Determinants of Non-Adherence to Treatment Among Patients with Type 2 Diabetes in Kenya: A Systematic Review

Abstract

Introduction

Non-adherence to the prescribed treatment regimen in patients with type 2 diabetes mellitus is quite high. Furthermore, it has been associated with higher rates of hospital admissions, suboptimal health outcomes, increased morbidity and mortality, and increased health care costs. The present systematic review study aimed to explore the determinants that contribute to non-adherence to treatment among patients with type 2 diabetes mellitus in Kenya.

Methods

A systematic review of studies conducted in Kenya on the present research problem published in English between December 2013 and May 2020. The databases included Scopus, Web of Science, Science Direct, Cochrane Library, PUBMED, OVID and Google Scholar. The following were the key words used in the search: “Non-adherence Diabetes Patients”, “Determinants of Non-adherence Diabetes Patients” AND “Health Facilities” AND “Kenya”. Qualitative analysis was used to present data under thematic domains.

Results

The search generated 17,094 articles of which only 15 met the inclusion criteria. The major determinants were presented under three thematic domains: 1) Cost – income, insurance, distance, bills of drugs and food; 2) Patient characteristics – perception of (efficacy, severity, effects of non-adherence), knowledge, co-morbidity, family support, self unfounded beliefs; and 3) Health system – health education, multiple drugs, evaluations and support, guidelines, poor perception of system.

Conclusion

A multitude of factors including unaffordable care, patient’s poor knowledge on the disease process, less family support in patient’s daily self-care management, complex drug regimen and unsatisfactory health messages from the health providers were observed to be associated with non-adherence. Implementing integrated care programs will help in reducing levels of non-adherence among type 2 diabetes mellitus patients.

Keywords:

• diabetes mellitus
• humans
• hypoglycemic agents
• Kenya
• medication adherence
• type 2

Abbreviations

DM, diabetes mellitus; Hb A1C, glycated hemoglobin – this test gives an average of blood glucose over the last 2 to 3 months. Patients with an Hb A1C greater than 6.5% (48 mmol/mol) are diagnosed as having DM; T2DM, type 2 diabetes mellitus.

Acknowledgments

The authors would like to extend their gratitude to the librarians who helped them to access information resources at The University of South Africa (UNISA); South Africa.

Author Contributions

All authors contributed to data analysis, drafting or revising the article, have agreed on the journal to which the article will be submitted, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

The researchers were granted research funds by the University of South Africa, which supported the present study.