Patient Beliefs Have a Greater Impact Than Barriers on Medication Adherence in a Community Health Center

Monica D. Gagnon, MPH; Eve Waltermaurer, PhD; Adam Martin, MPH; Colette Friedenson, MPH; Eric Gayle, MD; Diane L. Hauser, MPA


J Am Board Fam Med. 2017;30(3):331-336. 

In This Article

Abstract and Introduction


Purpose: Nonadherence to medicines contributes to poor health outcomes, especially for patients with complicated medicine regimens. We examined adherence among patients at a family health center and the impact that barriers to getting medicines and negative beliefs about medicines have on adherence.

Methods: A survey was administered incorporating the 8-item Morisky Medication Adherence Scale, questions from the Beliefs about Medicine Questionnaire, and questions about patients' external barriers to getting medicines. Low adherence was examined by any external barrier and by higher negative beliefs, adjusting for patient characteristics.

Results: The convenience sample of 343 participants is demographically representative of the larger population. Among these patients, 54% report low adherence, 51% have at least 1 barrier to adherence, and 52% report more negative than positive beliefs about medicines. When beliefs and barriers are examined together, patients with negative beliefs are 49% less likely to adhere than those with more positive beliefs, whereas barriers show no significant impact on adherence.

Conclusions: Negative beliefs about medicines are as prevalent in this population as external barriers to accessing medicines, but negative beliefs were more significantly associated with adherence than external barriers. Physicians should identify and address patients' negative beliefs about medicines to improve adherence rates.


Nonadherence to medicines, defined as the extent to which a patient does not take medicines as prescribed,[1] is a major contributor to poor health outcomes that often goes undetected. The World Health Organization has estimated the average medication adherence rate to be 50% in developed countries.[2] Nonadherence accounts for nearly 125,000 deaths and over $290 billion in health care costs per year.[3–7] Patients with chronic diseases have particular difficulty adhering because of complicated medication regimens.[8] Chronic diseases are the leading causes of death and disability in the United States, affecting about half of all American adults.[9]

Researchers suggest using a patient-centered approach when treating nonadherence.[10] This may be accomplished by focusing on patients' beliefs about medicines, an important factor affecting adherence.[11–13] Beliefs have been found to be positive predictors of nonadherence for chronic diseases,[14,15] but logistic or external barriers to accessing medicines, while acknowledged as affecting adherence, have not been as systematically studied. Better understanding patients' beliefs about their medicines in the context of external barriers preventing them from accessing medicines is necessary to adequately address nonadherence.

With the goal of improving family medicine providers' understanding of patients' barriers to using and beliefs about medicines, we conducted a study among patients at a health center providing family medicine services to primarily low-income patients in New York City. Our research questions examine adherence rates among the patient population and the impact of barriers and beliefs on adherence.