Self-reported medication adherence among patients with diabetes or hypertension, Médecins Sans Frontières Shatila refugee camp, Beirut, Lebanon: A mixed-methods study

Abstract

Introduction Low adherence to medications, specifically in patients with Diabetes (DM) and Hypertension (HTN), and more so in refugee settings, remains a major challenge to achieving optimum clinical control in these patients. We aimed at determining the self-reported medication adherence prevalence and its predictors and exploring reasons for low adherence among these patients. Methods A mixed-methods study was conducted at Médecins Sans Frontières non-communicable diseases primary care center in the Shatila refugee camp in Beirut, Lebanon in October 2018. Data were collected using the validated Arabic version of the 8-items Morisky Medication Adherence Scale (MMAS-8) concurrently followed by in-depth interviews to explore barriers to adherence in patients with DM and/or HTN. Predictors of adherence were separately assessed using logistic regression with SPSS© version 20. Manual thematic content analysis was used to analyze the qualitative data. Results Of the 361 patients included completing the MMAS, 70% (n = 251) were moderately to highly adherent (MMAS-8 score = 6 to 8), while 30% (n = 110) were low-adherent (MMAS-8 score<6). Patients with DM-1 were the most likely to be moderately to highly adherent (85%; n = 29). Logistic regression analysis showed that patients with a lower HbA1C were 75% more likely to be moderately to highly adherent [(OR = 0.75 (95%CI 0.63–0.89), p-value 0.001]. Factors influencing self-reported moderate and high adherence were related to the burden of the disease and its treatment, specifically insulin, the self-perception of the disease outcomes and the level of patient’s knowledge about the disease and other factors like supportive family and healthcare team. Conclusion Adherence to DM and HTN was good, likely due to a patient-centered approach along with educational interventions. Future studies identifying additional factors and means addressing the barriers to adherence specific to the refugee population are needed to allow reaching optimal levels of adherence and design well-informed intervention programs.

Development of a Prediction Model for the Management of Noncommunicable Diseases Among Older Syrian Refugees Amidst the COVID-19 Pandemic in Lebanon

“…The predictive model had a moderate discriminative ability, which may be explained by missing predictors. 12,36,51,52 Furthermore, the calibration of the model showed overfitting, and the model may not perform well JAMA Network Open | Global Health in future samples; hence, future studies should aim to be larger if they wish to develop a predictive model. The study outcome was subjective and may be prone to misclassification; future studies should aim to measure blood pressure, cholesterol, and fasting glucose or hemoglobin A 1c and to collect symptoms and adherence using validated questionnaires.…”

“…A study conducted in 2018 on Palestinian refugees in Lebanon found that 30% of the sample had low adherence to medications. 12 Furthermore, refugee populations in Lebanon may have difficulty in adherence owing to poor access to health services, unavailability of medications, unaffordability of transportation, being food insecure, having limited health literacy, and other stressors. 13,14 In Lebanon, large populations of Syrian refugees are situated in the Bekaa valley and North Lebanon and reside in informal tented settlements or residential areas.…”

“…19,20 Studies on NCD management among refugees in Lebanon and the Middle East, a region that hosts one of the largest refugee populations, are scarce. 12 Understanding the barriers and predictors of self-reported management of NCDs among older refugees, a population at high risk for severe COVID-19 outcomes, is important to allow resource allocation and contextualized humanitarian assistance to prevent premature mortality and morbidity. The present study aimed to elucidate the predictors of the inability to manage NCDs in older Syrian refugees and describe barriers to accessing health care and managing these chronic conditions.…”

Predictors and barriers for the management of non-communicable diseases among older Syrian refugees amidst the COVID-19 pandemic in Lebanon: A cross-sectional analysis of a multi-wave survey

“…Furthermore, this study is one of the largest on older Syrian refugees in the published literature with a high response rate of >85% among those who were eligible. 11 The study was limited as the predictive model had a moderate discriminative ability, which may be explained by missing predictors, such as perception of medication regime as being complicated, not knowing the purpose of the medication, accessibility issues, side effects due to medication, lack of healthcare support, lack of trust in doctors, stressful living conditions and time since diagnosis 15,30,44,45 . Furthermore, the calibration of the model showed overfitting and may not perform well in future samples, hence, future studies should aim to be larger if they wish to develop a predictive model.…”

“…Studies on the management of NCDs among refugees in Lebanon and the Middle East, a region that hosts one of the largest refugee populations, are scarce. 15 Understanding the barriers and predictors of self-reported management of NCDs among older refugees, a population at high-risk, is important to allow resource allocation and contextualized humanitarian assistance to prevent premature mortality and morbidity. The present study aimed to elucidate the predictors of inability to manage NCDs in older Syrian refugees and describe barriers to accessing healthcare and managing these chronic conditions.…”