Running Head: WOMEN WITH TYPE II DIABETES

Effects of Socioeconomic Status on Medication Adherence

in Women with Type II Diabetes
Allie Cronk, Kendall Farley, Kacy Edsall, Jane Ludwig, Sarah Musa
James Madison University

WOMEN WITH TYPE II DIABETES

Introduction
For the topic, focus was placed on patients who have a low socioeconomic status
and reasons why they have a difficult time managing their diabetes. This was then
compared to patients who have a higher socioeconomic status and are able to afford their
medication. The PICO states, Are women with Diabetes Type II of low socioeconomic
status at increased risk for non-adherence with medication regimen compared with
women of high economic status? According to the CDC 29 million people in the US
have diabetes, and 86 million people have pre-diabetes. Among pre-diabetics, 9 out of 10
are unaware of their condition. Non-Hispanic black, Hispanic, and American Indian are
twice as likely to be diagnosed with diabetes as non-Hispanic white adults. Diabetes is an
important topic due to the fact that it affects patients health and can lead to complications
such as: blindness, kidney failure, nerve damage, heart disease, stroke, and loss of toes,
feet, or legs.

Comparison of Articles
Evidence demonstrates that socioeconomic status has a large impact on
medication adherence with poverty being a major contributor. Research indicates that
living at or below the poverty level is a major predictor to whether a patient will have
uncontrolled diabetes due to nonadherence to their medication regimen. Collectively,
geographic location, access to care, health literacy and education level were identified as
the main barriers to adherence as a result of poverty. It was shown that those living in
poverty often lived in high stress environments, far from their health care providers, and
had poor community influences. The cost of medications and health care insurance was

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shown to have the greatest burden on those living in poverty. The ability to read,
understand, and follow directions is associated with a patients education level. Often low
socioeconomic status could be contributed to lack of education. Nonadherence to
medication regimen can lead to poor health outcomes, exacerbations of illness and
comorbidities.

Contrasting Articles
Although the articles contribute to the PICO in someway, there were also some
apparent differences. First, the articles were different in the demographics; there were a
variety of ethnicities, nationalities, education levels, income levels, races, etc. Second,
some articles focused on interventions that could help increase medication adherence.
Whereas, there were other articles that explored patient perceptions on barriers to
medication adherence and compliance. However, because the articles differed, it was
evident through multiple lenses how medication adherence is impacted based on
socioeconomic status.

Limitations
All research studies will have limitations because there are influence the
researcher is unable to control. These limitations may have a dramatic effect on the data
collected. When trying to answer the PICO question, the articles used were those with
which limitations would not be too influencing. One of the first limitations noted was:
most studies included both male and female participants while the PICO question only
focused on females. Another problem was too small of sample sizes in a few articles. For

WOMEN WITH TYPE II DIABETES

example, one article had only five participants, which is not an efficient amount of data
collected for the study to be reliable. Additionally, a few studies only focused on a certain
geographic area, which is limiting when examining women across the nation. For
example, one article focused only on African Americans in Baltimore, another was
limited to one region in California and a few were performed out side the U.S. in Africa
and Israel. All articles were found to have informative and valuable sources of
information, however, these specific limitations kept us from staying true to our specific
PICO question.

Implications for Nursing

Education is an important role of the nurse to help increase patient adherence and
reduce future hospitalizations. Nurses can educate patients on important topics such as
diet, exercise, and medication. When educating, methods such as the teach-back method
are useful, especially when teaching patients about medication administration to insure
full understand. Also, providing patients with information on how to possibly received
financial help from programs such as Medicaid or Medicare could help reduce the
financial barrier of noncompliance. Lastly, using tools such as the Patient-perceived
difficulty of diabetes treatment (PDDT) scale could help health care providers recognize
potential barriers to noncompliance, and focus their treatment plans to avoid those
potential barriers.

Conclusion

WOMEN WITH TYPE II DIABETES

Diabetes is a pervasive problem not only in the United States but also in the entire
world. The ease of managing this chronic disease can vary depending on specific social
determinants. Research was used to answer the question of whether women of lower
incomes were at increased risk for medication non-adherence than women with higher
incomes. Research provided a variety of evidence noting the disparity between
adherences in women with lower incomes versus women with higher incomes.
Information showed several ways in which adherence in these women that are at risk
could be increased. By providing women in low income brackets with a plan for success
in lifestyle modification and on getting proper resources the health disparities for these
women can be decreased. Nurses should use this information into consideration with
patients who are Type 2 Diabetics. Using the knowledge of access in groups with lower
incomes, plans of care for adherence and tight glucose control can be taken for these
women.

WOMEN WITH TYPE II DIABETES

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