Submission ID 130755
| Issue/Objective | Non-communicable diseases (NCDs) are ubiquitous and increasingly prevalent across low- and middle-income countries (LMICs). Medication non-adherence and complex care-seeking experiences influence NCD management in many LMIC contexts. The objectives of this study were to (1) explore the structural, macro-level factors shaping medication adherence and interrelated care-seeking behaviours (i.e., together considered as 'therapeutic itineraries') among individuals with NCDs in the Philippines; and (2) identify and characterize the strategic actions taken by health care workers, NCD patients, and their social networks to support medication adherence and broader NCD management. |
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| Methodology/Approach | This research was conducted in collaboration with International Care Ministries, a Philippines-based non-governmental organization. From July to August 2025, semi-structured interviews (n = 115) were conducted among individuals with NCDs, members of their social networks, and health care workers in Leyte, Philippines. Interviews focused on participants' 'therapeutic itineraries' for NCD care, the role of social networks therein, and health care worker perspectives on NCD management. Interviews were audio-recorded and transcribed, then analyzed thematically using a constant comparative method. |
| Results | The following intersecting, macro-level factors influenced participants' NCD therapeutic itineraries: lack of free medication and sporadic distribution across a decentralized health system; poverty; a complex ecosystem of social welfare programs with variable implementation across municipalities and coverage gaps; and 'pharmacy deserts' in rural and remote communities. Individuals were disincentivized to access formal health services amid medication shortages and relied on self-treatment with herbal medicines or medication-sharing among social networks. Material, social, and emotional support within social networks facilitated medication adherence and formal care-seeking. Health care workers 'rationed' how free NCD medication was distributed to optimize supply and expand coverage across their patient population. |
| Discussion/Conclusion | This study provides insight into the complexity of NCD management in the Philippines and intersecting structural factors that shape individuals' therapeutic itineraries. Ultimately, these findings contribute to understanding how and where, across the care pathway, strategic actions by health care workers, and broader health interventions by governmental and non-governmental actors, may be most effective in supporting NCD management within the Philippines. |
| Presenters and Affiliations | Laura Jane Brubacher University of Waterloo Monica Bustos University of Waterloo Hannah Rayel University of Waterloo Warren Dodd University of Waterloo |
