ASPO Abstracts
Testing a new measure of medication cost-coping strategies among underserved adults
Category: Cancer Health Disparities
Conference Year: 2019
Abstract Body:
PURPOSE: To evaluate a new multi-item measure of medication cost-coping with a sample of low-income patients with at least one chronic condition. METHOD: Five items using the same response format (1=Never, 2=Rarely, 3=Sometimes, 4=Often, 5=Always) were asked of all participants (N=270): How often… do you delay filing or refilling a prescription because of cost? Did you not fill a new prescription? Did you take smaller doses to make the medicine last longer and reduce cost? Have you skipped a dose to make the medicine last longer and reduce the cost? Did you skip or reduce one medicine so you could afford a different medicine? We conducted Pearson correlations among items and a confirmatory factor analysis using maximum likelihood estimation. Construct validity was examined with bivariate associations between cost-coping and related variables (socioeconomic status, health, and healthcare access).RESULTS: The hypothesized single factor did not fit the data well, despite the high loadings (>.50; p<.001). The final model allowed a correlated error term (r=0.67, p<.001) between the two, highest correlated, items related to delays in or not filling prescriptions. The final model fit the data well; χ2(4)=6.12, p=.19, CFI=.997, RMSEA=.044 (<.001-.110). The internal-consistency reliability was good (alpha = .85). Medication cost coping behavior was associated negatively with age and positively with having any insurance, being unemployed, having talked and feeling comfortable talking to providers about cost concerns, and having put off other healthcare visits, dental care, or glasses because of cost concerns. Also, more cost coping was reported among those in poor health. Number of healthcare visits, hospitalizations, or prescriptions was not associated with cost coping.CONCLUSIONS: Medication adherence is important for optimum dosing and treatment effectiveness. However, many patients may engage in well-intentioned behaviors to cope with the costs of medications in the context of other financial priorities and challenges. This measure reflects some of the behaviors voiced by study participants in a concurrent qualitative study, and results support its use in future research.
Keywords: medication adherence, financial strain, health disparity, psychometrics