Cultural connections: Breaking barriers to better medication adherence

• Cultural beliefs influence medication adherence, shaping illness perceptions, trust in healthcare, and treatment acceptance.^1,2
• Barriers include traditional beliefs, trust in natural remedies, communication styles, administration preferences, religious values, family decisions, and level of acculturation.^2,3,5-9,10
• Targeted, culturally sensitive interventions and improved provider communication are essential for overcoming barriers and to enhance medication adherence.^14,15

When patients don’t follow prescribed treatments, it’s tempting to assume they’re forgetful or unmotivated. But often, the reasons run deeper—rooted in tradition, and belief systems that shape how individuals view health, illness, and medicine itself.

It is well established that adherence is key to successful health outcomes. But what happens when the care offered doesn’t align with how patients understand their condition or treatment?⁴ In increasingly multicultural settings, failing to account for these perspectives can lead to poor engagement, preventable complications, and widening health disparities.^4,14,15

This article explores how cultural beliefs impact medication adherence, highlighting real-world barriers and offering tools and strategies to support more effective, traditionally adapted care.

How culture influence medication use?

Culture influences more than just ethnicity or language—it shapes how people interpret symptoms, whether they trust modern treatments, and what role they believe medications should play in healing.^1,2 These perspectives are often passed down through generations, reinforced by religious teachings, family dynamics, or community traditions.^1,2

For example, some patients may avoid medications that contain animal-derived ingredients due to religious observance. Others may stop taking prescribed drugs during fasting periods or avoid pills altogether in favor of natural remedies believed to be more in harmony with the body.^2,3 While such decisions are often made with the best intentions, they can have serious health consequences if left unaddressed. A previously published article “Impact of belief and misconception in medication non-adherence”detailed how misconceptions rooted in their beliefs can also turn potentially life-saving therapies into sources of fear or mistrust.

Understanding key cultural barriers to medication adherence

• Cultural beliefs and misconception

Numerous studies have shown that traditional misconceptions can lead patients to mistrust or abandon prescribed treatments. In chronic conditions like asthma, diabetes, and hypertension, patients from some communities may turn to traditional remedies—such as herbal medicines or rituals—instead of or alongside conventional therapies.⁴

A systematic review found that belief in traditional practices often caused patients to skip doses or delay seeking medical advice. Among older adults, stronger adherence to traditional health beliefs was directly linked to medication adherence.⁵

Epilepsy provides a particularly stark example. In some Hispanic and African communities, the condition is misattributed to demonic possession, substance abuse, or moral failings. These misconceptions often result in stigma, social isolation, and resistance to seeking help. In fact, in some traditions, mentioning the word “epilepsy” remains taboo—complicating diagnosis and care from the very beginning.⁶

• Preference for “Natural” remedies

In many collectivist traditions, example Malaysia, there is a strong belief that “natural means safe.”² Patients may view modern medicine as harsh or toxic and instead opt for herbal remedies passed down through family traditions.

Family influence also plays a significant role. In households where traditional medicine is favored, patients may stop taking prescription medicines to align with family expectations and avoid arguments. This can be particularly dangerous in chronic illnesses like hypertension, where adherence is critical to long-term health.²

• Communication norms

In some traditions, direct disagreement with authority figures—including doctors—is seen as disrespectful^2,7. Patients may nod in agreement during consultations, even if they have no intention of following the advice. This “false compliance” is often driven by a desire to maintain harmony or avoid confrontation.

Such interactions can create a false sense of understanding and trust. Without honest two-way communication, critical gaps in adherence often go unnoticed until complications arise.²

• Preference around route of administration

Cultural attitudes toward how medication is administered can also influence adherence. A global study of more than 4,000 adults found significant variation in preferences for pills, injections, or topical treatments.³

In some European countries, oral medications were overwhelmingly favored. But in African-Islamic, South Asian, and Latin American regions, patients showed a preference for injections or topical treatments. In some communities, routes such as vaginal or rectal administration were strongly opposed due to cultural taboos. Thus, when route of medication administration conflict with traditional expectations, adherence to medication is likely to be compromised.

• Religious and spiritual beliefs

Faith and spirituality can have both positive and negative effects on adherence.¹ For example, studies show that participation in religious activities is associated with improved adherence (OR 1.20, 95% CI 1.01–1.14, P=0.038), possibly due to community support and reduced stress.

On the other hand, fatalistic beliefs—such as the idea that health outcomes are predetermined by destiny—can lead to passivity in managing chronic disease. In some Asian traditions, this mindset may prevent patients from actively engaging in treatment or making lifestyle changes.⁸

In Latino communities, strong family ties and collective decision-making are central to health behavior. While this can be a source of support, it can also create barriers if family members are skeptical of Western medicine or advocate for alternative treatments.^7,9

• Acculturation

When patients migrate to a new country, they must adapt not just to a new language but also to a new healthcare system, set of norms, and expectations. Research shows that immigrants who are more acculturated—those who adopt the language and values of their new environment—are generally more likely to adhere to prescribed treatments.

For example, Arab Americans and Chinese immigrants with higher levels of acculturation were found to be more consistent in following their treatment plans.¹⁰ Similarly, U.S. Hispanics show better medication adherence than non-Hispanics. But the relationship isn’t always linear. Among native Spanish speakers, limited English proficiency can make navigating the healthcare system challenging, even if other aspects of acculturation are present.¹¹

Tools to assess cultural influences on medication behavior

To provide more culturally responsive care, healthcare providers increasingly rely on tools that move beyond surface-level assessments and delve into the deeper social and psychological roots of patient behavior.

• A:care Insight: This validated predictive behavioral diagnostic tool is designed to identify patients at risk of non-adherence and uncover the personal and cultural motivations influencing their decisions.¹² A:care Insight examines the behavioral drivers i.e. Social, Psychological, Usage, and Rational— to provide a structured yet personalized view of patient behavior. By analyzing these behavioral drivers, the tool generates actionable insights for healthcare professionals and guides the development of culturally sensitive, patient-centered strategies to improve outcomes.
• Cultural Competence Assessment Instrument (CCAI): This tool helps healthcare providers evaluate their cultural awareness, knowledge, and skills. It can identify areas where additional training is needed to improve communication and patient trust.¹³

Strategies to address cultural issues in medication adherence

Improving adherence in diverse populations isn’t about convincing patients to abandon their beliefs—it’s about finding common ground. Addressing these challenges requires strategic, traditionally sensitive interventions that are both targeted and multifaceted. It means building trust, communicating clearly, and respecting diversity as shown in the table below. By adopting these approaches, healthcare systems can fulfil patient’s needs, values in realities and build trust to strengthen treatment engagement across traditionally varied communities.

Table: Key intervention strategies to overcome cultural barriers

Conclusion:

Cultural beliefs, communication norms, perceptions of natural remedies and medication routes, unique values, and levels of acculturation all significantly influence medication adherence. Addressing these barriers through culturally tailored interventions is essential to improving medication adherence in diverse populations.