Factors Associated With Non-Compliance to Diabetes Medication in a Rapidly Urbanizing Region in Ghana: A Mixed-Methods Study.

Background: Failure to achieve adequate glycaemic control can lead to debilitating complications for diabetics. Strict compliance to prescribed diet, lifestyle and medication can prevent complications. Methods In order to examine factors accompanying non-compliance behaviour to diabetes medication in a rapidly urbanizing region of Ghana, a mixed approach was adopted. Study subjects (N: 160, mean age: 58.3) were interviewed at the Diabetic Clinic of the Brong-Ahafo Regional Hospital, Sunyani. Compliance to diabetes treatment was evaluated with an adapted Morisky Medication Adherence Scale (MMAS). Face-to-face interviews of 20 subjects allowed for more personalized exploration of psychosocial aspects of non-compliance. The interviews were audio recorded, transcribed verbatim, and coded using the Nvivo software. Qualitative data was processed and subjected to inductive thematic analysis. Results Majority of study participants reported an optimum (n = 121, 75.6%) level of compliance to diabetes medication, although some also reported poor compliance (n = 39, 24.4%). Qualitative responses received during interviews suggest that poor compliance may be attributable to misconceptions about religious beliefs and practices. Psychosocial factors relating to felt stress, the inevitability of fate and compliance fatigue were also discovered to undermine compliance. Non-compliance behaviour was also explained by socioeconomic status and barriers to health-seeking behaviour. Conclusion Reported medication compliance was among the highest in out-patient settings in Ghana. However, contextual determinants of non-compliance have to be addressed. Efforts to improve compliance to diabetic medication could benefit from interventions that address superstition, target psychological aspects of chronic disease management and remove operational barriers to healthcare delivery such as transportation costs and long waiting times.