Adherence to Treatment for Non-Communicable Diseases in Rural Armenia: A Qualitative Study

Abstract Introduction Non-communicable diseases require long-term, consistent treatment, including medications and lifestyle changes. Yet, adherence to treatment remains challenging, particularly in rural settings with limited resources. This study qualitatively explored the barriers, facilitators, and needs of patients with type 2 diabetes and hypertension for adhering to their treatment regimens, from the perspective of patients and providers in rural Armenia. Methods The data were collected through focus group discussions and in-depth interviews (IDI) with patients with either one or both diseases, as well as IDIs with primary healthcare providers. In total, 64 patients and 9 providers participated. Deductive content analysis was used to identify common and diverging themes across stakeholder groups. Findings Both patients and providers identified common facilitators of treatment adherence, including effective physician-patient communication, provider follow-up, trust in the provider, family support, patient's motivation, access to free medications, and previous educational programs. Patients also noted reminder systems for taking their medications. Providers identified low health literacy among patients, financial burden, and reluctance to follow dietary recommendations as key barriers. Patients also mentioned the latter two, along with occupational challenges, forgetfulness, and seasonal weather-related limitations on physical activity. Providers expressed a need for structured patient educational programs, adherence-focused professional training, and access to insulin delivery devices for diabetic patients. Patients emphasized constant access to more effective medications, financial support for testing equipment, support groups, and better access to diabetes-friendly food. Conclusions Triangulated insights emphasized the need for system-level changes, combining medical, educational, and social support to improve long-term management of these diseases in rural settings. Key messages • The study revealed shared and unique views on barriers, facilitators, and needs for diabetes and hypertension treatment adherence among patients and providers in rural Armenia, echoing prior research. • Educational programs for patients, family members, and providers, support groups, as well as better access to treatment resources are recommended to improve outcomes of these diseases in rural areas.