Abdul Wahab Noor Azizah, Makmor Bakry Mohd, Ahmad Mahadir, Mohamad Noor Zaswiza, Mhd Ali Adliah
Centre of Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, 50300, Malaysia.
Faculty of Pharmacy and Health Sciences, Universiti Kuala Lumpur Royal College of Medicine Perak, Perak, 30450, Malaysia.
Patient Prefer Adherence. 2021 Oct 5;15:2249-2265. doi: 10.2147/PPA.S319469. eCollection 2021.
Hypertension is one of the major risk factors of stroke and leading risk factors for global death. Inadequate control of blood pressure due to medication non-adherence remains a challenge and identifying the underlying causes will provide useful information to formulate suitable interventions.
This study aimed to explore the roles of culture, religiosity, and spirituality on adherence to anti-hypertensive medications.
A semi-structured qualitative interview was used to explore promoters and barriers to medication adherence among hypertensive individuals residing in urban and rural areas of Perak State, West Malaysia. Study participants were individuals who are able to comprehend either in Malay or English, above 18 years old and on antihypertensive medications. Interview transcriptions from 23 participants were coded inductively and analyzed thematically. Codes generated were verified by three co-investigators who were not involved in transcribing process. The codes were matched with quotations and categorized using three levels of themes named as organizing, classifying and general themes.
Cultural aspects categorized as societal and communication norms were related to non-adherence. The societal norms related to ignorance, belief in testimony and anything "natural is safe" affected medication adherence negatively. Communication norms manifested as superficiality, indirectness and non-confrontational were also linked to medication non-adherence. Internal and organizational religiosity was linked to increased motivation to take medication. In contrast, religious misconception about healing and treatment contributed towards medication non-adherence. The role of spirituality remains unclear and seemed to be understood as related to religiosity.
Culture and religiosity (C/R) are highly regarded in many societies and shaped people's health belief and behaviour. Identifying the elements and mechanism through which C/R impacted adherence would be useful to provide essential information for linking adherence assessment to the interventions that specifically address causes of medication non-adherence.
高血压是中风的主要危险因素之一，也是全球死亡的主要危险因素。因药物治疗依从性不足导致血压控制不佳仍是一项挑战，找出潜在原因将为制定合适的干预措施提供有用信息。
本研究旨在探讨文化、宗教信仰和精神性对降压药物治疗依从性的作用。
采用半结构化定性访谈，以探究居住在马来西亚西部霹雳州城乡地区的高血压患者药物治疗依从性的促进因素和障碍。研究参与者为年龄在18岁以上、能理解马来语或英语且正在服用降压药物的个体。对23名参与者的访谈记录进行归纳编码并进行主题分析。生成的代码由三名未参与转录过程的共同研究者进行验证。这些代码与引文匹配，并使用组织、分类和一般主题三个层次的主题进行分类。
归类为社会和沟通规范的文化方面与不依从有关。与无知、相信证词以及“天然的就是安全的”相关的社会规范对药物治疗依从性产生负面影响。表现为表面性、间接性和非对抗性的沟通规范也与药物治疗不依从有关。内在和组织性宗教信仰与服药动机增加有关。相比之下，对治愈和治疗的宗教误解导致了药物治疗不依从。精神性的作用仍不明确，似乎被理解为与宗教信仰有关。
文化和宗教信仰在许多社会中受到高度重视，并塑造了人们的健康信念和行为。确定文化和宗教信仰影响依从性的因素和机制，将有助于提供重要信息，以便将依从性评估与专门解决药物治疗不依从原因的干预措施联系起来。
