Background: Nonadherence to blood pressure lowering medication is a main contributor to poor hypertension control. While trust in the medical profession has been found to be associated with health behaviors such as treatment adherence, it has rarely been examined in Hispanics with hypertension and its relationship with health-related quality of life (HRQOL) is unknown.
Objective: We evaluated a priori hypotheses positing that trust in the medical profession would be associated with greater medication adherence, resilience, and, in turn, better HRQOL in patients with hypertension. The three specific aims of this study were to: 1) examine the overall association (total effect) of trust in the medical profession and HRQOL (self-reported physical and mental health); 2) assess whether the association of trust with HRQOL is mediated by medication adherence and resilience; and 3) evaluate whether these associations vary by ethnicity (Hispanic vs. non-Hispanic).
Methods: A cross-sectional survey that included the PROMIS® global physical and mental health scales and Morisky Medication Adherence Scale-8 was conducted with 201 adults (101 Hispanics and 100 non-Hispanics) under treatment for hypertension at a practice with seven cardiologists. A structural equation model was estimated to examine hypothesized associations (direct and indirect effects) among variables. Model fit was assessed via the chi-square statistic and three fit indices (Root Mean Square Error of Approximation; Comparative Fit Index; Non-Normed Fit Index).
Results: The proposed model fit the data well and explained 37% of the variance in mental health and 15% of the variance in physical health. Trust was positively associated with physical health (β = 0.32, P < 0.001) and mental health (β = 0.43, P < 0.001). Trust was also positively associated with resilience (β = 0.18, P < 0.05), and medication adherence (β = 0.25, P < 0.05). Resilience was not significantly associated with physical health, but it was positively associated with mental health (β = 0.34, P < 0.001). Medication adherence was not significantly associated with either physical or mental health. Additionally, resilience partially mediated the relationship between trust and physical and mental health. And medication adherence partially mediated the relationship between trust and mental health, but did not significantly mediate the relationship between trust and physical health. A simultaneous group analysis indicated that Hispanic ethnicity did not moderate the associations between trust, medication adherence, resilience, and HRQOL.
Conclusions: Findings suggest that trust in the medical profession serves as a protective mechanism for improving health in patients with hypertension by enhancing medication adherence, resilience, and global health irrespective of Hispanic ethnicity.