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

大众的药物依从性、健康素养和文化健康信念。CHC

基本信息

批准号：
8987444
负责人：
SUSAN J SHAW
金额：
$ 37.13万
依托单位：
UNIVERSITY OF ARIZONA
依托单位国家：
美国
项目类别：
财政年份：
2014
资助国家：
美国
起止时间：
2014-01-01 至 2016-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8987444
关键词：
Address Adherence Affect Affordable Care Act African American Belief Budgets Caring Chronic Chronic Disease Cities Clinic Community Health Centers Complex Comprehension Cost Control Coupled Cross-Sectional Studies Data Diabetes Mellitus Disease Management Dyslipidemias Equilibrium Ethnic group Ethnography Face Food Formularies Funding Grant Health Health Insurance Health Personnel Health Status Healthcare Healthcare Systems Heart Diseases Hispanics Home environment Hypertension Immigrant Incidence Individual Informed Consent Instruction Insurance Insurance Coverage Interview Investigation Laboratories Language Latino Link Literature Low Income Population Low income Manuals Massachusetts Measures Medicine Methods Minority Modeling Obesity Outcome Participant Patient Education Patient Self-Report Patients Pharmaceutical Preparations Play Policies Population Population Heterogeneity Poverty Primary Health Care Provider Qualitative Methods Quality of life Readability Recommendation Recruitment Activity Regimen Reporting Research Research Personnel Risk Role Sampling Self Management Severity of illness Shapes Site Social support Socioeconomic Factors Stroke Stroke prevention Surveys Transportation United States Agency for Healthcare Research and Quality United States National Institutes of Health abstracting base compliance behavior copayment cost cost shifting diaries ethnographic method experience health belief health disparity health literacy high risk improved inner city literacy medication compliance meetings mortality pill programs skills social socioeconomics

项目摘要

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.

描述（由申请人提供）：马萨诸塞州社区健康中心摘要健康素养中的药物依从性，健康素养和文化健康信念，被广泛定义为人们用来管理其健康的“广泛的技能和能力”（Zarcadoolas等人，等等，等2005，196-197），是慢性疾病自我管理的重要方面（Mancon and Mancon 2006），虽然是2006年的重要方面）在多个研究中的依从性。尽管研究人员继续研究健康素养，药物依从性和健康成果之间的关系，但很少有人成功整合了个人级别的因素，例如健康素养与结构和社会因素。在拟议的研究中，我们依靠民族志和定性数据与定量方法结合使用，以探讨用药依从性如何受到慢性病管理中的广泛问题，它是由诸如保险共汇款以及文化健康信念之类的结构性因素所影响的。在我们先前的研究基础上（Shaw等人，2012a，Shaw等，2009b），拟议的研究研究了健康素养，健康信念和五个族裔患者（非裔美国人，西班牙裔，白人，越南，越南和俄罗斯移民）的药物依从性的障碍。我们在马萨诸塞州的这项研究基础，该研究最近扩大了在公共资助计划下被保险人数的人数，同时实施了可能限制对处方药的使用成本控制措施，尤其是对于穷人而言。借鉴自我报告调查，药丸计数，图表审查，深入的访谈和其他定性方法，本研究将达到以下特定目的：1。使用两种不同的定量方法，以评估5个族裔患者的药物依从性：（非洲裔美国人，西班牙裔，白人，白人和越南和俄罗斯疾病，或抑制糖尿病，或抑制催眠症（非洲裔美国人，白人，白人和俄罗斯）， 2。使用定性和人种学方法探索可能与健康素养结合的慢性疾病健康信念，以塑造药物依从性； 3。确定健康素养低的患者与药物依从性相关的因素，包括：关于药物的信念； b。粮食不安全； c。社会经济因素（例如，健康保险范围的类型；格式更改）；和d。社会支持。 4。为初级保健提供者和政策制定者提出建议，以改善慢性病低收入患者的药物依从性和缓解正式变化。马萨诸塞州近乎全世界保险范围的独特条件星座，加上严格的成本控制措施，因为国家努力平衡其预算范围的研究机会，并作为《可负担得起法案的出现》（Addandable Care Act）面临的其他州面临的临时变化是重要的决定性。拟议的研究地点护理健康中心服务的患者人数多样化，提供了一个自然实验室，可以在其中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以塑造城市，少数群体和低收入患者的药物依从性。对这些复杂动态的了解可以更好地理解原始医疗保健提供者，以提高依从性，并有助于降低患有高血压和其他慢性病患者的中风风险。