INVESTIGATION OF FINANCIAL CONSTRAINTS AND ITS EFFECTS ON DRUG ADHERENCE OF DIABETIC PATIENTS ATTENDING CLINIC IN UBTH, BENIN CITY

Abstract

This study examined the effect of financial constraints and socioeconomic factors on drug adherence among diabetic patients attending the University of Benin Teaching Hospital (UBTH). It employed a cross-sectional survey research design to assess how economic and social variables influence patients' compliance with prescribed medications. A structured questionnaire was used to collect data from a sample of 333 respondents selected from the diabetic clinic at UBTH. The data obtained were analyzed using the Statistical Package for the Social Sciences (SPSS) version 27. Descriptive statistics were used to present the demographic distribution and levels of drug adherence, while the one-sample t-test was employed to test the research hypotheses. The results showed that financial constraints significantly influenced patients' ability to adhere to their drug regimens. Many participants reported challenges affording their medications due to income limitations and competing financial demands. Additionally, the study found a significant association between income level and drug adherence, with those earning higher incomes exhibiting better adherence patterns. Socioeconomic variables such as educational attainment and employment status also played a role in influencing medication compliance, as patients with higher education levels and stable employment were more likely to understand and follow prescribed treatment plans. The study concluded that financial and socioeconomic barriers substantially hinder medication adherence among diabetic patients. It recommended interventions such as subsidized healthcare services, expansion of health insurance schemes, public health education, and economic empowerment programs to improve drug adherence and diabetes outcomes. Addressing these underlying challenges is essential for reducing complications and enhancing the quality of life for diabetic patients. These findings contribute to a deeper understanding of how social and economic realities impact chronic disease management in Nigeria and offer practical implications for healthcare providers and policymakers (Fasanu et al., 2024; Oguoma et al., 2025; NHIA, 2025; Sapkota et al., 2024).

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Diabetes mellitus is a chronic metabolic disorder that manifests in elevated blood glucose levels (hyperglycemia) due to either insufficient insulin production, impaired insulin action, or a combination of both mechanisms (International Diabetes Federation [IDF], 2024). The disease is broadly categorized into Type 1 and Type 2 diabetes, with the latter accounting for over 90% of all cases globally. Over recent decades, diabetes has transitioned from a relatively rare disease to a significant global public health concern. According to the International Diabetes Federation (IDF), over 537 million adults were living with diabetes in 2021, and this number is projected to rise to 783 million by the year 2045 if current trends persist (IDF, 2024).

The burden of diabetes is particularly profound in low- and middle-income countries (LMICs), including Nigeria. These nations often grapple with fragile health systems, limited diagnostic capacity, and inadequate access to essential medicines, making disease management challenging (Oguoma et al., 2025). In Nigeria, the prevalence of diabetes has steadily increased due to urbanization, sedentary lifestyles, poor dietary habits, and increasing rates of obesity (Fasanu et al., 2024). Despite increased awareness of the condition, many patients are diagnosed late, often after complications have set in. Early and consistent intervention, especially through pharmacological treatment, is essential for mitigating the disease’s long-term impacts.

Effective management of diabetes involves a multifaceted approach, including lifestyle modifications (such as diet and exercise), blood glucose monitoring, regular clinical evaluations, and most importantly, adherence to prescribed medications (American Diabetes Association [ADA], 2025). Medication adherence is pivotal in preventing acute complications like hyperglycemia and hypoglycemia, as well as chronic complications such as diabetic neuropathy, nephropathy, retinopathy, and cardiovascular disease (Lam & Fresco, 2025). However, achieving optimal adherence remains a persistent challenge among patients in both developed and developing countries.

In Nigeria, the challenge of medication adherence is exacerbated by financial constraints. Unlike high-income countries where health insurance systems often cover the costs of chronic illness treatments, most Nigerians bear the full financial burden of their healthcare, including medications, laboratory tests, and clinic visits (National Health Insurance Authority [NHIA], 2025). Nigeria's health financing system is characterized by a high degree of out-of-pocket (OOP) expenditure, which accounts for over 76% of total health spending (NHIA, 2025). This financial model is particularly detrimental to individuals with chronic illnesses like diabetes, which require sustained and often costly care.

At tertiary health institutions such as the University of Benin Teaching Hospital (UBTH) in Benin City, a significant proportion of diabetic patients come from low-income backgrounds. These individuals often struggle to afford routine medical care, leading to medication rationing, dose skipping, and, in severe cases, complete abandonment of treatment (Oguoma et al., 2025). Patients are frequently faced with the tough decision of choosing between meeting basic family needs and purchasing life-saving medications (Uloko et al., 2024). This phenomenon is not only detrimental to individual health but also contributes to a growing burden on the national health system due to preventable complications and increased hospital admissions.

Several empirical studies have highlighted the negative impact of financial hardship on treatment adherence. A qualitative study by Adeloye et al. (2024) revealed that diabetic patients often discontinue or reduce medication usage due to the high cost of drugs and lack of supportive social services. Similarly, research by Fasanu et al. (2024) identified financial constraints as a primary reason for delayed clinic attendance and inconsistent use of prescribed therapies among hospitalized diabetes patients. In another study conducted in northern Nigeria, physician therapeutic practices and patient compliance were significantly influenced by patients' ability to afford medications (Uloko et al., 2024). These findings underscore the critical role of socioeconomic factors in diabetes care.

Even when medications are available, their affordability remains a barrier. The prices of oral hypoglycemic agents and insulin therapies in Nigeria are not subsidized for most patients, and the lack of functional health insurance schemes for the informal sector means that many must finance their treatment entirely out-of-pocket (NHIA, 2025). Consequently, the high cost of medication often results in suboptimal glycemic control, increased risk of complications, and poorer quality of life for affected individuals (Sapkota et al., 2024).

The UBTH, being a referral center for several states in southern Nigeria, receives a diverse population of diabetic patients. Many of these patients present with advanced disease stages due to delays in diagnosis and treatment, often linked to the unaffordability of consistent care (Oguoma et al., 2025). The financial demands of managing diabetes—ranging from drug costs to transport fares and laboratory fees—can be overwhelming. For example, some patients may reduce their insulin dose to extend its duration or skip follow-up appointments to save money, thereby compromising their treatment outcomes (Lam & Fresco, 2025).

Despite the critical implications of financial constraints on drug adherence, there is a noticeable gap in local research specifically examining this relationship in tertiary healthcare settings like UBTH. Existing literature has tended to generalize the factors affecting adherence without isolating the economic dimension, particularly within institutional frameworks where the potential for policy intervention is strongest. Therefore, a targeted investigation into how financial difficulties influence adherence among diabetic patients in UBTH can yield valuable insights for improving health service delivery.

Understanding the interplay between financial hardship and medication non-adherence can also inform the development of effective intervention strategies. For example, hospital-based subsidy programs, expansion of community health insurance schemes, and the provision of free or low-cost essential medications are possible approaches to improve adherence (ADA, 2025). Additionally, counseling and education programs can help patients understand the importance of prioritizing medication and attending regular clinical visits, even in the face of financial strain (Adeloye et al., 2024).

Moreover, identifying the specific cost-related challenges faced by diabetic patients can assist healthcare providers and policymakers in creating more supportive environments that mitigate the risk of treatment abandonment. A comprehensive response will not only improve health outcomes but also reduce the long-term economic burden of diabetes on the healthcare system and society at large.

1.2 Statement of the Problem

Diabetes mellitus is a chronic disease requiring lifelong management through consistent medication use, lifestyle modifications, and regular clinical follow-ups. Despite advances in treatment protocols, poor medication adherence continues to compromise the health outcomes of diabetic patients, especially in low- and middle-income countries like Nigeria (Lam & Fresco, 2025). Among the numerous factors influencing adherence, financial constraints remain one of the most pervasive and debilitating challenges (Fasanu et al., 2024; Uloko et al., 2024).

In Nigeria, the burden of out-of-pocket health expenditure is exceptionally high. Most patients do not have access to functional health insurance schemes, thereby financing their healthcare entirely on personal income (NHIA, 2025). This is particularly concerning in the case of diabetes, which requires the sustained purchase of medications, diagnostic tests, and regular hospital visits. Patients at tertiary hospitals such as the University of Benin Teaching Hospital (UBTH) often face the dilemma of choosing between essential living expenses and purchasing medications (Oguoma et al., 2025). As a result, many engage in partial adherence strategies, such as dose skipping or self-modified treatment plans, which increase the risk of complications like neuropathy, retinopathy, and cardiovascular disease (Sapkota et al., 2024; IDF, 2024).

Several studies have examined the general barriers to drug adherence among diabetic populations in Nigeria and other developing contexts. For instance, Adeloye et al. (2024) identified a correlation between low socioeconomic status and non-adherence among patients with both diabetes and hypertension. Similarly, Uloko et al. (2024) highlighted the link between poverty and treatment default in diabetic patients in northern Nigeria. However, these studies often generalize financial constraints without examining them as a primary determinant, and few have focused specifically on tertiary care institutions like UBTH, which serve as referral centers for complex cases and diverse socioeconomic backgrounds.

Furthermore, existing literature seldom explores patients’ personal narratives and specific cost burdens such as transport, medication prices, and laboratory investigations which are critical to understanding how financial barriers manifest in real-world scenarios (Adeloye et al., 2024; Oguoma et al., 2025). This gap limits the development of context-specific interventions or policy frameworks aimed at improving adherence through financial support mechanisms.

Thus, there is an urgent need to investigate the extent to which financial constraints affect medication adherence among diabetic patients attending clinics at UBTH. Filling this gap can inform policy reforms, enhance patient-centered care, and reduce diabetes-related morbidity and mortality in Nigeria.

1.3 Objectives of the Study

The main objective of this study is to investigate the effect of financial constraints on drug adherence among diabetic patients attending the clinic at the University of Benin Teaching Hospital (UBTH), Benin City.

The specific objectives are:

1. To assess the level of drug adherence among diabetic patients attending the clinic at UBTH.
2. To determine the extent to which financial constraints affect drug adherence among these patients.
3. To examine other socioeconomic factors (e.g., income level, employment status, and education) that influence medication adherence in diabetic patients.

1.4 Research Questions/Hypotheses

Research Questions The study seeks to answer the following research questions:

1. What is the level of drug adherence among diabetic patients attending the UBTH clinic?
2. To what extent do financial constraints influence drug adherence in these patients?
3. What other socioeconomic factors are associated with drug adherence among diabetic patients at UBTH?

Research Hypotheses To guide the investigation, the following hypotheses are proposed:

1. There is no significant relationship between financial constraints and drug adherence among diabetic patients in UBTH.
2. There is no significant association between income level and medication adherence among diabetic patients.
3. Socioeconomic factors such as employment status and education level do not significantly influence drug adherence.

1.5 Significance of the Study

This study holds significant relevance for a wide range of stakeholders within the healthcare sector, particularly in the context of chronic disease management in low-resource settings such as Nigeria. For healthcare providers, the research offers critical insights into the socioeconomic and financial factors that serve as barriers to effective diabetes management. While much focus is often placed on clinical treatment, non-medical determinants such as affordability and access to medications are frequently overlooked. By identifying and analyzing the impact of financial constraints on drug adherence, the study will enable healthcare professionals to adopt more patient-centered care approaches that consider patients’ financial realities when recommending treatment plans (ADA, 2025).

Policy makers also stand to benefit from the outcomes of this research. In many parts of Nigeria, the burden of healthcare costs is borne directly by patients through out-of-pocket spending. The study’s findings can provide evidence-based guidance for designing interventions aimed at reducing this financial burden. This may include the expansion of health insurance coverage to include chronic disease management or the implementation of subsidy programs targeting low-income patients. Insights from the study can also help inform policies around drug pricing and availability, which are critical issues in diabetes care (NHIA, 2025).

For patients and their families, the study can raise awareness about the importance of medication adherence and the long-term risks associated with poor compliance. Understanding how financial difficulties contribute to non-adherence can empower families to make more informed decisions regarding household budgeting and prioritization of health needs. Additionally, the findings can help patients advocate for more support from governmental and non-governmental sources, including community-based health financing initiatives (Oguoma et al., 2025).

Researchers and academicians will also find value in the study as it contributes to the relatively limited body of knowledge concerning drug adherence and financial hardship in sub-Saharan African contexts. While several international studies have investigated adherence behavior, there is a gap in region-specific evidence, especially within tertiary healthcare institutions like the University of Benin Teaching Hospital (UBTH). This research not only fills that gap but also serves as a reference point for future studies examining the intersection of economic status and chronic disease management (Sapkota et al., 2024).

Ultimately, the study’s implications extend beyond the immediate findings, offering actionable insights that can drive systemic improvements in diabetes care and overall public health in Nigeria.

1.6 Scope of the Study

This study is limited to diabetic patients attending the diabetes clinic at the University of Benin Teaching Hospital (UBTH), Benin City. The research focuses specifically on examining how financial constraints influence medication adherence among these patients. It also considers other socioeconomic factors that may affect adherence such as income, education, and employment status. The study does not cover other chronic illnesses or healthcare institutions outside UBTH.

1.7 Operational Definition of Terms

• Drug Adherence: The extent to which a patient takes their medications as prescribed by their healthcare provider. This includes dose, timing, and frequency (Lam & Fresco, 2025).
• Financial Constraints: Limitations or challenges that individuals face in meeting their monetary obligations, particularly related to healthcare expenses such as medications, transportation, or hospital bills (NHIA, 2025).
• Diabetic Patients: Individuals who have been medically diagnosed with diabetes mellitus and are receiving treatment at the UBTH clinic.
• Socioeconomic Factors: Elements such as income level, educational attainment, and employment status that influence an individual’s economic and social position, potentially affecting health behaviors (Adeloye et al., 2024).
• University of Benin Teaching Hospital (UBTH): A federal tertiary health institution in Benin City, Edo State, Nigeria, providing specialized care, including treatment for diabetes.
• Chronic Illness: A long-lasting health condition that requires ongoing medical attention and management, such as diabetes (IDF, 2024).
• Out-of-Pocket Expenditure: Payments made by individuals directly to healthcare providers without reimbursement from health insurance (NHIA, 2025).
• Medication Rationing: The practice of reducing dosage or skipping medications to extend the duration of a prescription, usually due to financial hardship (Uloko et al., 2024).