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“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

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Abstract

Background

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.

Methods

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.

Results

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.

Discussion

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.

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Funding

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.

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Authors and Affiliations

  1. College of Pharmacy, University of Arkansas for Medical Sciences, Northwest, 1125 N. College Ave, Fayetteville, AR, 72703, USA

    Michelle L. Balli, Tiffany A. Dickey & T. Scott Warmack

  2. Office of Community Health and Research, University of Arkansas for Medical Sciences, Northwest, 1125 N. College Ave, Fayetteville, AR, 72703, USA

    Rachel S. Purvis

  3. College of Medicine, University of Arkansas for Medical Sciences, Northwest, 1125 N. College Ave, Fayetteville, AR, 72703, USA

    Sheldon Riklon & Pearl A. McElfish

Authors
  1. Michelle L. Balli
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  2. Tiffany A. Dickey
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  3. Rachel S. Purvis
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  4. T. Scott Warmack
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  5. Sheldon Riklon
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  6. Pearl A. McElfish
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Corresponding author

Correspondence to Pearl A. McElfish.

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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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Balli, M.L., Dickey, T.A., Purvis, R.S. et al. “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. J. Racial and Ethnic Health Disparities 6, 652–659 (2019). https://doi.org/10.1007/s40615-019-00563-2

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  • DOI: https://doi.org/10.1007/s40615-019-00563-2

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