title: Cultural relevance in medication adherence interventions with underrepresented adults: systematic review and meta-analysis of outcomes.
abstract: OBJECTIVE
  This meta-analysis systematically compiles intervention research designed to increase medication adherence among underrepresented adults.
  
  
  METHODS
  Comprehensive searching located published and unpublished studies with medication adherence behavior outcomes.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.
  
  
  CONCLUSIONS
  The modest magnitude of improvements in medication adherence behavior documents the need for further research with clear testing of cultural relevance features.
authors.affiliation: Sinclair School of Nursing, University of Missouri, Columbia, MO 65211, USA. Electronic address: conn@missouri.edu.
authors.forename: Vicki S
authors.initials: VS
authors.lastname: Conn
authors.affiliation: Sinclair School of Nursing, University of Missouri, Columbia, MO 65211, USA. Electronic address: enriquezm@missouri.edu.
authors.forename: Maithe
authors.initials: M
authors.lastname: Enriquez
authors.affiliation: Sinclair School of Nursing, University of Missouri, Columbia, MO 65211, USA. Electronic address: ruppart@missouri.edu.
authors.forename: Todd M
authors.initials: TM
authors.lastname: Ruppar
authors.affiliation: Sinclair School of Nursing, University of Missouri, Columbia, MO 65211, USA. Electronic address: chankc@missouri.edu.
authors.forename: Keith C
authors.initials: KC
authors.lastname: Chan
mesh_terms: D000328:Adult; D000368:Aged; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data; D008297:Male; D055118:Medication Adherence / Q000208:ethnology*; D008875:Middle Aged; D008913:Minority Groups / Q000706:statistics & numerical data*; D009656:North America; D055553:Prescription Drugs; D035862:Vulnerable Populations / Q000706:statistics & numerical data*; D016903:Drug Monitoring
chemical_list: D055553:Prescription Drugs
keywords: Medication adherence; Meta-analysis; Minority groups