Patients’ beliefs about adherence to oral antidiabetic treatment: a qualitative study

Figures & data

Table 1 Participant characteristics according to the focus groups (n=45)

Focus group number	Number of participants	Sex		Age (years)		Years with type 2 diabetes		Adherent according to MMAS-4
		Men	Women	<65	≥65	≤5	>5	Yes	No
1	9	6	3	5	4	4	5	2	7
2	7	5	2	3	4	3	4	3	4
3	6	3	3	3	3	0	6	5	1
4	8	5	3	4	4	4	4	3	5
5	7	4	3	3	4	2	5	3	4
6	8	3	5	3	5	3	5	2	6

Abbreviation: MMAS-4, 4-item Morisky Medication Adherence Scale.

Table 2 Modal behavioral beliefs of the 45 type 2 diabetes patients who participated in the focus groups, in decreasing order of frequency

Behavioral beliefs (ie, advantages/disadvantages of taking OADs as prescribed)
Avoid long-term complications
“I’m starting to have a lot, they started about two years ago, numbness in the feet, toes, legs, nerves that hurt […]. It scares me because I know all the complications, I don’t want to get there.” [M, FG5]
Control glycemia
“The benefits of taking them are that your glycemia will be more regular. I think that if you forget too often, there’s going to be too great a variation.” [M, FG1]
Side effects
“[…] to feel certain symptoms, for example sweating, dizziness, etc.” [M, FG5]
Feel good
“You’re in much better shape, if you follow your medication, it’s obvious you won’t have any negative effects, like dizziness or being sick, but if you don’t, you’re the only one to feel bad.” [W, FG4]
Feel less tired
“If I don’t take my medication, I don’t have much energy and I feel tired.” [M, FG3]
Not having to increase my medication
“It’s sad to have your medication adjusted, sometimes I would forget to take it, but when my medication was increased, I started taking this more seriously.” [W, FG5]
Avoid switching to insulin
“If I don’t take my medication, I will definitely end up with type 1, and insulin-dependent, so that is what happens if you keep your glycemia elevated and if you ignore your medication.” [W, FG4]

Note: Participant codes definition: M, Man; W, Woman; FG, Focus group, and the number refers to the focus group number.

Abbreviation: OADs, oral antidiabetic drugs.

Table 3 Modal normative beliefs of the 45 type 2 diabetes patients who participated in the focus groups, in decreasing order of frequency

Normative beliefs (ie, people who agree or disagree with OAD-taking as prescribed)
My spouse
“We’ve been dating for a couple of months and she’s really annoying […]. She’s acting like my mother, but … it’s positive, she reminds me to take my medication.” [M, FG1]
My children
“[…] my children are concerned, they set us straight … I would say they don’t advise us but they keep an eye on us.” [M, FG1]
My family
“[…] I think that everyone in the family, they are proud to see me as dedicated to taking my medication, because they apparently care about me [laughs].” [W, FG1]

Note: Participant codes definition: M, Man; W, Woman; FG, Focus group, and the number refers to the focus group number.

Abbreviation: OAD, oral antidiabetic drug.

Table 4 Modal control beliefs of the 45 type 2 diabetes patients who participated in the focus groups, in decreasing order of frequency

Control beliefs (ie, barriers and facilitating factors for OAD-taking as prescribed)
Facilitating factors
To have them always on me
“[…] I always have some [medication] on me; I always keep some in my purse […] I developed the reflex to put some back in my purse so that I always have some on me.” [W, FG5]
To keep an eye on them on the counter
“My pill organizer is on the counter top […] so it’s easier to see them.” [M, FG1]
To have a routine
“Because I would forget to take it [the pill] at night, now, when I’m setting the table, as I put a water jug on the table, I put my pill organizer next to my glass, so that I’m okay, it’s now part of my routine.” [W, FG1]
To have somebody to remind me (eg, when they eat)
“It’s easier when you live with someone, especially when they’re diabetic and they remind you to take your medication.” [W, FG4]
To use a pill dispenser
“I don’t forget it very often, I use a pill organizer at home […]. If I didn’t have it, I wouldn’t be able to keep track. […] On Sunday mornings, I place my pills in the little boxes, I know it’s done for the week, and I don’t have to think about what I have to take, it’s all there, morning and night.” [W, FG6]
To have a trick to help me remember (eg, an alarm on a watch or a cell phone)
“I set an alarm around dinner time, so it’s like I’m telling myself, it won’t stop by itself if I don’t do anything about it, and it reminds me that I need to take my medication.” [W, FG4]
Barriers
When we are away, on vacation, or in a restaurant
“Sometimes you just forget. I go to the movies and come back later, anything, and then it hits me, I forgot to take my medication.” [M, FG2]
“The worst is when you’re on a trip or at work; you don’t always keep your pills in your pockets.” [M, FG5]
“When you go to a restaurant and you didn’t plan for it, you won’t have your medication with you, so you have to take it later and you can forget about it […].” [M, FG5]
Not accepting my disease and my medication
“In the beginning I think I didn’t take it seriously, I was telling myself: I’m fine, I don’t know why she’s [the physician] giving me that, maybe one day I won’t be needing it anymore.” [W, FG5]
Not having confidence in the physician’s prescription
“You have someone [the physician] in your life who’s playing around with the medication, but he doesn’t seem to take it seriously, because as time goes on, the more he prescribes and you don’t know why.” [W, FG3]
When people come over
“When I have people over. I usually place my medication where I sit at the table, but if someone sits in my chair, I don’t want to bother anyone by getting my medication. I do take it eventually, but not at the usual time.” [M, FG4]

Note: Participant codes definition: M, Man; W, Woman; FG, Focus group, and the number refers to the focus group number.

Abbreviation: OAD, oral antidiabetic drug.