As a clinical nurse educator on the cardiac surgical unit at Abington Jefferson Health, Tierra Smith ’21 MSN, CCRN-CSC, spent three years teaching nurses how to care for patients with cardiac disease and an array of other cardiac issues. “However, I’m learning that to really effect change, educators must start with prevention,” says Tierra, who is now a nurse professional development specialist at the hospital.

And so she spent the final year of her master’s program in Nursing Education at Villanova’s M. Louise Fitzpatrick College of Nursing immersed in preventive research with the potential to make a major impact. Specifically, what are the barriers that contribute to non-adherence to medication for African American women with high blood pressure?

With guidance from Villanova Nursing Professor Mary Ann Cantrell, PhD, RN, CNE, FAAN, Tierra embarked on a literature review to uncover some answers in the research—and seek to bring about a change in practice.

The Significance

According to the American Heart Association, African American women in the US have the highest prevalence of high blood pressure, clinically known as hypertension, both nationwide and worldwide—and those rates continue to increase. “As an African American woman, I have always been interested in health disparities that disproportionately affect minorities,” says Tierra, noting that this population is vastly underrepresented in the literature.

The Findings

“Affecting medication adherence in this population requires a multi-factorial approach that should consider social and discriminatory factors,” Tierra explains. In addition to key factors that include age, income, knowledge about medication, medication side effects, and the asymptomatic nature of the disease, the cost of medications as well as unsatisfactory patient/provider interactions lead to non-adherence. Racism and discrimination are also factors: “Some patients felt they just weren’t being heard when they voiced concerns,” Tierra says. “They thought physicians possibly didn’t listen just because of who they were.”

The Takeaway

“Sometimes patients who don’t comply with their treatment regimen are looked at negatively,” Tierra says. “We in the medical community need to look at patients holistically, as whole people, find out what’s holding them back, and see how we can help them to adhere to their treatment regimen and gain better outcomes.”