Patient and provider's perspective on barriers and facilitators for medication adherence among adult patients with cardiovascular diseases and diabetes mellitus in India: a qualitative evidence synthesis

Objective To explore the various stakeholders' perspectives on barriers and facilitators for medication adherence among patients with cardiovascular diseases (CVDs) and diabetes mellitus (DM)in India. Design Systematic review of qualitative studies. Data sources A comprehensive systematic search was conducted in Medline, Cochrane Library, Science Direct and Google Scholar from January 2010 to July 2020. We included all qualitative peer-reviewed studies, reporting barriers and facilitators of medication adherence, from India, for our current review. Data extraction and synthesis Data extraction was performed by two independent authors who also assessed the quality of included studies using the Critical Appraisal Skills Programme criteria. This qualitative evidence synthesis adhered to the enhancing transparency in reporting the synthesis of qualitative research checklist Results In total, 18 studies were included. Major barriers reported were lack of understanding about the disease, complications related to non-adherence, followed by forgetfulness, lack of family support and risk communication. Health system-related barriers such as accessibility, affordability and acceptability were also reported by majority of the studies. Creation of peer support groups, digital reminder systems, integration of native Indian systems of India, physiotherapy and geriatric clinics at the primary healthcare level and innovations in patient care were suggested to counter these barriers in medication adherence. Conclusion Such patient-specific targeted interventions need to be developed to achieve better control among patients with CVD and DM. PROSPERO registration number CRD42020199529.

Automated summary

This systematic review explored the perspectives of various stakeholders on barriers and facilitators for medication adherence among patients with cardiovascular diseases (CVDs) and diabetes mellitus (DM) in India. The results identified major barriers including lack of disease understanding, complications related to non-adherence, forgetfulness, lack of family support, and health system-related barriers such as accessibility, affordability, and acceptability. Suggestions to counter these barriers included the creation of peer support groups, digital reminder systems, integration of native Indian systems, physiotherapy and geriatric clinics, and innovations in patient care.