“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
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.
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.
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.
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.
KeywordsMarshallese Pharmacy Pharmacist Medication adherence Minority health Pacific Islander Community health worker
The project described was supported by the Translational Research Institute (TRI), grant 1U54TR001629-01A1 through the National Center for Advancing Translational Sciences of the National Institutes of Health (NIH). This pilot study was also funded in part by a grant from the Sturgis Foundation. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or Sturgis Foundation.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study design and procedures were reviewed and approved by the University of Arkansas for Medical Sciences’ Institutional Review Board (IRB #206483).
- 1.Hixson L, Hepler B, Kim M. The Native Hawaiian and Other Pacific Islander population 2010. Washington, DC: United States Census Bureau; 2012.Google Scholar
- 2.Grieco E. The Native Hawaiian and other Pacific Islander population: census 2000 brief. Washington, DC: United States Census Bureau; 2001.Google Scholar
- 3.United States Census Bureau. American community survey demographic and housing estimates: 2012-2016 ACS 5-year estimates, table DP05. 2016. Available from: factfinder.census.gov. Accessed 3 Oct 2018.
- 4.United States Census Bureau. Profile of general demographic characteristics: 2000 Census summary file 1, table DP-1. 2000. Available from: factfinder.census.gov. Accessed 3 Oct 2018.
- 5.Barker H. Bravo for the marshallese: regaining control in a post-nuclear, post-colonial world. Belmont: Cengage Learning; 2012.Google Scholar
- 6.108th United States Congress. Compact of free association amendments act of 2003. December 17 2003, May 25 2014. Available from: http://www.gpo.gov/fdsys/pkg/PLAW-108publ188/html/PLAW-108publ188.htm. Accessed 3 Oct 2018.
- 8.Asian and Pacific Islander American Health Forum. Medicaid restoration for compact of free association migrants. 2014. April 28 2014. Available from: http://www.apiahf.org/policy-and-advocacy/policy-priorities/health-care-access/medicaid-restoration-compact-free-associati. Accessed 3 Oct 2018.
- 9.United States Court of Appeals for the Ninth Circuit. Appeal from the United States District court for the district of Hawai'i Korab V. Fink. San Francisco, CA; 2014.Google Scholar
- 12.Stewart D, et al. Medication-taking beliefs and diabetes in American Samoa: a qualitative inquiry. Transl Behav Med. 2013;30–8.Google Scholar
- 15.McElfish PA, et al. Engagement practices that join scientific methods with community wisdom: designing a patient-centered, randomized control trial with a Pacific islander community. Nurs Inq. 2016.Google Scholar
- 19.Sandelowski M. What's in a name? Qualitative description revisited. Res Nurs Health. 2010;33(1):77–84.Google Scholar
- 21.Hu D, et al. Issues affecting medication use among Asian Americans, native Hawaiians, and Pacific islanders: a qualitative study. Calif J Health Promot. 2016;14(2):45–55.Google Scholar
- 22.McElfish PA, Chughtai A, Low LK, Garner R, Purvis RS. Just doing the best we can': health care providers' perceptions of barriers to providing care to Marshallese patients in Arkansas. Ethn Health. 2018;1–14.Google Scholar
- 28.Arkansas State Board of Pharmacy. Pharmacy lawbook: rules and regulations. 2018. Available from: https://www.pharmacyboard.arkansas.gov/pharmacy-lawbook. Accessed 3 Oct 2018.