Online Program

Association between social stress and medication adherence among diverse, low-income patients with chronic disease at a community health center

Tuesday, November 3, 2015 : 1:42 p.m. - 2:00 p.m.

Cristina Huebner Torres, MA, Doctoral Candidate, Department of Research and Wellness, Caring Health Center, Springfield, MA
Josephine Korchmaros, Ph.D., Southwest Institute for Research on Women University of Arizona, University of Arizona, Tucson, AZ
Jeannie Lee, PharmD, BCPS, CGP, Pharmacy Practice and Science, University of Arizona College of Pharmacy, Tucson, AZ
Molly Totman, MPH, Research and Wellness, Caring Health Center, Springfield, MA
Sabina Dhakal, MPH, Department of Research and Wellness, Caring Health Center, Springfield, MA
Amanda Hilton, MA, School of Anthropology, University of Arizona, Tucson, AZ
Susan Shaw, PhD, Department of Anthropology, University of Arizona, Tucson, AZ
Prevalence of chronic disease is high among low income, diverse patients in community health centers. Medication adherence is a key component of chronic disease management, however, many patients face barriers to adherence.

Using cross sectional data from the Medication Adherence, Health Literacy and Cultural Health Beliefs (RxHL) Study, we aimed to examine the association between social stressors and medication adherence. Social stress was measured using the 20-item Tool for Assessing Patients’ Stressors (TAPS). Medication adherence, the outcome variable, was assessed using the 8-item Morisky Medication Adherence Scale (MMAS-8).

Participants (N=129) were recruited from a federally qualified health center (FQHC).  Eligible participants reported at least one chronic disease including diabetes (45%), hypertension (75%), dyslipidemia (58%), depression (22.5%) and/or anxiety (10.9%) and identified as white (7.8%), African American (25.6%), Vietnamese (27.9%), Russian speaking (14%), or Hispanic (24.8%). The mean age was 57 and 58.9% were female. 

After multivariable adjustment for depression status, race/ethnicity, gender, and age, the odds ratio for medication adherence associated with social stressors was 0.82 (95% CI 0.714-0.947, p=0.007). For every one unit increase in social stress (e.g., for every additional stressor on the TAPS), the odds of medication adherence decreased by 18%. In addition, age (OR 1.11 95% CI 1.043-1.183, p=0.001), gender (OR 0.144 95% CI 0.037-0.567, p=0.006) and African American racial status (OR 0.045 95% CI 0.002-0.984, p=0.049) were statistically significantly associated with medication adherence.   

Increased social stressors contribute to decreased medication adherence. Adherence interventions should consider social stressors and be tailored to age, gender, and cultural needs.

Learning Areas:

Chronic disease management and prevention
Public health or related research

Learning Objectives:
Define social stressors and medication adherence Describe the association between social stressors and medication adherence Discuss the need to consider social stressors when developing medication adherence/chronic disease self-management interventions

Keyword(s): Stress, Adherence

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the Project Director and am the Site Principal Investigator of multiple federally funded grants focused on health literacy, medication adherence, cultural beliefs and disease outcomes at a community health center and in collaboration with partner universities. Among my scientific interests is social and chronic disease epidemiology and issues of management and prevention among lower income, ethnically diverse community health center populations.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.