Thesis:

Predictors of non-adherence to type ii diabetes management among adult inmates in Machakos county prisons, Kenya

Global prevalence of type II diabetes has been up surging since the year 2014 with statistics noting a likelihood of recording 693 million people diabetic by the year 2045 as reported by Cho et al., (2018). While the management of Type II diabetes continues to experience progressive changes, non-adherence with medications has emerged as a threat that could jeopardize public health gains. The incarcerated population best captures the 21st-century concern, where the special group is faced with limited decision-making capabilities. The aim of this study was to establish the predictors that influence non-adherence to type II diabetes treatment among adult inmates in Machakos County Prisons. The study specific objectives were to assess how patient- level factors, provider level factors, prison environment factors and barriers of management that influence non-adherence to type II diabetes management among the adult inmates. Medication non-adherence underlies a huge economic burden, with a key concern remaining preventable health care costs. Social-cognitive, planned action and social-ecological theories were employed. The study used a facility-based, descriptive cross-sectional design to achieve the objective. Mixed methods approaches were used for data collection and analysis. The target population was the type II diabetic inmates and staff in Yatta prison and Machakos GK prisons and a sample size of 268 participants. Primary data was collected through face to face interviews using a topic guide for qualitative interviews and a key informant interview to get an expert opinion. Quantitative data was analyzed by the use of SPSS and the presentation of the data was through frequency distribution tables, bar charts, and percentages. Logistic regression analysis was used to establish the associations between independent (Socio-demographic related factors) and dependent variables. The study found that patient-related factors such as inmates’ age (p-value=0.000), level of education (p-value=0.000), home location (p-value=0.027), previous occupation (p-value=0.023), duration of hSaving type II diabetes (p-value=0.012), and Facility that provided diagnosis (p-value=0.000) had an influence on non-adherence to type II diabetes management among adult inmates. In addition, provider- related factors such as adequacy of professionals at the prison clinic (p-value=0.000) and provision of guidance and counselling to patients (p-value=0.011) had an influence on non-adherence to type II diabetes management among adult inmates. Also, prison environment factors such as requesting the court to be taken to hospital (p-value=0.015), rating of treatment received in the prison clinic (p-value=0.001), government commitment in addressing Type II diabetes (p-value=0.003) and bribery to receive treatment in a health facility of choice (p-value=0.043) significantly influenced non-adherence to type II diabetes management. Barriers to effective type II management include missing prescribed drugs in the clinic (p-value=0.031), side effects (p-value=0.005), feeling the dose given is high (p-value=0.009) and complexity of drug (p-value=0.008). The study recommends that the Ministry of Health in collaboration with the Kenya Prisons Service should conduct awareness on symptoms, risk factors, consequences of type II diabetes management and conditions associated with type II diabetes.