“I did not want to take that medicine”: African-Americans’ reasons for diabetes medication nonadherence and perceived solutions for enhancing adherence

Figures & data

Table 1 African-Americans’ reasons for medication adherence

Themes	Reasons	Sample quotes
Staying alive to fulfill functional roles	Prevention of diabetes complications and hospitalization	See, what made me take my medication, […] about six months ago, I was in the hospital nine days, simply because of not taking stuff I was supposed to take for my diabetes, high blood pressure, high cholesterol, asthma […] that was real stupid. And I was in the hospital. I had to get serious because I couldn’t breathe, my sugars were out of whack. It was just crazy. So that, to me, made me get serious now […] because I don’t want to go through that again. [WOMAN]
	Prevention of death to see family	I just want to be here for my grandkids. I want to be around for my grandkids. That’s why I try to take my medicine. I want to see them grow up to be teenagers. [DBPID_0041]
Belief in health care	Doctor treatment recommendation	There’s all kinds of side effect. I know I get tired when I take some of my meds. I still take it […] Because […] I’m going by what the doctor told me. [DBPID_0041]
	Medication helpfulness	The pills can help you maintain diabetes […] you have to make other life changes along with the pill if you actually want to have some control over diabetes. [DBPID_003] Well, we need them (medications) to survive. [DBPID_0018] I know the medicine has got to be doing something. I know without it, I wouldn’t be here. I’d have been dead. I probably would have had a stroke. I probably would have had a heart attack […] I’d probably be confined in a nursing home somewhere, you know, the whole left side of your body paralyzed, so I don’t take my medicine for granted, because I know that’s the only thing that’s going to keep me alive. [DBPID_0038]

Table 2 African-Americans’ perceived solutions for improving medication adherence

Roles	Themes	Sample quotes
Provider	Educate on the necessity of medicines and the consequences of not taking them	Your doctor and a pharmacist should tell you like every time you go to the pharmacy […] what I think they should do is tell you, even though you’ve been taking this for a while, and it’s not new to you, you still should take this, because it’s going to help you. They don’t say that. some people don’t like to […] take their medication. I believe that the pharmacist should tell you when you pick up your medication, you should take this because it’s going to help you. [DBPID_0024]
	Scare patient on the seriousness of diabetes complications	You sit down and talk to them sternly or whatever, whatever it takes. [DBPID_0034] I don’t know if they scare them more and say […] you’ll live longer […] you got to be serious, take that approach serious. Fear will wake you up. [DBPID_0041]
	Provider should be educated on working with members of the health care team and the African-American community	Talk to pharmacists […] that pharmacist is your friend. The pharmacist, the doctor, the patient, the family of the patient […], because it should be a teamwork. I think once a year a doctor should sit down with a team of, you know […] (AA patients) like us, and talk. If you working in this community, I think it should be mandated for the doctor to come to a community meeting or to meet and find out his community. [DBPID_0017]
Patient	Support groups and buddy systems	You’ve got to have friends, family members […] talk to each other. Because my family is full of diabetes. Everybody’s got diabetes and high blood pressure or something going on. [DBPID_0041] I always say have a buddy system. You make sure you’ve got a person […] we got to first get ourselves together before we can help somebody else and do education, talking, communication. It’s like be an advocate. But you need someone with you. [DBPID_0017]
	Teach self-advocacy	And I think I have to be a true advocate for myself when I go and see the doctor. And I don’t think that’s the same experience that someone that is non-black experiences. [DBPID_001] […] we’ve got to advocate. you’ve got to be proactive […] In our black community now we lost, when we was growing up we talked […] And now in our community, we don’t have that […] if something happened, the community came together […] have a buddy system. You make sure you’ve got a person […] we got to first get ourselves together before we can help somebody else and do education, talking, communication. It’s like be an advocate. But you need someone with you. [DBPID_0017]
	Ask provider questions	And we don’t ask questions after they say that (you are borderline) Just questioning it […] That’s the thing. We dont question […]. [DBPID_004] You got to learn how to ask, what are the side effects to this pill? Because every pill has a side effect, you know. [DBPID_002]
The church	Act as a communication resource	lot of elders in church […] They be sick. And I think we (the church) act like a health check, and have somebody go, and give their medication, someone advocate for them […] (church name) […] they had health checks. The mothers, they come and say Girl, go over there and see about Ms. So-and-So…see if she’s taking her meds […]. I don’t see that now in church. The church I was going to in (city name) […] we had RNs, home nurse staff […] if you got diabetes, you need help, they will link you to a nurse, and a nurse would help you like that, privately […] maybe two times a year they would have some kind of thing for health […] coming in. But I think the church needs to be more consistent. [DBPID_0017]