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

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Published Feb 15, 2026
https://doi.org/10.62438/tunismed.v103i12.5814
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Vol. 103 No. 12 (2025): Tunis Med Dec 2025

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Amel Amara
Research Laboratory “LR12ES03”, Department of Familial and Community Medicine, Faculty of Medicine of Sousse, University of Sousse, Tunisia
https://orcid.org/0000-0002-1300-8664
Nour Douss
Department of Familial and Community Medicine, Faculty of Medicine of Sousse, University of Sousse, Tunisia
Omar Khalil Ben Saad
Research Laboratory “LR12ES03”, Department of Familial and Community Medicine, Faculty of Medicine of Sousse, University of Sousse, Tunisia
Ines Aissa
Carthage Health Association
Malek Guetet
Carthage Health Association
Taib Ach
Endocrinology Departement , Farhat Hached University Hospital, Sousse, Tunisia
Ahmed Guiga
Department of Internal Medicine, Farhat Hached Hospital, Sousse, Tunisia
Rania Bannour
Research Laboratory “LR12ES03”, Department of Familial and Community Medicine, Faculty of Medicine of Sousse, University of Sousse, Tunisia
Jihene Sahli
Research Laboratory “LR12ES03”, Department of Familial and Community Medicine, Faculty of Medicine of Sousse, University of Sousse, Tunisia
Menel Mellouli
Research Laboratory “LR12ES03”, Department of Familial and Community Medicine, Faculty of Medicine of Sousse, University of Sousse, Tunisia
Mariem ELghardellou
Research Laboratory “LR12ES03”, Department of Familial and Community Medicine, Faculty of Medicine of Sousse, University of Sousse, Tunisia
Chekib Zeddini
Research Laboratory “LR12ES03”, Department of Familial and Community Medicine, Faculty of Medicine of Sousse, University of Sousse, Tunisia
Ali Mtiraoui
Research Laboratory “LR12ES03”, Department of Familial and Community Medicine, Faculty of Medicine of Sousse, University of Sousse, Tunisia

Abstract

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)

Keywords:

Diabetes, Cost, Out-Of-Pocket, Treatment, Adherence, Beliefs

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