More to be done to support children from black and ethnic minority backgrounds in medicines adherence and optimisation

The article ‘Communicating with parents and involving children in medicines optimisation’ written by Ashifa Trivedi and published in The Pharmaceutical Journal (2017;299(7906):231­–234) was an enjoyable and thought-provoking read, especially while I embark on a PhD concerning medication adherence in adolescents with asthma from black and ethnic minority backgrounds.

Trivedi highlights that children often rely on their parents and/or carers to administer their medications, therefore involving parents — and children, where possible — in decision-making is essential to medicines optimisation. It was suggested that communicating with and educating parents improves morbidity, knowledge, adherence, self-management, control of asthma, and quality of life.

Having read the article, however, I was left with a sense that there is so much more to consider on this important topic. I wonder if the challenges faced by parents (of children with asthma) from minority ethnic groups are considered when designing and proffering intervention strategies for medicines adherence. Most intervention strategies geared towards improving medicines adherence in paediatric asthma are directed at majority populations with a one-size-fits-all approach. This potentially widens health inequalities. Few studies have investigated relationships between the management of paediatric asthma and factors associated with ethnicity, such as migration and immigration status, religious beliefs, language barrier, health literacy, educational level of parent/carer, culture and tradition, and early-years environmental exposure. Parent/caregiver education is pertinent to medicines optimisation in paediatric populations, but the provision of this education must be tailored to meet individual needs, and cultural differences in ethnic minority populations must be considered.

A recent NHS-commissioned framework to explore the best investment of scarce medicines optimisation resources identified overcoming cultural barriers as an important area for improvement. In my practice as a community pharmacist in West Yorkshire, a recent consultation with a mother (of an asthmatic child) from a minority ethnic group highlighted the importance of tailoring information to meet individual need, taking into account the patient’s circumstances, preferences and background. The child had to go without his inhaler for two weeks because the mother, who is not computer-literate and has no computer, was asked to request the repeat prescription online.

In summary, proffering culturally relevant interventions for medicines adherence is essential to developing the most effective approaches of improving medicines adherence among children with asthma. Healthcare professionals must examine the needs of specific population groups and consider interventions that take into account the wide diversity and differences within any population group.

Omaedo Iyoko, community pharmacist, West Yorkshire, and PhD student, University of Leeds