Understanding System-Level Experiences Impacting Black Americans' Adherence to Antihypertensive Medication

Black Americans have higher rates of antihypertensive medication nonadherence, leading to increased morbidity and mortality. The impact of system-level experiences on medication adherence (MA) has so far been understudied. We sought to understand patients' perceptions of system-level experiences influencing antihypertensive MA. Using a qualitative descriptive design, we conducted semi-structured interviews via Zoom. Transcripts were reviewed and coded, with spot checking of themes and coding by a second team member. A community advisory group performed member checking as a credibility audit. Fifteen participants were enrolled. We identified four main themes: social and economic barriers, social and economic facilitators, health system-level barriers, and health system-level facilitators. Subthemes highlighted logistical challenges and the complexities of system-level impacts on antihypertensive MA. Social and economic and health system-level facilitators should be considered when designing future interventions to promote antihypertensive MA and when augmenting existing policy and healthcare delivery structures.