Abstract
Purpose
The aim of this study was to explore medicine use among first-generation immigrants from Pakistan who had been residing in Norway 10 years or more, with emphasis on cultural influences, language proficiency, and sociodemographic variables.
Methods
Personal interviews with 82 first-generation Pakistani immigrants (40–80 years) were conducted primarily in the participant’s home using a semistructured questionnaire. The participants were users of antihypertensives, and/or antidiabetics, and/or cholesterol-lowering drugs.
Results
All participants had a family doctor in Norway. They used on average 6.7 (range: 1–28) prescription drugs, and 48% used nonprescription drugs (primarily analgesics) as well. Fifteen percent were occasionally using drugs acquired from Pakistan. Two thirds reported various disease symptoms despite being on medication. Fifty-one percent lacked essential knowledge of their drug therapy, but 93% were of the opinion that it was important to take drugs every day. Nearly half of the participants altered their drug taking during Ramadan. Women were overrepresented when it came to reporting symptoms, fasting, frequent physician visits, and communicational challenges in the pharmacies. Women and/or those with low educational levels were most likely to send someone else to collect their drugs from the pharmacy or bring family members along to act as translators.
Conclusion
This study shows that cultural influences may affect medicine use among first-generation immigrants from Pakistan after having lived 10 years or more in Norway. Although access to drugs and basic health care services seems to be problem free, language proficiency is a considerable problem that obstructs access to information and is detrimental to the level of communication with health professionals.
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References
Statistics Norway Immigration and immigrants. http://www.ssb.no/english/subjects/00/00/10/innvandring_en/. Accessed 7 July 2011
Dalgard O, Thapa S (2007) Immigration, social integration and mental health in Norway, with focus on gender differences. Clin Pract Epidemol Ment Health 30:24
Hjellset VT, Bjørge B, Eriksen HR, Høstmark AT (2011) Risk factors for type 2 diabetes among female Pakistani immigrants: the InvaDiab-DEPLAN study on Pakistani immigrant women living in Oslo, Norway. J Immigr Minor Health 13:101–110
Syed HR, Dalgard OS, Hussain A, Dalen I, Claussen B, Ahlberg NL (2006) Inequalities in health: a comparative study between ethnic Norwegians and Pakistanis in Oslo. Norway. Int J Equity Health 29:7
Tran AT, Diep LM, Cooper JG, Claudi T, Straand J, Birkeland K, Ingskog W, Jenum AK (2010) Quality of care for patients with type 2 diabetes in general practice according to patients' ethnic background: a cross-sectional study from Oslo. Norway. BMC Health Serv Res 28:145
Glenday K, Kumar B, Tverdal A, Meyer H (2006) Cardiovascular disease risk factors among five major ethnic groups in Oslo, Norway: the Oslo Immigrant Health Study. Eur J Cardiovasc Prev Rehabil 13:348–355
Håkonsen H, Toverud EL (2011) Special challenges for drug adherence following generic substitution in Pakistani immigrants living in Norway. Eur J Clin Pharmacol 67:193–201
Mead N, Roland M (2009) Understanding why some ethnic minority patients evaluate medical care more negatively than white patients: a cross sectional analysis of a routine patient survey in English general practices. BMJ 16;339:b3450. doi:10.1136/bmj.b3450
Suurmond J, Uiters E, de Bruijne MC, Stronks K, Essink-Bot ML (2011) Negative health care experiences of immigrant patients: a qualitative study. BMC Health Serv Res 14:10
Babar ZU, Jamshed S (2008) Social pharmacy strengthening clinical pharmacy: why pharmaceutical policy research is needed in Pakistan? Pharm World Sci 30:617–619
Kiani A, Qadeer A, Mirza Z, Khanum A, Tisocki K, Mustafa T (2006) Prices, availability and affordability of medicines in Pakistan. Report of The Network for Consumer Protection, Islamabad http://www.haiweb.org/medicineprices/surveys/200407PK/survey_report.pdf Accessed 7 July 2011
Ali NS, Khuwaja AK, Zafar AM (2009) Characteristics of patients using psychoactive drugs in Karachi, Pakistan. Pharm World Sci 31(3):369–372
Scheppers E, van Dongen E, Dekker J, Geertzen J, Dekker J (2006) Potential barriers to the use of health services among ethnic minorities: a review. Fam Pract 23:325–348
Horne R, Graupner L, Frost S, Weinman J, Wright SM, Hankins M (2004) Medicine in a multi-cultural society: the effect of cultural background on beliefs about medications. Soc Sci Med 59:1307–1313
Kumar K, Gordon C, Toescu V, Buckley CD, Horne R, Nightingale PG, Raza K (2008) Beliefs about medicines in patients with rheumatoid arthritis and systemic lupus erythematosus: a comparison between patients of South Asian and White British origin. Rheumatol Oxf 47:690–697
Lawton J, Ahmad N, Hallowell N, Hanna L, Douglas M (2005) Perceptions and experiences of taking oral hypoglycaemic agents among people of Pakistani and Indian origin: qualitative study. BMJ 330:1247
Lip GY, Khan H, Bhatnagar A, Brahmabhatt N, Crook P, Davies MK, West Birmingham heart failure project (2004) Ethnic differences in patient perceptions of heart failure and treatment: the West Birmingham heart failure project. Heart 90:1016–1019
Bhopal RS (2007) Ethnicity, race, and health in multicultural societies: foundations for better epidemiology, public health and health care. Oxford University Press, Oxford
Fagerli RA, Lien ME, Wandel M (2007) Health worker style and trustworthiness as perceived by Pakistani-born persons with type 2 diabetes in Oslo, Norway. Health Lond 11:109–129
Håkonsen H, Eilertsen M, Borge H, Toverud EL (2009) Generic substitution: additional challenge for adherence in hypertensive patients? Curr Med Res Opin 25:2515–2521
Traylor AH, Schmittdiel JA, Uratsu CS, Mangione CM, Subramanian U (2010) Adherence to cardiovascular disease medications: does patient-provider race/ethnicity and language concordance matter? J Gen Intern Med 25:1172–1177
Westberg S, Sorensen T (2005) Pharmacy-related health disparities experienced by non-english-speaking patients: impact of pharmaceutical care. J Am Pharm Assoc 45:48–54
Salti I, Bénard E, Detournay B, Bianchi-Biscay M, Le Brigand C, Voinet C, Jabbar A (2004) A population-based study of diabetes and its characteristics during the fasting month of Ramadan in 13 countries: results of the epidemiology of diabetes and Ramadan 1422/2001 (EPIDIAR) study. Diabetes Care 27:306–311
Ahmadani MY, Riaz M, Fawwad A, Hydrie MZI, Hakeem R, Basit A (2008) Glycaemic Trend During Ramadan in Fasting Diabetic Subjects: A study from Pakistan. Pak J Biol Sci 11:2044–2047
Benaji B, Mounib N, Roky R, Aadil N, Houti IE, Moussamih S, Maliki S, Gressier B, El Ghomari H (2006) Diabetes and Ramadan: review of the literature. Diabetes Res Clin Pract 73:117–125
M'Guil M, Ragala MA, El Guessabi L, Fellat S, Chraibi A, Chebraoui L, Israili ZH, Lyoussi B (2008) Is Ramadan fasting safe in type 2 diabetic patients in view of the lack of significant effect of fasting on clinical and biochemical parameters, blood pressure, and glycemic control? Clin Exp Hypertens 30:339–357
Hughes AO, Fenton S, Hine CE, Pilgrim S, Tibbs N (1995) Strategies for sampling black and ethnic minority populations. J Public Health Med 17:187–192
Acknowledgements
The authors are sincerely grateful to the International Health and Social Group and the Pakistani Women’s Group. This study was supported financially for interpreter services by the Foundation for the Promotion of Pharmacy Practice (Norway).
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Håkonsen, H., Toverud, EL. Cultural influences on medicine use among first-generation Pakistani immigrants in Norway. Eur J Clin Pharmacol 68, 171–178 (2012). https://doi.org/10.1007/s00228-011-1111-7
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DOI: https://doi.org/10.1007/s00228-011-1111-7