Patients’ perspective of disease and medication adherence for type 2 diabetes in an urban area in Bangladesh: a qualitative study

Abstract

Background Patients’ perspective of diabetes and adherence to its prescribed medications is a significant predictor of glycemic control and overall management of the disease. However, there is a paucity of such information in Bangladesh. This study aimed to explore patients’ perspective of diabetes, their experience of taking oral hypoglycemic medications and explore factors that contribute to medication adherence in patients with type 2 diabetes in Bangladesh.Methods We conducted in-depth face-to-face interviews with 12 type 2 diabetes patients attending a tertiary hospital in Dhaka city between February and March, 2014. Participants were purposively sampled representing different age groups, education levels, years since diagnosis with diabetes, and glycemic status, to achieve maximum variation sampling. All interviews were conducted using a topic guide and were audio-recorded, transcribed verbatim, checked for errors, coded and analyzed by means of a qualitative content analysis framework.ResultsThe data analysis generated rich information on the participants’ knowledge and perception on diabetes, its causes, self-management, medication use, adverse effects of medication use, medication adherence, and impact of diabetes, Although most of the participants demonstrated substantive knowledge on diabetes and its consequences, they also reported numerous misconceptions about the disease. Knowledge on diabetes medication, their appropriate use and side effects was rather poor. Respondents also reported non-compliance to dietary and physical activity advice by their physicians and concerns on diabetes diabetes-induced psychological stress. High cost of medications, concerns over medication side effects and forgetfulness was noted as factors for non-adherence to medication.ConclusionParticipants’ knowledge and perception on diabetes are key factors determining their adherence to medications and, thereby, diabetes management. Healthcare providers should explore to better understand patients’ perspective on diabetes, medication beliefs, identify psychological stress and provide more effective health education interventions to enhance medication adherence.

Knowledge regarding medicines management of type 2 diabetes amongst patients attending a Community Health Centre in South Africa

“…This is an indication that most patients did not commence with antidiabetic medication as soon as they were diagnosed or they could have been prescribed lifestyle modification first. However, most patients (nearly 80%) did not know how their medicines control their diabetes (Figure ), which is similar to other studies amongst ambulatory care patients in lower‐ and middle‐income countries . Our findings are also similar to a study carried out amongst patients with diabetes visiting their general practitioner in the United Kingdom where only 15% of them knew the correct mechanism of action of their medication and in India, where 50% of diabetic patients in the Warangal region were unaware what diabetes is .…”

“…However, most patients (nearly 80%) did not know how their medicines control their diabetes (Figure 2), which is similar to other studies amongst ambulatory care patients in lower-and middle-income countries. [33] Our findings are also similar to a study carried out amongst patients with diabetes visiting their general practitioner in the United Kingdom where only 15% of them knew the correct mechanism of action of their medication [38] and in India, where 50% of diabetic patients in the Warangal region were unaware what diabetes is. [39] However, our findings are different from patients in Iraq attending a diabetic centre in Hilla city who were seen to have an acceptable level of knowledge regarding their disease and activities to keep their disease stable, [40] and in India where 75.8% of patients attending an ambulatory care clinic knew about the names and doses of their diabetes medicines.…”

Lay perceptions and illness experiences of people with type 2 diabetes in Indonesia: a qualitative study

“…Findings from this study emphasised that people with diabetes constructed illness concepts into their personal narratives based on their experiences. The use of local terms and common lay knowledge about diabetes were also common in other low and middle-income countries (Islam, Biswas, Bhuiyan, Mustafa, & Islam, 2017;Mendenhall et al, 2016;Suparee et al, 2015). The use of local terms, however, may lead to misconceptions of the disease and its symptoms.…”

Health and economic burden of diabetes in Bangladesh: Priorities for attention and control

“…Personal diet, physical exercise, and proper medication are crucial for the management of diabetes, but proper management of diabetes is rarely seen among the Bangladeshi population due to lack of time, lack of suitable places for walking or exercising, and even the misconception of those activities. 5 Therefore, a large campaign is necessary to develop a societal movement to control and manage diabetes. Our estimates show that overall US$297 could be saved annually if one case of diabetes could be prevented, which provides insights for policy makers because, in the absence of social insurance, most of the medical expenditures are incurred at the houshold level in Bangladesh, which could lead to finacial catastrophes for many Bangladeshi households.…”