"You Want to Give the Best Care Possible, and You Know When They Leave Your Pharmacy, You Didn't Give the Best Care Possible Most of the Time": Pharmacist- and Community Health Worker-Identified Barriers and Facilitators to Medication Adherence in Marshallese Patients.

BACKGROUND: The Marshallese experience high rates of chronic diseases including hypertension and diabetes. Medication adherence is crucial to successful disease management, and healthcare providers play a crucial role in assisting their patients with medication adherence. METHODS: A qualitative study design was used with individual interviews and focus groups with pharmacists and community health workers (CHWs) serving the Marshallese community in Northwest Arkansas. Participants were asked about their experiences with and perceptions of barriers and facilitators to medication adherence among Marshallese adults in Northwest Arkansas. RESULTS: Eight pharmacists and nine CHWs were interviewed. Five themes emerged regarding barriers to medication adherence: (1) financial, (2) transportation, (3) language, (4) health literacy and understanding of Western medicine, and (5) mistrust. Four themes emerged regarding facilitators to medication adherence: (1) in-depth patient education strategies, (2) efforts to address the language barrier, (3) family engagement, and (4) public transportation and prescription home delivery. DISCUSSION: Pharmacists and CHWs identified the same barriers to medication adherence, which are consistent with those documented in previous studies. Pharmacists also reported distress over their inability to confirm Marshallese patient understanding in relation to the use of prescribed medications.

Rate of positive depression screenings among Marshallese patients with diabetes in Northwest Arkansas.

INTRODUCTION: The lifetime risk of developing depression is 16.6%, however the risk is 2-fold in patients with diabetes. The rate of diabetes is much higher for the Marshallese than the general US population, with a prevalence ranging from 25% to 50%, however the prevalence of depression is not well defined among this minority group. The primary objective of this study was to obtain the rate of positive depression screenings, using the Patient Health Questionnaire-2 (PHQ-2), among adult Marshallese patients with diabetes. METHODS: A retrospective chart review was performed for Marshallese adults receiving care in a student-led clinic in Northwest Arkansas. Marshallese adults with a documented PHQ-2 score and a diagnosis of type 1 or 2 diabetes, as outlined by the American Diabetes Association, were included. Demographic information was obtained from the medical records. The data were analyzed using descriptive statistics. RESULTS: The study included 96 patients. Ten patients scored a 3 or higher on the PHQ-2, indicating a positive screen. Of these, scores ranged from 3 to 6, with the majority of patients scoring 4 (N = 6). The average hemoglobin A1C for patients with a positive PHQ-2 score was 10.5%. DISCUSSION: This project identified a rate of 10.4% of patients with a positive PHQ-2 from the study sample. This finding is similar to the prevalence of depression for the general US population, however it is lower than rates cited in the literature for patients diagnosed with diabetes. Future studies should use Native Marshallese community health workers and focus groups to develop a multistep approach to obtain a culturally appropriate, translated tool with high sensitivity for patient response.

Identifying and Understanding Barriers and Facilitators to Medication Adherence Among Marshallese Adults in Arkansas.

Background: Significant health disparities are present in Marshallese adults residing in the United States, most notably a high incidence of type 2 diabetes and other chronic conditions. There is limited research on medication adherence in the Marshallese population. Objective: This study explored perceptions of and experiences with medication adherence among Marshallese adults residing in Arkansas, with the aim of identifying and better understanding barriers and facilitators to medication adherence. Methods: Eligible participants were Marshallese adults taking at least one medication for a chronic health condition. Each participant completed a brief survey and semistructured interview conducted in Marshallese by a bilingual Marshallese staff member. Interviews were recorded, transcribed, and translated from Marshallese to English. Qualitative data were coded for a priori and emergent themes. Results: A total of 40 participants were included in the study. The most common contributing factor for nonadherence was forgetting to take medication (82%). A majority of participants (70%) reported difficulty paying for medicine, 45% reported at least one form of cost-related nonadherence, and 40% engaged in more than one cost-related nonadherence practice. Family support and medication pill boxes were identified as facilitators for medication adherence. The majority of the participants (76.9%) stated that they understood the role of a pharmacist. Participants consistently desired more education on their medications from pharmacy providers. Conclusion: This is the first study to explore barriers and facilitators to medication adherence among Marshallese patients. The findings can be used to develop methods to improve medication adherence among Marshallese.