The effect of acculturation and harm beliefs on medication adherence on Middle Eastern hypertensive refugees and migrants in Australia
- Shahin, Wejdan, Kennedy, Gerard, Cockshaw, Wendell, Stupans, Ieva
- Authors: Shahin, Wejdan , Kennedy, Gerard , Cockshaw, Wendell , Stupans, Ieva
- Date: 2021
- Type: Text , Journal article
- Relation: International Journal of Clinical Pharmacy Vol. 43, no. 5 (2021), p. 1283-1292
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- Description: Background Different populations have different levels of acculturation, and beliefs about medications. Little is known about the differences between refugees and migrants regarding these various beliefs. Adherence to medications is influenced by many factors, including individuals’ characteristics, acculturation, and their perceptions about medications. Having a thorough understanding of these beliefs contributes to understanding medication adherence in refugee and migrant populations. Objectives To evaluate the differences between Middle Eastern refugees and migrants in Australia regarding acculturation, beliefs about medications, and medication adherence, and to evaluate the association of acculturation and beliefs about medications and natural remedies with medication adherence. Setting Participants were recruited from various community groups and English language learning centres in Australia. Arabic Facebook community groups were also used to recruit participants for this study. Method A total of 320 Middle Eastern refugees and migrants with hypertension completed Arabic or English versions of the general Beliefs about Medicine Questionnaire (BMQ)—harm scale, a question about beliefs in natural remedies, six items about acculturation and the Medication Adherence Questionnaire. Two models of multiple mediation were applied. The first model examined the role of acculturation, length of residency, beliefs about natural remedies, and harm beliefs as mediators between migration status and medication adherence. The second model identified the role of acculturation, and beliefs about natural remedies as mediators between migration status and medication harm beliefs. Main outcome measure Medication adherence, harm beliefs about medication, acculturation, and beliefs about natural remedies. In addition, the differences between refugees and migrants regarding these beliefs and medication adherence. Results Differences were found between refugees and migrants for medication adherence and medication beliefs. Refugees were likely to have more harm beliefs towards medicine and were less acculturated than migrants (p = 0.0001). They were also less likely to adhere to medications (p = 0.0001), and perceived natural remedies to be safer than Western medications (p = 0.0001). Perceiving medications as harmful substances, and beliefs in natural remedies were mediators in the relationship between migration status and medication adherence. Beliefs in natural remedies and acculturation were mediators in the relationship between migration status and harm beliefs. Conclusion Beliefs about medications and natural remedies, and acculturation in refugees and migrants need to be better understood to enhance medication adherence and potentially overall health outcomes. © 2021, The Author(s), under exclusive licence to Springer Nature Switzerland AG part of Springer Nature.
- Authors: Shahin, Wejdan , Kennedy, Gerard , Cockshaw, Wendell , Stupans, Ieva
- Date: 2021
- Type: Text , Journal article
- Relation: International Journal of Clinical Pharmacy Vol. 43, no. 5 (2021), p. 1283-1292
- Full Text:
- Reviewed:
- Description: Background Different populations have different levels of acculturation, and beliefs about medications. Little is known about the differences between refugees and migrants regarding these various beliefs. Adherence to medications is influenced by many factors, including individuals’ characteristics, acculturation, and their perceptions about medications. Having a thorough understanding of these beliefs contributes to understanding medication adherence in refugee and migrant populations. Objectives To evaluate the differences between Middle Eastern refugees and migrants in Australia regarding acculturation, beliefs about medications, and medication adherence, and to evaluate the association of acculturation and beliefs about medications and natural remedies with medication adherence. Setting Participants were recruited from various community groups and English language learning centres in Australia. Arabic Facebook community groups were also used to recruit participants for this study. Method A total of 320 Middle Eastern refugees and migrants with hypertension completed Arabic or English versions of the general Beliefs about Medicine Questionnaire (BMQ)—harm scale, a question about beliefs in natural remedies, six items about acculturation and the Medication Adherence Questionnaire. Two models of multiple mediation were applied. The first model examined the role of acculturation, length of residency, beliefs about natural remedies, and harm beliefs as mediators between migration status and medication adherence. The second model identified the role of acculturation, and beliefs about natural remedies as mediators between migration status and medication harm beliefs. Main outcome measure Medication adherence, harm beliefs about medication, acculturation, and beliefs about natural remedies. In addition, the differences between refugees and migrants regarding these beliefs and medication adherence. Results Differences were found between refugees and migrants for medication adherence and medication beliefs. Refugees were likely to have more harm beliefs towards medicine and were less acculturated than migrants (p = 0.0001). They were also less likely to adhere to medications (p = 0.0001), and perceived natural remedies to be safer than Western medications (p = 0.0001). Perceiving medications as harmful substances, and beliefs in natural remedies were mediators in the relationship between migration status and medication adherence. Beliefs in natural remedies and acculturation were mediators in the relationship between migration status and harm beliefs. Conclusion Beliefs about medications and natural remedies, and acculturation in refugees and migrants need to be better understood to enhance medication adherence and potentially overall health outcomes. © 2021, The Author(s), under exclusive licence to Springer Nature Switzerland AG part of Springer Nature.
A qualitative exploration of the impact of knowledge and perceptions about hypertension in medication adherence in Middle Eastern refugees and migrants
- Shahin, Wejdan, Kennedy, Gerard, Stupans, Ieva
- Authors: Shahin, Wejdan , Kennedy, Gerard , Stupans, Ieva
- Date: 2021
- Type: Text , Journal article
- Relation: Exploratory Research in Clinical and Social Pharmacy Vol. 3, no. (2021), p. 100038-100038
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- Description: Knowledge and perceptions about chronic disease and medications play a crucial role in determining long-term treatment adherence to diseases such as hypertension. Exploring in depth the barriers and enablers to medication adherence in specific population subgroups such as Middle Eastern refugees and migrants in Australia is important. This may provide a better understanding of each of these groups' beliefs and knowledge and suggest strategies and interventions to improve medication adherence. This study aimed to understand Middle Eastern refugees' and migrants' experiences, perceptions, and knowledge about hypertension and to explore factors affecting medication adherence. In this study 15 participants who identified themselves as Middle Eastern refugees and migrants in Australia and had been diagnosed with hypertension were interviewed (migrants = 5, refugees =10) using semi-structured interviews. Recorded interviews were analysed using a thematic analysis framework and the findings were reported according to consolidated criteria for reporting qualitative research. Three key themes emerged from the interview analysis: (1) dealing with the illness in terms of understanding the symptoms and causes, self-managing of high blood pressure, and coping and acquaintance with the illness (2) beliefs, practices around medication adherence and the barriers and facilitators to taking medications regularly and (3) healthcare encounters represented by participants trust in healthcare providers. Differences were found between refugees and migrants relating to the understanding, control, and coping with hypertension, beliefs about medications, trust of healthcare providers, and taking medications as prescribed. There were also differences in the social context of the two groups. Understanding the factors that prevent adherence to hypertension in Middle Eastern refugees addressed the gap in the literature regarding refugees' beliefs and medication adherence. Future studies are recommended to assess the improvement in medication adherence in refugees by modifying their beliefs, attitude, and knowledge about medications and illness. In addition, healthcare providers should consider the differences between Middle Eastern refugees and migrants when providing the health advice that targets each of these population independently to ultimately improve their overall health and adherence to medications. Erratum: The publisher regrets that the section below was accidentally anonymized in the original published version of this article: “Ethical approval was obtained from (redacted) 60–19/22299”. This section should read: “Ethical approval was obtained from RMIT University Ethics Committee 60–19/22299”. The publisher would like to apologise for any inconvenience caused.
- Authors: Shahin, Wejdan , Kennedy, Gerard , Stupans, Ieva
- Date: 2021
- Type: Text , Journal article
- Relation: Exploratory Research in Clinical and Social Pharmacy Vol. 3, no. (2021), p. 100038-100038
- Full Text:
- Reviewed:
- Description: Knowledge and perceptions about chronic disease and medications play a crucial role in determining long-term treatment adherence to diseases such as hypertension. Exploring in depth the barriers and enablers to medication adherence in specific population subgroups such as Middle Eastern refugees and migrants in Australia is important. This may provide a better understanding of each of these groups' beliefs and knowledge and suggest strategies and interventions to improve medication adherence. This study aimed to understand Middle Eastern refugees' and migrants' experiences, perceptions, and knowledge about hypertension and to explore factors affecting medication adherence. In this study 15 participants who identified themselves as Middle Eastern refugees and migrants in Australia and had been diagnosed with hypertension were interviewed (migrants = 5, refugees =10) using semi-structured interviews. Recorded interviews were analysed using a thematic analysis framework and the findings were reported according to consolidated criteria for reporting qualitative research. Three key themes emerged from the interview analysis: (1) dealing with the illness in terms of understanding the symptoms and causes, self-managing of high blood pressure, and coping and acquaintance with the illness (2) beliefs, practices around medication adherence and the barriers and facilitators to taking medications regularly and (3) healthcare encounters represented by participants trust in healthcare providers. Differences were found between refugees and migrants relating to the understanding, control, and coping with hypertension, beliefs about medications, trust of healthcare providers, and taking medications as prescribed. There were also differences in the social context of the two groups. Understanding the factors that prevent adherence to hypertension in Middle Eastern refugees addressed the gap in the literature regarding refugees' beliefs and medication adherence. Future studies are recommended to assess the improvement in medication adherence in refugees by modifying their beliefs, attitude, and knowledge about medications and illness. In addition, healthcare providers should consider the differences between Middle Eastern refugees and migrants when providing the health advice that targets each of these population independently to ultimately improve their overall health and adherence to medications. Erratum: The publisher regrets that the section below was accidentally anonymized in the original published version of this article: “Ethical approval was obtained from (redacted) 60–19/22299”. This section should read: “Ethical approval was obtained from RMIT University Ethics Committee 60–19/22299”. The publisher would like to apologise for any inconvenience caused.
Health beliefs and chronic illnesses of refugees : a systematic review
- Shahin, Wejdan, Stupans, Ieva, Kennedy, Gerard
- Authors: Shahin, Wejdan , Stupans, Ieva , Kennedy, Gerard
- Date: 2021
- Type: Text , Journal article
- Relation: Ethnicity and Health Vol. 26, no. 5 (2021), p. 756-768
- Full Text: false
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- Description: Objective: To evaluate beliefs, and attitudes about health of refugees with chronic conditions such as diabetes mellitus type 2, hypertension, chronic obstructive pulmonary disease, and posttraumatic stress disorder and the consequent effects on self-care in comparison to resident populations. Design: A systematic review methodology was used. PubMed, Embase, PsycINFO and CINAHL databases were searched for relevant articles. The main terms analysed were health beliefs, chronic conditions and refugee populations. From 844 articles, 45 were retained for further assessment, and finally 5 met the inclusion criteria. Results: Differences in the health beliefs, attitudes and self-care management approaches of refugees compared to resident populations were identified in two studies. The remaining three papers did not make comparisons between the refugees and the resident population, nor did they specifically explore the refugees’ health beliefs. Of the five studies, three were carried out in Sweden and two in the US. Refugees who have poorer mental and physical health as well as higher prevalence of chronic diseases than the populations among which they resettle seem to lack the knowledge about their illness, symptoms and self-management and thus are less able to control their chronic conditions. Conclusion: The findings highlighted the deficiency in the literature of studies which examine health beliefs and attitudes of minority groups such as refugees who have chronic conditions. The findings also gave insight to the need for a distinctive understanding of refugee health and the management of chronic conditions in comparison to other non-refugee migrant groups. Further research is needed to fully understand the differences between refugees and local populations in terms health beliefs, chronic disease and self-management. © 2018 Informa UK Limited, trading as Taylor & Francis Group.
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