Multidimensional correlates of adherence to cardiovascular treatment among patients with multimorbidity from tribal communities in South India: an exploratory cross-sectional study.

Résumé

INTRODUCTION: Tribal people in India face a growing risk of multimorbidity, primarily from cardiovascular diseases (CVD) due to changing lifestyles and unique socio-cultural and political factors. We aimed to identify treatment patterns and barriers to medication adherence for CVD. This will inform culturally sensitive implementation strategies that may improve outcomes among tribal communities.METHODS: We conducted an exploratory cross-sectional study among participants with multimorbidity in a South-Indian tribal setting. We used a structured questionnaire, guided by the Consolidated Framework for Implementation Research(CFIR), to assess comorbidities, treatment patterns, adherence and potential factors influencing adherence. Descriptive statistics and multivariable logistic regression identified correlates for medication non-adherence.RESULTS: We recruited 200 participants with a mean age of 64.6±9.71 years. The majority were female (115, 57.5%), of tribal origin (160, 80%) and had no formal education (169, 84.5%). The commonly reported comorbidities included hypertension (168, 84%) and diabetes (113, 56.5%) followed by chronic kidney disease (CKD) (47, 24%). Self-reported non-adherence to medications (missing at least one CVD pill in the past week) was reported by 120 (60%) participants. Key correlates of non-adherence identified were lower levels of education (OR 8.27, 95% CI 1.96 to 35.01, p=0.004), diabetes (2.94, 95% CI 1.04 to 8.33, p=0.04) and high pill burden (5.04, 95% CI 1.88 to 28.84, p=0.03), while social support (0.85, 95% CI 0.7 to 0.97, p=0.013) and positive illness perception (0.95, 95% CI 0.91 to 0.99, p=0.05) were positively associated with good adherence.CONCLUSION: These tribal communities face complex challenges in managing CVD and multimorbidity. Improving adherence will require developing simple, patient-centred and culturally appropriate strategies through community engagement. Simplified medication regimens, including rational fixed dose combination pills may improve adherence. Additionally, the high prevalence of CKD observed underscores the need for investigation and integration of regular CKD screening in the health system.