Assessing Barriers to Medication Adherence in Underserved Patients With Diabetes in Texas

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The purpose of this study was to assess (1) medication adherence in individuals with diabetes, (2) barriers to adherence, and (3) what factors were related to medication nonadherence.


A self-administered anonymous survey was provided to adults with diabetes (N = 59) who used a grocery store chain pharmacy or a community clinic for the underserved. Participants were recruited by pharmacy staff to complete a 10- to 15-minute survey to assess adherence, access, barriers, medication use, and demographics. Adherence was measured using the 8-item Morisky Medication Adherence Scale (MMAS), which is a reliable and valid self-report adherence instrument. Access (eg, use medications from Mexico, transportation), barriers (eg, cost, language difficulties), medication use (eg, complementary and alternative medicine, prescription medication), and demographics were also measured. The survey was available in English and Spanish. Data collection occurred from December 2010 through February 2011.


Fifty-nine participants completed the survey. Approximately 57% of study participants were male, 85% were Hispanic, and the mean age was 50.4 ± 10.3 years. Over 50% of participants had hypertension or dyslipidemia and were taking 3 or more medications. Participants (52.6%) reported their health status as good or excellent and over one-half (56%) of the participants were nonadherent (score 0–6). The following factors were significantly (P < .05) related to nonadherence: cost, no refills, poor health status, fewer disease states, and any reason.


This study increased awareness of barriers to medication adherence in a predominantly Hispanic underserved patient population. This may lead to more informed recommendations and perhaps address gaps in health disparities.

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