CHAPTER IV ANALYSIS AND INTERPRETATION OF DATA

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1 CHAPTER IV ANALYSIS AND INTERPRETATION OF DATA This chapter deals with analysis and interpretation of data collected from 1286 people in the rural and urban area diagnosed and getting drugs for hypertension and diabetes mellitus. The relevant data was collected with the help of Morisky scale, demographic performa, modified Srivastava s socioeconomic scale, scale on knowledge, medical complexity, social relationships and patient provider interaction. The SF-36 scale was used to assess the health status of the person as a factor influencing drug compliance. All data obtained were coded and Statistical Package for Social Sciences (SPSS 16.0 Version) was used to analyze the data. 23,535 Data were analyzed based on the objectives of the study which were to: 1. Assess the level of drug compliance and identify the factors influencing it in the selected population 2. Compare and correlate the level of drug compliance and factors influencing it among the various populations 3. Associate the level of drug compliance with selected demographic variables (age, sex, education, occupation, socio economic status, place of residence, nature of treatment) 4. Plan and evaluate the effect of an awareness programme on drug compliance. In order to fulfill the objectives the following null hypotheses were stated and tested at 0.05 level of significance. H 01 : There will be no significant relationship between the level of drug compliance and the factors influencing it. H 02 : There will be no significant difference in the level of drug compliance and the factors influencing it among various populations H 03 : There will be no significant association between level of drug compliance and selected demographic variables. Manipal University Page 64

2 H 04 : There will be no significant difference in drug compliance practices among the people after the awareness programme. During the analysis, the data were reduced to an interpretable form to summarize the findings, to test the hypotheses and to establish the relationship between variables. ORGANIZATION OF THE FINDINGS The analysis of data is organized and presented under the following headings: Section 1: Demographic characteristics of the samples Section 2: Level of drug compliance Section 3: Nature of disease and treatment Section 4: Description of factors influencing drug compliance Section 5: Relationship between drug compliance and factors influencing drug compliance Section 6: Association between drug compliance and selected variables. Section 7: Difference in Level of drug compliance before and after teaching Section -1: Demographic characteristics A sample of 1286 people diagnosed and under treatment with hypertension and diabetes mellitus from Malpe, Athradhy, Marne and Herebettu, Udupi district were taken using purposive sampling method. Demographic characteristics had variables such as age, sex and socioeconomic status. Demographic characteristics are described in the Table 10. Manipal University Page 65

3 Table-10.Frequency and percentage distribution of demographic characteristics (N =1286) Sample characteristics Age and above Area Rural (n=684) Urban (n=602) Frequency Percentage Frequency Percentage Sex Male Female Socio Economic status Low Medium High The data represented in Table-10 show that, out of 1286 subjects, 684 (53.19%) belonged to rural area and 602 (46.81%) belonged to urban area.246 (42.69%) belonged to years of age in rural area and in urban area 182(30.23%) belonged to years. In both areas most of the samples were females i.e. 388 (56.73%) and 318 (52.82%) respectively. In rural 413(60.38%) belonged to the low socioeconomic status and in urban 312(51.83%) belonged to the medium category. Manipal University Page 66

4 Section -2: Level of drug compliance The sample were classified as low, medium and sure adherence to medication based on the details of Morisky scale. Table -11 Frequency and percentage distribution of Level of drug compliance (N=1286) Level of Drug Area Compliance Rural (n=684) Urban (n=602) Frequency Percentage Frequency Percentage Sure Adherence Medium Adherence Low Adherence The data in Table-11 describes the sample in terms of their level of drug compliance. In rural area 540(78.95%) were adhering to drugs were as in urban area only 418(69.44%) were adhering to the drugs. Section -3: Nature of disease and treatment The history of drug intake was collected. This section identified the samples in terms of diabetes mellitus, hypertension and the drugs taken by them; it also found the system of medicine followed by the people. Manipal University Page 67

5 Table -12.Frequency and percentage distribution of Nature of disease and treatment (N=1286) Nature of disease and treatment Disease Hypertension Diabetes mellitus Both Rural (n=684) Frequency Area Urban (n=602) Percentage Frequency Percentage System of medicine Allopathy Ayurveda Table-12 shows out of the samples in rural area 340(49.71%) were getting treatment for hypertension and in urban 283(47.01%) were getting treatment. In both areas most of the samples were following the allopathic system of medicine. Allopathy It is the system of medicine practice which treats disease by the remedies which produce effects different from those produced by the disease under treatment. It is also called conventional medicine. The term allopathy was coined by C.F.S. Hahnemann in Ayurveda-It is a Sanskrit word meaning complete knowledge for long life. It is a system of traditional medicine native to India and practiced in other parts of the world as alternative medicine. 70 The common drugs prescribed for the samples are represented in the following figures. Manipal University Page 68

6 Fig-4 Frequency distribution of drugs prescribed for hypertension N= rural hypertension urban hypertension 0 The figure shows that for hypertension aten was prescribed for 92 of rural and 97 of urban people. Combination drugs included diuretics and other classes of hypertensive drugs. Vitamin B was the supplementary drug prescribed. Fig-5 Frequency distribution of drugs prescribed for diabetes mellitus N= rural diabetes urban diabetes Figure shows that 52 of the rural and 58 of the urban people were prescribed glibenclamide and metformin was given to 51 rural and 33 urban patients. Manipal University Page 69

7 Fig-6 Frequency distribution of drugs prescribed for both diseases N= rural both urban both. Figure shows that 46 in rural and 63 in urban were receiving drugs for both the diseases while few were treated for one and had no drugs for the other. Drug names are given as reported by people from their prescriptions. Section 4: Description of factors influencing drug compliance The factors were listed from review of literature and the mean and standard deviation of the scores are presented below. Manipal University Page 70

8 Table -13.Mean and standard deviation of Factors influencing drug compliance (N=1286) Factors influencing Area Rural (n=684) Urban (n=602) Mean SD Mean SD Knowledge Medical Complexity Social Relations Husband/wife Family member Friends Patient Provider Interaction SF-36 scores Table-13 elicits that the mean and standard deviations of most of the scores were similar in the rural and urban area. Knowledge scale assessed knowledge regarding drugs, side effects score range 8-24, higher the score higher the knowledge, medical complexity was used to find the feasibility of taking the medicine, score range 12-36, lower the score higher the complexity. Social relations scale revealed who was supporting the person during disease, score range 0-24, higher the score the more supportive. Patientprovider interaction found whether the nurse. pharmacist and doctor interacted during the process of giving drugs, score range 17-51, desirable score was a higher score. Overall scores of SF-36 is given, each category had different score range. Manipal University Page 71

9 Section 5: Relationship between drug compliance and factors influencing drug compliance In order to find the relationship between drug compliance and factors influencing drug compliance the following null hypothesis was tested. H 01 : There will be no significant relationship between the level of drug compliance and the factors influencing it at 0.05 level of significance. In order to determine the relationship between drug compliance and the various factors Kruskal wallis test was used as data did not follow normality. The relationship is presented in Table 14 Table-14 Relationship between factors influencing drug compliance and level of drug compliance (N=1286) Factors influencing drug Level of drug compliance 2 df p compliance Mean ranks sure medium low knowledge <0.01 Medical complexity <0.01 Social relations Husband/wife Family member Friends Patient provider interaction SF The table shows that the factors of knowledge, medical complexity and relation of husband or wife are only significant, hence the null hypothesis is rejected for these variables and accepted for the remaining factors. In order to identify the relationship between the level of drug compliance and the factors in different populations the following null hypothesis was formulated Manipal University Page 72

10 H 02 : There will be no significant difference in the level of drug compliance and the factors influencing it among various populations at 0.05 level of significance The hypothesis was tested using chisquare test for association for the level of drug compliance and Mann WhitneyU for the factors. Table-15 Association between area and level of drug compliance (N=1286) Area Level of drug compliance 2 df p sure medium low Rural Urban <0.001 The above table shows that there is a significant association between area and level of drug compliance. Hence the null hypothesis is rejected and it is concluded that there is a significant difference in the level of drug compliance among the populations. Manipal University Page 73

11 Table-16. Relationship between areas and factors influencing drug compliance (N=1286) Factors influencing drug compliance Area Mean ranks Z p Rural Urban knowledge Medical complexity Social relations Husband/wife Family member Friends <0.001 <0.001 Patientprovider interaction SF The above table shows that there is a significant difference between the area and factors only for knowledge of medicines taken, relationship between sample and family member and friends to motivate to take medicines and the health status score SF-36..Hence the null hypothesis is rejected with respect to these factors ie there is a difference between the rural and urban populations in the factors influencing drug compliance. Section 6: Association between drug compliance and selected variables To know the association between level of drug compliance and the other variables in the study a chisquare test was done. The null hypotheses tested was H 03 : There will be no significant association between level of drug compliance and selected demographic variables Manipal University Page 74

12 Table -17. Association between demographic factors and levels of drug compliance (N=1286) Variables Level of drug compliance 2 df p Age and above Sex Male Female Socioeconomicstatus Low Medium High Disease Hypertension Diabetes mellitus Both System of medicine Allopathy Ayurveda sure medium low Manipal University Page 75

13 Medicines Prescribed Amlodipine Aten Metformin Glibenclamide DM &HT Combination HT Combination DM <0.001 Ayurveda drugs With supplements The above table-17 shows that there is an association between the disease and drug compliance, hence the null hypothesis is accepted in relation to all other variables as age, sex, socioeconomic status and system of medicine. Further a regression analysis was done with the factors associated and it is concluded that there is a relationship between knowledge (OR= 1.28, CI ,p<0.001), medical complexity (OR= 1.14,CI ,p<0.001) and the people getting drug metformin (OR=0.278,CI ,p<0.03) with sure complying of drugs. In medium compliance there was a relation with hypertension (OR=2.70,CI ,p=0.003), diabetes(or=2.84, CI ,p=0.003), knowledge (OR=1.14,CI ,p<0.001) and medical complexity (OR=1.05,CI ,p=0.16). Hence it is concluded that knowledge and medical complexity were the two factors affecting drug compliance. Manipal University Page 76

14 Section 7: Difference in Level of drug compliance before and after teaching The demographic characteristics of the people who did not comply with drug is presented in table18. Table-18. Frequency and percentage of distribution of demographic characteristics of Phase III (N =328) Sample characteristics Age and above Rural (n=144) Frequency Area Urban (n=184) Percentage Frequency Percentage Sex Male Female Socioeconomic status Low Medium High Among the people who did not comply to medicine most of them were in the age group of years in both rural and urban area. In rural it was 63(43.75%) and urban 56(30.43%). The females did not comply with drugs more than males in both groups (61.81% in rural and 54.89% in urban) and they belonged to medium socioeconomic status. Manipal University Page 77

15 Table -19.Frequency and percentage distribution of Nature of disease and treatment (N=328) Nature of disease and treatment Disease Rural (n=144) Frequency Area Urban (n=184) Percentage Frequency Percentage Hypertension Diabetes mellitus Both System of medicine Allopathy Ayurveda Medicines Prescribed Amlodipine Aten Metformin Glibenclamide DM &HT Combination HT Combination DM Ayurveda drugs With supplements Table-19 shows out of the samples not complying to drugs in rural area 73(50.69%) were getting treatment for hypertension and in urban also 87(47.28%) were getting treatment for hypertension. In both areas most of the samples were following the allopathic system of medicine. It also reveals that 22 (15.28%) in rural area who were not complying to drugs were getting amlodac but in urban the people were on aten (13.59%). Manipal University Page 78

16 Table-20 Frequency of knowledge scores pre test and post test in experimental and control group (N=328) Score Experimental Group Control Group posttest pretest posttest pretest Total To find the difference in the pretest and posttest level of drug compliance the following null hypothesis was stated H 04 There will be no significant difference in drug compliance practices among the people after the awareness programme at 0.05 level ofsignificance. Chisquare test was done between the experimental and control group and also between the pretest and posttest levels of compliance. Manipal University Page 79

17 Table -21. Association between experimental and control groups (N=328) Group Level of drug compliance 2 df p sure medium low Experimental Control <0.001 Table -22 Association between level of drug compliance in pre and post test (N=328) Pretest Level of drug compliance Posttest Sure Medium Low Medium Low df p <0.001 Both tables show that there is a significant difference between level of drug compliance after the teaching and counseling programme. Further the knowledge aspect which was relating to the need for medicine intake was also assessed in the posttest, table-23 shows the difference in knowledge scores by Wilcoxin s sign rank test. Table -23. Difference in knowledge pre and post test (N=328) Knowledge Mean ranks Z p Pretest Posttest <0.001 Table-24. Difference in knowledge between experimental and control groups (N=328) Posttest Mean ranks Man Whitney U Z p Experimental Control <0.001 Manipal University Page 80

18 Both tables show that there is a significant difference in the knowledge level. The posttest level of significance and post test knowledge was also compared using Kruskal Wallis test and the results are given below. Table -25. Relation between level of drug compliance and knowledge in posttest (N=328) Level of drug compliance Posttest 2 df p Sure Medium Low Post test knowledge <0.001 The table25 shows there is a relationship between the knowledge and level of drug compliance in posttest. With all the above it is concluded there was a difference in the level of compliance between pretest and posttest and hence the null hypothesis was rejected. Summary This chapter describes about analyses of data and interpretation of the findings of the study. The data obtained were summarized and both descriptive and inferential statistics were used for analysis. The analyses were organized under seven sections. Frequencies and percentages were used to analyze the selected demographic variables of the subjects and the nature of treatment. The factors were described in terms of mean and percentage. Various non-parametric tests and chisquare were done to elicit the relationships and association between the level of drug compliance and the factors and area. Regression analysis elicited that there is a relationship between knowledge and medical complexity and level of drug compliance. Further it was also found that an awareness programme is helpful to change the drug compliance of the people. Manipal University Page 81