Improving Medication Adherence in the Alabama Black Belt
| Status: | Completed |
|---|---|
| Conditions: | Diabetes |
| Therapuetic Areas: | Endocrinology |
| Healthy: | No |
| Age Range: | 19 - Any |
| Updated: | 3/6/2019 |
| Start Date: | April 2016 |
| End Date: | January 31, 2019 |
Medication adherence is especially critical in regions like rural Alabama, where residents
have among the worst health outcomes in the US. This project was designed in collaboration
with our community member partners and builds on a 5-year partnership of community-engaged
research on diabetes peer coaching interventions and our experience with peer storytelling.
The investigators will test the hypothesis that an intervention designed within the Corbin
and Strauss framework can improve adherence and health outcomes compared to usual care.
have among the worst health outcomes in the US. This project was designed in collaboration
with our community member partners and builds on a 5-year partnership of community-engaged
research on diabetes peer coaching interventions and our experience with peer storytelling.
The investigators will test the hypothesis that an intervention designed within the Corbin
and Strauss framework can improve adherence and health outcomes compared to usual care.
Improving medication adherence is one of the greatest challenges in modern medicine. Despite
decades of research on the topic, as many as half of patients with chronic diseases are not
taking medications as recommended, and costs of nonadherence have been estimated at $290
billion annually. One reason for this persistent finding could be that interventions rarely
acknowledge medications within the larger context of the lived experience of illness. Drawing
on hundreds of patient interviews, Corbin and Strauss showed that chronic illness is a
fundamentally destabilizing influence that forces us to confront the potential limitations of
our "new", chronically ill self. Accepting our illness may be a crucial step in embracing
medication adherence and other self-management behaviors as ways to restore balance following
this disruption. The Corbin and Strauss framework is not often used to develop and test
interventions to improve medication adherence, and this is the central objective of this
proposal.
Medication adherence is especially critical in regions like rural Alabama, where residents
have among the worst health outcomes in the US. Rates of cardiovascular mortality, diabetes
and obesity are very high, but resources are scarce and the area's predominately black
residents have deep-seated mistrust of the healthcare system (the region includes Tuskegee,
site of the infamous syphilis study). This project was designed in collaboration with our
community member partners and builds on a 5-year partnership of community-engaged research on
diabetes peer coaching interventions and our experience with peer storytelling. The
investigators will test the hypothesis that an intervention designed within the Corbin and
Strauss framework can improve adherence and health outcomes compared to usual care. Our Aims
are:
Aim 1: With our community partners, using qualitative research methods, build on already
developed culturally tailored education material to develop the medication adherence
intervention. The intervention will consist of educational DVDs with integrated storytelling
about how community members accepted their disease and overcame barriers to medication
adherence, plus one-on-one telephonic peer coaching. Activities include conducting focus
groups with patients; creating the DVDs and the coaching intervention protocol; training peer
coaches; and pilot testing.
Aim 2: Conduct a randomized controlled trial with 500 individuals with type 2 diabetes and
medication nonadherence. The trial will compare the effect of usual care and the intervention
on medication adherence and physiologic risk factors including A1c, blood pressure and low
density lipoprotein cholesterol (primary outcomes), and quality of life and self-efficacy
(secondary outcomes).
This innovative approach would be a major shift in how patients are helped in under resourced
areas living with chronic diseases commit to taking medications, improving health and
eventually reducing health disparities.
decades of research on the topic, as many as half of patients with chronic diseases are not
taking medications as recommended, and costs of nonadherence have been estimated at $290
billion annually. One reason for this persistent finding could be that interventions rarely
acknowledge medications within the larger context of the lived experience of illness. Drawing
on hundreds of patient interviews, Corbin and Strauss showed that chronic illness is a
fundamentally destabilizing influence that forces us to confront the potential limitations of
our "new", chronically ill self. Accepting our illness may be a crucial step in embracing
medication adherence and other self-management behaviors as ways to restore balance following
this disruption. The Corbin and Strauss framework is not often used to develop and test
interventions to improve medication adherence, and this is the central objective of this
proposal.
Medication adherence is especially critical in regions like rural Alabama, where residents
have among the worst health outcomes in the US. Rates of cardiovascular mortality, diabetes
and obesity are very high, but resources are scarce and the area's predominately black
residents have deep-seated mistrust of the healthcare system (the region includes Tuskegee,
site of the infamous syphilis study). This project was designed in collaboration with our
community member partners and builds on a 5-year partnership of community-engaged research on
diabetes peer coaching interventions and our experience with peer storytelling. The
investigators will test the hypothesis that an intervention designed within the Corbin and
Strauss framework can improve adherence and health outcomes compared to usual care. Our Aims
are:
Aim 1: With our community partners, using qualitative research methods, build on already
developed culturally tailored education material to develop the medication adherence
intervention. The intervention will consist of educational DVDs with integrated storytelling
about how community members accepted their disease and overcame barriers to medication
adherence, plus one-on-one telephonic peer coaching. Activities include conducting focus
groups with patients; creating the DVDs and the coaching intervention protocol; training peer
coaches; and pilot testing.
Aim 2: Conduct a randomized controlled trial with 500 individuals with type 2 diabetes and
medication nonadherence. The trial will compare the effect of usual care and the intervention
on medication adherence and physiologic risk factors including A1c, blood pressure and low
density lipoprotein cholesterol (primary outcomes), and quality of life and self-efficacy
(secondary outcomes).
This innovative approach would be a major shift in how patients are helped in under resourced
areas living with chronic diseases commit to taking medications, improving health and
eventually reducing health disparities.
Inclusion Criteria:
- adults
- type 2 diabetes
- taking medications for diabetes
- medication non adherent
Exclusion Criteria:
- nursing home residence
- plans to move away in the next year
- advanced illnesses such as hemodialysis, cancer or dementia
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