Medication adherence among Turkish type-2 diabetics in Belgium: results from a qualitative study

Abstract title: Medication adherence among Turkish type-2 diabetics in Belgium: results from a qualitative study. Aim: Prevalence of diabetes in Belgium is 2 to 3 times higher among people from Turkish descent. Medication adherence, an essential element of the diabetic regimen, appears to be lower among nonwhite ethnic groups. This study identifies factors influencing medication adherence among Turkish type-2 diabetics living in Belgium. Methods: Since this topic hasn’t been studied before we conducted an explorative, qualitative study using semi-structured in-depth interviews with the aid of an interpreter. The topicslist was based on insights from the literature and conversations with Turkish diabetics and health care workers and was slightly adjusted after the first interviews. 21 Turkish type-2 diabetics living in Belgium were selected using theoretical sampling. Respondent’s most recent HbA1c-values were also collected. Interviews lasted between 2 and 5 hours, were audio-taped, fully transcribed and translated. Thematic analysis was conducted by the first two authors with different educational backgrounds (sociologist/pharmacist). The first phase was a detailed, thematic analysis of the individual cases, in the second phase an analysis across cases, distinguishing adherers from non-adherers, identified factors influencing medication adherence. NVivo 8 was used for managing, coding and analysing the qualitative data. Results: Factors influencing medication adherence among type-2 diabetics from Turkish descent include knowledge of and attitudes towards diabetes and antidiabetics, health and medication beliefs, social support from health care providers and family members, the nature of the patient-provider relationship, perceptions of health care worker’s expertise and social roles in daily life. A typology was constructed identifying different constellations of factors that distinguish adherers from non-adherers. Implications for clinical practice are discussed. Conclusion: This qualitative study identifies factors influencing medication adherence among type-2 Turkish diabetics living in Belgium and provides a typology, distinguishing adherers from non-adherers, that may guide clinical practice. Results from this qualitative study will be tested in a future, quantitative study