Pharmacological adherence in Type 2 diabetes mellitus, social inequalities and technological influences in Barbados

Type 2 diabetes mellitus (T2DM) represents a critical public health burden in Barbados. Additionally, social inequalities and the evolving role of technology each intersect with T2DM management in complex ways that are poorly understood in the Caribbean context. This study aimed to explore the experiences of low socioeconomic patients living with T2DM (PLWT2DM) and their healthcare workers regarding adherence to pharmacological treatment, and the use of smartphone technology. A qualitative research design utilized purposive sampling to recruit 52 participants across five polyclinics in the highest-poverty parishes. Thirty PLWT2DM (7 male, 23 female) and 22 healthcare professionals (4 male, 18 female; including doctors, nurses, pharmacists, podiatrists and nutritionists) participated in semi-structured in-depth interviews conducted. Interviews were transcribed using a modified verbatim technique and analyzed using thematic content analysis. T2DM pharmacological adherence influencers were found to include the bio-psycho-social behaviour, barriers to treatment, and the need for a patient-centred health system. The global theme established that patient-centred T2DM management is the optimal mechanism for improving pharmacological adherence among low socioeconomic patients, who identified financial limitations, relative isolation, and psychological distress as major drivers of non-adherence. Future research should integrate technological interventions and health policy reform to ensure equitable and effective management.