Perspectives on adherence to blood pressure–lowering medications among Samoan patients: qualitative interviews

Abstract

AIM: To explore influences on adherence to taking long-term medications among Samoan patients in an Auckland general practice. METHODS: Twenty Samoan participants from an Auckland general practice were identified and interviewed about their views on adherence or non-adherence to taking blood pressure–lowering medications. One-to-one semi-structured interviews using open-ended questions were undertaken in Samoan and English, recorded, transcribed and translated into English. Transcriptions were examined by two researchers to identify themes. FINDINGS: Patients with ‘high’ and ‘lower’ rates of adherence to taking usual medication were identified using medication possession ratio cut-offs from medical records of timely prescribing. Ten participants with ‘high’ and 10 with ‘lower’ rates of adherence were interviewed, including 11 women and nine men. Themes identified for those with lower adherence included ‘lack of transport’, ‘family commitments’, ‘forgetfulness’, ‘church activities’, ‘feeling well’ and ‘priorities’. Themes identified for those with high rates of adherence included ‘prioritising health’, ‘previous event’, ‘time management’, ‘supportive family members’ and ‘relationship with GP (language and trust)’. A theme common to both was ‘coping with the stress of multiple comorbidities’. CONCLUSION: Reasons for adherence and non-adherence to taking blood pressure–lowering medications among the Samoan patients interviewed were multifactorial and encompass personal, social, cultural and environmental factors. Interdisciplinary teams to support treatment decisions (including Pacific health professionals or community health workers), systematic identification of those with low rates of adherence, phone or text follow-up, use of church or family networks, provision of transport where needed and better tools and resources may help address this problem. KEYWORDS: Medication adherence; New Zealand; Pacific Islands; ethnic groups; qualitative research; antihypertensive agents