This document presents a concept map that identifies three pathways by which medication non-compliance can be conceptualized from a social perspective. All three pathways begin with education policy and its impact. One pathway shows how low education quality can lead to low health literacy and difficulty following medication instructions. Another pathway shows how high dropout rates from underfunded schools can result in low-wage jobs without insurance, reducing ability to afford or access medication. A third pathway notes self-efficacy and unwanted side effects can influence the relationship between ability to comply with a medication regimen and actual compliance. The document concludes by outlining interventions that could help address medication non-compliance at various points in the concept map.

1. (2) Education policy
Quality of education
(6) Health literacy
(7) Self efficacy
(1) High school graduation rate
(3) Type of work/wages
(4) Insurance coverage
(5) Affordability of medication
(6) Ability to access doctor/pharmacy
Ability to comply with medication regimen
Medication Compliance
(8) Unwanted side effects
STRUCTURAL DETERMINANTS
INTERMEDIARY DETERMINANTS
Medication non-compliance, or failing to take prescribed
medication consistently or correctly, is an ongoing issue among
patients and can lead to serious health problems if unaddressed.
Often, medical professionals blame the patient for this, seeing it
as a choice the patient has made to not take the medication
correctly. This concept map identifies Three likely pathways by
which medication non-compliance can be conceptualized and
addressed from a social perspective are depicted above, with all
three beginning at the larger structural determinant of Education
policy.
One pathway begins with education policy and runs through a
lack of quality education in public schools. In turn, this leads to
low health literacy which can mean difficulty understanding
instructions for how and when to take medication, leading to a
higher chance that someone will fail to take medication
correctly.

2. Education policy that underfunds schools can also lead to higher
dropout rates. Both dropout rates and low-quality education
leads to low wage employment and these positions typically do
not offer healthcare coverage. Without health insurance, the
ability to afford prescribes medication or to even access a
physician for treatment is reduced. The outcome is an inability
to comply with any medication regime (if in fact one can be
sought and obtained).
The dotted arrow between the ability to comply with medication
regimen and medication compliance shows that self-efficacy
moderates this relationship. That is, higher levels of self-
efficacy will contribute to a stronger relationship between
ability to comply and actual compliance, while low levels of
self-esteem will weaken this relationship. Another moderator
between the ability to comply and actual compliance is
unwanted side effects. If side effects are high—or serious, the
ability to comply will not be a strong predictor of compliance.
If, however, there are no or few side-effects, the relationship
between ability to comply and compliance will be strong.
Throughout this concept map, there are several points at which
interventions can help decrease the amount of medication non-
compliance:
Implementing a work-credit program to help students who
would otherwise drop out of school to make money graduate
with their degree.
Implement a mandatory, state-wide health education curriculum
for public schools that focuses on health literacy.
Implement a ”living wage” level minimum wage.
Protect policy that requires employers to provide part-time
employees with the option of health insurance
Policies that regulate the cost of pharmaceuticals or offer
subsidies for medications for those who are low income.
Provide transportation to free clinics, doctor’s offices, and
pharmacies.

3. Create support networks with physicians, nursing assistants, and
other health providers to reach out to patients to remind and
coach them on compliance.
Provide counseling for new diagnoses on how to recognize and
deal with side effects of new medications (or ask for changes in
medications).
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