Factors influencing glaucoma medication adherence: A qualitative study of patients and ophthalmologists in India

Purpose: Adherence to glaucoma medication helps prevent disease progression. Barriers to adherence exist, particularly in low- and middle-income countries. We explored factors influencing medication adherence from the perspectives of patients and ophthalmologists in India. Design: Cross-sectional, qualitative study. Methods: Semi-structured interviews with a purposive patient sample prescribed intraocular pressure (IOP)-lowering eyedrops and ophthalmologists involved in glaucoma care at a tertiary center. The theoretical domains framework (TDF) of behavior change guided deductive and inductive thematic analysis of interview transcripts to identify personal, sociocultural, and environmental influences on adherence. Results: Twenty-two participants ( n = 11 patients, n = 11 ophthalmologists) were recruited. Seven TDF domains were key to patient adherence and practitioner management. Patient barriers mapped to TDF domains: Environmental context and resources (difficulties obtaining medication, lifestyle changes, hospital system issues), Memory, attention and decision processes (forgetfulness), and Skills (difficulty administering drops). Practitioner barriers related to Environmental context and resources (time constraints and medication availability). Patient enablers mapped to Social influences (family support), Knowledge (understanding glaucoma and treatments), Beliefs about consequences (perceived treatment necessity), and Behavioral regulation (establishing routines). Ophthalmologist enablers included Environmental context and resources (organizational infrastructure), Knowledge (knowing how to classify adherence, awareness of non-adherence), Skills (effective communication), Memory, attention and decision processes (tailoring patient care), Social professional role/identity (professional responsibility), and Social influences (practitioner influence). Conclusions: A complex interplay of factors influences adherence. Identifying modifiable behaviors provides a basis for developing culturally sensitive interventions to reduce barriers, enhance patient and family support, and equip practitioners with tools to manage non-adherence effectively.