Chauke Gloria Dunisani, Nakwafila Olivia, Chibi Buyisile, Sartorius Benn, Mashamba-Thompson Tivani
Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
Department of Public Health, School of Nursing and Public Health, University of Namibia, Oshakati Campus, Namibia.
Heliyon. 2022 Jun 15;8(6):e09716. doi: 10.1016/j.heliyon.2022.e09716. eCollection 2022 Jun.
Poor medication adherence among patients with Chronic Diseases is one of the significant health problems globally. Despite this, evidence on chronic medication adherence in low and middle-income countries is unclear.
This scoping review aimed to identify factors influencing poor medication adherence amongst patients with chronic diseases in low and middle-income countries.
We searched studies exploring factors influencing poor medication adherence amongst patients in low and middle-income countries across the following databases published between 2008 to 2018: Public or publisher Medline, Google scholar, Cumulated Index to Nursing and Allied Health Literature, Health Source, and Medline with full text via Elton B. Stephen's Company host. Methodological quality assessment of the primary studies was done as recommended by Levac Colquhoun, and O'Brien (2010) review using a Mixed-Method Appraisal Tool 2018. We reported the results following the Preferred Reporting Item for Systematic reviews and Meta-Analyses extension for Scoping Review guidelines.
From the initial 154 records screened, we identified six (6) eligible studies that presented evidence on factors influencing poor medication adherence amongst patients in low and middle-income countries. Studies included were from the following countries: Jordan, South Africa, Guatemala, Ethiopia, Indonesia, India, and Palestine. Kappa agreement of the full article screening shows that there was 76.92% agreement versus 58.12% expected by chance which constitutes a considerably good agreement between screeners (Kappa statistic = 0.45 and p-value <0.05). Of the six included studies that underwent methodological quality, five scored 100%, which is regarded as the highest score the remaining one scored between 50-75%, indicating a moderate to low risk bias overall. All included studies presented evidence on medication adherence as being in either knowledge of the diseases, attitudes towards medication taking, beliefs that a patient holds about the treatment or disease, and quality control amongst chronic diseases patients.
Our scoping review provides evidence that poor medication adherence in LMICs is influenced by a lack of knowledge, negative attitudes, and negative beliefs, leading to poor quality of life. There is limited research evidence on the effect of patients' beliefs and perceptions on medication adherence in low and middle-income countries. We call upon further research on beliefs, perceptions, and effectiveness of interventions towards chronic medication adherence in low and middle-income countries.
慢性病患者用药依从性差是全球重大的健康问题之一。尽管如此，关于低收入和中等收入国家慢性疾病用药依从性的证据仍不明确。
本综述旨在确定影响低收入和中等收入国家慢性病患者用药依从性差的因素。
我们检索了2008年至2018年期间发表在以下数据库中探索影响低收入和中等收入国家患者用药依从性差的因素的研究：公共或出版商的Medline、谷歌学术、护理及相关健康文献累积索引、健康源以及通过Elton B. Stephen公司主机获取的全文Medline。按照Levac、Colquhoun和O'Brien（2010年）的建议，使用2018年混合方法评估工具对主要研究进行方法学质量评估。我们按照系统评价和Meta分析扩展的范围综述指南的首选报告项目报告结果。
在最初筛选的154条记录中，我们确定了6项符合条件的研究，这些研究提供了关于影响低收入和中等收入国家患者用药依从性差的因素的证据。纳入的研究来自以下国家：约旦、南非、危地马拉、埃塞俄比亚、印度尼西亚、印度和巴勒斯坦。全文筛选的卡帕一致性显示，一致性为76.92%，而预期的偶然一致性为58.12%，这表明筛选者之间的一致性相当好（卡帕统计量=0.45，p值<0.05）。在接受方法学质量评估的6项纳入研究中，5项得分为100%，这被视为最高分，其余1项得分在50%-75%之间，表明总体风险偏倚为中度至低度。所有纳入研究均提供了关于用药依从性的证据，涉及对疾病的了解、对服药的态度、患者对治疗或疾病的信念以及慢性病患者的质量控制。
我们的范围综述提供了证据表明，低收入和中等收入国家用药依从性差受到知识缺乏、消极态度和消极信念的影响，导致生活质量低下。关于低收入和中等收入国家患者信念和认知对用药依从性的影响的研究证据有限。我们呼吁对低收入和中等收入国家慢性疾病用药依从性的信念、认知和干预效果进行进一步研究。
