Illness and medication beliefs among elderly Kuwaiti patients with type 2 diabetes in primary health care setting in Kuwait: a qualitative study

Kuwait is ranked as one of the top ten countries in the world in regard to the incidence of adult diabetes mellitus (DM).[1] Although there are health services in Kuwait for DM it is important to understand the beliefs that impact on the health-related behaviours of Kuwaiti diabetics. This will help identify the triggers that prompt people to seek medical advice for their condition, to understand how people take their medications, and how/where they obtain medical information. This research aimed to explore the beliefs of older DM patients’ about their condition and use of medicines in Kuwait. Ethical approval was obtained from Kuwaiti Ministry of Health Ethics Committee to conduct semi-structured inter-views with type two DM patients. A topic guide, developed from the objectives of the study was used to guide the inter-views. Participants were recruited from the primary healthcare diabetic clinics pharmacy by the researcher (MA). A sampling frame was employed in the recruitment process, whereby every fifth patient who met the inclusion criteria was invited to participate in the study. The inclusion criteria were: type two DM for >6 months, living in Kuwait, age 50and over, and receiving oral hypoglycaemic medications (but not insulin). Informed consent was obtained from all participants. Interviews were audio-recorded and conducted inArabic. Interviews were transcribed verbatim and analysed using thematic analysis.[2]Interviews were conducted with 15 patients (7 males) and lasted between 20 and 40 minutes. Nine themes emerged rom the data: causes of diabetes, behaviour toward medication, attitude to control diabetes, views about medicine, views about doctors and pharmacists, medication reminders, sources of information and support, social gatherings for men or women and social behaviour related to social gatherings. This paper reports the strongest theme “behaviour towards medication.” Within this theme participants described wanting only the best treatment which related to evaluating diabetic medications according to their trade name, preferences for medicines originating from western over middle-eastern countries and the original medicines packaging over hospital packaging: ‘honestly, if the Glucophage wasn’t made in Germany I wouldn’t consider to take it’. Participants’ narratives revealed that patients trust the doctor’s but not the pharmacist’s medicines advice. Patients also described hoarding and stock piling medicines after the Iraqi invasion, during which time there had been no access to medicines, as well as sharing DM medicine between husband and wife or amongst neighbours and friends. This is the first qualitative study to explore the social and cultural beliefs of diabetic patients’ illness and medicine-taking behaviour in Kuwait. However, it is recognised that this is a small study which cannot be generalised to the wider population. Future work will include investigating whether these views are prevalent amongst a wider diabetic population. An understanding of how the illness and medication beliefs held by Kuwaiti DM patients influences their health behaviours will be helpful in identifying ways of shaping their behaviour through targeted interventions to promote a healthier lifestyle and improved DM management.1. International Diabetes Federation. IDF Diabetes Atlas, 6th edn. Brussels, Belgium: International Diabetes Federation,2013.2. Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Research in Psychology 2006; 3(2):77–101.