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


The majority of the 343 survey participants were between the ages of 41 and 65 years, were black/African American, and had an income <$10,000. Slightly more women were included, and 30% had less formal education than a high school diploma. Where we have comparable health center data, these demographics are reflective of the health center population. The most noted chronic disease was high blood pressure, and nearly a quarter of participants had ≥3 chronic diseases. Nearly half of participants reported taking ≥4 medicines regularly. Among participants, 54% reported low adherence to their medication regimens. Adherence to medicines was significantly lower among younger patients. Just over half of participants reported at least 1 barrier to medicine adherence, and just over half also reported more negative than positive beliefs about medicines (Table 1).

The most reported barrier to medicine adherence was cost, followed by challenges filling prescriptions. Cost, refill access, side effects, forgetting to get refills, transportation, and hospitalization were each significantly associated with low adherence. The most reported negative belief about medicines was fear of dependence, followed by disbelief that medicine is keeping the patient from being very sick. All negative beliefs, except for the disbelief that the patient would be very sick without medicines, were significantly associated with lower medication adherence (Table 2).

When examining barriers to adherence independent of beliefs about medicines (adjusting for race, education, income, number of medicines, and disease burden), patients with ≥1 barrier were approximately 47% less likely to adhere compared with patients reporting no barriers to medication adherence (P < .05). When examining beliefs independent of barriers (adjusting for the same covariates), patients reporting more negative beliefs toward medicine were 53% less likely to adhere to medication regimens than patients reporting more positive beliefs (P < .05). When beliefs and barriers are examined together (adjusting for the same covariates), barriers no longer showed any significant effect on adherence, whereas beliefs remain significant: patients with more negative beliefs about medicine were 49% less likely to adhere than patients with more positive beliefs (Table 3).