Differences in Attitudes Toward Immunosuppressant Therapy in a Multi-ethnic Sample of Kidney Transplant Recipients

Abstract

Barriers for renal transplant patients to immunosuppressant medication adherence are poorly understood, despite the high rate and toll of non-adherence. We sought to assess factors that contribute to barriers to immunosuppressive medication adherence in an ethnically diverse sample of 312 renal transplant patients recruited from three transplant centers across New York City. Transplant patients who were at least 6 months post-transplant completed questionnaires while waiting for their medical appointment. Ethnic differences were observed on barriers to immunosuppressant adherence. Black and Hispanic participants reported significantly more barriers to adherence compared to Caucasian participants. Differences in perception about the potential harm and necessity of immunosuppressant medications also were present. Using hierarchical multiple regression, age and income were significant predictors of reported barriers to adherence, even while controlling for ethnicity. The most robust predictor of reported barriers was the perception of the medication cost-benefit differential, i.e., the balance between concerns about immunosuppressant medications and their perceived helpfulness (B = - 0.5, p < .001), indicating that varying beliefs about the medication's necessity and utility rather than ethnicity explain the differences in barriers to medication adherence. Future interventions targeting non-adherence should aim to reduce the barriers to adherence by addressing perceived risks and benefits of taking immunosuppressant medication.

<p>Prevalence and Risk Factors of Immunosuppressant Nonadherence in Heart Transplant Recipients: A Single-Center Cross-Sectional Study</p>

“…However, other studies of kidney recipients found adherence was not associated with concerns about immunosuppressants (as measured by the BMQ) 6,26. One possible explanation for the discrepancy is that recipients had different perceptions about immunosuppressants 34. Nonadherent recipients in the present study may have had more concerns about the potential for adverse effects of immunosuppressants compared with adherent recipients.…”

Reliability and Validity of the Japanese Version of the Basel Assessment of Adherence to Immunosuppressive Medications Scale in Kidney Transplant Recipients

“…Studies conducted in Juiz de Fora, Brazil, and Pittsburgh, United States, reported that higher income was associated with MNA, whereas a study conducted in New York, United States, reported that lower income was associated with MNA. 33 , 47 , 48 In the United States, 70% of KTRs reported serious problems with paying for their medications, and 68% of KTRs reported deaths or graft losses as a result of cost-related MNA. 49 By contrast, in Japan, patients have free access to any healthcare provider, from small clinics to large hospitals with the latest facilities, and the self-pay burden of KTRs is minimized to only 0 to 20 000 yen according to income level by the country’s Medical Payment for Services and Supports for Persons with Disabilities.…”

Patient-related factors associated with medication adherence behavior in patients with end-stage renal disease

“…In terms of ethnicity, non-Caucasian's adherence type was most likely to be intentional nonadherence (i.e., I refused to take my medication) because they have greater concerns about the effectiveness of the medication[ 39 ]. A similar study by Constantiner et al .,[ 55 ] found that Blacks and Hispanics (non-Caucasians) reported significantly more barriers to consuming immunosuppressant medication than Caucasians. However, there were no apparent differences in controllable barriers (e.g., “I miss a dose of my immunosuppressant medication (s) as I think there may be side effects”) in Constantiner's study.…”