Faculty Bibliography

Since low adherence rates contribute to morbidity and mortality among hypertensive African Americans, health beliefs known to influence nonadherence must be explored. Hypertensive African Americans were recruited from an urban, public hospital and divided into two categories: adherent, well-controlled versus nonadherent, poorly controlled participants. Separate focus group sessions were held for each category. Participants proved similar with respect to sociodemographic variables but varied in the duration of hypertension. Some beliefs were mentioned more often among nonadherent participants than among adherent participants when describing medical treatments and physicians' encounters. Some participants perceived medication to be harmful and noneffective, and some expressed distrust of pharmaceutical companies and physicians, believing them to use patients for experimentation to test medications. Their descriptions of dialogues with physicians suggested authoritarian and ethnicity-inappropriate communication patterns. To reduce the nonadherence rate among African Americans, it may be necessary to integrate health beliefs into educational interventions and physician-patient communication.

While patients frequently do not comprehend health information, little is known about patient and physician factors that influence lack of comprehension. To assess effectiveness of health information exchange, 19 physicians and 145 patients were given post-encounter questionnaires to evaluate the preceding visit. We analyzed differences in beliefs between patients who comprehended health information and patients who did not, and whether physicians' attitudes and self-assessment of their educational abilities influenced this comprehension. Patients with insufficient comprehension were more likely to have schooling below college and cited language as a barrier. Physicians who believed health information delivery to be important had fewer patients with comprehension difficulties, while physicians who assessed themselves as very effective educators had significantly more patients with lack of comprehension, compared with physicians who did not feel as effective. Patients' comprehension of health information was associated not only with patient factors but also with physicians' attitude and self-assessment.