Addressing ethnic inequities in medication adherence

A literature review focusing on challenges faced by patients from different ethnic groups in medication adherence, and potential approaches to mitigating these disparities.

Abstract

Introduction

According to the World Health Organization (WHO), medication adherence is defined as “the extent to which a person’s behaviour in terms of taking medications corresponds to agreed recommendations from a healthcare provider”​1​. In 2003, the WHO reported that “increasing the effectiveness of adherence interventions may have a far greater impact on the health of the population than any improvement in specific medical treatment”​2​. Medication adherence has the potential to positively impact clinical outcomes across a spectrum of health conditions​2–6​; for example, Bramley et al. found that people with hypertension (n=840) who achieved a medication-possession ratio (MPR) of 80–100% had better blood pressure control than those with an MPR <50% (OR 1.45, 95% CI 1.04–2.02)​4​.

MPR is defined as the proportion or percentage of days’ supply obtained during a specified period or across multiple refill intervals​7​. Like other measures derived from secondary database analyses, such as proportion of days covered (PDC), MPR is based on prescription refill data and is commonly used as a proxy indicator of medication adherence. However, it does not directly capture actual medication-taking behaviour​8​. Previous research has also reported that suboptimal medication adherence has a negative impact on morbidity, mortality rates and the risk of hospitalisation​2,3​. A nine-year cohort study of people with type 2 diabetes mellitus (T2DM) (n=65,076) examined how adherence to antidiabetic medication, measured by PDC, influenced all-cause mortality and new-onset cerebrovascular disease or myocardial infarction.

After adjustment for socio-economic and clinical covariates, people with low adherence (PDC <20%) had a 45% higher combined risk of death and cerebrovascular events than those with high adherence (PDC ≥80%) (HR 1.45, 95% CI 1.36–1.54)​9​. PDC is calculated as the number of days the medication was available divided by the total number of days in the study period​7​. Additionally, medication non-adherence has also been associated with increased healthcare costs​10,11​. A large systematic review of 79 studies conducted by Cutler et al. confirmed this by investigating the economic effect of non-adherence to medical therapy in people with long-term diseases. Despite differences in how medication adherence was measured across studies, including MPR, PDC and self-report measures, suboptimal adherence was consistently associated with higher total healthcare costs​10​.

Despite the importance placed on supporting medication adherence, and providing equitable and accessible healthcare services, significant inequities still affect people across ethnic groups and long-term health conditions​12–14​. These inequities can negatively impact disease progression, hospitalisations and mortality​15–17​. This review is aimed to examine the multifaceted influence of ethnic inequities on medication adherence, focusing on the underlying factors that contribute to these inequities, while exploring the interventions and strategies developed to address them.

By reviewing the existing literature, this article aims to contribute to a deeper understanding of the challenges faced by individuals from different ethnic and racial groups in adhering to medication, and the promising approaches to mitigate these disparities.

Throughout the review, the term ‘ethnicity’ is used in preference to ‘race’, following Senior and Bhopal’s definition that “ethnicity implies one or more of the following: shared origins or social background; distinctive culture and traditions maintained across generations that foster a sense of group identity; and a common language or religious heritage”​18​. This broader construct better captures the cultural and geographical factors that may contribute to differences in medication adherence. This term will be used consistently throughout the review, except when discussing studies that employ alternative terminology in reporting their findings. In such cases, where populations are classified using racial categories (e.g. ‘black’ or ‘white’), these terms are reported as defined in the original studies and interpreted with caution, recognising that they are socially constructed and do not represent ethnically homogeneous groups.

Previously reported data on ethnic disparities in medication adherence

Studies have consistently demonstrated ethnic differences in adherence to prescribed medication regimens for various health conditions. For instance, one US-based study that used 2007 Medicare Part D claims (n=168,522) reported that black and Hispanic patients had 47% and 42% lower odds of adherence to antihypertensive medication, respectively, when compared with their white counterparts​19​.

Similar findings were reported in another US-based study (n=367,861), where average adherence rates were 4.8 to 6.5 percentage points lower among people from black and Hispanic racial groups than their white counterparts​13​.

According to a systematic review of 41 international studies examining the association between ethnicity and antidiabetic medication adherence, there were ethnic variations reported in 38 studies, despite adjustment for several socioeconomic and clinical variables that may otherwise explain these differences​12​.

A similar trend can be seen in asthma management. One study involving 277 adults with persistent asthma examined racial and ethnic disparities in adherence to inhaled corticosteroids. This study reported that people identified as having African-American and Hispanic ethnicity had 47% and 42% lower adherence, respectively, than their white counterparts​20​.

A scoping review investigating the connection between ethnicity and adherence to non-surgical COPD management interventions — such as smoking cessation support, medication, long-term oxygen therapy, pulmonary rehabilitation and vaccinations — demonstrated ethnic disparities in adherence across 37 global studies​21​. These disparities persisted even after adjustment for socio-economic status and educational level, emphasising the influence of ethnicity on adherence to COPD management​21​.

In the context of cardiovascular disease, a meta-analysis aimed to investigate the impact of ethnicity on adherence to statin therapy for heart disease prevention. Across 53 studies, predominantly conducted in the United States, people from non-white racial groups had a 53% higher likelihood of non-adherence, compared with people from white racial groups​22​.

Other studies have further illustrated disparities in medication adherence among people living with HIV. In a pooled analysis of 13 US-based studies, employing electronic drug monitoring to measure adherence in 1,809 adults, Simoni et al. reported that people identified as African-American averaged 61% monthly antiretroviral therapy adherence versus 72% among white participants, and were significantly less likely to achieve perfect adherence (OR 0.60 (95% CI 0.52–0.70)) compared to white participants​23​. Additionally, heart failure research that looked at Medicare data (n=171,097) reported that the rates of adherence were lower among people from Asian, black, Hispanic and Native American racial groups compared to white American racial groups, even after controlling for different demographic variables such as income and educational level​24​.

Ethnic inequities in medication adherence are evident among individuals with psychiatric conditions. In the United States, Opolka et al. examined the association between ethnicity and adherence to antipsychotic medication across three ethnic groups (African-American, Mexican-American and white) comprising individuals living with a diagnosis of schizophrenia (n=3,583). The findings revealed that people of white ethnicity had a significantly higher number of adherence days (measured as a days’ supply of antipsychotics dispensed over the 365-day follow-up), than people of African-American and Mexican-American ethnicities​25​. It is important to note that this dispensing-based measure reflects medication availability rather than confirmed medication-taking behaviour, and therefore represents a proxy indicator of adherence, particularly in individuals with mental illness, where adherence is a known concern. These results were consistent with other prospective observational study examining ethnic disparities in antidepressant adherence, which reported significantly lower four-month adherence and higher rates of non-adherence, defined as missing ≥ two doses per week or not initiating treatment, among individuals from black racial groups compared with individuals from white racial groups​26​.

The findings from these studies collectively highlight the persistent issue of ethnic inequities influencing medication adherence across a range of long-term health conditions. Such inequities not only compromise the overall health outcomes of affected populations but underscore the urgent need to investigate contributing factors, develop comprehensive interventions and target healthcare policies to begin addressing them.

Factors contributing to disparities in medication adherence

Ethnic inequities in medication adherence can be attributed to different factors, as shown in the Figure and discussed below.

Figure: Factors contributing to disparities in medication adherence

Cultural factors

Personal views on illness management can be shaped by an individual’s cultural heritage, family history, cultural influences and individual preferences​27​. These factors may go beyond the usual considerations that are typically addressed during consultations​27​. Accordingly, ethnic variations in beliefs about illness, medication necessity, long-term treatment need and medication safety have been reported across chronic conditions, such as diabetes, HIV/AIDS, hypertension, coronary heart disease and depression​23,28–34​. For example, research shows that people of African-Caribbean ethnicity have shared perceptions that hypertension was not a long-term medical condition, but rather a result of stress; in turn, preferring to use antihypertensive medications on a short-term basis​35​.

Similar perceptions have previously been shared by people of South Asian ethnicity with T2DM, with some individuals not recognising diabetes as a long-term condition requiring continuous adherence to antidiabetic medication​32​. Some people held the belief that these medications provided instant results and that if they ever felt they no longer required them or if they reduced their food intake, they considered the medications unnecessary​32,36​. Comparable beliefs around coronary heart disease have been reported among older people of South Asian ethnicity, who viewed it as an acute disease that could be cured following a surgical procedure, with no need for subsequent long-term treatment​33​. 

A cross-sectional US-based survey illustrated that African-American individuals living with HIV/AIDS (n=71) shared beliefs that HIV was a man-made virus and expressed reluctance to take antiretroviral treatment​37​. Similar beliefs and reasons for reduced medication adherence among African-American men with HIV/AIDS (n=214) were reported in another study, where treatment-related beliefs were associated with a lower likelihood of optimal adherence at one-month follow-up (adjusted OR 0.60, 95% CI 0.37–0.96)​34​. Collectively, these beliefs could play a significant role in shaping cultural perspectives towards healthcare, which could impact how people from different ethnic backgrounds accept self-management recommendations, ultimately influencing medication adherence and health outcomes, all of which contribute to health disparities.

The use of complementary and alternative medicine may contribute to ethnic inequities in medication adherence. This encompasses a diverse range of practices, treatments and products that are not considered part of conventional medicine. These therapies are used alongside, or in place of, conventional medical treatments and can include practices such as acupuncture, herbal remedies and chiropractic care​38​. The utilisation of complementary and alternative medicine by the general population varies widely across countries worldwide, ranging from 9.8% to 76.0%​39​. In studies of long-term illnesses, the use of these therapies differed by ethnic group, suggesting that complementary and alternative medicine use could be associated with differences in medication adherence across those groups​40–43​. For instance, people of Mexican-American and Vietnamese-American ethnicity with T2DM were more likely than those of non-Hispanic-white ethnicity to use complementary and alternative medicine in place of prescribed diabetes medication​41​.

Several studies have examined the utilisation of alternative medicines and its connection to adherence to conventionally prescribed medications across different ethnic groups. Preference for alternative medicines resulting from distrust of Western medicine, fear of adverse effects or dependency have all been shown to be a barrier to adherence to antidiabetic medication in people from minority ethnic groups​44​. A qualitative study of 23 Indian migrants with T2DM living in Australia found that three participants delayed or stopped antidiabetic medication because they feared adverse effects, turning instead to traditional herbal remedies​45​.

Similarly, a multi-country qualitative study involving 26 focus groups with 180 Ghanaian adults living in Europe and Ghana found that participants across focus groups in five study locations expressed beliefs that herbal medicines were highly effective, and that long-term use of conventional medication could be harmful. Within these discussions, participants described the use of faith-based remedies or herbal treatments in place of prescribed medication​46​. This pattern is reflected in findings from a study on antihypertensive medication in older adults in the United States (n=2,180), where people identified as black exhibited a higher use of complementary and alternative medicine and, concurrently, a lower adherence to their prescribed medication​47​. A systematic review examining antiretroviral therapy adherence in sub-Saharan Africa has also reported patient preferences towards alternative medicine, such as herbal medicines and visits to a spiritual healer, as a crucial barrier to their adherence to antiretroviral therapy​48​. Existing insights suggest the use of complementary and alternative medicine, often as a replacement rather than alongside conventional treatments, has influenced medication adherence among various ethnic groups.

Socio-economic factors

Socio-economic factors are strongly associated with medication adherence across populations and have contributed to observed ethnic disparities in adherence​1​. Several studies have shown lower rates of medication adherence among populations with lower socio-economic status (SES), compared to their counterparts with a higher SES​13,27​. This association has been shown to exist across different ethnic groups for various therapeutic classes of medication​49–52​. Individuals from lower socio-economic backgrounds often face multiple barriers to medication adherence; for example, financial constraints, which can significantly hinder access to medication. In England, prescription charges — and in the United States, co-payments — can be prohibitively high for people without fee exemptions or adequate insurance, and have been linked to lower adherence among those with long-term conditions​13,53​. Additionally, qualitative evidence exists to demonstrate that people are prioritising the purchasing of other essential items, such as food, over their medication​54,55​.

Educational attainment is also closely linked to SES, which in turn has been associated with poorer rates of medication adherence​56,57​. Low health literacy has been shown to negatively influence medication adherence across diverse ethnic groups​1,58​. However, evidence suggests that some ethnic minority groups may experience a disproportionate burden of low health literacy even when educational attainment and income are comparable​59–61​. The likelihood that people from these groups will adhere to their medication may be lower if they lack a clear understanding of how and why they should take their medication. For example, a cross-sectional survey involving Hispanic people, diagnosed with hypertension (n=1,355), explored the relationship between health literacy and antihypertensive medication adherence. These findings concluded that having adequate health literacy was associated with higher levels of medication adherence​62​. It should be noted that health literacy is also shaped by the clarity, quality and accessibility of communication between healthcare professionals and patients, particularly for people from ethnically diverse backgrounds​63,64​.

People from ethnic minority groups living in socio-economically disadvantaged areas may also have less access to social support​65,66​. This is critical for encouraging and assisting in managing health conditions, as well as influencing adherence to medication​14,67,68​. A US study analysing 2017 Medicare claims found that, compared with non-Hispanic white beneficiaries, people identified as black had higher odds of non-adherence to medications for diabetes, hypertension, and hyperlipidaemia, while people identified as Hispanic had higher odds of non-adherence to hyperlipidaemia medication​14​. The authors of the study postulated that such disparities could be partly explained by factors including community wealth, regional variation, and gender differences within the ethnic groups​14​.

In addition to these factors, people from minority ethnic groups may be affected by broader social determinants, such as housing instability, food insecurity and unemployment, which can have a significant impact on an individual’s ability to adhere to their medication consistently​69–71​. Overall, SES may intersect with ethnicity to produce a complex set of factors contributing to medication adherence disparities.

Ethnic inequities in medication adherence may also be influenced by factors related to the healthcare system. The geographical location of healthcare services, clinic hours, and difficulties with transportation frequently lead to challenges for people from minority ethnic groups in accessing healthcare​72–74​. Beyond these access issues, healthcare organisations and professionals have been shown to exhibit organisational and implicit biases that have a disproportionate impact on minority groups​75,76​.

Implicit biases — referring to unconscious attitudes or assumptions that can influence healthcare professionals’ perceptions and clinical decisions without conscious awareness — can manifest in several ways, such as underestimating the level of pain a patient is experiencing; making assumptions about their lifestyle or their likelihood of following treatment recommendations; or not providing them with the same level of care or attention that other groups would receive​77–79​. As a result, patient-provider relationships may be negatively affected, leading to feelings of distrust and a reluctance to adhere to medication regimens​75​. One 2015 US-based systematic review reported negative bias towards people of non-white racial/ethnic groups, graded by the implicit association test, which had a significant impact on the patient outcomes, treatment adherence and overall treatment decisions​75​.

Recognition of such biases has prompted broader attention within pharmacy and the wider medical profession to examine cultural competency as a way of understanding and addressing inequities in care​80,81​. Cultural competency is aimed to support effective communication, interaction and collaboration across diverse cultures, by fostering understanding, respect and appreciation for cultural differences​82,83​.

The healthcare provider–patient relationship has been strongly linked to influencing medication adherence, with effective communication cited as fundamental for building relationships and empowering patients with the understanding and motivation to follow their prescribed treatment plan accurately and consistently​1,84–86​. For people from culturally and linguistically diverse backgrounds, clear and effective communication is especially important to support their understanding of medication regimens and the need for adherence​87​. This often involves culturally competent care, such as using interpreters or speaking to patients in their native language, to help overcome language barriers​85,88​. Several studies have shown that language concordance between patients and physicians can improve medication adherence, whereas people who speak English as an additional language or do not speak English often have lower adherence when this concordance is lacking​27,89,90​.

Medical mistrust is another major barrier to the healthcare provider-patient relationship. A lack of trust towards healthcare professionals, and the healthcare system more broadly, has been evidenced to negatively influence medication adherence across different ethnic groups​91,92​. A cross-sectional study, that included females identifying as black (n=80) who were prescribed antihypertensive medication, assessed the impact of trust on adherence rates​91​. The authors reported a direct positive association between the level of reported trust in healthcare providers and self-reported medication adherence; those who had greater trust in their healthcare providers were more likely to adhere to medication regimens​91​. A recent UK report similarly highlighted that poorer patient experience, including not feeling listened to or treated fairly, was associated with reduced trust in primary care among ethnic-minority groups​93​.

Examples of evidence-based interventions addressing ethnic inequities in medicines adherence

The following interventions have been studied as ways of tackling existing inequities in medication adherence among ethnically minoritised groups, to support more equitable treatment outcomes and improve adherence.

Culturally tailored interventions

Cultural tailoring of interventions is a process that involves creating health promotion interventions and materials by integrating cultural sensitivity​85,94​. This means considering the unique ethnic and cultural characteristics, experiences, norms, values, behavioural patterns, beliefs, historical, environmental and social contexts of specific minority populations​85,95​. The aim is to adapt and design these interventions in a way that resonates more closely with the targeted groups, ensuring the information is accessible, understandable, appropriate and potentially has a higher likelihood of effectiveness within specific cultural contexts​95​. These approaches have been shown to improve health behaviours and outcomes for those from ethnic minority groups. This includes specific improvements in dietary and self-management behaviours among minority ethnic groups of Asian origin with diabetes, and medication adherence in minority ethnic groups of African-American origin with diabetes​96–99​. 

While cultural competence has shown promising results in improving health outcomes, only a few studies have examined its effect on improving medication adherence for those from ethnically minoritised groups. A systematic review examining medication management among minority Asian and black ethnic older people living in the UK identified cultural beliefs, health literacy and communication barriers as important influences on medication management, and highlighted culturally appropriate education and communication as a potential approach to improving medication management among these minority groups​31​. Similarly, one small feasibility study from 2021 examined a culturally tailored education programme for Haitian immigrants (n=42) diagnosed with hypertension​100​. The intervention involved the provision of evidence-based education specifically designed to integrate with Haitian cultural norms and practices through culturally adapted sessions led by a Haitian nurse, and tailored educational materials aimed at enhancing participants’ understanding of hypertension, improving medication adherence and managing their blood pressure​100​. The culturally tailored intervention demonstrated statistically significant improvements in systolic and diastolic blood pressure, as well as increased self-reported medication adherence and hypertension knowledge​100​. These findings highlight the need for more in-depth research to explore, develop and utilise culturally tailored interventions to enhance medication adherence across diverse ethnic populations.

Digital health-based interventions

Interventions related to digital health involve the utilisation of electronic or digital resources to support and simplify healthcare interventions​101​. Several studies have examined the use of these interventions to improve medication adherence in ethnically diverse populations. In one US-based, randomised controlled trial, adults of African-American ethnicity with hypertension (n=337) were evaluated for effectiveness of a culturally adapted, automated telephone system designed to improve medication adherence, dietary behaviours and physical activity​102​. After randomising the participants into either an intervention group or an education-only control group, the study found significant improvements in diet quality and energy expenditure among participants in the intervention group. However, there were no statistically significant differences between the intervention and control groups in systolic blood pressure or medication adherence​102​. 

Similarly, a fully automated text-messaging intervention was found to be feasible and acceptable for adults of African-American ethnicity with uncontrolled hypertension, with slight improvements in medication adherence and blood pressure that were not statistically significant compared with usual care​103​. In 2021, a systematic review considered 34 articles and identified strategies that could improve medication adherence among ethnically diverse patients with cardiovascular-related diseases​104​. One of these strategies identified in the review was the use of text-message and phone-based interventions. These interventions included automated reminders, personalised messages and educational content delivered via text or phone calls. Although several studies in this review showed that these interventions were promising in enhancing medication adherence, the results were inconsistent across different ethnic groups and health conditions​104​. Beyond text message-based interventions, a 2025 systematic review and meta-analysis including 14 randomised controlled trials found that mobile app-based interventions improved medication adherence across multiple chronic conditions​105​. Interventions duration ranged from 1 month to 12 months and involved diverse populations with different conditions, including Parkinson’s disease, coronary heart disease, psoriasis and hypertension. All 14 trials reported improvements in adherence, with 10 of them showing statistically significant effects​105​. However, this review did not specify the populations targeted in terms of ethnicity, highlighting the need for more rigorous intervention studies that are tailored to the needs and cultural contexts of diverse ethnic groups, and evaluate their effectiveness through measured changes in relevant outcomes.

Healthcare provider-led interventions

Healthcare provider-led medication adherence interventions include strategies and programmes initiated and conducted by healthcare professionals such as pharmacists, nurses and doctors, or by a collaborative team comprising various specialists to enhance patients’ adherence to their medication​104–106​. Several studies have investigated the use of these interventions to improve medication adherence among ethnically diverse populations. For instance, pharmacist-led interventions to provide education and case management to people with hypertension was investigated in two studies including people of Latino/Hispanic-American and African-American backgrounds. The study by Lai et al. revealed that participants of Latino/Hispanic-American ethnicity showed improvement in refilling their medications on time after a community pharmacy-based hypertension disease-management programme involving pharmacist consultations, medication review, education, lifestyle counselling and support for home blood pressure monitoring was implemented. However, this does not necessarily indicate an improvement in actual medication adherence, as prescription refill measures reflect medication acquisition rather than confirmed medication-taking behaviour​107​. 

In contrast, for people of African-American ethnicity, Vivian et al. found no significant differences between the control and intervention groups in terms of forgetting to take doses at least once a week or in refilling medications within two weeks of the scheduled date following a pharmacist-managed hypertension clinic intervention involving monthly pharmacist consultations, medication adjustments, counselling and follow-up​108​. The differences in results between the two studies may be attributed to the specific approach of the intervention in the first study, as pharmacists who shared similar ethnic backgrounds with the participants delivered the intervention​107​. This may have enhanced cultural relevance and communication effectiveness. Another example is a nurse-led intervention providing culturally appropriate hypertension education among people of Surinamese and Ghanaian ethnicity (n=146) in the Netherlands. This study found that the intervention was not associated with a significant improvement in self-reported medication adherence compared with the control group​109​. However, another study showed improvements in medication adherence among individuals of black ethnicity with hypertension following a culturally sensitive education programme. The programme focused on lifestyle changes and medication adherence, and was delivered by a study team primarily consisting of nurses​110​. Overall, the effectiveness of healthcare provider-led interventions may be enhanced if they are provided by individuals who have either received culturally tailored training or share a racial and ethnic background with the minority groups. 

Barriers for developing and implementing interventions addressing ethnic inequities in medication adherence

The implementation of interventions to address ethnic inequities in medication adherence can face barriers ranging from systemic issues within healthcare systems to factors that are individual to the patient. At the systemic level, the lack of culturally competent healthcare providers — defined as individuals who possess the awareness, knowledge and skills to effectively interact across cultural differences and tailor care to patients’ cultural beliefs, language and medication use practices has been presented as a significant barrier that could hinder the development or reduce the efficacy of interventions designed for ethnically diverse groups when implemented​80,81,111,112​.

On the individual level, there may be several unique barriers that people face on the grounds of their ethnicity when adhering to medication for a variety of medical conditions. Ethnic-minority communities reported specific adherence barriers, such as language differences, cultural beliefs and practices that may conflict with Western medicine, and limited access to healthcare resources, as well as digital literacy and access-related barriers such as limited device or internet access​27,30,43,113,114​. These challenges may be addressed through culturally tailored education, interpreter support, and improved access to healthcare and digital resources​115,116​. Nevertheless, there remains a crucial need for qualitative research to thoroughly explore adherence challenges across ethnic groups with different medical conditions. Consequently, the lack of detailed data on the specific needs and barriers faced by people from ethnic minority groups complicates the design of effective interventions, and often leads to a generalised approach that fails to address specific disparities.

To effectively tackle this significant challenge, it is essential to conduct targeted research and collect detailed data that focus specifically on describing the health behaviours, outcomes, and barriers unique to diverse ethnic groups. Additionally, the engagement of communities through community-based participatory research, as advocated by Israel et al., further enriches this data collection process by ensuring that health interventions not only reflect the specific perspectives and needs of communities, but also incorporate local knowledge​117​. As a result, the relationship between healthcare providers and communities may improve and interventions are more likely to be effective. 

Furthermore, the limited digital competency and training of healthcare professionals may impede the implementation of digital health adherence interventions, especially when these tools must be tailored to meet the needs of ethnically diverse populations​118,119​. Thus, enhancing digital health capacity in healthcare systems through training for healthcare professionals, technical support, and culturally and linguistically appropriate digital resources may facilitate the effective implementation of digital-enabled adherence interventions​113,120​.

Five approaches can enhance cultural competence in the healthcare system: 

  • Promoting and maintaining diversity among the healthcare workforce; 
  • Providing cultural competency education for healthcare workers; 
  • Providing interpreter services to facilitate effective communication between different ethnic groups; 
  • Developing health education resources tailored to the cultural nuances of different communities;
  • Establishing healthcare settings that are sensitive to the cultural specifics of the populations they serve​121​.

Although evidence suggests that culturally competent interventions can reduce healthcare disparities, it is difficult to demonstrate sustained improvements in adherence among minority ethnic groups through patient engagement alone​122​. There is a need for comprehensive evidence to examine whether these interventions improve adherence to medication, health outcomes and equity of services across different ethnic groups, collectively aiming to reduce ethnic disparities influencing medication adherence​123​.

Future research and recommendations

According to existing literature, multiple approaches have been proposed to address ethnic inequities in medication adherence among diverse populations. These include culturally competent healthcare, improved healthcare provider–patient communication, and the involvement of community health workers​27,121,123​. A combination of qualitative, quantitative, and mixed-methods research can help uncover the lived experiences and contextual factors affecting different ethnic groups. Qualitative studies may explore how context shapes adherence behaviours, while quantitative analyses and trials can measure adherence patterns and evaluate intervention effectiveness. Such research should consider how ethnicity intersects with other social and demographic factors, such as gender, age, or disability in shaping medication adherence behaviours and the design of adherence interventions​124​.

Moreover, qualitative research can provide valuable insight into the unique experiences of individuals from different ethnic backgrounds​125​. The findings of this review may help healthcare researchers and decision-makers gain a deeper understanding of the barriers faced by different groups when adhering to medication, supporting the development of tailored interventions and culturally sensitive care practices. These insights may also inform the design of digital health interventions that better meet the needs of diverse populations.

It is crucial for healthcare providers to receive culturally competent training to better understand how culture can influence and shape a person’s approach to medication adherence. Community health workers who share similar ethnic backgrounds with the patients they serve can bridge the gap between healthcare providers and communities​126​. They may also offer education and support that is culturally aligned with the patients’ needs, and may be involved in the development of culturally tailored interventions.

Limitations

This review has several limitations. The existing evidence base is constrained by the frequent use of broad and inconsistently defined racial or ethnic categories. Many studies rely on aggregate labels (e.g. ‘black’ or ‘white’) that do not capture within-group heterogeneity, and may obscure important cultural, historical and contextual differences. As a result, interpretation of ethnic inequities in medication adherence is limited by these methodological constraints, highlighting the need for more precise, transparent, and disaggregated approaches to defining and reporting ethnicity in future research.

In addition, much of the available evidence originates from specific national contexts, particularly the United States. Differences in healthcare systems, migration histories, social structures and approaches to ethnic classification may limit the generalisability of these findings to other settings. Therefore, conclusions drawn from this review should be interpreted with consideration of contextual differences across healthcare systems and populations.

Conclusion

Healthcare delivery systems should be examined and reviewed to ensure they are culturally sensitive and appropriate, to best meet the needs of an ethnically diverse population. Despite the proven link between adherence and clinical outcomes, adherence gaps persist among minority ethnic groups, caused by the interplay of cultural, socioeconomic and healthcare-related factors. A multifaceted approach that focuses on addressing medication adherence inequities at the system and individual levels can be promising for mitigating these inequities.

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The Pharmaceutical Journal, PJ April 2026, Vol 318, No 8008;()::DOI:10.1211/PJ.2026.1.408129

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    This article has been peer reviewed by relevant subject experts prior to acceptance for publication. The reviewers declared no relevant affiliations or financial involvement with any organisation or entity with a financial involvement with any organisation or entity with a financial interest in or in financial conflict with the subject matter or materials discussed in this article.