Exploring medication safety through a social determinants of health and health literacy lens

BACKGROUND: The study addressed an evidence gap in Northern Ireland (NI) on social determinants of health & medication safety. Almost 50% more prescription items are prescribed in the most deprived areas and they suffer a heavier burden of illness & higher mortality rates. Low health literacy is associated with medication adherence & more negative beliefs about medication. The research aimed to discover the social circumstances behind unsafe medication practices and avoidable medication-related harm to inform the implementation of the Transforming Medication Safety in NI plan. METHODS: This exploratory study used a community-based participatory research (CBPR) approach that engaged community members to share their unique perspectives & local knowledge. A community survey & interviews with key stakeholders informed the sample & topic guides for focus groups with people in the community (63 participants) & health & social care staff (25 participants). Data underwent thematic analysis & findings were discussed & interpreted at a Knowledge Exchange Workshop. RESULTS: Many social factors influence medication safety, such as busy lives, prioritising others, social support, work, physical & psychological capabilities, mental health, addiction, income, transport, access to healthcare & social stigma. Health literacy was a key theme; people have varying abilities accessing, understanding, appraising, remembering, & using information about their medication. Health & social care staff can assume people to know & understand how to take their medication correctly. Health literacy was influenced by many sources including friends’ & family's experiences, individual research, health & social care staff, social media, & stories in the media. CONCLUSIONS: The research gathered people's lived experiences on medication use at home. It is evident that the social determinants of health, health literacy and social practices and norms need to be considered in medication safety.