Medication adherence and health beliefs among South Asian immigrants with diabetes in the United States: A qualitative study

Abstract

AbstractIntroductionPeople of South Asian descent carry a high burden of cardiovascular disease (CVD) and type 2 diabetes mellitus (DM2) both globally and in the United States. Although retrospective cohort studies indicate decreased medication adherence among South Asian immigrants, data exploring contributing factors are limited.ObjectivesTo explore how cultural perspectives of South Asian immigrants in the U.S. impact adherence to medications for DM2 and CVD.MethodsThis qualitative research study recruited South Asian immigrants in the U.S. with CVD and/or DM2. Semi‐structured interviews were conducted utilizing the conceptual frameworks of the Patient Explanatory Model and HOPE questions. A modified version of the Voils DOSE‐Nonadherence measure was administered to all participants. Interviews were transcribed, coded, and analyzed through an iterative process to develop overarching themes.ResultsTwelve individuals participated: half were female, with an average age of 63 (range 49‐75), and the majority emigrated from Pakistan. The average extent of nonadherence score on the modified version of the Voils DOSE‐Nonadherence measure was 1.36 (range 1‐2.33). Five overarching themes were identified: (1) Numerical results motivated health change; (2) Open communication improved medication adherence; (3) Self‐management and autonomy valued; (4) Religious/spiritual beliefs may strengthen medication adherence; and (5) Complementary and alternative medicines (CAM) augment Western medicines.ConclusionProviders may engage in various culturally‐based strategies to optimize medication adherence in South Asian immigrants. Resources should be allocated toward facilitating disease state education, encouraging self‐monitoring, and providing training for providers on CAM. Providers should engage the patient‐family dyad and cultivate collaborative relationships with patients. Providers should be aware that patients desire autonomy in making health care decisions, and those with higher health literacy and health care providers in their social network may be more likely to self‐titrate medications.