Abstract
Background The prevalence of coronary heart disease amongst South Asian population in the UK is higher compared to the general population. Objective This study sought to investigate beliefs and experiences of South Asian patients regarding coronary heart disease and medication taking behaviour. Setting A London Heart Attack Centre. Methods This mixed method study is part of an original pilot randomised study on 71 patients involving a pharmacy-led intervention to improve medication adherence in coronary heart disease patients. South Asian patients from the randomised study took part in qualitative semi-structured telephone interviews. Both South Asian and non-South Asian patients completed the questionnaire about adherence and beliefs regarding medicines using Morisky Scale and the Belief About Medicines Questionnaire-Specific at 2 weeks, 3 and 6 months. Outcome Patients’ beliefs about coronary heart disease and medication adherence. Results Seventeen South Asian patients and 54 non-South Asian patients took part. Qualitative data from 14 South Asian patients showed that while some attributed coronary heart disease to genetic, family history for their illness, others attributed it to their dietary patterns and ‘god’s will’ and that little could be done to prevent further episodes of coronary heart disease. On the Belief About Medicines Questionnaire-Specific in South Asian patients, beliefs about necessity of medicines outweighed concerns. South Asian patients (n = 17) showed a similar pattern of adherence compared to non-Asian patients (n = 54). Adherence decreased with time in both populations, adherence measured by Morisky Scale. Conclusion South Asian patients in this study often attributed coronary heart disease to additional causes besides the known risk factors. Future studies on their understanding of the importance of cultural context in their attitudes to prevention and lived experience of the disease is warranted.
Highlights
Coronary heart disease remains the most common cause of premature death in the UK
There remains a need for education within the South Asian communities on the causes and prevention of coronary heart disease
People who have had a myocardial infarction (MI) benefit from treatment to reduce the risk of further manifestations of vascular disease; this is known as secondary prevention
Summary
Coronary heart disease remains the most common cause of premature death in the UK. In 2014, 15% of male deaths and 10% of female deaths were from CHD, a total of around 69,000 deaths [1]. Several theories in previous literature include migration, disadvantaged socioeconomic status, proatherogenic diet, lack of exercise, high levels of homocysteine and LP(a) lipoprotein, endothelial dysfunction, enhanced plaque and systemic inflammation [4] Other studies attribute this to the fact that SAs have substantially higher rates of diabetes, a risk factor often linked to higher CHD mortality [5]. There has been little research on adherence to coronary heart disease medication in SA patients living in the UK, despite the relatively high prevalence of cardiovascular conditions in this group [6] It is not clear if ethnicity plays a role in medication non adherence [12], only few studies have been conducted [11, 12] and have shown that adherence to cardiovascular medication is low when compared to non-Asian counterparts [12]. The prevalence of coronary heart disease amongst South Asian population in the UK is higher compared to the general population
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