The rate and predictors of taking medication correctly among Ethiopians with chronic diseases in the US

Raniya Ali Al-Matari, B.Pharm., Ph.D.

Research Assistant, College of Pharmacy

2300 4th St NW, Washington, DC 20059

Howard University

ralmatari@gmail.com

 

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.     

References 

  1. World Health Organization (WHO). Adherence to Long-term Therapies – evidence for action (2003). Retrieved from http://whqlibdoc.who.int/publications/2003/9241545992.pdf
  2. Foley EE. HIV/AIDS and African immigrant women in Philadelphia: structural and cultural barriers to care. AIDS Care. Nov 2005;17(8):1030-1043.
  3. Schoenthaler A, Allegrante JP, Chaplin W, Ogedegbe G. The Effect of Patient-Provider Communication on Medication Adherence in Hypertensive Black Patients: Does Race Concordance Matter? Annals of behavioral medicine : a publication of the Society of Behavioral Medicine. 2012;43(3):372-382.
  4. DiBonaventura M, Gabriel S, Dupclay L, Gupta S, Kim E. A patient perspective of the impact of medication side effects on adherence: results of a cross-sectional nationwide survey of patients with schizophrenia. BMC Psychiatry. 2012;12:20.
  5. Williams GC, Patrick H, Niemiec CP, et al. Reducing the Health Risks of Diabetes: How Self-determination Theory May Help Improve Medication Adherence and Quality of Life. Diabetes Educ. May–Jun 2009;35(3):484-492.
  6. Katz IT, Ryu AE, Onuegbu AG, et al. Impact of HIV-related stigma on treatment adherence: systematic review and meta-synthesis. Journal of the International AIDS Society. 2013;16(3Suppl 2):18640.
  7. The Washington post. African immigrant population doubling each decade. D.C. area among group’s top destinations. Retrieved from. http://www.washingtonpost.com/local/african-immigrant-population-doubling-each-decade-washington-area-among-highest/2014/10/01/efbada70-498f-11e4-891d-713f052086a0_story.html
  8. TADIAS. http://www.tadias.com/10/15/2014/census-foreign-born-africans-most-educated-immigrants-in-u-s/. Acessed 4_18_2017
  9. Migration Policy Institute tabulation of data from the U.S. Census Bureau’s pooled 2011-2015 American Community Survey.http://www.migrationpolicy.org/programs/data-hub/charts/us-immigrant-population-state-and-county. Accessed on 03/22/2017
  10. Ethnomed. Diabetes in the Eritrean and Ethiopian Community: Cultural Information and Recommendations for Diabetes Educators (2010).Retrieved from https://ethnomed.org/clinical/diabetes/diabetes-in-the-eritrean-and-ethiopian-community-cultural-information-and-recommendations-for-diabetes-educators
  11. Willis LA, Opoku J, Murray A, et al. Diagnoses of Human Immunodeficiency Virus (HIV) Infection Among Foreign-Born Persons Living in the District of Columbia. J Immigr Minor Health. Jul 30 2013.
  12. Increasing the cultural competence of health care providers serving Minnesota’s diverse populations. StratisHealt. http://culturecareconnection.org/matters/diversity/ethiopian.html
  13. Beyene Y. Potential HIV risk behaviors among Ethiopians and Eritreans in the diaspora: A bird’s-eye view. Northeast African Studies. 2000;7(2):119-142.
  14. Chaumba J. Health status, use of health care resources, and treatment strategies of Ethiopian and Nigerian immigrants in the United States. Soc Work Health Care. 2011;50(6):466-481.
  15. Al Matari RA, Maneno MK, Daftary MN, Wingate LM, Ettienne EB. Development and Validation of Amharic Version of the Simplifi ed Medication Adherence Questionnaire among Literate Amharic Speaking Persons an Urban Teaching Hospital in Washington DC Region. Int J Case Rep Short Rev. 2019;5(1): 001-005.
  16. AL-Matari, R. A., Maneno, M. K., Daftary, M., Ettienne, E. B., Wingate, L. T., & Hailemeskel, B. (2018). Evaluation of Adherence and its Predictors Among Persons of Ethiopian Descent in Washington DC. Value in Health, 21, S112.
  17. Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. Aug 4 2005;353(5):487-497.
  18. Bezabhe WM, Peterson GM, Bereznicki L, Chalmers L, Gee P. Adherence to antiretroviral drug therapy in adult patients who are HIV-positive in Northwest Ethiopia: a study protocol. BMJ open. 2013;3(10):e003559.
  19. Zeng B, Sun W, Gary RA, Li C, Liu T. Towards a Conceptual Model of Diabetes Self-Management among Chinese Immigrants in the United States. Int J Environ Res Public Health. Jul 2014;11(7):6727-6742.
  20. Wells AA, Palinkas LA, Qiu X, Ell K. Cancer patients’ perspectives on discontinuing depression treatment: the “drop out” phenomenon. Patient Prefer Adherence. 2011;5:465-470.
  21. Islam NS, Wyatt LC, Patel SD, et al. Evaluation of a Community Health Worker Pilot Intervention to Improve Diabetes Management in Bangladeshi Immigrants with Type 2 Diabetes in New York City: Bangladeshi Community Health Worker Evaluation. Diabetes Educ. Jul-Aug 2013;39(4):478-493
  22. Tailakh AK, Evangelista LS, Morisky DE, Mentes JC, Pike NA, Phillips LR. Acculturation, Medication Adherence, Lifestyle Behaviors, and Blood Pressure Control Among Arab Americans. Journal of Transcultural Nursing. 2016;27(1):57-64.

91 thoughts on “The rate and predictors of taking medication correctly among Ethiopians with chronic diseases in the US

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