Medication management in Minority, Asian and Black ethnic older people in the United Kingdom: A mixed-studies systematic review

WHAT IS NEW AND OBJECTIVES

Older people from ethnic minorities experience the intersectionality of age and ethnicity in relation to complex medication management and polypharmacy. Minority ethnic groups in the United Kingdom are at risk of poor medication management because factors such as cultural beliefs, language barriers, lack of knowledge of how the healthcare system works may affect their ability to safely manage their medications. The aim of this systematic review was to review the literature focussing on medication management in the older population amongst ethnic minority communities in United Kingdom.

METHODS

The review was conducted and reported according to methods in the Cochrane Handbook and in the PRISMA 2020 statement using databases such as EMBASE, ASSIA, MEDLINE, PsychINFO and others. Studies conducted in the United Kingdom on individuals over 60 years of age and from a minority ethnic background were included. A thematic analysis was used to synthesize the results.

RESULTS AND DISCUSSION

Nine studies (eight from initial searches, one from a search update in 2021) met the inclusion criteria. Three main themes were identified: misbeliefs around medications, poor health literacy, communication and education as possible intervention to improve medication management. Misbeliefs around long-term illnesses exert a negative impact on medication management. Poor health literacy around medications influences patients' adherence to treatments. Poor communication is perceived as barrier to successful medication management. Despite extensive searching, the team identified a limited number of studies and a lack of intersectional studies focussing on minority ethnic groups and the older population.

WHAT IS NEW AND CONCLUSION

Our findings suggest tailored education as a possible intervention to improve medication management amongst these minority groups. Future research should look at recruiting participants from specific ethnic groups and from rural as well as urban areas to explore how medication management operates in different areas of the United Kingdom.

Mental health in hypertension: assessing symptoms of anxiety, depression and stress on anti-hypertensive medication adherence

Background

Patients with chronic conditions like hypertension may experience many negative emotions which increase their risk for the development of mental health disorders particularly anxiety and depression. For Ghanaian patients with hypertension, the interaction between hypertension and symptoms of anxiety, depression and stress remains largely unexplored. To fill this knowledge gap, the study sought to ascertain the prevalence and role of these negative emotions on anti-hypertensive medication adherence while taking into account patients’ belief systems.

Methods

The hospital-based cross-sectional study involving 400 hypertensive patients was conducted in two tertiary hospitals in Ghana. Data were gathered on patient’s socio-demographic characteristics, anxiety, depression and stress symptoms, spiritual beliefs, and medication adherence.

Results

Hypertensive patients experienced symptoms of anxiety (56%), stress (20%) and depression (4%). As a coping mechanism, a significant relation was observed between spiritual beliefs and anxiety (x² = 13.352, p = 0.010), depression (x² = 6.205, p = 0.045) and stress (x² = 14.833, p = 0.001). Stress among patients increased their likelihood of medication non-adherence [odds ratio (OR) = 2.42 (95% CI 1.06 – 5.5), p = 0.035].

Conclusion

The study has demonstrated the need for clinicians to pay attention to negative emotions and their role in medication non-adherence. The recommendation is that attention should be directed toward the use of spirituality as a possible mechanism by which negative emotions could be managed among hypertensive patients.

Health and social care needs of Somali refugees with visual impairment (VIP) living in the United Kingdom: a focused ethnography with Somali people with VIP, their caregivers, service providers, and members of the Horn of Africa Blind Society

PURPOSE

To explore the health and social care needs of Somali refugees with visual impairment (VIP).

DESIGN

We conducted a three-phased focused ethnography in collaboration with the Horn of Africa Blind Society (HABS) through all stages from research design to findings dissemination.

METHOD

Engaging in participatory research, HABS members (n = 26), service providers (n = 10), and two Somali community groups (n = 8 and n = 7) whose members were sighted (Phase 1) took part in four focus group interviews. Phases 2 and 3 consisted of interviews with Somali refugees with VIP (n = 32) and their informal carers (n = 5). We used framework data analysis methodology.

FINDINGS

Four major themes emerged: (1) sociocultural perceptions of blindness and visual impairment, (2) access to services, (3) isolation and insecurity, and (4) mobility.

CONCLUSION

Somali people with VIP experience profound unmet social and health care needs related largely to social support, awareness of mobility options, and the stigmatization of visual impairment. Appropriate community outreach may improve access to services and quality of life for Somali people with VIP. Tailored information is needed to increase awareness of mobility and security services. Significant considerations exist when planning discharge from acute care settings to ensure continuity of support.

Identification of nursing assessment models/tools validated in clinical practice for use with diverse ethno-cultural groups: an integrative review of the literature

Background

High income nations are currently exhibiting increasing ethno-cultural diversity which may present challenges for nursing practice. We performed an integrative review of literature published in North America and Europe between 1990 and 2007, to map the state of knowledge and to identify nursing assessment tools/models which are have an associated research or empirical perspective in relation to ethno-cultural dimensions of nursing care.

Methods

Data was retrieved from a wide variety of sources, including key electronic bibliographic databases covering research in biomedical fields, nursing and allied health, and culture, e.g. CINAHL, MEDline, PUBmed, Cochrane library, PsycINFO, Web of Science, and HAPI. We used the Critical Appraisal Skills Programme tools for quality assessment. We applied Torraco's definition and method of an integrative review that aims to create new knowledge and perspectives on a given phenomena. To add methodological rigor with respect to the search strategy and other key review components we also used the principles established by the Centre for Reviews and Dissemination.

Results

Thirteen thousand and thirteen articles were retrieved, from which 53 full papers were assessed for inclusion. Eight papers met the inclusion criteria, describing research on a total of eight ethno-cultural assessment tools/models. The tools/models are described and synthesized.

Conclusions

While many ethno-cultural assessment tools exist to guide nursing practice, few are informed by research perspectives. An increased focus on the efficiency and effectiveness of health services, patient safety, and risk management, means that provision of culturally responsive and competent health services will inevitably become paramount.

Using the Colored Eco-Genetic Relationship Map with children

BACKGROUND

The Colored Eco-Genetic Relationship Map (CEGRM) is a hybridized assessment tool that combines the ecomap, the family genogram, and the genetic pedigree to produce a unique, participant-generated picture of an individual's social networks, information exchange patterns, and sources of support. To date, the CEGRM has been used successfully with adults, providing insights into their social networks and the communication patterns they use in the update and exchange of health-related information.

OBJECTIVE

To explore the feasibility and the utility of adapting elements of the CEGRM for use with children.

METHODS

Twenty children, 7 to 10 years of age, distributed by gender, socioeconomic status, and geographic heritage, participated in one-on-one sessions in which they created modified CEGRMs using adapted art directives. A qualitative descriptive design and approach to analysis were used.

RESULTS

Children were able to create a modified CEGRM, and resultant discussions provided considerable insights. A focused analysis revealed a kaleidoscope of social networks being accessed by today's children as well as surprising information exchange sources and patterns. Although all the children included one parent, family composition varied. Extended family, other adults, peers, and media sources were not only prevalent but also often preferred over the nuclear family as sources of health information. Of particular interest, mothers were rarely identified as children's primary source of health-related information.

DISCUSSION

Elements of the CEGRM are adapted easily for use with children using children's drawings and may prove to be an effective, adjunctive assessment and interventional tool for parents, researchers, educators, and providers working with young children.