What helps and hinders metformin adherence and persistence? A qualitative study exploring the views of people with type 2 diabetes.

AIM:To explore the views of people with type 2 diabetes who had initiated metformin monotherapy about what influences adherence and persistence. METHODS:We recruited participants through primary care, using purposive sampling, and undertook face-to-face, audio-recorded, semi-structured interviews with 10 Māori, 10 Pacific, and 10 non-Māori non-Pacific patients who had started metformin monotherapy for type 2 diabetes within the previous two years. A thematic analysis was undertaken using the Theory of Planned Behaviour as the overall theoretical framework. RESULTS:The perceived benefits of taking metformin included improving glycaemic control, preventing or slowing the progression of type 2 diabetes, and avoiding serious complications. Side effects (predominantly gastrointestinal) were the most commonly cited disadvantage. Participants employed a variety of strategies to help them take metformin regularly. Key reasons for initial sub-optimal adherence and persistence were side effects and not accepting the diagnosis of type 2 diabetes. Subsequently, omitting to take tablets was commonly unintentional (due to 'forgetfulness'). For many Pacific participants, changes in routine related to community and church events, or shift work, contributed to sub-optimal adherence. Some Māori participants would have preferred to use traditional medicines. CONCLUSION:We identified a number of factors within the scope of healthcare services that may assist healthcare providers to focus on, and address, some of the issues that appear to be of primary importance to people when they are prescribed metformin.