ABSTRACT
Introduction
Diabetes mellitus (DM) is a life-long advancing metabolic
disorder delineated by an increase in blood glucose level. One of the three
major types of diabetes is type 2 diabetes and it’s the most common type. In
this condition there is a high level of sugar (glucose) in the blood as a
result of absolute or relative deficiency of insulin hormone. Available
evidence suggests that, vigorous management of type 2 diabetes mellitus can
reduce the morbidity and mortality of the disease by decreasing the chronic
complications that come along with it. However, research suggests that
compliance to therapy is low among clients with type 2 DM. As a result, the
study aimed at assessing the factors that influence compliance to treatment in clients
with type 2 diabetes at the Komfo Anokye Teaching Hospital (KATH) Diabetic
Center.
Methods
Descriptive cross-sectional study design was used to conduct
the study and the study population included type 2 diabetes mellitus clients
who visited the diabetic clinic of Komfo Anokye Teaching Hospital during the
period of the study. Data were gathered using structured questionnaire and
systematic random sampling technique was adopted to administer the structured
questionnaire to 400 diabetic patients. The data were entered into Microsoft
Access 2013 and was transported to Stata version 12.0 for analysis. Statistical
significant was set at 0.05
Majority of the respondents (99.0%) acknowledged the fact
that type 2 DM can be managed by treatment compliance with medications, diet
planning, exercises, monitoring and injury prevention management. Also, most of
the clients mentioned factors such as accessibility of KATH (28.5%),
registration with NHIS (94.3%), medications covered by NHIS (62.2%), ability to
afford medications not covered by the NHIS (26.1%) as perceived factors
influencing treatment compliance. Finally, there was a significant relationship
between socio-demographic characteristics such as educational level of the
respondents and their compliance to diet (p-value=0.03), medication (0.01) and
injury prevention (p-value=0.03). Also the relationship between occupational
status of the diabetics (p-value=0.01) as socio-demographic characteristic and
compliance to medication was statistically significant.
Conclusion and
Recommendation
Accessibility of KATH, registration with NHIS,
medications covered by NHIS, clients’ ability to afford medications not covered
by NHIS were found to be factors influencing treatment compliance from the
perspective of clients. Therefore, the need to create support fund by the
support organizations to assist diabetes patients in the purchase of
non-insured medications.
CHAPTER ONE: INTRODUCTION
1.0 Background of the study
Diabetes mellitus (DM) is a
lifelong advancing metabolic disorder delineated by an increase in blood
glucose level (Shrivastava et al., 2013). This is mainly due to absolute or
relative deficiency of insulin hormone which could result in extensive damage to
most of the systems in the body especially the nerves and blood vessels
(Shrivastava et al., 2013). DM has been classified into two main types namely;
type 1 insulin dependent diabetes mellitus and type 2, non-insulin dependent
diabetes mellitus (Thent et al., 2013).
Worldwide, 347 million people have
diabetes and type 2 diabetes makes up about 90% (WHO, 2013). The World Health
Organization (WHO) has projected it to be the seventh leading cause of death by
2030 (WHO, 2013). In addition, the WHO has estimated that about 80% of people
suffering from DM live in the low and middle income countries like Ghana (WHO,
2013). In Africa, the prevalence is increasing dramatically with estimated rate
of 10.4 million people (WHO, 2013). Ghana has about 4million people who have
been affected by diabetes mellitus (G.N.A, 2012) and the national prevalence
for diabetes in 2013 was 3.35% (International Diabetes Federation, 2013)
Compliance to healthcare is defined
as the extent to which a patient’s behavior in terms of taking medication,
executing the lifestyle changes, undergoing medical test or keeping appointment
with the physician coincides with the healthcare provider’s recommendations for
health and medical advice (Khan et al., 2012). Research suggests that compliance
to therapy is low among clients with type 2 diabetes mellitus (Vermeire et al.,
2009). Available evidence suggests that, vigorous management of type 2 diabetes
mellitus can reduce the morbidity and mortality of the disease by decreasing the chronic
complications that come along with it (Wens et al., 2005). Irrespective of the
benefits derived from therapy, studies in the USA have shown that recommended
glycemic goals are attained by 50% of patients which is related to decreased
compliance to treatment (Garcia-Perez et al., 2013). In relation to this, a
study conducted in Sudan revealed that about 45% of the type 2 diabetics had
poor metabolic control. This was also due to non-compliance with diet, drugs
and lack of education on the condition (Bos and Agyemang, 2013).
Compliance to treatment in patients
with type 2 diabetes mellitus is dependent upon a number of factors, including
those specific to the patient, to the provider, and to the treatment (David,
2012). Non-compliance to therapy is thus not restricted to client’s failure to
take prescribed medication. It also encompasses their refusal to change their
lifestyle, carrying out prescribed investigations and adhering to review
appointments. A study carried out in Nigeria to assess the factors that
influence compliance to oral hypoglycemic revealed that factors like
forgetfulness, high cost and fear of side effects contributed to non-compliance
to treatment (Adisa et al., 2009). Thus, the problem of poor adherence to
therapy is a very complex one as it is multifaceted. In Ghana, available
evidence indicates that, complications which often result in the death and
disability of type 2 diabetics can be attributed to poor compliance to
treatment and late diagnosis, making DM the eleventh top cause of death in the
country (WHO, 2013).
Records available at the KATH
Biostatistics Unit (2010) indicate that diabetes featured prominently among the
top 10 causes of admission and death. Irrespective of the numerous efforts made
by health care workers to reduce the burden the disease imposes on clients,
lots of complications and death are still recorded at KATH. This may be due to
a low level of compliance to treatment regimen.
However, the contributing factors for clients’ compliance to their treatment
regimen have not been fully exploited. This has necessitated the conduct of a
study to assess the factors that influence compliance to treatment among type 2
diabetics.
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