Assessment of medication non-adherence and associated factors among type 2 diabetes mellitus patients attending the diabetic clinic at Kenyatta National Hospital

Abstract

Medication non-adherence is a global problem facing health care providers treating adult Type 2 diabetes mellitus patients. It results in disease progression, development of complications, premature disability and death. As the prevalence of diabetes mellitus continues to increase in Kenya, there is need for clear definition of factors that lead to medication non-adherence. The objective of this study was to assess the prevalence and factors associated with medication non-adherence among Type 2 diabetes mellitus patients. This study adopted a cross-sectional study design and was conducted at the diabetic clinic at Kenyatta National Hospital from November 2015 to January 2016. The sample size used was two hundred and ninety Type 2 diabetes patients. A questionnaire was used to collect information on patients’ demographic and clinical characteristics and challenges relating to diabetes treatment. Adherence levels were determined by the patients’ self-report scored on the Morisky Medication Adherence Scale-8(MMAS-8) and glycaemic control by blood sample assay for glycosylated haemoglobin (HbA1C). Data was analysed using STATA statistical software. Logistic regression was used to determine the association between medication non-adherence and various patient, disease and treatment variables. Ethical approval was obtained from the ethics and research committee at the hospital. The prevalence of medication non-adherence was 54.5 %. Glycaemic control was good for 107 (36.9%) of the study participants. A significant association was found between medication adherence and glycaemic control. Factors found to be associated with non-adherence were; dissatisfaction with family members support in regard to diabetes mellitus management, patients with duration disease between 2 – 10 years, ever being admitted for diabetes mellitus, presence of a challenge in drug access and dissatisfaction with attending clinicians. In conclusion, a majority of Type 2 diabetes mellitus patients are non-adherent to medication which was associated with poor blood sugar control. Family support, affordability of medications and good healthcare provider-patient communication are important in curbing medication non-adherence. This study recommends the hospital management seeks to identify patients that are poorly adhering to medication for prompt interventions, including determination of HbA1C. The MMAS-8 can screen for these patients. Further, family members should be facilitated to participate in the diabetic patient care process, insurance schemes can improve medication affordability and regular health provider communication skills trainings should be conducted.