forgetting to take medications (p  =  .01) and difficulty getting to the clinic to obtain medications (p < .001).
  
  
  CONCLUSIONS
  Multilevel interventions that focus on individual behavior and community-level targets (e.g., how health care is accessed and delivered) may be needed to improve medication adherence among low-income rural residents.
authors: Division of Preventative Medicine, University of Alabama at Birmingham, Birmingham, Alabama 35294-4410, USA. mymartin@uab.edu
authors: Michelle Y
authors: MY
authors: Martin
authors: Young-il
authors: YI
authors: Kim
authors: Polly
authors: P
authors: Kratt
authors: Mark S
authors: MS
authors: Litaker
authors: Connie L
authors: CL
authors: Kohler
authors: Yu-Mei
authors: YM
authors: Schoenberger
authors: Stephen J
authors: SJ
authors: Clarke
authors: Heather
authors: H
authors: Prayor-Patterson
authors: Tung-Sung
authors: TS
authors: Tseng
authors: Maria
authors: M
authors: Pisu
authors: O Dale
authors: OD
authors: Williams
mesh_terms: D000407:Alabama; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D001521:Behavior Therapy / Q000379:methods*; D003201:Computers; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D019212:Multimedia / Q000706:statistics & numerical data; D011203:Poverty; D012111:Residence Characteristics; D012424:Rural Population; D012648:Self Care; D012959:Socioeconomic Factors; D013689:Telephone; D016903:Drug Monitoring
chemical_list: D000959:Antihypertensive Agents