Non-adherence to prescription medication regimens is recognized as a serious medical problem. Across a number of medical conditions including hypertension and cardio-vascular disease, dia-betes, HIV, and chronic pain, the prevalence of non-adherence to physician instructions regarding the use of medications has been shown to range from 15% up to well over 50%. The literature on non-adherence, however, is somewhat fragmented in that studies focus on one medical condition. In addition, the studies often provide only partial theoretical explanations for the phenomenon. In this project, we seek to provide a broader theoretical framework for examining the problem of medication non-adherence and to test it relative to two quite different medical conditions—hypertension and chronic non-malignant pain.
In prior work supported by the SNF, the applicants have developed and begun to test a model of health literacy and patient empowerment that may shed new light on the problem of medication non-adherence. Ideally, of course, literacy and empowerment will join to enable the patient or healthcare consumer to make informed and constructive health choices that will advance his or her health outcomes and quality-of-life. However, the framework suggests and our preliminary data suggest that the case of low health literacy and high psychological empowerment can lead the patient to make choices that place the patient in danger of making poor choices.
In order to examine this problem, we propose a multi-method approach involving three studies. In the first study, qualitative depth interviews of patients suffering from either hypertension or from chronic non-malignant pain will be conducted to elucidate the patients’ understanding of their condition, the medications that have been prescribed (benefits and potential side effects), their feelings about the medication and its use, and any “mythologies” they may have regarding the medication. In the second study, we seek to specify the relationships between the issues uncovered in Study 1 and medication regimen adherence and quality-of-life. The study will involve a survey of 200 patients being treated by a physician for hypertension and 200 being treated for chronic pain. In Study 3, we seek to build on the relationships identified in Study 2 to develop interventions to improve health literacy and health empowerment, and test their impact and interaction in improving medication adherence.
The planned study will be the first to test the framework of health empowerment and its effects, which the applicants developed in recent years, and will therefore be a part in the expansion of the concept of health literacy from a narrow functional understanding to a more comprehensive concept of wider utility. The study will complement our knowledge of the antecedents of non-compliance with medication therapy prescribed by a physician, and thus address an important factor with a high potential for health damages. The complementing concerns the study area, Ti-cino, and the medical conditions, high blood pressure and pain. But most decisively, the planned study pens up new venues for studying the causes of medication non-compliance in view of con-temporary, theoretically grounded concepts, which are also health policy ideals.