Student Theses, Dissertations and Capstones

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD) in Pharmacy

Copyright Statement

All rights reserved. This publication is intended for use solely by faculty, students, and staff of Nova Southeastern University. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, now known or later developed, including but not limited to photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author or the publisher.

Department

College of Pharmacy

First Advisor

Jesús Sánchez

Second Advisor

Silvia E. Rabionet

Third Advisor

Albert Wertheimer

Publication Date / Copyright Date

2020

Publisher

Nova Southeastern University

Abstract

Research into health outcomes of Arab-descent Americans (ADAs) is sparse. ADAs identify as “White,” instead of in a separate census category, contributing to their underrepresentation in the census and the limited amount of research on their health outcomes. In the current U.S. sociopolitical climate, better understandings are needed of the impact of discrimination and Arabic culture, including level of health literacy, on ADAs’ general health and health outcomes. This study employed mixed methods to explore the impact of health literacy level and perceived discrimination on HSU and medication adherence for ADAs in South Florida. In its qualitative phase, a convenience sample of 27 eligible participants was recruited in nonclinical settings using snowball sampling. Study participants were divided into three focus groups led by a moderator. In the quantitative phase, a cross-sectional online self-administrated survey was utilized to collect data on 210 eligible ADA participants. Binary and hierarchical logistic regression analyses were used to identify predisposing, enabling, and needs factors associated with HSU and medication adherence. Qualitative findings provided detailed descriptions of factors impacting ADAs’ health status. Six minor subcategory themes emerged: characteristics of Arabic culture, access to healthcare and insurance, health literacy, perceived discrimination, reactive attitudes toward physical health, and mental health stigma. The quantitative phase revealed that 68.6% of participants reported outpatient visits, 31.4% preventive care utilization, and 25.2% an optimal medication adherence level. The final model of the hierarchical logistic regression indicated that ADAs who had U.S. parents were less likely to have outpatient visits, whereas those having high income, health insurance, adequate health literacy level, or multiple illnesses were more likely. Women, older, and insured participants were more likely to utilize preventive care. Age, beliefs about medicines, lack of health insurance, and physical quality-of-life variables were significant predictors of optimal medication adherence. The synergy resulting from the interplay of both data sources revealed numerous factors influencing HSU and medication adherence, among which perceived discrimination, health literacy, health insurance knowledge, and beliefs about medicines can be alleviated by promoting cultural competency in healthcare and pharmacy practice to overcome health disparities and improve access to high-quality healthcare services for ADAs.

Disciplines

Pharmacy and Pharmaceutical Sciences

Keywords

Medication adherence, Arab-descent Americans, Health outcomes

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