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Adherence behavior assessment of oral antidiabetic medication use: a study of patient decisions in long-term disease management in primary health care centers in Surabaya

  • Lisa Aditama EMAIL logo , Umi Athiyah , Wahyu Utami and Abdul Rahem



Adherence to medication has an important role in the long-term management of diabetes. The Indonesian Endocrinologist Association found that of the 50% of the entire population who have been diagnosed with diabetes, two-thirds are undergoing therapy and only one-third have been achieving the intended outcomes of the drug therapy. This study aimed to identify patients’ adherence behavior and the root causes of non-adherence.


This study used a non-experimental mixed-methods approach. A total of 40 patients with type 2 diabetes mellitus (T2DM), who were part of the referral program of the National Health Care Security System (BPJS Kesehatan) were recruited by purposive sampling from 17 primary health care centers in Surabaya, Indonesia.


The adherence behavior assessment revealed non-adherence among 80% of the patients. The highest instances of non-adherence based on the percentage scores involved the following: patients forgot to take the medications (38.23%), patients preferred not to take the medications (20.59%) and the drug products were not available for the patient (14.71%). The factors influencing non-adherence included the complex instructions for taking medication, the absence of a reminder, the unwanted side effects of the drug, the feeling of repetition, the feeling that drugs were ineffective and the concern for the drug’s effects on the kidney.


The high rates of non-adherence identified in this study encourage pharmacists to implement better medication therapy management for chronic diseases. The patients’ understanding of drug therapy indications and regimens is very important in increasing the expectations of achieving effective treatment, awareness and concern for medication safety and treatment compliance.


The Adherence Behavior Questionnaire.

NoAdherence behaviorYesNo
1I need help from other people every time I read the instructions for use of my medicine
2The information written on the label is unclear, I use my own rules
3I don’t always use my medicine on time
4I am not sure how to use my medicine correctly (*)
5I don’t redeem medicine that are prescribed to be purchased at other pharmacies (if you have never experienced them, no need to answer)
6I replace my medicine with another drugs (herbs or alternative therapies)
7I save on the use of my medicine so that it is enough to use
8I only take my medicine when I feel my blood sugar level is high/rising
9When I feel dizzy, weak or unhealthy, I decide not to use my medicine without checking my blood sugar level
10I feel that my medicine caused a negative change to me, so I don’t use it
11I feel my condition does not improve with medication, so I stop it
12I am worried that my medicine will affect the kidneys, so I don’t use it regularly
13I often feel uncomfortable when using my medicine, so I don’t use it regularly
14I sometimes forget to use my medicine, because I get more than 1 drug with different instructions for use
15I sometimes forget to use my medicine, because my activities are crowded
16I sometimes forget to use my medicine, because nobody reminds me
17I sometimes forget to use my medicine because I fall asleep
18Prescription medicine are not available at the Primary Health Center, so I don’t use the medicine
19Sometimes the medicine at the Primary Health Center is lacking, I don’t go back to the Primary Health Center to get the rest of my medicine
20When my medicine is running out, I don’t buy my medicine myself at the pharmacy
21I have difficulty using medicine, because I cannot swallow or use the medicine
  1. (*) If you have a special drug, show how to use it after filling out the questionnaire.


The authors would like to thank The Ministry of Research, Technology and Higher Education of Indonesia for providing grants for the implementation of this research. The authors are also grateful for the support of the heads of the Surabaya City Health Office who have given us permission to carry out this research.

  1. Research funding: A doctoral dissertation grant from The Ministry of Research, Technology and Higher Education of Indonesia.

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: The authors declare no conflicts of interest or financial interests in any product or service mentioned in this article, including grants, gifts, or honoraria.

  4. Informed consent: Informed consent was obtained from all individuals included in this study.

  5. Ethical approval: This research has obtained permission from the Surabaya City Health Office with a permit number for research: 072/20362/436.7.2/2018.


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Received: 2019-09-07
Accepted: 2019-12-10
Published Online: 2020-01-18

© 2019 Walter de Gruyter GmbH, Berlin/Boston

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