Baghikar Sara, Benitez Amanda, Fernandez Piñeros Patricia, Gao Yue, Baig Arshiya A
Department of Emergency Medicine, University of Illinois at Chicago, 808 S Wood Street, Chicago, IL, 60612, USA.
Enlace Chicago, Chicago, IL, USA.
J Immigr Minor Health. 2019 Dec;21(6):1334-1341. doi: 10.1007/s10903-019-00867-9.
Mexican-Americans carry a high burden of type 2 diabetes and are disproportionately affected by diabetes related mortality and morbidity. Poor adherence to medication is an important barrier to achieving metabolic control and contributes to adverse health outcomes and health disparities. Little is known about barriers and facilitators to medication adherence among Mexican-Americans with diabetes. This is a qualitative study of semi-structured interviews with a sample of 27 adults (25 Mexican-Americans and 2 Latinos of other origin) with self-reported type 2 diabetes who were recruited as part of a church-based, randomized controlled trial for diabetes self-management education in a low-income, immigrant neighborhood of Chicago. Face-to-face, in-depth interviews were conducted (one in English and 26 in Spanish), audio-recorded, transcribed verbatim, and professionally translated. Systematic qualitative methods were used to analyze interviews. All 27 participants were Latino, and 25 were of Mexican descent. Participants' mean age was 57 years, 81% were female, 69% had an annual income less than $20,000 and 48% had no health insurance. Mean A1C level was 8.6% and mean systolic blood pressure was 125 mmHg. The majority of participants (85%) reported using oral diabetes medication and 35% reported taking insulin. 76% reported being affiliated with one of the two partnering catholic churches based in the South Lawndale neighborhood of Chicago, also known as Little Village. Concerns regarding effectiveness and negative impact of diabetes medication were prevalent and expressed by 13 (48%) of 27 participants. Dissatisfaction with ineffective provider communication and not being able to pay for medication were other important barriers to adherence and were expressed by 7% and 11% of participants, respectively. Family support, for example, family members assisting in organizing medications in boxes and reminding participants to take them, was reported by 15% of participants and emerged as an important facilitator to medication adherence. There is a gap in research on factors influencing adherence to diabetes medication among Mexican-Americans. Our study suggests that concerns regarding negative impact of diabetes medication and concerns regarding effectiveness are prevalent barriers to adherence. These barriers can be addressed through educational efforts targeting patients and clinicians by specifically including content on beliefs that lead to poor adherence in diabetes self-management interventions for patients and continuing medical education for providers and by developing interventions that engage family members as a support system for medication adherence.
墨西哥裔美国人患2型糖尿病的负担很重，且在糖尿病相关死亡率和发病率方面受到的影响尤为严重。药物依从性差是实现代谢控制的一个重要障碍，会导致不良健康后果和健康差距。对于患有糖尿病的墨西哥裔美国人而言，关于药物依从性的障碍和促进因素知之甚少。这是一项定性研究，对27名自述患有2型糖尿病的成年人（25名墨西哥裔美国人以及2名其他族裔的拉丁裔）进行了半结构化访谈，这些参与者是在芝加哥一个低收入移民社区开展的一项基于教会的糖尿病自我管理教育随机对照试验中招募的。进行了面对面的深入访谈（1次用英语，26次用西班牙语），进行了录音、逐字转录并进行了专业翻译。采用系统的定性方法对访谈进行分析。所有27名参与者均为拉丁裔，其中25名是墨西哥裔。参与者的平均年龄为57岁，81%为女性，69%的年收入低于2万美元，48%没有医疗保险。平均糖化血红蛋白水平为8.6%，平均收缩压为125毫米汞柱。大多数参与者（85%）报告使用口服糖尿病药物，35%报告使用胰岛素。76%的参与者报告隶属于位于芝加哥南朗代尔社区（也称为小村庄）的两个合作天主教会之一。27名参与者中有13名（48%）普遍表达了对糖尿病药物有效性和负面影响的担忧。对无效的医患沟通不满意以及无力支付药物费用是依从性的其他重要障碍，分别有7%和11%的参与者表达了这些障碍。15%的参与者报告有家庭支持，例如家庭成员协助将药物整理在盒子里并提醒参与者服药，这成为药物依从性的一个重要促进因素。在影响墨西哥裔美国人糖尿病药物依从性的因素研究方面存在差距。我们的研究表明，对糖尿病药物负面影响的担忧以及对有效性的担忧是依从性的普遍障碍。可以通过针对患者和临床医生的教育努力来解决这些障碍，具体做法包括在针对患者的糖尿病自我管理干预措施以及针对医疗服务提供者的继续医学教育中特别纳入导致依从性差的信念相关内容，并制定让家庭成员作为药物依从性支持系统参与其中的干预措施。
