Medication Taking Beliefs among American Samoan Adults with Type 2 Diabetes

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1 Medication Taking Beliefs among American Samoan Adults with Type 2 Diabetes Diana W. Stewart, M.A. Society for Behavioral Medicine April 30, 2011 BROWN Alpert Medical School

2 Contributing Authors Judith DePue, EdD, MPH Rochelle K. Rosen, PhD Nicole Bereolos, PhD Michael Goldstein, MD John Tuitele, MD Stephen McGarvey, PhD, MPH Supported by NIDDK, R18-DK (PI: S. McGarvey)

3 Diabetes and American Samoa Type 2 diabetes is a universal epidemic, affecting 220 million worldwide [WHO, 2009] 10.7% of US adults have diabetes [NIDDK, 2007] Recently modernized nations such as the Pacific Islands are disproportionately affected [DiBello et al., 2009; Zimmet et al., 2001] In American Samoa (AS), 22% of adults have diabetes In less modernized Western Samoa, 11.5% have diabetes

4 Medication Adherence Diabetes is best managed with diet and lifestyle modification and strict medication adherence [ADA, 2011; Wing et al., 2001] Patients responsible for management Medication non-adherence is common for those with chronic illnesses such as diabetes [e.g., Osterberg & Blaschke, 2005] Largely because medications are used to prevent complications little positive reinforcement

5 Medication Taking Beliefs Medication non-adherence is associated with a variety of barriers (e.g., health literacy, transportation) to taking medications [McPherson et al., 2008; Walker et al., 2006] Research has explored the role of medication taking beliefs in those with diabetes Low adherence associated with beliefs inconsistent with chronic disease model [Mann et al., 2009] Concern about medication side effects Diabetes only occurs when blood sugar is high

6 Role of Samoan Culture on Health Beliefs Harmonious social relationships are part of health [Capstick et al., 2009] Beliefs are pluralistic both traditional and Western [Capstick et al., 2009] 2 Paradigms [Norris et al., 2009] Samoan illnesses treated with Samoan medicines Palagi illnesses (e.g., diabetes) treated with Western medicines Family members influence beliefs about what an illness is and how to treat it [Norris et al., 2009]

7 Purpose of Present Study Cultural aspects might affect medication taking beliefs and thereby influence medication adherence We explored whether or not cultural beliefs might impact opinions about medication taking in AS adults with diabetes

8 American Samoa 2600 miles southeast of Hawaii 6 inhabited islands 83% ethnic Samoans 57% below poverty level Medically underserved with a shortage of health professionals

9 Procedures 6 focus groups conducted Facilitated by local project staff Part of a larger study formative step to culturally translate a diabetes intervention Questions assessed barriers and facilitators to diabetes care

10 Participants 39 adults with type 2 diabetes recruited from the Tafuna Family Health Center (TFHC) 56% female Mean age 59 years old Education 0-8 years 23% 9-12 years 44% years 13% Missing 20%

11 Data Preparation and Analyses Focus groups were translated, transcribed, and entered into NVivo 8 software for management and analyses Transcripts were reviewed by at least 2 coders using codes pertaining to medication taking and adherence

12 Results Confusion about how and when to take medications and potential side effects I have taken all these different pills, but they make my body weak. So it s better to just don t [take] any pills unless you feel your blood sugar high. He [the doctor] gave me Glucophage to [take]. I [took] it twice, and what I felt then was my body was so weak. So I guess it s of no use for me to [take] it.

13 Results Unclear about high vs. low blood sugar and how to use medication to regulate changes in blood sugar When I check my sugar level, I really don t know what is high and what is low. Concern about medication costs Our strips and insulin shots are being taken care of by our kids off island because it s too expensive here in Samoa.

14 Results Samoan cultural beliefs characterized as: Adherence to self-care and doctor s advice for the sake of, or to honor family, and in respect for God Obey the doctor and you will live longer. The Lord made our bodies so He knows the problems and the things we are supposed to do. My family would be upset if I did not take care of myself.

15 Results Non-adherence was described when faced with conflicts with family or cultural obligations, or due to belief in traditional Samoan medicines I have never gone back for any of my appointments right now, I just love to [take] the Samoan leaves [as] medications. When I give money to fa alavelave, or to the church, I can t pay for the medicine. Traditional Samoan medicine works better on Samoans than diabetes pills, which were made for Palagis.

16 Conclusions Diabetes rates are extremely high in newly westernized nations such as AS Barriers like medication costs and confusion about medications may negatively impact medication-taking beliefs and adherence Cultural values might work for and against medication adherence

17 Limitations Focus groups were designed to assess barriers and facilitators to diabetes care Did not pertain specifically to beliefs about medication taking Qualitative analyses done with translated transcripts Subtleties might have been missed Medication adherence was not assessed

18 Implications and Future Directions First known study to evaluate medication taking beliefs in a sample of AS adults with diabetes Further research needed to assess medication adherence in this population Studies in progress: Compare focus group results to in-depth interviews with health clinic staff to explore differences in perceptions of medication taking Explore how community health workers might be helpful in teaching patients about medication

19 Thank you!

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