Government and private sector cooperation on security of critical information infrastructures

A Research Report submitted to the Faculty of Management, University of the Witwatersrand, in 50% fulfilment of the requirements for the Degree of Master of Management in Public Policy (in the field of Security).Information and Communications Technologies (ICTs), in particular interconnected computer and related digital systems, create opportunities for innovation, competitiveness and economic growth. These technologies also expose key sectors of the economy such as banking, telecommunications, manufacturing, emergency services, transportation, energy, and social services to new security risks and threats. This security challenge has given rise to a need for the adoption of appropriate strategies to secure critical information systems commonly referred to as Critical Information Infrastructures or CIIs. The European Union defines CIIs as ICT systems that are critical and essential for the operation of Critical Infrastructures, such as telecommunications, computers, the internet, and communications satellites. The African Union has defined CIIs as the cyber infrastructures essential to vital services for public safety, economic stability, national security, international stability, and the sustainability and restoration of critical cyberspace. Given their complexity and sophistication, CIIs are increasingly owned or operated by the private sector, and governments generally purchase these services on behalf of the general public. This interdependence between the public and private sectors calls for structured co-operation aimed at ensuring the security and uninterrupted availability of CIIs. This study examines the extent to which South Africa’s public policies for securing CIIs promote co-operation between the government and the private sector. It includes a literature review which shows that policy aimed at promoting and regulating public-private cooperation is a key element of efforts to secure CIIs and combat cybercrime in Europe, the Americas and Asia. The report also shows that the Council of Europe, through the Budapest Convention, has played a central role in creating a legal framework for combating cybercrime and promoting public- private cooperation on cybersecurity. Government and private sector cooperation on security of Critical information Infrastructures Page 11 of 80 Research also shows that not much has been done in Africa to combat cybercrime. Some initiatives have been undertaken by Senegal, Morocco, South Africa and Mauritius. These countries are members of the Budapest Convention, and participated in initiatives of the Council of Europe in their capacity as members of the Convention. In 2014, the AU adopted the AU Convention on Cyber Security and Personal Data Protection. This convention has only been signed by eight of 54 African countries, and has not entered into force because it has not been ratified by the required number of countries. This means that there is no valid instrument for promoting cooperation on cyber security in Africa. Since 2002, the South African government has adopted various policies and laws aimed at promoting cooperation with the private sector. However, there is no evidence of these policies or legislation being implemented. The research also shows that the government has failed to develop a consistent strategy for implementing policy in this field. In 2015, the government approved the National Cybersecurity Policy Framework (NCPF), which calls for public–private partnerships and cooperation. However, the research shows that it has not adopted a strategy that will allow this approach to succeed. In this regard, the research report points to the 5C protocol as a useful guide to successful policy implementation. In interviews conducted for this study, senior government officials acknowledge that, as in many other areas of governance, good policy has been made, but implementation is lagging. The study concludes with recommendations for improving cyber security in South Africa. These include fast-tracking the Cybersecurity and Cybercrimes Bill, which has been tabled in Parliament; developing and institutionalising a policy implementation framework in line with the 5C protocol; and developing the required skills and capacity to institutionalise and structure cooperation between the government the private sector in identifying and protecting CIIs, and pursuing a regional approach to cybersecurityGR201

A family based intervention to manage type 2 Diabetes in patients from lower socio-economic background

Background The quality of care in the management of type 2 diabetes has a significant impact on glycaemic control and quality of life of patients. Recent research in developing countries aiming to establish the factors that influence the quality of care of patients with type 2 diabetes has shown that poor adherence to medication and resistance to behavior change is associated with poor glycaemic control, development of complications and increased health care utilization in patients with type 2 diabetes. Factors contributing to quality of care have been thus far stated as the willingness of a patient to take control of the disease, good communication between the clinician and the patient to improve the patient‟s understanding and environmental factors. Environmental factors include the socioeconomic status and health system which determine health care utilization. There has been an improvement in the models of care for type 2 diabetes in which the use of diabetes self-management education strategies as described by the National Standards of Diabetes Management is the most recommended worldwide. South Africa has also adopted some of these strategies and drew guidelines for the management of type 2 diabetes in South Africa which are contained in National Health Policy document published in 2007. This study aimed to establish the effects a family based intervention which used diabetes self management education strategies in the management of type 2 diabetes in patients from poor socioeconomic backgrounds. Objectives The objectives of this thesis were: 1. to determine the demographic background (including socio-economic status (SES)) of patients with type 2 diabetes from lower socio-economic at Dr George Mukhari hospital. 2. to determine the availability of diabetes education programmes at Dr George Mukhari hospital. 3. to assess the appropriateness of the existing diabetic education programmes at Dr George Mukhari hospital. 4. to determine the level of knowledge of patients from lower socio-economic backgrounds with type 2 diabetes at Dr George Mukhari hospital about the management of the disease. 5. to determine the effects of a family based education and exercise intervention on the control of the levels of random blood results on the following parameters: i. HbA1c ii. Blood glucose iii. Lipogram 6. to determine the impact of a family based education and exercise intervention on the health related quality of life of patients with type 2 diabetes at Dr George Mukhari hospital. 7. to determine the factors that affect the management of diabetes in patients with type 2 diabetes at Dr George Mukhari hospital. Four studies were conducted to address the above seven objectives. The steps below were followed in sequence to answer the specified objectives as described below: Methods Two preliminary studies were conducted to develop a knowledge questionnaire and to test the validity and reliability of a developed knowledge questionnaire and an internationally validated health related quality of life tool, (DIMS). To answer objectives 1 and 2, stated above, a qualitative approach where data were collected using focus groups and in-depth interviews was used. This approach was explored to establish the opinions of both patients and the management team regarding the medical management and services provided to treat patients with type 2 diabetes. A total of 10 patients and 13 members of the management team took part in the study. Qualitative survey methodology was followed to interpret the data. Five themes emerged from the qualitative data and these were used to develop a quantitative tool, a diabetes knowledge questionnaire which was used in the study population. Following this approach, a quantitative approach was used to determine the validity and reliability of a developed diabetes knowledge questionnaire and an internationally standardised Diabetes Impact Measurement Scale (DIMS). A total of 25 participants with type 2 diabetes took part in this study. Participants were selected from the clinic using a sample of convenience and they answered both questionnaires one after another. Cronbach‟s α coefficient was used to test the internal consistency that is the homogeneity of the questionnaire items. The test-retest reliability of the questionnaires was assessed by calculating the intraclass correlation coefficient (ICC). The two valid and reliable questionnaires were used to gather demographic characteristics of patients with type 2 diabetes consulting at Dr George Mukhari Hospital. To answer objectives 3 and 4, as stated above, a cross sectional descriptive study, where a total of 135 black participants with type 2 diabetes, aged between 28 to 70 years were recruited from a population with type 2 diabetes consulting at Dr George Mukhari hospital. Participants were selected using simple random sampling. Both the knowledge questionnaire and DIMS were administered to all participants at the same time to establish the demographic characteristics. Descriptive statistics were used to interpret data. Findings of this study were used as needs analysis for interventions that are needed to address the problems of this population. To answer objectives 5, 6 and 7, as stated above, a prospective single blinded randomized controlled trial was used. A total of 135 patients with type 2 diabetes were randomized into three groups after determining their demographic data. The family supported group which selected a family member who was called once a month also engaged in a home walking and education programme plus the usual care given at the hospital; the no family supported group, only had education and home walking plus the usual care given at the hospital; and the control group, only got the usual care given at the hospital. Patients‟ baseline characteristics and health status were determined using a diabetes knowledge questionnaire and the Diabetes Impact Measurement Scale (DIMS). The intervention lasted for six months and there was a further six months follow up during which time there was no intervention. All outcome measures were evaluated at baseline, after six months of intervention and after 12 months (six months of no intervention).Data were collected from August 2008 – February 2010. Groups were compared using an ANOVA. A multivariate logistic regression analysis was done to establish the effects of the intervention. Results Five themes emerged from the patients‟ and the professionals‟ focus groups. These were knowledge through health communication, education, behaviour change, support and patient-centered approach. These themes guided the domains of the developed knowledge questionnaire. Cronbach‟s α coefficient for all standardized items for the knowledge questionnaire, ranged between 55% and 69%, (95% Ci, 0.54 ; 0.69), indicating good validity. Intraclass correlation coefficient ranged between 69 % and 71%, indicating good reliability. The total score for DIMS ranged from 0. 62 to 0.71 for Cronbach‟s α coefficient and 0.63 to 0.70 for intraclass correlation coefficient also indicating good validity and reliability. The results of the cross sectional study to determine demographic backgrounds showed that there were more females than males diagnosed with type 2 diabetes. Female patients with type 2 diabetes consulting at Dr George Mukhari hospital were obese and male patients are overweight. All participants came from lower socioeconomic backgrounds and were sedentary. Education levels showed that participants had low schooling levels, (the majority of patients had a grade 11). The knowledge scores showed that there were diabetes education programmes, however these programmes were not appropriately conducted when comparing them to the guidelines recommended by the National Standards of Diabetes Self-Management Education Strategies and the South African National Health Policy. All participants had poor glycaemic and poor health related quality of life. These results showed poor quality of care at Dr George Mukhari hospital. A randomized control trial showed that groups were similar at baselines, (p>0.05). Following the six months intervention, the knowledge scores improved significantly in all groups but better in the family supported group. Health related quality of life also improved compared to baseline. Blood pressure and resting pulse did not change. The distance walked improved significantly at six months and 12 months compared to baseline, (p<0.05) but there were no significant differences between groups. There were significant improvements in total cholesterol, and LDL-C, after 6 months and again after 12 months in all groups, but better in the family supported group,(p<0.05). Health related quality of life; HDL-C and triglycerides not significant statistically even though the results on symptoms of the health related quality of life improved after the six months intervention compared to baseline. The findings of the multivariate logistic regression showed that group1 (family support) had a reduced risk of poor glycaemic control (OR= 0.58), whilst group 2 (no family group) showed a higher risk of poor glycaemic control (OR=1.1). Again for random blood glucose, similar effect was also confirmed, group 1 showed a reduced risk of poor glycaemic control (OR=0.64) and group 2 showed a higher risk of poor glycaemic control (OR=1.5). These results were not significant statistically. Conclusion The results from the qualitative approach showed that despite the psychosocial problems that were raised by patients when diagnosed with type 2 diabetes, participants did not think of diabetes as a lifelong disease that needs understanding and control. Therefore it is important to reinforce the understanding of these patients through health communication, encourage behaviour change by encouraging physical activity and adherence to recommended diet. Individual patient‟s environmental backgrounds should be considered because patients are unique. These results were used to design a diabetes knowledge questionnaire that was used to gather demographic data. Reliability study showed that the developed knowledge questionnaire and DIMS were good and reliable questionnaires to use in patients with type 2 diabetes consulting at Dr George Mukhari hospital. The demographic study suggested that patients with type 2 diabetes consulting at Dr George Mukhari hospital had poor glycaemic control and poor health related quality of life; this indicated poor quality of care. The randomised control trial showed that a 12 months family based intervention improved knowledge, distance walked and lipids except HDL-C and triglycerides in patients with family support. This intervention showed that this intervention can improve self-care behaviours and its effects can be sustained for 12 months

Peace support operations in sub-Saharan Africa: lived experiences of emergency care providers during external deployment

Military emergency medical care in support of mission personnel in operational areas serves as a vital element of peace support operations, as it ensures the maintenance of the human resources deployed in mission areas. Although the South African National Defence Force is facing significant financial constraints, it is becoming increasingly mobile, as South Africa continues to pledge military and diplomatic assistance in the African continent to maintain peace and stability, promote development and provide security. Consequently, when deployed abroad, military emergency care providers face unique challenges.The aim of this paper is to describe the lived experiences of Gauteng-based emergency care providers in delivering emergency medical care amid resource constraints during external deployment. The descriptions were extracted from a larger study titled “exploring lived experiences of Gauteng-based military pre-hospital emergency care providers during external deployment”. The research was conducted using a qualitative, exploratory research design and was guided by a phenomenological approach.The findings indicate that Gauteng-based military emergency care providers often did not have enough equipment or appropriate transportation to perform their duties during external deployment. As a result, they are hindered from providing quality care to ill and injured patients.Keywords: Military experiences, external deployment, emergency medical car

Rehabilitation of HIV-associated neurocognitive disorder : a systematic scoping review of available interventions

OBJECTIVE : Strong healthcare systems require rich rehabilitation protocols for improving the outcomes of disabling ailments such as HIV-associated neurocognitive disorder (HAND). Currently, the rehabilitative interventions for HAND are unknown. We thus reviewed the putative rehabilitative interventions for HAND and evaluated their post-treatment outcomes. METHODS : This is a systematic scoping review of articles published in English, between 2009 and 2019. The review was guided by the PRISMA extension for scoping reviews. We searched for articles in PubMed, MEDLINE, Cochrane Library, CINAHL, Academic Search Complete and PsycINFO. Data were selected and extracted according to predesigned eligibility criteria using a standardised data extraction table. We appraised the methodological quality of the included studies using the Mixed Method Appraisal Tool. RESULTS : We identified 423 records, which were screened for eligibility. Twenty two articles were identified, representing a sample of 2795 PLWHIV, who were on average 47 ± 8 years old, with 13 ± 3 years of education. From the reviewed literature, we identified two putative rehabilitative intervention options for HAND, namely cognitive training otherwise known as psycho-cognitive training, and physical activity interventions. All articles reporting on cognitive training for HAND showed improved post-treatment performance, while two of the six interventional physical activity studies recorded improved post-treatment cognitive performance. DISCUSSION : There are limited rehabilitative options available for HAND. Psycho-cognitive training appears to be an effective intervention for HAND, however, the conditions of far-transfer effects need to be set forth. There is insufficient evidence available to support the use of physical activity for HAND thus warranting further research. REGISTRATION : The review protocol was registered with Open Science Framework (OSF) registry. The registration DOI:10.17605/OSF.IO/RWQCF.The University Pretoria Doctoral Research Bursary.https://www.tandfonline.com/loi/ramh20hj2023Physiotherap

Physiological effects of physical activity on neurocognitive function in people living with HIV : a systematic review of intervention and observational studies

The inadequacy of antiretroviral therapy in the treatment of HIV-associated neurocognitive disorders paves a way for regular physical activity as a lifestyle modification alternative. However, uncertainty exists among scholars regarding the use of physical activity as a means of managing cognitive disorders among HIV-seropositive individuals. The objective of the review was to examine the potential therapeutic value of physical activity intervention in the rehabilitation of people living with HIV (PLWHIV) experiencing cognitive disorders. Undertaken in this study was a systematic literature review by narrative and quantitative synthesis examining studies from 2000 to 2019. Data sources for the review included the following electronic databases: Medline, PubMed, Cochrane Library, CINAHL (The Cumulative Index to Nursing and Allied Health Literature), Academic Search Complete, PsycINFO and relevant reference lists. The eligibility criteria for the selected studies included in the review were interventional and observational studies, which investigated the interaction of physical activity and cognitive function in adult PLWHIV. Fourteen studies met the inclusion criteria. The study outcomes were cognitive function, aerobic fitness and sociodemographic characteristics. Meta-analyses were executed using RevMan 5.3 and MedCalc, with alpha set at 0.05. A total of 2516 PLWHIV with a mean age of 54±8 years and education, 13±2 years participated in the studies reviewed. Men constituted a greater percentage (60%) of the study participants. Physical activity was not superior to control over cognitive function (Z=0.86; p=0.39; Tau2=61.79 and I2=94%). However, there was a significant correlation between physical activity and neurocognitive function (r=0.26; p<0.05). It was concluded that physical activity was not superior to control over cognitive function in PLWHIV with no reported cognitive deficit.https://www.ajol.info/index.php/ajpherdam2022Physiotherap

Impact of HIV‑associated cognitive impairment on functional independence, frailty and quality of life in the modern era: a meta‑analysis

HIV-associated neurocognitive disorder (HAND) is an important sequela of HIV infection. Combined antiretroviral therapy (cART) has improved the health outcomes of many people living with HIV but has given rise to a less severe but limiting form of HAND. The study aimed to evaluate the impact of HAND on medication adherence, activities of daily living (ADL), quality of life and frailty. This systematic review adheres to the guidelines for Preferred Reporting Items for Systematic Reviews and Meta-Analyses. We searched MEDLINE, PubMed, CINAHL, Academic Search Complete, and PsycINFO online databases. Studies were included if they examined the relationship between HAND and medication adherence, ADL, quality of life and frailty, and were conducted between 1997 and 2021. We used a random-efects meta-analysis model to assess the impact of HAND on outcome variables. Forty papers, totaling 11,540 participants, were included in the narrative and quantitative syntheses. Cognitive impairment was associated with poorer medication adherence (r= 0.601, CI 0.338 to 0.776, p = 0.001, I 2 = 94.66). Cognitive impairment did not infuence ADL (r = 0.167, CI-0.215 to 0.505, p = 0.393) and quality of life (r = 0.244, CI 0.117 to 0.548, p = 0.182). In the cART era, HAND appears to be associated with adherence to medication, which may infuence future health outcomes. In PLWHIV who are adherent to cART, cognitive impairment does not appear to interfere with ADL and quality of life.The National Student Financial Aid Scheme (NSFAS) via the University Pretoria Doctoral Research Bursary.https://www.nature.com/srepPhysiotherap

Aerobic exercise in HIV-associated neurocognitive disorders : protocol for a randomized controlled trial

BACKGROUND : Since the introduction of antiretroviral therapy (ART), the incidence of HIV-associated dementia has drastically fallen. Despite using ART, people living with HIV continue to experience less severe but limiting forms of HIV-associated neurocognitive disorder (HAND). People living with HIV who are on ART and experiencing symptoms of HAND may benefit from aerobic exercise. OBJECTIVE : This protocol describes a randomized controlled trial designed to determine the effects of a 12-week aerobic exercise program on HAND in Southeastern Nigeria. METHODS : At least 68 patients diagnosed with HAND will be randomly placed into either an aerobic exercise group or control group. Patients in the aerobic exercise group will perform a moderate intensity workout on a stationary bicycle ergometer, 3 times a week for 12 weeks. We will measure the primary outcomes including neurocognitive performance, prevalence of HAND, viral load, and CD4 count. We will evaluate postexercise neurocognitive performance using reliable neuropsychological tests relevant to people living with HIV, in line with the Frascati criteria. We will assess secondary outcomes such as quality of life, activity limitation, and social participation using the World Health Organization Quality of Life (WHOQOL)-Brief, and the Oxford Participation and Activities questionnaire. We will use exploratory statistics to test the data for normality and homogeneity. We will analyze the effect of the exercise program on HAND using relative risk (RR) and absolute risk reduction (number needed to treat). Analysis of covariance will be run to estimate the effect of exercise on quality of life and activity and participation level. RESULTS : This funded trial was approved by the Institutional Review Board in May 2020. The protocol was approved on June 15, 2020. Enrollment commenced in January 2021 and was completed in May 2021. Over 60% of the participants were recruited at the time of first submission to JMIR Mental Health. Data curation is still ongoing; hence, data analysis is yet to be executed. Study outcomes are expected to be published in March 2022. CONCLUSIONS : This is a protocol for a randomized controlled trial that aims to evaluate the effect of a 12-week aerobic exercise program on HAND in Southeastern Nigeria.SUPPLEMENTARY MATERIALS : APPENDIX 1. Beck Depression Inventory.APPENDIX 2. Alcohol Use Disorder Identification Test (AUDIT).APPENDIX 3. Drug Abuse Screening Test.APPENDIX 4. International HIV Dementia Scale.APPENDIX 5. Controlled Oral Word Association Test (COWAT) (Verbal Fluency Test).APPENDIX 6. Hopkin Verbal Learning Test-Revised.APPENDIX 7. Trail Making Test A & B.APPENDIX 8. Digit span test.APPENDIX 9. Lawton Instrumental Activities of Daily Living (IADL) scale.APPENDIX 10. The World Health Organization Quality of Life (WHOQoL) Bref.APPENDIX 11. Oxford Participation and Activities Questionnaire (Ox-PAQ).APPENDIX 12. Physical Activity Readiness Questionnaire.APPENDIX 13. Adverse events form.The National Student Financial Aid Scheme (NSFAS) via the University Pretoria Doctoral Research Bursary.http://www.researchprotocols.orgPhysiotherap

Normative scores for select neuropsychological battery tests for the detection of HIV‑associated neurocognitive disorder amongst Nigerians

BACKGROUND : The study aimed to derive socio‑demographic–corrected norms for selecting neuropsychological (NP) battery tests for people living with HIV (PLWHIV) in Nigeria. This cross‑sectional study was conducted amongst patients who attended the general outpatient clinic and junior staff of the University of Nigeria Teaching Hospital (UNTH), Ituku‑Ozalla. AIMS AND OBJECTIVES : To determine the normative scores for select neuropsychological battery test for the detection of neurocognitive disorder amongst Nigerians PLWHIV. A sample of 92 individuals received voluntary HIV testing. METHODS : Eligibility criteria were being HIV negative, aged 18–64 years and formal education. We undertook a brief neuromedical examination to identify putative exclusion criteria. We sampled four NP tests covering seven cognitive domains and the motor speed component of the International HIV Dementia Scale (IHDS‑MS). We presented the normative scores using statistics of mean, median, standard deviation (SD), kurtosis and skewness. RESULTS : All the participants were Nigerians aged 18–64 years. Most (74.1%) of the participants were females. The mean and median ages of the participants were 42.6 ± 11.42 years and 44 years, respectively. The effect of gender on NP performance was limited to the digit span test (DST)‑forwards, while education affected all expect IHDS‑MS and DST‑backwards. The cut‑off scores for defining mild and severe impairment varied (moving from 1SD to 2SD) for all cognitive domains except for IHDS‑MS and DST. CONCLUSIONS : With these preliminary normative scores, it will be easier to identify and classify the severity of neurocognitive impairment amongst PLWHIV in Nigeria, thus facilitating the goal of keeping HIV‑associated dementia to a minimum. The lack of variability in the IHDS‑MS and DST is unfavourable.http://www.npmj.orgam2023Physiotherap

Meta-analysis of factors affecting prevalence estimates of HIV-associated neurocognitive disorder in sub-Saharan Africa

Successful treatment of HIV with anti-retroviral therapy (ART) is resulting in more people living with HIV-associated neurocognitive disorder (HAND). In sub-Saharan Africa, this calls for strategic planning and judicious allocation of scarce resources, which requires an accurate estimate of the prevalence of HAND. Estimates of the prevalence of HAND in sub-Saharan Africa vary greatly, between 18.8% and 88.3%. This variability may be explained by factors such as different diagnostic approach, neuromedical examination, ART status, sampling method, substance abuse, assessors’ qualification, depression and outcome measure. Different methods of diagnosing HAND, different outcome measures and non-random sampling techniques make it almost impossible to accurately estimate the prevalence of HAND in subSaharan Africa, often resulting in overestimation of the burden of disease. Consumers of health research should consider certain study characteristics and exercise appropriate caution when interpreting burden of disease in sub-Saharan Africa, especially when pursuing policy shift. Underestimating the prevalence of HAND will certainly affect the capacity and speed of containment, while overestimating will draw unnecessary attention and result in the misallocation of scarce resources. Significance: • The high prevalence of HAND in sub-Saharan Africa as estimated in this review calls for further research on the impact of HAND on activities of daily living and putative therapeutic modalities. • We highlight which study characteristics should be critically checked when using prevalence estimates for the purpose of health policy and distribution of scarce resources in sub-Saharan Africa. • By favouring certain factors, this review will guide HIV health researchers in which techniques should be used to estimate the burden of HAND. These factors may also apply to estimating the burden of other diseases in sub-Saharan Africa.University of Pretoria.https://sajs.co.zaPhysiotherap

A systematic review of qualitative research on the contributory factors leading to medicine-related problems from the perspectives of adult patients with cardiovascular diseases and diabetes mellitus

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/Objectives: To synthesise contributing factors leading to medicine-related problems (MRPs) in adult patients with cardiovascular diseases and/or diabetes mellitus from their perspectives. Design: A systematic literature review of qualitative studies regarding the contributory factors leading to MRPs, medication errors and non-adherence, followed by a thematic synthesis of the studies. Data sources: We screened Pubmed, EMBASE, ISI Web of Knowledge, PsycInfo, International Pharmaceutical Abstract and PsycExtra for qualitative studies (interviews, focus groups and questionnaires of a qualitative nature). Review methods: Thematic synthesis was achieved by coding and developing themes from the findings of qualitative studies. Results: The synthesis yielded 21 studies that satisfied the inclusion and exclusion criteria. Three themes emerged that involved contributing factors to MRPs: patient-related factors including socioeconomic factors (beliefs, feeling victimised, history of the condition, lack of finance, lack of motivation and low self-esteem) and lifestyle factors (diet, lack of exercise/time to see the doctor, obesity, smoking and stress), medicine-related factors (belief in natural remedies, fear of medicine, lack of belief in medicines, lack of knowledge, non-adherence and polypharmacy) and condition-related factors (lack of knowledge/understanding, fear of condition and its complications, and lack of control). Conclusions: MRPs represent a major health threat, especially among adult patients with cardiovascular diseases and/or diabetes mellitus. The patients' perspectives uncovered hidden factors that could cause and/or contribute to MRPs in these groups of patients.Peer reviewedFinal Published versio