Barriers to medication taking among Kuwaiti patients with type 2 diabetes: a qualitative study

Figures & data

Table 1 Sociodemographic and medical history of study participants (n=20)

Variables	Summary statistics
Age, years
Mean	53.7
30–39	1 (5%)
40–49	6 (30%)
50–59	8 (40%)
60–69	3 (15%)
≥70	2 (10%)
Sex, n (%)
Female	10 (50)
Male	10 (50)
Education, n (%)
No formal education	3 (15)
Primary/intermediate school	1 (5)
High/secondary school	7 (35)
Diploma/bachelor	6 (30)
Marital status, n (%)
Single	2 (10)
Married	18 (90)
Employment, n (%)
Employed	6 (30)
Retired	10 (50)
Never employed	4 (20)
Area of residence, n (%)
Urban	14 (70)
Rural	6 (30)
Place of diabetes care, n (%)
Primary care clinic	13 (65)
Secondary care (outpatient hospital) clinic	2 (10)
Combination of primary and secondary	5 (25)
Duration of diabetes, n (%)
<1 year	2 (10)
1 year	2 (10)
5–10 years	5 (25)
>10 years	11 (55)
Diabetes treatment, n (%)
Oral hypoglycemic agent	14 (70)
Insulin	1 (5)
Oral plus insulin	5 (25)
Dosage regimen, n (%)
Once daily	1 (5)
Twice daily	9 (45)
Three times daily	6 (30)
Four times daily	4 (20)
Evidence of diabetes complications, n (%)	10 (50)
Comorbidity, n (%)	16 (80)

Figure 1 Types of identified barriers to medication adherence.

Table S1 Interview topic guide

1. Diagnosis

•Could you tell me when and how were you diagnosed?

•How did you experience the diagnosis of diabetes?

2. Knowledge about diabetes and medications

•In your opinion what causes diabetes?

•In your opinion, how should diabetes best be treated?

•How do you describe your health at the present, and what do you think it is going to be like in 10–20 years’ time?

•Could you describe the consequences of diabetes in the future? (Probe: complications)

•How do you know when you are sick with your diabetes? (Probe: describe symptoms of hypoglycemia, hyperglycemia)

•Could you describe what do you do when you are sick with diabetes? (Probe: hyperglycemia, hypoglycemia, foot problems)

•What is/are the source(s) of your information/knowledge about diabetes/its medications?

3. Views and experiences with diabetes medications

•Are you currently treated with tablets, insulin, or both for your diabetes?

•What medications are you currently taking for your diabetes?

•How do you take your medications?

•What do you think of your medications? (Probe: effectiveness in the short-term and in the long-term)

•Could you describe your experience of taking your diabetes tablets/insulin? (Probe: effectiveness, practical difficulties, adverse effects)

•Have you ever experienced difficulties taking your mediations for diabetes? If yes, please describe

•Can you remember a time where you could not take your medications as prescribed by your doctor? If yes, can you tell me what happened?

•Some people alter the use of their medications and find their own way of using their medications for many reasons. Can you think of a time when you have done so?

•If yes, how do you feel about this? Do you tell anyone about these decisions?

4. Views and experiences with alternative/herbal medicines

•Do you use herbal/complimentary medicines for your diabetes?

•If yes, could you describe your experience with such therapy?

•If yes, how do you feel about these compared to your regular medications? (Probe: adverse effects, effectiveness)

5. Views and experiences with health care providers (doctors, pharmacists, nurses, dietitians)

•Could you describe your views and experiences with your doctor? (Probe: type of relationship, communication style)

•How do you feel about the education and counseling provided by your doctor about diabetes/medications? (Probe: sufficiency of informationreceived about your diabetes/medications/other treatment behaviors)

•Has your doctor involved you in decisions relating to your own treatment plan? (Probe: to what degree?)

•If your doctor has decided on your therapeutic regimen, how do you feel about that? (Probe: degree of control and responsibility for own treatment desired)

•Do you always get the chance to be followed up with the same doctor? If not, how do you feel about that?

•Could you describe your experience with pharmacists?

•How do you feel about the education and counseling provided by your pharmacists?

•Could you describe your experience with other health care providers who were involved in your diabetes, eg, nurses, dietitians, etc? (Probe: who? What do you think of them in terms of diabetes care provided?)

6. Views and experiences with current health care system at the Ministry of Health

•What is your view of the current health care system? (Probe: health services provided)

•How do you feel about access to health care providers or medications? (Probe: describe ease/difficulty?)

•What should the Ministry of Health do to help patients with type 2 diabetes? (Probe: sufficiency of what it currently provided)

7. Impact of diabetes on participant’s life

•In what way have diabetes changed your life? (Probe: describe living with diabetes on a daily basis, how does your life differ from someone who does not have diabetes?)

•How do you feel about these changes?

8. Actual/perceived social support

•Do you receive any kind of support from your family in terms of managing your diabetes? (Probe: help with medications, SBGM, preparation ofdiabetic meals, etc)

•If yes, could you describe the role of your family in management of your disease? (Probe: practical or moral support)

Is there anything else you think that you wanted to say?

Thank and close

Abbreviation: SBGM, self-blood glucose monitoring.