What Helps African Americans to be Adherent with Diabetes Medication?

Background: Arizona African-Americans are diagnosed with diabetes (16.2%) at more than twice the rate of non-Hispanic whites (8%.). Moreover, African Americans experience poorer glycemic management, lower rates of diabetes medication adherence, and more diabetes-related complications than non-Hispanic whites. Improving diabetes medication adherence has potential to reduce the prevalence of complications associated with poor glucose control and reduce healthcare costs. While much is known about medication non-adherence, there is a dearth of information from a strengths-based resiliency perspective; therefore, the focus of this study was on resiliency. The guiding research question for this exploratory qualitative study was: What mechanisms are associated with adherence to diabetes medication(s), including insulin, for African-Americans?

Method: This qualitative study viewed medication adherence through the lens of resiliency, focusing on strengths present in this Arizona African American community. Inclusion criteria included self-identified as African American, an adult diagnosed with Type II diabetes, taking insulin, and adherent to diabetes medication(s) as measured by the SMAQ questionnaire. A total of twenty-three people participated in focus groups and individual interviews, which included 13 women and 10 men. Content analysis was conducted to analyze data utilizing MAXQDA software for sorting purposes. Moreover, a community-based participatory research (CBPR) approach, with an orientation of community members as experts, was used to engage the African American community in the research process.

Findings: Salient constructs associated with diabetes medication adherence in all participants were acceptance of diagnosis, understanding the seriousness of diabetes, and negotiation of perceived diabetes-related stigma in the African American community. Many participants were unaware of their family medical history until they shared their diabetes diagnosis with a family member. Moreover, 83% of informants participated in Diabetes Self-management Education (DSME) at least once since diagnosis. Findings included four emerging typologies: 1) Alpha women, 2) Networking women, 3) Warrior men, and 4) Trustee men. Each typology had a unique orientation toward and negotiation of diabetes-related stigma, illness perception, and view of support from healthcare providers and significant others.

Conclusion and Implications: Social workers can be a valuable member of the healthcare team as facilitators of assessment leading to individualized intervention to improve diabetes medication adherence in patients. The emerging typologies are useful in assisting healthcare providers, including social workers, to create positive messages for diabetes medication adherence based upon the strengths present in the African-American community. Understanding the mechanisms that lead to medication adherence has potential to increase medication adherence, which in turn can reduce the rate and severity of complications due to poor glucose management and decrease healthcare costs in this population. Moreover, assisting healthcare teams to understand various pathways that lead to medication adherence may allow for individualized approaches to overcoming barriers to adherence.