Date of Award


Document Type

Open Access Dissertation


College of Social Work


Social Work

First Advisor

Teri Browne


This dissertation explored the racial medication adherence disparity in end-stage renal disease (ESRD) patients. Prior research suggests that there are poor rates of medication adherence in the African American ESRD population. However, the reasons for this racial inequity are not understood. This dissertation explored the impact of everyday racism in the healthcare system in general and dialysis centers in particular on medication adherence. To gain an understanding of the possible contribution of everyday racism to medication nonadherence, Critical Race Theory (CRT) was used as the theoretical foundation of the study.

A total of 46 African American ESRD patients participated in the study. Twenty seven patients participated in semi-structured, in-depth interviews. Some participants did explicate that they experienced everyday racism in the healthcare system and such experiences impacted their medication adherence. Additionally, all 46 participants completed a survey regarding self-reported medication adherence and everyday racism in the healthcare setting. There was a statistically significant negative relationship between the two constructs. The results of the Pearson’s correlation showed a significant negative relationship (r = -.477, p < .01) between medication adherence and everyday racism in the healthcare system.

This study has several limitations. A convenience sample was used for both the qualitative and quantitative portions. Additionally, the quantitative study used a nonexperimental cross-sectional design with a small sample. However, this is the first study to ever examine the impact of everyday racism on medication adherence within the African American ESRD population. Furthermore, these results both qualitatively and quantitatively suggest that everyday racism did impact the medication adherence of the participants. Thus further study is needed to explore this phenomenon since medication nonadherence in the ESRD population results in increased hospitalizations, morbidity, and mortality.

Further study could result in new information that could be used to generate novel interventions to address everyday racism in the healthcare system. Social workers are uniquely qualified given their educational training which focuses on cultural competency and their ethical obligation to address social injustice. Additionally, every dialysis patient has a social worker to help them achieve positive health outcomes. Thus, social workers are equipped to work with African American ESRD patients, healthcare providers, and dialysis clinicians to design and implement possible future interventions to achieve medication adherence racial parity within the ESRD population.


© 2017, Tamara Estes Savage

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