“我不想服用那种药物”：非裔美国人不坚持服用糖尿病药物的原因及对提高依从性的认知解决方案
"I did not want to take that medicine": African-Americans' reasons for diabetes medication nonadherence and perceived solutions for enhancing adherence.
作者信息
Shiyanbola Olayinka O, Brown Carolyn M, Ward Earlise C
机构信息
Division of Social and Administrative Sciences, School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA.
Division of Health Outcomes and Pharmacy Practice, College of Pharmacy, University of Texas at Austin, Austin, TX, USA.
出版信息
Patient Prefer Adherence. 2018 Mar 19;12:409-421. doi: 10.2147/PPA.S152146. eCollection 2018.
BACKGROUND
Diabetes is disproportionally burdensome among African-Americans (AAs) and medication adherence is important for optimal outcomes. Limited studies have qualitatively examined reasons for nonadherence among AAs with type 2 diabetes, though AAs are less adherent to prescribed medications compared to whites. This study explored the reasons for medication nonadherence and adherence among AAs with type 2 diabetes and examined AAs' perceived solutions for enhancing adherence.
METHODS
Forty AAs, age 45-60 years with type 2 diabetes for at least 1 year prior, taking at least one prescribed diabetes medication, participated in six semistructured 90-minute focus groups. Using a phenomenology qualitative approach, reasons for nonadherence and adherence, as well as participants' perceived solutions for increasing adherence were explored. Qualitative content analysis was conducted.
RESULTS
AAs' reasons for intentional nonadherence were associated with 1) their perception of medicines including concerns about medication side effects, as well as fear and frustration associated with taking medicines; 2) their perception of illness (disbelief of diabetes diagnosis); and 3) access to medicines and information resources. Participants reported taking their medicines because they valued being alive to perform their social and family roles, and their belief in the doctor's recommendation and medication helpfulness. Participants provided solutions for enhancing adherence by focusing on the roles of health care providers, patients, and the church. AAs wanted provider counseling on the necessity of taking medicines and the consequences of not taking them, indicating the need for the AA community to support and teach self-advocacy in diabetes self-management, and the church to act as an advocate in ensuring medication use.
CONCLUSION
Intentional reasons of AAs with type 2 diabetes for not taking their medicines were related to their perception of medicines and illness. Solutions for enhancing diabetes medication adherence among AAs should focus on the roles of providers, patients, and the church.
背景
糖尿病在非裔美国人（AA）中造成的负担尤为沉重，而药物依从性对于实现最佳治疗效果至关重要。尽管与白人相比，AA对处方药的依从性较低，但针对2型糖尿病AA患者不依从原因的定性研究较少。本研究探讨了2型糖尿病AA患者药物不依从和依从的原因，并研究了AA患者认为的增强依从性的解决方案。
方法
40名年龄在45 - 60岁、患有2型糖尿病至少1年且正在服用至少一种糖尿病处方药的AA患者参加了6个90分钟的半结构化焦点小组。采用现象学定性方法，探讨不依从和依从的原因以及参与者认为的增加依从性的解决方案。进行了定性内容分析。
结果
AA患者故意不依从的原因与以下方面有关：1）他们对药物的认知，包括对药物副作用的担忧以及服药相关的恐惧和沮丧；2）他们对疾病的认知（对糖尿病诊断的怀疑）；3）药物及信息资源的获取。参与者表示服药是因为他们重视活着以履行社会和家庭角色，以及他们对医生建议和药物有效性的信任。参与者通过关注医疗保健提供者、患者和教会的作用，提出了增强依从性的解决方案。AA患者希望医疗保健提供者就服药的必要性和不服药的后果提供咨询，这表明AA社区需要在糖尿病自我管理中支持和教导自我倡导，教会需要在确保药物使用方面发挥倡导作用。
结论
2型糖尿病AA患者不服药的故意原因与他们对药物和疾病的认知有关。提高AA患者糖尿病药物依从性的解决方案应关注医疗保健提供者、患者和教会的作用。
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