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Hamalaw S, Hama Salih A, Weli S. Non-adherence to Anti-diabetic Prescriptions Among Type 2 Diabetes Mellitus Patients in the Kurdistan Region of Iraq. Cureus 2024; 16:e60572. [PMID: 38779435 PMCID: PMC11110466 DOI: 10.7759/cureus.60572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Treatment adherence is a primary key in controlling diabetes disease. The study aims to determine the prevalence of treatment adherence in type 2 diabetes mellitus (T2DM) patients, investigate the potential influence of adherence on elevated blood glucose levels, and identify the key factors which play a role in non-adherence to the prescribed drugs. METHOD A cross-sectional study method was utilized to collect data from all T2DM patients at the Diabetic and Endocrine Centre and Shar Hospital in Sulaymaniyah city in the Kurdistan region of Iraq from February 2022 to April 2022. The data collection was performed through a structured questionnaire. The prevalence of drug adherence was assessed using the Morisky Medication-Taking Adherence Scale (4-item), and the glycated hemoglobin test (A1C) was used to determine the blood glucose level. RESULT A total of 300 participants were studied, and more than half of them (192; 64%) revealed that they did not adhere to their anti-diabetic medications. Non-adherence was significantly associated with higher A1C. Several barriers to non-adherence were identified as multiple medications, feeling the dose given is high, lack of finance, and side effects by 209 (70%), 116 (39%), 113 (38%), and 103 (34%), respectively. CONCLUSION The current study's result revealed that most T2DM patients have no adherence to their medication. This non-adherence is significantly linked to higher A1C levels, emphasizing the critical role of medication compliance in managing diabetes effectively. The study also sheds light on the multiple barriers such as taking multiple prescriptions, the perception that the dose is excessive, lack of finances, and experiencing side effects, which contribute to non-adherence among diabetes patients. These findings underscore the need for healthcare providers to address these barriers and develop tailored strategies to enhance medication adherence among individuals with diabetes.
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Affiliation(s)
- Soran Hamalaw
- Nursing Department, Sulaimani Polytechnic University, Sulaymaniyah, IRQ
| | - Aso Hama Salih
- Nursing Department, Sulaimani Polytechnic University, Sulaymaniyah, IRQ
| | - Sardar Weli
- Nursing Department, Sulaimani Polytechnic University, Sulaymaniyah, IRQ
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Norvell DC, Turner AP, Morgenroth DC, Henderson AW, Halsne EG, Hurwitz M, Czerniecki JM. The effect of depression on prosthesis prescription in men and women who have undergone a lower limb amputation. Disabil Rehabil 2024; 46:1204-1211. [PMID: 37035925 DOI: 10.1080/09638288.2023.2192976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/15/2023] [Indexed: 04/11/2023]
Abstract
PURPOSE To determine gender disparities and potential factors that modify prosthesis prescription practices in veteran patients who have undergone their first major unilateral amputation due to diabetes or peripheral arterial disease. MATERIALS AND METHODS A retrospective cohort study using the VA Corporate Data Warehouse to compare prosthesis prescription rates and time to prescription between men and women veterans. The primary exposure was gender. The primary outcome was a qualifying prosthesis prescription within 12 months of the incident amputation. The secondary outcome was time to prosthesis prescription. Multiple logistic and linear regression was used to control for potential confounders and identify potential effect modification. RESULTS 2,862 individuals met study criteria, with 1690 (60%) prescribed a qualifying prosthesis. Men were more likely to receive a prosthesis prescription than women (59% versus 45%, respectively; p = 0.03). This difference was observed primarily among those with a diagnosis of major depressive disorder. In this subgroup, the odds of men receiving a prosthesis over women was over 3 times (adjusted odds ratio = 3.3; 95% Confidence Interval, 1.5, 7.4). Men had a mean shorter time to prescription compared to women (112 ± 72 versus 136 ± 79 days, respectively, p = 0.08). Depression in women negatively impacts their prosthesis prescription rates and time to prescription compared to men. This disparity may have significant impacts on future function and quality of life.Implications for RehabilitationThis study found that men more commonly received a prosthesis prescription and received it earlier than women.This disparity was most extreme among women who had been diagnosed with major depressive disorder.Providers should identify at risk patients early and consider targeted interventions to address depression during the preoperative and immediate postoperative phases.Future research should continue to work to identify gender-specific needs that exacerbate disparity.
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Affiliation(s)
- Daniel C Norvell
- VA Puget Sound Health Care System, WA, Seattle
- Department of Rehabilitation Medicine, University of Washington, WA, Seattle
- Center for Limb Loss and Mobility (CLiMB), Seattle, WA
| | - Aaron P Turner
- VA Puget Sound Health Care System, WA, Seattle
- Department of Rehabilitation Medicine, University of Washington, WA, Seattle
- Center for Limb Loss and Mobility (CLiMB), Seattle, WA
| | - David C Morgenroth
- VA Puget Sound Health Care System, WA, Seattle
- Department of Rehabilitation Medicine, University of Washington, WA, Seattle
- Center for Limb Loss and Mobility (CLiMB), Seattle, WA
| | - Alison W Henderson
- VA Puget Sound Health Care System, WA, Seattle
- Center for Limb Loss and Mobility (CLiMB), Seattle, WA
| | - Elizabeth G Halsne
- VA Puget Sound Health Care System, WA, Seattle
- Department of Rehabilitation Medicine, University of Washington, WA, Seattle
- Center for Limb Loss and Mobility (CLiMB), Seattle, WA
| | - Max Hurwitz
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, PA, Pittsburgh
| | - Joseph M Czerniecki
- VA Puget Sound Health Care System, WA, Seattle
- Department of Rehabilitation Medicine, University of Washington, WA, Seattle
- Center for Limb Loss and Mobility (CLiMB), Seattle, WA
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Venditti V, Bleve E, Morano S, Filardi T. Gender-Related Factors in Medication Adherence for Metabolic and Cardiovascular Health. Metabolites 2023; 13:1087. [PMID: 37887412 PMCID: PMC10609002 DOI: 10.3390/metabo13101087] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/05/2023] [Accepted: 10/12/2023] [Indexed: 10/28/2023] Open
Abstract
This review explores the impact of gender on medication adherence in the context of metabolic and cardiovascular diseases. Optimal adherence to medication is crucial for achieving treatment goals and preventing adverse outcomes in chronic diseases. The review examines specific conditions such as type 2 diabetes, hypercholesterolemia, arterial hypertension, cardiovascular diseases, and heart failure. In type 2 diabetes, female sex, younger age, new drug prescription, non-white ethnicity, low education level, and low income were identified as predictors of non-adherence. Depressive disorders were also found to influence adherence. In hypercholesterolemia, women exhibited poorer adherence to statin therapy compared to men, with statin-related side effects and patient perception being significant factors. Adherence to anti-hypertensive therapy showed conflicting results, with studies reporting both higher and lower adherence in women. Limited evidence suggests that women may have poorer adherence after acute myocardial infarction and stroke. Regarding heart failure, adherence studies have shown inconsistent findings. The reasons for gender differences in medication adherence are multifactorial and include sociodemographic, disease-related, treatment-related, and psychological factors. This review emphasizes the need for further research to better understand these differences and develop gender-customized interventions that can improve medication adherence and reduce the burden of metabolic and cardiovascular diseases.
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Affiliation(s)
- Vittorio Venditti
- Department of Experimental Medicine, “Sapienza” University of Rome, Viale Regina Elena 324, 00161 Rome, Italy; (V.V.); (E.B.); (S.M.)
| | - Enrico Bleve
- Department of Experimental Medicine, “Sapienza” University of Rome, Viale Regina Elena 324, 00161 Rome, Italy; (V.V.); (E.B.); (S.M.)
| | - Susanna Morano
- Department of Experimental Medicine, “Sapienza” University of Rome, Viale Regina Elena 324, 00161 Rome, Italy; (V.V.); (E.B.); (S.M.)
| | - Tiziana Filardi
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Via di Val Cannuta, 247, 00166 Rome, Italy
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4
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Sah E, Casten RJ, Rovner BW. Depression and Medication Beliefs in African Americans with Diabetes. Community Ment Health J 2023; 59:1436-1438. [PMID: 37140846 DOI: 10.1007/s10597-023-01131-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 04/21/2023] [Indexed: 05/05/2023]
Abstract
Medication non-adherence impacts health significantly in African Americans with diabetes. We performed a retrospective data analysis on 56 patients who presented to the emergency departments of two hospitals in Philadelphia, PA, USA. Demographic data, medical history, and point-of-care hemoglobin A1c were collected at baseline. Using Spearman rank correlations, we examined whether depressive symptoms measured with the Patient Health Questionnaire-9 (PHQ-9) were associated with diabetes health beliefs, which were assessed with the Diabetes Health Belief Scale (DHBS). PHQ-9 scores were significantly correlated with DHBS's Perceived Side Effects scores [r(56) = 0.474, p < 0.01] and Perceived Barriers scores [r(56) = 0.337, p < 0.05]. These findings suggest that negative health beliefs may play a role in the relationship between depression and low medication adherence. Treatment of diabetes in middle-aged and older African American individuals should address both depression and negative health beliefs on side effects and perceived barriers.
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Affiliation(s)
- Eric Sah
- Departments of Neurology, Psychiatry, and Ophthalmology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Robin J Casten
- Department of Psychiatry, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Barry W Rovner
- Departments of Neurology, Psychiatry, and Ophthalmology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, 19107, USA.
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Scarton L, Nelson T, Yao Y, DeVaughan-Circles A, Legaspi AB, Donahoo WT, Segal R, Goins RT, Manson SM, Wilkie DJ. Association of Medication Adherence With HbA1c Control Among American Indian Adults With Type 2 Diabetes Using Tribal Health Services. Diabetes Care 2023; 46:1245-1251. [PMID: 37068266 PMCID: PMC10234744 DOI: 10.2337/dc22-1885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 03/20/2023] [Indexed: 04/19/2023]
Abstract
OBJECTIVE To examine HbA1c levels and adherence to oral glucose-lowering medications and their association with future HbA1c levels among American Indian adults with type 2 diabetes (T2D) receiving medications at no cost from a tribal health care system. RESEARCH DESIGN AND METHODS Tribal citizens with T2D who used Choctaw Nation Health Services Authority (CNHSA) and Pharmacies and had HbA1c data during 2017-2018 were included in this study. Medication adherence (proportion of days covered [PDC] ≥0.80) was calculated using 2017 CNHSA electronic health record data. RESULTS Of the 74,000 tribal citizens living on tribal lands, 4,560 were eligible; 32% had HbA1c at or below target (≤7%), 36% were above target (>7 to ≤9%), and 32% were uncontrolled (>9%) in 2017. The percentage of patients with PDC ≥0.80 was 66% for those using biguanides, 72% for sulfonylureas, 75% for dipeptidyl peptidase 4 inhibitors, and 83% for sodium-glucose cotransporter 2 inhibitors. The proportion of patients with HbA1c at or below target increased slightly from 32% in 2017 to 42% in 2018. Higher average PDC in 2017 was associated with lower HbA1c levels in 2018 (β = -1.143; P < 0.001). CONCLUSIONS Medication adherence was higher than that found in previous studies using self-report methods in American Indian populations, although a smaller proportion of patients had HbA1c at or below target relative to U.S. adults with T2D. Medication adherence was associated with improved HbA1c levels for most oral glucose-lowering medication classes. Future studies of American Indians should use both longitudinal prescription data from both electronic health records and pharmacy refills.
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Affiliation(s)
- Lisa Scarton
- College of Nursing, University of Florida, Gainesville, FL
| | - Tarah Nelson
- College of Nursing, University of Florida, Gainesville, FL
| | - Yingwei Yao
- College of Nursing, University of Florida, Gainesville, FL
| | | | | | | | - Richard Segal
- College of Pharmacy, University of Florida, Gainesville, FL
| | - R. Turner Goins
- College of Health and Human Sciences, Western Carolina University, Cullowhee, NC
| | - Spero M. Manson
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO
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Nelson T, Wilkie DJ, Scarton L. Medication Adherence in American Indians With Type 2 Diabetes: An Integrative Review. Diabetes Spectr 2023; 36:193-200. [PMID: 37193204 PMCID: PMC10182960 DOI: 10.2337/ds21-0096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Tarah Nelson
- University of Florida College of Nursing, Gainesville, FL
| | | | - Lisa Scarton
- University of Florida College of Nursing, Gainesville, FL
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Huang LC, Lin CL, Chang YT, Chen RY, Bai CH. Gender Impact on Diabetes Distress Focus at Medical Communication Concerns, Life and Interpersonal Stress. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15678. [PMID: 36497755 PMCID: PMC9737495 DOI: 10.3390/ijerph192315678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION along with the rapidly aging population in many countries around the world, the global prevalence of diabetes and suffering from diabetes-related depression have risen in middle-aged and elderly adults. However, given that psychological stress is deeply influenced by culture, gender inequality in these statistics is often exhibited and increases with age. The aim of this study was to explore the gender difference in diabetes distress among middle-aged and elderly diabetic patients. METHODS 395 participants from four hospitals were recruited for a cross-sectional survey. The Taiwan Diabetes Distress Scale (TDDS) was used to measure diabetes distress. Linear regression was conducted to assess the gender difference in different types of diabetes distress. RESULTS there was significant gender difference in each diabetes distress domain. In particular, men who had received diabetes education in the past six months seemed to be more concerned about diabetes complications and felt pressured to communicate with doctors. In addition, women seemed to be more affected by diabetes distress because of their marital status, especially for married women. CONCLUSIONS diabetes distress seems to have significant gender differences; however, more longitudinal research is needed on the causal relationship between gender and diabetes distress.
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Affiliation(s)
- Li-Chi Huang
- Endocrinology & Metabolism, Cathay General Hospital, Taipei 106438, Taiwan
- School of Public Health, Taipei Medical University, Taipei 110301, Taiwan
| | - Ching-Ling Lin
- Endocrinology & Metabolism, Cathay General Hospital, Taipei 106438, Taiwan
- School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan
- School of Medicine, National Tsing Hua University, Hsinchu 300044, Taiwan
| | - Yao-Tsung Chang
- School of Public Health, Taipei Medical University, Taipei 110301, Taiwan
| | - Ruey-Yu Chen
- School of Public Health, Taipei Medical University, Taipei 110301, Taiwan
| | - Chyi-Huey Bai
- School of Public Health, Taipei Medical University, Taipei 110301, Taiwan
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8
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Scarton L, Nelson T, Yao Y, Segal R, Donahoo WT, Goins RT, DeVaughan-Circles A, Manson SM, Wilkie DJ. Medication Adherence and Cardiometabolic Control Indicators Among American Indian Adults Receiving Tribal Health Services: Protocol for a Longitudinal Electronic Health Records Study. JMIR Res Protoc 2022; 11:e39193. [PMID: 36279173 PMCID: PMC9641513 DOI: 10.2196/39193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 07/26/2022] [Accepted: 07/26/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND American Indian adults have the highest prevalence of type 2 diabetes (T2D) in any racial or ethnic group and experience high rates of comorbidities. Uncontrolled cardiometabolic risk factors-insulin resistance, resulting in impaired glucose tolerance, dyslipidemia, and hypertension-increase the risk of mortality. Mortality is significantly reduced by glucose- and lipid-lowering and antihypertensive medication adherence. Medication adherence is low among American Indian adults living in non-Indian Health Service health care settings. Virtually nothing is known about the nature and extent of medication adherence among reservation-dwelling American Indian adults who primarily receive their medications without cost from Indian Health Service or tribal facilities. Electronic health records (EHRs) offer a rich but underused data source regarding medication adherence and its potential to predict cardiometabolic control indicators (C-MCIs). With the support of the Choctaw Nation of Oklahoma (CNO), we address this oversight by using EHR data generated by this large, state-of-the-art tribal health care system to investigate C-MCIs. OBJECTIVE Our specific aims are to determine, using 2018 EHR data, the bivariate relationships between medication adherence and C-MCIs, demographics, and comorbidities and each C-MCI and demographics and comorbidities; develop machine learning models for predicting future C-MCIs from the previous year's medication adherence, demographics, comorbidities, and common laboratory tests; and identify facilitators of and barriers to medication adherence within the context of social determinants of health (SDOH), EHR-derived medication adherence, and C-MCIs. METHODS Drawing on the tribe's EHR (2018-2021) data for CNO patients with T2D, we will characterize the relationships among medication adherence (to glucose- and lipid-lowering and antihypertensive drugs) and C-MCIs (hemoglobin A1c ≤7%, low-density lipoprotein cholesterol <100 mg/dL, and systolic blood pressure <130 mm Hg); patient demographics (eg, age, sex, SDOH, and residence location); and comorbidities (eg, BMI ≥30, cardiovascular disease, and chronic kidney disease). We will also characterize the association of each C-MCI with demographics and comorbidities. Prescription and pharmacy refill data will be used to calculate the proportion of days covered with medications, a typical measure of medication adherence. Using machine learning techniques, we will develop prediction models for future (2019-2021) C-MCIs based on medication adherence, patient demographics, comorbidities, and common laboratory tests (eg, lipid panel) from the previous year. Finally, key informant interviews (N=90) will explore facilitators of and barriers to medication adherence within the context of local SDOH. RESULTS Funding was obtained in early 2022. The University of Florida and CNO approved the institutional review board protocols and executed the data use agreements. Data extraction is in process. We expect to obtain results from aims 1 and 2 in 2024. CONCLUSIONS Our findings will yield insights into improving medication adherence and C-MCIs among American Indian adults, consistent with CNO's State of the Nation's Health Report 2017 goal of reducing T2D and its complications. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/39193.
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Affiliation(s)
- Lisa Scarton
- College of Nursing, University of Florida, Gainesville, FL, United States
| | - Tarah Nelson
- College of Nursing, University of Florida, Gainesville, FL, United States
| | - Yingwei Yao
- College of Nursing, University of Florida, Gainesville, FL, United States
| | - Richard Segal
- College of Pharmacy, University of Florida, Gainesville, FL, United States
| | - William T Donahoo
- College of Medicine, University of Florida, Gainesville, FL, United States
| | - R Turner Goins
- College of Health and Human Sciences, Western Carolina University, Cullowhee, NC, United States
| | | | - Spero M Manson
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Diana J Wilkie
- College of Nursing, University of Florida, Gainesville, FL, United States
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Veal B, Sadeq NA, Atkinson TJ, Andel R. Who Volunteers? Results From an Internet-Based Cognitive Monitoring Study of Community-Based Older Adults. HEALTH EDUCATION & BEHAVIOR 2022; 50:359-368. [PMID: 35703406 DOI: 10.1177/10901981221101355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives. Volunteering promotes well-being and may provide added purpose to life after retirement. Limited evidence exists regarding the characteristics and study adherence among those who participate in longitudinal studies while also volunteering outside the study. We assessed characteristics and adherence of older adults who volunteered outside of participation in a regular monthly cognitive monitoring study. Method. All 124 participants with complete data were included. Participants were from a regular cognitive monitoring study that required completion of a 15-min monthly online cognitive assessment. Analysis of covariance and logistic regression analysis were performed to examine differences between volunteers and nonvolunteers. Results. Those who volunteered outside the study were significantly less likely to be college-educated (although all participants were highly educated) but the two groups were cognitively similar. Volunteers had significantly lower scores for neuroticism. Those who volunteered also were significantly less likely to drop out but had poorer study adherence. The most frequent type of volunteering was religious activities. Volunteers were motivated mainly by altruism, although most reported multiple reasons. Conclusion. Older adults who enroll in a longitudinal research study and volunteer outside the study have similar personal characteristics as those who opt out of additional volunteering, with somewhat less education and more favorable personality traits. However, they may be more likely to drop out and need more reminders. Therefore, those who volunteer outside a study may need more attention from study administrators and potentially a more individualized schedule that works around their volunteer obligations.
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Affiliation(s)
| | | | | | - Ross Andel
- University of South Florida, Tampa, FL,USA
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Green M, Resnicow K, Tariq M, Syed N, Alhawli A, Patel M. Risk and Protective Factors for Cost-Related Nonadherence Among Middle East and North African (MENA) Adults. Ethn Dis 2022; 32:11-20. [PMID: 35106040 PMCID: PMC8785864 DOI: 10.18865/ed.32.1.11] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023] Open
Abstract
OBJECTIVE Cost-related nonadherence to health maintenance behaviors is common in the general population, yet we know little about these behaviors in Middle East and North African (MENA) Americans. We examined cost-related nonadherence (CRN) in the MENA community in SE Michigan to determine demographic predictors, and risk and protective factors. DESIGN SETTING AND PARTICIPANTS We used data from a cross-sectional convenience sample of MENA adults (N=398) conducted May-September 2019 to identify relevant demographic predictors, as well as the association between individual health, social, and clinical factors and the likelihood of reporting CRN. METHODS AND MEASURES CRN was defined by whether respondents reported any of the following: that they took less medicine, skipped doses, or delayed getting a prescription filled. Other factors included patient/provider communication and racial concordance, mental health distress, food insecurity and insurance status. We used multivariable logistic regression models to determine association of these health and social factors with CRN. RESULTS Those with highest incomes were least likely to report CRN. Participants with private insurance and with no coverage were more likely to report CRN compared with those with Medicaid coverage. Risk factors for CRN included food insecurity and mental health distress, though strong patient/provider communication was protective of CRN. DISCUSSION The risk factors for CRN in the MENA community align with risk factors in the general population. As provider communication is protective of CRN, interventions focused on improving patient/provider communication may serve as a way to protect against financially motivated medication nonadherence.
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Affiliation(s)
- Molly Green
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, MI
| | - Kenneth Resnicow
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, MI
- University of Michigan Rogel Cancer Center, Ann Arbor, MI
| | - Madiha Tariq
- Arab Community Center for Economic and Social Services, Dearborn, MI
| | - Nadia Syed
- Arab Community Center for Economic and Social Services, Dearborn, MI
| | - Asraa Alhawli
- Arab Community Center for Economic and Social Services, Dearborn, MI
| | - Minal Patel
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, MI
- University of Michigan Rogel Cancer Center, Ann Arbor, MI
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Hamilton JE, Blanco E, Selek S, Wirfel KL, Bernstam EV, Velligan D, Gudala M, Roberts K. Patient and Provider Perspectives on Medication Non-adherence Among Patients with Depression and/or Diabetes in Diverse Community Settings - A Qualitative Analysis. Patient Prefer Adherence 2022; 16:1581-1594. [PMID: 35795010 PMCID: PMC9252600 DOI: 10.2147/ppa.s328785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/15/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Diabetes and depression affect a significant percentage of the world's total population, and the management of these conditions is critical for reducing the global burden of disease. Medication adherence is crucial for improving diabetes and depression outcomes, and research is needed to elucidate barriers to medication adherence, including the intentionality of non-adherence, to intervene effectively. The purpose of this study was to explore the perspectives of patients and health care providers on intentional and unintentional medication adherence among patients with depression and diabetes through a series of focus groups conducted across clinical settings in a large urban area. METHODS This qualitative study utilized a grounded theory approach to thematically analyze qualitative data using the framework method. Four focus groups in total were conducted, two with patients and two with providers, over a one-year period using a semi-structured facilitation instrument containing open-ended questions about experiences, perceptions and beliefs about medication adherence. RESULTS Across the focus groups, communication difficulties between patients and providers resulting in medication non-adherence was a primary theme that emerged. Concerns about medication side effects and beliefs about medication effectiveness were identified as perceptual barriers related to intentional medication non-adherence. Practical barriers to medication adherence, including medication costs, forgetting to take medications and polypharmacy, emerged as themes related to unintentional medication non-adherence. CONCLUSION The study findings contribute to a growing body of research suggesting health system changes are needed to improve provider education and implement multicomponent interventions to improve medication adherence among patients with depression and/or diabetes, both chronic illnesses accounting for significant disease burden globally.
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Affiliation(s)
- Jane E Hamilton
- The University of Texas Health Science Center at Houston, McGovern Medical School, Louis Faillace Department of Psychiatry and Behavioral Sciences, Houston, TX, USA
- Correspondence: Jane E Hamilton, The University of Texas Health Science Center at Houston, McGovern Medical School, Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, 1941 East Road, BBSB 1204, Houston, TX, 77054, USA, Tel +1 713-486-2858, Email
| | - Eduardo Blanco
- Arizona State University, School of Computing and Augmented Intelligence, Tempe, AZ, USA
| | - Salih Selek
- The University of Texas Health Science Center at Houston, McGovern Medical School, Louis Faillace Department of Psychiatry and Behavioral Sciences, Houston, TX, USA
| | - Kelly L Wirfel
- The University of Texas Health Science Center at Houston, McGovern Medical School, Department of Internal Medicine, Houston, TX, USA
| | - Elmer V Bernstam
- The University of Texas Health Science Center at Houston, McGovern Medical School, Department of Internal Medicine, Houston, TX, USA
- The University of Texas Health Science Center at Houston, School of Biomedical Informatics, Houston, TX, USA
| | - Dawn Velligan
- The University of Texas Health Science Center at San Antonio, Long School of Medicine, Department of Psychiatry, San Antonio, TX, USA
| | - Meghana Gudala
- The University of Texas Health Science Center at Houston, School of Biomedical Informatics, Houston, TX, USA
| | - Kirk Roberts
- The University of Texas Health Science Center at Houston, School of Biomedical Informatics, Houston, TX, USA
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Elm JHL. Adverse Childhood Experiences and Internalizing Symptoms Among American Indian Adults with Type 2 Diabetes. J Racial Ethn Health Disparities 2020; 7:958-966. [PMID: 32095973 DOI: 10.1007/s40615-020-00720-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 01/31/2020] [Accepted: 02/04/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND Decades of evidence link adverse childhood experiences (ACEs) to worse health. Despite disproportionate rates of ACEs and health disparities in tribal communities, a gap exists in understanding the effects of ACEs on American Indian (AI) health. The purpose of this study is to estimate frequencies of eight categories of ACEs, assess the risk for internalizing symptoms by each ACE category, and determine if moderate and high levels of ACEs exposures have differential, increasing risk associated with internalizing symptoms for a sample of AI adults with T2D. METHODS Five tribal communities participated in a community-based participatory research study. Data from AI adults with T2D were analyzed (N = 192). Frequencies of eight childhood events and situations were assessed, and exposure levels of low (0-1), moderate (2-3), and high levels (4 +) of ACEs were calculated. Odds of screening positive for depression and generalized anxiety disorder (GAD) by each ACE type and moderate and high levels of ACEs were estimated using regression analyses. RESULTS Relative to other studies, exposure estimates for each of the eight ACE categories and moderate and high levels of ACEs were high. Sexual and physical abuse, neglect, and household mental illness were positively associated with depressive symptoms, and physical abuse was positively associated with anxiety symptoms. Exposures to moderate and high levels of ACEs were associated with increased odds of screening positive for current depression in a dose-response fashion. A high level of ACEs exposure was also associated with an increased odds of a positive GAD screening. CONCLUSIONS This research extends limited knowledge about ACEs and health among AIs. More research is needed to understand the health consequences of ACEs for a population exhibiting health inequities. Components of strategies for addressing ACEs, mental health, T2D complications, and comorbidities are proposed for AIs generally and AI adults with T2D specifically.
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Affiliation(s)
- Jessica H L Elm
- Johns Hopkins University, Department of International Health, Bloomberg School of Public Health, Center for American Indian Health, Great Lakes Hub, Duluth, MN, USA.
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