Methods: This exploratory study collected qualitative information via focus groups from African American medically underserved women diagnosed with breast cancer in an urban city in the South. Participants were recruited from a breast cancer organization that provides supportive services to underserved African American women with breast cancer. Two focus groups (n=24) were comprised of volunteers who met the criteria of being diagnosed with breast cancer, over 18 years of age, and having completed chemotherapy and radiation at least one year prior to the study. Sessions were audio-taped and transcribed for later analysis. The transcripts were analyzed using thematic analysis methods to identify themes and salient issues. Two researchers independently coded and obtain consensus with analysis.
Results: The results yielded four salient themes for this sample of women regarding health literacy and medication adherence: inequality of access to health information, acquisition of medication information, medication usage and adherence, and barriers to access to medications. Frustration over medication coverage was paramount. Women with inadequate or no health insurance struggled with how to pay for medications. A lack of uniformity in access to medication information was echoed across the current sample. Women voiced concern that insurance dictated the types of medications given and where medications could be obtained. Women reported taking numerous medications for comorbid diseases, which impacted their ability to fully understand all the side effects and complications. Participants voiced how important the medical team was during treatment, but noted how difficult support was following the completion of acute treatment. Lastly, findings revealed a clear lack of psychosocial or client-specific services provided by social workers or other allied health professionals.
Implications: Social workers have the values, training, and skills which make them naturally suited to assume a leading role in the meeting the complex needs of underserved populations and advocating for equity in the provision of healthcare. Within a collaborative care structure is the opportunity for social workers to collaborate on the education of proper medication usage, screening for health literacy access to resources, and identification of barriers to proper medication use. It is important for social workers to be aware of patterns of medication adherence, and it is equally important for other health professionals to be aware of the health literacy of patients. The collaborative framework and a team approach to health is the best fit for achieving this outcome.
