Working with CALD groups: testing the feasibility of an intervention to improve medication self-management in people with kidney disease, diabetes, and cardiovascular disease

Introduction: Australia is an ageing multicultural society with an increased prevalence of chronic conditions. The rise of coexisting diabetes, kidney disease and hypertension is placing a significant and increasing demand on Australian health services. Prescribed medications are a key component of reducing the disease burden of these coexisting conditions, and successful treatment is largely dependent on self-management of medications. Culturally and linguistically diverse (CALD) groups have an increased risk of medication mismanagement and are often excluded from intervention studies. We examined an intervention in this group and report on some of the difficulties and resource issues involved with studying CALD groups. Methods: Patients aged ≥18 years of age with chronic kidney disease, diabetes and cardiovascular disease whose preference it was to speak Greek, Italian or Vietnamese were recruited from nephrology outpatients' clinics of two Australian metropolitan hospitals in 2009. A translated, multifactorial intervention, consisting of a medication review, a short PowerPoint presentation and motivational interviewing designed to improve medication self-efficacy and adherence, was tested in a randomised controlled trial (RCT) with 12 months follow-up post-baseline. People collecting data and assessing outcomes were blinded to group assignment. Results: Seventy-eight participants were recruited and 29 participants completed the study. There were no significant differences in medication self-efficacy or adherence between the intervention and control groups at three, six and 12 months post-baseline. Conclusion: The pilot study was not feasible due to high attrition rates. This work has highlighted difficulties with conducting research into CALD groups using interpreting services and health literacy issues affecting medicine self-management in this group.