Factors influencing medication adherence in multi-ethnic Asian patients with chronic diseases in Singapore: A qualitative study

Abstract

Background: Poor medication adherence can lead to adverse health outcomes and increased healthcare costs. Although reasons for medication adherence have been widely studied, less is explored about factors affecting medication adherence for patients in non-Western healthcare setting and from Asian cultures. This study aimed to explore cultural perspectives on factors influencing medication adherence among patients with chronic diseases in a multi-ethnic Asian healthcare setting.Methods: We conducted a qualitative study involving in-depth interviews with patients with chronic conditions purposively recruited from a community hospital in Singapore until data saturation was achieved. A total of 25 patients participated in this study. Interviews were transcribed and thematically analyzed. Themes were subsequently mapped into the World Health Organization (WHO) Framework of Medication Adherence.Results: Participants commonly perceived that sides effects (therapy-related dimension), poor understanding of medication (patient-related dimension), limited knowledge of condition (patient-related dimension), forgetfulness (patient-related dimension) and language issues within a multi-ethnic healthcare context (healthcare team and system-related dimension) as the main factors contributing to medication adherence. Importantly, medication adherence was influenced by cultural beliefs such as the notion of modern medicines as harms and fatalistic orientations towards escalation of doses and polypharmacy (patient-related dimension). Participants made various suggestions to foster adherence, including improved patient-physician communication, enhanced care coordination across providers, use of language familiar to patients, patient education and empowerment on the benefits of medication and medication adjustment.Conclusion: A wide range of factors influenced medication adherence, with therapy- and patient-related dimensions more pronounced compared to other dimensions. Findings demonstrated the importance of cultural beliefs that may influence medication adherence. Future efforts to improve medication adherence should consider a person-centered approach to foster more positive health expectations and self-efficacy on medication adherence, supplemented with routine reviews, development of pictograms and cultural competence training for healthcare professionals.

Perspectives on self‐management of individuals living with chronic illnesses: A qualitative study in the Asian context

“…Therefore, it is proposed that a fifth role, that of individuals as “partners in care” be considered in self‐management, to promote collaborative goal‐setting and shared decision‐making (Duprez et al, 2020) in the Asian context. Our findings are consistent with earlier qualitative studies with Asian individuals which suggests that individuals' voices should be included when developing a self‐management plan that considers their cultural practices and preferences to achieve greater adherence (Kumar et al, 2016; Yoon et al, 2023).…”

“…However, there is a need for absolute trust in individuals' capability to partner in their own self‐management‐related decisions. Thus, motivating individuals by including their voices and promoting their ownership as equal partners is needed as suggested in studies from Asia (Kumar et al, 2016; Yoon et al, 2023) and Western countries (e.g., Duprez et al, 2020). The dominant position of HCPs and families of individuals in the current Asian healthcare system might hinder the inclusion of individuals as partners.…”

Insights Into Medication Adherence Among Patients With Chronic Diseases in Jeddah, Saudi Arabia: A Cross-Sectional Study

“…In addition to patient-related factors, healthcare providers should also focus on healthcare system-related factors that affect medication adherence [15][16][17][18]. For example, the availability and affordability of medications, the accessibility of healthcare facilities, and the quality of healthcare services.…”

Exploring barriers and facilitators of primary care physicians towards optimising statin therapy in patients with hyperlipidaemia in the very high-risk group: a qualitative study in Singapore

“…Patients also reported uncertainties about the efficacy of statins, scepticism about overprescribing and mistaken perceptions that statins are indicated only for patients with serious health conditions 10. Additionally, medication adherence is also influenced by cultural beliefs such as the notion of modern medicines as harms and fatalistic orientations towards escalation of doses and polypharmacy 26. Previous studies have shown that patients with negative medication beliefs were more than twice as likely to be non-adherent as patients with positive beliefs, and those with greater concerns regarding medication were significantly less likely to adhere 27 28.…”

“…Importantly, these beliefs about medicines have been shown to be potentially modifiable by patient education and counselling 29. Some strategies that could be employed include using familiar language for patient education, patient empowerment on the benefits of medication optimisation and combining individual risk assessment using computer programmes with a shared decision-making process 26 30…”