What At-Risk Populations Have High Rates of Nonadherence and Why?
Medication adherence is not dependent on the severity of the disease, especially for chronic conditions. There is a common misconception that if the stakes are high enough for patients, such as for antiretroviral therapy (ART) for HIV/AIDS, where being medically adherent can mean the difference between life and death, patients will be inclined to adhere to their medication. However, research highlights that even with high-stakes medications, nonadherence remains a pressing issue, highlighting the need to understand and address broader factors influencing adherence beyond the sole importance of the medication (Massot Mesquida et al., 2021; W.H.O. Diet, 2022). As a result, acknowledging and addressing the disparities across various populations with chronic conditions is crucial for improving health outcomes and ensuring equitable healthcare.
Increasing Adherence Among Youth
Medication adherence among children and adolescents with chronic conditions is a complex issue influenced by an array of variables. Understanding attributes contributing to poor adherence is crucial for developing effective interventions to enhance adherence among this population. For instance, research highlights that adherence rates vary significantly based on youth demographic factors, the type of illness, and methods used to measure adherence.
Demographics play a significant role in successful medication adherence. The adolescent population exhibits lower adherence rates than younger children due to their developmental stage, which involves an increasing desire for independence and questioning authority figures, including medical professionals (KyngAs et al., 2000). Furthermore, disparities in adherence rates among adolescents of different racial and socioeconomic groups are striking, with minority and low socioeconomic status adolescents frequently facing additional barriers to medication adherence, including obstacles such as cultural differences in health practices, a lack of access to healthcare, and financial limitations (Wise, 2007).
The type of illness and its severity also significantly impact medication adherence among adolescents. Chronic diseases, such as HIV, diabetes, and asthma, require ongoing and complex treatment regimens. The severity and complexity of managing chronic illnesses can often seem overwhelming to youth because managing chronic diseases involves adhering to a strict medication schedule and possibly adjusting their whole lifestyle (Borus & Laffel, 2019; Kaplan & Price, 2020; Murphy et al., 2001). For instance, HIV treatment often requires antiretroviral medication to be taken at specific and numerous times of the day (Kaplan & Price, 2020; Murphy et al., 2001). These demanding regimens require consistency and responsibility, which can be particularly challenging for adolescents who have not fully developed the executive functioning skills necessary to use and apply them in their daily lives.
Furthermore, adolescent's psychological and cognitive development plays a crucial role in this dynamic. Adolescents are often focused on the present and have difficulty considering the long-term benefits of adherence, such as reducing complications or disease progression. Their developing brains, especially adolescent boys, are more inclined toward risk-taking and less capable of gratification delay, making the discipline necessary for consistent medication adherence extremely challenging (Boucquemont et al., 2019; El-Rachidi et al., 2017; Fiese & Everhart, 2006; KyngAs, 2000; Sawyer & Aroni, 2003). If adolescents do not perceive any immediate benefits from being medically adherent, they are less likely to adhere to their medication regimen (Butz, 2006; El-Rachidi et al., 2017). Gender differences further complicate this, with young women demonstrating better adherence rates on average than young men, which is theorized to be due to earlier cognitive maturation in females (Boucquemont et al., 2019). This is particularly problematic for chronic conditions, many of which, especially in the early stages of stable periods of their diagnosis, may not present obvious symptoms, leading adolescents to reconsider the necessity of their medication. For instance, the main benefits of adherence to HIV medication are preventative, aiming to maintain viral suppression and prevent progression, as opposed to addressing noticeable symptoms (KyngAs, 2000; Office of AIDS Research, 2024).
Psychosocial factors further complicate medication adherence among adolescents. Fear of social isolation is a significant barrier, especially for conditions such as HIV, where disclosing this status can lead to rejection from peers and family (Hosek et al., 2015). Furthermore, the stigma associated with certain conditions can lead to nonadherence in adolescents striving to avoid being labeled or judged by peers (Kalaman et al., 2023; Sawyer & Aroni, 2003). Additionally, parental support is crucial in managing chronic conditions in adolescence, with conflicts between parents and young adults greatly contributing to nonadherence among adolescents (Fiese & Everhart, 2006; Kalaman et al., 2023).
In conclusion, the issue of nonadherence among adolescents with chronic conditions is multifaceted, involving a wide array of factors. Barriers, including demographics, illness type, psychological, and psychosocial factors, highlight the need for tailored interventions that address the specific needs of this population. Education for adolescents and parents, in addition to improved communication between healthcare providers and younger patients, is crucial for enhancing adherence and improving overall health outcomes (Kalaman et al., 2023; World Health Organization, 2003).
Increasing Adherence in the Elderly
Nonadherence to medication is common among elderly patients due to a combination of physiological, psychological, and systemic factors. For instance, older patients' complex medications regimens pose a significant issue, as they are more likely to have multiple chronic conditions requiring numerous medications. The need for more than one medication increases the risk of confusion, dosing errors, and physical and cognitive burdens of managing complex regimens (Marcum & Gellad, 2012).
Notably, cognitive decline is far more prevalent in elderly patients, resultantly it is a significant factor affecting medication adherence in older adults. Conditions such as dementia or mild cognitive impairments can lead to forgetfulness, misinterpretation of medication instructions, and difficulty in maintaining daily medication regimens (Campbell et al., 2016). Moreover, this cognitive decline can result in taking too many doses of medication, leading to an increased risk of overdose or drug toxicity (Halli-Tierney et al., 2019; Von Moltke et al., 2001). Furthermore, sensory impairments, like poor vision or hearing, may make it difficult for elderly patients to read and hear instructions from healthcare providers (Alhusein et al., 2019; Barber et al., 2004). Physical limitations also play a critical role in medication nonadherence among the elderly. Various issues, such as arthritis, tremors, and other mobility issues, can make it difficult for older adults to open medication bottles, split pills, or administer medications (Alhusein et al., 2019; Salive, 2013). Furthermore, transportation barriers can prevent elderly patients from getting to pharmacies for refills or attending medical appointments, interrupting medication regimens (Gellad et al., 2011; K et al., 2023; Piette et al., 2004).
Financial constraints also contribute significantly to medication adherence. Many older adults live on fixed incomes, which may result in them struggling with the high costs of medications, especially when they are on numerous medications. Out-of-pocket expenses can pose a considerable burden to older patients, leading them to skip doses, split pills, or completely discontinue their medications altogether to save money (Gellad et al., 2011; K et al., 2023; Heisler et al., 2004).
Medication nonadherence can also occur in elderly adults due to psychosocial factors, including depression and social isolation. Depression can reduce motivation to adhere to medication regimens and impair cognitive functions necessary for managing medications (Holvast et al., 2019). Social isolation means fewer support systems to assist with medication management, which is vital for adherence (Grenard et al., 2011; K et al., 2023).
Additionally, elderly patients often lack adequate education and understanding about their prescriptions. Health literacy tends to be lower in older adults, and they may not fully comprehend the importance of adherence, the potential side effects, or the consequences of nonadherence (Mosher et al., 2015). Poor communication with healthcare providers can further amplify this issue, as elderly patients might be less likely to ask questions or express concerns about their medications (Britten et al., 2000; K et al., 2023).
In summary, medication nonadherence among older patients is driven by a multitude of complex factors, including intricate medication regimens, cognitive and physical limitations, financial constraints, psychosocial factors, and inadequate health literacy. Addressing these challenges requires multifaceted interventions tailored to the older patients' needs.
Supporting Low Socioeconomic Status (SES) Patients
Patients with low socioeconomic status (SES) experience high rates of medication nonadherence due to a range of economic, educational, and social barriers. Financial constraints are a significant factor, as individuals with low SES often struggle to afford medications, even when they are covered by insurance. High out-of-pocket payments, including copayments and deductibles, can deter patients from filling prescriptions or adhering to long-term medication regimens (Briesacher et al., 2007; Wenger et al., 2016). Additionally, limited financial resources may force patients to prioritize immediate needs, such as food and housing, over purchasing medications (Wenger et al., 2016).
Educational barriers also play a crucial role in medication nonadherence among low socioeconomic status populations. Lower levels of health literacy are common in this population, which may lead to misunderstandings about medication instructions and the importance of adherence (Gazmararian et al., 2003; Miller, 2016). Patients with limited health literacy may face challenges navigating the healthcare system, understanding prescription instructions, and following complex medication regimens, increasing the likelihood of nonadherence (Berkman et al., 2011; Miller, 2016).
Additionally, social factors, such as unstable living conditions and a lack of social support, further exacerbate nonadherence amongst low socioeconomic status individuals. Those experiencing housing instability or homelessness may face additional challenges in taking medication regularly and having consistent access to their medications (Baggett et al., 2010; Fernandez et al., 2022). Moreover, these patients may lack the social support systems that encourage and assist them with remaining adherence, such as family members or caregivers who help manage their medication needs (DiMatteo, 2004; Shahin et al., 2021).
Transportation barriers also significantly impact medication adherence in low-income populations. With inconsistent transportation, patients may find it difficult to travel to pharmacies to fill prescriptions or attend follow-up medical appointments, leading to missed doses and inconsistent treatment (Syed et al., 2013; Wolfe et al., 2020). Public transportation options may also be limited or unaffordable, further complicating access to necessary healthcare services (Wolfe et al., 2020).
In conclusion, low socioeconomic status is a significant determinant of medication nonadherence, driven by economic hardships, educational deficiencies, social instability, and transportation challenges. Addressing these barriers requires comprehensive strategies to improve affordability, health literacy, access to care, and social support for low socioeconomic populations.
Compliance Concerns for Racial and Ethnic Minorities
Patients identifying as racial and ethnic minorities frequently experience high rates of medication nonadherence due to a combination of socioeconomic, cultural, and systematic factors. Socioeconomic barriers, such as lower income levels and lack of insurance, disproportionately affect minority populations, limiting their access to necessary medications and healthcare services (Dong et al., 2021; McQuaid & Landier, 2018). Financial constraints often result in difficult choices between purchasing medications and meeting other essential needs, leading to inconsistent adherence (Qato et al., 2010; Wenger et al., 2016).
Cultural and linguistic differences also play a significant role in medication nonadherence among this population. Language barriers can prevent effective communication between healthcare providers and patients, resulting in misunderstandings about medication instructions and the importance of adherence (Anderson & Bulato, 2024; Ngo-Metzger et al., 2007). Additionally, cultural beliefs and practices may influence patients’ perceptions of their condition and treatment, leading to reluctance to follow medication regimens (Anderson & Bulato, 2024; Kressin et al., 2001).
Historical context also plays a role in the inherent distrust of the healthcare system among minority populations, especially among the Black population. This distrust largely stems from unethical, historical experiments, such as the infamous Tuskegee Syphilis Study, in which Black men were told they were receiving free governmental healthcare in exchange for their participation, but not informed or treated for syphilis (Centers for Disease Control and Prevention, 2022). Healthcare professionals behaved unethically in studying the natural progression of untreated syphilis, failing to provide these men with penicillin, the standard treatment for syphilis when it was released in 1947 (Centers for Disease Control and Prevention, 2022; Scharff et al., 2010). The numerous deaths and disabilities from this unethical behavior have left a lasting impact on Black communities, fostering a deep sense of mistrust in the healthcare system. Unfortunately, systemic issues persist in the modern day, such as implicit bias and discrimination within healthcare systems, further amplifying nonadherence rates among racial and ethnic minorities. Implicit bias refers to the unconscious attitudes and prejudices an individual has developed due to prior influences and learned associations throughout their lives (Shah & Bohlen, 2023). Studies have shown that minority patients continue to receive lower-quality care and face greater barriers to accessing healthcare services compared to individuals who identify as white (Anderson & Bulato, 2024; Nelson, 2002). This leads to distrust in the healthcare system and a reduction in the likelihood of following medical advice, including medication adherence (Anderson & Bulato, 2024; Traylor et al., 2010).
Moreover, minorities are less likely to have a regular source of care, which is crucial for managing chronic conditions and maintaining adherence. Intermittent continuity in care can result in fragmented treatment and poor medication adherence monitoring (Doty et al., 2018). Furthermore, minority patients often live in areas with fewer healthcare resources, including pharmacies, making it more challenging to obtain medications consistently (Committee on Assuring the Health of the Public in the 21st Century, 2003; Doty et al., 2018).
High rates of medication nonadherence among patients of racial and ethnic minorities are driven by a combination of socioeconomic challenges, cultural and linguistic barriers, and systematic inequalities within healthcare systems. Addressing these issues requires targeted interventions that improve access to care, enhance patient-provider communication, and reduce disparities in healthcare.
Compliance Concerns for Patients Residing in Rural Locations
Patients in rural areas exhibit high rates of medication nonadherence due to the complex interplay of factors that encompass geographic, economic, and systematic barriers. The long distances to hospitals commonly located in urban centers impose significant travel burdens on patients residing in rural areas, particularly those managing chronic diseases (Xu et al., 2021). Additionally, the necessity for frequent medication refills and follow-up visits exacerbates these travel difficulties, as patients are required to make regular trips to healthcare facilities that are often far from their homes. These travel difficulties are furthered by limited public transportation options and fewer local pharmacies, making regular visits for prescription refills difficult (Wroth & Pathman, 2006; Xu et al., 2021).
Moreover, insurance coverage restrictions further hinder medication adherence. For instance, reimbursement caps often leave patients unable to afford necessary medication, especially when managing multiple medications for numerous conditions at once (Xu et al., 2021). Even when insured, the stipulation that patients can only obtain limited medication supplies necessitates frequent and costly trips to healthcare facilities, decreasing accessibility. Additionally, lower education levels and income in rural areas contribute to gaps in patient knowledge about their condition and treatment, further amplifying nonadherence (Xu et al., 2021). In the context of chronic conditions, the scarcity of specialized facilities and prevalent stigma within rural communities add to the reluctance of patients to adhere to treatment (Chai et al., 2021). Collectively, these factors create a substantial barrier to consistent medication adherence for patients residing within rural areas.
References
Abbass, I., Revere, L., Mitchell, J., & Appari, A. (2017). Medication Nonadherence: The Role of Cost, Community, and Individual Factors. Health services research, 52(4), 1511–1533. https://doi.org/10.1111/1475-6773.12547.
Alhusein, N., Killick, K., Macaden, L., Smith, A., Stoddart, K., Taylor, A., Kroll, T., & Watson, M. C. (2019). "We're really not ready for this": A qualitative exploration of community pharmacy personnel's perspectives on the pharmaceutical care of older people with sensory impairment. Disability and health journal, 12(2), 242–248. https://doi.org/10.1016/j.dhjo.2018.10.006.
Anderson, N. B., & Bulatao, R. A. (Eds.). (2004). Understanding racial and ethnic differences in health in late life: a research agenda. National Library of Medicine.
Baggett, T. P., O'Connell, J. J., Singer, D. E., & Rigotti, N. A. (2010). The unmet health care needs of homeless adults: a national study. American journal of public health, 100(7), 1326-1333. https://doi.org/10.2105/AJPH.2009.180109.
Barber, N., Parsons, J., Clifford, S., Darracott, R., & Horne, R. (2004). Patients’ problems with new medication for chronic conditions. BMJ Quality & Safety, 13(3), 172-175. https://doi.org/10.1136/qshc.2003.005926.
Beckman, A. G., Parker, M. G., & Thorslund, M. (2005). Can elderly people take their medicine?. Patient education and counseling, 59(2), 186-191. https://doi.org/10.1016/j.pec.2004.11.005.
Borus, J. S., & Laffel, L. (2010). Adherence challenges in the management of type 1 diabetes in adolescents: prevention and intervention. Current Opinion in Pediatrics, 22(4), 405–411. https://doi.org/10.1097/MOP.0b013e32833a46a7.
Boucquemont, J., Pai, A. L. H., Dharnidharka, V. R., Hebert, D., Furth, S. L., & Foster, B. J. (2019). Gender Differences in Medication Adherence Among Adolescent and Young Adult Kidney Transplant Recipients. Transplantation, 103(4), 798–806. https://doi.org/10.1097/TP.0000000000002359.
Briesacher, B. A., Gurwitz, J. H., & Soumerai, S. B. (2007). Patients at-risk for cost-related medication nonadherence: a review of the literature. Journal of general internal medicine, 22, 864-871. https://doi.org/10.1007/s11606-007-0180-x.
Britten, N., Stevenson, F. A., Barry, C. A., Barber, N., & Bradley, C. P. (2000). Misunderstandings in prescribing decisions in general practice: qualitative study. Bmj, 320(7233), 484-488. https://doi.org/10.1136/bmj.320.7233.484.
Butz, A. M. (2006). Evidence-based practice: what is the evidence for medication adherence in children?. Journal of Pediatric Health Care.
Campbell, N. L., Boustani, M. A., Skopelja, E. N., Gao, S., Unverzagt, F. W., & Murray, M. D. (2012). Medication adherence in older adults with cognitive impairment: a systematic evidence-based review. The American journal of geriatric pharmacotherapy, 10(3), 165-177. https://doi.org/10.1016/j.amjopharm.2012.04.004.
Centers for Disease Control and Prevention. (2022). The U.S. Public Health Service syphilis study at Tuskegee timeline. U.S. Department of Health and Human Services. https://www.cdc.gov/tuskegee/timeline.htm.
Chai, X., Liu, Y., Mao, Z., & Li, S. (2021). Barriers to medication adherence for rural patients with mental disorders in eastern China: a qualitative study. BMC Psychiatry, 21, 1-8. https://doi.org/10.1186/s12888-021-03144-y.
Committee on Assuring the Health of the Public in the 21st Century. (2003). The Future of the Public's Health in the 21st Century. National Academy Press.
DiMatteo, M. R. (2004). Social Support and Patient Adherence to Medical Treatment: A Meta-Analysis. Health Psychology, 23(2), 207–218. https://doi.org/10.1037/0278-6133.23.2.207.
Ding, A., Dixon, S. W., Ferries, E. A., & Shrank, W. H. (2022). The role of integrated medical and prescription drug plans in addressing racial and ethnic disparities in medication adherence. Journal of managed care & specialty pharmacy, 28(3), 379-386. https://doi.org/10.18553/jmcp.2022.28.3.379.
Dong, X., Tsang, C. C. S., Wan, J. Y., Shih, Y. T., Chisholm-Burns, M. A., Dagogo-Jack, S., Cushman, W. C., Hines, L. E., & Wang, J. (2021). Exploring Racial and Ethnic Disparities in Medication Adherence Among Medicare Comprehensive Medication Review Recipients. Exploratory research in clinical and social pharmacy, 3, 100041. https://doi.org/10.1016/j.rcsop.2021.100041.
Doty, M. M., Tikkanen, R., Shah, A., & Schneider, E. C. (2020). Primary Care Physicians’ Role In Coordinating Medical And Health-Related Social Needs In Eleven Countries: Results from a 2019 survey of primary care physicians in eleven high-income countries about their ability to coordinate patients’ medical care and with social service providers. Health Affairs, 39(1), 115-123. https://doi.org/10.1377/hlthaff.2019.01088.
El-Rachidi, S., LaRochelle, J. M., & Morgan, J. A. (2017). Pharmacists and Pediatric Medication Adherence: Bridging the Gap. Hospital pharmacy, 52(2), 124–131. https://doi.org/10.1310/hpj5202-124/.
Fernandez, S. B., Lopez, C., Ibarra, C., Sheehan, D. M., Ladner, R. A., & Trepka, M. J. (2022). Examining Barriers to Medication Adherence and Retention in Care among Women Living with HIV in the Face of Homelessness and Unstable Housing. International journal of environmental research and public health, 19(18), 11484. https://doi.org/10.3390/ijerph191811484.
Fiese, B. H., & Everhart, R. S. (2006). Medical adherence and childhood chronic illness: family daily management skills and emotional climate as emerging contributors. Current opinion in pediatrics, 18(5), 551-557. Doi: 10.1097/01.mop.0000245357.68207.9.
Gazmararian, J. A., Williams, M. V., Peel, J., & Baker, D. W. (2003). Health literacy and knowledge of chronic disease. Patient education and counseling, 51(3), 267-275. https://doi.org/10.1016/S0738-3991(02)00239-2.
Gellad, W. F., Grenard, J. L., & Marcum, Z. A. (2011). A systematic review of barriers to medication adherence in the elderly: looking beyond cost and regimen complexity. The American journal of geriatric pharmacotherapy, 9(1), 11-2. https://doi.org/10.1016/j.amjopharm.2011.02.004.
Grenard, J. L., Munjas, B. A., Adams, J. L., Suttorp, M., Maglione, M., McGlynn, E. A., & Gellad, W. F. (2011). Depression and medication adherence in the treatment of chronic diseases in the United States: a meta-analysis. Journal of general internal medicine, 26, 1175-1182. https://doi.org/10.1007/s11606-011-1704-y.
Heisler, M., Langa, K. M., Eby, E. L., Fendrick, A. M., Kabeto, M. U., & Piette, J. D. (2004). The health effects of restricting prescription medication use because of cost. Medical care, 42(7), 626-634. Doi: 10.1097/01.mlr.0000129352.36733.cc.
Holvast, F., Oude Voshaar, R. C., Wouters, H., Hek, K., Schellevis, F., Burger, H., & Verhaak, P. F. (2019). Non-adherence to antidepressants among older patients with depression: a longitudinal cohort study in primary care. Family practice, 36(1), 12-20. https://doi.org/10.1093/fampra/cmy106.
Hosek, S. G., Harper, G. W., & Domanico, R. (2005). Predictors of medication adherence among HIV-infected youth. Psychology, health & medicine, 10(2), 166–179. https://doi.org/10.1080/1354350042000326584.
Kalaman, C. R., Ibrahim, N., Shaker, V., Cham, C. Q., Ho, M. C., Visvalingam, U., Shahabuddin, F. A., Abd Rahman, F. N., A Halim, M. R. T., Kaur, M., Azhar, F. L., Yahya, A. N., Sham, R., Siau, C. S., & Lee, K. W. (2023). Parental Factors Associated with Child or Adolescent Medication Adherence: A Systematic Review. Healthcare (Basel, Switzerland), 11(4), 501. https://doi.org/10.3390/healthcare11040501.
K, J., Rao, M., Yn, S., Thunga, G., N, R., Sudhakar, C., & Sanatombi Devi, E. (2023). Determinants of Medication Non-Adherence Among the Elderly with Co-Existing Hypertension and Type 2 Diabetes Mellitus in Rural Areas of Udupi District in Karnataka, India. Patient preference and adherence, 17, 1641–1656. https://doi.org/10.2147/PPA.S380784.
Kaplan, A., & Price, D. (2020). Treatment Adherence in Adolescents with Asthma. Journal of Asthma and allergy, 13, 39–49. https://doi.org/10.2147/JAA.S233268.
Kressin, N. R., & Petersen, L. A. (2001). Racial differences in the use of invasive cardiovascular procedures: review of the literature and prescription for future research. Annals of internal medicine, 135(5), 352-366. https://www.acpjournals.org/doi/full/10.7326/0003-4819-135-5-200109040-00012.
KyngAs, H. A., Kroll, T., & Duffy, M. E. (2000). Compliance in adolescents with chronic diseases: a review. The Journal of adolescent health : Official publication of the Society for Adolescent Medicine, 26(6), 379–388. https://doi.org/10.1016/s1054-139x(99)00042-7.
Marcum, Z. A., & Gellad, W. F. (2012). Medication adherence to multidrug regimens. Clinics in geriatric medicine, 28(2), 287-300. https://doi.org/10.1016/j.cger.2012.01.008.
Massot Mesquida, M., de la Fuente, J. A., Andrés Lorca, A. M., Arteaga Pillasagua, I., Balboa Blanco, E., Gracia Vidal, S., Pablo Reyes, S., Gómez Iparraguirre, P., Seda Gombau, G., & Torán-Monserrat, P. (2021). Primary Care Records of Chronic-Disease Patient Adherence to Treatment. International journal of environmental research and public health, 18(7), 3710. https://doi.org/10.3390/ijerph18073710.
McQuaid, E. L., & Landier, W. (2018). Cultural issues in medication adherence: disparities and directions. Journal of General Internal Medicine, 33, 200-206. https://doi.org/10.1007/s11606-017-4199-3.
Miller T. A. (2016). Health literacy and adherence to medical treatment in chronic and acute illness: A meta-analysis. Patient education and counseling, 99(7), 1079–1086. https://doi.org/10.1016/j.pec.2016.01.020.
Mosher, H. J., Lund, B. C., Kripalani, S., & Kaboli, P. J. (2012). Association of health literacy with medication knowledge, adherence, and adverse drug events among elderly veterans. Journal of health communication, 17(3), 241-251. https://doi.org/10.1080/10810730.2012.712611.
Murphy, D. A., Wilson, C. M., Durako, S. J., Muenz, L. R., & Belzer, M. (2001). Antiretroviral medication adherence among the REACH HIV-infected adolescent cohort in the USA. AIDS Care, 13(1), 27-40. https://doi.org/10.1080/09540120020018161.
Nelson A. (2002). Unequal treatment: confronting racial and ethnic disparities in health care. Journal of the National Medical Association, 94(8), 666–668.
Ngo-Metzger, Q., Sorkin, D. H., Phillips, R. S., Greenfield, S., Massagli, M. P., Clarridge, B., & Kaplan, S. H. (2007). Providing high-quality care for limited English proficient patients: the importance of language concordance and interpreter use. Journal of general internal medicine, 22, 324-330. https://doi.org/10.1007/s11606-007-0340-z.
Office of AIDS Research. (2024). Adherence to the continuum of care. Clinicalinfo. https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-arv/adherence-continuum-care#:~:text=Cost%2Drelated%20issues%20(e.g.%2C,doses%2C%20refills%2C%20or%20appointments.
Osterberg, L., & Blaschke, T. (2005). Adherence to medication. The New England journal of medicine, 353(5), 487–497. https://doi.org/10.1056/NEJMra050100.
Piette, J. D., Heisler, M., & Wagner, T. H. (2004). Problems paying out-of-pocket medication costs among older adults with diabetes. Diabetes Care, 27(2), 384-391. https://doi.org/10.2337/diacare.27.2.384.
Qato, D. M., Alexander, G. C., Conti, R. M., Johnson, M., Schumm, P., & Lindau, S. T. (2008). Use of prescription and over-the-counter medications and dietary supplements among older adults in the United States. Jama, 300(24), 2867-2878. doi:10.1001/jama.2008.892.
Rohatgi, K. W., Humble, S., McQueen, A., Hunleth, J. M., Chang, S. H., Herrick, C. J., & James, A. S. (2021). Medication Adherence and Characteristics of Patients Who Spend Less on Basic Needs to Afford Medications. Journal of the American Board of Family Medicine : JABFM, 34(3), 561–570. https://doi.org/10.3122/jabfm.2021.03.200361
Salive, M. E. (2013). Multimorbidity in older adults. Epidemiologic reviews, 35(1), 75-83. https://doi.org/10.1093/epirev/mxs009.
Sawyer, S. M., & Aroni, R. A. (2003). Sticky issue of adherence. Journal of Paediatrics and Child Health, 39(1), 2-5. https://doi.org/10.1046/j.1440-1754.2003.00081.x.
Scharff, D. P., Mathews, K. J., Jackson, P., Hoffsuemmer, J., Martin, E., & Edwards, D. (2010). More than Tuskegee: Understanding mistrust about research participation. Journal of Health Care for the Poor and Underserved, 21(3), 879–897. https://doi.org/10.1353/hpu.0.0323.
Shah, H. S., & Bohlen, J. (2023). Implicit bias. StatPeals Publishing. https://www.ncbi.nlm.nih.gov/books/NBK589697/.
Shahin, W., Kennedy, G. A., & Stupans, I. (2021). The association between social support and medication adherence in patients with hypertension: A systematic review. Pharmacy practice, 19(2), 2300. https://doi.org/10.18549/PharmPract.2021.2.2300.
Smith, D., Lovell, J., Weller, C., Kennedy, B., Winbolt, M., Young, C., & Ibrahim, J. (2017). A systematic review of medication non-adherence in persons with dementia or cognitive impairment. PloS one, 12(2), e0170651. https://doi.org/10.1371/journal.pone.0170651.
Syed, S. T., Gerber, B. S., & Sharp, L. K. (2013). Traveling towards disease: transportation barriers to health care access. Journal of Community Health, 38, 976-993. https://doi.org/10.1007/s10900-013-9681-1.
Traylor, A. H., Schmittdiel, J. A., Uratsu, C. S., Mangione, C. M., & Subramanian, U. (2010). Adherence to cardiovascular disease medications: does patient-provider race/ethnicity and language concordance matter?. Journal of general internal medicine, 25, 1172-1177. https://doi.org/10.1007/s11606-010-1424-8.
Wenger, L. M., Rosenthal, M., Sharpe, J. P., & Waite, N. (2016). Confronting inequities: a scoping review of the literature on pharmacist practice and health-related disparities. Research in Social and Administrative Pharmacy, 12(2), 175-217. https://doi.org/10.1016/j.sapharm.2015.05.011.
Wise P. H. (2007). The future pediatrician: the challenge of chronic illness. The Journal of Pediatrics, 151(5 Suppl), S6–S10. https://doi.org/10.1016/j.jpeds.2007.08.013.
World Health Organization. (2003). Failure to take prescribed medicine for chronic diseases is a massive, world-wide problem: Patients fail to receive needed support. Retrieved from https://www.who.int/news/item/01-07-2003-failure-to-take-prescribed-medicine-for-chronic-diseases-is-a-massive-world-wide-problem.
W. H. O. Diet (2003). Chronic Diseases. Geneva: World Health Organization. https://theamericanchiropractor.com/article/2022/11/1/natural-intervention-for-top-chronic-conditions-in-the-united-states.
Xu, J., Zhao, M., Vrosgou, A., Yu, N. C. W., Liu, C., Zhang, H., ... & Bettger, J. P. (2021). Barriers to medication adherence in a rural-urban dual economy: a multi-stakeholder qualitative study. BMC Health Services Research, 21, 1-9. https://doi.org/10.1186/s12913-021-06789-3.