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Noor Azizah Abdul Wahab,1,2 Mohd Makmor Bakry,1 Mahadir Ahmad,3 Zaswiza Mohamad Noor,2 Adliah Mhd Ali1 1Centre of Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, 50300, Malaysia; 2Faculty of Pharmacy and Health Sciences, Universiti Kuala Lumpur Royal College of Medicine Perak, Perak, 30450, Malaysia; 3Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, 50300, MalaysiaCorrespondence: Adliah Mhd AliFaculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, 50300, MalaysiaTel +603-9289 7964Fax +603-2698 3271Email adliah@ukm.edu.myBackground: Hypertension is one of the major risk factors of stroke and leading risk factors for global death. Inadequate control of blood pressure due to medication non-adherence remains a challenge and identifying the underlying causes will provide useful information to formulate suitable interventions.Purpose: This study aimed to explore the roles of culture, religiosity, and spirituality on adherence to anti-hypertensive medications.Methodology: A semi-structured qualitative interview was used to explore promoters and barriers to medication adherence among hypertensive individuals residing in urban and rural areas of Perak State, West Malaysia. Study participants were individuals who are able to comprehend either in Malay or English, above 18 years old and on antihypertensive medications. Interview transcriptions from 23 participants were coded inductively and analyzed thematically. Codes generated were verified by three co-investigators who were not involved in transcribing process. The codes were matched with quotations and categorized using three levels of themes named as organizing, classifying and general themes.Results: Cultural aspects categorized as societal and communication norms were related to non-adherence. The societal norms related to ignorance, belief in testimony and anything “natural is safe” affected medication adherence negatively. Communication norms manifested as superficiality, indirectness and non-confrontational were also linked to medication non-adherence. Internal and organizational religiosity was linked to increased motivation to take medication. In contrast, religious misconception about healing and treatment contributed towards medication non-adherence. The role of spirituality remains unclear and seemed to be understood as related to religiosity.Conclusion: Culture and religiosity (C/R) are highly regarded in many societies and shaped people’s health belief and behaviour. Identifying the elements and mechanism through which C/R impacted adherence would be useful to provide essential information for linking adherence assessment to the interventions that specifically address causes of medication non-adherence.Keywords: hypertension, medication adherence, cultural, religiosity, spirituality |
