Almane, MB; (2017) Adherence to cardiovascular medications among Arabic women living in Kuwait. Doctoral thesis , UCL (University College London).

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Abstract

BACKGROUND: Little is known about Arab women’s (AW) perceptions of medication use in Kuwait. Women with cardiovascular disease (CVD) manage their condition in the context of their lives and responsibilities, so a culturally adapted intervention may have a greater impact on individual behaviour. This study aims to assess adherence to CVD medications among Arab women with cardiovascular disease (AW-CVD), to explore barriers to adherence from the perspectives of both patients and healthcare providers (HCP), to examine possible service developments and to make recommendations to optimise treatment outcomes. METHOD: A mixed methods approach was used, including a cross-sectional survey (N=270) followed by 29 face-to-face and telephone semi-structured interviews with AW-CVD and 17 face-to-face interviews with HCP. Settings: Multiple health centres across Kuwait (N=10). Survey instruments: Patients’ demographics, clinical variables, the 8-item Modified Morisky Adherence Scale (MMAS-8), the Brief Illness Perception Questionnaire, the Beliefs about Medication Questionnaire (Necessity and Concern Scale), social support from family and friends section of the Chronic Illness Resources Survey, measurement of healthcare provisions, beliefs about herbal remedies, and measurement of CVD self-care behaviours. All interviews investigated perceived barriers to medication adherence. The HCP interviews further explored HCPs’ current practice, their suggestions on how to improve current practice and a discussion on the difficulties and opportunities of applying these suggestions. Alongside a review of existing worldwide models of chronic disease management, the collected data helped inform the development of culturally sensitive chronic care services and behaviour change intervention. RESULTS: Ninety-three per cent of AW-CVDs were sub-optimally adherent to medications based on MMAS-8. Several barriers to medication adherence were identified from both AW-CVD and HCP perspectives: patient-related factors, HCP-related factors, disease-related factors, therapy-related factors and social factors. The HCPs tried to support medication adherence by educating the patients, simplifying the treatment regimen and ensuring the availability of medications. However, a number of limitations in their work structure restrict such progress, including time constraints, shortage of work force, lack of training and resources, lack of performance evaluations and poor cooperation among HCPs. The development of a chronic disease management model was proposed to overcome this gap. Such a model would suggest integrated services in which the HCP is provided with the necessary skills and resources to educate patients to become proactive and make informed decisions with the support of their communities. CONCLUSION: This research extends our knowledge of barriers to CVD medication adherence. The findings of the thesis suggest that there is a definite need for reorganization of the current chronic care system in Kuwait. This information was used to develop a chronic disease management model. The challenge now for future studies is to understand the feasibility of the proposed model.

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