Adherence to Anti-Diabetic Medication, Its Associated Factors, Barriers, Facilitators and Strategies for Improvements among Adults with Type 2 Diabetes Mellitus Attending Regional Referral Facility in Eastern Uganda: a Mixed Study Design

Adherence to Anti-Diabetic Medication, Its Associated Factors, Barriers, Facilitators and Strategies for Improvements among Adults with Type 2 Diabetes Mellitus Attending Regional Referral Facility in Eastern Uganda: a Mixed Study Design | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Adherence to Anti-Diabetic Medication, Its Associated Factors, Barriers, Facilitators and Strategies for Improvements among Adults with Type 2 Diabetes Mellitus Attending Regional Referral Facility in Eastern Uganda: a Mixed Study Design Brenda Lalam, John Michael Okusa, Lucy Ezatiru, Ronald Opito, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8097219/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 16 Mar, 2026 Read the published version in BMC Primary Care → Version 1 posted 11 You are reading this latest preprint version Abstract Background Type 2 diabetes mellitus (T2DM) is the most common type of endocrine disorder among adults, accounting for 90%-95% of diabetes mellitus globally. In Uganda, non-adherence to anti-diabetic medication remains high at 38.1%. This results in complications like diabetic ketoacidosis, hyperglycemia and microvascular complications. Objective To determine the prevalence of adherence to anti-diabetic medication, its associated factors, barriers, facilitators, and strategies for improvements among adults with T2DM attending the diabetic clinic at Soroti Regional Referral Hospital. Method The study employed an explanatory sequential mixed design at SRRH. The quantitative study participants were 376 adults aged 18 years and above with T2DM, while qualitative data was collected from 15 participants with diabetes mellitus. Quantitative data was collected using semi-structured interviewer-administered questionnaires, while qualitative data was collected using in-depth interview guide. The prevalence of adherence was expressed as a percentage. Modified Poisson regression was used to determine the association, with the prevalence ratio being the measure of association for quantitative data while deductive thematic analysis was used for qualitative data. Results The prevalence of adherence medication was 51.3% (95% CI: 0.46–0.56). Factors significantly associated with adherence included: sex of the participants (aPR = 2.215, p-value < 0.001), having a family support (aPR = 2.972, p-value of < 0.001), having ever received health education (aPR = 2.522, p- value of < 0.001), and finding anti-diabetic medication always available at the hospital pharmacy (aPR = 2.194, p-value of 0.029). Qualitative findings revealed that the key barriers to adherence included financial constraints, drug stock-outs, side effects, and lack of understanding. The key facilitators included family support, health education, and regular follow-up. Participants s uggested several strategies that could improve adherence including strengthening community support, improving drug supply, and enhancing patient-provider communication. Conclusion Adherence to anti-diabetic medication remains suboptimal, with only half of the participants adhering. Both quantitative and qualitative findings underscore that family support, gender, health education, and consistent medication supply are critical determinants of adherence. To improve adherence, health facilities should implement routine adherence assessments, strengthen family engagement, ensure consistent drug availability, and provide structured, continuous health education. Integration of adherence counselling into professional training and community education programs is essential. Adherence Anti-Diabetic Medication Associated Factors Adults Type 2 Diabetes Mellitus Figures Figure 1 Introduction Diabetes Mellitus (T2DM) is the most prevalent endocrine disorder and has been on the raise with close to 830 million cases globally, of these type 2 diabetes mellitus contributes 90–95% of all diabetes cases worldwide [ 1 , 2 ]. The global prevalence rate stands at 6,059 per 100,000 individuals and is projected to rise to 7,079 per 100,000 by 2030 [ 3 , 4 ]. Diabetes mellitus contributes to approximately 6.7 million deaths annually, with one person dying every five seconds due to complications arising from poor adherence to treatment [ 5 ]. T2DM is a chronic metabolic condition characterized by hyperglycemia due to insulin resistance or inadequate insulin production, leading to complications such as diabetic ketoacidosis, neuropathy, nephropathy, retinopathy, and cardiovascular diseases [ 6 , 7 ]. The management of T2DM involves medication, diet modification, regular exercise, and blood glucose monitoring, with metformin, glimepiride, and insulin forming the core pharmacological interventions [ 7 ]. Despite the availability of these interventions, global non-adherence rates to anti-diabetic medication range between 20% and 60% [ 8 – 10 ]. In Africa, an estimated 24 million adults live with diabetes, representing a prevalence of 4.5%, with 54% of cases remaining undiagnosed [ 11 ]. The region is projected to experience a 134% increase in diabetes cases by 2045[ 12 ]. In Uganda, approximately 1.4 million people live with diabetes, of whom 1.26 million have T2DM [ 13 ]. The prevalence of non-adherence to anti-diabetic medication among Ugandan adults with T2DM is 38.1% [ 14 ]. Poor adherence to anti-diabetic therapy contributes significantly to disease complications, hospital admissions, and premature deaths. The major factors influencing non-adherence include advanced age, comorbidities, high cost of drugs, side effects, unavailability of medication, lack of health education, and weak healthcare provider-patient relationships [ 14 – 16 ]. There has been an increasing number of hospital admissions due to T2DM complications, reflecting poor medication adherence. Although the Ministry of Health has implemented strategies such as free blood glucose monitoring and improved drug supply[ 7 , 17 , 18 ], challenges persist. Therefore, this study sought to determine the prevalence of adherence to antidiabetic medication, its associated factors, barriers, facilitators and strategies for improvement among adults with T2DM. The findings aim to generate evidence-based recommendations for improving medication adherence, strengthening diabetes management, and informing policy and clinical practice in Uganda. Methods Study Design and Setting This study employed an explanatory sequential mixed-methods design, beginning with a quantitative phase followed by a qualitative phase. Quantitative data were collected using a cross-sectional design to determine the level and factors associated with adherence to antidiabetic medication, while qualitative data were gathered using an exploratory descriptive design to gain deeper insights into barriers and facilitators of adherence. The study was conducted at the Diabetic Clinic of Soroti Regional Referral Hospital (SRRH), located about 326 km northeast of Kampala, Uganda. SRRH, established in the 1920s and upgraded to a regional referral hospital in 1996, serves as the main referral center for the Teso sub-region. It has a 267-bed capacity and provides both general and specialized health services to eight surrounding districts. The hospital records approximately 21,728 annual admissions and 99,666 outpatient visits. The Diabetic Clinic operates every Thursday from 8:00 a.m. to 5:00 p.m., attending to an average of 80 patient’s weekly. The clinic is staffed by five nurses, one physician, and internship doctors. SRRH was selected for this study because it is the primary center for diabetes care in the Teso sub-region. Study Population: The study was conducted among adult clients age 18 years and above with T2DM receiving care in the diabetic clinic at Soroti regional referral hospital during February to May 2025 who had met the inclusion criteria. Inclusion Criteria The study included adult clients age 18 years and above diagnosed with Type 2 diabetes mellitus and initiated on treatment for at least 6 months before the time of data collection, receiving care at the diabetic clinic at Soroti Regional Referral Hospital between 1st February to 30th March 2025. Participants who had consented were included in the study. Exclusion Criteria The study excluded adult clients age 18 years and above with Type 2 diabetes mellitus who were critically ill and needed emergency care and those who were mentally impaired. 3.5 Sample Size Determination The sample size for quantitative data of this study was computed using the formula for a single proportion (Kish and Leslie, 1965). n = \(\:\frac{{z}^{2}p(1-p)}{{d}^{2}}\) Where; n was the required sample size, d was tolerable sampling error ( precision) set at 5%, Z was a standard normal value corresponding to set 95% confidence interval on a normal distribution curve (z = 1.96), p was the estimated prevalence of adherence to T2DM management from a previous study at 67% (Faisal et al., 2022) This was adjusted for the 10% non-response gives a sample size of 376. For the qualitative component, the sample size was determined based on data saturation, which was reached after interviewing 10 adult patients with type 2 diabetes mellitus attending the diabetic clinic at Soroti Regional Referral Hospital. Data collection continued until no new themes or information emerged, ensuring adequate depth and richness of the qualitative findings. Sampling Method For quantitative data, simple random sampling technique was used to select participants from the diabetic clinic register at Soroti Regional Referral Hospital (SRRH). The clinic register served as the sampling frame, and participants were randomly selected from adults attending the clinic who met the inclusion criteria and provided informed consent. The diabetic clinic operates every Thursday, and data collection was conducted once weekly over a four-month period. A total of 376 participants were recruited for the study, with an average of 23 to 25 participants sampled each Thursday. On each clinic day, eligible patients were assigned numbers based on the attendance register, after which random numbers were generated to identify participants for inclusion. This approach ensured that every eligible patient had an equal chance of being selected, thereby minimizing selection bias. For the qualitative component, the study employed purposive sampling to select adult patients with type 2 diabetes mellitus attending the diabetic clinic at Soroti Regional Referral Hospital who could provide rich and relevant information on adherence to anti-diabetic medication. Maximum variation sampling was applied to ensure diversity in participants’ age, gender, duration of diabetes, and adherence levels, capturing a wide range of experiences and perspectives. Data Collection Tool and Procedure Quantitative data were collected using a semi-structured, interviewer-administered questionnaire developed for this study from validated tools and relevant literature (Supplementary 1: questionnaire). Adherence to anti-diabetic medication was assessed using the Medication Compliance Questionnaire (MCQ), adapted from the Morisky Self-Reporting Scale and Hill-Bone Compliance Scale. The MCQ comprised seven items rated on a 4-point Likert scale (1–4), giving a total score range of 7–28, with scores ≥ 27 indicating high adherence. Additional questions on factors influencing adherence were developed from previous studies to fit the local context. The questionnaire was initially written in English and translated into Ateso the local language to ensure clarity and comprehension. Data were collected over a four-month period, every Thursday, when the diabetic clinic operates at Soroti Regional Referral Hospital. A total of 376 participants were recruited, averaging 23 to 25 participants per week, using a simple random sampling approach. After obtaining informed consent, trained research assistants and the principal investigator conducted private interviews to ensure confidentiality. Blood glucose levels were measured using a glucometer. Finger-prick blood samples were obtained with sterile disposable lancets after cleaning the site with alcohol swabs, and readings were recorded to the nearest 0.1 mmol/L. Hyperglycemia was defined as fasting blood glucose > 7.0 mmol/L or random blood glucose > 11.1 mmol/L, while hypoglycemia was defined as blood glucose < 3.9 mmol/L. Qualitative data were collected using an in-depth interview guide developed specifically for this study by the principal investigator (Supplementary 2: In-depth interview guide). The principal investigator and research assistant explained the study purpose and obtained written informed consent before each interview. Interviews were conducted in a private room by trained research assistants. With participants’ permission, interviews were audio-recorded, and detailed notes were taken to capture non-verbal cues and contextual information. Quantitative Data Management and Data Analysis Plan The principal investigator cleaned, processed and checked the data for correctness. The filled questionnaires were kept in a lockable cabinet and external hard drive which is password coded. The collected data was entered into EpiData version 4.6. Double data entry and validation was done to ensure correctness and completeness. Data was cleaned for missing, duplicate and illogical entries. The data was exported from EpiData to SPSS version 27 for analysis. The collected data was displayed in tables and graphs. Continuous data was described using means and standard deviations since the data was normally distributed. Categorical data were described using frequencies, percentages and proportions. The prevalence of adherence to anti-diabetic medication was expressed inform of a percentage with its corresponding confidence interval. To determine the factors associated with adherence to type 2 diabetes mellitus medication, modified Poisson regression with robust standard errors was used. The measure of association was the prevalence ratio. A bivariate analysis was conducted to select variables with a p-value of less than 0.2 for multivariate analysis. At multivariate analysis, interactions were assessed between significant independent variables by forming interaction terms for only significant basic variables at p-value < 0.05. The log likelihood ratio test was used to determine if the model without interaction terms was better than a model with the interaction term and since it was not significant with the p-value of 0.90, the model without interaction term was considered. Manual stepwise backward elimination was done to maintain in the model only significant variables with p-value < 0.05. The non-significant basic variables were then assessed for confounding. Qualitative Data Management and Analysis The audio recordings of in-depth interviews were transcribed verbatim by the principal investigator and an experienced social scientist. Interviews conducted in Ateso were initially transcribed in the original language and then translated into English to ensure accuracy and consistency. All transcripts and related qualitative data were securely stored on an encrypted external hard drive, accessible only to the principal investigator and authorized team members. Qualitative data analysis was a collaborative effort between the principal investigator and the social scientist. Transcripts were imported into Open Code version 4.03, a qualitative data analysis software. Inductive thematic analysis was employed, following six steps: (1) familiarization with the data, (2) generating codes, (3) identifying themes, (4) reviewing themes, (5) defining and naming themes, and (6) selecting exemplars to illustrate findings. The researchers independently read and coded the transcripts, highlighting emerging themes and patterns. They then discussed areas of agreement and discrepancy to collaboratively refine the themes. Findings were organized into themes and sub-themes and illustrated using direct quotations from participants to enrich interpretation and support credibility. Data Quality Control and Assurance For the quantitative component, validity was ensured through the use of well-structured questionnaires developed from established literature and aligned with the study’s conceptual framework on adherence to anti-diabetic medication. The tool was reviewed by experts and the research supervisor to confirm clarity and relevance. A pilot test involving 20 diabetic patients at Soroti Regional Referral Hospital (excluded from the final sample) was conducted to assess reliability, clarity, and consistency. Feedback from the pretest informed tool refinement. To ensure data collection uniformity, a trained research assistant conducted all interviews under the supervision of the principal investigator, with translation into Ateso to enhance accuracy and understanding. For the qualitative component, trustworthiness was ensured through pretesting of the in-depth interview guide among three participants not included in the main study. Credibility was enhanced through member checking and peer debriefing, while dependability and confirmability were achieved through transparent documentation and maintaining an audit trail. Adherence to established qualitative research methodologies and systematic analysis ensured the rigor and authenticity of findings. Results Study profile of participants From the diabetic clinic, 1280 participants were available which was used as sampling frame. Out of this sampling frame, 2 participants were excluded because they had diabetes ketoacidosis (DKA) and were critically ill and the study then selected 378 participants (Fig. 1 ). Descriptive Statistics Description of the socio-demographic characteristics of patients with Type 2 diabetes. Of the 376 participants with type 2 diabetes mellitus, 212(56.4%) were female, and 252(67.0%) of the respondents were aged 50 years and above. A majority, 349(92.8%) of the participants were Christians, and 218(58.0%) of the participants attained primary education. The majority, 307 (81.6%) of participants were living in rural areas, most, 275(73.1%) of the respondents were not employed, and 271(72.1%) of the respondents were married. Most 301(80.1%) of the participants had a low family income level, and 338(89.9%) of the respondents had a financial challenge with buying their medications ( Table 1 ). Table 1 Socio-demographic and lifestyle characteristics of patients Characteristic Frequency(N = 376) Percentage (%) Age 18 to 30 Years 26 6.9 31 to 49 years 98 26.1 50 years and above 252 67.0 Sex Female 212 56.4 Male 164 43.6 Religion Christianity 349 92.8 Muslim and Others 27 7.2 Level of Education No formal education 65 17.3 Primary 218 58.0 Secondary 60 16 Tertiary 33 8.8 Residence Urban 69 18.4 Rural 307 81.6 Occupation Employed 41 10.9 Not employed 275 73.1 Self employed 60 16.0 Marital Status Married 271 72.1 Single 105 27.9 Family Income Level Low 301 80.1 Medium to High 75 19.9 Alcohol Intake Status Yes 33 8.8 No 343 91.2 Smoking Status Yes 26 6.9 No 350 93.1 Family Support Status Yes 292 77.7 No 84 22.3 Financial constraint Yes 338 89.9 No 38 10.1 Clinical characteristics of adults with type 2 diabetes mellitus Of the 376 participants with type 2 diabetes mellitus, the majority, 213(56.6%) of the participants had lived with type 2 diabetes for more than 5 years and 216 (57.4%) of the respondents had other comorbidities. The majority, 292(77.7%) of the participants had good family support and 198(52.7%) of the respondents had ever been admitted to the hospital due to a complication of type 2 Diabetes Mellitus. The majority, 354(94.1%) of the participants had a positive perception on anti-diabetic medication in managing their condition and 297(79.0%) of the participants were on oral medication. Most 241(64.1% ) of the respondents had experienced side effects of the medication while majority 366(97.3%) of the respondents were not having private health insurance. Most 281(74.7%) of the participants had ever received health education on medication adherence, most 316(84.0%) of the participants did not find their medication available at the hospital pharmacy. Majority 367(97.6%) of the respondents did not have patient follow up by the health worker, and the majority 359(95.5%) of the participants reported a good health-worker to patient relationship. ( Table 2 ). Table 2 Clinical characteristics of participants with type 2 diabetes mellitus Characteristic Frequency(N = 376) Percentage (%) Duration of T2DM 4 Years and below 163 43.4 5 Years and above 213 56.6 Comorbidity Yes 216 57.4 No 160 42.6 History of hospital admission Yes 198 52.7 No 178 47.3 Medication usefulness perception Yes 354 94.1 No 22 5.9 Type anti-diabetes medication Oral medication 297 79.0 Insulin injection 79 21.0 Experience side effect Yes 135 35.9 No 241 64.1 Private health insurance Yes 10 2.7 No 366 97.3 Ever received health education Yes 281 74.7 No 95 25.3 Medication availability Yes 60 16.0 No 316 84.0 Health worker-patient follow-up Yes 9 2.4 No 367 97.6 Health worker-patient relationship Yes 359 95.5 No 17 4.5 Prevalence of Adherence to Anti-Diabetic Medication among Patients with Type 2 Diabetes Mellitus The prevalence of adherence to anti-diabetic medication is 51.3% (95%CI: 0.46–0.56). This was generated from the MCQ seven questions, and those that had a total score of 27 and 28 were considered adherent to anti-diabetic medication. Bivariate analysis factors associated with adherence to anti-diabetic medication among type 2 diabetes mellitus patients At bivariate analysis, the variables with a p-value of less than 0.2 were considered for multivariate analysis. The sociodemographic and lifestyle factors considered included: sex of the participants and occupation of the participants. Other variables included marital status of the respondents, financial constraints in buying the anti-diabetic medication, and family support ( Table 3 ). The clinical related factor considered included: history of hospital admission due to complications and experiencing side effects of medication. Ever received health education on how to take the medication, medication availability at the hospital pharmacy and health worker-patient relationship ( Table 4 ) . Table 3 Bivariate analysis on the socio-demographic and lifestyle factors associated with adherence to anti-diabetic medication Characteristics Prevalence of adherence (N = 376) cPR* 95% CI* P-Value Non-adherence (n/%) Adherence (n/%) Age 18 to 49 Years 66(53.2) 58(46.8) 0.762 0.495–1.172 0.216 50 years and above 117(46.4) 135(53.6) 1 Sex Female 85(40.1) 127(59.9) 2.219 1.464–3.362 < 0.001 Male 98(59.8) 66(40.2) 1 Marital Status Married 124(45.8) 147(54.2) 1.521 0.966–2.393 0.070 Single 59(56.2) 46(43.8) 1 Religion Christianity 167(47.9) 182(52.1) 1.585 0.715–3.513 0.257 Muslim and Others 16(59.3) 11(40.7) 1 Level of Education Educated 50(52.1) 46(47.9) 0.832 0.525–1.324 0.438 Not Educated 133(47.5) 147(52.5) 1 Residence Urban 32(46.4) 37(53.6) 1.119 0.663–1.889 0.673 Rural 151(49.2) 156(50.8) 1 Occupation Employed 49(55.1) 40(44.9) 0.715 0.443–1.153 0.169 Not Employed 134(46.7) 153(53.3) 1 Family Income Level Low 151(50.2) 150(49.8) 0.739 0.444–1.231 0.246 Medium to High 32(42.7) 43(57.3) 1 Alcohol Intake Status Yes 18(54.5) 15(45.5) 0.772 0.377–1.583 0.480 No 165(48.1) 178(51.9) 1 Financial constraint Yes 170(50.3) 168(49.7) 0.514 0.254–1.038 0.064 No 13(34.2) 24(65.8) 1 Family Support Status Yes 125(42.8) 167(57.2) 2.980 1.776-5.000 < 0.001 No 58(69.0) 26(31.0) 1 COR*: Crude Odds Ratio CI* Confidence interval Table 4 Bivariate analysis on clinical factors associated with adherence to anti-diabetic medication Characteristics Prevalence of adherence cPR* 95% CI* P-Value Non-adherence (n/%) Adherence (n/%) Duration with T2DM ≤ 4 years 75(46.0) 88(54.0) 1.207 0.802–1.816 0.367 ≥ 5 years 108(50.7) 105(49.3) 1 Comorbidity Yes 110(50.9) 106(49.1) 0.809 0.537–1.218 0.310 No 73(45.6) 87(54.4) 1 Hospital Admission Status Yes 105(53.0) 93(47.0) 0.691 0.460–1.038 0.075 No 78(43.8) 100(56.2) 1 Medication usefulness Perception Yes 173(48.9) 181(51.1) 0.872 0.367–2.070 0.756 No 10(45.5) 12(54.5) 1 Type Anti-Diabetes Medication Oral medication 140(47.1) 157(52.9) 1.339 0.814–2.204 0.250 Insulin injection 43(54.4) 36(45.6) 1 Experience Side Effect Yes 77(57.0) 58(43.0) 0.591 0.387–0.905 0.015 No 106(44.0) 135(56.0) 1 Health Insurance Status Yes 5(50.0) 5(50.0) 0.947 0.270–3.326 0.932 No 178(48.6) 188(51.4) 1 Ever received Health Education Yes 118(42.0) 163(58.0) 2.993 1.828–4.901 < 0.001 No 65(68.4) 30(31.6) 1 Medication Availability Yes 17(28.3) 43(71.7) 2.799 1.531–5.118 < 0.001 No 166(52.5) 150(47.5) 1 Patient follow-up Yes 4(44.4) 5(55.6) 1.190 0.315–4.503 0.798 No 179(48.8) 188(51.2) 1 Health worker-patient relationship Yes 170(47.4) 189(52.6) 3.613 1.156–11.294 0.027 No 13(76.5) 4(23.5) 1 COR*: Crude Odds Ratio CI* Confidence interval Multivariate analysis on factors associated with adherence to anti-diabetic medication. At multivariate manual backward stepwise analysis was done and 4 variables with p-value < 0.05 were found to be associated with malnutrition. The variables included: sex, (aPR = 2.215, P-value < 0.001, 95%CI: 1.419–3.459), availability of family support (aPR = 2.972, p value < 0.001, 95%CI: 1.707–5.173), ever received health education (aPR = 2.522, p value < 0.001, 95%CI: 1.502–4.237), and medication availability (cPR = 2.194, p value: 0.029, 95%CI: 1.084–4.441). Financial constrain was found to confound the relationship between availability of antidiabetic medication and adherence to type 2 antidiabetic medication at (11.5%). The interaction was assessed using the log likelihood ratio test by generating the two-way interaction terms and since it was non-significate (P-value = 0.90) the reduced model was better than the model with interaction terms. The goodness of fit of the model was assessed using the Hosmers and Lemeshow test and since it was not significant( p-value = 0.180), the model is best fitted for predicting the relationship between medication adherence and associated factors of sex, family support, financial constraint, ever received health education and medication availability. ( Table 5 ). Table 5 Multivariate Analysis on Factors Associated with Adherence. Characteristic aPR 95%CI P-value Sex Female 2.215 1.419–3.459 < 0.001 Male 1 Family Support Status Yes 2.972 1.707–5.173 < 0.001 No 1 Ever received Health Education Yes 2.522 1.502–4.237 < 0.001 No 1 Medication Availability Yes 2.194 1.084–4.441 0.029 No 1 Financial constraint Yes 0.720 0.307–1.685 0.449 No 1 aPR*: Adjusted Prevalence Ratio CI*: Confidence interval Barriers and Facilitators of Adherence to Anti-diabetic medication among patients with Type 2 diabetes at Soroti Regional referral Hospital. Socio-demographic characteristics of participants A total of 15 participants took part in the qualitative study exploring barriers, facilitators, and strategies to improve adherence to anti-diabetic medication among adults with Type 2 Diabetes Mellitus. The participants were predominantly from rural setting (n = 10), with the majority being married (n = 13). Their ages ranged from 38 to 80 years, indicating that most were middle-aged to elderly adults who had lived with diabetes for several years. Most were females (n = 9) slightly outnumbered males (n = 6), reflecting the higher attendance of women in chronic disease clinics. Most participants were engaged in farming or informal occupations, with limited financial resources (Table 6 ). Table 6 Socio-Demographic Characteristics of Participants (N = 15) Participant Residence Age (years) Sex Marital Status 1 Rural 51 Male Married 2 Rural 39 Female Married 3 Rural 80 Female Married 4 Rural 42 Male Married 5 Rural 40 Female Married 6 Rural 38 Female Married 7 Urban 42 Female Married 8 Rural 47 Female Married 9 Rural 53 Male Married 10 Urban 62 Male Married 11 Rural 49 Female Single 12 Urban 56 Male Married 13 Rural 60 Female Widow 14 Urban 58 Female Married 15 Rural 45 Male Married 1. Barriers to Adherence to Anti-Diabetic Medication a) Forgetfulness Forgetfulness was a common barrier, especially among participants engaged in farming and household activities. Many forgot to take medication when occupied with work or when daily routines changed. A participant said “Sometimes I just forget to take my tablets, especially when I am busy with farm work or chores.” Participant 6 Another participant said “I get distracted during the day, and then I miss my medication.” Participant 2 b) Financial Constraints Participants cited the high cost of drugs and transport to health facilities as key barriers. Limited finances affected their ability to refill prescriptions or buy drugs from private pharmacies when out of stock at hospitals. A participant said “There are days I don’t have enough money to buy my medicines, so I skip the dose until I can afford it.” Participant 10 Another said “Sometimes the medicine is not here in the hospital, and I don’t have money to buy.” Participant 1 c) Side Effects Adverse effects such as dizziness, nausea, and stomach pain discouraged some participants from consistent medication use. One participant said “The tablets sometimes make me feel dizzy and like I want to vomit, so I avoid taking them on some days.” Participant 1 Another one said “I get stomach pain after taking the medicine, and it discourages me from taking it regularly.” Participant 8 d) Complex Medication Regimens (Pill Burden) Taking multiple drugs for diabetes and other comorbidities, such as hypertension, was overwhelming for several participants. A participant said “I have many medicines to take at different times; it is hard to remember all of them.” Participant 5 Another said “Taking several pills every day is confusing; sometimes I mix them up or forget a dose.” Participant 9 e) Lack of Family or Social Support Participants without close family support often missed doses or failed to keep appointments. Participant said “No one reminds me to take my medications; I often forget because I am alone at home.” Participant 7 f) Use of Alternative or Herbal Medicines Some participants alternated prescribed drugs with herbal remedies due to cultural beliefs or community influence. A participant said “I sometimes use herbal remedies instead of my tablets because I believe they are safer.” Participant 2 A participant said “Some people in my village told me herbs can cure diabetes, so I mix them with my prescribed medicine.” Participant 10 g) Limited Health Education Inadequate understanding of diabetes management contributed to poor adherence. Some participants were unaware of the importance of consistent medication. Participant said that “I didn’t know that missing a dose could affect my blood sugar, so I sometimes skip.” Participant 6 Another participant said “I only recently learned why taking medicine daily is important; before that, I used to take it randomly.” Participant 1 2. Facilitators of Adherence a) Strong Family Support Family involvement emerged as a strong facilitator. Spouses and children provided reminders and moral support. A participant said “My wife always reminds me to take my medicine and sometimes gives it to me; it helps a lot.” Participant 4 Another participant said “My children keep checking if I have taken my pills, which motivates me to take them on time.” Participant 9 b) Health Education and Counseling Health talks and counseling from healthcare workers improved adherence by enhancing patients’ understanding of their condition. A participant said that “The nurse explained why I need to take my medicine daily, and now I understand its importance.” Participant 3 Another participant said “After the health talk, I realized skipping medicine can be dangerous.” Participant 7 c) Personal Motivation and Self-Discipline Participants motivated by health goals or family responsibilities were more consistent in medication use. A participant said “I want to stay healthy for my children, so I make sure I never miss my medicine.” Participant 10 Another participant said “I remind myself every day that controlling my blood sugar is important for my life, I fear falling sick.” Participant 2 d) Positive Patient–Provider Relationship Trust and good communication with healthcare workers encouraged adherence. Participant said “I trust doctors and nurses, and I follow their advice carefully because I know it helps me.” Participant 5 Another said “The nurses are good to me and explained everything clearly.” Participant 8 3. Suggested Strategies to Improve Adherence a) Consistent Drug Supply at Health Facilities Participants emphasized the need for a steady supply of anti-diabetic drugs and testing kits. A participant suggested “When the government provides drugs, it means I can take them as per the doctor’s instruction.” Participant 1 Another participant suggested that “The government should make sure medicine is always at the hospital.” Participant 2 b) Strengthening Follow-up and Reminder Systems Regular follow-up and phone reminders were proposed to minimize missed appointments. Participant said that “The hospital should be reminding us to go back for reviews, they should be calling to remind about return dates.” Participant 4 c) Enhancing Family and Community Support Training family members to support diabetes care was recommended. A participant said “Have a family member who can be reminding you on the time of taking the medicine.” Participant 4 d) Improved Health Education and Counseling Continuous education through clinics and community outreach could empower patients. A participant suggested that “Patients should be taught the dangers of missing medicine and how to manage side effects.” Participant 3 e) Strengthening Health System Response Participants suggested that the government prioritize diabetes management through resource allocation and improved diagnostic support. Another participant said that “The number of DM cases is increasing, so the government should put more effort on DM.” Participant 7 Discussion This study explored adherence to anti-diabetic medication among adults with Type 2 Diabetes Mellitus (T2DM) at Soroti Regional Referral Hospital using a mixed-methods approach. The overall prevalence of adherence was moderate at 51.3%, indicating that nearly half of the patients were not consistently following their prescribed regimens. This finding is concerning, as suboptimal adherence contributes to poor glycemic control and increases the risk of complications such as nephropathy, neuropathy, and cardiovascular disease. The moderate adherence level observed in this study is consistent with adherence reported from Cameroon of 45.6% [ 15 ] and that reported from a study conducted in Mbarara Regional Referral Hospital, Uganda of 61.9% [ 14 ], but lower than that reported in Eastern Uganda of 83.3% [ 19 ]. The variation may be attributed to differences in adherence assessment tools, health education levels, and medication supply systems. The study identified both individual and health system factors that either hindered or promoted adherence to anti-diabetic medication. These findings were supported and enriched by qualitative insights from patient interviews. Socio-demographic and lifestyle factors such as sex and family support were significantly associated with adherence. Female participants were more likely to adhere compared to males (AOR = 2.215, p < 0.001). This finding aligns with a study conducted in Ghana [ 20 ], suggesting that women tend to be more health-conscious, follow medical advice, and engage in care-seeking behavior. Qualitative findings also indicated that women often received encouragement and reminders from their spouses or children, reinforcing their adherence. Conversely, male participants were more likely to forget doses or deprioritize medication due to occupational commitments or lower health-seeking behavior. Family support emerged as both a quantitative predictor and qualitative facilitator of adherence. Participants who received reminders, moral support, and practical assistance from family members were nearly three times more likely to adhere (AOR = 2.972, p < 0.001). This resonates with other African studies that underscore the role of family networks in chronic disease management[ 20 ]. Conversely, participants who lived alone or lacked family support frequently missed doses and clinic appointments, citing loneliness and lack of encouragement. This finding underscores the importance of involving families in diabetes care as a source of emotional, informational, and logistical support. Health education was another major factor influencing adherence. Patients who had ever received diabetic health education were twice as likely to adhere to their medication (AOR = 2.522, p < 0.001). Similar findings have been reported in studies from Uganda and Ghana, where health education improved patients’ understanding of diabetes, the importance of consistent medication use, and management of side effects [ 19 , 20 ]. Education empowers patients with knowledge that enhances self-efficacy and fosters adherence. Qualitative findings in this study reinforced this—participants who attended health talks or counseling sessions demonstrated greater awareness of the consequences of missed doses and reported better adherence. In contrast, those with limited health knowledge often skipped doses or alternated medication with herbal remedies due to misconceptions about treatment efficacy [ 21 ]. This supports the Health Belief Model, which posits that knowledge, perceived benefits, and perceived susceptibility are key precursors to behavioral change [ 22 ]. Health system factors also significantly affected adherence. Patients who reported that anti-diabetic medications were consistently available in the hospital pharmacy were more likely to adhere (AOR = 2.194, p = 0.029). This aligns with findings from France and Uganda [ 19 , 23 , 24 ], emphasizing that uninterrupted access to medication is essential for sustained treatment adherence. In the qualitative findings, frequent stock-outs and high drug costs were major barriers. Some participants resorted to skipping doses or discontinuing treatment when drugs were unavailable or unaffordable. Other barriers identified included forgetfulness, side effects, financial constraints, and use of herbal remedies. Forgetfulness was common among those engaged in farming or daily labor, while side effects such as dizziness and nausea discouraged regular medication use. Financial hardship prevented some from purchasing drugs when hospital stock was depleted, while cultural beliefs promoted the use of herbal alternatives perceived as “natural” or “safer.” These findings are consistent with other studies in Africa, which report that psychosocial, economic, and cultural factors significantly influence medication adherence [ 19 – 21 , 25 ]. These barriers highlight that adherence is influenced by a web of psychosocial, economic, and cultural determinants. Addressing these barriers requires multifaceted interventions, including patient education, consistent drug supply, and culturally sensitive counseling. On the other hand, facilitators such as personal motivation, positive patient–provider relationships, and simplified medication regimens enhanced adherence. Participants who were motivated by health goals or family responsibilities displayed higher commitment to medication. Trust and good communication with healthcare providers fostered confidence in treatment plans and improved medication-taking behavior. Simplified regimens, such as once-daily combination pills, reduced pill burden and minimized confusion. These findings align with other studies, which have shown that patient motivation, strong provider–patient relationships, and simplified medication regimens significantly improve adherence among adults with Type 2 Diabetes in both African and global settings [ 19 – 21 , 23 , 26 ]. Collectively, these findings emphasize that effective diabetes care requires both patient empowerment and a supportive healthcare environment. Participants proposed practical and feasible strategies to address barriers and strengthen adherence. Key recommendations included ensuring consistent drug supply at health facilities to prevent stock-outs, establishing follow-up and reminder systems such as phone calls or SMS alerts to address forgetfulness, and enhancing family and community involvement through education and support programs. Continuous health education and counseling were also emphasized to dispel myths about medication, improve understanding of diabetes management, and empower patients to manage side effects. Additionally, participants recommended strengthening the overall health system response by prioritizing diabetes care, allocating adequate resources, and improving diagnostic and follow-up services. These findings align with previous studies, which report that interventions combining health education, family and community support, medication availability, and reminder systems significantly improve adherence among patients with Type 2 Diabetes [ 23 , 27 ]. The strategies also align with global best practices for chronic disease management, which advocate for an integrated approach combining patient education, system-level interventions, and community engagement[ 28 – 30 ]. Implementing these strategies could improve medication adherence, reduce diabetes complications, and ultimately enhance quality of life for patients living with T2DM in similar resource-limited settings. Study Limitations Recall bias since self-reported data was collected from participants, the findings may have be prone to recall and social desirability bias, potentially leading to overestimated adherence. However, the participants will be thoroughly informed about the purpose of the study and need to be as honest as possible. The cross-sectional design did not capture the insights of causality. There was reporting bias where the participant responded in a way, they think is appropriate to the researchers. The study used a self-reporting tool, Medication Compliance Questionnaire to measure adherence other than HBA1c, which is the gold standard for measuring adherence in this group. The qualitative design of the study may not be generalizable to other settings. Conclusions and Recommendations The prevalence of adherence to anti-diabetic medication among adults with T2DM remains low at only 51.3%, with only 5 in 10 patients adhering. The key factors significantly associated with adherence include being female, receiving family support, health education, and medication availability. These findings highlight the importance of family support, access to healthcare, and patient-centred communication in improving treatment outcomes. Each of these factors contributes to a complex set of determinants that can either enhance or hinder medication adherence. Qualitative findings further enriched these results by highlighting multifaceted barriers such as forgetfulness, financial constraints, side effects, pill burden, lack of family support, limited health education, and use of herbal remedies. Conversely, strong family support, health education, patient motivation, simplified drug regimens, and positive patient–provider relationships were identified as key facilitators of adherence. Participants also suggested strategies such as ensuring consistent drug supply, establishing reminder systems, strengthening family involvement, and enhancing diabetes education to improve adherence. To improve medication adherence among adults with Type 2 Diabetes Mellitus, the study recommends strengthening routine adherence assessment, providing structured health education, ensuring consistent drug supply, and promoting family involvement in patient care. It also calls for integrating adherence counselling into continuing professional development and enhancing community health education for patients and caregivers. Further research should explore patients’ beliefs and experiences and evaluate innovative interventions such as mobile health reminders and family-based counselling programs to enhance adherence and improve diabetes outcomes. Operational Definition Adherence is defined as the extent to which a person’s behavior that is taking medication, following a diet, and or executing lifestyle changes which corresponds with agreed recommendations from a qualified health care provider (WHO, 2023, UCG, 2023). Diabetes mellitus Diabetes mellitus is a chronic, non-communicable, metabolic disease characterized by elevated levels of blood glucose due to decreased insulin secretion or peripheral resistance to the action of insulin, or a combination of the two (WHO, 2023). Type 2 diabetes mellitus Is a type of diabetes mellitus that starts at adulthood and occurs when the body cells become resistance to insulin and with insufficient production of insulin as the disease progresses. Hyperglycemia is a random capillary blood glucose level equal or above 11.1 mmol/l or a fasting capillary blood glucose level above 6.1 mmol/l. Management of type 2 diabetes mellitus it encompasses the four major aspect of management as use of ant-diabetic medicines, following dietary recommendations, blood glucose monitoring and physical exercise. Antidiabetic medication Are drugs used to lower blood sugar levels in patients with diabetes mellitus. In the management of type two diabetes mellitus the first line drug for treatment is Metformin, second line is Glimepiride and third line is insulin (WHO, 2023). List of Abbreviations/ Acronyms DKA Diabetic ketoacidosis FBS Fasting Blood Sugar HbA1c Glycated hemoglobin IDF International Diabetes Federation MCQ Medication Compliance Questionnaire MoH Ministry of Health OHA Oral anti-Hyperglycemic Agent RBS Random Blood Sugar T2DM Type 2 diabetes mellitus. UDA Uganda Diabetes Association WHO World Health Organization. Declarations Author contributions Brenda Lalam designed the study, collected study data and wrote the main manuscript text, Samuel Okello designed the study, performed the statistical analyses, results, supervised the work and revised the final manuscript. Safina Akello, John Micheal Okusa, Ronald Opito and Patrick Lubogo were involved in designing the method, Lucy Ezatiru and Dr. Simon Eleku were involved in data analysis, study design, and data collection. Funding The study had no funding. Data availability The data, which is mentioned in the manuscript, will be made available upon request from the authors. Please feel free to contact the authors for access to the data. Ethical approvals and consent to participants The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. The study protocol was reviewed and approved by the Mbale Regional Referral Hospital Research Ethics Committee (MRRH-2025-557). Written informed consent was obtained from all participants. Participation was voluntary, and confidentiality and anonymity were maintained throughout the study. Consent to publish Not applicable. Conflict of interest There is no conflict of interest. Acknowledgement I acknowledge my supervisors Mr. Samuel Okello for the guidance and mentorship. I also acknowledge my lecturers. Finally I acknowledge the staff of Soroti regional referral hospital. References Statista. 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Additional Declarations No competing interests reported. Supplementary Files Supplementary.docx Cite Share Download PDF Status: Published Journal Publication published 16 Mar, 2026 Read the published version in BMC Primary Care → Version 1 posted Editorial decision: Revision requested 06 Jan, 2026 Reviews received at journal 28 Dec, 2025 Reviews received at journal 24 Dec, 2025 Reviewers agreed at journal 22 Dec, 2025 Reviewers agreed at journal 15 Dec, 2025 Reviewers agreed at journal 10 Dec, 2025 Reviewers invited by journal 05 Dec, 2025 Editor assigned by journal 03 Dec, 2025 Editor invited by journal 13 Nov, 2025 Submission checks completed at journal 13 Nov, 2025 First submitted to journal 13 Nov, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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1","display":"","copyAsset":false,"role":"figure","size":88352,"visible":true,"origin":"","legend":"\u003cp\u003eStudy profile of participants\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8097219/v1/6d7fdb56a660bdeeeacc42d6.jpg"},{"id":105223514,"identity":"d0c05f48-1bae-4f33-85a2-1f93a78b69d9","added_by":"auto","created_at":"2026-03-23 16:07:58","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3138228,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8097219/v1/36f2c706-092c-4455-b45f-2b66ac32b154.pdf"},{"id":97900636,"identity":"4c321db9-43aa-4576-ab48-cc92aa15aa92","added_by":"auto","created_at":"2025-12-10 15:45:41","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":21497,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementary.docx","url":"https://assets-eu.researchsquare.com/files/rs-8097219/v1/328017ee452ce3d4ca93b29a.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Adherence to Anti-Diabetic Medication, Its Associated Factors, Barriers, Facilitators and Strategies for Improvements among Adults with Type 2 Diabetes Mellitus Attending Regional Referral Facility in Eastern Uganda: a Mixed Study Design","fulltext":[{"header":"Introduction","content":"\u003cp\u003eDiabetes Mellitus (T2DM) is the most prevalent endocrine disorder and has been on the raise with close to 830\u0026nbsp;million cases globally, of these type 2 diabetes mellitus contributes 90\u0026ndash;95% of all diabetes cases worldwide [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The global prevalence rate stands at 6,059 per 100,000 individuals and is projected to rise to 7,079 per 100,000 by 2030 [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Diabetes mellitus contributes to approximately 6.7\u0026nbsp;million deaths annually, with one person dying every five seconds due to complications arising from poor adherence to treatment [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. T2DM is a chronic metabolic condition characterized by hyperglycemia due to insulin resistance or inadequate insulin production, leading to complications such as diabetic ketoacidosis, neuropathy, nephropathy, retinopathy, and cardiovascular diseases [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe management of T2DM involves medication, diet modification, regular exercise, and blood glucose monitoring, with metformin, glimepiride, and insulin forming the core pharmacological interventions [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Despite the availability of these interventions, global non-adherence rates to anti-diabetic medication range between 20% and 60% [\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. In Africa, an estimated 24\u0026nbsp;million adults live with diabetes, representing a prevalence of 4.5%, with 54% of cases remaining undiagnosed [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The region is projected to experience a 134% increase in diabetes cases by 2045[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. In Uganda, approximately 1.4\u0026nbsp;million people live with diabetes, of whom 1.26\u0026nbsp;million have T2DM [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The prevalence of non-adherence to anti-diabetic medication among Ugandan adults with T2DM is 38.1% [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e\u003cp\u003ePoor adherence to anti-diabetic therapy contributes significantly to disease complications, hospital admissions, and premature deaths. The major factors influencing non-adherence include advanced age, comorbidities, high cost of drugs, side effects, unavailability of medication, lack of health education, and weak healthcare provider-patient relationships [\u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. There has been an increasing number of hospital admissions due to T2DM complications, reflecting poor medication adherence. Although the Ministry of Health has implemented strategies such as free blood glucose monitoring and improved drug supply[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], challenges persist. Therefore, this study sought to determine the prevalence of adherence to antidiabetic medication, its associated factors, barriers, facilitators and strategies for improvement among adults with T2DM. The findings aim to generate evidence-based recommendations for improving medication adherence, strengthening diabetes management, and informing policy and clinical practice in Uganda.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy Design and Setting\u003c/h2\u003e\u003cp\u003eThis study employed an explanatory sequential mixed-methods design, beginning with a quantitative phase followed by a qualitative phase. Quantitative data were collected using a cross-sectional design to determine the level and factors associated with adherence to antidiabetic medication, while qualitative data were gathered using an exploratory descriptive design to gain deeper insights into barriers and facilitators of adherence.\u003c/p\u003e\u003cp\u003eThe study was conducted at the Diabetic Clinic of Soroti Regional Referral Hospital (SRRH), located about 326 km northeast of Kampala, Uganda. SRRH, established in the 1920s and upgraded to a regional referral hospital in 1996, serves as the main referral center for the Teso sub-region. It has a 267-bed capacity and provides both general and specialized health services to eight surrounding districts. The hospital records approximately 21,728 annual admissions and 99,666 outpatient visits. The Diabetic Clinic operates every Thursday from 8:00 a.m. to 5:00 p.m., attending to an average of 80 patient\u0026rsquo;s weekly. The clinic is staffed by five nurses, one physician, and internship doctors. SRRH was selected for this study because it is the primary center for diabetes care in the Teso sub-region.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eStudy Population:\u003c/h3\u003e\n\u003cp\u003eThe study was conducted among adult clients age 18 years and above with T2DM receiving care in the diabetic clinic at Soroti regional referral hospital during February to May 2025 who had met the inclusion criteria.\u003c/p\u003e\n\u003ch3\u003eInclusion Criteria\u003c/h3\u003e\n\u003cp\u003eThe study included adult clients age 18 years and above diagnosed with Type 2 diabetes mellitus and initiated on treatment for at least 6 months before the time of data collection, receiving care at the diabetic clinic at Soroti Regional Referral Hospital between 1st February to 30th March 2025. Participants who had consented were included in the study.\u003c/p\u003e\n\u003ch3\u003eExclusion Criteria\u003c/h3\u003e\n\u003cp\u003eThe study excluded adult clients age 18 years and above with Type 2 diabetes mellitus who were critically ill and needed emergency care and those who were mentally impaired.\u003c/p\u003e\u003cp\u003e\u003cb\u003e3.5 Sample Size Determination\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe sample size for quantitative data of this study was computed using the formula for a single proportion (Kish and Leslie, 1965).\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003en = \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\frac{{z}^{2}p(1-p)}{{d}^{2}}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eWhere;\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003en was the required sample size, d was tolerable sampling error ( precision) set at 5%, Z was a standard normal value corresponding to set 95% confidence interval on a normal distribution curve (z\u0026thinsp;=\u0026thinsp;1.96), p was the estimated prevalence of adherence to T2DM management from a previous study at 67% (Faisal et al., 2022)\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eThis was adjusted for the 10% non-response gives a sample size of 376.\u003c/p\u003e\u003cp\u003eFor the qualitative component, the sample size was determined based on data saturation, which was reached after interviewing 10 adult patients with type 2 diabetes mellitus attending the diabetic clinic at Soroti Regional Referral Hospital. Data collection continued until no new themes or information emerged, ensuring adequate depth and richness of the qualitative findings.\u003c/p\u003e\n\u003ch3\u003eSampling Method\u003c/h3\u003e\n\u003cp\u003eFor quantitative data, simple random sampling technique was used to select participants from the diabetic clinic register at Soroti Regional Referral Hospital (SRRH). The clinic register served as the sampling frame, and participants were randomly selected from adults attending the clinic who met the inclusion criteria and provided informed consent. The diabetic clinic operates every Thursday, and data collection was conducted once weekly over a four-month period. A total of 376 participants were recruited for the study, with an average of 23 to 25 participants sampled each Thursday. On each clinic day, eligible patients were assigned numbers based on the attendance register, after which random numbers were generated to identify participants for inclusion. This approach ensured that every eligible patient had an equal chance of being selected, thereby minimizing selection bias.\u003c/p\u003e\u003cp\u003eFor the qualitative component, the study employed purposive sampling to select adult patients with type 2 diabetes mellitus attending the diabetic clinic at Soroti Regional Referral Hospital who could provide rich and relevant information on adherence to anti-diabetic medication. Maximum variation sampling was applied to ensure diversity in participants\u0026rsquo; age, gender, duration of diabetes, and adherence levels, capturing a wide range of experiences and perspectives.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eData Collection Tool and Procedure\u003c/h2\u003e\u003cp\u003eQuantitative data were collected using a semi-structured, interviewer-administered questionnaire developed for this study from validated tools and relevant literature (Supplementary 1: questionnaire). Adherence to anti-diabetic medication was assessed using the Medication Compliance Questionnaire (MCQ), adapted from the Morisky Self-Reporting Scale and Hill-Bone Compliance Scale. The MCQ comprised seven items rated on a 4-point Likert scale (1\u0026ndash;4), giving a total score range of 7\u0026ndash;28, with scores\u0026thinsp;\u0026ge;\u0026thinsp;27 indicating high adherence. Additional questions on factors influencing adherence were developed from previous studies to fit the local context. The questionnaire was initially written in English and translated into Ateso the local language to ensure clarity and comprehension. Data were collected over a four-month period, every Thursday, when the diabetic clinic operates at Soroti Regional Referral Hospital. A total of 376 participants were recruited, averaging 23 to 25 participants per week, using a simple random sampling approach. After obtaining informed consent, trained research assistants and the principal investigator conducted private interviews to ensure confidentiality.\u003c/p\u003e\u003cp\u003eBlood glucose levels were measured using a glucometer. Finger-prick blood samples were obtained with sterile disposable lancets after cleaning the site with alcohol swabs, and readings were recorded to the nearest 0.1 mmol/L. Hyperglycemia was defined as fasting blood glucose\u0026thinsp;\u0026gt;\u0026thinsp;7.0 mmol/L or random blood glucose\u0026thinsp;\u0026gt;\u0026thinsp;11.1 mmol/L, while hypoglycemia was defined as blood glucose\u0026thinsp;\u0026lt;\u0026thinsp;3.9 mmol/L.\u003c/p\u003e\u003cp\u003eQualitative data were collected using an in-depth interview guide developed specifically for this study by the principal investigator (Supplementary 2: In-depth interview guide). The principal investigator and research assistant explained the study purpose and obtained written informed consent before each interview. Interviews were conducted in a private room by trained research assistants. With participants\u0026rsquo; permission, interviews were audio-recorded, and detailed notes were taken to capture non-verbal cues and contextual information.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eQuantitative Data Management and Data Analysis Plan\u003c/h3\u003e\n\u003cp\u003eThe principal investigator cleaned, processed and checked the data for correctness. The filled questionnaires were kept in a lockable cabinet and external hard drive which is password coded. The collected data was entered into EpiData version 4.6. Double data entry and validation was done to ensure correctness and completeness. Data was cleaned for missing, duplicate and illogical entries.\u003c/p\u003e\u003cp\u003eThe data was exported from EpiData to SPSS version 27 for analysis. The collected data was displayed in tables and graphs. Continuous data was described using means and standard deviations since the data was normally distributed. Categorical data were described using frequencies, percentages and proportions. The prevalence of adherence to anti-diabetic medication was expressed inform of a percentage with its corresponding confidence interval.\u003c/p\u003e\u003cp\u003eTo determine the factors associated with adherence to type 2 diabetes mellitus medication, modified Poisson regression with robust standard errors was used. The measure of association was the prevalence ratio. A bivariate analysis was conducted to select variables with a p-value of less than 0.2 for multivariate analysis. At multivariate analysis, interactions were assessed between significant independent variables by forming interaction terms for only significant basic variables at p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05. The log likelihood ratio test was used to determine if the model without interaction terms was better than a model with the interaction term and since it was not significant with the p-value of 0.90, the model without interaction term was considered. Manual stepwise backward elimination was done to maintain in the model only significant variables with p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05. The non-significant basic variables were then assessed for confounding.\u003c/p\u003e\n\u003ch3\u003eQualitative Data Management and Analysis\u003c/h3\u003e\n\u003cp\u003eThe audio recordings of in-depth interviews were transcribed verbatim by the principal investigator and an experienced social scientist. Interviews conducted in Ateso were initially transcribed in the original language and then translated into English to ensure accuracy and consistency. All transcripts and related qualitative data were securely stored on an encrypted external hard drive, accessible only to the principal investigator and authorized team members.\u003c/p\u003e\u003cp\u003eQualitative data analysis was a collaborative effort between the principal investigator and the social scientist. Transcripts were imported into Open Code version 4.03, a qualitative data analysis software. Inductive thematic analysis was employed, following six steps: (1) familiarization with the data, (2) generating codes, (3) identifying themes, (4) reviewing themes, (5) defining and naming themes, and (6) selecting exemplars to illustrate findings. The researchers independently read and coded the transcripts, highlighting emerging themes and patterns. They then discussed areas of agreement and discrepancy to collaboratively refine the themes. Findings were organized into themes and sub-themes and illustrated using direct quotations from participants to enrich interpretation and support credibility.\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eData Quality Control and Assurance\u003c/h2\u003e\u003cp\u003eFor the quantitative component, validity was ensured through the use of well-structured questionnaires developed from established literature and aligned with the study\u0026rsquo;s conceptual framework on adherence to anti-diabetic medication. The tool was reviewed by experts and the research supervisor to confirm clarity and relevance. A pilot test involving 20 diabetic patients at Soroti Regional Referral Hospital (excluded from the final sample) was conducted to assess reliability, clarity, and consistency. Feedback from the pretest informed tool refinement. To ensure data collection uniformity, a trained research assistant conducted all interviews under the supervision of the principal investigator, with translation into Ateso to enhance accuracy and understanding.\u003c/p\u003e\u003cp\u003eFor the qualitative component, trustworthiness was ensured through pretesting of the in-depth interview guide among three participants not included in the main study. Credibility was enhanced through member checking and peer debriefing, while dependability and confirmability were achieved through transparent documentation and maintaining an audit trail. Adherence to established qualitative research methodologies and systematic analysis ensured the rigor and authenticity of findings.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eStudy profile of participants\u003c/p\u003e\u003cp\u003eFrom the diabetic clinic, 1280 participants were available which was used as sampling frame. Out of this sampling frame, 2 participants were excluded because they had diabetes ketoacidosis (DKA) and were critically ill and the study then selected 378 participants (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eDescriptive Statistics\u003c/h2\u003e\u003cp\u003e\u003cb\u003eDescription of the socio-demographic characteristics of patients with Type 2 diabetes.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eOf the 376 participants with type 2 diabetes mellitus, 212(56.4%) were female, and 252(67.0%) of the respondents were aged 50 years and above. A majority, 349(92.8%) of the participants were Christians, and 218(58.0%) of the participants attained primary education. The majority, 307 (81.6%) of participants were living in rural areas, most, 275(73.1%) of the respondents were not employed, and 271(72.1%) of the respondents were married. Most 301(80.1%) of the participants had a low family income level, and 338(89.9%) of the respondents had a financial challenge with buying their medications \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSocio-demographic and lifestyle characteristics of patients\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFrequency(N\u0026thinsp;=\u0026thinsp;376)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePercentage (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18 to 30 Years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e31 to 49 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e26.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e50 years and above\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e252\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e67.0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eFemale\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e212\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e56.4\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e164\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e43.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eReligion\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eChristianity\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e349\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e92.8\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMuslim and Others\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLevel of Education\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo formal education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e17.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003ePrimary\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e218\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e58.0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSecondary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTertiary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eResidence\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUrban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eRural\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e307\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e81.6\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOccupation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEmployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eNot employed\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e275\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e73.1\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSelf employed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMarital Status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eMarried\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e271\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e72.1\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSingle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e105\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e27.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFamily Income Level\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eLow\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e301\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e80.1\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMedium to High\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e19.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAlcohol Intake Status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e343\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e91.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSmoking Status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e350\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e93.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFamily Support Status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e292\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e77.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e22.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFinancial constraint\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eYes\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e338\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e89.9\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eClinical characteristics of adults with type 2 diabetes mellitus\u003c/h2\u003e\u003cp\u003eOf the 376 participants with type 2 diabetes mellitus, the majority, 213(56.6%) of the participants had lived with type 2 diabetes for more than 5 years and 216 (57.4%) of the respondents had other comorbidities. The majority, 292(77.7%) of the participants had good family support and 198(52.7%) of the respondents had ever been admitted to the hospital due to a complication of type 2 Diabetes Mellitus. The majority, 354(94.1%) of the participants had a positive perception on anti-diabetic medication in managing their condition and 297(79.0%) of the participants were on oral medication. Most 241(64.1% ) of the respondents had experienced side effects of the medication while majority 366(97.3%) of the respondents were not having private health insurance. Most 281(74.7%) of the participants had ever received health education on medication adherence, most 316(84.0%) of the participants did not find their medication available at the hospital pharmacy. Majority 367(97.6%) of the respondents did not have patient follow up by the health worker, and the majority 359(95.5%) of the participants reported a good health-worker to patient relationship. \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eClinical characteristics of participants with type 2 diabetes mellitus\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFrequency(N\u0026thinsp;=\u0026thinsp;376)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePercentage (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eDuration of T2DM\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 Years and below\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e163\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e43.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e5 Years and above\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e213\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e56.6\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eComorbidity\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e57.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e160\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e42.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHistory of hospital admission\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e198\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e52.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e178\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e47.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMedication usefulness perception\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e354\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e94.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eType anti-diabetes medication\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOral medication\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e297\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e79.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInsulin injection\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eExperience side effect\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e135\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e35.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eNo\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e241\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e64.1\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePrivate health insurance\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eNo\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e366\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e97.3\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEver received health education\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eYes\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e281\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e74.7\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e25.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMedication availability\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eNo\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e316\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e84.0\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHealth worker-patient follow-up\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eNo\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e367\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e97.6\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHealth worker-patient relationship\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eYes\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e359\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e95.5\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003ePrevalence of Adherence to Anti-Diabetic Medication among Patients with Type 2 Diabetes Mellitus\u003c/h2\u003e\u003cp\u003eThe prevalence of adherence to anti-diabetic medication is 51.3% (95%CI: 0.46\u0026ndash;0.56). This was generated from the MCQ seven questions, and those that had a total score of 27 and 28 were considered adherent to anti-diabetic medication.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eBivariate analysis factors associated with adherence to anti-diabetic medication among type 2 diabetes mellitus patients\u003c/h2\u003e\u003cp\u003eAt bivariate analysis, the variables with a p-value of less than 0.2 were considered for multivariate analysis. The sociodemographic and lifestyle factors considered included: sex of the participants and occupation of the participants. Other variables included marital status of the respondents, financial constraints in buying the anti-diabetic medication, and family support \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe clinical related factor considered included: history of hospital admission due to complications and experiencing side effects of medication. Ever received health education on how to take the medication, medication availability at the hospital pharmacy and health worker-patient relationship \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBivariate analysis on the socio-demographic and lifestyle factors associated with adherence to anti-diabetic medication\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristics\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003ePrevalence of adherence (N\u0026thinsp;=\u0026thinsp;376)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ecPR*\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e95% CI*\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eP-Value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNon-adherence (n/%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAdherence (n/%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18 to 49 Years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e66(53.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e58(46.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.762\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.495\u0026ndash;1.172\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.216\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e50 years and above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e117(46.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e135(53.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e85(40.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e127(59.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e2.219\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e1.464\u0026ndash;3.362\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e98(59.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e66(40.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMarital Status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e124(45.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e147(54.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e1.521\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e0.966\u0026ndash;2.393\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e0.070\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSingle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e59(56.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e46(43.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eReligion\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eChristianity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e167(47.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e182(52.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.585\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.715\u0026ndash;3.513\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.257\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMuslim and Others\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e16(59.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e11(40.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLevel of Education\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEducated\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e50(52.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e46(47.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.832\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.525\u0026ndash;1.324\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.438\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNot Educated\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e133(47.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e147(52.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eResidence\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUrban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e32(46.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e37(53.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.119\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.663\u0026ndash;1.889\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.673\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e151(49.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e156(50.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOccupation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEmployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e49(55.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e40(44.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.715\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e0.443\u0026ndash;1.153\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e0.169\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNot Employed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e134(46.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e153(53.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFamily Income Level\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e151(50.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e150(49.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.739\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.444\u0026ndash;1.231\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.246\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMedium to High\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e32(42.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e43(57.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAlcohol Intake Status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e18(54.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e15(45.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.772\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.377\u0026ndash;1.583\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.480\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e165(48.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e178(51.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFinancial constraint\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e170(50.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e168(49.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.514\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e0.254\u0026ndash;1.038\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e0.064\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e13(34.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e24(65.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFamily Support Status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e125(42.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e167(57.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e2.980\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e1.776-5.000\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e58(69.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e26(31.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003eCOR*: Crude Odds Ratio CI* Confidence interval\u003c/h2\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBivariate analysis on clinical factors associated with adherence to anti-diabetic medication\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristics\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003ePrevalence of adherence\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ecPR*\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e95% CI*\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eP-Value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNon-adherence (n/%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAdherence (n/%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eDuration with T2DM\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;4 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e75(46.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e88(54.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.207\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.802\u0026ndash;1.816\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.367\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;5 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e108(50.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e105(49.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eComorbidity\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e110(50.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e106(49.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.809\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.537\u0026ndash;1.218\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.310\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e73(45.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e87(54.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHospital Admission Status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e105(53.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e93(47.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.691\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e0.460\u0026ndash;1.038\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e0.075\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e78(43.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e100(56.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMedication usefulness Perception\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e173(48.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e181(51.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.872\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.367\u0026ndash;2.070\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.756\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10(45.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e12(54.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eType Anti-Diabetes Medication\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOral medication\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e140(47.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e157(52.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.339\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.814\u0026ndash;2.204\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.250\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInsulin injection\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e43(54.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e36(45.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eExperience Side Effect\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e77(57.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e58(43.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.591\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e0.387\u0026ndash;0.905\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e0.015\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e106(44.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e135(56.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHealth Insurance Status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5(50.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5(50.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.947\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.270\u0026ndash;3.326\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.932\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e178(48.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e188(51.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEver received Health Education\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e118(42.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e163(58.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e2.993\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e1.828\u0026ndash;4.901\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e65(68.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e30(31.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMedication Availability\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e17(28.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e43(71.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e2.799\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e1.531\u0026ndash;5.118\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e166(52.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e150(47.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePatient follow-up\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4(44.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5(55.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.190\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.315\u0026ndash;4.503\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.798\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e179(48.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e188(51.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHealth worker-patient relationship\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e170(47.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e189(52.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e3.613\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e1.156\u0026ndash;11.294\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e0.027\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e13(76.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4(23.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003eCOR*: Crude Odds Ratio CI* Confidence interval\u003c/h2\u003e\u003cp\u003e\u003cb\u003eMultivariate analysis on factors associated with adherence to anti-diabetic medication.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAt multivariate manual backward stepwise analysis was done and 4 variables with p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 were found to be associated with malnutrition. The variables included: sex, (aPR\u0026thinsp;=\u0026thinsp;2.215, P-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001, 95%CI: 1.419\u0026ndash;3.459), availability of family support (aPR\u0026thinsp;=\u0026thinsp;2.972, p value\u0026thinsp;\u0026lt;\u0026thinsp;0.001, 95%CI: 1.707\u0026ndash;5.173), ever received health education (aPR\u0026thinsp;=\u0026thinsp;2.522, p value\u0026thinsp;\u0026lt;\u0026thinsp;0.001, 95%CI: 1.502\u0026ndash;4.237), and medication availability (cPR\u0026thinsp;=\u0026thinsp;2.194, p value: 0.029, 95%CI: 1.084\u0026ndash;4.441). Financial constrain was found to confound the relationship between availability of antidiabetic medication and adherence to type 2 antidiabetic medication at (11.5%). The interaction was assessed using the log likelihood ratio test by generating the two-way interaction terms and since it was non-significate (P-value\u0026thinsp;=\u0026thinsp;0.90) the reduced model was better than the model with interaction terms. The goodness of fit of the model was assessed using the Hosmers and Lemeshow test and since it was not significant( p-value\u0026thinsp;=\u0026thinsp;0.180), the model is best fitted for predicting the relationship between medication adherence and associated factors of sex, family support, financial constraint, ever received health education and medication availability. \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMultivariate Analysis on Factors Associated with Adherence.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eaPR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e95%CI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e2.215\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e1.419\u0026ndash;3.459\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFamily Support Status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e2.972\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e1.707\u0026ndash;5.173\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEver received Health Education\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e2.522\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e1.502\u0026ndash;4.237\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMedication Availability\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e2.194\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e1.084\u0026ndash;4.441\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.029\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFinancial constraint\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.720\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.307\u0026ndash;1.685\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.449\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003eaPR*: Adjusted Prevalence Ratio CI*: Confidence interval\u003c/h2\u003e\u003cp\u003e\u003cb\u003eBarriers and Facilitators of Adherence to Anti-diabetic medication among patients with Type 2 diabetes at Soroti Regional referral Hospital.\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\u003ch2\u003eSocio-demographic characteristics of participants\u003c/h2\u003e\u003cp\u003eA total of 15 participants took part in the qualitative study exploring barriers, facilitators, and strategies to improve adherence to anti-diabetic medication among adults with Type 2 Diabetes Mellitus. The participants were predominantly from rural setting (n\u0026thinsp;=\u0026thinsp;10), with the majority being married (n\u0026thinsp;=\u0026thinsp;13). Their ages ranged from 38 to 80 years, indicating that most were middle-aged to elderly adults who had lived with diabetes for several years. Most were females (n\u0026thinsp;=\u0026thinsp;9) slightly outnumbered males (n\u0026thinsp;=\u0026thinsp;6), reflecting the higher attendance of women in chronic disease clinics. Most participants were engaged in farming or informal occupations, with limited financial resources (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSocio-Demographic Characteristics of Participants (N\u0026thinsp;=\u0026thinsp;15)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParticipant\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eResidence\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAge (years)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMarital Status\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUrban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUrban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSingle\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUrban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eWidow\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUrban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e1. Barriers to Adherence to Anti-Diabetic Medication\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003ea) Forgetfulness\u003c/b\u003e\u003c/p\u003e\u003cp\u003eForgetfulness was a common barrier, especially among participants engaged in farming and household activities. Many forgot to take medication when occupied with work or when daily routines changed.\u003c/p\u003e\u003cp\u003eA participant said \u003cem\u003e\u0026ldquo;Sometimes I just forget to take my tablets, especially when I am busy with farm work or chores.\u0026rdquo;\u003c/em\u003e \u003cb\u003eParticipant 6\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAnother participant said \u003cem\u003e\u0026ldquo;I get distracted during the day, and then I miss my medication.\u0026rdquo;\u003c/em\u003e \u003cb\u003eParticipant 2\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\u003ch2\u003eb) Financial Constraints\u003c/h2\u003e\u003cp\u003eParticipants cited the high cost of drugs and transport to health facilities as key barriers. Limited finances affected their ability to refill prescriptions or buy drugs from private pharmacies when out of stock at hospitals.\u003c/p\u003e\u003cp\u003eA participant said \u003cem\u003e\u0026ldquo;There are days I don\u0026rsquo;t have enough money to buy my medicines, so I skip the dose until I can afford it.\u0026rdquo;\u003c/em\u003e \u003cb\u003eParticipant 10\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAnother said \u003cem\u003e\u0026ldquo;Sometimes the medicine is not here in the hospital, and I don\u0026rsquo;t have money to buy.\u0026rdquo;\u003c/em\u003e \u003cb\u003eParticipant 1\u003c/b\u003e\u003c/p\u003e\u003cdiv id=\"Sec22\" class=\"Section3\"\u003e\u003ch2\u003ec) Side Effects\u003c/h2\u003e\u003cp\u003eAdverse effects such as dizziness, nausea, and stomach pain discouraged some participants from consistent medication use.\u003c/p\u003e\u003cp\u003eOne participant said \u003cem\u003e\u0026ldquo;The tablets sometimes make me feel dizzy and like I want to vomit, so I avoid taking them on some days.\u0026rdquo;\u003c/em\u003e \u003cb\u003eParticipant 1\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAnother one said \u003cem\u003e\u0026ldquo;I get stomach pain after taking the medicine, and it discourages me from taking it regularly.\u0026rdquo;\u003c/em\u003e \u003cb\u003eParticipant 8\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec23\" class=\"Section2\"\u003e\u003ch2\u003ed) Complex Medication Regimens (Pill Burden)\u003c/h2\u003e\u003cp\u003eTaking multiple drugs for diabetes and other comorbidities, such as hypertension, was overwhelming for several participants.\u003c/p\u003e\u003cp\u003eA participant said \u003cem\u003e\u0026ldquo;I have many medicines to take at different times; it is hard to remember all of them.\u0026rdquo;\u003c/em\u003e \u003cb\u003eParticipant 5\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAnother said \u003cem\u003e\u0026ldquo;Taking several pills every day is confusing; sometimes I mix them up or forget a dose.\u0026rdquo;\u003c/em\u003e \u003cb\u003eParticipant 9\u003c/b\u003e\u003c/p\u003e\u003cdiv id=\"Sec24\" class=\"Section3\"\u003e\u003ch2\u003ee) Lack of Family or Social Support\u003c/h2\u003e\u003cp\u003eParticipants without close family support often missed doses or failed to keep appointments.\u003c/p\u003e\u003cp\u003eParticipant said \u003cem\u003e\u0026ldquo;No one reminds me to take my medications; I often forget because I am alone at home.\u0026rdquo;\u003c/em\u003e \u003cb\u003eParticipant 7\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec25\" class=\"Section3\"\u003e\u003ch2\u003ef) Use of Alternative or Herbal Medicines\u003c/h2\u003e\u003cp\u003eSome participants alternated prescribed drugs with herbal remedies due to cultural beliefs or community influence.\u003c/p\u003e\u003cp\u003eA participant said \u003cem\u003e\u0026ldquo;I sometimes use herbal remedies instead of my tablets because I believe they are safer.\u0026rdquo;\u003c/em\u003e \u003cb\u003eParticipant 2\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA participant said \u003cem\u003e\u0026ldquo;Some people in my village told me herbs can cure diabetes, so I mix them with my prescribed medicine.\u0026rdquo;\u003c/em\u003e \u003cb\u003eParticipant 10\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec26\" class=\"Section3\"\u003e\u003ch2\u003eg) Limited Health Education\u003c/h2\u003e\u003cp\u003eInadequate understanding of diabetes management contributed to poor adherence. Some participants were unaware of the importance of consistent medication.\u003c/p\u003e\u003cp\u003eParticipant said that \u003cem\u003e\u0026ldquo;I didn\u0026rsquo;t know that missing a dose could affect my blood sugar, so I sometimes skip.\u0026rdquo;\u003c/em\u003e \u003cb\u003eParticipant 6\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAnother participant said \u003cem\u003e\u0026ldquo;I only recently learned why taking medicine daily is important; before that, I used to take it randomly.\u0026rdquo;\u003c/em\u003e \u003cb\u003eParticipant 1\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e2. Facilitators of Adherence\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003ea) Strong Family Support\u003c/b\u003e\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e\u003cp\u003eFamily involvement emerged as a strong facilitator. Spouses and children provided reminders and moral support.\u003c/p\u003e\u003cp\u003eA participant said \u003cem\u003e\u0026ldquo;My wife always reminds me to take my medicine and sometimes gives it to me; it helps a lot.\u0026rdquo;\u003c/em\u003e \u003cb\u003eParticipant 4\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAnother participant said \u003cem\u003e\u0026ldquo;My children keep checking if I have taken my pills, which motivates me to take them on time.\u0026rdquo;\u003c/em\u003e \u003cb\u003eParticipant 9\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec27\" class=\"Section2\"\u003e\u003ch2\u003eb) Health Education and Counseling\u003c/h2\u003e\u003cp\u003eHealth talks and counseling from healthcare workers improved adherence by enhancing patients\u0026rsquo; understanding of their condition.\u003c/p\u003e\u003cp\u003eA participant said that \u003cem\u003e\u0026ldquo;The nurse explained why I need to take my medicine daily, and now I understand its importance.\u0026rdquo;\u003c/em\u003e \u003cb\u003eParticipant 3\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAnother participant said \u003cem\u003e\u0026ldquo;After the health talk, I realized skipping medicine can be dangerous.\u0026rdquo;\u003c/em\u003e \u003cb\u003eParticipant 7\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003ec) Personal Motivation and Self-Discipline\u003c/h3\u003e\n\u003cp\u003eParticipants motivated by health goals or family responsibilities were more consistent in medication use.\u003c/p\u003e\u003cp\u003eA participant said \u003cem\u003e\u0026ldquo;I want to stay healthy for my children, so I make sure I never miss my medicine.\u0026rdquo;\u003c/em\u003e \u003cb\u003eParticipant 10\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAnother participant said \u003cem\u003e\u0026ldquo;I remind myself every day that controlling my blood sugar is important for my life, I fear falling sick.\u0026rdquo;\u003c/em\u003e \u003cb\u003eParticipant 2\u003c/b\u003e\u003c/p\u003e\u003cdiv id=\"Sec29\" class=\"Section2\"\u003e\u003ch2\u003ed) Positive Patient\u0026ndash;Provider Relationship\u003c/h2\u003e\u003cp\u003eTrust and good communication with healthcare workers encouraged adherence.\u003c/p\u003e\u003cp\u003eParticipant said \u003cem\u003e\u0026ldquo;I trust doctors and nurses, and I follow their advice carefully because I know it helps me.\u0026rdquo;\u003c/em\u003e \u003cb\u003eParticipant 5\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAnother said \u003cem\u003e\u0026ldquo;The nurses are good to me and explained everything clearly.\u0026rdquo;\u003c/em\u003e \u003cb\u003eParticipant 8\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e3. Suggested Strategies to Improve Adherence\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003ea) Consistent Drug Supply at Health Facilities\u003c/b\u003e\u003c/p\u003e\u003cp\u003eParticipants emphasized the need for a steady supply of anti-diabetic drugs and testing kits.\u003c/p\u003e\u003cp\u003eA participant suggested \u003cem\u003e\u0026ldquo;When the government provides drugs, it means I can take them as per the doctor\u0026rsquo;s instruction.\u0026rdquo;\u003c/em\u003e \u003cb\u003eParticipant 1\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAnother participant suggested that \u003cem\u003e\u0026ldquo;The government should make sure medicine is always at the hospital.\u0026rdquo;\u003c/em\u003e \u003cb\u003eParticipant 2\u003c/b\u003e\u003c/p\u003e\u003cdiv id=\"Sec30\" class=\"Section3\"\u003e\u003ch2\u003eb) Strengthening Follow-up and Reminder Systems\u003c/h2\u003e\u003cp\u003eRegular follow-up and phone reminders were proposed to minimize missed appointments.\u003c/p\u003e\u003cp\u003eParticipant said that \u003cem\u003e\u0026ldquo;The hospital should be reminding us to go back for reviews, they should be calling to remind about return dates.\u0026rdquo;\u003c/em\u003e \u003cb\u003eParticipant 4\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec31\" class=\"Section3\"\u003e\u003ch2\u003ec) Enhancing Family and Community Support\u003c/h2\u003e\u003cp\u003eTraining family members to support diabetes care was recommended.\u003c/p\u003e\u003cp\u003eA participant said \u003cem\u003e\u0026ldquo;Have a family member who can be reminding you on the time of taking the medicine.\u0026rdquo;\u003c/em\u003e \u003cb\u003eParticipant 4\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\n\u003ch3\u003ed) Improved Health Education and Counseling\u003c/h3\u003e\n\u003cp\u003eContinuous education through clinics and community outreach could empower patients.\u003c/p\u003e\u003cp\u003eA participant suggested that \u003cem\u003e\u0026ldquo;Patients should be taught the dangers of missing medicine and how to manage side effects.\u0026rdquo;\u003c/em\u003e \u003cb\u003eParticipant 3\u003c/b\u003e\u003c/p\u003e\n\u003ch3\u003ee) Strengthening Health System Response\u003c/h3\u003e\n\u003cp\u003eParticipants suggested that the government prioritize diabetes management through resource allocation and improved diagnostic support.\u003c/p\u003e\u003cp\u003eAnother participant said \u003cem\u003ethat \u0026ldquo;The number of DM cases is increasing, so the government should put more effort on DM.\u0026rdquo;\u003c/em\u003e \u003cb\u003eParticipant 7\u003c/b\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study explored adherence to anti-diabetic medication among adults with Type 2 Diabetes Mellitus (T2DM) at Soroti Regional Referral Hospital using a mixed-methods approach. The overall prevalence of adherence was moderate at 51.3%, indicating that nearly half of the patients were not consistently following their prescribed regimens. This finding is concerning, as suboptimal adherence contributes to poor glycemic control and increases the risk of complications such as nephropathy, neuropathy, and cardiovascular disease. The moderate adherence level observed in this study is consistent with adherence reported from Cameroon of 45.6% [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] and that reported from a study conducted in Mbarara Regional Referral Hospital, Uganda of 61.9% [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], but lower than that reported in Eastern Uganda of 83.3% [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The variation may be attributed to differences in adherence assessment tools, health education levels, and medication supply systems.\u003c/p\u003e\u003cp\u003eThe study identified both individual and health system factors that either hindered or promoted adherence to anti-diabetic medication. These findings were supported and enriched by qualitative insights from patient interviews.\u003c/p\u003e\u003cp\u003eSocio-demographic and lifestyle factors such as sex and family support were significantly associated with adherence. Female participants were more likely to adhere compared to males (AOR = 2.215, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001). This finding aligns with a study conducted in Ghana [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], suggesting that women tend to be more health-conscious, follow medical advice, and engage in care-seeking behavior. Qualitative findings also indicated that women often received encouragement and reminders from their spouses or children, reinforcing their adherence. Conversely, male participants were more likely to forget doses or deprioritize medication due to occupational commitments or lower health-seeking behavior.\u003c/p\u003e\u003cp\u003eFamily support emerged as both a quantitative predictor and qualitative facilitator of adherence. Participants who received reminders, moral support, and practical assistance from family members were nearly three times more likely to adhere (AOR = 2.972, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001). This resonates with other African studies that underscore the role of family networks in chronic disease management[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Conversely, participants who lived alone or lacked family support frequently missed doses and clinic appointments, citing loneliness and lack of encouragement. This finding underscores the importance of involving families in diabetes care as a source of emotional, informational, and logistical support.\u003c/p\u003e\u003cp\u003eHealth education was another major factor influencing adherence. Patients who had ever received diabetic health education were twice as likely to adhere to their medication (AOR = 2.522, p \u0026lt; 0.001). Similar findings have been reported in studies from Uganda and Ghana, where health education improved patients’ understanding of diabetes, the importance of consistent medication use, and management of side effects [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Education empowers patients with knowledge that enhances self-efficacy and fosters adherence. Qualitative findings in this study reinforced this—participants who attended health talks or counseling sessions demonstrated greater awareness of the consequences of missed doses and reported better adherence. In contrast, those with limited health knowledge often skipped doses or alternated medication with herbal remedies due to misconceptions about treatment efficacy [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. This supports the Health Belief Model, which posits that knowledge, perceived benefits, and perceived susceptibility are key precursors to behavioral change [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eHealth system factors also significantly affected adherence. Patients who reported that anti-diabetic medications were consistently available in the hospital pharmacy were more likely to adhere (AOR = 2.194, \u003cem\u003ep\u003c/em\u003e = 0.029). This aligns with findings from France and Uganda [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], emphasizing that uninterrupted access to medication is essential for sustained treatment adherence. In the qualitative findings, frequent stock-outs and high drug costs were major barriers. Some participants resorted to skipping doses or discontinuing treatment when drugs were unavailable or unaffordable.\u003c/p\u003e\u003cp\u003eOther barriers identified included forgetfulness, side effects, financial constraints, and use of herbal remedies. Forgetfulness was common among those engaged in farming or daily labor, while side effects such as dizziness and nausea discouraged regular medication use. Financial hardship prevented some from purchasing drugs when hospital stock was depleted, while cultural beliefs promoted the use of herbal alternatives perceived as “natural” or “safer.” These findings are consistent with other studies in Africa, which report that psychosocial, economic, and cultural factors significantly influence medication adherence [\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e–\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. These barriers highlight that adherence is influenced by a web of psychosocial, economic, and cultural determinants. Addressing these barriers requires multifaceted interventions, including patient education, consistent drug supply, and culturally sensitive counseling.\u003c/p\u003e\u003cp\u003eOn the other hand, facilitators such as personal motivation, positive patient–provider relationships, and simplified medication regimens enhanced adherence. Participants who were motivated by health goals or family responsibilities displayed higher commitment to medication. Trust and good communication with healthcare providers fostered confidence in treatment plans and improved medication-taking behavior. Simplified regimens, such as once-daily combination pills, reduced pill burden and minimized confusion. These findings align with other studies, which have shown that patient motivation, strong provider–patient relationships, and simplified medication regimens significantly improve adherence among adults with Type 2 Diabetes in both African and global settings [\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e–\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Collectively, these findings emphasize that effective diabetes care requires both patient empowerment and a supportive healthcare environment.\u003c/p\u003e\u003cp\u003eParticipants proposed practical and feasible strategies to address barriers and strengthen adherence. Key recommendations included ensuring consistent drug supply at health facilities to prevent stock-outs, establishing follow-up and reminder systems such as phone calls or SMS alerts to address forgetfulness, and enhancing family and community involvement through education and support programs. Continuous health education and counseling were also emphasized to dispel myths about medication, improve understanding of diabetes management, and empower patients to manage side effects. Additionally, participants recommended strengthening the overall health system response by prioritizing diabetes care, allocating adequate resources, and improving diagnostic and follow-up services. These findings align with previous studies, which report that interventions combining health education, family and community support, medication availability, and reminder systems significantly improve adherence among patients with Type 2 Diabetes [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. The strategies also align with global best practices for chronic disease management, which advocate for an integrated approach combining patient education, system-level interventions, and community engagement[\u003cspan additionalcitationids=\"CR29\" citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e–\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Implementing these strategies could improve medication adherence, reduce diabetes complications, and ultimately enhance quality of life for patients living with T2DM in similar resource-limited settings.\u003c/p\u003e\u003cdiv id=\"Sec35\" class=\"Section2\"\u003e\u003ch2\u003eStudy Limitations\u003c/h2\u003e\u003cp\u003eRecall bias since self-reported data was collected from participants, the findings may have be prone to recall and social desirability bias, potentially leading to overestimated adherence. However, the participants will be thoroughly informed about the purpose of the study and need to be as honest as possible.\u003c/p\u003e\u003cp\u003eThe cross-sectional design did not capture the insights of causality.\u003c/p\u003e\u003cp\u003eThere was reporting bias where the participant responded in a way, they think is appropriate to the researchers.\u003c/p\u003e\u003cp\u003eThe study used a self-reporting tool, Medication Compliance Questionnaire to measure adherence other than HBA1c, which is the gold standard for measuring adherence in this group.\u003c/p\u003e\u003cp\u003eThe qualitative design of the study may not be generalizable to other settings.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusions and Recommendations","content":"\u003cp\u003eThe prevalence of adherence to anti-diabetic medication among adults with T2DM remains low at only 51.3%, with only 5 in 10 patients adhering. The key factors significantly associated with adherence include being female, receiving family support, health education, and medication availability. These findings highlight the importance of family support, access to healthcare, and patient-centred communication in improving treatment outcomes. Each of these factors contributes to a complex set of determinants that can either enhance or hinder medication adherence.\u003c/p\u003e\u003cp\u003eQualitative findings further enriched these results by highlighting multifaceted barriers such as forgetfulness, financial constraints, side effects, pill burden, lack of family support, limited health education, and use of herbal remedies. Conversely, strong family support, health education, patient motivation, simplified drug regimens, and positive patient–provider relationships were identified as key facilitators of adherence. Participants also suggested strategies such \u003cb\u003eas\u003c/b\u003e ensuring consistent drug supply, establishing reminder systems, strengthening family involvement, and enhancing diabetes education to improve adherence.\u003c/p\u003e\u003cp\u003eTo improve medication adherence among adults with Type 2 Diabetes Mellitus, the study recommends strengthening routine adherence assessment, providing structured health education, ensuring consistent drug supply, and promoting family involvement in patient care. It also calls for integrating adherence counselling into continuing professional development and enhancing community health education for patients and caregivers. Further research should explore patients’ beliefs and experiences and evaluate innovative interventions such as mobile health reminders and family-based counselling programs to enhance adherence and improve diabetes outcomes.\u003c/p\u003e\u003ch2\u003eOperational Definition\u003c/h2\u003e\u003cp\u003e\u003cstrong\u003eAdherence\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eis defined as the extent to which a person’s behavior that is taking medication, following a diet, and or executing lifestyle changes which corresponds with agreed recommendations from a qualified health care provider (WHO, 2023, UCG, 2023).\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eDiabetes mellitus\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eDiabetes mellitus is a chronic, non-communicable, metabolic disease characterized by elevated levels of blood glucose due to decreased insulin secretion or peripheral resistance to the action of insulin, or a combination of the two (WHO, 2023).\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eType 2 diabetes mellitus\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eIs a type of diabetes mellitus that starts at adulthood and occurs when the body cells become resistance to insulin and with insufficient production of insulin as the disease progresses.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eHyperglycemia\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eis a random capillary blood glucose level equal or above 11.1 mmol/l or a fasting capillary blood glucose level above 6.1 mmol/l.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eManagement of type 2 diabetes mellitus\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eit encompasses the four major aspect of management as use of ant-diabetic medicines, following dietary recommendations, blood glucose monitoring and physical exercise.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eAntidiabetic medication\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eAre drugs used to lower blood sugar levels in patients with diabetes mellitus. In the management of type two diabetes mellitus the first line drug for treatment is Metformin, second line is Glimepiride and third line is insulin (WHO, 2023).\u003c/p\u003e"},{"header":"List of Abbreviations/ Acronyms","content":"\u003cp\u003eDKA Diabetic ketoacidosis\u003c/p\u003e\u003cp\u003eFBS Fasting Blood Sugar\u003c/p\u003e\u003cp\u003eHbA1c Glycated hemoglobin\u003c/p\u003e\u003cp\u003eIDF International Diabetes Federation\u003c/p\u003e\u003cp\u003eMCQ Medication Compliance Questionnaire\u003c/p\u003e\u003cp\u003eMoH Ministry of Health\u003c/p\u003e\u003cp\u003eOHA Oral anti-Hyperglycemic Agent\u003c/p\u003e\u003cp\u003eRBS Random Blood Sugar\u003c/p\u003e\u003cp\u003eT2DM Type 2 diabetes mellitus.\u003c/p\u003e\u003cp\u003eUDA Uganda Diabetes Association\u003c/p\u003e\u003cp\u003eWHO World Health Organization.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBrenda Lalam designed the study, collected study data and wrote the main manuscript text, Samuel Okello designed the study, performed the statistical analyses, results, supervised the work and revised the final manuscript.\u0026nbsp;Safina Akello, John Micheal Okusa, Ronald Opito and Patrick Lubogo were involved in designing the method, Lucy Ezatiru and Dr. Simon Eleku were involved in data analysis, study design, and data collection.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study had no funding.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data, which is mentioned in the manuscript, will be made available upon request from the authors. Please feel free to contact the authors for access to the data.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approvals and consent to participants\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. The study protocol was reviewed and approved by the Mbale Regional Referral Hospital\u0026nbsp;Research Ethics Committee (MRRH-2025-557). Written informed consent was obtained from all participants. Participation was voluntary, and confidentiality and anonymity were maintained throughout the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to publish\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere is no conflict of interest.\u003c/p\u003e\n\u003cp id=\"_Toc202700495\"\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eI acknowledge my supervisors Mr. Samuel Okello for the guidance and mentorship. I also acknowledge my lecturers. Finally I acknowledge the staff of Soroti regional referral hospital.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eStatista. Diabetes - Statistics \u0026amp; Facts. In.; 2024.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDiabetes facts. 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Diabetes Res Clin Pract. 2022;183:109119.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSun H, Saeedi P, Karuranga S, Pinkepank M, Ogurtsova K, Duncan BB, Stein C, Basit A, Chan JCN, Mbanya JC, et al. IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Pract. 2022;183:109119.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLima JEBF, Moreira NCS, Sakamoto-Hojo ET. Mechanisms underlying the pathophysiology of type 2 diabetes: From risk factors to oxidative stress, metabolic dysfunction, and hyperglycemia. Mutat Research/Genetic Toxicol Environ Mutagen 2022, 874\u0026ndash;5:503437.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMoH. Uganda Clinical Guideline. National guideline for management of common health conditions; 2023.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBoonpattharatthiti K, Songkla PN, Chantara J, Koomsri C, Krass I, Chaiyakunapruk N, Dhippayom T. Prevalence of adherence to oral antidiabetic drugs in patients with type 2 diabetes: A systematic review and meta-analysis. J Diabetes Investig. 2024;15(11):1614\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMedication adherence in patients with type 2 diabetes. Barriers \u0026amp; interventions. [\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://acarepro.abbott.com/articles/cardio-metabolic/medication-adherence-in-type-diabetes/]\u003c/span\u003e\u003cspan address=\"https://acarepro.abbott.com/articles/cardio-metabolic/medication-adherence-in-type-diabetes/]\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePiragine E, Petri D, Martelli A, Calderone V, Lucenteforte E. Adherence to Oral Antidiabetic Drugs in Patients with Type 2 Diabetes: Systematic Review and Meta-Analysis. J Clin Med 2023, 12(5).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFederation ID. Diabetes in Africa. Prevalence of Diabetes (20\u0026ndash;79 years). In.; 2021.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAl-lela OQ, Abdulkareem RA, AL-Mufti L, Kamal N, Qasim S, Sagvan R, Hinir Z, Khidr H. Medication adherence among diabetic patients in developing countries: review of studies. Syst Rev Pharm. 2020;11(8):270\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFacts about diabetes mellitus in Uganda. [ \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://idf.org/our-network/regions-and-members/africa/members/uganda/uganda-diabetes-association/]\u003c/span\u003e\u003cspan address=\"https://idf.org/our-network/regions-and-members/africa/members/uganda/uganda-diabetes-association/]\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFaisal K, Tusiimire J, Yadesa TM. Prevalence and Factors Associated with Non-Adherence to Antidiabetic Medication Among Patients at Mbarara Regional Referral Hospital, Mbarara, Uganda. Patient Prefer Adherence. 2022;16:479\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAminde LN, Tindong M, Ngwasiri CA, Aminde JA, Njim T, Fondong AA, Takah NF. Adherence to antidiabetic medication and factors associated with non-adherence among patients with type-2 diabetes mellitus in two regional hospitals in Cameroon. BMC Endocr Disord. 2019;19(1):35.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eQutubuddin M, Rahman RA, Ghafoor E, Riaz M, Khan R. Assessment of factors associated with non-compliance to self-management practices in people with type 2 diabetes. Cureus 2021, 13(10).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRubin RR, Peyrot M, Siminerio LM, Panel IDA. Health care and patient-reported outcomes: results of the cross-national Diabetes Attitudes, Wishes and Needs (DAWN) study. Diabetes Care. 2006;29(6):1249\u0026ndash;55.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePolonsky WH, Henry RR. Poor medication adherence in type 2 diabetes: recognizing the scope of the problem and its key contributors. Patient Prefer Adherence 2016:1299\u0026ndash;307.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBagonza J, Rutebemberwa E, Bazeyo W. Adherence to anti diabetic medication among patients with diabetes in eastern Uganda; a cross sectional study. BMC Health Serv Res. 2015;15:168.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAfaya RA, Bam V, Azongo TB, Afaya A, Kusi-Amponsah A, Ajusiyine JM, Abdul Hamid T. Medication adherence and self-care behaviours among patients with type 2 diabetes mellitus in Ghana. PLoS ONE. 2020;15(8):e0237710.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMogre V, Johnson NA, Tzelepis F, Paul C. Barriers to diabetic self-care: A qualitative study of patients' and healthcare providers' perspectives. J Clin Nurs. 2019;28(11\u0026ndash;12):2296\u0026ndash;308.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJanz NK, Becker MH. The Health Belief Model: a decade later. Health Educ Q. 1984;11(1):1\u0026ndash;47.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTiv M, Viel J-F, Mauny F, Eschw\u0026egrave;ge E, Weill A, Fournier C, Fagot-Campagna A, Penfornis A. Medication Adherence in Type 2 Diabetes: The ENTRED Study 2007, a French Population-Based Study. PLoS ONE. 2012;7(3):e32412.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLogie CH, Okumu M, Latif M, Musoke DK, Odong Lukone S, Mwima S, Kyambadde P. Exploring resource scarcity and contextual influences on wellbeing among young refugees in Bidi Bidi refugee settlement, Uganda: findings from a qualitative study. Confl Health. 2021;15(1):3.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOngugo RA. Contributors of Non-Adherence to Type Ii Diabetes Treatment Among Patients at Thogoto Hospital in Kiambu County, Kenya. Kenyatta University; 2022.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMurwanashyaka JD, Ndagijimana A, Biracyaza E, Sunday FX, Umugwaneza M. Non-adherence to medication and associated factors among type 2 diabetes patients at Clinique Medicale Fraternite, Rwanda: a cross-sectional study. BMC Endocr disorders. 2022;22(1):219.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWaltz TJ, Powell BJ, Fern\u0026aacute;ndez ME, Abadie B, Damschroder LJ. Choosing implementation strategies to address contextual barriers: diversity in recommendations and future directions. Implement Sci. 2019;14(1):42.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWagner EH, Austin BT, Davis C, Hindmarsh M, Schaefer J, Bonomi A. Improving chronic illness care: translating evidence into action. Health Aff (Millwood). 2001;20(6):64\u0026ndash;78.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSsemata AS, Smythe T, Sande S, Menya A, Hameed S, Waiswa P, Mbazzi FB, Kuper H. Suggested solutions to barriers in accessing healthcare by persons with disability in Uganda: a qualitative study. BMC Health Serv Res. 2024;24(1):1010.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBalis LE, Houghtaling B. Matching barriers and facilitators to implementation strategies: recommendations for community settings. Implement Sci Commun. 2023;4(1):144.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-primary-care","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"famp","sideBox":"Learn more about [BMC Primary Care](https://bmcprimcare.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12875","title":"BMC Primary Care","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Adherence, Anti-Diabetic Medication, Associated Factors, Adults, Type 2 Diabetes Mellitus","lastPublishedDoi":"10.21203/rs.3.rs-8097219/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8097219/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eType 2 diabetes mellitus (T2DM) is the most common type of endocrine disorder among adults, accounting for 90%-95% of diabetes mellitus globally. In Uganda, non-adherence to anti-diabetic medication remains high at 38.1%. This results in complications like diabetic ketoacidosis, hyperglycemia and microvascular complications.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e\u003cp\u003eTo determine the prevalence of adherence to anti-diabetic medication, its associated factors, barriers, facilitators, and strategies for improvements among adults with T2DM attending the diabetic clinic at Soroti Regional Referral Hospital.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e\u003cp\u003eThe study employed an explanatory sequential mixed design at SRRH. The quantitative study participants were 376 adults aged 18 years and above with T2DM, while qualitative data was collected from 15 participants with diabetes mellitus. Quantitative data was collected using semi-structured interviewer-administered questionnaires, while qualitative data was collected using in-depth interview guide. The prevalence of adherence was expressed as a percentage. Modified Poisson regression was used to determine the association, with the prevalence ratio being the measure of association for quantitative data while deductive thematic analysis was used for qualitative data.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe prevalence of adherence medication was 51.3% (95% CI: 0.46\u0026ndash;0.56). Factors significantly associated with adherence included: sex of the participants (aPR\u0026thinsp;=\u0026thinsp;2.215, p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001), having a family support (aPR\u0026thinsp;=\u0026thinsp;2.972, p-value of \u0026lt;\u0026thinsp;0.001), having ever received health education (aPR\u0026thinsp;=\u0026thinsp;2.522, p- value of \u0026lt;\u0026thinsp;0.001), and finding anti-diabetic medication always available at the hospital pharmacy (aPR\u0026thinsp;=\u0026thinsp;2.194, p-value of 0.029). Qualitative findings revealed that the key barriers to adherence included financial constraints, drug stock-outs, side effects, and lack of understanding. The key facilitators included family support, health education, and regular follow-up. Participants \u003cb\u003es\u003c/b\u003euggested several strategies that could improve adherence including strengthening community support, improving drug supply, and enhancing patient-provider communication.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eAdherence to anti-diabetic medication remains suboptimal, with only half of the participants adhering. Both quantitative and qualitative findings underscore that family support, gender, health education, and consistent medication supply are critical determinants of adherence. To improve adherence, health facilities should implement routine adherence assessments, strengthen family engagement, ensure consistent drug availability, and provide structured, continuous health education. Integration of adherence counselling into professional training and community education programs is essential.\u003c/p\u003e","manuscriptTitle":"Adherence to Anti-Diabetic Medication, Its Associated Factors, Barriers, Facilitators and Strategies for Improvements among Adults with Type 2 Diabetes Mellitus Attending Regional Referral Facility in Eastern Uganda: a Mixed Study Design","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-10 09:56:20","doi":"10.21203/rs.3.rs-8097219/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-01-06T15:43:34+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-28T17:06:49+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-25T03:56:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"136572579606060948877809224406871539690","date":"2025-12-22T20:34:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"294076188616371237521075242533332133336","date":"2025-12-15T15:13:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"130737780242020726027175478518936915997","date":"2025-12-10T18:41:04+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-05T10:59:06+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-03T12:42:30+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-11-13T16:37:38+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-13T16:12:42+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Primary Care","date":"2025-11-13T16:09:34+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-primary-care","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"famp","sideBox":"Learn more about [BMC Primary Care](https://bmcprimcare.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12875","title":"BMC Primary Care","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5c16c9df-c02c-4c4d-93f1-9b9ff6d5cbef","owner":[],"postedDate":"December 10th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-03-23T16:04:49+00:00","versionOfRecord":{"articleIdentity":"rs-8097219","link":"https://doi.org/10.1186/s12875-026-03267-9","journal":{"identity":"bmc-primary-care","isVorOnly":false,"title":"BMC Primary Care"},"publishedOn":"2026-03-16 15:58:46","publishedOnDateReadable":"March 16th, 2026"},"versionCreatedAt":"2025-12-10 09:56:20","video":"","vorDoi":"10.1186/s12875-026-03267-9","vorDoiUrl":"https://doi.org/10.1186/s12875-026-03267-9","workflowStages":[]},"version":"v1","identity":"rs-8097219","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8097219","identity":"rs-8097219","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}