Conventional medication adherence and self-treatment practices among South Asian immigrants: a qualitative study
Sumera Saeed Akhtar 1 , Mudassir Anwar 2 , Kirsten J. Coppell 3 , Sherly Mathew Parackal 1 *1
2
3
Abstract
Globally, cardiovascular disease (CVD) is a common cause of death. The highest CVD rate is among South Asian populations and South Asian immigrants have a higher risk of developing CVD than other ethnic groups. While treatment of established CVD risk factors is recommended, medication adherence may be poor.
This qualitative study aimed to explore medication adherence practices of New Zealand South Asians who are prescribed medications for type 2 diabetes, and/or hypertension, and/or dyslipidaemia, established risk factors for CVD.
Twenty-one semi-structured telephone interviews were conducted with South Asians with type 2 diabetes, and/or hypertension, and/or dyslipidaemia. Data were transcribed, then analysed thematically using NVivo12. Codes and inductively derived themes were discussed.
Five themes with 12 subthemes were identified. The five themes included daily routine and medication adherence practices, perceived necessity of medications and concerns about side effects, concern and hesitancy to start conventional medications, integration of herbal and alternative therapies, and the role of healthcare providers and communication.
These findings highlight the importance of personalised approaches to medication management that consider patients’ beliefs, daily routines, and cultural contexts to reduce CVD risk and improve health outcomes among South Asians.
Keywords: alternative treatments, cardiovascular disease risk, lifestyle changes, medication adherence, medication hesitancy, New Zealand, role of healthcare providers, South Asians.
References
1 Selak V, Poppe K, Grey C, et al. Ethnic differences in cardiovascular risk profiles among 475,241 adults in primary care in Aotearoa, New Zealand. 2020. Available at https://researchspace.auckland.ac.nz/bitstream/handle/2292/53539/Ethnic%20differences.pdf?sequence=2
2 Perumal L, Wells S, Ameratunga S, et al. Markedly different clustering of CVD risk factors in New Zealand Indian and European people but similar risk scores (PREDICT‐14). Aust N Z J Public Health 2012; 36(2): 1411-4.
| Crossref | Google Scholar | PubMed |
3 Parackal S, Coppell K, Yang CL, et al. Hidden figures and misnomers: a case for disaggregated Asian health statistics in Aotearoa New Zealand to improve health outcomes. N Z Med J 2021; 134(1546): 109-16.
| Google Scholar | PubMed |
4 Statistics New Zealand. Birthplace (broad geographic areas) and years since arrival in New Zealand by age and sex, for the overseas born census usually resident population count, 2006, 2013, and 2018 Censuses (RC, TA, SA2, DHB). 2020. Available at http://nzdotstat.stats.govt.nz/wbos/index.aspx?_ga=2.194604781.1109808399.1620695530-1637168086.1462318868&_gac=1.60112351.1620695602.Cj0KCQjws-OEBhCkARIsAPhOkIbTBbukLLTS5DisIpKbUKAqdKn2pLMnkSI2ypGHquWXEGMEjHOmqccaAsJUEALw_wcB#
5 Chan WC, Wright C, Riddell T, et al. Ethnic and socioeconomic disparities in the prevalence of cardiovascular disease in New Zealand. N Z Med J 2008; 121(1285): 11-20.
| Google Scholar | PubMed |
6 Grey C, Jackson R, Wells L, et al. Trends in ischaemic heart disease: patterns of hospitalisation and mortality rates differ by ethnicity (ANZACS-QI 21). N Z Med J 2018; 131: 21-31.
| Google Scholar | PubMed |
7 Jatrana S, Richardson K, Blakely T, et al. Does mortality vary between Asian subgroups in New Zealand: an application of hierarchical Bayesian modelling. PLoS One 2014; 9(8): e105141.
| Crossref | Google Scholar | PubMed |
9 Kearney PM, Whelton M, Reynolds K, et al. Worldwide prevalence of hypertension: a systematic review. J Hypertens 2004; 22(1): 11-9.
| Crossref | Google Scholar | PubMed |
10 Misra A, Jayawardena R, Anoop S. Obesity in South Asia: phenotype, morbidities, and mitigation. Curr Obes Rep 2019; 8: 43-52.
| Crossref | Google Scholar | PubMed |
11 Chan WC. The need for better focus on primary and secondary prevention of cardiovascular disease. Auckland, 2020. Available at https://countiesmanukau.health.nz/assets/About-CMH/Reports-and-planning/Diabetes/2020_Need_for_better_focus_primary_secondary_prevention.pdf
12 Liu Q, Quan H, Chen G, et al. Antihypertensive medication adherence and mortality according to ethnicity: a cohort study. Can J Cardiol 2014; 30(8): 925-31.
| Crossref | Google Scholar | PubMed |
13 Lai EJ, Grubisic M, Palepu A, et al. Cardiac medication prescribing and adherence after acute myocardial infarction in Chinese and South Asian Canadian patients. BMC Cardiovasc Disord 2011; 11: 56.
| Crossref | Google Scholar | PubMed |
14 Chong E, Wang H, King‐Shier K, et al. Prescribing patterns and adherence to medication among South‐Asian, Chinese and white people with Type 2 diabetes mellitus: a population‐based cohort study. Diabet Med 2014; 31(12): 1586-93.
| Crossref | Google Scholar | PubMed |
15 Ens TA, Seneviratne CC, Jones C, et al. South Asians’ cardiac medication adherence. Eur J Cardiovasc Nurs 2014; 13(4): 357-68.
| Crossref | Google Scholar | PubMed |
16 Jalal Z, Antoniou S, Taylor D, et al. South Asians living in the UK and adherence to coronary heart disease medication: a mixed-method study. Int J Clin Pharm 2019; 41(1): 122-30.
| Crossref | Google Scholar | PubMed |
17 Chaudri NA. Adherence to long-term therapies evidence for action. Ann Saudi Med 2004; 24(3): 221-2.
| Crossref | Google Scholar |
18 Miao Y, Luo Y, Zhao Y, et al. Effectiveness of eHealth interventions in improving medication adherence among patients with cardiovascular disease: systematic review and meta-analysis. J Med Internet Res 2024; 26: e58013.
| Crossref | Google Scholar |
19 Hamine S, Gerth-Guyette E, Faulx D, et al. Impact of mHealth chronic disease management on treatment adherence and patient outcomes: a systematic review. J Med Internet Res 2015; 17(2): e52.
| Crossref | Google Scholar | PubMed |
21 Coyne IT. Sampling in qualitative research. Purposeful and theoretical sampling; merging or clear boundaries? J Adv Nurs 1997; 26(3): 623-30.
| Crossref | Google Scholar | PubMed |
22 Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006; 3(2): 77-101.
| Crossref | Google Scholar |
23 Dhakal K. NVivo. J Med Libr Assoc 2022; 110(2): 270-2.
| Crossref | Google Scholar | PubMed |
24 Vähäsarja K, Kasila K, Kettunen T, et al. I saw what the future direction would be’: experiences of diabetes risk and physical activity after diabetes screening. Br J Health Psychol 2015; 20(1): 172-93.
| Crossref | Google Scholar | PubMed |
25 Coppell KJ, Abel S, Whitehead LC, et al. A diagnosis of prediabetes when combined with lifestyle advice and support is considered helpful rather than a negative label by a demographically diverse group: a qualitative study. Prim Care Diabetes 2022; 16(2): 301-6.
| Crossref | Google Scholar | PubMed |
26 Jimmy B, Jose J. Patient medication adherence: measures in daily practice. Oman Med J 2011; 26(3): 155-9.
| Crossref | Google Scholar | PubMed |
27 Fenerty SD, West C, Davis SA, et al. The effect of reminder systems on patients’ adherence to treatment. Patient Prefer Adherence 2012; 6: 127-35.
| Crossref | Google Scholar | PubMed |
28 Ens TA, Seneviratne CC, Jones C, et al. Factors influencing medication adherence in South Asian people with cardiac disorders: an ethnographic study. Int J Nurs Stud 2014; 51(11): 1472-81.
| Crossref | Google Scholar | PubMed |
29 Kvarnström K, Westerholm A, Airaksinen M, et al. Factors contributing to medication adherence in patients with a chronic condition: a scoping review of qualitative research. Pharmaceutics 2021; 13(7): 1100.
| Crossref | Google Scholar | PubMed |
30 Abel S, Whitehead L, Coppell K. Making dietary changes following a diagnosis of prediabetes: a qualitative exploration of barriers and facilitators. Diabet Med 2018; 35(12): 1693-9.
| Crossref | Google Scholar | PubMed |
31 Ramaswamy P, Mathew Joseph N, Wang J. Health beliefs regarding cardiovascular disease risk and risk reduction in South Asian immigrants: an integrative review. J Transcult Nurs 2020; 31(1): 76-86.
| Crossref | Google Scholar | PubMed |
32 Khosla N, Hahn L, Tran C. US South Asian youths’ perspectives on the use of Complementary and Alternative Medicine (CAM). J Racial Ethn Health Disparities 2024; 11: 2044-54.
| Crossref | Google Scholar | PubMed |
33 Aslani P, Brien J-a, Sapkota S. Blood glucose monitoring in type 2 diabetes-Nepalese patients’ opinions and experiences. Glob Health Action 2017; 10: 1322400.
| Crossref | Google Scholar | PubMed |
34 Kivelä K, Elo S, Kyngäs H, et al. The effects of health coaching on adult patients with chronic diseases: a systematic review. Patient Educ Couns 2014; 97(2): 147-57.
| Crossref | Google Scholar | PubMed |
35 Shirazian S, Crnosija N, Weinger K, et al. The self-management experience of patients with type 2 diabetes and chronic kidney disease: a qualitative study. Chronic Illn 2016; 12(1): 18-28.
| Crossref | Google Scholar | PubMed |
36 Limbachia J, Ajmeri M, Keating BJ, et al. Effects of lifestyle interventions on cardiovascular risk factors in South Asians: a systematic review and meta-analysis. BMJ Open 2022; 12(12): e059666.
| Crossref | Google Scholar | PubMed |