Community pharmacy-based interprofessional care and health literacy: implications for medication beliefs and adherence in an underserved community

Abstract

Background: Social determinants of health and limited health literacy are major contributors to health inequities within underserved communities. Community pharmacies represent accessible healthcare locations where interprofessional collaborative teams can address such challenges. Understanding how health literacy influences medication beliefs and adherence may inform strategies to improve education and patient outcomes. Objective: To compare medication beliefs and medication refill adherence behaviors between underserved residents with adequate versus inadequate health literacy attending interprofessional-led health events in community pharmacies, using a social-ecological perspective. Methods: This cross-sectional study was conducted in partner pharmacies serving underserved communities between May and November 2019. Interprofessional collaborative teams included faculty and students from pharmacy, social work, athletic training, and nursing. Services provided included cardiovascular risk assessments, glucose and blood pressure screenings, medication counseling, and referrals for free physician follow-up visits. Consenting participants completed interviewer-administered questionnaires assessing health literacy, beliefs about medicines, and demographics. Medication refill data for diabetes, hypertension, and cholesterol therapies were collected from pharmacy records, and medication refill adherence was calculated. Differences between participants with adequate versus inadequate health literacy were analyzed using chi-square tests, analysis of variance, and t-tests. Results: A total of 120 participants completed the researcher-administered questionnaire. No significant differences in demographic or clinical variables were observed between the health literacy groups. Medication refill adherence did not significantly differ between adequate and inadequate literacy groups. However, participants with inadequate literacy reported significantly stronger necessity of medication beliefs (p=0.01) and greater concern beliefs about potential adverse effects (p=0.03) than those with adequate health literacy. Overall, forty-percent of participants reported a necessity score associated with medications lower than or equal to their concern score. Conclusion: While health literacy was not directly associated with medication refill adherence, it was strongly linked to beliefs about medications. Patients with inadequate health literacy simultaneously expressed greater belief in the necessity of medications and heightened concerns about adverse effects. These findings underscore the importance of tailoring provider-patient communication to address both necessity and concern beliefs, particularly within underserved populations. Interprofessional teams in community pharmacy settings, guided by a social-ecological perspective, may be well positioned to improve health literacy, support medication counseling, and reduce health disparities.