Patient and Provider Perspectives on Medication Non-adherence Among Patients with Depression and/or Diabetes in Diverse Community Settings – A Qualitative Analysis

Jane E Hamilton,1 Eduardo Blanco,2 Salih Selek,1 Kelly L Wirfel,3 Elmer V Bernstam,3,4 Dawn Velligan,5 Meghana Gudala,4 Kirk Roberts4 1The University of Texas Health Science Center at Houston, McGovern Medical School, Louis Faillace Department of Psychiatry and Behavioral Sciences, Houston, TX, USA; 2Arizona State University, School of Computing and Augmented Intelligence, Tempe, AZ, USA; 3The University of Texas Health Science Center at Houston, McGovern Medical School, Department of Internal Medicine, Houston, TX, USA; 4The University of Texas Health Science Center at Houston, School of Biomedical Informatics, Houston, TX, USA; 5The University of Texas Health Science Center at San Antonio, Long School of Medicine, Department of Psychiatry, San Antonio, TX, USACorrespondence: Jane E Hamilton, The University of Texas Health Science Center at Houston, McGovern Medical School, Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, 1941 East Road, BBSB 1204, Houston, TX, 77054, USA, Tel +1 713-486-2858, Email Jane.E.Hamilton@uth.tmc.eduBackground: Diabetes and depression affect a significant percentage of the world’s total population, and the management of these conditions is critical for reducing the global burden of disease. Medication adherence is crucial for improving diabetes and depression outcomes, and research is needed to elucidate barriers to medication adherence, including the intentionality of non-adherence, to intervene effectively. The purpose of this study was to explore the perspectives of patients and health care providers on intentional and unintentional medication adherence among patients with depression and diabetes through a series of focus groups conducted across clinical settings in a large urban area.Methods: This qualitative study utilized a grounded theory approach to thematically analyze qualitative data using the framework method. Four focus groups in total were conducted, two with patients and two with providers, over a one-year period using a semi-structured facilitation instrument containing open-ended questions about experiences, perceptions and beliefs about medication adherence.Results: Across the focus groups, communication difficulties between patients and providers resulting in medication non-adherence was a primary theme that emerged. Concerns about medication side effects and beliefs about medication effectiveness were identified as perceptual barriers related to intentional medication non-adherence. Practical barriers to medication adherence, including medication costs, forgetting to take medications and polypharmacy, emerged as themes related to unintentional medication non-adherence.Conclusion: The study findings contribute to a growing body of research suggesting health system changes are needed to improve provider education and implement multicomponent interventions to improve medication adherence among patients with depression and/or diabetes, both chronic illnesses accounting for significant disease burden globally.Keywords: medication adherence, patient and provider preferences, intentional versus unintentional nonadherence