Impacts on practice
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There is a need to promote both primary and secondary prevention interventions for adherence to medication in UK South Asian patients with coronary heart disease.
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There remains a need for education within the South Asian communities on the causes and prevention of coronary heart disease.
Introduction
Aim of the study
Ethics approval
Methods
Study setting
Data collection
Data processing and analysis
Results
Belief about medicines questionnaire
Patient no. | Control | Intervention | Result on BMQ | Adherence baseline, 3 months 6 months | ||
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1 | BMQ 25/10 | Positive | 8 | 8 | 8 | |
2 | BMQ 25/19 | Positive | 8 | 8 | 8 | |
3 | BMQ 25/12 | Positive | 6.75 | 8 | 7 | |
4 | BMQ 25/12 | Positive | 7.5 | 8 | 7.5 | |
5 | BMQ 21/15 | Positive | 8 | 8 | 8 | |
6 | BMQ 24/11 | Positive | 8 | 8 | 8 | |
7 | BMQ 17/21 | Negative | 5.75 | 5.75 | 5.75 | |
8 | BMQ 20/19 | Positive | 8 | 8 | 8 | |
9 | BMQ 21/15 | Positive | 8 | 8 | 8 | |
10 | BMQ 15/20 | Negative | 5.75 | 0.7 | 0 | |
11 | BMQ 19/10 | Negative | 7 | 7 | 8 | |
12 | BMQ 19/14 | Positive | 7 | 6.75 | 7 | |
13 | BMQ 20/13 | Positive | 8 | 8 | 5.5 | |
14 | BMQ 21/16 | Positive | 8 | 8 | 6.75 | |
21/15 | Mean score |
Adherence
Qualitative interviews
Theme 1 perception of patients regarding their disease
South Asian patients’ beliefs and lived early experiences about CHD
Beliefs regarding the disease feeling ill versus healthy
Some relatively older patients in this sample believed that the disease was acute and after they had a procedure they were cured and therefore questioned the necessity of using medicine for a long period.I had a breathing problem heavily too much and now I am walking no breathing problem (male 68 years of Indian origin participant no. 1).
When considering the Morisky scale for these patients it was observed that they had low scores (e.g. BMQ negative score, Morisky scale 5.75 at baseline, 3, 6 months- Fig. 1). Other patients found it difficult to accept the disease.The disease is not serious now, I am not sure whether I need medicines and should I continue medicines or not? (68 years, male of Indian origin participant no. 1).
I was healthy and I didn’t take medicine all my life and then suddenly you have 6 different medicines a day this is a confusion (32 years old male from Bangladesh participant no. 3).
Causes of the disease
My family history my father died only when he was 51 and my brother when he was only 31 and he died he had another heart attack (male from Bangladesh participant no. 12).
Some patients mentioned that the cause could be related to their food which was described as containing a lot of rice and red meat and also the use of ghee for cooking.May be my family, it is running in my family, once you have it you have it (male from Bangladesh participant no. 3)
The younger patients in this sample linked the importance of healthy lifestyle choices for disease prevention.It is our food, we Asians we eat a lot of curry and rice and greasy food (male from Bangladesh participant no. 14).
I was going to the gym and I always look carefully at what I eat and I cut down on my alcohol (Patient of Pakistani origin age 48 participant no. 4).
Other reported causes from the interviews included stress and a flu after going for Hajj.I exercise nearly every day, I do this all the time, every day I have to go out for a good walk (43 year-old patient from Indian origin participant no. 7).
I am stressed from my work and it is stress that caused my heart attack but God gave me the life (52 years old female of Pakistani origin participant no. 2).
Before I was healthy but then I had a flu after back from Hajj, this is what it is (72 years old Male Pakistani origin participant no. 10).
Fatality: some patients mentioned the idea of the will of God and not the individual to determine future health.
Worries of having a second heart attack were raised in more than half of the patients’ interviews.What can you do I mean if God gave you the life whatever he gave, you have to live, it is in God’s hands (Female of Pakistani origin participant no. 2).
Some patients in this sample believed that the medicines might be able to prevent recurrence of CHD, these patients had positive BMQ-S scores.Now I worry all the time, it could happen any time again (male of Pakistani origin participant no. 10).
Theme 2 perception of patients regarding their medicines
South Asians’ beliefs, experiences and behaviours relating to medication taking in CHD
Role of medication necessity verses concerns
I think they are pretty important that is the reason they gave them to me but too much medicine, is this good for you? (male of Indian origin participant no. 8.)
Knowledge regarding the medicines
They are for cholesterol and clotting something like that, do not really know (male of Bangladeshi origin participant no. 5).
Chemist explained but memory not good (male of Bangladeshi origin participant no. 9).
Yes my GP told my son and at the hospital they told my son this is for this and this is for that, but they are important to take (Female Pakistani origin participant no. 2).
Theme 3 factors that influenced adherence to secondary prevention medication
Factors derived from the interviews that influenced adherence in interviewed South Asian patients
Forgetfulness
These patients were young patients and reported that their non-adherence was unintentional. They expressed a need to accept the disease and adapt to a new life style and routine that would include medication taking. Ways to remember to take medicines were reported as use of a pill box, writing on the boxes in native language, arranging them in a bag and making them accessible around the house.I take the medication all once a day so if I forget I forget the whole lot (Bangladeshi patient aged 42 participant no. 12).
Family support
My sister and my cousin they are trying to help me, my daughter gives me the medicine and I just take so I remember (male of Indian origin participant no. 6).
Side effects
One tablet ramipril tablet I was coughing and the coughing comes and goes every time, I told my GP and now I am on a different medication and I take it every day (male of Pakistani origin participant no. participant no. 10).
My feet do feel cold then they do not stay long it is just you know, it is not a major thing I still take my medicine (Female of Pakistani origin participant no. 2).
Relying on health care practitioner
The doctor said they are important for my body, I do not think about it if doctor says I need it then I need it that’s it (male of Indian origin participant no. 11).
Living in areas of deprivation
I have been living in this hostel for 4 years and people in this place are too many they are always banging shouting and screaming, I cook my food and if I leave it for 10 min it is gone from the cooker, I need to get out of this hole (male of Bangladeshi origin participant no. 5) BMQ Negative score, Morisky scale 5.75, 0.7, 0 at baseline, 3, 6 months).
Cardiac rehabilitation
The patients’ who attended cardiac rehabilitation reported that it was very useful and helpful.No I didn’t go to cardiac rehabilitation. If they start putting injections again, I do not want to go through that again (male of Bangladeshi origin participant no. 3).
I went to cardiac rehabilitation and I am thinking right now of joining a gym, I have changed the food I eat after cardiac rehabilitation (male of Bangladeshi origin participant no. 5).