Qualitative exploration of the modifiable factors for medication adherence among subsidised and self-paying patients in Malaysia

BACKGROUND: Numerous studies have evaluated the related factors of medication adherence among patients with chronic disease. However, the factors influencing medication adherence and non-adherence among subsidised patients with chronic diseases—for whom medication costs may not be a constraint—remain unexplored. Thus, this study aims to identify and compare the potential factors that may influence subsidised and non-subsidised (i.e., self-paying) patients’ adherence to medication. METHODS: Subsidised and self-paying patients were identified at public and private healthcare institutions in three states of Malaysia. Patients were then purposively selected for semi-structured, face-to-face interviews according to their medication adherence status (including adherent and non-adherent patients), which was measured using the Medication Event Monitoring System (MEMS). Adherence was defined as having 80% or more for the percentage of days in which the dose regimen was executed as prescribed. The interview was conducted from January to August 2016 and during the interviews, patients were asked to provide reasons for their medication adherence or non-adherence. The patient interviews were audio recorded and transcribed verbatim. Data were analysed using thematic analysis with NVivo 11 software. RESULTS: Thirteen subsidised and 12 self-paying patients were interviewed. The themes found among subsidised and self-paying patients were similar. The factors that influenced adherence to medication include the ‘perceived importance of quality of life’ and ‘perceived benefit or value of the medications’. A unique factor reported by patients in this study included ‘perceived value of the money spent on medications’; more specifically, patients adhered to their medications because they valued the money spent to buy/receive the medications. CONCLUSION: Medication adherence among subsidised and self-paying patients was influenced by many factors, including a unique factor relating to their perceptions of the value of money spent on medications.