Adherence to diabetes medication: perspectives of patients and professionals on adherence and involved cognitions

Abstract

Background: Diabetes medication adherence is essential to delay disease progression. Research shows that prevalences of adherence range from under 40% to over 90%. As non-adherence is associated with disease worsening and early mortality, it is important to identify the current situation and cognitions underlying (non)-adherence. An extensive qualitative study was used to identify: 1) diabetes medication adherence, and 2) salient cognitions of (non)-adherence, using the I-Change Model. Methods: Data was collected from 18 type-2 diabetes (T2D) patients, and 9 healthcare professionals. Semi-structured, audio recorded, individual interviews were transcribed, anonymized, and analyzed using Nvivo content analysis. Findings: Patients report a more positive perspective on their own adherence, than professionals. Still many patients report any form of non-adherence, either intentional or unintentional. Concerning medication beliefs, patients see more advantages than disadvantages towards medication, e.g. “it keeps me healthyâ€, and “it prevents worseningâ€. Many patients receive social support, by e.g being reminded/prompted by a partner/peer or professional. Although many patients can’t explain the working mechanism and purpose of their medication, many state to be adherent because “the doctor says soâ€. In line with professionals, patients indicate out of routine situations like vacation, irregular shifts, and experiencing stress as underlying non-adherence, often explained by professionals as ‘excuses’. Discussion: Adherence to diabetes medication is suboptimal. Professionals and patients have different perspectives with regard to adherence rates. Professionals’ autonomy and social support are potentially important determinants of adherence. Medication knowledge, and self-efficacy in out of routine situations could be targeted in interventions to enhance adherence rates.