Medicine Adherence and Associated Factors in Immigrants and Refugees: A Systematic Review

Abstract

Medicine nonadherence is a major contributing factor to morbidity and mortality. Almost half of the chronically ill patients are nonadherent to their medication. Vulnerable groups like immigrants and refugees are at a higher risk of poor medication adherence. This study aims to determine the rate of medicine adherence and the factors associated with medicine nonadherence in a population of immigrants and refugees. A protocol-led (PROSPERO ID: CRD42021285419) systematic review was conducted by searching PubMed, Medline, Embase, Scopus, CINAHL, and Cochrane Library for studies published between 1st January 2000 and 4th November 2021. PRISMA guidelines were followed. The NIH quality assessment tool and CASP checklist were used to quality assess the papers. Data were searched, screened, and extracted. Extracted data were tabulated for descriptive and narrative analyses. 15 studies were conducted across six countries including participants with various medical conditions. The rate of medicine adherence reported ranged from 10.1% to 74.5%. Higher rates of nonadherence were observed in immigrants and refugees compared to migrant and native groups. Socio-economic factors, including language proficiency, level of education, and financial burden, and patient-related factors involving cultural behaviours and beliefs were common themes for nonadherence among immigrants and refugees. Further research is required to address the effect of nonadherence on clinical outcomes. Studies should focus on using a consistent definition of adherence and the same objective methods to measure rates of adherence to allow for meta-analysis of data and definitive results. Healthcare professionals (HCPs) are recommended to target interventions at improving adherence and reducing modifiable risk factors in immigrants and refugees, thus reducing health disparities among the population.

Impairment of Endogenous Synthesis of Omega-3 DHA Exacerbates T-Cell Inflammatory Responses

“…Our observed modulation of DHA in exacerbated Th1/Th17 responses might also be due to a potential effect on enhancing Tregs. These findings are in line with several recent evidence on the role of omega-3 PUFAs like DHA and EPA in modulating T cell functions in vitro or in vivo [ 35 , 36 , 37 ] as well as following dietary supplementation [ 20 , 38 , 39 , 40 ]. Although we cannot define the mechanism by which DHA deficiency impacts T cell responses in this study, it is plausible that the purported DHA receptors GPR40, GPR120 and PPAR-γ are involved, given that these receptors have recently been associated to Th functions [ 41 , 42 , 43 , 44 ].…”

A qualitative study on diverse experiences of medication safety among foreign-born persons living in Sweden

“…It is well established that economic inequality might lead to poverty and increased health inequalities [ 40 ]. In a systematic review [ 41 ], it is shown that socio-economic factors, including language proficiency, level of education, financial burdens, were common themes for non-adherence to medication, compromising patient safety. These findings might be a result of increasing inequalities.…”

Evaluation of adherence to pharmacological treatments by undocumented migrants with chronic diseases: a 10-year retrospective cohort study

“…Taking Europeans as the reference geographical group, MA was the highest at 6 months for Asians, but it fell significantly below that of Europeans for all ethnicities at 12 months. It is known that many factors affect MA, including belonging to an ethnic minority, 27 28 and having cultural beliefs about medications, 29 with even differences between migrants and refugees. 30 However, we favour the hypothesis that comparable personal, social and economic determinants are important in our patients independently from their ethnicity and that their interplay is responsible for similar patterns of MA.…”