Determinants of Medication Non-Adherence Among the Elderly with Co-Existing Hypertension and Type 2 Diabetes Mellitus in Rural Areas of Udupi District in Karnataka, India

Jeyalakshmi K; Mahadev Rao; Shashidhara Yn; Girish Thunga; Ravishankar N; Christopher Sudhakar; Elsa Sanatombi Devi

doi:10.2147/PPA.S380784

Determinants of Medication Non-Adherence Among the Elderly with Co-Existing Hypertension and Type 2 Diabetes Mellitus in Rural Areas of Udupi District in Karnataka, India

Patient Prefer Adherence. 2023 Jul 13:17:1641-1656. doi: 10.2147/PPA.S380784. eCollection 2023.

Authors

Jeyalakshmi K¹, Mahadev Rao², Shashidhara Yn¹, Girish Thunga², Ravishankar N³, Christopher Sudhakar⁴, Elsa Sanatombi Devi⁵

Affiliations

¹ Department of Community Health Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, Karnataka, India.
² Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India.
³ Department of Biostatistics, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India.
⁴ Department of Mental Health Nursing & Director - Quality, Manipal Academy of Higher Education, Manipal, Karnataka, India.
⁵ Department of Medical Surgical Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, Karnataka, India.

Abstract

Purpose: Medication adherence is a crucial component in the management of elderly with co-morbid chronic conditions. Hence, this study aimed to investigate the determinants of medication non-adherence among rural elderly with co-morbid chronic conditions of hypertension (HTN) and type 2 diabetes mellitus (T2DM) in India.

Patients and methods: This cross-sectional study adopted the probability proportional to size (PPS) sampling technique to find the determinants of medication non-adherence among elderly residing in rural coverage areas of five randomly selected primary health centres (PHC) in Udupi district, Karnataka, India. A total of 360 elderly (72 samples from each cluster) who met the inclusion criteria and consented were interviewed using predesigned prevalidated and standardized or reliable tools. The data were coded and entered in SPSS version 16.0 and analyzed using both descriptive and inferential statistics.

Results: The study found that 55.6% (n=200) of rural elderly with co-morbid conditions HTN and T2DM were non-adherent to their medications and established Spearman correlation coefficient rank (r) value between undesirable person-related factors (r=-0.444); good family support (including financial support) (r=0.185); poor accessibility to healthcare facility (r=-0.209); detrimental medication-related factors including high cost of medication (r=-0.237) were found to be significant at 0.05 level of confidence (p < 0.05). Further, the study depicted that the chi-square test (χ²) was identified to be significantly associated (p<0.05) with a variable such as education, knowledge, number of illnesses and impairments, vision, memory, and physical impairments.

Conclusion: Medication adherence could be improved among rural elderly with co-morbid conditions by identifying and addressing the determinants at the earliest. Further, it is vital to identify the suitable intervention program to address these avoidable problems.

Keywords: drug compliance; factors; multiple chronic conditions; old age people.