Author ORCID Identifier

Date of Award


Degree Type


Degree Name

Doctor of Philosophy (PhD)



First Advisor

Dawn Aycock

Second Advisor

Fayron Epps

Third Advisor

Melissa Faulkner


African American (AA) adults are disproportionately affected by type 2 diabetes (T2D) and hypertension, with greater prevalence and disease-related complications. Disease complications may be prevented or delayed with adequate disease self-management (DSM). The literature indicates greater patient activation and health literacy and lower treatment burden and illness burden are associated with improved DSM, but AAs with comorbidities were underrepresented in these studies. The purpose of this study was to examine associations among patient activation, health literacy, treatment burden, illness burden, medication workloads, and medication adherence for AA adults with T2D and hypertension. This study also explored the perceived impact of COVID-19 on medication management.

A non-experimental, predictive, correlational design was used. Participants were recruited using social media and flyers distributed via email. Data were collected via surveys administered through Qualtrics® and telephone/online interviews. Spearman’s correlations and hierarchical regression analyses were conducted to examine relationships among the study variables.

Participants (N = 91) ranged in age from 25 to 73 years (M = 39.6), were mostly male (66%), college-educated (71%), and earning incomes of $30,000 or more (66%). Most were diagnosed with T2D and hypertension for less than five years (respectively, 64% and 75%) and averaged four (±1.3) prescribed medications.

On average, participants had high patient activation scores, low health literacy scores, and moderate levels of treatment and illness burden. Overall, medication adherence scores (M = 2.4) indicated the presence of non-adherence; 66% were classified as non-adherent. The model, including all predictor variables, was significant in predicting medication adherence, accounting for 19% of the variance. However, patient activation was the only significant contributor; for each one-point increase in patient activation, medication adherence improved by .03.The perceived impact from the COVID-19 pandemic on medication management was moderate, with participants feeling worried about leaving their homes (e.g., to get medications) and paying for medications.

In this sample of mostly younger AA men with T2D and hypertension, medication adherence was inadequate, but was only partially explained by patient activation. Further research is needed on DSM in AAs with T2D and hypertension to identify additional factors that may promote or hinder their medication adherence.

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