Adherence is a rising public health concern in the United States. Half of all Americans do not adhere to their prescribed medications. Side effects, cost, and simple forgetfulness are common reasons people do not take their medicines as prescribed. Although many additional factors influence medicine-taking behaviors, I think cultural beliefs are one significant factor often overlooked by healthcare providers.
Culture is defined as “the shared characteristics of a group of people, which may include patterns of behavior, beliefs, customs, traditions, artistic expression and language,” and is the part of each of us that guides our values, beliefs, and behaviors. Every culture has beliefs about health, disease, treatment, and healthcare providers, and people from immigrant cultures bring their beliefs into our healthcare system.
Many of my relatives of Southeast Asian origin have have been living in the United States for decades and have acculturated into American society. Until recently, I did not understand how cultural beliefs about treatment could have negative consequences on one’s health. I always assumed my relatives followed their doctors’ orders. While most of my relatives do adhere to treatment as prescribed, I learned that one close relative, a man in his early 50s, did not.
My relative was prescribed Western, or conventional, treatment for high blood pressure. Instead of following his doctor's orders, he consulted with a friend from his native country and replaced the prescribed treatment with homeopathic medicine, a popular complementary and alternative medicine practiced within the Indian culture. He did not communicate this decision to family members or, more important, his healthcare provider.
As a consequence of his not adhering to prescribed treatment, my relative experienced a major complication. He underwent emergency surgery because of a ruptured abdominal aortic aneurysm, a result of his lack of compliance with his antihypertensive treatment. Poor compliance could have cost him his life.
Having survived the surgery, my relative now truly understands the importance of treatment. He also became a more engaged patient. He keeps himself informed about his condition and works closely with his healthcare provider.
As a health educator, I am proud of my relative for shifting his beliefs and behaviors to adhere to treatment as prescribed for his condition. Unfortunately, he learned firsthand that nonadherence can come with risks and complications.
Despite one’s educational or income level, cultural beliefs may trump other influences on medication-taking behaviors. As we know, the American fabric is made up of several different cultures and will surely continue to diversify in the coming years. Awareness of patients' cultural beliefs is paramount to assessing their ability to adhere to treatment. The following strategies can help healthcare providers address underlying beliefs and behaviors and improve adherence:
- Foster supportive and trusting relationships
- Encourage open communication
- Understand the cause of illness from a patient’s cultural point of view
- Elicit information, without being judgmental, about use of nonconventional treatment
- Acquire the skills and competencies necessary for high-quality cross-cultural care
To learn more, visit the resources listed below:
Culturally competency resources from the Office of Minority Health. The Office of Minority Health provides valuable resources and guidelines on cultural competency.
Cultural Competence Works: Using Cultural Competence to Improve the Quality of Health Care for Diverse Populations and Add Value to Managed Care Arrangements, a report from the Health Resources and Services Administration (HRSA). This report provides a summary of culturally competent practices.
National Center for Cultural Competence. This component ofGeorgetown University Center for Child and Human Development provides national leadership and research on cultural and linguistic competency and advocates for policy changes.
A Physician’s Practical Guide to Culturally Competent Care, a continuing medical education program for physicians, supported by the Office of Minority Health.
Script Your Future, a campaign recently launched by the National Consumer League to raise awareness about medication adherence and provide useful resources to patients and providers.
"Your Medicine: Be Smart. Be Safe," a guide from the Agency for Healthcare Research and Quality, which provides information and tools to help people adhere to treatment.