Cultural Differences in Illness Perception and Adherence to Treatment of Cystic Fibrosis Patients

Abstract

Background: Patients with Cystic Fibrosis (CF) have a complex treatment regimen which pos-es emotional, social and economic burden. Adherence to treatment may be influenced by the patient’s own beliefs about the disease, which may be influenced by his religious/cultural back-ground. The Israeli population consists of a majority of Jews. The Arabs, which are a minority, have different socioeconomic status, cultural beliefs and values.
Objectives: To examine the cultural differences in illness perception and treatment adherence between Jewish and Arab CF patients, and the possible association between them.
Methods: A cross-sectional, single Israeli CF center pilot study. Each patient completed the Ill-ness perception-revised questionnaire (IPQ-R) and CF My Way questionnaire to assess adherence to therapy. Illness severity was scored using CF-ABLE score. The correlations between religious/cultural background (Jews/Arabs), illness perception and adherence to treatment were examined.
Results: Ten Jews and 23 Arabs (Muslims, Christians or Druze).Their median age was 21(13-49) years. The illness perception questionnaire revealed differences between the two groups. Arabs considered their disease as more cyclical and less predictable (cyclical score 12.6 vs. 8.8, p=0.002). Only severe Arab patients assumed that treatment can affect their disease (p=0.049). In both groups, there was a correlation between consequences score and adherence to inhaled antibiotics and between timeline score and adherence to mucolytics. Adherence to physiotherapy was lower than recommended (p=0.02 Jews, 0.003 Arabs) and there were numerous mis-conceptions about the causes of the disease.
Conclusions: Arabs related to CF course as less predictable. Those who understood their dis-ease tended to have better adherence. Patients largely misunderstand the cause of CF and tend to perform less physiotherapy than recommended. Further studies are needed to assess cultural differences and adherence interventions should be culture-sensitive.