The World Health Organisation notes that the average non-adherence rate is 50 percent among those with chronic illnesses such as diabetes and hypertension.

Consequently, non-adherence to medicine leads to worsening of conditions and increased co-morbid diseases, increased health care costs and deaths.

In the United States, it is estimated that medication non-adherence is associated with 125 000 deaths, 10 percent of hospitalisations and $100 billion in health care services annually.

Though a plethora of socio-economic issues can possibly affect medicine adherence, belief systems are very influential.

According to classical sociologist, Emile Durkheim, religion forms the supra-structure of society.

More importantly, religion shapes human behaviour. And failure to abide by agreed social constructs is viewed as “social anomie”.

Durkhemian sociology critically emphasised the role of religion in bringing about social cohesion and social solidarity.

For functional sociologists, society achieves a state of equilibrium through social cohesion and social solidarity. Beliefs, customs, norms and values are critical for social stability.

On the contrary, Karl Marx viewed religion as “the opium of the mass”.

And for Marxists, religion is an ideological state apparatus, continuously manipulated by the bourgeoisie to exploit proletariats.

Accordingly, religion was craftily designed to pacify the poor.

Marxian sociology viewed health as big business, used and abused by the rich to accumulate capital at the expense of the poor.

In explaining health behaviours, social determinants such as spirituality and religiosity have been increasingly identified as impacting health and treatment.

Spirituality and religiosity are separate, but related, concepts.

Spirituality refers to an inner freedom to engage in faith and a relationship with a Supreme Being, such as God.

According to Kretchy et al. (2013), “religion is the outward adherence to highly prescribed beliefs, practices and rituals related to the Supreme Being, such as church attendance and associated activities”.

Many classical and contemporary religious institutions have entirely embraced health care systems.

Biblically, St Luke was a physician and Deaconess Phoebe was a nurse.

On the other hand, some Christian religious sects have vehemently rejected contemporary health systems.

Johhane Marange Apostolic sect – an indigenous Christian church – does not subscribe to the “doctrine of medicine”.

To them, disease is a consequence of evil spirits, far much detached from the biological, physical, psychological and environmental forces.

Although some religious sects embrace health care systems, they seem to have ideological reservations on some medical services.

Jehovah’s Witness congregants appreciate the role of contemporary health systems, but, blood transfusion is deemed “a religious deviance”.

Leventhal (1970) proposed the common-sense model of illness representation. The common sense model of self regulation explains how individuals respond to and manage health threats.

It suggests that people actively engage in problem-solving by developing mental models of health threats, subjective and objective treatment goals, and practices and procedures most likely to achieve those goals.

Patients’ acceptance of medical advice – including medication use – may be influenced by subjective beliefs about their health condition.

Treatment adherence is often a predominant factor in the management of chronic diseases. Adherence is the process by which patients take their medication as prescribed.

In this rich vein, common sense, decision-making and evaluation are all relative to socialisation.

Socialisation is the process of learning to behave in a way that is acceptable to society. According to the symbolic interactionist perspective, “an individual is a mirror image of society”.

Symbolic interactionism is a micro-level sociological theory that focuses on the relationships among individuals within a society.

Communication – the exchange of meaning through language and symbols – is believed to be the way in which people make sense of their social worlds.

While primary socialisation essentially takes place at home, the church and school form secondary institutions of socialisation.

Tertiary socialisation comes in the form of institutions such as colleges, universities, employment and other social settings.

Crucially, global populations manifestly behave according to socially constructed religious and spiritual prescriptions, passed on through generations.

African traditional religion has always compounded the already dire situation of non-adherence as patients intensely seek alternative remedies.

Some researchers argue that a number of patients utilise both forms of medicine, jeopardising treatment adherence.

Of note, traditional churches such as the Roman Catholic, Methodist, Anglican, Salvation Army and the Seventh Day Adventist have always played a major role in educating members of the society.

Apart from running schools, traditional churches have historically addressed community health needs through construction of mission hospitals.

Apparently, socialised church members are more likely to appreciate the essence of education and health services and adhere to prescribed medicine.

However, some emerging Pentecostal churches have seemingly brought consequences to medicine adherence.

Prophet Walter Magaya hogged the limelight for wrong reasons when he pronounced that he had found an HIV cure.

As many people keenly follow the popular religious figure, followers are likely to default on prescribed pharmacotherapy.

In fact, beliefs must be taken into account when giving health advice and, or providing medical treatment.

However, poor socio-economic conditions can impede medicine adherence amongst vulnerable populations.

Non-adherence is a result of many causes and there is no one-size-fits-all approach that exists to curb the problem.

Therefore, the relationship between health care practitioners and patients is very important in addressing medication non-adherence.

In this context, open and on-going communication between the stakeholders is essential to combating the challenge.

Pharmacists, through their training and accessibility are well positioned to address non-adherence.

Equally, nurses should ensure that patients are well informed about the chronic disease and complications associated with non-adherence.

Ultimately, the goal is to achieve optimal health outcomes. Religiosity and spirituality must actively promote medicine adherence and ease the global health burden.

Everisto Mapfidze is a registered general nurse who holds a Bsc Honours in Sociology (UZ). For feedback: [email protected]