Barriers of medication adherence in patients with type-2 diabetes: a pilot qualitative study

“Data analysis was performed alongside the interviews, based on the method suggested by Lundman and Graneheim: 1) transcription of the entire interviews as quickly as possible; 2) reading the entire interview transcript to get an overall understanding of the content; 3) determination of manifest units and primary codes…”

“It means that the disease is analyzed through the person’s way of life, experience of the world, and interaction with other people.(18) The present study was conducted using a qualitative approach to explain adherence to treatment in patients with diabetes in Saghez, Kurdistan province, Iran.”

“9% for treatment adherence, respectively.(14,15)”

“In a study by Delamater et al, adherence to physical activity and diet was found to be 19% and 65%, respectively, and only 5% of the patients taking glucose-lowering oral pills monitored their blood sugar in a daily manner.(12) A review study by Mashrouteh et al showed that the prevalence of treatment adherence in Ira…”

“In a study by Mayberry and Osborn (2012), a group of family members of diabetic patients did not support their patients despite having knowledge of diabetes (a tedious strategy), and another group unintentionally intervened in their diet (the strategy of helplessness).(35) Because diabetes affects the families in addi…”

“These findings were consistent with those of Edessa et al about the role of financial weakness in adherence to diet therapy.36 Balkrishnan et al (2003) found that 10% increase in adherence to diet therapy was associated with a one-fourth reduction in treatment costs.37 Diabetes and its treatment…”

“Failure to adhere to the therapeutic regimen accelerates the complications of diabetes.(10) In a study by Osborn et al, the prevalence of adherence to oral glucose-lowering drugs was 36–87%, and prevalence rates ranging from 54% to 81% were reported for adherence to insulin alone or insulin and glucose-lowering drugs.”

“The Sweileh’s study described this condition as lack of awareness and knowledge about diabetes as a factor contributing to adherence to treatment.(24)”

“In the Hertz’s study (2005), the onset of insulin therapy was associated with a lack of adherence to the therapeutic regimen.(26) In a study by Adisa et al (2013), insulin-dependent patients were less likely to follow the diets recommended by their doctors compared to those receiving oral tablets.”

“Behavioral changes are the basis of treatment for chronic diseases, and failure to adhere to treatment is a common problem in patients with type-2 diabetes.(7) Similar to patients other with chronic conditions, patients with diabetes have poor adherence to treatment.”

“Also, Vermeire et al found that patients with diabetes felt that they had not received enough information on diabetes, and that part of the information provided to them was unclear or not easy to remember, or that they were not provided with information at an appropriate time.(25) In this study, the problem of lack of…”

“In terms of non-adherence to treatment, Bezie (2006) suggested that physicians should talk to the patients on how to follow treatment recommendations rather than prescribing a second drug or changing the current medications.(38) If doctors spend more time with diabetic patients, they will have the opportunity to discu…”

“Therefore, diabetes is the second leading cause of hospitalization due to non-adherence to treatment.(8,9)”

“These findings were consistent with those of Edessa et al about the role of financial weakness in adherence to diet therapy.(36) Balkrishnan et al (2003) found that 10% increase in adherence to diet therapy was associated with a one-fourth reduction in treatment costs.”

“In a study by Osborn et al, the prevalence of adherence to oral glucose-lowering drugs was 36–87%, and prevalence rates ranging from 54% to 81% were reported for adherence to insulin alone or insulin and glucose-lowering drugs.(11) In a study by Delamater et al, adherence to physical activity and diet was found to be…”

“In a qualitative study among patients with diabetes in Qatar, Jaam et al found three categories of factors, including patient-related factors, patient-provider factors, and societal and environmental factors as barriers to treatment adherence.(16) In another study, poor medical team performance, social dilemma, and pe…”

“9% for treatment adherence, respectively.(14,15)”

“Other studies have suggested that the more stressful events experienced by the patient, the higher the chance of non-adherence to treatment, and that depression and stress can lead to reduced adherence to treatment.(32,33) When caring for these patients, their roles in everyday life should be adequately examined, and…”

“Adherence behaviors in patients with type-2 diabetes include five categories: adherence to medication, dietary recommendations, increased physical activity, self-control of blood glucose, and proper care of legs.(8) Failure to adhere to the therapeutic regimen accelerates the complications of diabetes.”

“Other studies have suggested that the more stressful events experienced by the patient, the higher the chance of non-adherence to treatment, and that depression and stress can lead to reduced adherence to treatment.(32,33) When caring for these patients, their roles in everyday life should be adequately examined, and…”

“The findings of our study are in line with those of other studies on mental problems and psychological health.(30,31) In addition, stressful life events and depression(11,32) and their implications affect adherence to treatment in patients with type-2 diabetes.”

“In a study by Adisa et al (2013), insulin-dependent patients were less likely to follow the diets recommended by their doctors compared to those receiving oral tablets.(27) Diabetes nurses and medical teams should pay more attention to patients’ beliefs, and try to correct their false beliefs and increase their treatm…”

“Horvat et al found that age, type of treatment, and copayment were the most important predictors of treatment non-adherence.(23) The Sweileh’s study described this condition as lack of awareness and knowledge about diabetes as a factor contributing to adherence to treatment.”

“…adherence Systematic review Phenomenology has a place in studying adherence Phenomenological papers studying medication adherence Cardiovascular disease UK Rezaei et al., 2019 Barriers of medication adherence in patients with type-2 diabetes: A pilot qualitative study Individual…”

“Any strategy chosen to improve adherence must involve HCPs. Strengthening HCP– patient communication is therefore key, as patients feeling able to discuss any concerns or difficulties regarding their medications with their HCPs will remove many major barriers to adherence [41,42,94].”

“Author Country and language Study type Main aim Sample size Method Result nonadherence to the medications coding and thematic analysis and negative stimuli for adherence; (2) intentional noncompliance; (3) patient-provider relationship; (4) information and knowledge; (5) diabetes, inadequate health literacy is an impo…”

“The typed-up interviews (154 pages) were entered into MAXQDA-10 and were analyzed using conventional content analysis [20].”

“The physical constraints of patients may also provide challenges while administering the medication, which may call for steady hands or clear vision [39].”

“In this circumstance, they utilize drugs based on their self-perception without any medical command [20].”

“They argued that medical professionals should consider patients’ perceptions in promoting medication adherence [18].”

“suggest that gaining the patient’s trust can promote the relationship and medical teams should attempt to tailor care programs to each patient based on their lived experiences and unique challenges to increase their adherence to treatment [33].”

“Women’s failure to fulfill their family roles and their husbands’ lack of behavioral and emotional support undoubtedly bother them in life, and their cooking is strongly influenced by their husbands or children’s preferences.[26] Mukona et al.”

“It was likely that a lack of trust in healthcare providers is one potential contributor to nonadherence to medication therapy, as noted in previous studies (25, 26); for example, mistrust and tense relationships exist between physicians and patients in China (27).”

“In Iran it was found that non-adherence among patients with T2DM was influenced by lack of a deep understanding of the medical knowledge on diabetes in many aspects, and those who had little faith in doctors’ prescriptions and recommendations.(43) Appropriate health education and counseling should improve the adherenc…”

“Interactive and economical family support can improve medication adherence among people with DM [16].”

“System‑related factors Effective communication between healthcare providers and patients also influences adherence rates; communication barriers and lack of shared decision making negatively impact adherence [52, 60], and reduced trust in physicians may also reduce medication adherence [52, 54].”

“which is expected to reach six million due to increased age, prevalence of obesity, sedentary lifestyle, and diet changes in future years.(4) Lifelong self-care is required for”

“Misperceptions about insulin use were also mentioned as barriers by studies in USA [51] and Iran [62].”

“(54, male, government employee) All key informants explored the risk of DM if self-care was not practiced and if left untreated upon blood glucose rising.”

“Moreover, sometimes Iranian diabetic patients have difficulty in accessing a wide range of services including medicines, laboratory services, and services from public health centers [35, 36].”

“Most qualitative studies only dealt with pharmaceutical treatment (Bockwoldt et al., 2017; Rezaei et al., 2019), and were not based on the model, or did not address different individual, interpersonal, and external dimensions (Liu et al., 2018; Movahed et al., 2019).”

“Patient adherence to medication is known to affect the achievement of therapeutic targets [38, 39].”

“…may have contributed to the presence of the defining characteristic ineffective choices in daily liv-ingformeetinghealthgoals(Table2),asthepresenceofmorethanone disease can make it difficult to achieve health goals due to the complex therapeutic regimens (Barreto et al., 2018; Rezaei et al., 2019).”

“Comorbid conditions are often associated with an increased medication burden and a higher incidence of adverse effects [29].”

“9– 14 13, 15– 18 Specifically, this study aimed to (1) identify and summarize concepts reported in key qualitative publications related to patients’ experiences and perceptions of medication adherence and (2) conduct qualitative interviews to explore medication adherence drivers and behaviors in a…”

“34 The studies conducted in Iran identified concerns of care providers such as fear, distress, inadequate financial support, poor work conditions, 33 and trust issues with healthcare providers as key challenges and primary barriers to medication adherence.”

“26 Suboptimal T2D self-care is common and therefore mandates better training and motivational activities.”

“However, there may be additional factors relevant to refugee populations given unique challenges related to socioeconomics, culture, language, transportation, and health care access (de-Graft Aikins et al., 2019; Fernández et al., 2017; Njeru et al., 2017; Rezaei et al., 2019).”

“It should be noted that DM patients also need family and community support and the possibility of observing habits, especially dietary ones for patients will be very challenging and impractical if families do not adapt to new conditions of their members.[38] Therefore, family support correlates with decreased blood gl…”

“In contrast to present study, Mehdi Rezaei et al. , [8] an Iranian study, showed that lack of trust in health‑care workers, opinions, and beliefs of others and their own experiences prevented adherence to medication.”

“In his study, Rezaei reported daily life challenges and financial challenges as barriers to diabetes treatment adherence [51].”

“According to the study of Rezaei et al. [20], family support can certainly play a significant role in reducing the pressure on the diabetic patients.”

“30 This study found that participants faced socio-economic obstacles to following treatment plans, such as difficulties paying for transportation to the medical facility.”

“This result is consistent with a previous study on T2D treatment interruption (Rezaei et al., 2019).”

“Medication adherence is a complex topic, and more than 200 factors influence levels of adherence, including lack of understanding of the T2D illness process, the importance of medication, lifestyle challenges, understanding how to take medications, side effects and economic concerns [5–7].”

“…to consider patients’ perceptions during therapeutic prescription and work toward aligning the beliefs of the medical team and the patient to customize treatment and health recommendations to the needs and specificities of each person, thus minimizing barriers and challenges (Rezaei et al., 2019).”

“Similar studies have shown that any shortage of specialized human resources can lead to patient dissatisfaction due to a reduced level of responsiveness.(16,21) Regarding defects in executive processes, the participants also stated that they found it difficult to prepare some essential healthcare items.”

“reported that the patient’s distrust of medical explanations, the experience of the disease, life records, and economic problems are the causes of disruption to the treatment adherence in patients with diabetes mellitus [25,26].”

“While medication non-adherence has received considerable attention, clinical inertia has emerged as an equally consequential, yet comparatively neglected obstacle to optimal CVR management [ 4 , 5 ].”

“The type, frequency, and source of social support matter in different ways (Rezaei et al., 2019).”

“[15] Structured education programs, such as Diabetes Self‑Management Education and Support (DSMES), have proven effective in increasing compliance and improving patient outcomes across multiple settings, as also demonstrated in a recent quasi‑experimental study by Hermis and Muhaibes, which…”

“…medication when they feel their blood sugar is high (e.g., after sweating heavily) or when they feel it is necessary, rather than following the schedule prescribed by the doctor, and may even increase their insulin dose to continue consuming sweet foods (Mehdi Rezaei Sina Valiee & Gheshlagh, 2019).”

“Also, the presence of complications may be related to prior issues in the healthcare system such as a lack of trust in healthcare providers (Rezaei et al. 2019).”

“The results of a joint interpretation of most qualitative studies show that married people, due to a sense of duty to their family, often pay more attention to their illness and comply with treatment more favorably [ 56, 59, 68, 69].”

“There are several reasons for this spike, such as delayed diagnosis of diabetes, multiple co-morbidities, insulin production decline, and medication non-adherence [1, 24, 28, 29].”

“7–9] Addressing these barriers through targeted awareness programs and financial support mechanisms is crucial to ensure comprehensive management of non-communicable diseases in the community.”

“The boredom factor is the most common cause of non-compliance in respondents [10] In addition to the importance of insulin adherence to achieving treatment goals, there are other risk factors.”

“One of them was a pilot qualitative study conducted in diabetic healthcare center in Iran on 12 T2DM patients 36 .”

“Adherence to anti-diabetic medication means consistently taking the prescribed medication regimen as directed by a healthcare professional [16].”

“Over 4,000,000 people suffer from this disease in Iran, and the Iranian popu - lation of diabetes patients is predicted to reach 6,000,000 people by 2030 due to aging, increased prevalence of obesity, and changes in people’s lifestyle and diets [2, 3].”