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"Patients' understanding is the problem": physicians' views of nonadherence among Arabs with type 2 diabetes

Authors Waheedi M, Jeragh-Alhaddad FB, Awad AI, Enlund H

Received 31 March 2017

Accepted for publication 25 July 2017

Published 17 August 2017 Volume 2017:11 Pages 1413—1421

DOI https://doi.org/10.2147/PPA.S138468

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Doris Leung

Peer reviewer comments 2

Editor who approved publication: Dr Johnny Chen

Mohammad Waheedi,1 Fatima B Jeragh-Alhaddad,1 Abdelmoneim Ismail Awad,1 Hannes Enlund2

1Faculty of Pharmacy, Kuwait University, Kuwait; 2Finnish Medicines Agency, Kuopio, Finland

Purpose: Nonadherence to diabetes medication is a significant barrier toward achieving positive treatment outcomes. There is an abundance of research looking at the problem from the patient perspective, but less from the provider perspective. The Middle East region has one of the highest prevalences of type 2 diabetes in the world, with special cultural characteristics, which require research attention. The aim of this study was to explore the views of primary-care physicians on medication nonadherence among type 2 diabetes patients.
Materials and methods: A descriptive qualitative study was performed using one-on-one semistructured interviews of 21 primary-care physicians who were selected using stratified and random sampling from polyclinics in the five health districts in Kuwait. The interviews elicited the participants’ views about barriers and facilitators of medication adherence in type 2 diabetes patients. The interviews were audio-recorded and transcribed verbatim. Thematic content analysis with constant comparison was used to generate the codes and themes to arrive at a core category.
Results: Patient understanding, including knowledge, beliefs, and attitudes, was identified by respondents as the core determinant of medication nonadherence in type 2 diabetes. This was composed of six major themes: four against understanding and two for understanding. The ones against were “Patients do not understand diabetes”, “Patients do not understand the importance of medications”, “What the patient hears from friends is more important than what the doctor says”, “Patients are in denial (or difficult)”. Themes for understanding were “I need to educate more” and “Patients must hear it from other sources”.
Conclusion: That lack of understanding among patients results in medication nonadherence is the dominant view of primary-care physicians. This finding has implications in relation to the evolution of diabetes care toward more patient-centeredness within the cultural context.

Keywords: medication adherence, primary-care providers, qualitative, patient-centeredness, Kuwait

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