What constitutes ‘poor’ adherence to medical advice for chronic diseases? Insights from a qualitative study among hypertension and diabetes patients in urban informal settlements, Mumbai Metropolitan Region

Introduction The problem of poor adherence to medical advice in the case of non-communicable diseases, the reasons thereof, and how these are exacerbated in low- and middle-income countries (LMICs) is well-recognized. However, there is less clarity on what ‘poor’ adherence encompasses in these settings. Conventional classifications treat ‘poor’ adherence as a singular category, often disregarding its multifaceted nature. Through this study, we aimed to explore the nuances of what constitutes ‘poor’ adherence to medical advice for chronic diseases in vulnerable LMIC settings. This was done by examining the different ways in which hypertension and diabetes patients living in urban informal settlements in the Mumbai Metropolitan Region attempted to adhere to medical advice. Methods This is a descriptive qualitative study based on in-depth interviews with 26 hypertension and diabetes patients residing in three urban informal settlements in the Mumbai Metropolitan Region. Emerging patterns of adherence were coded and categorized using grounded analysis. Findings The study shows complex adherence patterns of patients who navigated the lived realities of urban informal settlements while attempting to adhere to medical advice. Hypertensive and diabetic patients in our setting adopted multiple ways of following medical advice related to medication, lifestyle changes and follow-ups. For instance, in attempting to adhere to prescribed medication, patients adjusted or skipped doses, mixed allopathic and alternative medication, switched medication without consultation with doctors, took breaks, or stopped their medications altogether. Patients also adhered well to some aspects of their medical advice and not to others. For instance, some followed dietary recommendations but did not adhere to medication advice. Conclusions By understanding the nuances and complexities of ‘poor’ adherence in urban informal settlements, the study builds an empirically grounded typology on adherence. Such a typology is useful for research and practice on improving adherence to medical advice in vulnerable LMIC settings.