Cultural Factors And Their Influence On Medications
Cultural Factors And Their Influence On Medications
Adherence is defined as the process by which patients take their medication as prescribed Patients’ acceptance of medical advice, including medication use, may be influenced by subjective beliefs about their health condition. Therefore, it is essential to take beliefs into account when giving health advice and/or providing medical treatment.3 It has been shown that medication adherence is multi-faceted. Factors contributing to medication adherence include illness perceptions, health literacy, self-efficacy, cognitive abilities such as memory, coping and problem-solving skills, as well as psychosocial factors such as personal and cultural beliefs related to medication taking.9
Factors of concern to patients, regarding their illness, may be conceptualized as patients’ illness perceptions. Leventhal and his colleagues proposed the common-sense model of illness representation to understand the processes by which people make sense of illness.10 Illness perceptions are personal beliefs and expectations about an illness or somatic symptoms. The basic assumption underlying this model is that illness perceptions, along with “common sense,” are used in interpreting the meaning of illness or somatic symptoms, deciding on a response, and evaluating the effectiveness of the response.11
Personal beliefs about illness include both cognitive and emotional representations. Cognitive beliefs include five core domains: (1) “identity” describes peoples’ beliefs about the label of illness and symptoms, and sets out the targets for change (such as to eliminate symptoms); (2) “timeline” refers to people’s perception of the duration of illness, including symptoms and recovery; (3) “consequences” refers to beliefs about the seriousness of the disease and the impacts on daily life; (4) “control” refers to perceptions about the amenability of the illness to being cured, prevented or treated; and (5) “causes” refers to people’s perceptions of the possible causes of their condition. Emotional representations are the feelings that arise as a result of illness, such as anxiety and/or depression.12
In explaining health behaviors, social determinants such as spirituality and religiosity have been increasingly identified as impacting health and treatment.7 Though often used interchangeably, spirituality and religiosity are separate, but related, concepts. While spirituality denotes an inner freedom to engage in faith and a relationship with a Supreme Being, such as God, religion refers to the outward adherence to highly prescribed beliefs, practices and rituals related to the Supreme Being, such as church attendance and associated activities.13 Cultural beliefs, defined as “a set of behavioral patterns related to thoughts, manners and actions, which members of society have shared and passed on to succeeding generations”14 may also influence the decision making of patients with chronic disease to take medication.14 Acculturation has been defined as culture change that results from continuous contact between two distinct cultural groups; it also refers to changes in an individual whose cultural group is collectively experiencing acculturation.15
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Health behaviors in the self-management of chronic diseases can also be affected by both health literacy and self-efficacy.16 High health literacy, ie, “the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand and use information in ways which promote and maintain good health”17 and high self-efficacy, ie, “the belief in one’s capacity to organize and execute the courses of action required to manage a prospective situation“17 are more likely to have better adherence to self-care tasks and medication adherence.18
In this review, we update and expand an earlier review9 to take into account findings from recent literature. Since 2006, a number of studies have been published which have examined illness perceptions conceptualized by the common sense model. Secondly, studies examining the impact of acculturation and religious beliefs on medication adherence have now also been published.
Although a number of systematic reviews on medication adherence have been conducted,12,19–21 none of these has explored the relationship between medication adherence and personal and cultural beliefs of patients with chronic diseases such as HTN, COPD, asthma and DMT2. These chronic diseases are currently the most significant in terms of population health in first-world countries.
