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Centre for Health Care Research, Faculty of Health, University of Brighton, Falmer Campus, Brighton BN1 9PH, UK
Division of Psychiatry and Psychology, Guys, Kings and St Thomas School of Medicine, 5th Floor, Thomas Guy House,
Guys Campus, London SE1 9RT, UK
c
UK School of Pharmacy and Biomolecular Sciences, University of Brighton, BN1 9PH, UK
Abstract
This exploratory, cross-sectional study examined the effect of self-reported cultural background on beliefs about
medicines (modern pharmaceuticals) and perceptions of personal sensitivity to the adverse effects of taking medication.
Using a validated questionnaire, beliefs about pharmaceutical medication were compared between 500 UK
undergraduate students who identied themselves as having an Asian or European cultural background. There was
a signicant association between cultural background and beliefs about the benets and dangers of medicines. Students
who self-reported to have an Asian cultural background expressed more negative views about medication than those
who reported a European cultural background. Students with an Asian cultural background were signicantly more
likely to perceive medicines as being intrinsically harmful, addictive substances that should be avoided. They were
signicantly less likely to endorse the benets of modern medication. There was no signicant relationship between
cultural background and perceptions of personal sensitivity to medication effects or belief about how doctors use
medication. In the total sample, past and present experience of taking medication was associated with a more positive
orientation to medicines in general. Students who considered themselves to have a European cultural background had
signicantly more experience with prescribed medication than those who selected an Asian cultural background. The
relationship between cultural background and beliefs about medicines in general was maintained after controlling for
potential confounding variables, including chosen degree course, experience of taking prescribed medication, age, and
gender. The identication of differences in beliefs about medication, between two specic cultural groups, suggests the
need for a greater understanding of the effects of cultural background on medicine-usage with potential implications for
the conduct of prescribing-related consultations and for the provision of patient information on medication.
r 2004 Elsevier Ltd. All rights reserved.
Keywords: Beliefs; Culture; Ethnicity; Medicines; Perceptions; UK
Introduction
Ethnicity and ethnic grouping rest on the cultural
differentiation of individuals and on the creation of
*Corresponding author. Health Psychology, Pharmacy Practice School of Pharmacy, University of Brighton, Biomed
Sciences, Cockroft Building, Lewes Road, Brighton BN2 4GJ,
UK. Tel.: +44-1273-642098; fax: +44-1273-679333.
E-mail address: r.horne@brighton.ac.uk (R. Horne).
0277-9536/$ - see front matter r 2004 Elsevier Ltd. All rights reserved.
doi:10.1016/j.socscimed.2004.01.009
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Method
Study design and sampling strategy
An exploratory cross-sectional study in which a
sample of 600 UK undergraduate students were asked
to complete questionnaires assessing beliefs about
medicines in general, perceptions of personal sensitivity
to the potential adverse effects of medication, past and
present experience of taking medication, and demographic characteristics. Beliefs about medicines were
compared between undergraduate students who identied themselves as having an Asian or European cultural
background, whilst controlling for experience of taking
medication (past and present) and choice of degree
course. All participants in this study had also taken part
in an earlier study, reported by Horne, Frost, Hankins,
and Wright (2001).
Measures
Demographic characteristics
Participants were asked to provide information on
their age, gender, degree course, year of study, and
cultural background. Participants were asked to select
their cultural origin from the following list: Afro
Caribbean, African, Asian, European, or other.
The Beliefs about Medicines Questionnaire (Horne et al.,
1999)
Participants beliefs about medicines in general were
assessed using the Beliefs about Medication Questionnaire (BMQ) General scale, which comprises two 4-item
sub-scales. The General-Harm scale assesses individuals
beliefs about the intrinsic properties of medicines and
the degree to which medicines in general are perceived to
be harmful, addictive poisons, which should not be
taken for long periods of time. Items in the scale include:
People who take medicines should stop their treatment for
a while every now and again, Most medicines are
addictive, Medicines can do more harm than good, and
All medicines are poisons. The General-Overuse scale
assesses beliefs about the way in which medicines are
used and the extent to which individuals perceive that
medicines are over-prescribed by doctors. Items in the
scale include: Doctors use too many medicines, Doctors
place too much trust on medicines, Natural remedies are
safer than medicines and If doctors had more time with
patients they would prescribe fewer medicines. The
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Statistical analysis
Statistical analysis was carried out with the SPSS for
Windows statistical software package. Independent
samples t-tests were performed to investigate the effect
of gender and experience of prescribed medication on
medication beliefs. The effect of cultural background on
beliefs about medicines was assessed in Asian and
European students. Due to the signicant association
between cultural background, choice of course, and
experience of prescribed medication, a regression
analysis was used to partial out the effects of chosen
course, experience of medicines, as well as age and
gender.
Results
Effect of gender on medication beliefs
Incomplete
or
spoiled
questionnaires
were
excluded, leaving a total of 500 completed
questionnaires from students who identied themselves
as having Asian or European cultural backgrounds,
Table 1
Sample characteristics for total sample, European students, and Asian students
Total (n 500)
European (n 417)
Asian (n 83)
Age (years)
Mean
SD
Range
23.9
6.5
1754
24.2
6.9
1754
22.0
2.8
1832
Gender
Male
Female
258
242
(51.6%)
(48.4%)
216
201
(51.8%)
(48.2%)
42
41
(50.6%)
(49.4%)
Coursea
Pharmacy
Mechanical engineering
Accounting and nance
Social policy and administration
Humanities
124
102
110
94
68
(24.9%)
(20.5%)
(22.1%)
(18.9%)
(13.7%)
84
88
85
90
68
(20.2%)
(21.2%)
(20.5%)
(21.7%)
(16.4%)
40
14
25
4
0
(48.2%)
(16.9%)
(30.1%)
(4.9 %)
Year of studyb
One
Two
Three
123
174
112
(42.7%)
(34.9%)
(22.4%)
183
139
94
(44.0%)
(33.4%)
(22.6%)
30
35
18
(36.1%)
(42.2%)
(21.7%)
248
252
(29.6%)
(50.4%)
214
203
(51.3%)
(48.7%)
34
49
(41.0%)
(59.0%)
a
b
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Table 2
Mean (SD) scores for beliefs about medicines for students with
and without current, or recent previous, experience of
prescribed medication
Variable
Yes (n 121)
No (n 379)
Variable
Yes (n 239)
2.79
1.50
2.38
0.89
(0.67)
(0.76)
(0.54)
(0.61)
No (n 261)
(0.67)
(0.77)
(0.53)
(0.59)
t (df=498)
t (df=498)
2.78
1.32
2.97
0.55
po0:05; po0:01:
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Table 3
Adjusted mean (SD) scores for beliefs about medicinesa for Asian and European undergraduate students
Variable
Asian (n 83)
European (n 417)
t (df=498)
p (two-tailed)
General harm
General overuse
General benet
Sensitive soma
2.90
3.47
3.70
2.37
2.54
3.35
3.99
2.27
5.47
1.39
4.97
1.29
o0.001
>0.05
o0.001
>0.05
0.7
0.6
(0.50)
(0.71)
(0.50)
(0.61)
(0.55)
(0.74)
(0.49)
(0.64)
Scores are adjusted for course, age, sex, and experience of medication.
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Discussion
This study quanties the effect of cultural background
on medication beliefs. The ndings suggest that there is
a strong association between cultural background and
beliefs about medicines in general, even when controlling for potentially confounding variables, such as
chosen degree course, experience of taking medicines,
and gender.
Cultural background inuenced students views about
the intrinsic nature of allopathic medicines (potential for
benet and harm) but not their views about whether
medicines are overused by doctors, or their beliefs about
personal sensitivity to the adverse effects of medication.
Students who identied themselves as Asian in origin
were more likely than students with a European origin
to perceive medicines as intrinsically harmful. These
ndings support previous research, which found that
students who identied themselves as Asian were
generally less satised with Western medical care
compared with Western students (Armstrong &
Swartzman, 1999).
Students who reported themselves as Asian in origin
did not perceive themselves to be more sensitive to the
potential adverse effects of medication and were no
more likely to have experienced adverse effects from
medication than their European-origin counterparts.
The effects of culture on beliefs about medicines are very
specic: the differences appear to be in beliefs about the
intrinsic properties of medicinestheir capacity for
harm and benetrather then the way in which they
are prescribed by doctors, or beliefs about personal
sensitivity to adverse effects.
It is relevant that Asian-origin respondents had
signicantly less experience with prescribed medication
than their European-origin counterparts. In the total
student sample, current and previous experience of
taking medication was associated with a more positive
orientation to medicines in general. Similar ndings
have been reported in the literature relating to attitudes
towards benzodiazepine tranquillisers, with users reporting more favourable attitudes towards these drugs
than non-users (Clinthorne, 1986; Mansbridge & Fisher,
1984). However, the clear differences in beliefs about
medicines between the two groups of participants could
not be accounted for by differential experience of taking
medication.
In this study no distinction was made between SouthEast Asian (e.g. Vietnam, Taiwan) and Indian or
Pakistani Asian. The notion of Asian cultural group in
this study thus encompasses a range of separate cultures
and explanatory systems. However, the many different
Asian cultures are associated with explanatory models
and attitudes to illness which are different to Western
biomedicine and which may predispose against it
(Khajuria & Thomas, 1992; Pachter et al., 2002; Uba,
Acknowledgements
We would like to thank Cara Davis, Research
Assistant at the Centre for Health Care Research,
University of Brighton, for help in the preparation of
this paper.
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