Cultural relevance in medication adherence interventions with underrepresented adults: Systematic review and meta-analysis of outcomes

Objective. This meta-analysis systematically compiles intervention research designed to increase medication adherence among underrepresented adults. Method. Comprehensive searching located published and unpublished studies with medication adherence behavior outcomes. Studies were included if samples were adults living in North America who had any of the following backgrounds or identities: African American, Native American, Latino, Latino American, Asian, Asian American, Pacific Islander, Native Alaskan, or Native Hawaiian. Random-effect analyses synthesized data to calculate effect sizes as a standardized mean difference and variability measures. Exploratory moderator analyses examined the association between specific efforts to increase the cultural relevance of medication adherence studies and behavior outcomes. Results. Data were synthesized across 5559 subjects in 55 eligible samples. Interventions significantly improved medication adherence behavior of treatment subjects compared to control subjects (standardized mean difference = 0.211). Primary studies infrequently reported strategies to enhance cultural relevance. Exploratory moderator analyses found no evidence that associated cultural relevance strategies with better medication adherence outcomes. Conclusion. The modest magnitude of improvements in medication adherence behavior documents the need for further research with clear testing of cultural relevance features. (C) 2014 Elsevier Inc. All rights reserved.