Adherence to Antiglycemic Regimens among Diabetes Patients in Rural Nigeria: Prevalence and Contributing Factors

Abstract

Aims: To estimate adherence to antiglycaemic regimens and identify contributing factors among patients with diabetes attending rural health facilities in Nasarawa State, Nigeria. Study Design: Descriptive cross-sectional mixed-methods study. Place and Duration of Study: General Hospitals in Nasarawa Eggon, Wamba, Obi, Doma, Garaku, and Keffi, Nasarawa State, Nigeria. Registered patients from 2021 to 2025 formed the study population, and data were collected in 2025–2026. Methodology: A structured questionnaire on socio-demographic characteristics and factors affecting antiglycaemic drug use was administered to 300 registered patients. They were purposively selected from a sampling frame of 3,235, with sample size determined using the Krejcie and Morgan table, and 295 (98.3%) questionnaires were valid. Two focus group discussions (FGDs) with 41 participants (patients, doctors, nurses, and pharmacists) explored patient-, therapy-, health system-, socioeconomic-, and disease-related barriers. Questionnaire data were summarised as frequencies and percentages, and FGD data were analysed thematically. Results: Most respondents (192/295; 65.1%) believed adherence could be reliably assessed in their facility. Among those who estimated population-level adherence, 239 (81.0%) placed it at 50–80%, while 56 (19.0%) placed it at 40–65%. Behavioural factors most often linked to poor adherence were smoking/alcohol use (56.7%), poor glycaemic control practices (26.7%), physical inactivity (23.7%), and inadequate fruit/vegetable intake (14.7%). Self-medication (40.7%) and polypharmacy (26.7%) were the most common irrational drug-use patterns, and both were associated with non-adherence. FGD participants estimated that about 60% of patients adhered well to dosing and clinic attendance. They cited forgetfulness, regimen complexity, cost, distance to facilities, and inconsistent patient-provider communication as the main drivers of non-adherence. Conclusion: Perceived adherence was moderate to high, but by respondents' estimates a substantial minority of patients (one in five to two in five) fell short of consistent regimen use. This was driven by overlapping modifiable behavioural, therapy-related, and health system factors. Interventions should combine forgetfulness- and lifestyle-focused counselling with regimen simplification where clinically feasible, and with better facility access and patient-provider communication.