Abstract
Barriers for renal transplant patients to immunosuppressant medication adherence are poorly understood, despite the high rate and toll of non-adherence. We sought to assess factors that contribute to barriers to immunosuppressive medication adherence in an ethnically diverse sample of 312 renal transplant patients recruited from three transplant centers across New York City. Transplant patients who were at least 6 months post-transplant completed questionnaires while waiting for their medical appointment. Ethnic differences were observed on barriers to immunosuppressant adherence. Black and Hispanic participants reported significantly more barriers to adherence compared to Caucasian participants. Differences in perception about the potential harm and necessity of immunosuppressant medications also were present. Using hierarchical multiple regression, age and income were significant predictors of reported barriers to adherence, even while controlling for ethnicity. The most robust predictor of reported barriers was the perception of the medication cost–benefit differential, i.e., the balance between concerns about immunosuppressant medications and their perceived helpfulness (B = − 0.5, p < .001), indicating that varying beliefs about the medication’s necessity and utility rather than ethnicity explain the differences in barriers to medication adherence. Future interventions targeting non-adherence should aim to reduce the barriers to adherence by addressing perceived risks and benefits of taking immunosuppressant medication.
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Acknowledgements
We thank the Bronx Center to Reduce and Eliminate Ethnic and Racial Health Disparities (funded by the NIH’s National Center for Minority Health & Health Disparities, Grant 339 No. P60 MD000514) for their assistance in translating study measures into Spanish.
Funding
This work was partially supported by an NIDDK Grant (DK089149) to Dr. Daniel Cukor.
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Melissa Constantiner, Deborah Rosenthal-Asher, Fasika Tedla, Moro Salifu, Judith Cukor, Katarzyna Wyka, Choli Hartono, David Serur, Graciela de Boccardo, and Daniel Cukor declare that they have no conflict of interest.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all participants in the study.
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Constantiner, M., Rosenthal-Asher, D., Tedla, F. et al. Differences in Attitudes Toward Immunosuppressant Therapy in a Multi-ethnic Sample of Kidney Transplant Recipients. J Clin Psychol Med Settings 25, 11–19 (2018). https://doi.org/10.1007/s10880-017-9524-9
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DOI: https://doi.org/10.1007/s10880-017-9524-9