Association between medication adherence and quality of life of patients with diabetes and hypertension attending primary care clinics: a cross-sectional survey

  • Sarah M. KhayyatEmail author
  • Mahmoud M. A. Mohamed
  • Salwa M. Saeed Khayyat
  • Raghda S. Hyat Alhazmi
  • Mulham Fouad Korani
  • Ebtesam Bakheet Allugmani
  • Sarah Fathallah Saleh
  • Deyaa Abdulla Mansouri
  • Qasim A. Lamfon
  • Osama Mohammed Beshiri
  • Muhammad Abdul Hadi



To evaluate the association between medication adherence and quality of life (QoL) of patients with diabetes and/or hypertension attending primary care clinics.


In this cross-sectional study, patients with at least one long-term condition (hypertension or diabetes mellitus) meeting the eligibility criteria were recruited from five primary care clinics in Saudi Arabia. Arabic version of Morisky Medication Adherence Scale (MMAS-8) and the World Health Organization Quality of Life-BREF (WHOQOL-BREF) tool were used to assess medication adherence and QoL, respectively. Patients’ sociodemographic, medical and medication data were collected using a structured, pilot-tested data collection form.


Three hundred patients with a mean (± SD) age of 56.79 (12.8) years participated in the study. Fifty-eight had hypertension only, 96 had diabetes (Type 1 or 2), and 146 had both hypertension and diabetes. After adjusting for socioeconomic characteristics, multiple linear regression analysis found that adherent patients had significantly higher mean overall perception of QoL and health scores by 14.6 (P = 0.001) and 17.2 (P = 0.001) points, respectively, compared to non-adherent patients. In addition, irrespective of the type of long-term condition, adherence status was found to be an independent predictor of all QoL domains.


There is an association between medication adherence and QoL among patients with diabetes and/or hypertension attending primary care clinics. Medication adherence should be assessed and emphasised during routine clinical consultations in primary care in order to achieve the desired clinical outcomes and overall well-being of patients.


Medication adherence Quality of life Compliance Hypertension Diabetes mellitus Primary care 



The authors would like to thank all members of primary health clinics for their assistance and cooperation in patient recruitment and data collection. Authors’ gratitude also goes to all the patients who participated in the study. Thanks to Professor Donald E. Morisky for allowing us to use MMAS-8© in this study. Use of the MMAS-8© is protected by US copyright laws. Permission for use is required. A license agreement is available from Donald E. Morisky, ScD, ScM, MSPH, Professor, Department of Community Health Sciences, UCLA Fielding School of Public Health, 650 Charles E. Young Drive South, Los Angeles, CA 90095-1772,


This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Ethics approval was obtained from the Institutional Review Board (IRB) at the Faculty of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia. In addition, ethics and governance approval were also sought from the General Directorate of Health Affairs of Makkah Region, Ministry of Health, Saudi Arabia (Ref # M/47/402/2,646,280).

Informed consent

All patients completed written consent form prior to enrolment in the study.


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Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  • Sarah M. Khayyat
    • 1
    Email author
  • Mahmoud M. A. Mohamed
    • 2
  • Salwa M. Saeed Khayyat
    • 3
  • Raghda S. Hyat Alhazmi
    • 4
  • Mulham Fouad Korani
    • 3
  • Ebtesam Bakheet Allugmani
    • 3
  • Sarah Fathallah Saleh
    • 3
  • Deyaa Abdulla Mansouri
    • 4
  • Qasim A. Lamfon
    • 3
  • Osama Mohammed Beshiri
    • 4
  • Muhammad Abdul Hadi
    • 5
  1. 1.Department of Clinical Pharmacy, Faculty of PharmacyUmm Al-Qura UniversityMakkahSaudi Arabia
  2. 2.Berlin-Brandenburg Centre for Regenerative TherapiesCharite Universitatsmedizin BerlinBerlinGermany
  3. 3.Joint Program of Family MedicineMinistry of HealthMakkahSaudi Arabia
  4. 4.Public Health CentresMinistry of HealthMakkahSaudi Arabia
  5. 5.School of Pharmacy, Institute of Clinical SciencesUniversity of BirminghamBirminghamUK

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