Balakrishnan Aparna, Weinmeyer Richard, Serper Marina, Bailey Stacy Cooper, Kaiser Karen, Wolf Michael
Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Res Social Adm Pharm. 2022 Oct;18(10):3846-3854. doi: 10.1016/j.sapharm.2022.05.010. Epub 2022 May 18.
Mixed methods are valuable in understanding multifaceted health behaviors like medication adherence. Kidney transplant recipients (KTRs) have complex medication regimens and are more vulnerable to nonadherence relative to other transplant recipients. Yet mixed methods have not been widely applied to examine adherence among KTRs, especially in relation to prescribed medications beyond immunosuppressants.
As part of a sequential approach, we used in-depth interviews to better understand findings from a previous quantitative study and to describe additional factors that influence prescription medication-taking among adult KTRs.
Semi-structured interviews were conducted with a purposive sample of 14 adult KTRs recruited from a transplant center in Chicago, IL. Deductive and inductive content analysis was used to code transcripts and identify key themes.
Across the sample, we identified insurance challenges, disruptions in routine, and poor mental well-being as barriers to adherence at the patient level. For Black and Hispanic KTRs, poor communication between providers and disjointed care transitions posed additional barriers at the health system level. Compared with White KTRs, Black and Hispanic KTRs experienced greater medication burden due to comorbidities, while medication and digital literacy challenges were unique to Hispanic KTRs.
KTRs are often motivated to take medications as prescribed, but sometimes lack the capacity or support to do so. Eliciting KTR perspectives is necessary in addressing knowledge and resource gaps at the patient and health system levels to improve adherence. In addition, recognizing the relative burden of taking comorbidity medications compared with immunosuppressants may important, particularly for Black and Hispanic KTRs.
混合方法对于理解诸如药物依从性等多方面的健康行为很有价值。肾移植受者（KTRs）有复杂的药物治疗方案，相对于其他移植受者，他们更易出现不依从情况。然而，混合方法尚未广泛应用于研究KTRs的依从性，尤其是与免疫抑制剂以外的处方药相关的依从性。
作为一种序贯方法的一部分，我们采用深入访谈来更好地理解先前定量研究的结果，并描述影响成年KTRs服用处方药的其他因素。
对从伊利诺伊州芝加哥市一家移植中心招募的14名成年KTRs进行了有目的抽样的半结构化访谈。采用演绎和归纳内容分析法对访谈记录进行编码并确定关键主题。
在整个样本中，我们确定保险方面的挑战、日常生活的干扰以及心理健康状况不佳是患者层面依从性的障碍。对于黑人和西班牙裔KTRs，医疗服务提供者之间沟通不畅以及护理过渡脱节在卫生系统层面构成了额外障碍。与白人KTRs相比，黑人和西班牙裔KTRs由于合并症而承受更大的药物负担，而药物和数字素养方面的挑战是西班牙裔KTRs所特有的。
KTRs通常有按规定服药的动机，但有时缺乏这样做的能力或支持。了解KTRs的观点对于解决患者和卫生系统层面的知识和资源差距以提高依从性是必要的。此外，认识到与免疫抑制剂相比服用合并症药物的相对负担可能很重要，特别是对于黑人和西班牙裔KTRs。
