King-Shier Kathryn, Quan Hude, Mather Charles, Chong Elaine, LeBlanc Pamela, Khan Nadia
Faculty of Nursing, University of Calgary, Calgary, Canada,
Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada,
Patient Prefer Adherence. 2018 Sep 7;12:1737-1747. doi: 10.2147/PPA.S169167. eCollection 2018.
There are ethno-cultural differences in cardiac patients' adherence to medications. It is unclear why this occurs. We thus aimed to generate an in-depth understanding about the decision-making process and potential ethno-cultural differences, of white, Chinese, and south Asian cardiac patients when making the decision to adhere to a medication regimen.
A hierarchical descriptive decision-model was generated based on previous qualitative work, pilot tested, and revised to be more parsimonious. The final model was examined using a novel group of 286 cardiac patients, using their self-reported adherence as the reference. Thereafter, each node was examined to identify decision-making constructs that might be more applicable to white, Chinese or south Asian groups.
Non-adherent south Asians were most likely to identify a lack of receipt of detailed medication information, and less confidence and trust in the health care system and health care professionals. Both Chinese and south Asian participants were less likely to be adherent when they had doubts about western medicine (eg, the effects and safety of the medication). Being able to afford the cost of medications was associated with increased adherence. Being away from home reduced the likelihood of adherence in each group. The overall model had 67.1% concordance with the participants' initial self-reported adherence, largely due to participants' overreporting adherence.
These identified elements of the decision-making process are generally not considered in traditionally used medication adherence questionnaires. Importantly these elements are modifiable and ought to be the focus of both interventions and measurement of medication adherence.
心脏病患者在药物治疗依从性方面存在种族文化差异。目前尚不清楚为何会出现这种情况。因此，我们旨在深入了解白种人、华裔和南亚裔心脏病患者在决定坚持药物治疗方案时的决策过程以及潜在的种族文化差异。
基于之前的定性研究成果构建了一个分层描述性决策模型，进行了预试验并进行修订以使其更简洁。使用一组新的286名心脏病患者对最终模型进行检验，以他们自我报告的依从性作为参考。此后，对每个节点进行检查，以确定可能更适用于白种人、华裔或南亚裔群体的决策构成要素。
不依从的南亚裔患者最常指出缺乏详细的用药信息，并且对医疗保健系统和医护人员的信心及信任度较低。华裔和南亚裔参与者在对西药（如药物的效果和安全性）存在疑虑时，依从性较低的可能性更大。能够负担药物费用与依从性增加相关。离家会降低每组患者的依从可能性。总体模型与参与者最初自我报告的依从性有67.1%的一致性，这主要是由于参与者对依从性的报告过高。
这些确定的决策过程要素在传统使用的药物治疗依从性问卷中通常未被考虑。重要的是，这些要素是可改变的，应该成为药物治疗依从性干预和测量的重点。
