In the intricate landscape of American healthcare, Asian-American immigrants often face unique challenges in accessing and adhering to medical treatment. I recently had the opportunity to interview Mrs. T, a first-generation Vietnamese immigrant and patient at Walgreens, to shed light on these struggles. Her experience is a powerful reflection of the barriers Asian-Americans encounter within the healthcare system, particularly when it comes to medication adherence.

I was especially drawn to Mrs. T's story because it reminded me of my family's first experience at an American pharmacy. At the time, we didn’t speak English and, unsure of what to do, we simply handed our IDs to the pharmacist, hoping they would understand our needs. For many ethnic minority patients, the simple act of handing over IDs has become a universal signal for help at community pharmacy counters. This resonates deeply with Mrs. T's experience and underscores the confusion and intimidation that many immigrants face when navigating an unfamiliar and complex healthcare system.

Lost In Translation

When asked about her access to healthcare in America, Mrs. T expressed that it has been significantly harder than what she was used to back in Vietnam. "The healthcare system here is more complicated, with too many strange words," she said. "Even just making an appointment or understanding what the doctor says can be a challenge." Indeed, it is considerably difficult for many Americans to understand terms such as referrals, the coverage-gap, and prior authorization. For many immigrants like Mrs. T, language barriers contribute to the difficulty, even with the help of online translation tools. Medical terminology in English can be complex, even for native speakers, making it extremely intimidating for those still learning the language.

Mrs. T highlighted that cultural differences further complicate her interactions with healthcare providers. Traditional remedies and practices are deeply ingrained in many Asian cultures, but explaining these to American doctors and pharmacists can be daunting. "Sometimes, they don't always take them seriously," Mrs. T shared, referring to how her cultural practices are perceived by healthcare professionals.

Medication adherence is a particular struggle for Mrs. T. The instructions on medication bottles are often detailed and use language that can be confusing. She mentioned the difficulty in understanding terms like "take with food" or "take on an empty stomach." Mrs. T’s hesitation is not unique; studies show that fewer than half of Asian-Americans prescribed psychotropic medications adhere to their treatment due to cultural beliefs and misunderstandings.1 The traditional approach to health in her culture, which emphasizes natural healing and the use of herbal remedies, can sometimes conflict with Western medicine's emphasis on long-term medication use.

Bridging Worlds

The lack of culturally relevant resources further exacerbates this issue. Mrs. T suggested that having more translators available or simpler instructions with pictures could make a meaningful difference. This aligns with findings from meta-analyses that highlight the need for culturally tailored medication adherence interventions. Despite evidence that such interventions can improve adherence, the healthcare system frequently lacks strategies that fully address these cultural nuances.

Asian-Americans are often underrepresented in studies on medication adherence, and even when they are included, their unique cultural barriers are not always fully addressed. This leads to lower adherence rates and, consequently, poorer health outcomes. Mrs. T’s experience serves as a potent reminder of the critical need for cultural competence in healthcare. Understanding and addressing the specific barriers faced by Asian-Americans, particularly first-generation immigrants, is essential to improving both medication adherence and overall healthcare outcomes.

By sharing Mrs. T’s story, I hope to bring greater awareness to the challenges faced by Asian-Americans in the healthcare system, and to emphasize the importance of cultural humility among healthcare workers. Only by recognizing and addressing these barriers can we create a more inclusive and effective healthcare environment for everyone.

References:

1. Fancher TL, Lee D, Cheng JK, Yang MS, Yang L. Interventions to improve adherence to psychotropic medication in clients of Asian descent: A systematic review. Asian American Journal of Psychology. 2014;5(1):22-34.  

2. Conn VS, Enriquez M, Ruppar TM, Chan KC. Cultural relevance in medication adherence interventions with underrepresented adults: Systematic review and meta-analysis of outcomes. Preventive Medicine. 2014;69:239-247. doi:10.1016/j.ypmed.2014.10.021.

3. Arndt RZ. Building trust through technology for medication adherence. Modern Healthcare. May 26, 2018.

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