ABSTRACT
Background: Medication adherence is a major aspect of managing chronic diseases, significantly influencing treatment outcomes and overall health. Effective adherence ensures that patients receive the full benefits of prescribed therapies, enhancing disease control and minimizing the risk of complications. However, barriers to medication adherence, including socioeconomic challenges, health literacy, and patient-provider communication, can undermine treatment effectiveness. Addressing these challenges is essential for improving health outcomes in individuals with chronic diseases. Objectives: The objectives of this study were to assess the knowledge, attitude, prevalence, and determinants of medication adherence among patients with chronic diseases attending the consultant outpatient department of The University of Benin Teaching Hospital. Methodology: A cross-sectional study design was conducted from October 2023 to October 2024. The study population was outpatients with chronic diseases attending the consultant outpatient department of The University of Benin Teaching Hospital. A two-stage sampling technique was used. The sample size was calculated using the formula for minimum sample size determination for a cross-sectional study design. Ethical approval was obtained from the Ethics and Research Committee, University of Benin Teaching Hospital. Data was collected using a structured self-administered questionnaire adapted and modified from the Morisky medication adherence scale (MMAS8) and the medication adherence reason scale (MARS). Data was analysed with IBM SPSS version 25.0 for analysis. The level of knowledge was grouped as good and poor knowledge, the attitude was grouped as positive and negative attitude while the prevalence was grouped as adherent or non-adherent. The level of significance was set at p < 0.05 and data presentation was done using charts, frequency tables, and prose. 15 Result: A total of 657 respondents with a mean age (SD) of 58.19 ± 16.0 years participated in this study. There was a higher proportion of females, with 354 (53.9%) of respondents being females. About all (77.6%) of the respondents were married, and the majority 407 (96.0%) of respondents practiced Christianity. Findings from the semi-structured questionnaire used in assessing knowledge revealed that the majority 604 (95.0%) had good knowledge of medication adherence and 32 (5.0%) had poor knowledge. Age, marital status and duration of treatment were significantly associated with knowledge of medication adherence (p<0.05). Level of education also appeared to be a significant predictor of knowledge of medication adherence with individuals with format education being 3.747 times more likely to have good knowledge of medication adherence. Findings from the assessment of attitude towards medication adherence revealed that most respondents, 613 (96.4%), demonstrated a positive attitude, while 23 (3.6%) had a negative attitude. Level of education significantly influenced attitude towards medication adherence (p = 0.043), with those having formal education being more likely to exhibit a positive attitude. Duration of treatment was also a significant factor (p = 0.013), as respondents treated for one year or more were more likely to have a positive attitude. However, age, sex, religion, and marital status were not significantly associated with attitude towards medication adherence (p > 0.05). Findings as regards prevalence indicate that a significant majority of respondents, 574 (90.3%), adhered to their medication, while a smaller group, 62 (9.7%), reported non-adherence. Age was identified as a significant predictor of medication adherence (p < 0.001), with older respondents (≥75 years) demonstrating the highest adherence rate (93.2%) compared to younger respondents (18-29 years) with the lowest rate (69.8%). Marital status was significantly associated with adherence (p = 0.008), with single respondents having the lowest 16 adherence (76.5%). Additionally, knowledge of medication adherence was significantly linked to adherence rates, with those possessing good knowledge showing a higher adherence rate (91.7%) compared to those with poor knowledge (69.8%) (p < 0.001). Attitude towards medication adherence also significantly influenced adherence, with a positive attitude correlating with higher adherence rates (90.7% vs. 78.3%) (p = 0.048). The assessment of factors influencing medication adherence revealed that lack of reminders (555, 87.3%), feeling well (547, 86.0%), and convenience of medication administration (542, 85.2%) were the most commonly identified barriers to adherence. Additionally, skepticism about medication necessity (530, 83.3%) and negative attitudes toward medications (521, 81.9%) significantly contributed to non-adherence. Conclusion: The study findings revealed that most respondents exhibited good knowledge of medication adherence, with younger individuals showing a higher prevalence of poor knowledge, while older respondents demonstrated better knowledge. Positive attitudes towards medication adherence were prevalent, increasing with age, and were significantly associated with education level and duration of treatment. A significant majority adhered to their medication regimens, with adherence rates also increasing with age; however, marital status was the only demographic factor associated with adherence. Notably, lack of reminders, feeling well, and the convenience of medication administration were identified as primary factors contributing to non-adherence. Keywords: Medication, Adherence, Outpatients, complications, chronic.
