Exploring perceptions, attitudes and beliefs of Thai patients with type 2 diabetes mellitus as they relate to medication adherence at an out-patient primary care clinic in Chiang Mai, Thailand

Abstract

Background: Within the sphere of diabetes self-management, much emphasis has been placed on medication adherence. There has been a shift in thinking about medication adherence, moving from "compliance" and historically paternalistic models of care, to seeking better ways of characterizing dynamic and complex relationships that determine medication adherence and diabetes control. This study sought to understand the relationship between patient's attitudes and medication adherence for oral anti-diabetics in Thailand. Methods: In-depth interviews of patients with type 2 diabetes mellitus, taking oral anti-diabetic drugs, at the outpatient clinic run by the Department of Family Medicine, Chiang Mai University between May and December 2016. Thematic analysis followed the WHO framework for medication adherence in chronic disease to explore patient's attitudes and their influence on medication compliance. Results: Of 24 patients, 9 were men. The mean age was 62 years (SD 8.9 years). 67% had high compliance. Four themes were identified as important factors related to medication adherence: attitudes toward disease, attitudes toward treatment, attitudes toward family support and attitudes toward health care team. Specifically, symptoms at diagnosis, understanding and acceptance in taking medication, the presence of family support and the perception of concern by the doctor relate to improved medication compliance. Conclusions: Medication adherence in Thai patients with diabetes requires support from both the health care providers and the family. The patient's perception of the doctor's concern creates greater patient trust in the health care team. This trust, along with family support, helps deepen patients' understanding of the disease, accept the chronic nature of their disease, and engenders a positive attitude towards taking medication that can improve medication adherence.

Illness perceptions, self-care practices, and glycemic control among type 2 diabetes patients in Chiang Mai, Thailand

“…In theory, patients who were less threatened by diabetes (illness perception) would be expected to perform better self-management activities, and consequently, have improved glycemic control [ 29 , 41 , 44 ]. While the results in this study generally supported this statement, there was insufficient evidence for an association between illness perceptions and self-management practices.…”

“…Thus suggesting that a patient’s illness perceptions can directly relate to their self-management behaviors [ 27 , 28 ]. While there is some evidence to suggest that aspects of illness perceptions are associated with medication adherence and attendance rate among patients with diabetes in Thailand [ 29 , 30 ], very little is known about the illness perceptions and current self-care practices and among diabetic patients in Thailand. Moreover, illness perceptions and self-care practices can also vary between different settings [ 31 , 32 ].…”

Effective coverage of diabetes and hypertension in Thailand: challenges and recommendations

“…In order to improve quality of care for chronic disease patients, a multidisciplinary team and Chronic Care Model--a collaborative partnership among patients, providers and health system, which incorporates a multilevel approach are required particularly for diabetes patients whose behaviors plays an important role in treatment outcomes [24,25,27,28,[35][36][37] Patient's attitude and perception play significant role. A qualitative study in Thailand found that patients' experiences of severe complications from diabetes have better medication adherence, while lacking overt symptoms results in complacency, and that "normal" blood sugar levels are interpreted by patients as cure and there is no needs for continued medication [39]. Adequate diabetic health literacy and better glycemic control are highly correlated [40].…”

Factors Influencing Public Awareness of and Attitudes Toward Palliative Care: A Cross-Sectional Analysis of the 2018 HINTS Data

“…For example, McLachlan and Philip ( 23 ) found that people who were aware of hospices had more favorable attitudes toward palliative care. In addition, research on predictors of people's awareness of and attitudes toward diseases and treatments in general has yielded meaningful implications and suggested the important role of other intrinsic, personal predictors such as perceived health status ( 28 ), self-care confidence ( 29 ) and past health care appointment ( 30 ), and extrinsic, interpersonal factors such as family support ( 31 , 32 ) and patient-doctor relationship ( 32 , 33 ) in people's understanding of the diseases and thereby treatment adherence. Accordingly, it remains to be examined whether the influence of such individual and interpersonal factors would extend to the palliative care context.…”