A quarter of all Australians were born overseas, many in countries whose languages, cultures, beliefs and health systems are very different from those in Australia. These influences may lead to difficulties using medicines safely and effectively.

The difficulties that people from culturally and linguistically diverse (CALD) backgrounds face are similar to those affecting people in general. However, they tend to be more marked, especially in those with poor English proficiency, and those who are socially isolated. The difficulties are often compounded by a lack of understanding of cultural differences on the part of health services, and a failure to use professional interpreting services.

Beliefs about medicines

Many CALD people come from cultures with long histories of using traditional remedies, including herbal medicines, for health and healing. Some also come from cultures that view health and illness in different ways from Australian health services. For example, some cultures believe that illness is the result of an imbalance of hot and cold in the body. These beliefs, including spiritual beliefs, may affect their understanding of the explanations they are given about their health problems. They may also affect their attitudes to treatment.

  

Many CALD people are not aware that herbal and traditional medicines may interact with prescription and over-the-counter medicines. As a result, they don’t tell their doctors and pharmacists that they use such medicines. They may also be reluctant to disclose their use for fear of disapproval.

Some CALD people, particularly those with little experience of western-style medicine, may not understand the different ways that medicines can be used. For example, they may not be familiar with using medicines to prevent rather than treat illness, or they may assume that injections are once-only treatments. They may also place certain meanings on the colour and size of medicines. For example, in some cultures, red coloured tablets indicate strong medicine.

Information about medicines

Difficulties with English mean that many CALD people are not given verbal explanations or instructions they can understand. In addition, they cannot make use of written information, such as the medicine label, the Consumer Medicine Information leaflet, or the internet.

These language difficulties are often exacerbated by a reluctance to seek clarification or ask questions of health professionals, because their English is not good enough or they don’t know what questions to ask. Many also come from cultures where asking questions of doctors and other professionals is seen as disrespectful.

Language difficulties are often exacerbated by a reluctance to

seek clarification or ask questions of health professionals.

As a result, CALD people often don’t understand what their medicines are for, how and when to take them, and for how long to take them. Also, many do not know about the side effects of their medicines, and what to do if they experience one.

The problem is not confined to those with little or no English. People with conversational English often have difficulties understanding complex medical explanations and instructions, particularly when they are unwell or in a stressful situation.

Attempting to alleviate these problems by using relatives or friends to interpret is not usually appropriate as they rarely have the necessary skills or medical knowledge.

Using medicines

Like all Australians, some CALD people have difficulties following the instructions for their medicines. The reasons may be unintentional: they don’t understand the instructions, can’t remember them, or can’t check the label. Or, they may be intentional: they don’t understand why they need to take the medicine as instructed, or don’t trust western medicines.

Other issues include:

• Adjusting the dosage of their medicine depending on their perception of their symptoms. This is more common in people who don’t understand that medicines may not work properly if not taken regularly.
• Stopping medicines too soon. The reasons are sometimes related to a lack of understanding about chronic conditions. If they don’t understand how long they need to take the medicine, they may stop taking it as soon as they feel better. If they don’t understand that the medicine takes a while to work, they may stop taking it if they feel that it has had no effect after a few days.
• A desire to save money may lead people to take less than the correct dose, spread out doses, use left-over medicines, or share medicines with others.
  

Fasting

Fasting is an important part of many faiths, including people who are Jewish, Buddhist, Muslim, Christian or Hindu. During these times, people may want to stop their medicines temporarily or take them at irregular times. This can cause problems for people with diabetes and other conditions where regular timing of their medicines is important. Others may continue to take their medicines but take them without food, which may also cause problems.

Sharing medicines

Sharing is a strong feature of some cultures and provides members with mutual aid and strengthens family and community networks. In such communities, sharing medicines may be seen as being no different to sharing food, clothes and other things. However, they may not be aware that a medicine that works for one person may not work for someone else, and may even harm them.

They may not be aware that a medicine that

works for one person may harm someone else.

A lack of knowledge about medicines may exacerbate the problem. Many people assume that the medicines used to treat a particular condition are interchangeable. For example, they may assume that all high blood pressure tablets are the same, when actually they can be very different.

 

Overseas medicines

Using medicines bought overseas is common practice in some CALD communities. In some cases, it allows community members to obtain traditional medicines not readily available in Australia. When it involves prescription medicines whose names or strengths differ from country to country, it increases the chance that a person may take two lots of the same medicine, and experience side effects as a result.

Some people also send medicines bought in Australia to family members overseas. They may do so to help their families obtain medicines they cannot afford or obtain in the home country. However, they may not realise that sending prescription medicines overseas is illegal if the medicine has been subsidised under the Pharmaceutical Benefits Scheme. The medicine may also not be appropriate for the recipient.