Treatment Non-Adherence in Type 2 Diabetes: A Qualitative Content Analysis from the Perspectives of Patients, Their Families, Physicians, and Healthcare Providers

Abstract

Background: With the rising global prevalence of type 2 diabetes and its complications, achieving glycemic control through adherence to treatment is a key goal of disease management. However, numerous socioeconomic, behavioral, and cultural factors adversely affect adherence. Objectives: This study aimed to elucidate the factors contributing to treatment nonadherence among patients with type 2 diabetes from the perspectives of patients, their families, and health care providers. Methods: A conventional qualitative content analysis based on the Graneheim and Lundman framework was conducted in Sari, northern Iran, from March to July 2025. Participants were purposively selected from Emam Hospital and health centers and included 6 physicians, 8 patients, 2 family members, and 5 healthcare providers. Data were collected through in-depth, semistructured interviews until saturation was reached. MAXQDA 10 software was used for data management. Results: The findings were organized into 3 categories and 7 subcategories: structural-institutional factors (service delivery challenges and economic challenges), sociocultural factors (gender inequalities, cultural norms, and weak support structures), and personal factors (cognitive barriers and implementation barriers). Conclusions: Treatment nonadherence in diabetes is shaped by structural-institutional, sociocultural, and personal barriers. Effective management is possible through a holistic approach that addresses these factors.