|Reference||Study aim||Study population/Participants||Setting||Study design & data collection method||Sample size||Key findings||Quality score|
|||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%|
|||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.
|||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||
(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%|
|||To explore medication use by older women||Women approximately 60 years old||Adelaide, SA||Semi structured interviews||
(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.
|||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.
|||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%|
|||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.
|||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||
(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).
|||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.
|||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|
|||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.
|||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.
|||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.
|||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%|
| & ||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.
|||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.
|||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%|
|||To document epidemiology of tuberculosis cases||All cases of tuberculosis notified from January 1993 – December 1997||Far North Queensland||Medical record review||
(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.
|||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.
|||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.
| & ||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.
|||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.
|||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||
(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%|
|||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||
(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.