RxHL: Medication Adherence, Health Literacy and Cultural Health Beliefs in a Massachusetts Community Health Center

The RxHL study investigates medication adherence among people with low health literacy in the wake of cost control measures associated with health care reform. Health literacy is a patient’s ability to understand and act on a doctor's instructions. It plays a pivotal role in management of chronic diseases like diabetes and high cholesterol. The Affordable Care Act will invest billions of dollars in community health centers over the next decade, and will enroll tens of millions of individuals in insurance coverage. Cost control measures such as changes in covered medications and increasing copays, which may profoundly shape patients’ relationships with their medications, will become increasingly common.

Dr. Shaw, co-investigator Jeannie K. Lee and a 13-member multidisciplinary research team are partnering with Caring Health Center in Springfield Massachusetts. The unique constellation of conditions in Massachusetts—of near-universal insurance coverage coupled with stringent cost control measures as the state struggles to balance its budget—serves as a critical bellwether for coming changes facing other states with the implementation of the Affordable Care Act. The diverse population of patients served by Caring Health Center provides an excellent opportunity to explore the effects of these policy changes as they intersect with culturally variable health beliefs to shape medication adherence among urban, minority and low-income patients. The study, with statistical support from the UA Southwest Institute for Research on Women, relies on both ethnographic and quantitative data to explore how medication adherence is influenced by both increasing patient costs and by cultural health beliefs among patients from five ethnic groups (Vietnamese and Russian immigrants, African-American, Hispanic, and white). This research is a follow up to Shaw’s Culture and Health Literacy study, also conducted at CHC and funded by NIH from 2006-2011.

Improved understanding of these complex dynamics will better prepare primary health care providers to improve medication adherence and help reduce stroke risk among patients with hypertension and other chronic conditions. Further, the research will inform the development of subsequent interventions to promote patient safety and improve effectiveness by helping culturally diverse populations with low health literacy improve their adherence to chronic disease medications.