Role of Medication Beliefs on Medication Adherence in Hypertensive Middle Eastern Refugees and Migrants in Australia

Abstract

BackgroundAdherence to medication is essential in some patients for achieving treatment control in hypertension. Medication beliefs is one of the personal modifiable factors that has been recognised to influence medication adherence in different populations. However, there is no published research to confirm the relationship between medication beliefs and medication adherence in Middle Eastern refugees and migrants in Australia. These two different groups may develop different beliefs about their medications that lead to different medication taking behaviours. Understanding the possible differences in beliefs may have a significant impact on enhancing medication adherence in these groups.Design320 Middle Eastern refugees and migrants with hypertension were approached via various social groups in Australia and asked to complete Arabic versions of the Beliefs about Medicine Questionnaire (BMQ) and the Medication Adherence Questionnaire. BMQ scores (necessity and concerns scales) were classified as "accepting", "indifferent", "ambivalent" or "skeptical". Multiple mediation modelling was applied to examine the role of necessity and concerns scales as mediators between migration status and medication adherence.ResultsThere were significant associations between medication adherence and medication beliefs scores (necessity and concerns scales) (p = 0.0001). Necessity, and concern were mediators in the relationship between migration status and medication adherence. Significant differences were found between refugees and migrants for medication adherence and medication beliefs. Refugees were likely to have less necessity, and more concern beliefs than migrants. They were also less likely to adhere to medications. Almost 30% of refugees could be classified as skeptical and 40% as ambivalent. In contrast, 50% of migrants had accepting beliefs, and around 35% held ambivalent beliefs. Refugees and migrants with “accepting” beliefs reported the highest adherence to medication and those holding “skeptical” beliefs reported the lowest adherence.ConclusionMedication beliefs are potentially modifiable and are reasonable targets for clinical interventions designed to improve medication adherence. Understanding these beliefs and the likely differences between refugees and migrants is crucial to provide specific and targeted advice to each group independently in order to improve medication adherence and overall health.

Recommendations for community pharmacy to improve access to medication advice for people from ethnic minority communities: A qualitative person‐centred codesign study

“…Specifically in this study, participants highlighted the importance of shared conversations with pharmacy professionals around medication excipients, alcohol‐content and religious festivals that affect adherence to medications (including periods of fasting). Perspectives raised in the workshops echoed those in the wider literature, where a person's medicines‐taking behaviour and subsequent access to medicines services can be influenced by their culture 37–40 . To enable culturally appropriate conversations and support the delivery of culturally competent medicines consultations, participants recognized the need to underpin community pharmacy service design and delivery with improved staff training.…”

“…Perspectives raised in the workshops echoed those in the wider literature, where a person's medicines-taking behaviour and subsequent access to medicines services can be influenced by their culture. [37][38][39][40] To enable culturally appropriate conversations and support the delivery of culturally competent medicines consultations, previously been identified, 41 and questions have been raised about the format, content and optimization of this training too. [42][43][44][45][46] In the updated standards for the initial education and training of pharmacists, the General Pharmaceutical Council placed emphasis on equality, diversity and inclusion to address health inequalities.…”

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

“…Almost half of the studies were conducted in the United States of America (7 out of 15 studies) [11][12][13][14][15][16][17]. 3 studies recruited participants from Australia [18][19][20], 2 studies from Korea [4,21], and 1 each from the Netherlands [22], Spain [23], and Jordan [24].…”

“…Tere are few studies addressing factors associated with medicine adherence in immigrants and refugees [11][12][13][14][15][16][17][18][19][20][21][22][23][24], and several studies focus on medicine nonadherence in general populations or concentrate on self-care and management of medicines or treatment [25][26][27][28]. Although this is the case, current evidence suggests that there is little evidence published that addresses the numerous factors involved in medication nonadherence in immigrants and refugees.…”

Understanding Medication-Related Belief in Patients with Type 2 Diabetes: a Meta-Analytic Review

“…It also reported that patients with "acceptance" belief showed the highest rate of medication adherence and patients with "doubt" belief showed the lowest rate of medication adherence. Performing clinical interventions and targeted counseling can make a positive change in beliefs and medication adherence [24]. Chin et al (2021) demonstrated that Health-related knowledge and health literacy lead people to use the medication more wisely [25].…”