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

描述(由申请人提供)：马萨诸塞州社区卫生中心的服药依从性、健康素养和文化健康信念摘要健康素养，广义上定义为人们用来管理自己健康的“广泛的技能和能力”(Zarcadoolas等人)。(2005年，196-197)，是慢性病自我管理的一个重要方面(Mancuso和Rincon，2006)，尽管在多项研究中，它与用药依从性并不一致。尽管研究人员继续研究健康素养、服药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层面的因素与结构性和社会性因素结合起来 各种因素。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，探索慢性疾病管理中普遍存在的用药依从性是如何受到保险共同支付等结构性因素以及文化健康信念的影响的。以我们以前的研究为基础(Shaw等人2012a、Shaw等人。2009b)，这项拟议的研究审查了来自五个民族(非洲裔美国人、西班牙裔、白人、越南人和俄罗斯移民)的患者的健康素养、健康信念和坚持用药的障碍。我们将这项研究的基础设在马萨诸塞州，最近马萨诸塞州扩大了公共资助项目的保险人数，同时实施了可能限制获得处方药的成本控制措施，特别是对穷人来说。运用问卷调查、药片计数、图表回顾、深度访谈等定性方法，本研究将达到以下具体目标：1.使用两种不同的定量方法，评估来自5个民族(非裔美国人、西班牙裔、白人、越南和俄罗斯移民)患有慢性病(高血压、糖尿病或血脂异常)的患者的服药依从性；2.使用定性和人种学方法探索慢性病健康信念，这些信念可能与健康素养相结合而形成用药依从性；3.确定与健康素养低的患者服药依从性相关的因素，包括：a.对药物的信念；B.粮食不安全；c.社会经济因素(例如，医疗保险覆盖范围的类型；处方变化)；d.社会支助。4.为初级保健提供者和政策制定者提出建议，以改善低收入慢性病患者的用药依从性和减轻处方变化。马萨诸塞州独一无二的一系列条件--保险覆盖面近乎全民，加上该州在努力平衡预算之际采取了严格的成本控制措施--提供了一个无与伦比的研究机会，也是随着《平价医疗法案》的出台，其他州即将面临的变化的关键风向标。拟议的研究地点关爱健康中心服务的患者群体多样化，提供了一个天然的实验室，在这里探索这些政策变化的影响，因为它们与文化上不同的健康信念交织在一起，塑造了城市、少数族裔和低收入患者的用药依从性。更好地了解这些复杂的动态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.