Factors associated with poor adherence to type 2 diabetes medication among IDPs in Northwest Syria

Background

Chronic disease management is challenging in conflict settings where health systems are fragmented and access to care is unstable. In Northwest Syria, internally displaced persons (IDPs) live in camps where insecurity, geographic barriers, and disrupted services complicate the management of non-communicable diseases such as type 2 diabetes. This study assessed adherence to diabetes medications among Syrian IDPs in Al-Dana subdistrict camps and identified factors associated with poor adherence.

Methods

A cross-sectional study was conducted from January to March 2025 among adults with type 2 diabetes attending two outpatient centers serving IDP camps in north west of Syria. Data were collected using a structured questionnaire covering sociodemographic characteristics, clinical history, healthcare access, health literacy, and medication adherence using the Arabic Adherence to Refills and Medications Scale (ARMS). Descriptive statistics and logistic regression were used to identify associated factors.

Results

Medication adherence was low, with 99.1% showing non-adherence (mean ARMS score 21.98 ± 5.59). Higher adherence was associated with attending Al Barakeh center (AOR = 49.44; 95% CI: 14.6–167.1) and regular doctor visits and health information (AOR = 5.26; 95% CI: 2.07–13.38). Lower adherence was associated with female sex (AOR = 0.31; 95% CI: 0.14–0.70), long distance to health facilities (AOR = 0.28; 95% CI: 0.08–0.98), and medication side effects (AOR = 0.26; 95% CI: 0.09–0.72).

Conclusions

Adherence to diabetes medications among IDPs in Northwest Syria is critically low and driven by structural, geographic, and behavioral factors. Ongoing conflict is a key underlying risk factor, while female sex represents a context-specific risk. Improving healthcare access, follow-up, patient education, and community support is essential.

Key messages

• Diabetes medication adherence among IDPs in Northwest Syria is critically low (99.1% non-adherence), driven by conflict, poor access, and system disruptions.

• Improving stability, healthcare access, and patient support is essential to enhance diabetes outcomes among displaced populations in conflict-affected settings.