Adherence to Anti-Diabetic Medication, Its Associated Factors, Barriers, Facilitators and Strategies for Improvements among Adults with Type 2 Diabetes Mellitus Attending Regional Referral Facility in Eastern Uganda: a Mixed Study Design

Background Type 2 diabetes mellitus (T2DM) is the most common type of endocrine disorder among adults, accounting for 90%-95% of diabetes mellitus globally. In Uganda, non-adherence to anti-diabetic medication remains high at 38.1%. This results in complications like diabetic ketoacidosis, hyperglycemia and microvascular complications. Objective To determine the prevalence of adherence to anti-diabetic medication, its associated factors, barriers, facilitators, and strategies for improvements among adults with T2DM attending the diabetic clinic at Soroti Regional Referral Hospital. Method The study employed an explanatory sequential mixed design at SRRH. The quantitative study participants were 376 adults aged 18 years and above with T2DM, while qualitative data was collected from 15 participants with diabetes mellitus. Quantitative data was collected using semi-structured interviewer-administered questionnaires, while qualitative data was collected using in-depth interview guide. The prevalence of adherence was expressed as a percentage. Modified Poisson regression was used to determine the association, with the prevalence ratio being the measure of association for quantitative data while deductive thematic analysis was used for qualitative data. Results The prevalence of adherence medication was 51.3% (95% CI: 0.46–0.56). Factors significantly associated with adherence included: sex of the participants (aPR = 2.215, p-value < 0.001), having a family support (aPR = 2.972, p-value of < 0.001), having ever received health education (aPR = 2.522, p- value of < 0.001), and finding anti-diabetic medication always available at the hospital pharmacy (aPR = 2.194, p-value of 0.029). Qualitative findings revealed that the key barriers to adherence included financial constraints, drug stock-outs, side effects, and lack of understanding. The key facilitators included family support, health education, and regular follow-up. Participants s uggested several strategies that could improve adherence including strengthening community support, improving drug supply, and enhancing patient-provider communication. Conclusion Adherence to anti-diabetic medication remains suboptimal, with only half of the participants adhering. Both quantitative and qualitative findings underscore that family support, gender, health education, and consistent medication supply are critical determinants of adherence. To improve adherence, health facilities should implement routine adherence assessments, strengthen family engagement, ensure consistent drug availability, and provide structured, continuous health education. Integration of adherence counselling into professional training and community education programs is essential.