In the midst of all this social media talk and the Internet being completely global, one of the essential aspects of effective healthcare delivery is often overlooked: the connection between clear communication and cultural background. When stakeholders come from different backgrounds, clear communication, and subsequently competent healthcare delivery may be hindered.
It is important to recognise that not everyone possesses Western views in relation to healthcare, illness, and treatments – both in the physical and spiritual sense, as the cultural backgrounds of patients can shape their views on the topic of well-being.
While a health belief model that attempted to explain patient behaviour in relation to cultural background was developed by social psychologists in the 1950s, it is important to explore the ways in which it is possible to predict and explain health behaviours in an era where digital health information is more widespread than ever.
Traditionally, studies on patient compliance are produced from a medicocentric perspective, where non-compliance is seen as a problem. If we consider non-compliance from a patient’s perspective, however, we may learn more about what motivates their actions. An anthropological study on patient attitudes towards drugs and illnesses concluded that non-compliance is rarely the result of patients misunderstanding the doctor but rather a result of them having different ideas and applying their rationality vis-à-vis the doctor’s. This rationality is comprised of political, economic, and social elements.
In the aforementioned study, Van der Geest, Whyte and Hardon concluded that especially in non-Western societies, pharmaceutical products are often recast in another knowledge system and used differently from the way they were intended in the regime of value where they were produced.
In order to exemplify just how relevant cultural background is from a patient’s perspective, we will take a look at a few examples.
According to a survey conducted by the Taiwanese Bureau of Health Promotion, up to one third of asthma sufferers in Taiwan do not take any kind of medication for the condition, and another third only use inhalers occasionally, or in the case of emergency, as opposed to taking long-term anti-inflammatory medication. A deeper look into Taiwan’s attitudes towards well-being reveals that almost 80% of asthma sufferers in Taiwan prefer to control their symptoms through a balanced diet and exercise, according to another article in The Taipei Times. Although the Taiwan Association of Asthma Education is encouraging sufferers to find out what their allergens are and take anti-allergy drugs, asthma is the 12th leading cause of death among Taipei city residents and Hsu Shi-ta, director-general of the association states that it is often difficult to identify mild asthma symptoms, as they are viewed as ‘habitual’.
Another interesting example to consider, as presented in the study featured in the Annual review of Anthropology by Van der Geest, Whyte and Hardon, identifies a tendency towards what the author calls ‘defective modernisation’ in South-East Asia. This trend manifests itself through the belief that health is something one can obtain solely through the use of pharmaceuticals. A potential upside to this is the fact that commodification of medicine in the area means that patients have more choice and are able to put more pressure on healthcare providers by refusing a treatment.
Lastly, we will also look at how outlooks towards prescriptions can differ from region to region, also based on Van der Geest, Whyte and Hardon’s anthropological study.When medication is seen as the essence of the medical practice, prescribing is the main action that will be expected from the physician, perhaps serving as a legitimization of sickness. Whilst in some cases, not prescribing might be preferable on medical grounds, it is not rational according to cultural criteria and doctors might feel like they have to comply with patient demands. A refusal to prescribe may cast doubt over the genuineness of the patients’ complaint, so it can be said that in certain regions prescriptions serve a social and cultural logic. A written referral to a medical specialist may often serve the same purpose.
The concerns associated with this practice are many: it may lead to erratic buying of medicine, it might encourage patients to self-medicate by imitating the prescriptions they have received, and in poorer areas it might force patients to choose arbitrarily from the long list of medicines prescribed if they cannot afford them all (the cheapest one, the first one on the list, the one in stock, etc.)
All this being said, however, it is preferable not to make assumptions regarding an individual’s health beliefs based on their cultural background, as opposed to simply asking about their own understanding and concerns, advises the UK Health Protection Agency.
Although anecdotal, these examples show us that that understanding attitudes towards drugs should be a priority for pharmaceutical companies looking to launch a drug in emerging markets, as it is in these markets that one tends to be confronted with less conventional attitudes (at least from a Western viewpoint) towards illness and wellbeing. That is why deep local knowledge and market-tailored decisions are necessary to transform information into healthy behaviours. Patient-oriented analytics are also needed to extract meaningful intelligence from large amounts of information about populations and patients.
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