Factors related to medication adherence among people experiencing homelessness

This study used the Behavioral Model for Vulnerable Populations to evaluate the relationships between medication adherence and traditional and vulnerable predisposing, enabling, and need (PEN) factors among people experiencing homelessness (PEH). A cross-sectional survey was administered to 150 PEH at two Austin homeless service agencies. Participants were [at least symbol]18 years old, currently homeless, took [at least symbol]1 oral medication for a chronic condition, and used the healthcare system in the past six-month. The nine-item Hill-Bone Medication Adherence Scale (HBMAS) (1=All the time to 4=None of the time; range 9-36, higher scores = better adherence) measured medication adherence. The other items evaluated the independent variables categorized as traditional and vulnerable predisposing (i.e., age, gender, race, ethnicity, length of homelessness, substance use, alcohol use, psychological distress, and perceived discrimination in the healthcare system), enabling (i.e., insurance type, medication affordability, competing needs/priorities, access to reliable transportation, medication storage area, and provider discrimination because of housing situation), and need (i.e., number of medications and presence of disability) factors. Data analysis included descriptive and bivariate analyses and linear regression. Alpha level was <0.05. On average, participants were 49.0 (±10.8) years old and 5.0 (±6.0) years homeless. Most were male (72.0%), half were white, and 25% were Hispanic. Over half (56.7%) used the medical access program and 44.7% were prescribed [at least symbol]5 medications. About one-third had very easy access to reliable transportation and secure medication storage. Most of them (82.0%) had some type of disability; 67.3% and 56.3% used illegal substances and alcohol, respectively. HBMAS score was 29.6 (±6.4)/36, perceived healthcare system discrimination score was 20.1 (±8.7)/45, psychological distress score was 12.7 (+5.9)/24; and competing needs/priorities was 19.0 (±4.9)/28; higher scores = higher levels of construct being measured. Medication affordability was 7.6 (±3.7)/16; higher scores = poor medication affordability. The regression analysis showed that medication adherence decreases as participants’ psychological distress (higher scores = high levels of distress) and medication affordability rating (high scores = poor affordability) increases (p<0.05), while controlling for respective PEN factors. This information can help homeless healthcare and social services experts tailor PEH’s medication adherence counseling, particularly addressing PEH psychological distress and challenges in medication affordability.

Name thesis:degree_name

Doctor of Philosophy

Discipline thesis:degree_discipline

Pharmaceutical Sciences

Grantor

The University of Texas at Austin

Year dc:date.issued

2025

Author dc:creator

• Baffoe, James O.

Advisor dc:contributor.advisor

• Moczygemba, Leticia R.

Committee members dc:contributor.committeemember

• Avanceña, Anton L.V.
• Brown, Carolyn M.
• Seales, Emily M.

• Psychological distress
• Homelessness
• Medication adherence
• Adherence
• Affordability of medications
• Medication affordability
• People experiencing homelessness

Language dc:language.iso

English

Identifier URI

https://doi.org/10.26153/tsw/61151

OAI identifier oai:identifier

oai:repositories.lib.utexas.edu:2152/133823