Table 1 Characteristics and findings of included journal articles

[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%