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Improving medication adherence in the Alabama Black Belt
Investigator (PI): Safford, Monika M
Performing Organization (PO): (Current): Cornell University, Weill Cornell Medical College, Department of Medicine, Division of General Internal Medicine / (212) 746-3443
(Past): University of Alabama at Birmingham, School of Medicine, Department of Medicine, Division of Preventive Medicine / (205) 934-3773
Supporting Agency (SA): Patient-Centered Outcomes Research Institute (PCORI)
Initial Year: 2016
Final Year: 2020
Record Source/Award ID: PCORI/AD-1306-03565-IC ; PCORI/AD-1306-03565
Funding: Total Award Amount: $2,126,513
Award Type: Contract
Award Information: PCORI: More information and project results (when completed)
Abstract: 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 health care 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 five-year partnership of community-engaged research on diabetes peer coaching interventions and our experience with peer storytelling. We 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 as follows. Aim 1 is, with our community partners, using qualitative research methods, to 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 is to 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 we help patients in under resourced areas living with chronic diseases commit to taking medications, improving health, and eventually reducing health disparities.
MeSH Terms:
  • Alabama
  • Blood Pressure
  • Cholesterol, LDL /blood
  • Community-Institutional Relations
  • Diabetes Mellitus, Type 2 /drug therapy
  • Hemoglobins /chemistry
  • Humans
  • * Medication Adherence
  • Outcome Assessment, Health Care
  • Peer Group
  • Program Development
  • Quality of Life
  • Randomized Controlled Trials as Topic
  • Rural Population
  • Self Care
  • Telemedicine
Country: United States || United States
State: New York || Alabama
Zip Code: 10021 / 35205
UI: 20143401
CTgovId: NCT02274844
Project Status: Ongoing
Record History: ('2019: Project extended to 2019 ',) ('2018: Project extended to 2018',) ('2017: PO and PI email address changed',) ('Project initial year changed from 2014 to 2016 per PCORI, institutional change, and project extended to 2020, 2/17/2020',)