03/04/2020 Adherence to Medication Regimens among Low-Income Patients with Multiple Comorbid Chronic Conditions | Health & Social

; Social Wor…

Adherence to Medication Regimens

among Low-Income Patients with
Multiple Comorbid Chronic Conditions
Shiraz I. Mishra, Deborah Gioia, Saltanat Childress, Beth Barnet,
Ramothea L. Webster

Health & Social Work, Volume 36, Issue 4, November 2011, Pages
249–258, https://doi.org/10.1093/hsw/36.4.249
Published: 01 November 2011 Article history 

Abstract
This qualitative study sought to explore facilitators and
barriers to adherence to multiple medications among low-
income patients with comorbid chronic physical and
mental health conditions. The 50 focus group participants
identi ed personal/contextual and health system factors
as major impediments to adherence to multiple
medications. These factors included medication side
e ects, fear of harm from medication, fear of dependence
on medication, complex instructions, suboptimal
communications with doctor, suspicion about doctors'
and pharmaceutical companies' motives in prescribing
medication, and the high cost of medications. Participants
also identi ed motivators, both internal (self-initiated)
and external (initiated by family, doctor, support groups),
to ensure adherence to multiple medications. These
motivators included self-discipline, sense of personal
responsibility, faith, support from family members and
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doctors, and focused health education and self-
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management support. Three themes emerged that
enhanced understanding of the complexity of adherence
to multiple medications: (1) reaching one's own threshold
for medication adherence, (2) lack of shared information
and decision making, and (3) taking less than the
prescribed medication. Further analysis of the data
revealed that the patients perceived a lack of shared
decision making in the management of their comorbid
chronic conditions and their medication regimen.

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03/04/2020 Adherence to Medication Regimens among Low-Income Patients with Multiple Comorbid Chronic Conditions | Health & Social Wor…

Keywords: comorbidity, disease management, focus group,

medication adherence or compliance, polypharmacy
Topic: chronic disease, comorbidity, decision making, drug
costs, fear, mental health, physicians, family, support
groups, health education, adverse e ects of medication,
medication adherence, prescribing behavior, low income,
pharmaceutical company, qualitative research, self-
management, shared decision making
Issue Section: Articles

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©2011 National Association of Social Workers

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