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Beliefs and Adherence to Glaucoma Treatment: A Comparison of Patients From Diverse Cultures

Rees, Gwyneth PhD*; Chong, Xue-Ling MBBS; Cheung, Carol Y. PhD; Aung, Tin MD, PhD†,‡,§; Friedman, David S. MD, PhD∥,¶; Crowston, Jonathan G. MD, PhD*; Lamoureux, Ecosse L. MSc, PhD*,‡

doi: 10.1097/IJG.0b013e3182741f1c
Original Studies

Purpose: To determine adherence rates and beliefs about glaucoma and its treatment in white Americans, African Americans, white Australians, and Singaporeans of Chinese descent.

Patients and Methods: Cross-sectional study of 475 glaucoma patients using topical eye drops for at least 6 months. The sample consisted of white Americans (n=133), African Americans (n=58), white Australians (n=107), and Singaporeans of Chinese descent (n=117). Self-reported adherence and beliefs about glaucoma and its treatment were assessed using the Reported Adherence to Medication scale, the Brief Illness Perception Questionnaire, and the Beliefs about Medicines–Specific Questionnaire.

Results: Accounting for sociodemographic differences, significant differences in self-reported adherence rates were identified (P<0.001). White Americans and Australians reported significantly higher adherence (65.4%, 67.7% reported complete adherence) than African Americans or Singaporeans (56.9%, 47.5%, respectively; P<0.05). Beliefs about glaucoma treatment were predictive of adherence only in the Australian and white American samples (P<0.05).

Conclusions: In western cultures, attempts to improve adherence may benefit from greater examination of individual’s concerns about, and perceived need, for glaucoma treatment. Further studies are needed to identify the critical predictors of adherence in nonwestern cultures and to validate measures in these populations.

*Health Services and Ocular Epidemiology Research Unit, Department of Ophthalmology, Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Australia

Yong Loo Lin School of Medicine, National University of Singapore

§Department of Glaucoma, Singapore National Eye Centre

Singapore Eye Research Institute, Singapore

Wilmer Eye Institute

Johns Hopkins Bloomberg School of Public Health, Baltimore, MD

E.L.L. is a recipient of the NHMRC Career Development Award Fellowship.

Disclosure: The authors declare no conflict of interest.

Reprints: Gwyneth Rees, PhD, Health Services and Ocular Epidemiology Research Unit, Department of Ophthalmology, Centre for Eye Research Australia, University of Melbourne, Locked Bag 8, East Melbourne, Vic 8002, Australia (e-mail:

Received April 5, 2012

Accepted August 28, 2012

© 2014 by Lippincott Williams & Wilkins.