“You Want to Give the Best Care Possible, and You Know When They Leave Your Pharmacy, You Didn’t Give the Best Care Possible Most of the Time”: Pharmacist- and Community Health Worker-Identified Barriers and Facilitators to Medication Adherence in Marshallese Patients

  • Michelle L. Balli
  • Tiffany A. Dickey
  • Rachel S. Purvis
  • T. Scott Warmack
  • Sheldon Riklon
  • Pearl A. McElfishEmail author



The Marshallese experience high rates of chronic diseases including hypertension and diabetes. Medication adherence is crucial to successful disease management, and healthcare providers play a crucial role in assisting their patients with medication adherence.


A qualitative study design was used with individual interviews and focus groups with pharmacists and community health workers (CHWs) serving the Marshallese community in Northwest Arkansas. Participants were asked about their experiences with and perceptions of barriers and facilitators to medication adherence among Marshallese adults in Northwest Arkansas.


Eight pharmacists and nine CHWs were interviewed. Five themes emerged regarding barriers to medication adherence: (1) financial, (2) transportation, (3) language, (4) health literacy and understanding of Western medicine, and (5) mistrust. Four themes emerged regarding facilitators to medication adherence: (1) in-depth patient education strategies, (2) efforts to address the language barrier, (3) family engagement, and (4) public transportation and prescription home delivery.


Pharmacists and CHWs identified the same barriers to medication adherence, which are consistent with those documented in previous studies. Pharmacists also reported distress over their inability to confirm Marshallese patient understanding in relation to the use of prescribed medications.


Marshallese Pharmacy Pharmacist Medication adherence Minority health Pacific Islander Community health worker 


Funding Information

The project described was supported by the Translational Research Institute (TRI), grant 1U54TR001629-01A1 through the National Center for Advancing Translational Sciences of the National Institutes of Health (NIH). This pilot study was also funded in part by a grant from the Sturgis Foundation. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or Sturgis Foundation.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

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. The study design and procedures were reviewed and approved by the University of Arkansas for Medical Sciences’ Institutional Review Board (IRB #206483).


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Copyright information

© W. Montague Cobb-NMA Health Institute 2019

Authors and Affiliations

  • Michelle L. Balli
    • 1
  • Tiffany A. Dickey
    • 1
  • Rachel S. Purvis
    • 2
  • T. Scott Warmack
    • 1
  • Sheldon Riklon
    • 3
  • Pearl A. McElfish
    • 3
    Email author
  1. 1.College of PharmacyUniversity of Arkansas for Medical SciencesFayettevilleUSA
  2. 2.Office of Community Health and ResearchUniversity of Arkansas for Medical SciencesFayettevilleUSA
  3. 3.College of MedicineUniversity of Arkansas for Medical SciencesFayettevilleUSA

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