The Moderating Effect of Demographics on Patient Adherence and Beliefs

Introduction

As defined by (Sabaté, Sabaté, & others, 2003), medication adherence is “the degree to which a person's behaviour corresponds to the recommendations made by a health care provider”. It is a vital part of patient care and necessary for accomplishing proper clinical outcomes. In its report in 2003, World Health Organization reported that “increasing the effectiveness of adherence interventions may have a far greater impact on the health of the population than any improvement in specific medical treatment” (Sabaté, Organization, & others, 2001). It is reported that hospitalization rates are double for patients who do not comply with their medication. According to (Sullivan, 1990) hospital admission rates attributed to non-adherence ranged between 2.9% to 19.5%. According to (Fenton, Blyler, & Heinssen, 1997), patients take 50 to 60% of prescribed medicines. The work of (Matsui, 2013) on patients suffering from diabetes and heart disease confirms that for non-adherent patients, the frequency of emergency room visits, mortality and hospitalization rates are higher (Sabaté et al., 2003). Demographic factors have always played an essential role in every research (Vermeire, Hearnshaw, Van Royen, & Denekens, 2001). This study tries to find the moderating effect of few selected demographic factors on medication adherence and beliefs of patients suffering from different types of diseases in the State of Sikkim in India.

The adherence rate is lower for patients with chronic diseases than those with acute conditions (Osterberg & Blaschke, 2005). A strong correlation has been found between treatment procrastination and medication non-adherence (Fenton et al., 1997). Studies report that increase in duration, cost (Chapman, Yeaw, & Roberts, 2010), frequency, dose complexity (Ingersoll & Cohen, 2008) and weight gain (Beerendrakumar, Ramamoorthy, & Haridasan, 2018; Manhas et al., 2019) are positively correlated with non-adherence. The disease is aggravated when patients regularly miss their medication (Wan, Gu, & Ni, 2020). (García-Herrero, Mariscal, García-Rodríguez, & Ritzel, 2012) reported that patients falling into the category of office goers frequently fail to adhere to their medication regime because of working situations. Ensuring medication regime timing helps in recovery (Harris, Fry, & Fitzpatrick, 2019) but deferring from the scheduled time of medication is common among patients (Sharkness & Snow, 1992; Webb, Horne, & Pinching, 2001). This behaviour of patients is positively associated with non-adherence (Garaix, Stern, Lamy, Dubel, & Kamar, 2018). Approximately 50% of the patients suffering from hypothyroid in Nepal deferred from their scheduled time of medication. Missing the dose was reported for 41.49% of the patients, while 16.81% accounted for discontinuation (Shakya Shrestha, Risal, Shrestha, & Bhatta, 2018).

The research aims to find the mediating effect of demographic factors like gender, place of dwelling, education level, occupation and income level of patients on their medication adherence and beliefs. The study is empirical and tries to highlight the difference in patient adherence and beliefs in the state of Sikkim in India. Sikkim is a small hilly state in India where the predominant tribes consist of Nepalese, Bhutia and Lepchas (Gupta, Jh, Sharma, Saha, & others, 2020). Service members and business community people from various states of India have also settled in this state. There is limited literature on the beliefs and medication adherence behaviour of the inhabitants of this state. Hence, this research aims to bridge the gap.