Medication-taking beliefs and diabetes in American Samoa: a qualitative inquiry

Abstract

In American Samoa (AS), nearly 22% of adults have type 2 diabetes. Diabetes is best managed by diet and lifestyle modifications and strict medication adherence. Cultural aspects might affect medication-taking beliefs, and thereby influence medication adherence. This study aims to explore diabetes medication-taking experiences and knowledge and related cultural beliefs in AS adults with diabetes and healthcare providers. Six focus groups were conducted with 39 AS adults with diabetes and individual interviews were performed with 13 diabetes healthcare providers. Data were transcribed and analyzed using NVivo 8 software. Themes pertaining to medication taking and adherence were identified. Patients and providers reported that barriers such as confusion about medications and concern about medication costs negatively influence medication taking, while cultural values and obligations both positively and negatively impact medication adherence. These findings help elucidate the relationship between medication-taking beliefs and culture in AS adults with diabetes and highlight the importance of continued research within this population.

Perceptions and experiences of taking oral medications for the treatment of Type 2 diabetes mellitus: a systematic review and meta‐synthesis of qualitative studies

“… suggested participants needed non‐judgemental guidance on missed doses but felt unable to discuss adherence choices with providers. The acceptance of provider instructions was linked to cultural beliefs in one study, as evidenced by an American Samoan patient's view that, ‘What the doctor tells us is the same as what the Bible tells us, “No to this” and “Yes to this” and “No to that”—it's the same thing.’ .…”

“…Database searches identified 805 unique citations. Seven met the inclusion criteria [16,17,20,[22][23][24][25] and an eighth study [26] was identified from forward searching of included studies. Some studies were excluded at full-text stage that met most of the inclusion criteria but which we judged did not have a primary focus on the experience of taking oral medication (e.g.…”

“…The acceptance of provider instructions was linked to cultural beliefs in one study, as evidenced by an American Samoan patient's view that, 'What the doctor tells us is the same as what the Bible tells us, "No to this" and "Yes to this" and "No to that"-it's the same thing.' [16].…”

“…Active Experimentation. The philosophy of 'obey the doctor and you will live longer' [16] was at odds with actual adherence behaviour. Across studies, authors characterized full adherence to medications rare, with the timing of dose particularly likely to be modified [20,22,24,26].…”

“…A potential contradiction to the actively experimenting patient concept came from the discussion of forgetting or lack of knowledge as a major cause of non-adherence, with broken routines a frequently described cause of forgetting [20,22,23,26]; however, strategies used by patients to improve adherence, including developing routines and the use of prompts and reminders [20,23], suggested that the impact of forgetting on adherence could be minimized when patients were truly motivated. This issue was openly [16,22,25,26] Dislike of multiple medications [20,[23][24][25][26] The passive patient as active experimenter…”