Patient Engagement in Treatment and its Determinants among Rural Indian Adults with Hypertension and Diabetes

Patient engagement enhances safety, improves quality, and leads to better treatment compliance and disease control, especially in chronic noncommunicable diseases. However, it continues to be poor in many developing countries. We assessed patient engagement in disease management and associated factors among people with diabetes and hypertension in a rural population of Faridabad, Haryana, India.

This community-based cross-sectional study was conducted among adults aged 30-65 years with known diabetes and/or hypertension, identified randomly from 20 villages under 10 primary health centers (PHC) in Faridabad, Haryana. Patient engagement was measured by the 20-item Patient Assessment for Chronic Illness Care (PACIC) tool with five subscales using a 5-point Likert scale administered at their homes. Socio-demographic factors and treatment seeking were also asked.

A multivariate linear regression was done using the PACIC score as the dependent variable and other socio-demographic factors and place of treatment as independent variables.

Among the 300 participants (56% women), the mean (SD) age was 51.8 (10.2) years; 64.3% were unemployed, and 31.7% were illiterate. The overall mean (SD) PACIC score was 2.1 (0.63) out of 5; domain-wise scores were patient activation (1.4), decision support (2.5), goal setting (2.2), problem solving (3.0), and follow-up (1.2). In the multivariate analysis, patients who were literate or belonged to a higher socioeconomic status had significantly higher PACIC scores, and those working as laborers or in caste-based occupations or cultivation had lower PACIC scores as compared to the unemployed.

Patient engagement in patients with diabetes and hypertension in the rural population of Haryana was low and was associated with poor literacy, occupation (laborer), and socioeconomic status.