From prescription to practice: a qualitative study of medication non-adherence in rural Tamil Nadu, India.

OBJECTIVES

To explore reasons for medication non-adherence among rural patients with diabetes and/or hypertension and to understand how health-system, personal and socio-cultural factors shape adherence behaviour.

DESIGN

Qualitative study using individual in-depth interviews

SETTING

A Rural Health and Training Centre in Thiruvallur district, Tamil Nadu, India.

PARTICIPANTS

15 adults aged ≥30 years with diabetes and/or hypertension for at least 1 year were purposively recruited from the non-communicable disease clinic. Interviews were conducted in Tamil, audio-recorded, transcribed verbatim and translated into English. Two researchers independently coded the transcripts. Sample adequacy was guided by information power and concurrent assessment of code saturation.

RESULTS

4 themes and 12 subthemes described health-system constraints, everyday routines and treatment beliefs, family relationships and emotional burden and experiences and strategies that reinforced medication use. Medication interruption occurred through three overlapping routes: structurally constrained interruption related to supply, affordability or access; unintentional interruption when routines were disrupted by work, travel or caregiving; and intentional modification based on perceived harm, symptoms or treatment need. Participants could move between interruption and renewed medication-taking as circumstances, emotional states and perceptions of risk changed. Family relationships could both support and hinder medication-taking, while symptoms and experienced or witnessed complications sometimes prompted re-engagement.

CONCLUSIONS

Medication-taking was dynamic rather than a fixed patient characteristic. Structural, unintentional and intentional interruptions require different responses. More flexible medicine supply, structured counselling that checks understanding, attention to household influences and fasting practices and recognition of emotional strain may better support long-term medication use in rural primary care.