Factors Influencing Therapeutic Non-Adherence Behavior Among Patients with Type 2 Diabetes in Two Public Hospitals in the Gambia: A Cross-Sectional Study

Figures & data

Table 1 Sociodemographic, Lifestyle, and Clinical Characteristics by Adherence to Antidiabetic Treatment Status (n=145)

Variables		Sample n(%)	Distribution		p-value
			Adherent (n=105)	Non-Adherent (n=40)
Age (Mean=56.8; SD=11.6)(years)					0.640
	≤50	37(25.5)	29 (27.6)	8 (20)
	51–60	48(33.1)	34 (32.4)	14 (35)
	≥61	60(41.4)	42 (40)	18 (45)
Sex					0.234
	Male	37(25.5)	24 (22.9)	13 (32.5)
	Female	108(74.5)	81 (77.1)	27 (67.5)
Marital Status
	Single	4(2.8)	3 (2.9)	1 (2.5)	0.911
	Married	111(76.6)	79 (75.2)	32 (80)
	Divorced	3(2.1)	2 (1.9)	1 (2.5)
	Widowed	27(18.6)	21 (20)	6 (15)
Occupation					0.232
	Employed	61(42.1)	41 (39.0)	20 (50.0)
	Unemployed	84(57.9)	64 (61.0)	20 (50.0)
Monthly income (in Dalasi)					0.665
	<1500	41(28.3)	30 (28.6)	11 (27.5)
	1500–2000	28(19.3)	22 (21)	6 (15)
	˃2000	76(52.4)	53 (50.5)	23 (57.5)
Education					0.041
	No formal education	92(63.4)	73 (69.5)	19 (47.5)
	Primary education	18(12.4)	10 (9.5)	8 (20)
	Secondary and above	35(24.1)	22 (21.0)	13 (32.5)
Estimated distance from hospital (Km)
	≤15	25(17.2)	17 (16.2)	8 (20.0)	0.625
	16–30	71(49.0)	54 (51.4)	17 (42.5)
	˃30	49(33.8)	34 (32.4)	15 (37.5)
Cigarette smoking					1.000*
	Yes	4(2.8)	3 (2.9)	1 (2.5)
	No	141(97.2)	102 (97.1)	39 (97.5)
Alcohol consumption					0.075*
	Yes	2(1.4)	0 (0.0)	2 (5.0)
	No	143(98.6)	105 (100)	38 (95.0)
Family history of diabetes					0.129
	Yes	87(60)	59 (56.2)	28 (32.2)
	No	58(40)	46 (43.8)	12 (30.0)
Length of diabetes (Years)					0.356
	≤10	99(68.3)	74 (70.5)	25 (62.5)
	˃10	46(31.7)	31 (29.5)	15 (37.5)
Oral medication(s) used					0.690
	Metformin only	80(55.2)	59 (56.2)	21 (52.5)
	Metformin and Glibenclamide	65(44.8)	46 (43.8)	19 (47.5)
Traditional treatment used					0.179
	Yes	14(9.7)	8 (7.6)	6 (15.0)
	No	131(90.3)	97 (92.4)	34 (26.0)
Frequency of doctor’s appointment					0.049
	Regularly	139(95.9)	103 (98.1)	36 (90.0)
	Not regularly	6(4.1)	2 (1.9)	4 (10.0)
HBM: perceived barriers					0.000
	No	63(43.4)	35 (33.3)	28 (70)
	Yes	82(56.6)	70 (66.7)	12 (30)
HBM: perceived benefits					0.041
	No	37(25.6)	22 (21)	15 (37.5)
	Yes	108(74.4)	83 (79)	25 (62.5)
HBM: perceived susceptibility					0.170
	No	70(48.3)	47 (44.8)	23 (57.5)
	Yes	75(51.7)	58 (55.2)	17 (42.5)
HBM: perceived severity					0.044
	No	28(19.4)	16 (15.2)	12 (30)
	Yes	117(80.6)	89 (84.8)	28 (70)

Notes: SD Standard deviation; Km Kilometer; Significance at p<0.05; *Fisher’s Exact Test; Traditional treatment used (simultaneous use of both hospital and herbal treatments); Frequency of doctor’s appointment (not missing more than one of four scheduled appointments).Copyright note: The MMAS-8 Scale (US Copyright Registration No. TX0008632533), content, name, and trademarks are protected by US copyright and trademark laws. Permission for use of the scale and its coding is required. A license agreement is available from MMAR, LLC., www.moriskyscale.com.

Table 2 Patient’s Health Belief on Diabetes (n=145)

Items	Agree n(%)	Do not know n(%)	Disagree n(%)
Perceived benefits
Sticking to my diabetes medication will help prevent diseases (complications) related to diabetes.	134 (92.4)	0 (0.0)	11 (7.6)
Sticking to my diabetes medication will help me control my diabetes.	135 (93.1)	0 (0.0)	10 (6.9)
Sticking to my diabetes medication will help me feel better.	134 (92.4)	0 (0.0)	11 (7.6)
Sticking to my diabetes medication will help me live longer.	76 (52.4)	2 (1.4)	67 (46.2)
Perceived barriers
I have difficulty remembering when to take my diabetes medication.	20 (13.8)	0 (0.0)	125 (86.2)
Family problems make it difficult for me to take my diabetes medication regularly.	13 (9)	1 (0.7)	131 (90.3)
I would have to change too many habits to take my diabetes medication regularly.	12 (8.3)	1 (0.7)	132 (91)
Taking my diabetes medication interferes with my normal daily activities.	13 (9)	0 (0.0)	132 (91)
I do not feel motivated to take my diabetes medication regularly.	10 (22)	4 (2.8)	131 (90.3)
Diabetes medications cause annoying side effects.	22 (15.2)	0 (0.0)	123 (84.8)
I sometimes worry about the long-term effects of my diabetes medication.	21 (14.5)	0 (0.0)	124 (85.5)
Perceived susceptibility
I am likely to develop the complications of diabetes or have the complications worsen.	75 (51.7)	0 (0.0)	70 (48.3)
I am likely to have a shortened life expectancy.	55 (37.9)	0 (0.0)	90 (62.1)
Perceived severity
I consider diabetes to be a severe health problem.	133 (91.7)	0 (0.0)	12 (8.3)
I consider complications arising from diabetes to be severe health problems.	136 (93.8)	0 (0.0)	9 (6.2)
I am confident in my ability to take my diabetes medications exactly as directed by my doctor	135 (93.1)	1 (0.7)	9 (6.2)

Table 3 Predictors of Therapeutic Non-Adherence (n=145)

Variables	Responses	Odds ratio (95% CI)	p-value
Education
	No formal education	1.59 (0.62–4.11)	0.335
	Primary education	0.36 (0.10–1.37)	0.135
	Secondary and above	Reference
Frequency of meeting appointment with doctor
	Regularly	3.91 (0.56–27.10)	0.168
	Not regularly	Reference
HBM: perceived barriers
	No	0.27 (0.11–0.62)	0.002
	Yes	Reference
HBM: perceived benefits
	No	0.51 (0.21–1.26)	0.144
	Yes	Reference
HBM: perceived severity
	No	0.68 (0.26–1.80)	0.437
	Yes	Reference

Notes: CI – Confidence Interval; Significance at p<0.05.

Abbreviations: ADA, American Diabetes Association; CI, Confidence Interval; DALY, Disability Adjusted Life Years; DM, Diabetes Mellitus; DSME, Diabetic Self-Management Education; EFSTH, Edward Francis Small Teaching Hospital; HBM, Health Belief Model; IDF, International Diabetes Federation; KGH, Kanifing General Hospital; MMAS, Morisky Medication Adherence Scale; T2DM, Type 2 Diabetes Mellitus; WHO, World Health Organization.