Raniya Ali Al-Matari, B.Pharm., Ph.D.
Research Assistant, College of Pharmacy
2300 4th St NW, Washington, DC 20059
According to the World Health Organization (WHO), medication adherence or taking medication as prescribed by healthcare provider in developing countries are lower (<50%) compared to developed countries, due to the lack of health care resources (1). Medication adherence of immigrant population may still be challenging after relocation to the United States (US) due to limited access to healthcare and acculturation issues (2). There are few studies have been carried out to showing adherence rate among foreign-born persons in the US (3-6), but there is no study that shows the adherence rate among the Ethiopian population in the United States and the factors that predict medication adherence.
Why study medication adherence among persons of Ethiopian descent in the US? 1) Persons of Ethiopian descent are the largest immigrant population and they have documented a high burden of chronic disease (7-12). 2) Persons of Ethiopian descent, face language barriers which can significantly impact their understanding of medication information from providers (10,13,14). 3) Little is known about the adherence rate and the factors that affect it among persons of Ethiopian descent. No translated Simplified Medication Adherence Questionnaire Amharic adherence tool has been developed in the Amharic language which is the predominant language spoken by persons of Ethiopian descent in the US.
A pilot study was conducted to validate the use of an Amharic-Version questionnaire to measure adherence among the Ethiopians in the US (15). This questionnaire was validated using Ethiopian patients with diabetes and their clinical data (A1C) to compare their adherence level. Finally, this questionnaire was used to measure adherence rate among the Ethiopian population with chronic disease and identify the factors that predict adherence. The adherence rate among the Ethiopians with chronic diseases recruited were about 34.0% (16). This number is relatively low to the optimal adherence level which is about 80.0% among persons with chronic disease (17). The low rate of adherence among this population was mainly impacted by similar factors in their home countries, such as holy water, physical activity, unhealthy eating, and education level. Additionally, the most common factor which is also seen in other immigrant population is difficulty in communicating in the English language.
Believing in Holy water and spiritual healing: the use of holy water and spiritual healing is a vital part of the Ethiopian community regardless of their practicing faith (Christianity/Islam). They strongly believe that holy water is blessed water that is sent by God and has the power of healing any kind of disease (18). Hence, this belief has shown an impact on their medication-taking behavior in Ethiopia. A recent study done in the USA supports this finding among this population. Majority of an Ethiopian immigrant who did not adhere to medication was due to their belief in holy water and spiritual healing (16).
Difficulty in communicating in English is a way of communicating to understand the instruction given by the healthcare provider in a language that the patient does not understand. Many studies show that foreign-born person in the USA have difficulty in communicating in the English language once they relocate to the US (19-21). In addition, a study done among Ethiopians in the US showed that when a healthcare provider communicates in a language (English) that the patient does not understand, it results in patients not following instructions of medication and understanding the seriousness of the disease which then results to non-adherence to medication (16).
Activity level: plays a great role in the overall health of a person. Ethiopians who are diagnosed with a chronic disease such as diabetes, hypertension, cholesterol, etc., are alerted by their healthcare provider the importance of changing their lifestyle. To become more active to manage their disease. Findings in various studies show that people who are less active have a higher chance of having a negative health outcome (19-22). A similar study done among Ethiopians in the US showed that people who have a low activity level are less cautious about their health outcome and are not adherent to medication (16).
An unhealthy diet is a major contributing factor to any chronic diseases. (19, 20). In the US culture, eating an unhealthy diet is a very common behavior. However, it has also been the situation among foreign-born persons who relocate to the US; due to their busy lifestyle which makes it easier and cheaper to access fast foods. The recent study done among the Ethiopian population showed that those who consume an unhealthy diet do not seem to understand the impact on their health condition and they do not adhere to medication. (16).
Conclusion: The rate of medication adherence among Ethiopians with chronic disease is very low. This low level is caused by the following significant factors which are difficulty in communicating in English, activity level, unhealthy diet, and holy water and spiritual healing. Therefore, it is important for healthcare providers to consider these factors when treating the Ethiopian population for a positive health outcome and a better quality of life.
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