Perceptions and experiences of taking oral medications for the treatment of type 2 diabetes mellitus: A systematic review and meta-synthesis of qualitative studies

Problem

Poor adherence to oral medications for Type 2 diabetes (T2DM) is common and associated with negative health outcomes and higher healthcare costs. Identifying modifiable factors associated with non-adherence remains a challenge, with only depression and medication cost shown to be consistently associated with non-adherence to T2DM medication across studies. Developing effective interventions requires a better understanding of medication taking behaviour in Type 2 DM.Qualitative research can help understand complex behaviours in context by emphasising the perceptions and experiences of participants. Although individual qualitative studies can offer valuable insights, bringing together a body of qualitative literature can facilitate the development of over-arching insights that go beyond individual study findings. The aim of this work was to conduct a systematic review and meta-synthesis to explore patients’ perceptions and experiences of taking oral medications for T2DM across qualitative studies.

Approach

Cinahl, EMBASE, Medline and PsycINFO databases were searched in 2014 to identify qualitative studies exploring patients’ perceptions or experiences of taking oral medications for the management of T2DM. 787 abstracts were identified and double-screened for inclusion. Key concepts and themes were extracted, appraised for quality, and synthesised using meta-ethnography.

Findings

Nine studies were included. Analysis of primary study findings were used to develop three higher-order constructs that moved beyond the results of individual studies. The first construct, "Medications for diabetes: A necessary evil", outlines how patients’ negative perceptions of medication risks co-exist with a resounding view that medications are beneficial. "Passive Patients but Active Experimenters" highlights the contrast between patients’ passive acceptance of medication prescriptions and the urge to actively experiment and adjust doses to optimise medication use in daily life. Finally, "Taking oral medication for Type 2 DM: A unique context" describes features specific to the Type 2 DM medication experience, including lack of symptoms and the perceived relationship between medication and diet, that impact on adherence.

Consequences

Medication taking for Type 2 DM is a unique adherence context, which may require condition-specific intervention. Our findings indicate patients understand the need for medications but adjust dosage and timing in line with their own beliefs. Our review also suggests the potential to acknowledge patient preferences in the development of management strategies during the consultation and highlights an opportunity to direct the motivation evident in patients’ experimentation towards potentially more beneficial medication taking behaviours.