Middle Eastern refugees' and migrants’ medication adherence: the role of illness perceptions, medication beliefs and cultural beliefs

<p>Background:  Assorted studies have been conducted worldwide to investigate personal and cultural beliefs and the association of these beliefs with medication adherence. However, few studies have comprehensively focused on the Middle Eastern refugee population.</p> <p>In the literature, there appears to be a lack of understanding of the term refugees, and consequently their medication adherence, and their beliefs about illness, medication and culture in comparison to non-refugee migrant groups. This is evidenced by the inclusion of both refugees and immigrants under the umbrella term migrants and using both terms interchangeably in the literature. The two terms refugees and migrants have distinct and different meanings and represent different populations.</p> <p>Personal and cultural perceptions including illness, medication and cultural beliefs may vary between different populations. This raises the question as to whether refugees and migrants of the same ethnic background have different personal and cultural perceptions.</p> <p>Perceptions about hypertension and medications of Middle Eastern refugees and migrants play a crucial role in determining long-term treatment adherence. Understanding differences may have a significant impact on enhancing medication adherence in these groups. Thus, it is critical to study specifically refugees' beliefs and thus, bridge the potential gap to improve health outcomes in this vulnerable population. In addition, exploring the barriers to medication adherence in refugees in comparison to migrants may provide a better understanding of each group and suggest strategies and interventions to improve adherence to prescribed medications.</p> <p>Aims: the aims of this research were to provide an overview of influences on medication adherence in Middle Eastern refugees and migrants explored through their beliefs about illness, medications and culture. Additionally, the aim is to compare these two different populations regarding their medication adherence and beliefs.</p> <p>Objectives: the objectives of this thesis were to establish the relationship between personal and cultural beliefs on medication adherence in Middle Eastern refugees with hypertension in Australia, and to evaluate qualitatively the differences between refugees and migrants regarding their medication adherence and beliefs about illness, medications, and culture.</p> <p>Methods: three systematic literature reviews were undertaken the first, to determine what was known about refugees' health beliefs and their adherence to medications; second to identify the impact of illness and cultural beliefs on medication adherence; and third, to evaluate the consequences of general medication beliefs on medication adherence.</p> <p>Thereafter, three cross-sectional studies compared refugees' and migrants' illness, medication, and cultural beliefs. These studies examined the association between these beliefs on medication adherence using validated and reliable questionnaires. Subsequently, refugees and migrants were interviewed qualitatively and a framework of the interventions to improve medication adherence was constructed. Lastly, the literature around social support as an intervention to improve medication adherence, was reviewed systematically.</p> <p>Results: from the first systematic review, a major gap in the literature was identified regarding understanding refugees' health beliefs and medication adherence. In addition, a lack of understanding about the differences between refugees and migrants from the same background was identified.</p> <p>The second systematic review identified that illness perceptions and cultural beliefs were significantly associated with medication adherence, and the third systematic review demonstrated the impact of general medication beliefs on medication adherence and cultural beliefs.</p> <p>In neither the second nor in the third review, were refugees or migrants specifically addressed in the included articles. This highlighted the gap in the literature about the impact of personal and cultural beliefs on medication adherence in refugee and migrant patients.</p> <p>After quantitatively analysing the data obtained from a survey of both Middle Eastern migrants and refugees which included an illness perception questionnaire, medication beliefs questionnaire, acculturation scale and medication adherence questionnaire, we found significant differences between Middle Eastern refugees and migrants regarding adherence and illness perceptions, medication beliefs and acculturation. Refugees had more negative illness perceptions, medication beliefs, lower levels of acculturation and were less adherent than migrants. Illness perceptions, medication beliefs and acculturation were found to be associated significantly with medication adherence. The strongest predictors of non-adherence versus adherence for refugees and migrants were perceptions of personal need for treatment against the concerns about potential adverse effects of medications. Similarly, those who attributed the causes of hypertension to supernatural beliefs were likely non adherent. Refugees who believed that taking natural remedies was safer than taking their prescribed Western medications reported higher levels of harm beliefs toward their medications and lower levels of medication adherence.</p> <p>Targets for adherence interventions were postulated after interviewing refugees and migrants and included the denial of having hypertension, health literacy, necessity beliefs, the asymptomatic nature of hypertension and social support.</p> <p>The findings from a fourth systematic review found that social support is a modifiable factor that is significantly and positively associated with medication adherence. Interventional studies identified through this systematic review described appointing a family member or a friend as a supervisor to remind the patients to take their medications regularly and to educate them about their medications.</p> <p>Conclusion: There is a major gap in the literature about refugees' health beliefs, illness beliefs, and medication adherence. Illness, medication, and cultural beliefs are modifiable factors and reasonable targets to enhance medication adherence. Understanding these beliefs and the likely differences between refugees and migrants is crucial to providing specific and targeted advice to each group independently to improve medication adherence and overall health.</p> <p>The lack of social support, poor health literacy, harm beliefs about medications, perceptions of medications as unnecessary, the denial of having hypertension, and language barriers appear to be other factors that prevent adherence to treatment in Middle Eastern refugees with hypertension.</p> <p>Refugees' families and friends should be actively engaged with healthcare providers in care, health and treatment plans to increase awareness, alleviate stress, and assist refugees to take their medications regularly.</p>