Who Won't Take Their Medicine?

UA anthropologist Susan J. Shaw and UA pharmacist Jeannie Lee have been awarded $1.48 million from the NIH to study medication adherence and health literacy.
January 30, 2014
Susan J. Shaw of the UA's School of Anthropology. (Photo: Amanda Quinby)
Jeannie Lee of the UA's College of Pharmacy and College of Medicine. (Image courtesy of Jeannie Lee)

UA associate professor of anthropology Susan J. Shaw and UA assistant professor of pharmacy Jeannie Lee have received $1.48 million from the National Institutes of Health to study factors that impact medication adherence among residents in Massachusetts, where state law mandated that nearly every resident receive a minimum level of health care insurance coverage.

The grant is a follow-up to a previous NIH award to Shaw to study how health literacy varies among different cultural populations in one particular Massachusetts city: Springfield. Shaw’s earlier work has indicated that medication adherence is likely to be impacted by patients’ culture-based beliefs about their medications, as well as by changing costs associated with health care reform.

Over the next four years, Shaw and Lee will examine factors that may influence medication adherence, such as culture-based beliefs about health, health literacy, and changing patient costs in five ethnic groups in Springfield: African-American, Hispanic and white residents as well as Vietnamese and Russian immigrants.

"Massachusetts initiated health care reform in 2006, so they have a few years' experience ahead of all the other states," said Shaw, of the UA's School of Anthropology. The state has faced expanding costs associated with providing health insurance for more people health insurance reform that the rest of the nation has yet to confront, and can serve as an exemplar state for implementing the Affordable Care Act, she said.

"As Massachusetts initiated health care reform and expanded the enrollment of their publicly supported health insurance programs,” Shaw said, the state simultaneously embarked on cost-control measures to mitigate some of the rising costs associated with publicly supported health insurance.

One common cost-control measure used by insurance companies is changing the list of medications that are covered by insurance plans, said Shaw, which can mean that patients' medications might change if certain prescriptions are no longer covered by insurance.

For example, a different brand of medication may be given in place of the original prescription but with different instructions on how the medication needs to be taken, Shaw explained. “It may be the same active ingredient in the medication and the same total dose, but with different instructions for the patient. That change could affect how well patients can stay on their medications."

Additionally, individuals hold personal beliefs about their medication needs that can be strongly influenced by their cultural background, Shaw noted.

"As an anthropologist I'm especially interested in how people think and feel about their medications," she said. "People may have fears and anxieties about their medications that can vary depending on their cultural backgrounds. We use in-depth interviews to try and uncover the range of factors that shape peoples' medication usage."

For example, she explained, some people feel that taking their prescriptions allows them to live a healthy life, while others may fear dependence on any long-term medication.  

"Some people have this idea that one or two medications is good but over a certain number of them is bad, so they only take the first two prescribed medications. I'm interested in the ways that people make those decisions, which are often completely inexplicable to their physicians," Shaw said.

"Many times health providers are dumbfounded as to why patients adhere to some medicines and not to others," added Lee, who is an assistant professor in the UA's College of Pharmacy and College of Medicine. "It's great for the clinical world to have this information and use it to educate the patient to overcome those barriers to medication adherence."  

Health literacy – or patients' ability to understand and act on their providers' instructions regarding health – is an issue that pharmacists and clinicians commonly confront in administering patient care, Lee said.

"My interest as a pharmacist is getting the patients to take their medications properly to improve their health," she said. "We invest a lot of resources to develop new and better drugs. But if patients don't use them properly, they don't work."

"Often patients don't fully understand their conditions or medication labels as written," Lee said. "Making those connections and helping people understand and adhere to their medications may achieve more for the patients' health than developing new drugs."

Shaw and Lee will work with data analyst Josephine Korchmaros, director of research methods and statistics at the UA's Southwest Institute for Research on Women in the College of Social and Behavioral Sciences, and with the Caring Health Center at the Springfield, Mass., study site.

"Ultimately we will have a set of recommendations that primary care providers can implement in their practices to help patients adhere to their medication regimens," Lee said.

"It's a really informative project for clinicians," she added, "and it's a good partnership to have an anthropologist like Susan to inform us about our patients' cultural beliefs and health literacy so that we can use that information to better care for those patients."