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. 2016 Dec 29;13:E179. doi: 10.5888/pcd13.160236

Table 3. Community Health Worker Responses Regarding Barriers to Medication Adherence and Roles of Community Health Workers in Medication Adherence for Hypertension, United States, 2014.

Dimension and Descriptiona Barrier (% Reporting) Role (% Reporting)
Patient-related — Inadequate knowledge and skills in managing the condition, lack of awareness about the cost and benefits of treatment. These barriers can be overcome through behavioral and motivational interventions, good patient–provider relationships, self-management, and memory aids and reminders. N = 82 N = 84

  • Forgetfulness of taking medicine (76%)

  • Perceived consequences of not taking medicines (71%)

  • Perceived need for treatment (65%)

  • Forgetfulness of getting medicine refilled (61%)

  • Perceived effectiveness of treatment (55%)

  • Other (5%)

  • Counseling about changing health behaviors (eg, diet, physical activity, smoking) (92%)

  • Counseling about the consequences of not taking medicine (88%)

  • Counseling about necessity of treatment (81%)

  • Counseling about the effectiveness of treatment (68%)

  • Memory aids and reminders for taking medicines (63%)

  • Memory aids and reminders for getting medicines refilled (52%)

  • Other (2%)
Condition-related — Include lack of understanding about hypertension and poor perceptions about the disease. These barriers can be overcome through education on the use of medications. N = 92 N = 84

  • Multiple health issues (85%)

  • Confusion if they are taking several medication for different medical conditions (83%)

  • Understanding they need to stay on their blood pressure medicines (79%)

  • Understanding of high risk of high blood pressure (76%)

  • Keeping medicine refilled (65%)

  • Taking correct dose of medicine at the right time (53%)

  • Smoking (53%)

  • Trouble reading medicine bottles (48%)

  • Using or opening medicine bottles or containers (19%)

  • Other (1%)

  • Encouraging healthy lifestyle (95%)

  • Increasing knowledge about seriousness of high blood pressure (90%)

  • Supporting patients with co-morbidities (86%)

  • Encouraging smoking reduction or cessation (83%)

  • Assisting with mental health and well-being issues (66%)

  • Helping with medicine bottles (opening, closing, reading) (47%)

  • Other (1%)
Therapy-related — Primarily include complex treatment regimens and adverse effects of treatment. To reduce these barriers, the World Health Organization recommends simplification of treatment regimens. N = 81 Qualitative responses only

  • Complex treatments (eg, patient takes more than 1 kind of medicine) (83%)

  • Patients failure with taking medicines in the past (68%)

  • Side effects (63%) — nausea, dizziness, fatigue

  • Medicines change frequently (43%)

  • Other (3%)

  • Education (following physician advice, medication education)

  • Follow-up and monitoring

  • Home visits

  • Communicating with health care providers

  • Communicating with pharmacist

  • Reviewing changes in medicines

  • Suggesting reminders, alerts, alarms, pill boxes, and labels
Health system–related and health care team–related — Lack of knowledge and training for health care providers on managing chronic diseases, poor patient–provider relationships, and lack of time by the provider. Training and education about medicines, positive patient–provider relationships, and continuous monitoring of self-management are interventions that reduce the health care barriers. N = 92 N = 92

  • Lack of knowledge by patient about high blood pressure medicine (82%)

  • Inability to get medicine refilled (74%)

  • Poor relationship between patient and doctor or provider (50%)

  • Lack of communication among provider (49%)

  • Access to health care provider (47%)

  • Doctor or provider doesn’t know about patient needs (40%)

  • Poor relationship between patient and pharmacist (37%)

  • Other (7%)

  • Helping patients schedule appointments (85%)

  • Helping patients access a health care provider (84%)

  • Spending time with patients discussing health systems barriers (78%)

  • Assistance with communication among providers (77%)

  • Helping patients get their medicine refills (75%)

  • Assistance with relationship between patient and provider (70%)

  • Educating provider about patient needs (59%)

  • Working with pharmacist (40%)

  • Other (8%)
Social and economic — Illiteracy, unemployment, high cost of medicines, overall poor socioeconomic status. Interventions to address these barriers and improve adherence include family’s ability to help, patient health insurance, an uninterrupted supply of medicines, and sustainable financing for hypertension treatment. N = 80 N = 80

  • Cost of medicines (80%)

  • Transportation (78%)

  • Cost of care and/or insurance (75%)

  • Literacy issues (69%)

  • Social support (58%)

  • Belief that medicines are a financial burden (56%)

  • Other (6%)

  • Helping patients get low-cost medicine (81%)

  • Helping patient’s family understand patient’s disease (77%)

  • Helping patient get health insurance (75%)

  • Helping with transportation needs (71%)

  • Helping to read medicine label (69%)

  • Other (7%)
a

According to the World Health Organization’s 5 dimensions of adherence (23).