African American grandparents are more likely than others to provide full-time care for their grandchildren; those providing full-time care are in poorer health than non-caregivers.Low medication adherence contributes to worse health outcomes for people with chronic medical conditions, and adherence is lower in blacks than whites.Patients' beliefs about medications and communication with prescribers and pharmacists have been shown to affect adherence.Semistructured interviews were held with 22 African American custodial grandmothers ages 40 or older with 1+ chronic health conditions.Questions on beliefs about medication, perceptions of patient-provider communication and barriers/facilitators to adherence were asked.Overprescribing or impersonal prescribing practices by providers was a major concern.Distrust of the medical establishment, including pharmaceutical companies was also expressed.Although participants with negative views agreed to the usefulness of medication, some chose to skip or discontinue prescribed medicines without informing providers.Media influence, particularly direct-to-consumer advertising, and concerns about side effects were sources of negative attitudes.On the other hand, participants often stated that medications were essential to their health, and adherence was seen as a positive way to maintain health; staying healthy in order to care for dependent children was a strong incentive for adherence.Daily routines and reminder devices helped participants take their medicines as prescribed.Participants were grateful to pharmacists who helped them with information on keeping medication costs low.Despite suspicions about motives of the pharmaceutical industry and prescribers, mature African American caregivers understand the importance of medication use.