Living with polypharmacy: a study with older Pakistanis in East London

By Najia Sultan & Deborah Swinglehurst

We recently published a research article in BMC Geriatrics, where we explored experiences of polypharmacy in older British Pakistani patients living in East London. 

The study uses the Biographical Narrative Interview method (BNIM).  BNIM interviews consists of a single opening interview question which is designed to elicit a narrative; in this case about patients’ experiences of polypharmacy in the context of their biographies and daily lives. Follow- up questions are then asked on the basis of the narrative response to the opening question. Interviews for this study were conducted in Urdu and English with 15 first-generation Pakistani patients in their homes. All participants were prescribed ten or more regular medications and were aged over 50.

Polypharmacy was seen to be enacted through networks of interpersonal and socio-material relationships. The doctor- patient relationship and the family network held particular significance to the older British Pakistanis interviewed here. Participants described emotional bonds between themselves and their medicines, identifying them as ‘forces for good’ and substances which allowed them to maintain their health through the intercession of God. Meanings attributed to medicines and enacted through these social, emotional, and spiritual relationships contributed to emerging and sustaining polypharmacy for the patients interviewed.  

This study demonstrated that for the British Pakistani participants interviewed, cultural understandings around medicines were key to how they made sense of their treatments and their expectations of care. 

Better understanding how medication practices in different communities are enacted is important for informing meaningful and effective conversations between doctors and patients, and when designing interventions for medication optimisation. In our article, you can learn more about the role of medications in the British Pakistani community. We would love to hear in the comments if these insights change the way you enter a conversation about medications with your patients or your clinician. There is also a wider need for research which informs culturally competent prescribing practices. The BNIM interview method might be a useful approach for researchers working with different communities. We hope you enjoy the article.

Sultan, N., & Swinglehurst, D. (2023). Living with polypharmacy: A narrative interview study with older Pakistanis in East London. BMC Geriatrics, 23(1), 746.

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