Chronic Disease Management Market Research: When Singapore Patients Don't Do What They're Told
Non-adherence is healthcare's most expensive problem. Physicians prescribe. Patients nod. Medications go untaken, lifestyle changes unmade, follow-up appointments skipped. The gap between clinical recommendation and patient behavior costs more than most treatments.
In Singapore, chronic disease prevalence is rising rapidly. According to MOH's Principal Causes of Death statistics, cardiovascular disease, cancer, and pneumonia are leading causes of mortality. HPB's National Population Health Survey shows approximately one in three Singapore residents aged 18-74 has at least one chronic condition—diabetes, hypertension, high cholesterol, or obesity.
Understanding why patients don't follow medical advice, and what would change their behavior, reveals opportunities for pharmaceutical brands, health systems, and digital health solutions that clinical research alone cannot surface.
What We're Observing
The "Feeling Fine" Problem
Many chronic conditions produce no symptoms until serious damage occurs. Patients prescribed medication for hypertension or high cholesterol often feel no different taking pills versus not taking them. Without visceral feedback, adherence feels optional.
"I only take my medication when I feel unwell" is common. The medication is meant to prevent feeling unwell—but this logic doesn't translate to daily behavior.
The Medisave Depletion Anxiety
Singapore's Medisave system, while providing financial protection, creates unexpected behavioral effects. Patients see their Medisave balance declining with each prescription refill and worry about funds remaining for "real" illness.
MOH's Chronic Disease Management Programme (CDMP) helps with costs, but patient perception often doesn't reflect actual financial burden. The anxiety about depletion affects adherence regardless of objective affordability.
The Poly Clinic Fatigue
Many chronic disease patients manage their conditions through polyclinics. While cost-effective, the experience, long waits, brief consultations, different doctors each visit, erodes engagement. Patients describe feeling like "just a number" rather than a person with a health condition.
Over time, polyclinic fatigue leads to appointment skipping. The condition isn't monitored. Deterioration goes undetected until crisis.
The Stigma Layer
Some chronic conditions carry stigma that affects care-seeking and disclosure. Diabetes in particular, associated with dietary indiscipline, creates shame. Patients may hide their condition from extended family, avoid taking medication in social settings, or resist insulin because it signals "serious" disease.
Mental health comorbidities (depression, anxiety) common in chronic disease often go entirely untreated due to stigma.
Patient Segments by Adherence Pattern
The Disciplined Compliers (15-20%) Follow medical advice consistently. Have integrated medication into daily routine. Attend all appointments. Often have experienced a health scare that motivated behavior change.
The Optimistic Adjusters (25-30%) Believe they can manage their condition through partial compliance. Take medication "most days." Skip when feeling well. Adjust dosages based on self-assessment. Believe they know their body better than guidelines do.
The Reluctant Participants (20-25%) Don't want to be "sick." Resist the patient identity. Comply minimally to satisfy family or avoid conflict with doctors. Would stop treatment if they thought no one would notice.
The Overwhelmed Non-Coper (15-20%) Have multiple conditions, complex regimens, and limited support. Miss appointments because scheduling is complicated. Miss doses because there are too many pills. Condition deteriorates through chaos rather than choice.
The Active Deniers (10-15%) Reject diagnosis or treatment. Believe Western medicine is wrong for them. Pursuing alternative approaches (TCM, diet, supplements) instead. May return to conventional medicine only after crisis.
Research Framework: Adherence Barrier Analysis
Why Patients Don't Follow Treatment Plans
| Barrier Type | Prevalence | Manifestation |
|---|---|---|
| Lack of perceived benefit | Very High | "I feel the same whether I take it or not" |
| Side effect concerns | High | "The medication makes me feel worse than the disease" |
| Regimen complexity | High | "I can't remember what to take when" |
| Cost concerns | Moderate | "I skip doses to make medication last longer" |
| Lifestyle interference | Moderate | "Taking medication during lunch meeting is awkward" |
| Belief system conflict | Moderate | "I prefer natural remedies" |
Tool: Adherence Intervention Mapping
Matching Interventions to Barrier Types
| If the Barrier Is... | Consider... | Evidence of Effectiveness |
|---|---|---|
| Lack of perceived benefit | Tangible feedback (home BP monitors, glucose tracking) | Moderate—works for some patients |
| Forgetfulness | Reminder apps, pill organizers, routine integration | Good—if barrier is purely logistical |
| Side effects | Alternative formulations, side effect management, expectation setting | Variable—depends on available alternatives |
| Cost | Generic alternatives, subsidy navigation support | Good—addresses real constraint |
| Lifestyle interference | Once-daily formulations, discrete delivery methods | Good—convenience drives adherence |
| Belief system conflict | Integration messaging (TCM + Western), trusted community voices | Difficult—deeply held beliefs resist change |
What Research Gets Wrong
Assuming adherence is rational
Patients know they should take medication. Knowledge isn't the barrier. Behavior change research shows that information rarely drives action. Emotional, social, and practical factors dominate.
Treating all non-adherence identically
The patient who forgets needs reminders. The patient who rejects the diagnosis needs something else entirely. Segment-specific interventions outperform generic adherence programs.
Ignoring the healthcare experience
A patient who feels respected, heard, and cared for during clinic visits is more likely to adhere. The transactional, rushed polyclinic experience may undermine adherence regardless of what else is done.
Questions Worth Exploring
For pharmaceutical brands: What adherence barriers exist for your specific medication? How could formulation, packaging, or support programs address them?
For digital health companies: Are you solving the actual adherence problem or the assumed one? Have you validated that your solution addresses real barriers?
For health systems: What would improve the chronic disease care experience? Would better experiences improve outcomes?
Chronic disease adherence research requires understanding patient lives, not just treatment protocols. The barriers to adherence are behavioral, emotional, social, and practical—rarely purely medical.
At Singapore Insights, we design research that reveals why patients do what they do. If you need to understand adherence barriers and opportunities in Singapore, let us have a conversation. You can also write to our Research Lead, Felicia at felicia@assembled.sg or give us a call at +65 8118 1048.
