Pharmacological adherence in Type 2 diabetes mellitus, social inequalities and technological influences in Barbados
Year: 2026
Type: article
Abstract: Background Type 2 diabetes mellitus (T2DM) represents a critical public health burden in Barbados, with a prevalence of 18.7% — nearly double the global average of 10.5%. Despite a universally accessible public healthcare system, pharmacological non-adherence among low socioeconomic patients remains a persistent challenge. Social inequalities, climate-related events, and the evolving role of technology each intersect with T2DM management in complex ways that are poorly understood in the Caribbean context. Objectives This study aimed to explore the phenomenological experiences of low socioeconomic patients living with T2DM (PLWT2DM) and their healthcare providers regarding adherence to pharmacological treatment, climate events, and the use of smartphone technology. Methods A qualitative research design was employed. Purposive sampling was used to recruit 52 participants across five polyclinics in the highest-poverty parishes of Barbados, identified using the 2016 Barbados Survey of Living Conditions. Thirty PLWT2DM (7 male, 23 female) and 22 healthcare professionals (including doctors, nurses, pharmacists, podiatrists and nutritionists) participated in semi-structured in-depth interviews conducted via WhatsApp during the COVID-19 pandemic. Interviews were transcribed using a modified verbatim technique and analysed using thematic content analysis with constant comparison, supported by ATLAS.ti software. Results Four basic themes emerged: (1) the bio-psycho-social behaviour of T2DM patients, (2) factors affecting treatment, including physical symptoms and use of herbal therapies, (3) barriers to treatment, and (4) recommendations for a patient-centred health system. Two organising themes were identified: the need for patient-centred care models grounded in social and behavioural theory, and a greater systemic focus on T2DM management. The global theme established that patient-centred T2DM management is the optimal mechanism for improving pharmacological adherence among low socioeconomic patients. Social inequalities — including financial limitations, relative isolation, and psychological distress — were major drivers of non-adherence. Both patients and healthcare workers demonstrated limited knowledge regarding the impact of climate events on T2DM. While technology was perceived as beneficial, elderly patients faced significant barriers to adoption. Conclusions Patient-centred T2DM management that addresses social inequalities, enhances health education, and leverages appropriate technology is essential for improving pharmacological adherence in Barbados. Future research should integrate climate-related factors, age-targeted technological interventions, and health policy reform to ensure equitable and effective chronic disease management.
Source: Scientific Reports
Authors: E. Mandeville, N. Greaves
Institution: University of the West Indies
Language: English
Subfield: Family Practice
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,690
OpenAlex ID: W7161135949