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Table 1 Characteristics and findings of included journal articles

From: A systematic review of adherence in Indigenous Australians: an opportunity to improve chronic condition management

Reference Study aim Study population/Participants Setting Study design & data collection method Sample size Key findings Quality score
[32] To explore patients’ understanding of end stage kidney disease Patients with end stage renal disease, health professionals (HPs) and other relevant people 9 hospital renal units & 17 dialysis centres from NSW, WA, QLD, SA & NT Interviews 241 patients (incl 146 Indigenous people) One patient indicated he didn’t take medicines because he was busy doing ‘cultural stuff’ 50%
[22] To identify social and cultural issues affecting kidney transplants, compliance and transplant outcomes Aboriginal and/or Torres Strait Islander people who received kidney transplant between October 1983 and February 1994 and HPs from a major referral hospital Patients who attended Princess Alexandra Hospital, Brisbane, QLD Medical record review & in depth interviews 11 patients (number of HPs not provided) One patient linked their graft rejection to poor adherence to medicine.
HPs indicated inadequate adherence was an issue; they were frustrated when their efforts to address adherence were not followed by changes in patient behaviour.
18%
[12] To identify the characteristics and outcomes of Aboriginal people with Type 2 diabetes mellitus (T2DM) Urban dwelling Aboriginal people with T2DM Fremantle, WA Self-reported adherence measured using standardised questionnaires 1312
(incl 18 Aboriginal patients)
42% of Aboriginal patients reported missing doses occasionally or regularly (compared with 20% of Anglo-Celt patients) (p = 0.07). 92%
[40] To explore medication use by older women Women approximately 60 years old Adelaide, SA Semi structured interviews 140
(incl 12 Aboriginal women)
Barriers to adherence: sharing medicines; stopping medicines when they felt better; forgetting to take doses.
Suggested strategy: development of culturally appropriate medicine education resources.
36%
[41] To evaluate the uptake and outcomes of a cardiac rehabilitation program Patients who attended Heart Health program Metropolitan Aboriginal Medical Service, WA Interviews, questionnaires, yarning sessions & assessment of risk factors Not reported Adherence: some patients indicated they took medicine inconsistently.
Barriers to adherence: sharing medicines; taking expired medicines.
39%
[44] To explore the interface of Warlpiri culture and identity with biomedical elements of T2DM People living with T2DM and their family members. Remote Central Australian community, NT Interviews 84 people with T2DM, 14 family members Barriers to adherence: forgetting medicines while travelling; clinic not providing sufficient medicines to cover duration of trip; difficulty accessing medicines away from primary clinic; belief in God which meant one participant did not believe she need to take medicine. 21%
[30] To explore issues faced by Indigenous people with mental health issues, carers and family members Indigenous people with mental health issues, carers and family members Urban, regional and remote areas, SA Interviews & focus groups 130 Barriers to adherence: low English literacy; competing priorities; cost of medicines; no safe storage for medicines at home; swapping medicines.
Suggested strategy: racism needs to be eliminated from health services.
HP perspective: one indicated that some patients ‘just didn’t care’ about being adherent.
75%
[53] To explore why people presented late for treatment of tuberculosis (TB), and explore issues with adherence Aboriginal community members, HPs, council employee Remote Top End community, NT Interviews, focus groups, (conducted in English) & observations 51
(18 individual interviews,
5 focus groups)
Barriers to adherence: low level of perceived risk of latent TB; HP reported that some patients believed in the power of the mind, and therefore did not take medicine; limited clinic opening hours prevented accessing medicines.
Authors suggest the long duration of treatment and side effects may impair adherence.
Suggested strategy: increase the involvement of Aboriginal Health Practitioners (AHPs).
14%
[29] Explore the use of medicines by Indigenous people from the perspective of Aboriginal Health Workers (AHW) Aboriginal Health Workers Community health centres & hospitals, mid western NSW In depth interviews 11 Attitude to adherence: some said taking medicine was ‘not cultural’.
Barriers to adherence: communication barrier between HP and patient; low literacy; sharing medicines.
Suggested strategies: involvement of AHWs in medicine management; cultural awareness training for pharmacists.
68%
[14] To evaluate a chronic disease program Community residents with risk factors for chronic disease Remote Top End community, NT 2001–2003 medicine adherence captured using clinical audit 264 In 1996–98 2/3 of participants reported taking medicines ‘some or most of the time’ (data collection method not reported).
In 2001–03 ~70% of prescribed medicines were being collected from the pharmacy.
Authors attribute deterioration in clinical outcomes to reduction in compliance (evidence of reduced compliance was provided as a personal communication by the pharmacist).
Could not be assessed
[28] To explore HPs’ experiences and attitudes towards adherence in Indigenous health HPs working in the NT 4 hospitals, 2 Aboriginal Medical Services and some Department of Health programmes, NT Pre interview question sheet, focus groups 76 97% HPs reported that ‘non compliance’ was a major or significant problem.
3 most frequently reported barriers to adherence: inadequate communication between HP and patient; inadequate cross cultural training of HPs; insufficient numbers of AHPs.
3 most commonly reported facilitators of adherence: an understanding of Western medicine; family support; good rapport between HP and patient.
39%
[15] To investigate characteristics of Indigenous Australians with poorly controlled T2DM Indigenous people, 18–65 years, with HbA1c ≥ 8.5% 12 clinics, rural north QLD Method for measuring adherence not reported 193 46% of Aboriginal participants were adherent to all medicines; 31% of Torres Strait Islander participants were adherent to all medicines.
Authors suggest inadequate dose titration and clinical inertia contributed to poor clinical outcomes.
96%
[18] To evaluate outcomes of Aboriginal patients after open heart surgery Aboriginal people who had open heart surgery between July 1996 and November 2001 Sir Charles Gairdner Hospital, WA Clinical record review & telephone follow up (method of measuring adherence not reported) 57 Authors report that three patients were ‘irregular’ with their anticoagulation medicines (data source unclear).
Authors assert that compliance in patients who could not be contacted was ‘likely to be low’.
Poor clinical outcomes and one death were attributed to poor compliance by the authors.
46%
[34] To identify barriers to providing culturally appropriate services to Aboriginal people with diabetes HPs working with Aboriginal people with T2DM Government administered health regions, SA Semi structured questionnaire 43 Barrier to adherence: patients did not consider T2DM a priority (they had other more pressing issues to manage) 36%
[27] & [37] To explore experiences of health professionals working with Aboriginal people with mental health issues HPs working with Aboriginal and Torres Strait Islander people with mental health issues Urban, regional and remote areas, SA Survey 114 39% health professionals reported compliance was an issue.
Most commonly reported barriers to adherence: sharing medicines; side effects; cost of medicines; not travelling with medicines.
Facilitators of adherence: DAAs; supporting patients to resolve broader life issues.
75%
[21] To explore barriers to mental health service delivery in remote communities HPs working in mental health in remote areas Remote primary health centres, NT Semi structured interviews 41 82.9% HPs said non adherence was a common cause of relapse.
87.2% HPs reported that poor compliance was a barrier to prescribing oral medicines.
−4%
[70] To explore HPs’ perspectives of the experience of Aboriginal people with cancer HPs providing cancer services to Aboriginal people Metropolitan and remote locations, WA In depth interviews 62 Suggested strategy: Aboriginal liaison officers or cancer nurse coordinators should repeat medical information to patients after they have seen the clinician 61%
[19] To document epidemiology of tuberculosis cases All cases of tuberculosis notified from January 1993 – December 1997 Far North Queensland Medical record review 87
(including 50 Aboriginal and/or Torres Strait Islander people)
All relapses occurred in Aboriginal and/or Torres Strait Islander patients; all had documented ‘compliance problems, mainly attributed to alcohol abuse’.
Facilitator of adherence (as reported by authors): increased employment of AHPs.
36%
[23] To determine the readiness of community pharmacists to play a larger role in Indigenous health Community pharmacists working in areas with significant Indigenous populations Urban, rural and remote NSW Semi structured in depth interviews 27 Attitudes towards adherence: participants felt that adherence was a major problem, and one stated that ‘they’re very poor tablet takers’.
Suggested strategies: DAAs; involvement of AHPs in dispensing; cultural training for HPs; development of culturally appropriate resources.
64%
[33] Explore experiences of Aboriginal and/or Torres Strait Islander people with medicines Aboriginal people taking multiple medicines Primary health centres in urban, rural and regional QLD, NT, SA, NSW and VIC Semi structured focus groups (conducted in English) 101 Barriers to adherence: difficulty accessing medicines while travelling; forgetting; fear of Western medicine; other more pressing issues; change in tablet appearance; information provided difficult to read and understand.
Facilitators of adherence: DAAs; reminders from families and friends.
Suggested strategy: provision of more information.
54%
[45] & [46] To explore perspective of Torres Strait Islander people with diabetes Torres Strait Islander people with T2DM 8 remote communities, Torres Strait Islands In depth interviews, focus groups 67 Barriers to adherence: forgetting; side effects; lack of family support; not wanting to feel like a diabetic (one person); some participants refused to take medicines, saying that they believed in God.
Suggested strategy: support groups.
Authors suggest that limited understanding of how medicines worked was likely to impair adherence and therefore clearer information was required.
57%
[49] To explore the role of alcohol in the lives of Aboriginal people with HIV Aboriginal people who were HIV + Metropolitan and rural areas, WA Semi structured interviews 20 Barrier to adherence: alcohol intake.
Facilitators of adherence:
Reducing intake of alcohol; waiting until all medicines taken for the day before starting drinking alcohol.
89%
[39] To explore perceptions of financial burden associated with chronic condition medicines People with a chronic condition or their carer Regional QLD, WA & NSW Semi structured in depth interviews 97
(incl 23 Aboriginal and/or Torres Strait Islander)
Barrier to adherence: some indicated cost was an issue, but most reported there was no cost for their medicines (they were covered by the Closing the Gap subsidy program). 79%
[13] To assess the contributions of alcohol, head trauma and medicine adherence to hospital presentations for seizure People presenting to hospital with a seizure between 19 October 2006 and 30 December 2007 Cairns Base Hospital, QLD Medical record review & questionnaire 127
(incl 26 Indigenous patients)
Self reported adherence for Indigenous Australians:
−35% never missed medicines;
−18% missed <2 times/month;
−0% missed >2 times/month;
−29% missed at least 2 times/week;
−18% hardly ever take/never take medicines.
Indigenous Australians were less likely to take medicines than non-Indigenous Australians (p < 0.05).
Suggested strategies (by authors) to enhance adherence: once daily dosing; prescription of medicines with the least side effects.
75%
  1. Abbreviations: AHP Aboriginal health practitioner, HP Health professional, T2DM Type 2 diabetes mellitus, TB Tuberculosis