Document Type : Original Article


1 Department of Health Promotion and Education, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

2 Department of Cardiology, Cardiovascular Intervention Research Center, Cardio‑Oncology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran

3 Department of Internal Medicine, School of Medicine Endocrinology and Metabolism Research Center Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran

4 Department of Health Education and Health Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

5 Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran


BACKGROUND: Treatment adherence is one of the behaviors associated with type 2 diabetes that
predicts whether it will be successfully treated or develop complications and become uncontrolled.
This study aimed to determine factors affecting nonadherence to treatment among diabetic patients
with limited health literacy from the perspectives of patients, their families, and healthcare providers.
MATERIALS AND METHODS: This qualitative study with a content analysis approach was conducted
on 84 eligible type 2 diabetes patients with limited health literacy and poor adherence to treatment,
as well as their families and healthcare providers using a purposive sampling method, in Kerman city
in 2021. Interviews were conducted using a semistructured interview guide with a broad, open‑ended
question to provide a general history of the disease separately. The interviewer asked participants
to identify the perceived barriers to treatment nonadherence. Each interview lasted 45–60 min.
MAXQDA version 20 and inductive content analysis were used to code and analyze extracted data.
RESULTS: Four major themes emerged from the patients’ perspectives as “financial problems,”
“individual factors,” “problems related to medication availability,” and “healthcare providers’ poor
practices.” Two major themes were classified from the perspective of patients’ families as “financial
problems” and “Individual factors,” and four major themes were identified from the viewpoint of
healthcare providers including “financial problems,” “individual factors,” “scarcity and medication
availability,” and “poor practice of the healthcare provider.” These mentioned barriers were confirmed
regarding treatment nonadherence among study participants.
CONCLUSION: Study findings revealed different factors of treatment nonadherence among diabetic
patients with limited health literacy. Therefore, these factors should be considered in tailoring
promotive educational and supportive interventions. Considering the importance of adherence to
treatment patients, planning empowerment family‑based interventions focusing on health literacy
improvement seems necessary.


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