Psychological distress and its influence on medication adherence among patients with co-morbid hypertension and diabetes: an explanatory sequential mixed-methods study

Background: Poor adherence to medication is generally an important concern throughout the world, especially in people with co-morbid hypertension and diabetes, and more so when psychological distress levels are high. This study investigated the impact of psychological distress and its correlates on medication adherence, explored patient views, and focused on informing the development of a contextually adapted psychosocial intervention. Methods: An explanatory sequential mixed-methods design was employed. The quantitative phase involved 328 patients with co-morbid hypertension and diabetes attending the Pentecost Hospital, Madina, Ghana. Adherence to medication, the primary outcome variable, was measured using the Medication Adherence Report Scale (MARS-5), while the main explanatory variable, psychological distress, was measured using the Brief Symptom Inventory-18. Logistic regression analyses revealed predictors of each outcome. The qualitative phase involved in-depth interviews conducted among 28 participants with focus on non-adherence and psychological distress. Results: The majority of the participants were female (n = 215; 65.56%) and above 60 years (n = 250; 76.21%). 37.8%(n = 124) of participants were non-adherent, and 27.7%(n = 91) experienced psychological distress. Those without psychological distress had a significantly twice greater likelihood of medication adherence than those with distress (AOR: 2.11; 95% CI: 1.15, 3.85; p = 0.016). The thematic findings also showed that emotional exhaustion, financial problems and complexity of regimen were major barriers, whereas family support, faith, and encouragement from provider acted as facilitators for adherence. Conclusion: In co-morbid hypertension and diabetes patients, psychological distress is associated with medication adherence. Integrating psychosocial support, such as family engagement, and health provider follow-up, into chronic disease management could enhance adherence and improve clinical outcomes in this population.