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


RESULTS
The 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.


CONCLUSIONS
Participants' 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.
NCD Program, International Center for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh. shariful.islam@icddrb.org.|Center for International Health, Ludwig-Maximilians Univetsitat, Munich, Germany. shariful.islam@icddrb.org.|The George Institute for Global Health, University of Sydney, Sydney, Australia. shariful.islam@icddrb.org.
Sheikh Mohammed Shariful
SM
Islam
NCD Program, International Center for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.
Tuhin
T
Biswas
NCD Program, International Center for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.
Faiz A
FA
Bhuiyan
Department of Public Health, The University of Southern Mississippi, Hattiesburg, MS, USA.|Bangladesh University of Health Science (BUHS), Dhaka, Bangladesh.
Kamrun
K
Mustafa
Faculty of Health, School of Health Policy and Management, York University, Toronto, Canada.|Department of Public Health, North South University, Dhaka, Bangladesh.
Anwar
A
Islam
D000328:Adult; D000368:Aged; D001459:Bangladesh; D001786:Blood Glucose / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy / Q000523:psychology*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D007722:Health Knowledge, Attitudes, Practice; D006306:Health Surveys / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D036301:Qualitative Research; D012648:Self Care / Q000706:statistics & numerical data; D062606:Tertiary Care Centers; D014504:Urban Health / Q000706:statistics & numerical data; D014505:Urban Population / Q000706:statistics & numerical data*
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents
Bangladesh; Compliance; Glycemic control; Medication adherence; Perception; Type 2 diabetes