Memory matters: Forgetfulness as a key barrier to medication adherence in rural Indonesian diabetes management

Introduction: Medication adherence is crucial for managing diabetes mellitus (DM), a significant health concern globally and in Indonesia. Sociocultural factors in rural Indonesian settings can uniquely influence adherence, yet are often underexplored. This study aimed to investigate medication adherence and its influencing factors among DM patients in the rural Ratahan Community Health Center. Methods: A mixed-methods design was employed. The quantitative phase involved a cross-sectional survey of 40 DM patients using the Morisky Medication Adherence Scale-8 (MMAS-8) and a questionnaire on sociodemographic and clinical characteristics. Spearman's correlation analyzed relationships between characteristics, MMAS-8 items, and adherence levels. The qualitative phase involved thematic analysis of semi-structured interviews with three purposefully selected patients representing high, medium, and low adherence to explore their experiences and influencing factors. Results: The majority of respondents exhibited medium (62.5%) medication adherence. Forgetfulness, indicated by significant positive correlations between specific MMAS-8 items (forgetting medication, forgetting when traveling, forgetting yesterday) and lower overall adherence (p<0.01), emerged as a key challenge. Qualitative findings corroborated this, with patients frequently citing forgetfulness despite employing coping mechanisms like alarms and family reminders. Social support, particularly from family and religious figures, appeared to positively influence adherence. Conclusion: Forgetfulness is a significant barrier to medication adherence among DM patients in rural Ratahan. Interventions should focus on simple, personalized reminders and leverage strong family support networks prevalent in this Indonesian rural context. Addressing practical memory challenges, rather than intentional non-adherence, is crucial for improving medication management in this community