Social Support, Treatment Adherence and Outcome among Hypertensive and Type 2 Diabetes Patients in Ambulatory Care Settings in southwestern Nigeria

Abstract

Objectives: To evaluate available and desired sources and types of social-support among hypertensive and type-2-diabetes (T2D) patients. Associations of medication adherence and clinical outcome with access to most available social-support and medicine affordability were subsequently investigated.

Design: Cross-sectional questionnaire-guided interview among 250-hypertensive and 200-T2D patients, and review of medical records to retrieve disease-specific clinical parameters.

Settings: University College Hospital and Ring-Road State Hospital, Ibadan, southwestern Nigeria.

Participants: Adults out-patients with hypertension, T2D, and T2D comorbid with hypertension were enrolled, while in-patients were excluded.

Results: Family source of support was the most available [hypertensive (225; 90.0%); T2D (174; 87.0%)], but government and non-governmental organisation support were largely desired, with financial support preferred, 233(93.2%) hypertensive and 190(95.0%) T2D, respectively. Adherent hypertensive patients with or without access to family support were (127; 56.4%) versus (18; 72.0%), p=0.135; while for T2D were (103; 59.2%) versus (21; 80.8%), p=0.035. Mean systolic blood pressure of hypertensive and fasting plasma glucose of T2D with access to family and financial support were better than their counterparts without access (p>0.05). Hypertensive (110; 76.4%) and T2D (87; 87.0%) participants who consistently afford medicine expenses had significantly better adherence and outcome (p<0.05).

Conclusions: Family source of support is the most accessible, but government and non-governmental organisation support were largely desired. Access to family support did not positively influence medication adherence, while access to financial support marginally impacted on outcome among hypertensive and T2D patients. However, unwavering tendency for therapy affordability significantly influenced adherence and outcome, thus, the need for expanded social-support system in order to consistently ensure improved outcome.

Funding: None declared.

Keywords: Hypertension; Out-patients; Social support system; Treatment adherence and outcome; Type 2 diabetes.