Social determinants of health influential to medication adherence in Hispanic women with cardiovascular disease

ABSTRACT AMY REID SOCIAL DETERMINANTS OF HEALTH INFLUENTIAL TO MEDICATION ADHERENCE IN HISPANIC WOMEN WITH CARDIOVASCULAR DISEASE The purpose of this study was to investigate the relationship between social determinants of health (socioeconomic-related, patient-related, treatment-related, condition-related, and health system-related factors) and medication adherence in Hispanic women with cardiovascular disease (CVD). The World Health Organization (WHO) Dimensions of Adherence Model postulates that medication adherence is influenced by factors in those five dimensions. A predictive correlational design was used to collect data on the dimensions in this framework. Medication adherence was measured using the Medication Adherence Report Scale (MARS-5). Patient-provider communication was evaluated using the Patient-Centered Communication for Cancer Care (PCC-Ca), and the Short Acculturation Scale for Hispanics (SASH) was used to measure acculturation. The data was analyzed using descriptive statistics, hierarchical linear regression, and one-way ANOVA. The first regression model included patient-provider communication and acculturation as predictors. Step 1 of the regression was significant, F (2,80 = 7.09, p = .001) and explained 15% of variance in medication adherence. Only patient-provider communication contributed significantly to the model (β = .385, p = <.001). After entry of the demographic variables in Step 2, the model was found to be significant, F (11,71) = 4.42, p = <.001) and that the total variance explained by the model was 40%. Patient/provider communication (β = .329, p =.004) and retired employment status (β =.422, p=>001) were found to contribute significantly to the model. There was no significant difference in medication adherence between first, second, and third generation groups (F (2,81) = .418, p = .659). Tukey’s HSD Test for multiple comparisons found that the mean value for medication adherence was not significantly different between first, second, and third generation groups. Assessment of social determinants of health as they relate to medication adherence is essential in the management of CVD. Assessment of the influence of social determinants of health on medication adherence is essential in the management of CVD. Nurses can play a valuable role in promoting adherence by collaborating with other members of the health care team and community partners to assess social determinants of health and develop strategies and programs to promote adherence behaviors. More research is needed to understand the causality of medication non-adherence in this, and other populations of patients diagnosed with chronic disease. Keywords: medication adherence, social determinants of health, cardiovascular disease Hispanic women