Skip to main content

Assessing Barriers to Medication Adherence Among Latinos with Diabetes: a Cross-sectional Study

INTRODUCTION

Latino adults have higher diabetes rates (12.8%) than non-Latinos (7.6%) and are more likely to have suboptimal glycemic control.1 Medication adherence can impact morbidity and mortality from diabetes.2 Prior research demonstrates that improving medication adherence among patients with chronic diseases is challenging and that Latino populations may be less adherent to medications than non-Latinos.1, 3 One study found that 37% of Latinos had high scores on Morisky Medication Adherence Scale versus 50% of non-Latinos, indicating poorer adherence among Latinos.4

In this study, we interviewed Latinos with diabetes to identify modifiable barriers to medication adherence that might be amenable to intervention.

METHODS

This cross-sectional study assessed patients’ perspectives about their challenges with medication adherence. Eligible patients were identified from four safety-net clinics in Los Angeles. From June 2017 to March 2018, patients meeting the following criteria were eligible for the study: age ≥ 18, self-identified as Latino/Hispanic/Chicano, diagnosed with diabetes for ≥ 6 months, and taking ≥ 1 diabetes medication. Investigators administered the survey to 30 patients at each site, for a total of 120 patients.

The questionnaire included demographic and Likert scale questions about medication adherence barriers and proposed interventions (Appendix). Participants completed the questions independently or with help from the investigator. Upon completion of the survey, participants received a $10 gift card.

Survey responses were recorded using Redcap software and analyzed using SPSS. The dependent variable for our analyses was controlled diabetes (HbA1c < 7.5%) vs. uncontrolled diabetes (HbA1c ≥ 7.5%). We chose a threshold HbA1c ≥ 7.5% because when this study began, most major diabetes treatment guidelines recommended a HbA1c target < 7.0%, but due to emergent data suggesting a less aggressive target, we opted for a more lenient threshold. With 120 participants, our study had a power of 76% to detect a difference in reported adherence rates of 0.24 on the Likert scale between participants with controlled vs. uncontrolled diabetes.

This study was approved by the University of Southern California’s Institutional Review Board (HS-17-00414).

RESULTS

Table 1 provides demographic characteristics of our study population (n = 120). Most subjects were female, Spanish-speaking, with an average age of 60, and with minimal formal education. On average, our patients took 6.5 prescribed medications daily and the majority (62%) had a HgbA1c ≥ 7.5.

Table 1 Demographics of Study Participants (N= 120)

Table 2 summarizes patient views regarding barriers to medication adherence. Of note, patients with out-of-control diabetes had 3.3 greater odds compared with those with diabetes under control of agreeing that “it is difficult to keep track of when to take all medications” (95% CI 1.32, 7.41). Also, patients with out-of-control diabetes had 2.74 higher odds of agreeing that “it is difficult for me to understand what each of my medication is for” (95% CI 1.19, 6.34). Furthermore, patients with out-of-control diabetes had 2.41 higher odds of agreeing that “I feel that I take too many medications” (95% CI 1.14, 5.13).

Table 2 Patient Views Regarding Medication Adherence

The majority of respondents from both groups (HbA1c ≥ 7.5% and < 7.5%) believed that all of the proposed specific interventions could reduce barriers to diabetes medication adherence. These include personalized picture prescriptions, weekly health education classes, and medication pill boxes (see Table 2B).

DISCUSSION

Our analysis identified several barriers to diabetes medication adherence associated with suboptimal glycemic control. In particular, patients who struggled to keep track of their medications, those uncertain about what their medications are for, and those who believe they take too many medications were substantially more likely to have out-of-control diabetes. Previous studies also indicate that the better a patient understands their medications, the better they will manage their disease.3 Also consistent with our results, Polonksy et al. found that both treatment complexity and convenience are key contributors to decreased adherence.3

Our findings suggest several potential approaches for improving medication adherence among Latinos with poorly controlled diabetes. The data indicate that interventions aimed at helping patients keep better track of their medications, educating patients about the treatment indications for their medications, and reducing unnecessary medications all might enhance adherence. Future research should assess the value of such interventions among Latinos with diabetes.

In summary, our results demonstrate that Latino patients with diabetes face substantial barriers to medication adherence, which may adversely impact glycemic control. Our data offers insight into future prospective research evaluating interventions for improved medication adherence in the Latino community.

References

  1. 1.

    Mayberry LS, Bergner EM., Chakkalakal RJ, Elasy TA, Osborn CY. Self-Care Disparities Among Adults with Type 2 Diabetes in the USA. Curr Diab Rep (2016) 16: 113 DOI https://doi.org/10.1007/s11892-016-0796-5

    Article  PubMed  PubMed Central  Google Scholar 

  2. 2.

    Centers for Disease Control. Diabetes: At a Glance 2016. Available at: https://www.cdc.gov/chronicdisease/resources/publications/aag/diabetes.htm. Accessed 05 August 2017.

  3. 3.

    Polonsky W, Henry R. Poor medication adherence in type II diabetes: recognizing the scope of the problem and its key contributors. Patient Prefer Adherence. 2016; 10: 1299–1307.

    Article  Google Scholar 

  4. 4.

    Lopez JM, Bailey RA, Rupnow MF, et al. Characterization of type 2 diabetes mellitus burden by age and ethnic groups based on a nationwide survey. Clin Ther. 2014;36:494–506.

    Article  Google Scholar 

Download references

Acknowledgments

We would like to acknowledge the following individuals and organizations for their invaluable contributions: Rachel Lim, Mike Cruz, MD, Family Care Specialists Medical Group, Clinica Romero-Marengo, Universal Community Health Center, and Edward Roybal Comprehensive Health Center.

Funding

This study is funded by the Gehr Center for Health Systems Science and Keck Research Fellowship both at the University of Southern California.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Andrea Banuelos Mota BA.

Ethics declarations

This study was approved by the University of Southern California’s Institutional Review Board (HS-17-00414).

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Prior Presentations

American College of Physicians Southern California Chapters Scientific Meeting 2017, American Medical Association and Network of Ethnic Physician Organizations 2017 Building Healthy Communities Summit, Southern California Public Health Association Annual Conference 2017, Innovations in Medical Education Conference 2018, Latino Medical Student Association (LMSA) West Regional Conference 2018, and the National Hispanic Medical Association Conference 2018.

Appendix

Appendix

figurea

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Banuelos Mota, A., Feliz Sala, E.E., Perdomo, J.M. et al. Assessing Barriers to Medication Adherence Among Latinos with Diabetes: a Cross-sectional Study. J GEN INTERN MED 35, 603–605 (2020). https://doi.org/10.1007/s11606-019-05041-3

Download citation