Increasing medication adherence in LEP (low-english proficiency) latino populations: Merging speech act theory and cultural competency

IntroductionPatients' lack of adherence to prescribed medical treatments is a problem that plagues the medical profession. Not only does it decrease the effectiveness of healthcare and potentially have a serious effect on the patient's outcome, it costs the US an estimated $100 billon every year (1). Adherence, defined as the -degree to which a patient follows instructions, proscriptions and prescriptions of his or her physician" (2), can pertain to a range of medical treatments from medication to life style changes such as diet and exercise (1,3). Patients can lack adherence in a variety of ways. For example, patients can fail to adhere to their medication by (a) not filling the prescription, (b) not taking the medication or stopping the medication before recommended, or (c) not correctly following the instructions for taking the medication, including taking it infrequently or not taking the proper dosage (2). In particular, the outcomes of nonadherence to medication can be very severe. Improper use of medication can lead to the continuation of a disease or illness, worsening of the health condition, hospitalization of the patient, or even death (1-3). All types of nonadherence are costly both economically and health wise, but recommendations for behavior change are most frequently about medication treatment (4).The Latino population living in the United States has been identified as a high-risk population in accessing and receiving quality health care (5-6) and specifically at risk for nonadherence to medication (67). The Latino population is the fastest growing population in the United States, and the Census Bureau speculates that the Latino population will increase to 20% of the population in the United States by 2035 (9). Healthcare providers need to be able to address barriers in quality health care that are unique to this population. One obvious obstacle is the language barrier. Out of the Latinos living in the US, who report speaking Spanish at home, half report having problems communicating in English (10). Low-English proficiency (LEP) Latinos are especially at risk for nonadherence to medication, even when compared to non-LEP Latinos with the same demographics (8).A plethora of research has studied medical adherence and the different factors that pertain to patient's adherence or lack thereof (1-3), although little research or theory has been conducted from a communication standpoint. A communication focus is especially relevant when looking at medication adherence in cross-cultural interactions, as the physician's attempt to get the patient to adhere to the medication can be classified as an act of compliance gaining. Medical schools have started incorporating communication curriculum into the graduation requirements, and recently have turned attention to medical students' cultural competency, in order to give future physicians the necessary tools to address the needs of the rapidly changing demographics of their future clientele (11). Little research has been done to identify what specific skill set a physician needs to be -culturally competent," although many cultural competency models have been suggested (11).The focus of this paper is specifically on Latino populations living within the United States, and how the physician-patient interaction, communication, and requests can affect medical adherence, given the cultural context. However, the framework suggested here could be expanded to address medication adherence in a variety of populations. To avoid generalizing all Latino cultures as having similar beliefs, this paper attempts to identify barriers to medication adherence that may be present in some of the Latino cultures, and attempts to provide physicians with culturally competent means to identify and overcome whichever barrier(s) that a particular Latino individual might face. Mediation adherence in Latino cultures is problematic across disease and illness diagnoses (1,7,8,12). …