Taking oral medications for type 2 diabetes: a systematic review and meta-synthesis of qualitative studies

Abstract

Background Poor adherence to oral medications for Type 2 diabetes (T2DM) is common and associated with negative outcomes. The current study aimed to explore patients’ perceptions and experiences of taking oral medications for T2DM to inform future intervention development. Methods Four databases were searched in 2014 to identify qualitative studies exploring patients’ perceptions or experiences of taking medications for the management of T2DM, yielding 787 abstracts that were double-screened for inclusion. Key concepts and themes were extracted, appraised for quality and synthesised using meta-ethnography. Findings The findings of nine studies were used to develop three higher-order constructs that moved beyond the results of individual studies. "Medications for diabetes: A necessary evil" outlines how patients’ negative perceptions of medication risks co-exist with a resounding view that medications are beneficial. "Passive Patients but Active Experimenters" highlights the contrast between patients’ passive acceptance of medication prescriptions and the urge to actively experiment and adjust doses to optimise medication use. Finally, "Taking oral medication for T2DM: A unique context" describes features of T2DM, including perceived relationships between medication and diet, which can impact on medication taking. Discussion T2DM is a unique adherence context, which may require the development of condition-specific interventions. Our findings indicate patients understand the need for medications but adjust dosage and timing in line with their own beliefs. Our review suggests providers should acknowledge patient preferences in the development of management strategies and highlights an opportunity to direct the motivation evident in patients’ experimentation towards more beneficial medication taking behaviours.