Review Article

Determinants of Poor Treatment Adherence among Patients with Type 2 Diabetes and Limited Health Literacy: A Scoping Review

Table 2

Studies on factors affecting poor treatment adherence among patients with type 2 diabetes with limited health literacy.

AuthorCountry and languageStudy typeMain aimSample sizeMethodResult

Rezaei et al. (2019) [27]Iran (English)QualitativeDetermining barriers to treatment adherence among patients with type 2 diabetesThis study was conducted using content analysis method. Semistructured interviews were used to collect data.Barriers to treatment adherence included four main categories: disbelief in descriptive/prescriptive medical knowledge, personal illness experiences, daily life challenges, and interactive/economic challenges.
Habte et al. (2017) [28]EthiopiaQualitativeDetermining barriers and facilitators of adherence to diabetes medications in patients with diabetesThis study was conducted purposefully. Open coding was used to analyze the data and to identify key topics.In this study, patients’ negative perceptions of the disease, concerns about the side effects of medications, lack of insulin, and the practice of healthcare providers were considered as barriers to treatment adherence.
Hussain et al. (2020) [29]Pakistan (English)Cross-sectionalStudying the effect of health literacy on treatment adherence among older women with type 2 diabetesThis study was conducted using convenience sampling. All participants in the study completed test of health literacy, diabetic numeracy test, and medication adherence rating scale.According to the study, people with good health literacy were more likely to remember to take their medications than those who had poor health literacy.
Mukona et al. (2017) [23]Zimbabwe, South Africa (English)QualitativeDetermining adherence barriers and possible solutions for nonadherence to diabetes treatment among women with gestational diabetes: patients’ perspectivesThis study was conducted on pregnant women aged 18-49 years. Each participant completed a semistructured questionnaire. Data were analyzed thematically and manually.Barriers mentioned in this study included poor socioeconomic status; lack of family, peer, and community support; pregnancy effects; complex treatment regimen; pathophysiology of diabetes; cultural and religious beliefs; and a poor health care system.
Alwazae et al. (2019) [30]Saudi Arabia (English)Cross-sectionalBarriers to treatment adherence to diabetic retinopathy in Saudi adultsA five-part questionnaire was used to collect data: demographic data, diabetes index, assessment of knowledge about DR, attitudes towards DRS, and DRS barriers. Data were analyzed using SPSS 23.The results showed that poor knowledge and financial problems were obstacles to treatment adherence.
Abdullah et al. (2020) [31]Malaysia (English)Cross-sectionalPrevalence of limited health literacy and its related factors among patients with type 2 diabetesThis cross-sectional study was conducted from January to March 2018. Health literacy level was measured using the HLS-EU-Q47.According to the results of this study, the prevalence of limited health literacy is high among patients with type 2 diabetes in Perak, Malaysia.
Huang and Shiyanbola (2021) [32]The US (English)Cross-sectionalEvaluation of barriers and facilitators of treatment adherence among patients with type 2 diabetes and different levels of health literacyIn this mix methods study, 205 participants completed the survey questionnaire and 23 participated in the semistructured interviews.A sense of over-control by taking diabetes medications, inability to take medications regularly, distrust in providers, concerns about drug safety, and ambiguity about the role of medications were some of the barriers to treatment adherence.
Fan et al. (2016) [33]The US (English)Cross-sectionalStudying the relationship between health literacy and unintentional and intentional nonadherence to treatment among patients with type 2 diabetesInformation was obtained from a written questionnaire and the patient’s medical record. Bivariate and multivariate regressions were used to investigate the predictors of medication nonadherence.The results of this study showed that limited health literacy was significantly associated with increased unintentional nonadherence to treatment, but was not associated with intentional nonadherence.
Nelson et al. (2018) [26]The US (English)Randomized controlled trialEvaluation of barriers to adherence to diabetes treatment using information-motivation-behavioral skill model (IMB)The checklist identifying barriers to adherence and HbA1c was completed for them. The most common adherence barriers were identified and the relationship between patient characteristics and barriers reported on each of the IMB constructs were examined.Forgetting doses, lower age, and poor health literacy were among the most reported barriers.
Mostafavi et al. (2021) [34]Iran (English)QualitativeDetermining psychosocial barriers to treatment adherence among patients with type 2 diabetesThis qualitative study was conducted in Isfahan. Participants were interviewed face to face from November 2017 to June 2018. Data were analyzed using MAXQDA-10 and content analysis.Data analysis revealed six categories of psychosocial barriers affecting treatment adherence: (1) fear, concern, and discomfort; (2) fatigue and burnout; (3) prioritization of children’s issues; (4) poor financial support; (5) communication challenges; and (6) improper work conditions.
Mousavizadeh et al. (2016) [3]Iran (Persian)QualitativeDetermining barriers to treatment adherence among patients with diabetesThis study conducted semistructured in-depth interviews. Data were collected from December 2015 to July 2016 and analyzed by contemporary content analysis.The results showed that the three main themes of poor practice of the healthcare team, social limitations, and personal helplessness were identified as barriers to treatment adherence.
Gholamaliei et al. (2016) [4]Iran (Persian)Cross-sectionalEvaluation of medication adherence and its related factors among patients with type 2 diabetesThe research instruments included a researcher-made questionnaire related to the factors affecting medication adherence and a questionnaire measuring the degree of medication adherence. SPSS19 was used for data analysis.The results of the present study showed that age, level of education, healthcare cost, healthcare team and health system costs, factors related to disease treatment and status, beliefs related to the disease, self-efficacy, and concerns about medication taking were factors affecting treatment adherence.
Kooshyar et al. (2014) [21]Iran (Persian)Descriptive-analyticalInvestigating the relationship between health literacy, adherence to treatment regimen, and quality of life related to health among older adults with diabetesCluster sampling was used. Data were collected using the brief-TOFHL, health-related quality of life, MMAS, a researcher-made tool for diet, and exercise compliance, as well as HbA1C and BMI measurements.According to the results, inadequate health literacy has a direct effect on adherence to the treatment regimen in older adults.
Dehvan et al. (2018) [24]Iran (Persian)Integrative reviewDetermination of inhibitors and facilitators of adherence to treatment regimens among patients with type 2 diabetesIn this review study, all full-text Persian and English articles (from 2000 onwards) on adherence to treatment regimens among patients with type 2 diabetes were reviewed, and finally, 53 articles were included in the study.Depression, financial problems, drug side effects and illness, memory problems, simultaneous use of several drugs, and the complexity of the treatment regimen were the most important barriers to adherence to the treatment regimen in this study.
Hashemi & Bouya et al. (2018) [35]Iran (Persian)ReviewAdherence to treatment among patients with diabetes: an important but neglected issueThe most important barriers to treatment adherence are poor practice of the healthcare team, social limitations, and personal helplessness.
Mehrtak et al. (2017) [22]Iran (Persian)Cross-sectionalEvaluation of the relationship between health literacy, adherence to medication, nutrition, and exercise among patients with type 2 diabetesThis study was conducted by random sampling. Data were collected by TOFHLA, MMAS-8, and adherence to diet and exercise questionnaire.According to the results of this study, the level of health literacy affects the proper adherence to medication, nutrition, and exercise among patients with type 2 diabetes.
Bauer et al. (2013) [36]California (English)Cross-sectionalEvaluation of health literacy and adherence to antidepressants among adults with diabetesAdults with type 2 diabetes who completed a survey in 2006 participated in the study. The accredited self-report scale measured health literacy.According to the results, patients with limited health literacy had poor adherence compared to patients with good health literacy.
Brundisini et al. (2015) [37]Canada (English)Qualitative meta-synthesisExamining the different views of patients with type 2 diabetes and providers about nonadherence to the medicationsThis study reviewed published articles between 2002 and 2013. Eighty-six studies were eligible for coding and thematic analysisThe results of this study identified 7 categories of barriers: (1) emotional experiences as positive and negative stimuli for adherence; (2) intentional noncompliance; (3) patient-provider relationship; (4) information and knowledge; (5) prescription of medicine; (6) social and cultural beliefs; and (7) financial problems.