Understanding ethno-cultural differences in cardiac medication adherence behavior: a Canadian study

Figures & data

Figure 1 The decision-tree model which was based on the qualitative interviews in stage A.

Abbreviations: N, no; Y, yes; C, compliant; NC, noncompliant; SC, sometimes compliant.

Table 1 Demographic characteristics of 286 stage C participants

Variable	Ethnic group			P-value
	White (n=117)	Chinese (n=79)	South Asian (n=90)
	n (%)	n (%)	n (%)
No of men	55 (47.0)	43 (54.4)	68 (75.6)	<0.001
Age (mean [SD])	66.99 (10.94)	73.99 (10.46)	63.0 (10.62)	<0.001
Language of survey				<0.001
English	117 (100)	10 (12.7)	45 (50)
Cantonese	–	29 (36.7)	–
Mandarin	–	40 (50.6)	–
Punjabi	–	–	40 (44.4)
Hindi	–	–	5 (5.6)
Time in Canada				<0.001
Canadian born	99 (84.6)	–	1 (1.1)
<5 years in Canada	–	14 (17.7)	1 (1.1)
5–9 years in Canada	–	12 (15.2)	9 (10)
10–19 years in Canada	–	8 (10.1)	21 (23.3)
>20 years in Canada	18 (15.4)	45 (57.0)	58 (64.4)
Marital status				<0.001
Married/common law	74 (63.2)	51 (64.6)	76 (84.4)
Divorced/separated	9 (7.7)	1 (1.3)	5 (5.6)
Widowed	21 (17.9)	25 (31.6)	7 (7.8)
Single	13 (11.1)	2 (2.5)	2 (2.2)
Habitation, living with…				<0.001
Spouse only	58 (49.6)	25 (31.6)	17 (18.9)
Spouse and (un)married children	14 (11.9)	24 (30.4)	56 (62.2)
(Un)married children/other family	9 (7.7)	20 (25.3)	9 (10)
Alone/other	36 (30.8)	10 (12.7)	8 (8.9)
Education				<0.001
None	–	4 (5.1)	5 (5.6)
<High schoola	11 (9.4)	30 (38)	21 (23.3)
High school	27 (23.1)	16 (20.3)	11 (12.2)
High school	79 (67.5)	29 (36.7)	53 (58.9)
Employment status				<0.001
Employed full time	30 (25.6)	9 (11.4)	27 (30)
Employed part time	10 (8.5)	4 (5.1)	9 (10)
Not employed (employable or disabled)	9 (7.7)	2 (2.5)	17 (18.9)
Retired/home maker	68 (58.1)	64 (81)	37 (41.1)

Note:

a Or equivalent.

Table 2 Factors significantly related to the model outcomes by ethnicitya

Tree item (# responders w/c/sa)	White (n=117)				Chinese (n=79)				South Asian (n =90)
	Outcome			P-value	Outcome			P-value	Outcome			P-value
	Consistently	Sometimes	Not at all		Consistently	Sometimes	Not at all		Consistently	Sometimes	Not at all
	(n=94)	(n=20)	(n=3)		(n=61)	(n=16)	(n=2)		(n=69)	(n=17)	(n=4)
Q9 (–/–/64)
Have you received detailed information from your family doctor about the importance of taking all of your own cardiac medications?
Yes									84.4% (41)	53.8% (7)	0% (0)	0.001
No	–	–	–	–	–	–	–	–	14.6% (7)	46.2% (6)	100% (3)
Q10 (–/–/79)
Did you have confidence and trust with the health care system and health professionals regarding the care and treatment of your heart?
Yes									98.3% (59)	93.8% (15)	0% (0)	<0.001
No	–	–	–	–	–	–	–	–	1.7% (1)	6.3% (1)	100% (3)
Q11 (90/–/–)
Do you believe and trust ONLY western medicine for the care of your heart?
Yes	94.6% (70)	73.3% (11)	100% (1)	0.031	–	–	–	–	–	–	–	–
No	5.4% (4)	26.7% (4)	0
Q18 (117/79/89)
Are you always able to afford the financial costs of all of your prescribed medications?
Yes	97.9% (92)	95% (19)	0% (0)	<0.001	91.8% (56)	87.5% (14)	0% (0)	0.011	91.3% (63)	82.4% (14)	33.3% (1)	0.026
No	2.1% (2)	5.0% (1)	100% (3)		8.2% (5)	12.5% (2)	100% (2)		8.7% (6)	17.6% (3)	66.7% (2)
Q19 (–/–/11)
Have you received any help or assistance in being able to afford the medications?
Yes	–	–	–	–	–	–	–	–	100% (6)	100% (3)	0% (0)	0.018
No									0% (0)	0% (0)	100% (2)
Q21 (101/–/–)
Do you have an established routine for obtaining and taking your medications, as prescribed?
Yes	100% (85)	87.5% (14)	0% (0)	0.024	–	–	–	–	–	–	–	–
No	0% (0)	12.5% (2)	0% (0)
Q23 (113/75/87)
Do you ever have trouble remembering to take all of your medication prescribed (including travel or leaving home)?
Yes	2.1% (2)	84.2% (16)	0% (0)	<0.001	5% (3)	66.7% (10)	0% (0)	<0.001	7.4% (5)	70.6% (12)	50% (1)	<0.001
No	97.9% (92)	15.8% (3)	0% (0)		95% (57)	33.3% (5)	0% (0)		92.6% (63)	29.4% (5)	50% (1)
Q24 (19/15/19)
Does this happen more than 3–4 times per year?
Yes	0% (0)	100% (17)	0% (0)	0.006	0% (0)	100% (11)	0% (0)	0.001	0% (0)	91.7% (11)	0% (0)	<0.001
No	100% (2)	0% (0)	0% (0)		100% (4)	0% (0)	0% (0)		100% (6)	8.3% (1)	100% (1)
Q25 (97/–/–)
Have you been free of new heart disease signs and symptoms and/or side effects from your cardiac mediations?
Yes	75.5% (71)	0% (0)	0% (0)	0.018	–	–	–	–	–	–	–	–
No	24.5% (23)	100% (3)	0% (0)
Q28 (–/61/67)
Do you believe that you need all of your prescribed cardiac medications?
Yes	–	–	–	–	100% (57)	0% (0)	0% (0)	<0.001	93.2% (55)	16.7% (1)	50% (1)	<0.001
No					0% (0)	100% (4)	0% (0)		6.8% (4)	83.3% (5)	50% (1)
Q29 (15/–/–)
Do you accept that you must adapt to these symptoms and/or side effects as the “new normal”?
Yes	83.3% (10)	0% (0)	0% (0)	0.022	–	–	–	–	–	–	–	–
No	16.7% (2)	100% (3)	0% (0)
Q31 (13/8/14)
Do you decide for yourself which cardiac medications to take or not take?
Yes	0% (0)	100% (3)	0% (0)	0.003	0% (0)	100% (4)	0% (0)	0.029	0% (0)	83.3% (5)	0% (0)	0.003
No	100% (10)	0% (0)	0% (0)		100% (4)	0% (0)	0% (0)		100% (7)	16.7% (1)	100% (1)

Note:

a Not all participants responded to each question in the model because they followed different paths along the decision tree.

Table 3 How ethnicity affected question responsea

Tree item and response	Ethnicity			P-value
	White (n=117)	Chinese (n=79)	South Asian (n=90)
Q11
Do you believe and trust ONLY western medicine for the care of your heart?
Yes	91.1% (82/90)	87.5% (56/64)	74.3% (55/74)	0.013
No	8.9% (8/90)	12.5% (8/64)	25.7% (19/74)
Q25
Have you been free of new heart disease signs and symptoms and/or side effects from your cardiac mediations?
Yes	73.2% (71/97)	81.8% (54/66)	59.7% (46/77)	0.014
No	26.8% (26/97)	18.2% (12/66)	40.3% (31/77)
Q30
Do you continue to consult with your doctor about your cardiac medications?
Yes	100% (74/74)	93% (53/57)	94.9% (56/59)	0.047
No	0% (0/74)	7% (4/57)	5.1% (3/59)

Note:

a Not all participants responded to each question in the model because they followed different paths along the decision tree.

Table 4 Self-report and actual model outcomes

Item	Ethnic group			P-value
	White	Chinese	South Asian
	(n=117)	(n=79)	(n=90)
	n (%)	n (%)	n (%)
Self-report
Consistently	102 (87.2)	61 (77.2)	75 (83.3)	NS
Sometimes	15 (12.8)	18 (22.8)	15 (16.7)
Not at all	–	–	–
Model outcome
Consistently	94 (80.3)	61 (79.2)	69 (76.7)	NS
Sometimes	20 (17.1)	16 (20.3)	17 (18.9)
Not at all	3 (2.6)	2 (2.6)	4 (4.4)

Abbreviation: NS, not significant.