Abstract
Introduction
Diabetes mellitus (DM) is a significant global public health challenge, with effective management relying heavily on patient adherence to treatment protocols. In South Africa, particularly in low-resource settings like the Soweto area in the Johannesburg Health District, treatment nonadherence among diabetic patients is a pressing concern, contributing to poor health outcomes and increased healthcare costs.
Purpose
This study aimed to identify and analyze factors associated with treatment nonadherence among patients diagnosed with diabetes mellitus attending primary healthcare facilities in Soweto, Johannesburg Health District, South Africa.
Methods
This was a cross-sectional quantitative study conducted among 490 diabetic patients attending primary healthcare facilities in Soweto using structured anonymous questionnaires. The chi-squared test was used to assess associations between treatment nonadherence and various factors. SPSS version 27 was used to analyze the data.
Results
The average age of the patients was 59 years, and 66% were female. The nonadherence rate among the patients was 31%, with 80% having occasionally missed a dose of their medication. Gender, marital status, monthly household income, number of years living with diabetes, and adherence to diet were significantly associated with nonadherence to diabetes treatment (p < 0.05).
Conclusion
The study highlights the multifaceted nature of treatment nonadherence among diabetic patients in Soweto. Addressing these factors requires a comprehensive approach, including improving patient education, enhancing social support, and addressing socioeconomic barriers.
References
Adegbola, S. A., Marincowitz, G. J. O., Govender, I., & Ogunbanjo, G. A. O. (2016). Assessment of self-reported adherence among patients with type 2 diabetes in Matlala District Hospital, Limpopo Province. African Journal of Primary Health Care & Family Medicine, 8(1), a900. https://doi.org/10.4102/phcfm.v8i1.900
Adisa, R., & Fakeye, T. O. (2014). Treatment non-adherence among patients with poorly controlled type 2 diabetes in ambulatory care settings in southwestern Nigeria. African Health Sciences, 14(1), 1–10. https://doi.org/10.4314/ahs.v14i1.2
Aminde, L. N., Tindong, M., Ngwasiri, C. A., et al. (2019). Adherence to antidiabetic medication and factors associated with non-adherence among patients with type-2 diabetes mellitus in two regional hospitals in Cameroon. BMC Endocrine Disorders, 19, 35. https://doi.org/10.1186/s12902-019-0360-9
Banday, M. Z., Sameer, A. S., & Saniya, S. (2020). Pathophysiology of diabetes: An overview. Avicenna Journal of Medicine, 10(4), 174–188.
Banu, B., Khan, M. M. H., Ali, L., Barnighausen, T., Sauerborn, R., & Souares, A. (2024). Pattern and predictors of non-adherence to diabetes self-management recommendations among patients in peripheral district of Bangladesh. Tropical Medicine & International Health, 29(3), 233–242. https://doi.org/10.1111/tmi.13966
Butt, M. D., Ong, S. C., Rafiq, A., et al. (2023). An observational multi-center study on type 2 diabetes treatment prescribing pattern and patient adherence to treatment. Scientific Reports, 13, 23037. https://doi.org/10.1038/s41598-023-50517-2
Divya, S., & Nadig, P. R. (2015). Factors contributing to non-adherence to medication among type 2 diabetes mellitus patients attending tertiary care hospital in South India. Asian Journal of Pharmaceutical and Clinical Research, 8(2), 274–276. https://doi.org/10.4066/biomedicalresearch.29-18-503
Howe, L. D., Hargreaves, J. R., Gabrysch, S., & Huttly, S. R. (2009). Is the wealth index a proxy for consumption expenditure? A systematic review. Journal of Epidemiology and Community Health, 63(11), 871–877.
International Diabetes Federation (IDF). (2021). Facts and figures. https://idf.org/about-diabetes/diabetes-facts-figures/
Kalyango, J. N., Owino, E., & Nambuya, A. P. (2008). Non-adherence to diabetes treatment at Mulago Hospital in Uganda: Prevalence and associated factors. African Health Sciences, 8(2), 67–73.
Kassahun, A., Fanta, E. M., & Rike, W. A. (2016). Nonadherence and factors affecting adherence of diabetic patients to anti-diabetic medication in Assela General Hospital, Oromia Region, Ethiopia. Journal of Pharmacy and Bioallied Sciences, 8(2), 124–129. https://doi.org/10.4103/0975-7406.171696
Krass, I., Schieback, P., & Dhippayom, T. (2015). Adherence to diabetes medication: A systematic review. Diabetic Medicine, 32(6), 725–737.
McGovern, A., Tippu, Z., Hinton, W., Munro, N., Whyte, M., & de Lusignan, S. (2018). Comparison of medication adherence and persistence in type 2 diabetes: A systematic review and meta-analysis. Diabetes, Obesity and Metabolism, 20(4), 1040–1043.
Mirahmadizadeh, A., Khorshidsavar, H., Seif, M., & Sharifi, M. H. (2020). Adherence to medication, diet, and physical activity and the associated factors amongst patients with type 2 diabetes. Diabetes Therapy, 11(2), 479–494. https://doi.org/10.1007/s13300-019-00750-8
Owolabi, E. O., Goon, D. T., Ajayi, A. I., & Adeniyi, O. V. (2022). Knowledge of diabetes and associated factors in rural Eastern Cape, South Africa: A cross-sectional study. PLOS ONE, 17(7), e0269811. https://doi.org/10.1371/journal.pone.0269811
Parajuli, J., Saleh, F., Thapa, N., & Ali, L. (2014). Factors associated with nonadherence to diet and physical activity among Nepalese type 2 diabetes patients; a cross-sectional study. BMC Research Notes, 7(1), 1–9. https://doi.org/10.1186/1756-0500-7-758
Ramzan, B., et al. (2022). Impact of diabetes-related knowledge and medication adherence on quality of life among type 2 diabetes patients in a tertiary health facility in Multan, Pakistan. Tropical Journal of Pharmaceutical Research, 21, 871–877.
Sapra, A., Malik, A., & Bhandari, P. (2023). Vital sign assessment. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK553213/
Shaikh, S. A. A., Kumari, J., & Bahmanshiri, Y. (2023). Assessing the adherence to antidiabetic medications among patients diagnosed with type 2 diabetes mellitus in Ajman, UAE. Cureus, 15(11), e49325. https://doi.org/10.7759/cureus.49325
Waari, G., Mutai, J., & Gikunju, J. (2018). Medication adherence and factors associated with poor adherence among type 2 diabetes mellitus patients on follow-up at Kenyatta National Hospital, Kenya. Pan African Medical Journal, 29, 82. https://doi.org/10.11604/pamj.2018.29.82.12639
World Health Organization (WHO). (2022). World Diabetes Day. https://www.who.int/campaigns/world-diabetes-day/2022
Yasmin, F., Ali, L., Banu, B., Rasul, F. B., Sauerborn, R., & Souares, A. (2020). Understanding patients’ experience living with diabetes type 2 and effective disease management: A qualitative study following a mobile health intervention in Bangladesh. BMC Health Services Research, 20(1), 1–3. https://doi.org/10.1186/s12913-019-4811-9
Yosef, T., Nureye, D., Tekalign, E., Assefa, E., & Shifera, N. (2023). Medication adherence and contributing factors among type 2 diabetes patients at Adama Hospital Medical College in eastern Ethiopia. SAGE Open Nursing, 9, 23779608231158975. https://doi.org/10.1177/23779608231158975

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