Comparative Analysis of Patient Adherence to Oral versus Injectable Antidiabetic Medications

Thesis Abstract

The continued prevalence of type 2 diabetes mellitus (T2DM) globally underscores the critical importance of medication adherence in effectively managing the condition and preventing long-term complications. Despite the availability of various antidiabetic therapies, non-adherence remains a major challenge, particularly among patients prescribed injectable medications, which are often associated with psychological barriers and injection-related discomfort. This study aims to conduct a comprehensive comparative analysis of patient adherence rates to oral versus injectable antidiabetic medications, with the objective of identifying demographic, psychosocial, and healthcare-related factors influencing adherence behaviors. The research adopted a cross-sectional descriptive design grounded in the Health Belief Model and the Transtheoretical Model to explore adherence patterns and the determinants influencing patients’ medication-taking behaviors. The study population comprised 450 adult T2DM patients receiving treatment at outpatient clinics in an urban tertiary hospital in the country. A stratified random sampling technique was employed to ensure adequate representation of patients on oral and injectable therapies, with 225 patients selected from each group. Data collection was conducted using a structured interview questionnaire and validated adherence measurement scales, including the Morisky Medication Adherence Scale (MMAS-8) and self-reported injection adherence logs. The instruments were pretested for validity and reliability, with Cronbach’s alpha coefficients exceeding 0.75, ensuring internal consistency. Quantitative data were analyzed using descriptive statistics to summarize adherence rates, chi-square tests to examine associations between categorical variables, and multiple logistic regression models to identify predictors of adherence. Statistical significance was set at p<0.05. Thematic analysis was applied to qualitative data from open-ended questions exploring patient perceptions and barriers related to medication adherence. Ethical approval was obtained from the institutional review board, and informed consent was secured from all participants, adhering strictly to confidentiality and ethical guidelines. It is anticipated that the study will reveal that adherence rates are significantly higher among patients on oral antidiabetic medications compared to those on injectable therapies, with factors such as fear of injections, depression, perceived severity of diabetes, and access to healthcare services playing crucial roles in adherence behaviors. The findings are expected to support the hypothesis that psychological and socioeconomic barriers disproportionately impact adherence to injectable treatments, in line with the Health Belief Model’s assertions about perceived barriers influencing health behaviors. This research contributes to the existing body of knowledge by providing context-specific data on adherence disparities between oral and injectable therapies within a developing country setting, highlighting the need for targeted interventions that address patient-specific barriers. Moreover, it offers evidence-based recommendations for healthcare providers and policymakers to enhance adherence strategies, such as patient education programs focused on injection techniques and psychological support mechanisms. The study also underscores the importance of personalized treatment approaches that consider patients’ beliefs and social determinants to optimize adherence outcomes. In conclusion, this study aims to generate comprehensive insights into the determinants of medication adherence among T2DM patients, informing intervention development to improve therapeutic adherence and health outcomes. The findings will emphasize the importance of integrated behavioral and healthcare interventions tailored to address specific barriers associated with injectable therapies, ultimately contributing to improved glycemic control and reduction of diabetes-related complications. Future research should explore longitudinal approaches to assess adherence trajectories over time and evaluate the effectiveness of intervention programs designed based on identified predictors.