The household financial burden of Diabetes Mellitus and its effect on adherence and beliefs abouts medicines among patients followed in primary care settings in a Sousse governorate, Tunisia

BACKGROUND: Diabetes Mellitus (DM) represents a significant public health challenge on a global scale, with rising prevalence rates and substantial economic burdens. The current study aimed to measure DM related Out-of-Pocket Costs among Tunisian patients and its effect on adherence to treatment and beliefs about medicines. METHODS: A cross-sectional study was conducted from May to July 2023 in basic health facilities in Sousse governorate, Tunisia. For data collection, we used the Arabic version of self-report scale "The Cost for Patients Questionnaire" in order to measure Health-Related Out-of-Pocket Costs. Assessment of patients' adherence to diabetes medications was made using the eight-item Morisky Medication Adherence Scale (MMAS-8). The third part included a self-reported questionnaire to measure patients' perceptions of medication; the Beliefs about Medicines Questionnaire (BMQ-specific). RESULTS: A total of 273 patients responded to the questionnaire from 8 Basic Health Center (BHC) in Sousse. The mean age of the patients was 60 ± 11,3 years, with extremes ranging from 28 to 86 years and Females predominance, with a sex ratio equal to 0.73. The study revealed that the median duration of diabetes among patients was 6 years, with (IQR) of [3-15] years. Among the respondents, 39.3% reported having paid employment, with a median salary equal to 600 Tunisian Dinars and (IQR) of [250-900]. Patients had a median direct medical cost of 75 TND (IQR: [20-170]). The median indirect medical cost for patients was 8 TND (IQR: [2.7-19.75]). Which gives a total of annual cost of 94.59 USD....( abstract truncated at 250 words).