Utilizing a 3S (strategies, source and setting) approach to understand the patient’s preferences when addressing medication non-adherence in patients with diabetes: a focus group study in a primary outpatient clinic

OBJECTIVE: Non-adherence with diabetes medicines is a challenge. Approximately 54% of patients are non-adherent with their diabetes medicines. The objective of this study was to understand patients’ preferences when addressing non-adherence based on the 3S approach—strategies (what approaches can be used in addressing non-adherence), settings (when and where should the intervention happen) and sources (who should provide the intervention). DESIGN: A focus group research design was used. SETTING: A primary outpatient clinic from an integrated healthcare system in the USA. PARTICIPANTS: Patients who were non-adherent with diabetes medicines. DATA COLLECTION: The focus group guide was based on the Medication Adherence Reasons Scale, which has 19 reasons identified for non-adherence. For each item in the scale, patients were asked for strategies that can be used in addressing that issue, the setting in which the interventions should be provided and the source to provide the interventions. DATA ANALYSIS: Open coding and content analysis. RESULTS: Two focus groups, each group having seven patients, were conducted. The major strategies identified were patient education, self-responsibility of patients, family support, reminders and societal support. The key educational needs were dealing with side effects and learning to use insulin properly, and a need for different learning styles when offering education. For the source, the major ones were physicians and pharmacists, having a continuous dialogue about the disease and medicines, and individuality in managing the disease. Respondents also recommended using a peer support group. For the setting, the patients preferred continuity of patient education throughout the disease. CONCLUSION: The 3S approach was able to elicit several recommendations from patients to improve their adherence with diabetes medicines. Educational strategies were identified as the foremost approach coming from physicians and pharmacists throughout their disease journey, in addition to peer support.