Understanding ethno-cultural differences in cardiac medication adherence behavior: a Canadian study

Abstract

BackgroundThere are ethno-cultural differences in cardiac patients’ adherence to medications. It is unclear why this occurs. We thus aimed to generate an in-depth understanding about the decision-making process and potential ethno-cultural differences, of white, Chinese, and south Asian cardiac patients when making the decision to adhere to a medication regimen.MethodsA hierarchical descriptive decision-model was generated based on previous qualitative work, pilot tested, and revised to be more parsimonious. The final model was examined using a novel group of 286 cardiac patients, using their self-reported adherence as the reference. Thereafter, each node was examined to identify decision-making constructs that might be more applicable to white, Chinese or south Asian groups.ResultsNon-adherent south Asians were most likely to identify a lack of receipt of detailed medication information, and less confidence and trust in the health care system and health care professionals. Both Chinese and south Asian participants were less likely to be adherent when they had doubts about western medicine (eg, the effects and safety of the medication). Being able to afford the cost of medications was associated with increased adherence. Being away from home reduced the likelihood of adherence in each group. The overall model had 67.1% concordance with the participants’ initial self-reported adherence, largely due to participants’ overreporting adherence.ConclusionThese identified elements of the decision-making process are generally not considered in traditionally used medication adherence questionnaires. Importantly these elements are modifiable and ought to be the focus of both interventions and measurement of medication adherence.

Cardiovascular disease recurrence and long-term mortality in a tri-ethnic British cohort

“…In one study, South Asians were more likely than their white counterparts to receive secondary preventative drugs at discharge following a coronary event 14 ; however, in another study the adherence to secondary preventative drugs among South Asians following cardiovascular disease was poor compared with other ethnic groups. 15 …”

“…In one study, South Asians were more likely than their white counterparts to receive secondary preventative drugs at discharge following a coronary event 14 ; however, in another study the adherence to secondary preventative drugs among South Asians following cardiovascular disease was poor compared with other ethnic groups. 15 Despite adjusting for various risk factors, reports from the SABRE cohort and a subsequent meta-analysis have found a higher risk of first coronary artery disease in South Asians compared with white subjects (HR 1.35, 95% CI 1.30 to 1.40). 14 16 In our study, the higher risk of cardiovascular disease recurrence in South Asians compared with Europeans was eliminated after accounting for baseline cardiovascular risk factors.…”

<p>Development of a Culturally Tailored Motivational Interviewing-Based Intervention to Improve Medication Adherence in South Asian Patients</p>

“…28 We interrogated previously collected qualitative interviews (n=64), focus groups (n=18 participants) and responses to open-ended survey questions (n=900) from SA cardiac patients to identify potential motivators and detractors of medication adherence. 13,34 These motivators and detractors are listed in Table 1.…”

“…[9][10][11] SA cardiac patients also have significant challenges with medication adherence. Studies have suggested poor adoption of heart-healthy behaviours such as medication adherence by SAs, 12,13 with 30% of SAs being non-adherent to cardiac medications compared to 15% in the general population. 14 Studies have also identified specific barriers that may contribute to medication non-adherence (eg, medication side-effects, cost, forgetfulness, higher frequency of dosing, language-barriers) in this group, [2][3][4] although these barriers may also apply to the general population.…”

Interventions to Improve Medication Adherence in Ethnically Diverse Patients: A Narrative Systematic Review

“…Issues such as medication side effects, cost, lack of knowledge about medications, lack of trust in Western medicines, and presence of language barriers have been attributed to resulting in reduced medication adherence in some ethnic groups. Furthermore, forgetfulness and higher frequency of dosing contributed to nonadherence (Ens et al, 2014; King-Shier et al, 2018). Previous studies have indicated that cardiovascular disease (CVD) and related diseases (e.g., hypertension, diabetes) are more prevalent in some ethnic groups (e.g., Blacks, South Asians, Hispanics/Latinos; Gujral et al, 2013; Holmes et al, 2012; Lai et al, 2011; Lauffenburger et al, 2014; Lewey et al, 2013; Shah & Kanaya, 2014; Sorlie et al, 2014; Whelton et al, 2016; Yoon et al, 2015; Zhang & Baik, 2014; Zhang et al, 2012).…”