title: Behind the scenes of adherence in a minority population.
abstract: BACKGROUND
  The rate of adherence to treatment for diabetes mellitus (DM), hypertension (HTN) and lipid metabolic disorder (LMD) is significantly lower in the Bedouin population compared with the lewish population in southern Israel.
  
  
  OBJECTIVE
  To investigate the reasons for non-adherence associated with cardiovascular risk factors among Bedouins.
  
  
  METHODS
  We identified Bedouin patients with HTN, DM or LMD from medical records and randomly selected 443 high adherent and 403 low adherent patients. Using trained interviewers we conducted in-depth structured interviews regarding knowledge and attitudes to chronic illness and its treatment, health services evaluation, and socio-demographic factors.
  
  
  RESULTS
  The study population included 99 high and 101 low adherent patients. More low adherent patients agreed that traditional therapy can replace prescribed medications for DM, HTN or LMD (47% vs. 26%, P< 0.01), and 10% used only traditional medications. Also, more low adherent patients believed that the side effects of prescribed drugs are actually worse than the disease itself (65% vs. 47%, P 0.05), and 47% cited this as a reason for discontinuing drug treatment (47% vs. 31%, P < 0.05).
  
  
  CONCLUSIONS
  Our findings suggest that in this minority population the basis for non-adherence derives directly from patients' perceptions of chronic disease and drug treatment. A focused intervention should emphasize the importance of early evidence-based drug therapy with open patient-physician dialogue on the meaning of chronic disease and the side effects of prescribed drugs.
authors.affiliation: Siaal Research Center for Family Medicine and Primary Care, Department of Family Medicine, Division of Community Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel.
authors.forename: Uri
authors.initials: U
authors.lastname: Yoel
authors.forename: Talab
authors.initials: T
authors.lastname: Abu-Hammad
authors.forename: Arnon
authors.initials: A
authors.lastname: Cohen
authors.forename: Alexander
authors.initials: A
authors.lastname: Aizenberg
authors.forename: Daniel
authors.initials: D
authors.lastname: Vardy
authors.forename: Pesach
authors.initials: P
authors.lastname: Shvartzman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018912:Arabs; D002318:Cardiovascular Diseases / Q000208:ethnology* / Q000628:therapy*; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D055118:Medication Adherence / Q000208:ethnology*; D008875:Middle Aged; D008913:Minority Groups; D010349:Patient Compliance / Q000208:ethnology* / Q000706:statistics & numerical data; D010817:Physician-Patient Relations; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult; D016903:Drug Monitoring