Jeragh-Alhaddad, FB; (2010) Nonadherence among Kuwaiti nationals with type 2 diabetes mellitus. Doctoral thesis , University of London.

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Abstract

Introduction: Nonadherence to medications and diabetes self-care behaviours among Kuwaitis with Type 2 Diabetes Mellitus (T2DM) is believed to be a major barrier to appropriate management of the disease. Published studies of nonadherence in T2DM suggest a Western bias which may not adequately describe the Kuwaiti experience. Aims: (1) To explore barriers to adherence to medications and other diabetes self-care behaviours among Kuwaitis with T2DM. (2) To assess the prevalence of nonadherence to medications and other diabetes self-care behaviours, and identify predictors of medication nonadherence. Methods: (1) A qualitative exploratory study, using in-depth interviews with 20 Kuwaiti T2DM patients. (2) A cross-sectional quantitative survey of 250 Kuwaiti T2DM patients, randomly selected from all the six districts of the country. Results: Qualitative interviews revealed that many barriers to diabetes medications and other self-care behaviours among Kuwaitis appeared specific to the Kuwaiti culture, such as patients' beliefs about Western brands of medications, fatalism and submission to God's will in coping with illness, perceptions of social support, and difficulties related to access and organisation of the Kuwaiti healthcare system. However, some reported barriers were similar to the Western literature. The quantitative survey showed 43% of Kuwaiti T2DM patients were nonadherent to their diabetes medications, of which 45% had made a decision not to take their medications. Over half of nonadherers (52%) inadvertently did not take the medications as prescribed, mostly as a result of forgetting (42%). Nonadherence to medications was associated with poorer health outcomes. Beliefs about medicines and perceptions of healthcare provider support were issues of concern. Nonadherence to other diabetes self-care behaviours was high, 15%-68%, depending on the behaviour. Conclusion: Diabetic nonadherence constitutes a significant proportion in Kuwait. Barriers to adherence were complex and often interlinked, suggesting that multiple, tailored interventions may be needed to improve diabetes adherence, care and outcomes.

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