Conceptual framework
A holistic conceptual framework model was identified during literature review and used to
describe the identified factors that influence medication adherence in diabetes (Jaam et al.,
2017). The model is suitable as it identifies factors ranging from the disease to the patient related
factors, health provider and health system factors, and the drug medication to societal related
factors in medication adherence. These factors have all been identified in different descriptive
studies including chronic disease management and are displayed in Figure below (Jaam et al.,
2017).
Medication related factors influencing medication adherence in DM
These factors relate to the drugs used in treatment of DM. Aside from lifestyle modification in
DM, patients receive oral hypoglycemic agents (medications), insulin and in some case a
combination of the two (Tziomalos, 2017). These medications are used at different quantities and
at different times of the day depending on each individual treatment. Some factors associated
with these medications include: side effects, size, quantity, drug form and frequency of
administration (Polinski et al., 2013).
Disease (diabetes) related factors influencing medication adherence in DM
Diabetes requires long term treatment and this can be a demotivating factor for the individual.
Also, the effect of glycemic control can present with complications including glaucoma, diabetic
nephropathy, hyperglycemia, ketoacidosis and diabetic foot ulcer can influence that can affect
medication adherence. Also, the disease affects the daily adjusted life years of the individual and
quality of life; hence an individual’s economic status is affected. Furthermore, medication
adherence can be influenced when the disease is asymptomatic
Patient related factors
The patient is a key factor in medication adherence; therefore, it is very important to look at
factors relating to the patients including demographic, socio cultural beliefs and perceptions,
educational level, financial status and knowledge about DM (Brundisini et al., 2015). There is
also the presence of comorbidities and the quality of life of the patient including their mental and
psychological status that could result to unintended adherence practices (Nam et al., 2011).
Furthermore, the delay of start of treatment and patient fear of administering the medication (in
the case of insulin use) affects medication adherence (Brundisini et al., 2015).
Societal related factors influencing medication adherence in DM
The society is the immediate environment of the patients with DM hence it is important to
identify the norms and cultures in Nigeria as regards DM. Issues such as stigma due to the
disease (the need for diet change) and its complications (such as glaucoma, diabetic foot ulcers
resulting to amputation), availability of a social support system to encourage treatment
(including the immediate family members). Also, societal practices concerning the practice of
traditional alternative medicines and the specific diet consumed in the societal that could
potentiate a drug food interaction.
Healthcare provider related factors influencing medication adherence in DM
The healthcare providers consist of all health professionals responsible for the DM patient. It is
important for the healthcare provider to have the required knowledge of treatment guidelines in
DM to provide effective care. Their attitude and communication skills while providing care is
also important. Also, the defined roles and shared decision making amongst all participating
healthcare professionals revolves around overall patient satisfaction and improvement. The
healthcare provider’s perception about medication adherence and his bias on the ability of
patients to strictly adhere to treatment regimen (Polinski et al., 2013). Further the workload of
the healthcare professional plays a role on the presentation of findings to the patients concerning
the disease and subsequent treatment plan.
Health system related factors influencing medication adherence in DM
The health system affects the medication adherence of individual with DM through the cost of
appointments and prescribed medications, availability of healthcare providers and duration of
care, having alternatives of medications (having a variety of brands) and shorter to moderate
waiting times. Furthermore, the option of insurance and what is covered by the insurance
companies, copayment plans (if it exists and who is liable). Also, important is the accessibility of
the healthcare institution and the monitoring and follow up procedures.