Cross-Cultural Considerations in Prescribing Medication

Culturally-based health beliefs and behaviors drive adherence to treatment recommendations. Since many mental health clients enter the mental health system via a referral from their primary care physician, how their physician shapes expectations is very important. A previous article “Effective Mental Health Referrals” covers best practices for primary care providers to follow in communicating mental health referrals in a manner that culturally responsive. You can access the article here in the Dimensions of Culture article archives.

Culturally Based Concepts of Medicine

It is important for both physical and mental health providers to examine culturally based concepts and expectations of medication. 

• Some people from some cultures place a lot of faith in western medications. They may feel that if drugs aren’t prescribed, they aren’t getting adequate care.
• People from other cultures may be afraid that western medicines are addictive.
• In some cultures, the consumption of medicines is tied to the hot/cold syndrome (a common culture-bound syndrome found worldwide.) Some herbs and medicines are believed to be hot, others cold. There is no reference book that defines which western medicines would be categorized as hot or cold, and there is great variability in hot/cold systems across different cultures. In general, if a patient is considered to have a “hot” condition he/she should be treated with a “cold” medicine.  For example, susto, or fright sickness, is common among Latinos. It is believed to be a hot illness. A client who believes her illness is “hot” will not take a medication that is also “hot.” If a western doctor does not understand this belief system, it could lead to noncompliance with medications he prescribes.

Explore your patients’ and caregivers’ beliefs around medicines with these questions:

The following questions explore sociocultural issues in taking medicines. Ethno-psychopharmacology considerations (the effects of psychoactive drugs on culturally and ethnically diverse patients) are beyond the scope of this article.

(These questions are from the excellent book Multicultural Care by Lillian Comas-Diaz.)

• How do you feel about taking medication?
• How do you feel about taking this particular (psychotropic) medication? Use language to frame intended benefits as opposed to talking in clinical terms. Few people will know what an SRI is.  Examples: “This medication that helps you sleep.” “This medication that helps you feel more calm.” 
• What do you expect from the medication?
• How do you feel about the amount of this medication you are taking?
• Are there any rules about medications you follow – like avoiding the sun, certain foods, etc.?
• Do you (did you) get the medication in the United States, in another country, or both?
• Did you get the medication from a doctor like me? (From a healer/friend/family member)
• Did you take the medication as you were told to take it?
• Do you share your medication with others?
• Do you use any herbs or other remedies?

Using questions such as these will help you assess people’s beliefs and expectations related to taking medications, especially psychotropic ones. If you have taken the time to build rapport and trust, people will be more willing to discuss their beliefs, revealing how health literate they are about western medicines. For example, do they understand why it is not a good idea to share medications with others? Do they understand that the dose recommended by a physician depends on many factors including body weight? Children should never be given medications prescribed for adults. Are patients aware of possible drug interactions with herbal remedies? As with all health beliefs, attitudes about taking medication are encased in a cultural context. Be sure to explore the context thoroughly.