Abstract
- Purpose Personal perceptions and beliefs are one of the least studied patient factors influencing medication adherence. This study explored adherence experiences of rural African Americans with type 2-diabetes in rural southeastern North Carolina. Methods- Social-ecological theory guided a mixed methods approach. The Morisky Medication Adherence Scale (MMAS) assessed adherence. Clinical variables, (HgA1c, fasting glucose levels, current medications) were obtained from medical records. Pearson’s correlation coefficients examined associations between demographics, clnical variables, and MMAS scores. Narrative data obtained from open-ended questions was analyzed through content analysis. Results The study enrolled 45 rural residents with longstanding type 2 diabetes (11yrs., 31% on insulin). The majority of MMAS scores (63%) reflected low adherence (<6); 30% averaged moderate adherence (6 to <8). Males had poor metabolic control (HgA1c 9.0); female glycemic control was moderately good (7.2). Adherence was associated with having health insurance (r = .594, p = .001) and working for pay (r = .440, p = .05). Participants frequently underused medications without consulting a provider; financial limitations served as a major barrier. Perceptions that diabetes only occurs when “sugar is high” are inconsistent with a chronic disease model. Conclusions- High levels of non-adherence remain a major challenge for nursing care providers in economically distress rural counties. Continued investment in adherence education programs is essential for eliminating health disparities.