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

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.