Abstract

Background: Non-adherence to prescription medications may at least partially explain high rates of morbidity and mortality from chronic illness among Black men. Black men from lower socioeconomic backgrounds have previously been identified as low adherers but little is known about Black men with adequate incomes and access to healthcare resources. The Ecological Model is used as a framework to examine barriers and facilitators of medication adherence among Black men. Purpose: The purpose of this study is to estimate the prevalence and identify barriers and facilitators to medication adherence among a socioeconomically diverse group of Black men with a range of chronic illnesses.
Methods: A cross-sectional study using a 105 item anonymous survey questionnaire was conducted. A convenience sample of 276 Black men (age 35-75 years) was recruited from 15 churches in Baltimore City, and Baltimore, Montgomery and Prince George’s counties. Mann-Whitney U, Kruskall-Wallis and Chi-square analysis were used to examine group differences and multinomial logistic regression provided odds ratio estimates of the association between various factors and low (reference), medium and high medication adherence.
Results: Half the sample (49%) were low adherers. Socioeconomic differences in medication adherence were identified by homeownership (X2 = 6.327, p = .042). No statistically significant differences were found for education, employment, income and health insurance coverage. Personal and interpersonal factors found to be associated with medium adherence were coping (AOR=.91, 95% CI=.84-.99), self-efficacy (AOR=6.74, 95% CI=2.79-16.27), income – (low - AOR=10.94, 95% CI=2.42-49.51, middle –AOR=3.34, 95% CI=1.38-8.10), marriage or having a significant other (AOR=5.40, 95% CI=1.83-15.92) and homeownership (AOR=3.37, 95% CI=1.04-10.92). Personal and interpersonal factors found to be associated with high adherence were self-efficacy (AOR=6.63, 95% CI=1.89-23.27), homeownership (AOR=9.32, 95% CI=1.41-61.60), income (low - AOR=8.55, 95% CI=1.31-55.68) and not sharing information with others (AOR=2.89, 95% CI=1.17-7.13). No associations were identified for community, organizational or government/policy level factors. Conclusions: Higher self-efficacy, homeownership and marital status were facilitators and higher coping, higher income and some forms of social support were barriers to medication adherence. This study illuminates opportunities for improving prescription medication education and implementing practice innovations to increase rates of adherence among Black men across the socioeconomic spectrum.