Understanding the influence of ethnicity on medicines adherence

Abstract

Diabetes is a significant global public health issue, resulting in serious and costly complications and reduced life expectancy. Adherence to prescribed medication is an essential component of diabetes management to obtain optimal outcomes. Understanding the factors influencing adherence is key to optimising adherence to antidiabetic medication. One factor that has yet to be studied in this context is ethnicity and given the increased incidence of diabetes in certain ethnic groups, it is important to establish if or how adherence to diabetes medication varies by ethnic group (Chapter 1). A systematic review of the existing quantitative literature was conducted to explore whether medication adherence to antidiabetic medications in people with diabetes varied by ethnicity (Chapter 2). Most of the included studies showed statistically significant disparities in adherence among different ethnic groups, with minority ethnic groups in high-income countries often reporting the lowest rates. A second systematic review (meta ethnography) was undertaken to synthesise the existing qualitative data to explore the barriers to and facilitators of adherence to antidiabetic medications experienced by people from minority ethnic communities in high-income countries (Chapter 3), revealing a gap in the literature concerning ethnicity-related factors from the perspectives of both minority ethnic communities and the majority within the context of socioeconomic deprivation. Chapters 4 and 5 detail two qualitative studies conducted in socioeconomically deprived settings in the United Kingdom and Saudi Arabia. The UK study (Chapter 4) explored the perspectives of people from South Asian and White British ethnic backgrounds in the North East of England. The results identified a range of barriers and facilitators, with some shared by both groups and others unique to the South Asian participants, including a preference for alternative medicine, certain religious-related beliefs and practices, social stigma associated with the condition, and unawareness of free prescription availability. The Saudi Arabian study (Chapter 5) involved participants from South Asian and Saudi Arabian backgrounds, highlighting a range of barriers and facilitators—some shared across both groups and others unique to each ethnic community. This research identified several factors influencing adherence, including ethnicity related and socioeconomic influences, as well as personal and healthcare system-related factors; these findings should inform the development of tailored interventions (Chapter 6).