Abstract / Summary
Chronic disease management is challenging in conflict settings, with fragmented health care systems and unstable access to health care. In Northwest Syria, millions of internally displaced persons (IDPs) live in camps where insecurity, geographic barriers, and disrupted health care services complicate the management of noncommunicable diseases, such as type 2 diabetes mellitus. This study aimed to assess medication adherence among Syrian IDPs living in camps in Al-Dana subdistrict in Northwest Syria and to identify the factors associated with suboptimal medication adherence. This cross-sectional study was conducted between January and March 2025 among adults with type 2 diabetes mellitus attending two health centers serving IDP camps. Data were collected using a structured questionnaire assessing sociodemographic characteristics, clinical history, health care access, health literacy, and medication adherence, which was also determined using the Arabic version of the Adherence to Refills and Medications Scale (ARMS). Descriptive statistics and stepwise logistic regression modeling and adjusted odds ratios (AOR) were used to identify the factors associated with adherence. Medication adherence was low, with 99.1% of participants demonstrating some degree of nonadherence (mean ARMS score = 21.10 ± 5.59). Higher adherence was associated with attending the Albarakeh health center (AOR = 37.68; 95% CI: 13.02–132.67) and receiving encouragement through regular physician visits and access to health information (AOR = 4.732; 95% CI: 2.022–12.40). Lower adherence was associated with female sex (AOR = 0.332; 95% CI: 0.149–0.713), skipping medication due to long distances to health facilities (AOR = 0.309; 95% CI: 0.089–0.993), and discontinuing medication due to side effects (AOR = 0.280; 95% CI: 0.098–0.728). Adherence to type 2 diabetes mellitus medications among IDPs in Northwest Syria is critically low and influenced by a combination of structural, geographic, and behavioral factors. Adherence is determined primarily by structural factors, whereas patients’ demographic characteristics play a significantly smaller role in medication adherence in the cohorts in the region studied.