Evidence-based interventions promoting adherence in Afro-Caribbean populations

¶ … Afro-Caribbeans

WHAT WORKS BEST

Adherence Intervention for Afro-Caribbeans

Recent improvements on prescription medications are beneficial only if patients adhere to them faithfully. Non-adherence is common and results in adverse conditions (Ho et al., 2009). This is a problem both to patients and heir care providers as well as the healthcare system itself. The solution consists of identifying the causes and motivations of non-adherence and the design and implementation of better interventions to improve adherence (Ho et al.). The following studies present and suggest more effective interventions for a variety of health conditions among Afro-Caribbean people who have been reported to have a high level of non-adherence to therapy.

Literature Review

Culture-Specific Interventions

Many health providers contend that more effective interventions in reducing risks for diseases, especially HIV / AIDS, through greater adherence need to culturally conform to the specific culture of the subject population (Archibald, 2011). This study used a naturalistic approach in securing the experiences of four self-identified Afro-Caribbean Americans through an interview. Results were consistent with those of the findings of Struthers, Eschiti and Patchell (2008). Content analysis revealed that the respondents have strong values, healthy intentions, and appropriate attitude, which are the critical factors for such precise interventions. The values that must guide interventions are embracing of both cultures, dialects, church and leaders, non-entitlement for American benefits, and respect. The conclusion emphasizes the need for healthcare to be culturally competent in responding to increasing prevalence of diversity in the U.S. (Archibald).

Knowledge and Attitudes as Key

This research focused on prevention in interviewing the respondents on their knowledge and attitudes, specifically towards HIV / AIDS and risky sexual behavior, and how preventive measures can be better adhered to (Archibald, 2007). Respondents were 22 adolescents who said that they had accurate knowledge about HIV / AIDS; would refuse to share their space and personal items with those infected with it; and that they abstained from sexual activity mainly out of parental fear and church teachings. Afro-Caribbean commonly share space and personal items among themselves. Their unwillingness to do this with those infected HIV / AIDS among them deserved further study (Archibald).

Only in Combination with Indigenous Medicines

A phenomenological study was conducted to determine the use of non-prescribable medicines in treating Type 2 diabetes in the specific population for the purpose of achieving greater adherence (Moss & McDowell, 2005). The respondents were patients consulting at a rural diabetes clinic in St. Vincent. The study used the four steps of bracketing, intuiting, analysis, and description in exploring the respondents' experiences and how they interpret these themselves. They use and view as effective a variety of non-prescribable herbal and folk medicines in treating their diabetes. They observe a strong religious basis for disease and self-care, which offered them symptom relief and satisfaction through spiritual revelations about them. They consider these non-prescribable, indigenous medicines effective. They are willing to take conventional medicine only in conjunction or combination with their non-prescribable, indigenous treatments or they will not take any conventional medicines at all. They perceive conventional medicine as an access to medical care. This finding is believed to be consistent or relevant to that of studies conducted in other rural populations where social and religious beliefs and prejudices are strong (Moss & McDowell).

Inadequate knowledge and understanding, mistrust, feared treatment

In a continuing effort at understanding how African-Caribbean people's health habits influence their managing illness, particularly diabetes, one-to-one interviews were conducted (Brown, 2007). Respondents were 16 African-Caribbean patients with type 2 diabetes from the inner-city Nottingham from 2003 to 2004. They related how they were influenced by memories of youth in the Caribbean, migration to the UK, their families' account of diabetes and their own experience of it. They admitted to a poor knowledge and understanding of the illness, mistrust in the effectiveness of the advice and treatment from healthcare professionals. They spoke well of them but also perceived them as not properly catering to Black people. They expressed preference for natural therapies. They feared insulin treatments. They perceived diet or medication control of diabetes as mild and not serious. Findings reveal how respondents deal with their illness, the delivery of diabetes care to this community, and the basis for an adherence intervention program (Brown).

Coping Strategies

African and Afro-Caribbean communities cope much with the stigma of a high HIV / AIDS incidence rate. A survey of this stigma and how they cope with it was conducted on HIV-positive and HIV-negative members of the Afro-Caribbean communities in the Netherlands (Stutterheim et al., 2012). Findings showed that stigma manifests as social distance, physical distance, words and silence. Poor adherence to treatment was one consequence. Psychological consequences included emotional pain, sadness, loneliness, anger, frustration and internalized stigma. Social consequences included reduced social contact size, limited social support, social isolation and self-imposed social withdrawal (Stutterheim et al.).

The respondents used both problem-focused and emotion-focuses coping strategies to lessen the impact of the negative consequences of a stigma (Stutterheim et al., 2012). Problem-focused coping strategies used included selective disclosure, disengagement, associating with similar persons, obtaining social support and activism but at a lesser degree. Emotion-focused strategies applied included distraction, positive reappraisal, religious coping, external attributions, reversing identification, and acceptance (Stutterheim et al.). These strategies should form part of an overall adherence intervention to HIV/ADS in order to be effective.

Barriers to Beginning and Maintaining Prostate Antigen Screening

This study examined the effect of race or ethnicity in starting and maintaining annual prostate specific antigen screening and the physician's role in its continuity (Gonzales et al., 2008). The justification/motivation was the likelihood of the highest global incidence of prostate cancer among Black American an Afro-Caribbean men. Respondents were 533 men, aged 45-70, from Brooklyn, New York who were White and Blacks born in the United States, immigrant Jamaican men and immigrant men from Trinidad and Tobago. Their screening behavior across their 4 ethnic groups was recorded and compared (Gonzales et al.).

Results showed that 28.3% of the participants reported for the annual screening, 44.5% did less than annually, and 27.2% never reported and were never screened (Gonzales et al., 2008). Jamaicans and those from Trinidad and Tobago were likely to submit for screening less than annually. All 3 black ethnic groups were less likely to maintain the screening than Whites and men who did not undergo annual physical examination and those with low knowledge about prostate cancer. The study concluded that Afro-Caribbean men may undergo initial screening but less likely to maintain annual screening. Physicians play an important role in insuring the continuity of this annual antigen screening. There is clear need for more culturally appropriate outreach efforts and educational intervention to improve or raise the level of compliance or adherence to screening (Gonzales et al.).

Knowledge and Correct Perceptions of Anticoagulants

A cross-sectional questionnaire study was conducted on patients receiving anticoagulants at the Birmingham teaching hospitals (Nadar et al., 2003). Respondents were 135 White Europeans, 29 Indo-Asians, and 16 Afro-Caribbeans. Results showed no significant differences among the groups. Indo-Asians were not too likely to know the name of their anti-coagulant medication. Afro-Caribbeans were not likely to know their condition for which they were receiving anti-coagulants. Few of all three groups could point out more than one side effect of the anticoagulant. Factors identified as possible contributions to a low score were age if over 61 years old, birth outside the UK, and the perception of their difficulty to comprehend. The study pointed to knowledge gaps among all ethnic minorities represented and deficiencies in providing information. The conclusion is the need for stronger patient education, especially in these high-risk groups (Nadar et al.).

The Healthy Project

The effectiveness of incentives and of peer-group organizers in the results of a health improvement program for seniors in a multi-ethnic location in West Midlands, England was examined (Holland et al., 2008). The study evaluated adherence, outcomes, and barriers to adherence, using a passport format. Seniors and Asians in origin were minimally represented. On the other hand, people of Afro-Caribbean were well represented. They were also likely to stay in the Project. Older participants were more likely to drop out because of age and/or illness. Significant improvements were noted in exercise, diet and the influenza vaccine shots, and eyesight tests. Positive outcomes were tabulated for incentives and the format. Reported barriers were lower involvement, lack of change, activities found too difficult, the level of understanding and transport and mobility issues. Positive changes resulted from an enjoyment of the scheme, in turn, with support from older people (Holland et al.).

Facilitators and Barriers to Adherence

The 50 respondents to a recent qualitative study on facilitators and barriers to adherence to multiple medications identified personal, contextual and health system factors in reply (Mishra et al., 2011). Barriers included medication side effects; fear of harm from, and dependence on, medication; complicated instructions; unclear communications with the doctor; suspicions over doctor's and pharmaceutical companies' true motives in prescribing; and high medication cost. Facilitators included self-discipline, sense of personal responsibility, faith, support from outside motivators, such as family members, doctors; and focused education and self-management support. Three issues surfaced that help understand the difficulty of adherence when taking multiple medications. These are reaching one's threshold for medication adherence, the lack of shared information and decision-making, and taking less than what is prescribed. Analysis of the finding also pointed to patients' lack of shared decision-making in managing their co-morbid chronic conditions and medication regimen (Mishra et al.).

Diabetes and Hypertension Guidelines

The current guidelines in the primary care of hypertension and diabetes in Barbados were perceived by their users as outdated, unavailable, difficult to remember, and had no pointers in dealing with barriers (Adams & Carter, 2010). Practitioners commented that these were not widely circulated, not promoted repeatedly during educational sessions, and were too lengthy. These were among the comments of the 63 health professionals and private sector participants, comprising focus groups in u public sector polyclinics in Barbados. Barriers to patients' adherence included denial and fear of stigma; financial resources for an appropriate diet, exercise and monitoring equipment; confusion over medication regimens; lack of appreciation for free medication; belief in alternative medicines; and the inability to change habits. System barriers included lack of access to blood tests, clinic equipment and medication; limited polyclinic personnel; and lack of coordinated team approach. Patients also confronted cultural barriers concerning meals, exercise, body size, footwear, taking of medication, responsibility for one's health, and difficulty leaving work to go to the clinic (Adams & Carter).