Factors related to medication adherence among people experiencing homelessness

Medication adherence among people experiencing homelessness (PEH) is consistently low. There is limited research investigating the factors related to adherence in PEH.

To describe and examine the relationship between traditional and vulnerable predisposing, enabling, and need (PEN) factors and medication adherence among PEH.

A cross-sectional survey was conducted at two homeless services agencies in central Texas, from June to August 2024. PEH who were at least 18 years old, took at least one oral prescription for a chronic condition, used the healthcare system in the past six months, and communicated in English were eligible. The dependent variable, medication adherence, was measured using the nine-item Hill-Bone Medication Adherence Scale (1 = all of the time to 4 = none of the time), range 9 - 36; higher scores indicated higher adherence. The independent variables were the traditional and vulnerable PEN factors. Data analysis included descriptive, bivariate, and linear regression analyses.

Participants (n = 150) were 49.0 (± 10.8) years old and were homeless for 5.0 (± 6.0) years. Most were male (72.0%), half (50.0%) were White, and a quarter (25.3%) were Hispanic. The mean adherence score was 29.6 ± 4.4/36, where 4.4 represents the standard deviation (SD). Substance use, psychological distress, affordability of medications, access to transportation, access to medication storage, competing needs/priorities, and number of medications were related to medication adherence (p < 0.05) in the bivariate analyses. After adjusting for independent variables, psychological distress (p = 0.0025) and medication affordability (p = 0.0055) were associated with medication adherence.

Healthcare professionals can consider tailoring medication adherence counseling to focus on strategies to mitigate psychological distress and medication affordability challenges.