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Asian Journal of Healthy and Science
p-ISSN: 2980-4302
e-ISSN: 2980-4310
Vol. 2 No. 12 December 2023
FACTORS INFLUENCING TREATMENT ADHERENCE AMONG NEWLY
DIAGNOSED DIABETIC CLIENTS OF LEDZOKUKU KROWOR
MUNICIPAL ASSEMBLY (LEKMA)
Emelia Yamoah Basoah
1
, Oscar Agyemang Opoku
2
1
Valley View University, Ghana
2
University of Cape Coast, Ghana
Email: oscar.opoku@stu.ucc.edu.gh
Abstract
The study focused on assessing compliance among newly diagnosed diabetic client
in Ledzokuku Krowor Municipal Assembly (LEKMA) Hospital. A descriptive
survey design was adopted and 120 diabetic patients were sampled using random
sampling techniques. A self-developed questionnaire instrument was the main data
collection tool and quantitative analysis was used with the aid of IBM SPSS (v.23).
The study found that most of the respondents were of the view that diabetes mellitus
was hereditary. It was recorded that all respondents considered hospital-based
treatment as effective in treating the condition. About 90 (72.0%) were of the view
that of a diabetic patient skipped a dose, he/she was to ignore that dose and wait till
the time for the next dose. Moreover, 116 (92.0%) respondents shared with researcher
that diabetics were supposed to avoid all fatty foods. All respondents visited the
hospital facility on a monthly basis to receive medical-care. Female turn to have
adhered more to their medication regimen than the males did, but it was not
statistically significant (t=.047, p= .963). Age has negative relationship (r = -.123, p=
533) with their adherence to medication. It was realized that those who had
secondary education adhered mostly to diabetic medications followed by tertiary
education and primary education attainers respectively. There was a positive
relationship (r = .050, p=0.732) between the marital status, occupational status (r =
.272, p = .056) of respondents and their adherence status to taking medications.
Respondents (40%) disagreed that prescribed medications were fully covered under
the National Health Insurance Scheme (NHIS). All of the respondents agreed that
finance was a challenge to seeking treatment and medical care for the management
of DM. About 40 percent of the respondents feared about side effect of drugs. It was
recommended that government should extend the NHIS to cater for DM
medications. There was also the need that government subsidized the treatment cost
of patients seeking for healthcare with respect to DM.
Keywords: treatment adherence, diabetes, ledzokuku krowor municipal,
knowledge, compliance
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INTRODUCTION
The World Health Organization (WHO) (2018) defines Diabetes as a chronic,
metabolic disease characterized by elevated levels of blood glucose (or blood sugar),
which leads over time to serious damage to the heart, blood vessels, eyes, kidneys,
and nerves. The most common is type 2 diabetes, usually in adults, which occurs
when the body becomes resistant to insulin or doesn't make enough insulin (WHO,
2018). In the past three decades the prevalence of type 2 diabetes has risen
dramatically in countries of all income levels. Type 1 diabetes, once known as
juvenile diabetes or insulin-dependent diabetes, is a chronic condition in which the
pancreas produces little or no insulin by itself (WHO, 2018).
Aflakpui (2016) reiterates that, DM is a chronic disease which arises as a result
of ineffective use of insulin produced by the body. The insulin produced by the body
aids in the regulation of glucose production in the human body. When the human
body is unable to make effective use of insulin to regulate the production of glucose,
a metabolic disorder occurs. DM is categorized as a lifelong advancing disorder. The
deterioration that this condition causes to the human system increases over time.
Thent, Das and Henry (2013) classify DM into two main types; type 1, insulin
dependent diabetes and type 2, non-insulin dependent diabetes mellitus. Type 1
diabetes is caused by the failure for the beta cells of the islets of Langerhans in the
pancreas. Type 2 diabetes is also caused by insulin resistance due to few insulin
receptors in the human body.
International Diabetes Federation Diabetes Atlas (2021) report that type 1 DM
arises due to some environmental factors such as having contacts with allergens and
viruses which leads to destruction of insulin-producing pancreatic beta cells. It may
also be caused by genetic predisposition. On the other hand, type 2 DM may also be
caused by inadequate secretion, excessive and/or inappropriate glucagon secretion
and a combination of resistance to insulin action. This according to Aflakpui (2016)
leads to ketosis and other health complications. According to the WHO, (2018) DM
will be the seventh leading cause of death globally by 2030. Currently, WHO (2018)
records that about 80% of DM patients live in middle- and low-income countries. An
estimation of 422 Million adults have diabetes. Also, 1.6 million deaths are directly
attributed to diabetes each year. 1 in 3 adults aged over 18 years is overweight and 1
in 10 is obese. 10. This high prevalence rate for Africa is very startling and requires
urgent attention (Gatimu et al., 2016).
In a study conducted by Aflakpui (2016), it was evident that the Tema General
Hospital for instance ranked diabetes mellitus among the top 10 hospital cases in
terms of admissions, OPD and mortality. The hospital reported the increase in cases
reported at their facility between 2013 and 2014; which was ranked third (14.4%).
Diabetes mellitus is ranked among the top 10 cases recorded at the Korle Bu Teaching
Hospital (KBTH) (The Korle Bu Annual Report, 2013). The mortality rate recorded
at health facilities across the country which has been ascribed to diabetes mellitus has
been on the rise (Owusu et al., 2021). Irrespective of the efforts made by health
officials and the governments to curtail the rise in diabetes mellitus and its effect
among Ghanaian adults, one pressing issue that hinders this effort is the compliance
to medication regimen among people living with this condition (Gatimu et al., 2016).
Awodele and Osuolale (2015) are of the view that one of the major problems
faced by public health across the globe and especially Africa is the non-adherence to
medication among diabetes mellitus patients. This poses a major risk in developing
935
cardiovascular and other chronic diseases. Adisa and Fakeye (2014) reiterate that
about 30-50% patients do not comply with medications which results in sub-optimal
treatment. Several factors have been identified to be associated with the non-
compliance of people living with diabetes mellitus to medication regimen. Factors
identified include lack of knowledge and education, and other lifestyles (Al-Qaza et
al., 2011; Aflakpui, 2016).
Irrespective of the reasons that results in the adherence to medication for those
living with the condition, much needs to be done to ensure that these people strictly
adhere to their medication regimen. Adherence to the medication regimen, according
to Latif and McNicoll (2009) is an integral component in the treatment of diabetic
patients. The non-adherence to medication has intense implications on the patients
as well as the healthcare system of the country (Latif & McNicoll, 2009). Moreover,
non-adherence to the medication regimen increases the risk to death which
proportionally increases mortality rate (Latif & McNicoll, 2009).
The noncompliance to medication regimen will equally result in failure in
treatment outcomes. It will also complicate associated conditions such as
neuropathy, retinopathy, kidney failure, sexual impotence, cardiovascular diseases
and diabetic foot gangrene which leads to amputation. These conditions which come
as a result of failure in treatment outcomes lead to premature death (WHO, 2015;
Jackson, et al., 2015). It also leads to increased hospitalization increasing the social
and economic burden on families (Guo et al., 2019). Families of patients who are
hospitalized due to diabetes mellitus spend a lot of resources in the upkeep of their
family members, presenting much pressure for families and the health system alike
(Hu et al., 2016). Owing to the beneficial side and the inevitable role medication
regimen plays in the treatment of diabetes mellitus, it is expedient that all efforts be
made to ensure that people diagnosed with the condition comply strictly with their
medication regimen (Barber et al., 2013).
1.2 Statement of the Problem
Report indicates that Africa has a DM mortality rate of 80% and is expected to
rise by 7.1% by 2030 (WHO, 2015; IDF, 2014). As projected by Leone, Coast,
Narayanan and de-Graft (2012), an estimated 82.5% of people in sub-Saharan
African countries will develop diabetes by 2030. The rise in the condition results in
associated complications and premature mortality (Aflakpui, 2016). Kratzer (2012)
reports that in 2012, death rate attributable to diabetes in Africa was 7.1% for males
and 7.9% for females aged 35-64 years.
The disease management requires special self-care throughout the patient's life,
including following a diabetic diet, physical activity, monitoring blood glucose, and
adhering to medication regimen (Ghaedi et al., 2016). These patients typically are
reluctant to adhere to all of mentioned principles, so they will eventually require oral
medications and even insulin therapy to control their blood glucose. One way to
control diabetes is treatment adherence that improves blood glucose control and
reduces glycosylated hemoglobin, resulting in fewer complications and all associated
costs (Khanjani Movaghar et al., 2021). Many patients with chronic diseases
disregard the recommended medication regimen due to prolonged course of
treatment and dissatisfaction with definitive treatment (Wu & Liu, 2016).
Uncontrolled diabetes is frequently associated with physical and psychological
complications, such as heart disease, stroke, hypertension, blindness, kidney failure,
amputation, depression, and poor quality of life (Goli Roshan et al., 2021).
936
Many therapists have been interested in how well patients with diabetes adhere
to their treatment plans that is one of the most important challenges in controlling
diabetes (Kooshyar et al., 2014). Early discontinuation of medication, non-
compliance with dietary instructions, and lack of physical activities are examples of
patient-related factors, which influence treatment adherence (Gholamaliei et al.,
2016). Lack of adequate adherence to treatment regimens increase disease
complications and healthcare costs, prolongs treatment duration, and double the
mortality rate of these patients compared with other patients (Badrizadeh et al.,
2021).
Yet, WHO (2015) reported that about 50% of patients diagnosed with diabetes
mellitus do not take their prescribed medications. This large number of patients do
not comply with medication regimen to ensure positive treatment outcome. WHO
(2018) in an assessment done to ascertain compliance with diabetes mellitus
medication regimen realized that there is an increased morbidity and mortality cases
in females as compared to males as a result of noncompliance to medication regimen
thus about 8% or 205 million women live with it worldwide. It must be echoed that
reports by WHO (2018) to the compliance with medication regimen calls for much
attention. Knowing that a treatment outcome is dependent on compliance with
medication regimen, it is expedient that patients are motivated to comply strictly with
treatment regimen. Studies conducted across the globe have indicated that some
factors including socio-economic influence adherences to chronic drug regimens
(Haghdoost et al., 2019; Braveman & Gottlieb, 2014).
From reviews, the researcher has come to realize that, though the impact of
medication regimen to treatment outcomes is acknowledged, compliance to
medication regimen still remains an albatross around the neck of the Ghanaian
health sector, especially among newly diagnosed diabetic patients (Gatimu et al.,
2016). Few studies that have been conducted on diabetic patents focused mainly on
the old diagnosed diabetic patients while others also considered rural communities
even though Afalkpui (2016) and The Korle Bu Annual Report (2013) ranked
diabetes mellitus among the top 10 cases recorded at the OPD and among mortality
cases. This gap has contributed to the low success in the fight against diabetes mellitus
by the government apparatus (Karachaliou et al., 2020). Based on this gap, the
researcher seeks to assess compliance among newly diagnosed diabetic client in a
district hospital; Ledzokuku Krowor Municipal Assembly Hospital in order to design
interventions and other plausible programmes to improve medication compliance
and increase treatment outcomes among diabetes mellitus patients.
RESEARCH METHODS
The research design employed in this study, as outlined by Leedy and Omrod
(2010), is a cross-sectional descriptive survey. This design primarily focuses on
quantifying various elements of interest without delving into the relationships among
variables. The research took place at LEKMA Hospital in Accra. It serves as the
Municipal Hospital for the Ledzokuku-Krowor (Teshie / Nungua) area. The study
included newly diagnosed diabetes mellitus patients aged 18years or above attending
the hospital, while excluding certain groups based on criteria such as age, health
status, and adherence issues. With the aid of Yamane (1967) formula for calculating
sample size, 120 patients were selected to formed part of the study. These patients
were selected with the aid of simple random sampling technique.
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Data collection primarily utilized a structured questionnaire, which was
divided into five sections covering socio-demographic information, knowledge of
diabetes management, medication regimen compliance, factors influencing
compliance, and compliance challenges. The questionnaire's validity was ensured by
experts' assessment and approval, while reliability was assessed through a pilot study
and the use of the Cronbach Alpha test. Data collection involved obtaining
permissions from relevant authorities, providing participants with informed consent
forms, and either self-administering the questionnaire or conducting interviews for
those unable to read or write. Quantitative data collected through the questionnaire
was processed using statistical software, and descriptive statistics, t-tests, and chi-
square tests were employed for analysis. Ethical considerations were observed,
including obtaining permissions, ensuring participant privacy and confidentiality,
and adhering to COVID-19 protocols.
RESULTS AND DISCUSSION
Demographic Characteristics
Demographic variables of respondents were ascertained to provide a clear
picture of the individuals who were sampled by researcher. Descriptive of these
variables are presented in Table 1.
Table 1: Descriptive Statistics of Respondents’ Demographics
Variable
Response
Frequency
Percent
Gender
Female
68
56.0
Male
52
44.0
Age (in years)
26-30
19
22.0
31-35
46
32.0
Above 35
53
46.0
Educational Level
Primary
16
16.0
Secondary
77
54.0
Tertiary
25
30.0
Marital Status
Single
28
34.0
Widowed
18
18.0
Married
74
48.0
Occupation
Self Employed
12
24.0
Government Worker
42
36.0
Unemployed
66
40.0
Duration of Sickness
1-5 years
120
100
Duration on Treatment
1-10 years
120
100
Type of Medication
Metformin
10
22.0
Metformin and Glibenclamide
74
52.0
Insulin
36
26.0
As indicated in Table 1, majority of the respondents sampled by researcher were
females. Female respondents were 68 (56.0%). Male respondents were 52 (44.0%).
With respect to age, the record on respondents was also not significant. Most of the
respondents, representing 53 (46.0%) were above 35 years of age. 46 (32.0%) were
between 31 and 35 years while 19 (22.0%) were aged 26 to 30 years of age. Moreover,
about 77 (54.0%) had attained secondary education with 25 (30.0%) having tertiary
938
education. Only 16 (16.0%) had attained only primary education. It is evident that
all respondents had attained some form of formal education making the use of the
questionnaire instrument appropriate.
In finding out the marital status of the respondents, most of them were found
to have been married. 74 (48.0%) said to have been married and 28 (34.0%) were
single. 18 (18.0%) had married but were widowed at the moment of the data
collection. Most of the respondents were gainfully employed, undertaking various
forms of professional duties. While 42 (36.0%) were engaged in various government
duties, 12 (24.0%) had their own form of work. Thus, they were self-employed. 66
(40.0%) were also unemployed.
All respondents (n = 120, 100.0%) had been diabetic for not more than 5 years.
Thus, respondents were newly diagnosed diabetic patients which had been medically
ascertained in the past 5 years. Similarly, all respondents had been on diabetes
treatment for not more than 10 years. It is clear that respondents started treatment
immediately they were diagnosed with the sickness. It was evident that most of the
respondents were using Metformin and Glibenclamide. 74 (52.0%) were using
Metformin and Glibenclamide, 36 (26.0%) were using Insulin while 10 (22.0%) were
also using Metformin.
Knowledge of Diabetic Clients on Management of Diabetic Mellitus
Objective one was posed to ascertain the awareness of clients towards diabetes.
It was to ascertain whether the clients had any information or education on the
sickness which they have been diagnosed with. Items raised in Section B of the
questionnaire instrument inquired respondents to identify what they knew about
diabetes. Table 2 presents responses gathered from respondents on their knowledge
on diabetes.
Table 2: Knowledge of Clients on Diabetes
Query
Response
Frequency
Diabetes is Hereditary
Yes
No
Not Sure
98
5
7
Diabetes Mellitus cannot be
treated with hospital base
treatment
False
120
What do you have to do when
you skip a dose?
Wait till next dose
Take it immediately
you remember
Omit the dose
90
22
8
What do you have to do when
side effects of medications
persist
Stop taking drug
Reduce the dosage
Report to the
hospital
94
8
18
What foods should a diabetic
avoid?
Fatty foods
No idea
116
4
What foods should a diabetic
avoid?
Fatty foods
No idea
116
4
Respondents shared with researcher a number of things they knew concerning
diabetes mellitus. Most of the respondents were of the view that diabetes mellitus was
939
hereditary. 98 (76.0%) indicated in the affirmative that diabetes mellitus was a
condition that was hereditary. On the other hand, 5 (10.0%) respondents also
considered this statement false. To them, diabetes mellitus is a condition that could
not be considered as hereditary.
Respondents were asked is they considered diabetes mellitus a condition that
could be treated with hospital-based treatment. It was recorded that all respondents
(n = 120, 100.0%) considered hospital-based treatment as effective in treating the
condition. In other words, respondents did not give prominence to traditional
methods of treating diabetes. Rather, they considered hospital-based treatment
regimen as the viable and effective plan for treating diabetes.
With respect to what clients were to do when they missed a dosage, most of
them shared the view that they were supposed to wait till next dose. 90 (72.0%) were
of the view that of a diabetic patient skipped a dose, he/she was to simple ignore that
dose and wait till the time for the next dose. 22 (20.0%) had the view that irrespective
of the time one remembers, he/she should simply take the dose. To these
respondents, it is advisable to take a forgotten dosage without skipping or ignoring it
without taking cognizance to the time one would remember to take the drug. 8 (8.0%)
respondents also pointed out that if a diabetic forgot to take a dose, he/she was to
omit the dose.
Respondents were also asked to share their views on what diabetics were to do
when they start to experience side effects of the medications they took. 94 (62.0%)
identified that in such situations, patients were to stop taking the drug. These
respondents held the idea that, patients who react negatively with the medications
they have been given are to ignore taking such medications again. 18 (32.0%) also
disagreed with such position and projected that, clients who reacted negatively with
their medications were to report such cases to the hospital. To these respondents,
before any further action could be taken, clients who had adverse reaction were to
make formal complaints at the hospital facility to receive medical advice on what
they were supposed to do. Surprisingly, 8 (6.0%) respondents had the idea that,
patients who reacted negatively with their medications were to reduce the dosage
prescribed them. These few respondents had the knowledge that it was approved for
patients to limit the amount of medications they take if they see any reaction to the
medications they are taking.
Knowledge in terms of food not prescribed for diabetics was also ascertained.
116 (92.0%) respondents shared with researcher that diabetics were supposed to
avoid all fatty foods. To these respondents, foods that a rich in fat, or foods that could
be classified that have contents dominated with fat and oil were to be avoided by
diabetics. These respondents share the opinion that fats and oil, probably in excess
was not healthy for people living with diabetes. 4 (8.0%) respondents opened up that
they had no idea whether fatty foods were medically recommended for otherwise for
diabetics. Thus, these respondents did not have any knowledge on the recommended
foods for diabetics.
Factors influencing compliance to medication
This objective was raised to find out how diabetic patients complied with their
medications. 4 items were raised to find out information concerning the compliance
of respondents to their various prescribed medications. Descriptive of responses
made by respondents is presented in Table 3.
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Table 3: Descriptive Statistics of Respondents’ Compliance to Diabetes
Medication
Query
Response
Frequency
Percentage
Are you able to take all your
medication?
Yes
No
10
32
36.0
64.0
How often do you take your drug?
Regularly
Whenever I
remember
78
10
92.0
8.0
Do you adhere to recommended
dietary regimen?
Always
Sometimes
30
80
40.0
60.0
How often do you visit the
hospital?
Monthly
120
100.0
Data provided in Table 3 supports the attitude of respondents on their
adherence to various medication regimen prescribed for them. Not all respondents
were found to be able to follow all regimen plans given to them. About 32 (64.0%)
indicated they were not able to fully comply with all medications given to them. Only
10 (36.0%) indicated their ability to follow all prescribed medications appropriately.
The record reveal that most of the diabetic clients are not able to follow all the
prescribed medication regime assigned them by the hospital facility.
In terms of the regularity for taking up medications, 78 (92.0%) respondents
admitted they took their medications regularly. About 10(8.0%) respondents
however pointed out they took their medications whenever they remembered. These
respondents thus had a poor attitude toward taking their medications, as they only
took them at points they remembered. Nonetheless, many of the respondents were
found faithful in taking up their medications, as they took all prescribed drugs
regularly as possible.
Researcher also found out the adherence rate of respondents towards their
dietary regimen. It was uncovered that most of the respondents basically were able
to adhere faithfully to the assigned dietary mechanisms spelt out to them by the
hospital facility. Also, 80 (60.0%) respondents pointed out they sometimes adhered
to the dietary specimen spelt out for them. 30 (40.0%) however indicated their full
ability to religiously follow all dietary regimen prescribed them by the hospital
facility.
Lastly, all respondents (n = 120, 100.0%) visited the hospital facility on a
monthly basis to receive medical-care. Further analysis was run to find out the
relationship between respondents’ demographic variables and their adherence to
taking their medications. Statistics of this computation is presented in Table 4.
Table 4: Inferential Statistics of Respondents Adherence to taking All
Medications
Variable
f (%)
Adherence
p value
Yes (%)
No (%)
Gender
Female
Male
68(56.0)
52(44.0)
22(55.6)
16(44.4)
58(56.3)
34(43.7)
t = .047
.963
Age (in years)
26-30
31-35
16(22.0)
26(32.0)
4(27.8)
6(33.3)
14(18.8)
20(31.2)
R = -.123
.397
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Above 35
68(46.0)
8(38.9)
60(50.0)
Educational Level
Primary
Secondary
Tertiary
12(16.0)
77(54.0)
35(30.0)
4(22.2)
36(44.4)
7(33.3)
4(12.5)
54(59.4)
5(28.1)
x
2
=
1.260
.533
Marital Status
Single
Widowed
Married
26(34.0)
20(18.0)
84(48.0)
6(33.3)
2(11.1)
72(55.6)
11(34.4)
7(21.9)
44(43.7)
R = .050
.732
Occupation
Self Employed
Government Worker
Unemployed
10(24.0)
20(36.0)
90(40.0)
1(5.6)
36(44.4)
88(50.0)
11(34.4)
10(31.2)
16(34.4)
R = .272
.056
Type of Medication
Metformin
Metformin and
Glibenclamide
Insulin
14(22.0)
88(52.0)
18(26.0)
14(11.1)
62(72.2)
3(16.7)
12(28.1)
54(40.7)
10(31.2)
x
2
=
4.670
.097
Total
18(36.0)
32(64.0)
(n = 120) p<.005**
From the inferential statistics provided in Table 4, it was uncovered that gender
was not a determining factor to the variations in adherence on diabetics in taking all
their medications. The t statistic value was found to be .047 and its significant value
was also .963. It could be concluded that the gender orientation of respondents does
not inform nor impact their full adherence to taking of diabetic medications. There
may be other factors that require further exploration and attention. However, females
turn to have adhered more to their medication regimen than the males did. The
difference between the adherence rate of males and females towards taking
medications could be accounted for by the difference (df = 6) between the two
sampled group.
It could also be seen that respondents aged above 35 years adhered to their
medications more than other group of respondents. However, the difference between
the age group of respondents who adhered strictly to their medications were not wide.
The correlative value computed was negative (r = -.123) indicating that, age of
respondents had a negative relationship with their adherence to medications. It could
be said that the variables age and adherence of medications were not mutually
complementary. The increase of decrease in age of diabetics does not correlate with
their tendency to adhere to their medications. Similarly, there was a not significant
relationship between the variables (p = .397).
With respect to educational level category of respondents, it was realized that
those who had secondary education adhered mostly to diabetic medications followed
by tertiary education and primary education attainers respectively. The Chi square
value was 1.260 with a not significant value of .533. The indication of this statistics
is that the educational level of diabetic patients did not significantly determine the
adherence rate of patients in taking their medications.
There was a positive relationship (r = .050) between the marital status of
respondents and their adherence status to taking medications. It could be said that
the two variables are mutually complementary rising together. However, the not
942
significant values of .732 revealed that marital status of diabetic patients does not
influence or determine the rate to medication adherence.
A positive correlation was also identified between occupation status of
respondents (r = .272, p = .056) and their rate of adherence to diabetic medications.
This implies that the professional category or status of diabetics positively impacted
their adherence to medications prescribed them by their medical professionals. Thus,
the working status of a diabetic to some extent impacts their adherence to taking all
their medications. However, the relationship though positive was not significant.
Challenges faced in compliance with medication regimen
The last objective was to find out the possible challenges’ diabetics faced in
taking their medications. Researcher raised queries that sought to engage respondents
to identify the challenges and barriers they met in adhering to all their medication
regimen. Descriptive statistics of responses gathered from respondents is presented in
Tale 5.
Table 5: Challenges Faced in Medication Compliance
Statement
SA (%)
A (%)
D (%)
SD (%)
The health facility is accessible to me
9 (18.0)
64(52.0)
9 (18.0)
26
(12.0)
All prescribed medications are covered
by NHIS
0(0)
40(20.0)
20
(40.0)
48
(40.0)
Drugs not covered by NHIS are
expensive
40
(20.0)
80 (80.0)
0(0)
0(0)
I do not spend much time at hospital
0(0)
80 (80.0)
40
(20.0)
0(0)
I fear the side effects of the drugs I take
40
(20.0)
20 (40.0)
30
(40.0)
0(0)
Responses made by sampled diabetics showed that accessibility was not a
challenge for clients in their attempts to access healthcare services. When researcher
posed the question that the health facility was accessible and close to respondents, as
many as 86 (52.0%) respondents agreed with 28 (18.0%) also making strong
agreement to the assertion made by researcher. On the other hand, 6 (18.0%)
indicated disagreement with 6 (12.0%) also making strong disagreement to the same
assertion.
Respondents also generally disagreed that prescribed medications were fully
covered under the National Health Insurance Scheme (NHIS). Researcher asserted
that all prescribed medications for diabetes management and treatment were being
taken care of by NHIS. When this assertion was made, 40 (40.0%) respondents apiece
strongly disagreed and disagreed. The emphatic disagreement made by respondents
support the fact that not all medications prescribed for the management of diabetes
mellitus were covered for under NHIS. However, 30 (20.0%) agreed that medications
were fully covered by NHIS. It could thus be concluded medications not being fully
covered by NHIS was a challenge for diabetics.
It also came clear that finance was a challenge to seeking treatment and medical
care for the management of diabetes mellitus. All respondents made agreements,
though on various degrees that medications that were not covered by NHIS were
expensive. About 90 (80.0%) agreed and 20 (20.0%) also strongly agreeing that
diabetes medications not covered by the NHIS were very expensive.
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With respect to the amount of time spent by diabetics at the hospital facility, 80
(80.0%) respondents opined that they did not spend much time at the hospital
whenever they went to seek for healthcare. Only 40 (20.0%) respondents said they
spent much time at the hospital whenever they went to access healthcare. The record
support the fact that diabetics who enter LEKMA do not waste much time at the
facility.
50 (40.0%) respondents agreed that they feared the side effects of the drugs
prescribed for them. Also, 20 (20.0%) also strongly agreed that they had some fear
towards the side effect they may encounter in taking diabetes drugs. However, 50
(40.0%) respondents indicated they were not afraid of the side effects they faced in
taking diabetes drugs. The majority of respondents who pointed out their fear makes
it possible to conclude that fear of possible side effects in taking diabetes medications
is a challenge faced by diabetics.
Other statements were raised to find out actions of diabetics as a result of
challenges faced in receiving diabetes treatment. Results of responses collated from
respondents is presented in Table 6.
Table 6: Attitudes of Diabetics in Diabetes Treatment
Statement
Response
Frequency
Percentage
Which people have been very supportive?
Family
120
100.0
Do you stop taking drugs when symptoms
are under control?
Yes
No
40
80
20.0
80.0
Is it difficult to take drugs every day?
Yes
No
50
70
40.0
60.0
Are you able to afford the prescribed drugs?
Yes
No
70
20
80.0
20.0
Respondents made it clear that their family member have been very supportive
in managing their condition. All respondents (n = 120, 100%) pointed out that their
family members have provided them all the support they require in managing and
treating their condition.
It was positively identified that respondents did not stop their medications
when they felt their condition has been brought under control. 50 (80%) respondents
pointed to the fact that they continued taking their medications though the symptoms
of the condition come under control. However, 30 (20%) stopped taking the drugs
whenever symptoms of the condition are brought under control.
Record also revealed that most diabetics do not find it difficult taking
medications every day. 50 (60%) responded favourably that they did not find it
difficult taking their drugs every day. 40 (40%) respondents however said it was very
difficult for them to take drugs every day. In terms of affordability, 90 (80%) indicated
they were able to afford the drugs prescribed for them in managing and treating
diabetes mellitus. Also, 30 (20%) however revealed they were not able to afford the
cost of drugs prescribed for them.
Knowledge of diabetic clients on management of diabetic mellitus
Respondents sampled from LEKMA hospital shared with researcher a number
of things they know concerning diabetes. It was uncovered that diabetics sampled
had the knowledge that diabetes was a hereditary condition. Most of the respondents
shared the view that diabetes is a condition that one mostly acquired as a result of
heredity. They believe one becomes diabetic by acquisition from the parents through
genes transmission. This denotes that diabetic patients believe they had the medical
944
condition not as any fault of theirs but as a result of their inheritance of the genes
from their parents. Respondents thus affirm positions taken by Kaur (2014) and
Elbein (2009) that a risk factor to DM is heredity. It as well denotes that diabetics
look forward to pass on the condition to their children, since they believe strongly
the condition is hereditary. The observation also to some extent conflicts the
education that lifestyle of people can result in they becoming diabetic. Believing that
diabetes is hereditary, people will then not embrace any form of education to alert
them of negative lifestyles that would put them at risk of contracting diabetes. The
onus then lies on health workers to intensify public education to educate the public
on the need to adopt a positive lifestyle, as it could also decrease ones possibility of
contracting diabetes mellitus.
It was also recorded that diabetes clients considered hospital medication as a
potent treatment regimen in managing the condition. All respondents shared the view
that hospital medications were appropriate in managing and treating diabetes. This
record shows how respondents did not place much emphasis and attention to
traditional and herbal preparations. This record is considered very heartwarming
giving the fact that there are a number of traditional
and herbal preparations on the Ghanaian markets that seeks to provide a
resolution and relieve to a number of medical conditions such as diabetes. Since
respondent were seen to have had positive attitude and knowledge on the efficacy of
hospital medicines and regimens, researcher believe this will auger well for the effort
of health professionals to projects the need for diabetics to access medical healthcare
for diabetes treatment. Similarly, researcher is confident that diabetics at LEKMA
will not hesitate any effort made by health professionals to prescribe medications for
the treatment of their condition. Also, diabetics would religiously take their
prescribed medications knowing how efficacious they are to ensuring their good
health.
Respondents also made it clear that a diabetic who misses his/her medications
was to wait till next dose. To the respondents, it a preferable that they simple wait till
it was time for their medications in the case when they forget to take a dose. There
was no need to take the medication immediately they remembered or were they
supposed to add it to their next dosage. This record shows that anytime diabetics
forgot to take their medications, they ignored it and simply took the other dosage
when it was time for them to take it.
In terms of experiencing the side effects of taking the medications, respondents
were of the view a diabetic was supposed to stop taking the drug if he/she starts
experiencing the side effects of the medications. The respondents believe once they
start reacting adversely towards the medications they are put on by their medical
advisors, there was the need to stop taking such drug. Though researcher considers
this idea not positive nor being in the right direction, respondents believe they were
to cut off further intentions of taking the dosage when they started reacting negatively
to the medications. Researcher was of the that when a diabetic start experiencing a
negative effect of the medications, he/she takes, the right thing to do was to consult
his/her medical professional for medical advice to be taken. However, this was not
the case, as respondents considered it appropriate to simple stop such medications
without even seeking for expert advice, in this case medical advice.
In terms of foods that were not advisable for diabetics to take in, respondents
held the view that fatty foods were not permissible for diabetics. Foods that were rich
945
in fat and oil were considered not appropriate for diabetics. To respondents, foods
that could be described as rich in fats, or having much contents in fats and oils were
not medically healthy for people diagnosed with diabetes mellitus. Foods such as fast
foods like sausage and cheese, fatty meats, fired foods, processed meats, desserts,
fatty salads, animal fats and whipped cream were to be avoided by diabetics. With
this knowledge, researcher believe that diabetics would not embrace such foods
knowing how unhealthy its contents are for their current medical condition. This
record is heartwarming as respondents appear to be very cautious of their meal intake
and knew which foods were healthy and would also contribute to the management
of their medical condition. With respect to literature, this record comes to affirm view
of Tuomilehto et al. (2001) and Chandalia et al. (2000) who advocate that among the
foods that are not to be taken by diabetics are fatty foods. To them, diabetics are to
avoid or limit the following: fatty meats, full cream dairy products, palm oil, coconut
oil and processed foods and saturated fat is to be restricted to less than 10% of total
energy intake. Respondents appeared to be aware of this information and researcher
believes they are putting it into practice as well.
Researcher concludes on these records that diabetic clients sampled from
LEKMA have some knowledge on diabetes. They knew about the condition being
hereditary, the efficacious nature of hospital treatment in managing diabetes mellitus
and the need to avoid fatty foods to improve the health of patients. These bits of
information is considered beneficial and essential in
managing and treating diabetes as they would help diabetics manage and
improve their health status.
Factors influencing compliance to medication
In finding the compliance of treatment regimen among diabetics, researcher
came to a realization that most of the diabetics sampled from LEKMA were not able
to take all their medications. Most of the respondents admitted openly to their
inability of taking all their medications. It was put on record that, for reason best
known to respondent, diabetes medications were not fully taken by respondents. It
comes clear that diabetics have not been able to take their medications. This shows
that respondents ignore taking their medications which is considered not appropriate.
This will not contribute towards the management of the condition as condition of
clients may be worsened. The seemingly poor adherence to medications comes to
affirm earlier speculations made by Awodele and Osuolale (2015), Adisa and Fakeye
(2014) and Al-Qaza et al. (2011) who posited that major problems faced by public
health across the globe and especially Africa is the non-adherence to medication
among diabetes mellitus patients. It was seen that diabetic patients from LEKMA did
not religiously adhere to all prescribed medications as they forgot to take some of
these medications. It appears that respondents forgot to take their medications for
reasons best known to them. The forgetfulness on the part of respondents which
resulted in they not taking all their medications is an affirmation to reports made by
Delamater (2006) and Gonzalez et al. (2005). Among other factors, forgetfulness was
identified as a very potent factor that accounted for the poor adherence to medication
among DM patients.
The record on adherence of diabetics towards taking their medications was
found to have no significant relationship with any demographic variable. None of the
demographic variables were seen to have any significant relationship with the
946
adherence rate to diabetes medication. However, a positive relationship was
identified between gender, educational level, marital status, occupational status and
the type of medication a patient is placed on with the rate of adherence in taking their
medication. This record was contrarily found in relation with studies by Naranjo et
al. (2011), Adisa et al. (2009), Martin et al. (2005) and Mandewo et al. (2014) who
identified demographic factors such as sex, age, marital status, educational level and
occupation as associated with compliance with medication regimen among patients
with diabetes mellitus. None of these factors were to have significant relationship
with the adherence to DM medication and treatment regimens.
However, respondents made it known to researcher they took their medications
regularly. Though they may not be able to take all medications as prescribed to them,
they made frantic effort to take medications regularly. Since most of them made such
assertion, researcher believes diabetics believe in the efficacy of hospital treatment
and medications and as such take them regularly with no or least resistance.
Relatedly, respondents made it clear that they visited the hospital facility
monthly to check on their health status. All respondents made it known that they did
not relent on visiting the health facility to check on their medical status and receive
expert medical advice and attention on their condition. This record further comes to
affirm the fact that respondents believe strongly in the role of hospital treatment and
schedules in managing diabetes mellitus. It is clear from this record that any attempt
and advice given by medical professionals to manage and treat diabetes mellitus
would be embraced by diabetics and would not receive any resistance. This record is
considered positive and in the right direction.
Challenges faced in compliance with medication regimen
Accessibility issues were also ascertained by researcher. It was uncovered that
the hospital facility was not a challenge to respondents in accessing medical care. It
was evident that respondents lived close to the health facility and thus it made it easy
and possible for them to receive medical care when the need arises. This record comes
as a welcoming news as researcher is assured that the positioning of LEKMA has
been a contributing factor to the positive attitude of diabetics in accessing medical
treatment in managing their medical condition. Hence if diabetics are not taking their
medications or have any reservations towards accessing procedures, accessibility to
the facility cannot be cited as an influencing factor.
It was also uncovered that the National Health Insurance Scheme (NHIS)
which is a government intervention to support Ghanaians seek medical care. This is
to improve the attitude of people in placing much prominence on hospital
medications over traditional an herbal preparations. The recorded made in this study
however reveals that not all drugs prescribed for diabetics were covered for by the
NHIS. Thus, diabetics were to spend extra money and financial resources in
purchasing these drugs. This is a challenge to diabetics as those who may not be
financially sound would find it very discomforting and impossible to purchase these
drugs. Once patients are not able to purchase the drugs, one could expect that they
would thus not be able to take the prescribed medications, making it impossible to
improve their health status and manage their condition. The effect of this is that, they
may end up having complicated and deteriorating condition. Sabate (2003) strongly
believes that health systems were a determining factor to compliance towards
medication among DM patients. The various actions and interventions made by
947
health managers goes a long way to determine the rate at which DM patients took
their medications. Relatedly, respondents made it clear that NHIS not covering all
mediations was a challenge and based on assumptions made by Sabate (2003),
researcher is confident that this challenge may mar the adherence and compliance
attitude of DM clients towards the medication.
Relatedly respondents made it evident that drugs that were not covered under
the NHS were very expensive. Respondents lamented on the exorbitant prices of
some diabetes medication. This was found as a challenge in the treatment and
management of diabetes among client sampled from LEKMA. It is obvious from the
record that management of diabetes was expensive as it demanded one to commit
much financial resources. This presented a challenge to diabetics in their attempt to
manage the condition.
However, it was favourably uncovered that diabetics were able to afford the
cost of the medications. No matter how expensive the medications were, clients told
researcher that they were able to purchase them. Knowing how important it was for
them to keep taking their drugs, respondents told researcher they found the means to
purchase the medications so as to be able to manage the condition. This record is
very heart warming, welcoming and positive as it comes to confirm all records that
diabetics at LEKMA take much interest in their health status and thus find means of
getting all necessary medications irrespective of how costly and expensive they may
be.
It was also found that hospital professionals were also helpful and energetic in
providing medical services to clients. Respondents admitted they did not spend nor
waste time any time they visited the health facility for medi care. This to a larger
extent resulted in clients accessing health care monthly without delays. Researcher
believes that this attitude of health professionals will immensely motivate clients to
visit the facility knowing health officials will provide timely response to their needs.
Researcher is confident on this report that health officials at LEKMA are
responsive to patients’ needs, smart and thus patients do not waste time at the
facility. Hence, time wastage at the health facility was not a challenge to diabetics in
seeking medical care for the treatment of their condition.
Another challenge that diabetics had was their fear of side effects with diabetes
medications. Respondent made it evident that feared possible reactions that may
develop in taking prescribed medications. Respondents were scared of adverse
reactions they may have as they took their medications. Though these medications
would improve their health status and manage the effect of diabetes on them, they
equally feared they would end up with other medical condition as a result of the
medications they were taking. The fear of the medications which was a challenge to
diabetics was considered unfortunate. This challenge implies then that respondents
may have the tendency if ignoring their medications. When these medications are
ignored, one could believe also that the health of the clients would not be improved
nor be made better.
Conclusions and Recommendations
A low adherence rate was observed among DM patients. They mostly skipped
or forgot to take some of their medications. Among these challenges were NHIS not
covering all DM drugs, expensive DM drugs and fear of possible side effect.
948
Therefore, education on the essence of adherence or compliance to DM medication
is needed to improve upon the adherence rate.
Also, the study found that fear of side effect of DM medication was among the
major challenges that confront compliance of DM medication. Therefore, education
and sensitization about the side effect of DM medication to DM patients and the
general public is necessary to improve upon the adherence rate.
Management of health facilities in collaboration with training and research
center and Director of nursing should encourage and organize workshops or seminar
on various strategies to employed in the nursing professionals to institute supportive
mechanisms to increase adherence rate to medications and treatment regimens
among diabetic patients.
The results of this research bring to light that nurses need to increase their effort
on public education on risk behaviour of diabetes mellitus. Similarly, there is the need
for nursing professionals to strategize and institute supportive mechanisms to
increase adherence rate to medications and treatment regimens among diabetic
patients.
The study was focused on assessing compliance among newly diagnosed
diabetic client in a district hospital; Ledzokuku Krowor Municipal Assembly
(LEKMA) Hospital. Further studies can focused on the health seeking behavior of
DM patients in Ledzokuku Krowor Municipal Assembly (LEKMA) Hospital.
Others can also look at the challenges and prospects of drug compliance among DM
clients.
Public education should be intensified to create awareness on risk behaviours
on diabetes mellitus. Government should consider expanding the NHIS to cover all
diabetes mellitus medications. Moreover, government should subsidize cost of
treatment regimen for diabetic patients. Further studies should consider exploring
more to find strategies to support diabetics to adhere to their treatment regimens and
medications. Future studies should adopt a longitudinal study approach to examine
the factors that militate adherence to treatment regime among diabetes mellitus
patients.
CONCLUSION
There are some problems with every study that must be taken into account.
First, this study looked at new diabetes patients at the LEKMA hospital by using a
quantitative research design. Though a quantitative research design was thought to
be the best way to study the thing being studied, it has the drawback that the
knowledge gained may be too abstract and general to be directly applied to specific
situations, contexts, and people. Also, quantitative methods don't tell you much
about how variables are related to each other. This study was only done on people
who had just been diagnosed with diabetes at the LEKMA hospital, which may have
led to bias. Also, the study sample was mostly made up of people who had just been
diagnosed with diabetes at LEKMA hospital's postsurgical adult units. This means
that the results cannot be applied to other groups of diabetes patients. Furthermore,
this study did not investigate the willingness of the patients to comply to diabetes
mellitus medication.
949
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Copyright holders:
Emelia Yamoah Basoah, Oscar Agyemang Opoku (2023)
First publication right:
AJHS - Asian Journal of Healthy and Science
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