Not at All Effective: Differences in Views on the Causes of Prescription Non-adherence Between North Korean Defectors and Medical Providers in South Korea

Abstract

By focusing on North Korean defectors' medical experiences in South Korea and their medical providers' experiences treating the defectors, this article considers the differences between the views of these two groups in regard to the causes of prescription non-adherence. The results suggest that (a) whereas the defectors tended to see their symptoms as being physical in nature, the medical providers often ascribed symptoms to psychological/socio-cultural influence; (b) whereas the defectors tended to trust in their ability to self-diagnose and in their belief systems established in North Korea, the medical providers tended not to place trust in these aspects; (c) whereas the defectors tended to view the available medical treatment as inappropriate for them, the medical providers often noted the presence of tolerant bacterial strains as causes of treatment failure; and (d) whereas the defectors felt that the treatment they received was slow and ineffective and attributed this to capitalism, the medical providers felt that the defectors failed to understand the concept of staged treatments. Based on the findings, some solutions are suggested to address the complex issue of North Korean defectors' prescription non-adherence in terms of subjective/objective health assessments and patient-centered care. North Korean defectors' established health beliefs/lack of medical knowledge based on their previous medical and cultural experiences gave rise to beliefs and practices associated with medicine that differ significantly from those of the health providers and that have the potential to severely compromise the defectors' health. Therefore, therapy negotiation and appropriate education are suggested as possible solutions, and as an agenda, the notion of civic friendship is addressed. Implications for medical practice, prevention, and intervention are also discussed.

Promoting health behaviors for preventing and controlling noncommunicable disease among North Korean defectors: A systematic review

“…The summary of the characteristics of selected studies is presented in Table 1. It includes 18 quantitative studies [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] and 4 qualitative studies [28][29][30][31]; among the quantitative studies, 5 studies report comparisons with South Korean people [11,[13][14][15]22]. The number of participants in these studies varied from 8 to 932 participants, and 54.6%-100% of them were women.…”

“…Among the 4 qualitative studies, 1 study investigated factors affecting cervical cancer screening [28], 2 studies for treatment adherence [29,30], and 1 study for health-seeking experience [31] (Table 3). NKRs commonly had poor or mistaken knowledge about cervical cancer [28] as well as symptoms associated with psychological/socio-cultural in uence and the concept of staged treatments [29].…”

“…Among the 4 qualitative studies, 1 study investigated factors affecting cervical cancer screening [28], 2 studies for treatment adherence [29,30], and 1 study for health-seeking experience [31] (Table 3). NKRs commonly had poor or mistaken knowledge about cervical cancer [28] as well as symptoms associated with psychological/socio-cultural in uence and the concept of staged treatments [29]. They also had incorrect awareness or mistrust that "cancer is a fatal disease" [28] or "medical environment in South Korea did not offer appropriate treatment for their physical health problems", while they did not know that they were antibiotic-resistant [29].…”

“…NKRs commonly had poor or mistaken knowledge about cervical cancer [28] as well as symptoms associated with psychological/socio-cultural in uence and the concept of staged treatments [29]. They also had incorrect awareness or mistrust that "cancer is a fatal disease" [28] or "medical environment in South Korea did not offer appropriate treatment for their physical health problems", while they did not know that they were antibiotic-resistant [29]. The NK women defectors also reported a low level of awareness of diseases, not to have known about CVD such as hypertension, hypotension, diabetes or any other disease until their rst health check-up after they entered South Korea.…”

“…Selected studies (years) Outcomes Kim et al (2017) [28] Barrier factors individual level: lack of knowledge about cervical cancer and Pap test, cancer worry, unfamiliar with receiving preventive care and concerns about cost community level: negative health outlook such as viewing cancers as fatal diseases Facilitator factors interpersonal level: social support from family, female healthcare providers systemic level: free screening programs Hong(2015) [29] The cause of prescription non-adherence: physical symptoms vs. psychological/socio-cultural influences trust in self-diagnosis and established beliefs vs. suspicion caused by this trust and these beliefs lack of medical treatments appropriate for NKD vs. the presence of tolerant bacterial strains slow and ineffective due to capitalism vs. lack of understanding the concept of staged treatments Choi & Choi (2009) [30] New experience related to treatment: physical abnormalities that were discovered after arriving in South Korea, an unfamiliar treatment environment, the cost and the benefit of the medical treatment, and an increased concern about one's improving health Types of treatment seeking behavior: being compliant with medical care, managing symptoms with self-treatment, and seeking complementary and alternative treatment Chung et al (2018) [31] The 4 categories of health-seeking experience: finding out about my own body, confusion regarding the medical treatment, and enjoying the health care benefits, and protecting my own health Table 3. Results of selected qualitative and review studies Abbreviation: NKD, North Korean defectors…”