title: "It is the medicines that keep us alive": lived experiences of diabetes medication use and continuity among adults in Southeastern Tanzania.
abstract: BACKGROUND
  Diabetes is a chronic condition which requires many patients to use medications for the remainder of their lives. While this regimen is demanding, little research has been done on the experiences individuals have with diabetes medication use and the continuity of use, especially patients from rural areas of Tanzania. This study explores the lived experiences of diabetes medication use and the continuity of use among adult diabetes patients from rural communities with limited access to diabetes medicines.
  
  
  METHODS
  We conducted 19 in-depth interviews to explore patients' experiences with diabetes medication use and the continuity of use. We employed the 5As of access to care to situate the behavioral practices surrounding diabetes medication use in the study settings. The data analysis followed grounded theory principles, and was conducted with the help of NVivo 9.
  
  
  RESULTS
  Study participants expressed positive attitudes toward the use of diabetes medicines, but also concerns about affordability. The patients employed two main strategies for dealing with the cost. The first was to increase their available funds by spending less money on family needs, selling household property, asking family and friends for money, or borrowing cash. They also reported sourcing medicines from pharmacies to save on consultation and laboratory costs. Second, participants reported using less than the recommended dosage or skipping doses, and sharing medicines. The geographic accessibility of diabetes service providers, the availability of medication, and the organization of the diabetes services were also cited as barriers to taking medications and to using them continuously.
  
  
  CONCLUSIONS
  The strategies employed by the people in this study illustrate their resilience in the face of poverty and failing health care systems. More comprehensive strategies are therefore needed to encourage consistent medication use among people with chronic conditions. These strategies could include the reduction of prices by pharmaceuticals, the strengthening of community risk-pooling mechanisms and sustained health campaigns aimed at patients and the community.
authors.affiliation: Ifakara Health Institute, P.O. Box 78373, Dar es Salaam, Tanzania. emetta@ihi.or.tz.|Population Research Center, Faculty of Spatial Sciences, University of Groningen, Landleven 1, 9742 AK, Groningen, The Netherlands. emetta@ihi.or.tz.
authors.forename: Emmy
authors.initials: E
authors.lastname: Metta
authors.affiliation: Population Research Center, Faculty of Spatial Sciences, University of Groningen, Landleven 1, 9742 AK, Groningen, The Netherlands. h.h.haisma@rug.nl.
authors.forename: Hinke
authors.initials: H
authors.lastname: Haisma
authors.affiliation: Mzumbe University, P.O. Box 20226, Dar es Salaam, Tanzania. fkessy@mzumbe.ac.tz.
authors.forename: Flora
authors.initials: F
authors.lastname: Kessy
authors.affiliation: Ifakara Health Institute, P.O. Box 78373, Dar es Salaam, Tanzania. egeubbels@ihi.or.tz.
authors.forename: Eveline
authors.initials: E
authors.lastname: Geubbels
authors.affiliation: Population Research Center, Faculty of Spatial Sciences, University of Groningen, Landleven 1, 9742 AK, Groningen, The Netherlands. i.hutter@rug.nl.
authors.forename: Inge
authors.initials: I
authors.lastname: Hutter
authors.affiliation: Population Research Center, Faculty of Spatial Sciences, University of Groningen, Landleven 1, 9742 AK, Groningen, The Netherlands. a.bailey@rug.nl.
authors.forename: Ajay
authors.initials: A
authors.lastname: Bailey
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease / Q000188:drug therapy; D003266:Continuity of Patient Care; D003920:Diabetes Mellitus / Q000188:drug therapy*; D005260:Female; D006297:Health Services Accessibility / Q000191:economics; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010594:Pharmacies; D011203:Poverty; D036301:Qualitative Research; D012017:Referral and Consultation; D012424:Rural Population; D013636:Tanzania; D055815:Young Adult