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


Patients with chronic diseases, particularly those with multiple chronic conditions, have especially complicated medication regimens. In a population with such a high burden of chronic disease, proper medication adherence is vital to disease management. However, more than half of participants, notably younger ones, reported low adherence to their medication regimens, revealing that nonadherence is prevalent among the study population.

Both beliefs and barriers contributed to participants not taking their medicines as prescribed. More than half of participants reported at least 1 barrier. Most patients said that cost was a barrier; however, this does not pose the greatest limitation on adherence. Although reported less frequently, concerns about side effects play a major role in adherence.

In addition to external barriers to getting their medicines, over half of participants reported having more negative than positive beliefs about medicines. Like barriers, most negative beliefs were significantly associated with lower adherence. The most commonly reported negative belief about medicines was fear of dependence, but this did not have the greatest association with adherence. Though reported less frequently, if patients did not feel that their doctor understood them or if they were taking alternative medications, they were less likely to take medicines as prescribed.

Our separate analyses of barriers and beliefs found that both independently affect adherence. When we examined barriers to getting medicines and strong negative beliefs about medicines in the same predictive model, we found that beliefs—not barriers—have a significant effect on adherence. Even in a population experiencing considerable barriers to medication adherence, negative beliefs are a larger obstacle.


The study was conducted at a single health center, which limits the generalizability of our findings. We developed a Spanish-language survey, but a Spanish-speaking administrator was not available for the full duration of the study, so Spanish-speaking patients (and speakers of other languages) are potentially underrepresented. Barriers to adherence might exist that are not represented here because the survey was not open-ended and we did not ask about all possible barriers. The survey also did not define medicines, so the term may not have been interpreted consistently. Finally, because any self-report measure may have limitations such as recall bias or overestimation,[24] low adherence may actually have been more prevalent among our population than the 54% reported here.