Exploring adherence to antihypertensive medication in Black African and Black Caribbean residents in South East London: a qualitative study.

Background: Hypertension disproportionately affects individuals identifying as Black African, Black Caribbean and Black other with higher rates of uncontrolled hypertension and related organ damage including stroke and kidney disease. Improved understanding of ethnic and cultural views about hypertension is needed to support medication adherence.

Aim: To explore the adherence barriers and facilitators to taking anti-hypertensive medication in people of Black African or Black Caribbean heritage in South East London (SEL).

Design & setting: Qualitative study with an electronic survey followed by semi-structured interviews.

Method: Public health and community interest company recruitment of 11 participants; 9 who completed an online survey and 6 who completed online interviews regarding their experience and thoughts around medical management of hypertension. Data were analysed using thematic analysis and then mapped to capacity, opportunity, and motivation behaviour (COM-B) model components.

Results: Substantial barriers exist to the adherence to antihypertensive medication for Black African and Black Caribbean patients in SEL due to mistrust on both system and interpersonal levels. People felt uninvolved in treatment decisions and that there was a lack of discussion about non-medical management. Adherence was facilitated by an understanding of the consequences of not taking antihypertensive medication, although this was also associated with fear and mistrust.

Conclusion: These barriers add new findings to existing studies on hypertension management and are congruent with current literature describing mistrust stemming from longstanding racial discrimination. Mapping to a COM-B model allows clinicians, and wider systems, to translate these findings into opportunities for interventions. Recommendations include patient-centred consultations to improve health literacy and shared-decision making, trust-based engagement with communities and cultural awareness training.