Interventions to Improve Medication Adherence in Ethnically Diverse Patients: A Narrative Systematic Review

Introduction: Ethnically diverse patients often have lower medication adherence relative to Whites. Certain ethnic groups are also more susceptible to cardiovascular and related diseases. It is critical to develop culturally tailored interventions to improve medication adherence in these ethnically diverse patients. Thus, the aim of this systematic review was to identify what interventions have been developed and tested to improve medication adherence in ethnically diverse patients with cardiovascular-related diseases. Method: A systematic search of peer-reviewed literature (MEDLINE, Cumulative Index to Nursing and Allied Health Literature, EMBASE, and Cochrane Central Register of Controlled Trials) was conducted to identify relevant articles. The narrative synthesis was performed based on elements offered by Popay et al. The mixed methods appraisal tool was used to appraise the quality of the included studies. Results: A total of 11,294 records were retrieved, and 34 articles met the inclusion criteria for this systematic review. Synthesis of the literature revealed four overarching intervention strategies used to improve medication adherence: pharmacist-mediated, primarily nurse-led, community-based and community-health worker led, and text-message and phone-based. Discussion: Several approaches can be used to improve medication adherence in ethnically diverse patients, although details on the approaches and conditions to produce optimal improvements for particular ethnic groups need to be determined in future studies. How does this affect culturally congruent health care?

Response to ‘Systematic reviews do not always capture context of real-world intervention programmes for childhood obesity’ by Wild et al., 2021 in BMC Public Health

In a correspondence to BMC Public Health, Wild et al. respond to our systematic review that synthesised results of interventions to prevent or treat childhood obesity in Māori and Pacific Islanders. Our review included the Whānau Pakari study as one of six included studies – a multidisciplinary intervention for Māori children and adolescents living with obesity led by their research team. Our review suggested that future research can incorporate stronger co-design principles when designing culturally-tailored interventions to maximise cultural specificity, enhance engagement, facilitate program ownership and contribute to improved health and weight-related outcomes. We commend Whānau Pakari and the team of Wild et al. on their sustained commitment to addressing obesity in priority populations and agree that systematic reviews struggle to capture real-world context of interventions for complex diseases such as obesity. In this article, we respond sequentially to the comments made by Wild et al. and (1) clarify the scope of our review article (2) reiterate our commendation of mixed-methods approaches that capture real-world context (3) explain a referencing error that caused a misinterpretation of our results (4) clarify our interpretation of some Whānau Pakari characteristics (5) welcome partnership to facilitate shared learning with Wild et al.

Examining How African American Family Dementia Caregivers Conceptualize and Manage Crisis Events

African American (AA) family dementia caregivers report high unmet needs, which often culminate in crisis – an unplanned stressful situation requiring immediate decision. However, perspectives from AA caregivers regarding crisis are lacking. To gain insight into caregivers’ conceptualization and experiences of crisis, we used community/coalitional-based recruitment of AA caregivers to conduct semi-structured interviews with 34 AA caregivers which were analyzed using thematic analysis (N=34, 94% female, 56% ages 65 to 74). AA caregivers largely perceived crisis as stressful events, a normal part of caregiving and viewed management of these events as routine. Crisis was characterized as ongoing, lengthy or emergent, sometimes necessitating external support (.e.g. hospitalization). Caregivers managed crisis by increasing caregiving work, de-prioritizing their own health and needs, involving family and friends, and accessing emotional support through neighborhood connections. These perspectives can inform future culturally-tailored interventions that are responsive to AA strengths, values, and help seeking preferences.

Culturally Responsive Mindfulness Interventions for Perinatal African-American Women: A Call for Action

Perinatal African-American women experience perinatal health disparities with increased levels of stress. Stress includes exposure to racism and sexism for African-American women. African-American perinatal women need a culturally tailored intervention to decrease stress and improve health. Culturally tailored interventions are more effective than non-adapted interventions. Mindfulness can reduce stress and improve health and may be an ideal intervention to culturally modify for perinatal African-American women. We will first discuss stress and its impact on perinatal health. Second, we will present stress and intersectionality for perinatal African-American women. Third, we will describe the existing research on mindfulness and its proposed benefits for perinatal women. Finally, we will highlight culturally responsive mindfulness approaches and how these may be uniquely suited to target and mitigate perinatal stress outcomes and promote healthy behaviors.

Treating Systemic Lupus Erythematosus (SLE): The Impact of Historical Environmental Context on Healthcare Perceptions and Decision-Making in Charleston, South Carolina

Introduction: Over 400,000 slaves were taken from Africa and brought to Charleston, South Carolina, as part of the transatlantic slave trade during the 18th and 19th centuries. Due to these negative historical events, the healthcare of African Americans in Charleston may be compromised in regard to chronic illnesses and other conditions affecting minorities, such as lupus. Materials and Methods: The current study used an ethnographic approach to obtain the perspectives of lupus patients with the goal of identifying gaps within current research. In addition to patient perspectives, the geographical location of Charleston, South Carolina was considered through inquiries around culture, community, advocacy, and client/patient interaction to establish a narrative for the themes that emerged. Results: The eleven major themes identified were connectedness, knowledge, experience with lupus, compliance, clinical trial participation, career and planning for the future, visits, access to resources, lifestyle, transition from child to adult care, and an overarching theme of self-management. Conclusion: Understanding healthcare perceptions and decision-making among culturally diverse populations, particularly those who have been defined by centuries of substandard care, marginalization, exploitation, and distrust, is critical to the development of culturally tailored interventions designed to improve patient outcomes and reduce health disparities.

Effectiveness of Culturally Tailored Interventions for Chronic Illnesses among Ethnic Minorities

Culturally tailored interventions have been applied to provide benefits to ethnic minorities’ care; however, the effectiveness of these interventions for chronic conditions is mixed. This systematic review of systematic reviews critically evaluates recent evidence of the effects that culturally tailored interventions have on health care outcomes among ethnic minorities with chronic conditions. It synthesizes results of eight English-language systematic reviews published between 2010 and 2018 and identifies four health care outcomes common to the reviews: disease knowledge, objective clinical outcomes, satisfaction, and access. Our findings suggest that culturally tailored interventions can contribute to the improvement of ethnic minorities’ health care outcomes and especially improve patients’ satisfaction with care. However, results overall are mixed. Further studies to better understand the value of culturally tailored interventions for ethnic minorities’ care are needed.