Medication Adherence, Health Literacy and Cultural Health Beliefs in a Mass. CHC

描述（申请人提供）：马萨诸塞州社区卫生中心的药物依从性、健康素养和文化健康信念摘要健康素养，广义上被定义为人们用来管理自己健康的“广泛的技能和能力（Zarcadoolas等，2005，196-197）是慢性疾病自我管理的重要方面（Mancuso和Rincon 2006），尽管在多项研究中它与药物依从性的相关性不一致。虽然研究人员继续调查健康素养，药物依从性和健康结果之间的关系，但很少有人成功地将健康素养等个人因素与结构和社会因素相结合。 因素在拟议的研究中，我们依靠人种学和定性数据，结合定量方法，探讨如何药物治疗依从性，一个普遍存在的问题，在慢性病管理，是由结构性因素，如保险共付额，以及文化的健康信念。基于我们之前的研究（Shaw，et al. 2012 a，Shaw，et al. 2009 b），拟定的研究检查了来自五个种族群体（非洲裔美国人、西班牙裔、白色、越南人和俄罗斯移民）的患者的健康素养、健康信念和药物依从性障碍。我们的这项研究是在马萨诸塞州进行的，该州最近扩大了公共资助项目的参保人数，同时实施了可能限制处方药获得的成本控制措施，特别是对穷人。本研究采自陈式问卷调查、药丸统计、病历回顾、深度访谈等质性研究方法，主要目的如下：1。使用两种不同的定量方法，以评估来自5个种族群体的患者的药物依从性：（非洲裔美国人、西班牙裔、白色、越南人和俄罗斯移民）患有慢性疾病（高血压、糖尿病或血脂异常）; 2.采用质性和民族志的方法，探讨慢性病健康信念可能联合收割机与健康素养形成服药依从性;确定与低健康素养患者的药物依从性相关的因素，包括：a.关于药物的信念; B.粮食不安全; c.社会经济因素（例如，健康保险覆盖范围的类型;处方变更）;以及d.社会抚养费4.为初级保健提供者和政策制定者提出建议，以提高低收入慢性病患者的用药依从性并减少处方变更。在马萨诸塞州的条件的独特星座-近乎普遍的保险覆盖面加上严格的成本控制措施，因为国家的斗争，以平衡其成本-提供了一个无与伦比的研究机会，并作为未来的变化面临其他国家的一个关键的风向标与平价医疗法案的到来。由关爱健康中心（Caring Health Center）提供服务的不同患者人群提供了一个天然的实验室，可以探索这些政策变化的影响，因为它们与文化上可变的健康信念相交，从而塑造城市，少数民族和低收入患者的药物依从性。对这些复杂动态的更好理解将更好地为初级卫生保健提供者做好准备，以提高依从性，并帮助降低高血压和其他慢性病患者的中风风险。

DESCRIPTION (provided by applicant): Medication Adherence, Health Literacy and Cultural Health Beliefs in a Massachusetts Community Health Center Abstract Health literacy, broadly defined as "the wide range of skills and competencies" that people use to manage their health (Zarcadoolas, et al. 2005, 196-197), is an important aspect of chronic disease self- management (Mancuso and Rincon 2006), though it has been inconsistently associated with medication adherence in multiple studies. While researchers continue to investigate the relationships among health literacy, medication adherence and health outcomes, few have successfully integrated individual-level factors such as health literacy with structural and social factors. In the proposed research, we rely on ethnographic and qualitative data, in combination with quantitative methods, to explore how medication adherence, a widespread problem in chronic disease management, is shaped by structural factors such as insurance copays, as well as by cultural health beliefs. Building on our previous research (Shaw, et al. 2012a, Shaw, et al. 2009b), the proposed study examines health literacy, health beliefs and barriers to medication adherence among patients from five ethnic groups (African-American, Hispanic, white, Vietnamese and Russian immigrant). We base this study in Massachusetts, which has recently expanded the number of people insured under publicly-funded programs while implementing cost-control measures that may limit access to prescription medications, especially for the poor. Drawing on self-report surveys, pill counts, chart review, in-depth interviews and other qualitative methods, this study will meet the following specific aims: 1. Using two different quantitative methods, to assess medication adherence among patients from 5 ethnic groups: (African-American, Hispanic, white, and Vietnamese and Russian immigrants) with chronic disease (hypertension, diabetes, or dyslipidemia); 2. Use qualitative and ethnographic methods to explore the chronic disease health beliefs that may combine with health literacy to shape medication adherence; 3. To identify factors associated with medication adherence among patients with low health literacy, including: a. beliefs about medicines; b. food insecurity; c. socioeconomic factors (e.g., type of health insurance coverage; formulary changes); and d. social support. 4. To develop recommendations for primary care providers and policymakers to improve medication adherence and mitigate formulary changes among low-income patients with chronic illness. The unique constellation of conditions in Massachusetts-of near-universal insurance coverage coupled with stringent cost control measures as the state struggles to balance its budget-offers an unmatched research opportunity and serves as a critical bellwether for coming changes facing other states with the advent of the Affordable Care Act. The diverse population of patients served by Caring Health Center, the proposed research site, provides a natural laboratory in which to explore the effects of these policy changes as they intersect with culturally variable health beliefs to shape medication adherence among urban, minority and low-income patients. Improved understanding of these complex dynamics will better prepare primary health care providers to improve adherence and help reduce stroke risk among patients with hypertension and other chronic conditions.