Association between patients' beliefs and oral antidiabetic medication adherence in a Chinese type 2 diabetic population

Understanding the struggle: Unique challenges of adherence in male diabetic patients in Tshwane

BACKGROUND

Type 2 diabetes prevalence is steadily increasing worldwide, and South Africa is one of the countries in Africa with the highest prevalence of this disease, along with other non-communicable diseases. The adherence to treatment in male patients with type 2 diabetes is influenced by their attitudes towards medication and how they perceive their condition. To some extent, these factors impact the treatment outcomes for patients undergoing type 2 diabetes treatment. The purpose of this study was to investigate the perceptions of male patients with type 2 diabetes on their adherence to diabetic therapy. The study was conducted in the clinics of the City of Tshwane Metropolitan municipality in Gauteng.

METHODS

This study followed a qualitative, exploratory design. Data were gathered from 15 male patients who were purposefully sampled through in-person, one-on-one interviews with the principal investigator. The eight steps outlined by Tesch were used to analyse the participant data.

RESULTS

Emergent themes indicated that there were barriers to adherence to diabetic treatment and also factors that promoted adherence to diabetic treatment among the participants. Several factors were found to affect treatment uptake among the participants.

CONCLUSION

Patients demonstrated various reactions to diabetic treatment, highlighting the need for reinforcing education at the time of diagnosis and treatment initiation. Additionally, regular patient follow-up may be essential to improve adherence among patients.Contribution: The study highlights the importance of health promotion and the need to develop materials for medication-specific counselling for patients receiving diabetic treatment, in order to promote adherence.

Medicine Non-Adherence: A New Viewpoint on Adherence Arising from Research Focused on Sub-Saharan Africa

Adherence is vital for medicine to have an effect, yet adherence is considered to be low, with approximately half of the patients not fully adherent. However, research into adherence tends to focus on quantitative analysis of performance, which fails to perceive how people are adherent in their many different environments. As a contribution to gaining a deeper understanding, interviews were held with thirty individuals in the UK, Egypt, Kazakhstan, and six countries in sub-Saharan Africa to understand their perceptions on adherence to a range of drugs, and these were compared with an existing well-regarded list. New or undocumented reasons for non-adherence were discovered. Reasons for non-adherence were consistent across both developing and developed worlds. A new viewpoint on adherence is suggested, which considers adherence to be a single act and therefore as an individual opportunity to be adherent, permitting greater focus on the enablers and inhibitors of adherence at any given point in time.

Assessing medication adherence and their associated factors amongst type-2 diabetes mellitus patients of Jazan Province, Saudi Arabia: A single-center, cross-sectional study

Background

The prevalence of type 2 diabetes mellitus (T2DM) globally is reaching epidemic proportions. By 2035, it is projected to increase to 417 million, which is of significant concern as T2DM represents the most oversized budget item in many healthcare systems, primarily due to the high rates of morbidity and mortality associated with the disease. The worldwide cost burden of T2DM has been inexorably growing. A key contributor to the remarkably high morbidity and mortality rates is poor glycemic control potentially associated with medication non-adherence.

Aim

The present research's main objective included assessing medication adherence among patients with T2DM in a single center in Jazan Province.

Methods

Three hundred nine patients with T2DM participated in a cross-sectional survey over three months (September to November 2022). The study participants comprised 50.8 % (females) and 49.2 % (males), with a mean age of 44.12 years (SD ± 12.70). A 31-item self-report questionnaire was used for data collection.

Results

Sixty-six percent of the sample were found to be adherent to their T2DM therapy. A positive association was noticed between the GMAS score and the participant's age (r = 0.24; p < 0.01). The participants' medication adherence was significantly associated with having age above 50 years (χ2 = 13.62; p = 0.001), residing in urban localities (χ2 = 21.37; p < 0.001), being married (χ2 = 12.80; p = 0.002), having glycated hemoglobin level more than 8 % (χ2 = 6.99; p = 0.03) and taking between one to three medications per day (χ2 = 17.63; p < 0.001).

Conclusion

The majority of T2DM patients in the present study were found adherent to their anti-diabetic medications, particularly older patients. Future studies should focus on exploring the reasons for the reported high adherence among older patients and non-adherence among younger patients, as this could facilitate the development of a strategy to enhance adherence.

Adherence to Oral Antidiabetic Drugs in Patients with Type 2 Diabetes: Systematic Review and Meta-Analysis

Poor adherence to oral antidiabetic drugs (OADs) in patients with type 2 diabetes (T2D) can lead to therapy failure and risk of complications. The aim of this study was to produce an adherence proportion to OADs and estimate the association between good adherence and good glycemic control in patients with T2D. We searched in MEDLINE, Scopus, and CENTRAL databases to find observational studies on therapeutic adherence in OAD users. We calculated the proportion of adherent patients to the total number of participants for each study and pooled study-specific adherence proportions using random effect models with Freeman-Tukey transformation. We also calculated the odds ratio (OR) of having good glycemic control and good adherence and pooled study-specific OR with the generic inverse variance method. A total of 156 studies (10,041,928 patients) were included in the systematic review and meta-analysis. The pooled proportion of adherent patients was 54% (95% confidence interval, CI: 51-58%). We observed a significant association between good glycemic control and good adherence (OR: 1.33; 95% CI: 1.17-1.51). This study demonstrated that adherence to OADs in patients with T2D is sub-optimal. Improving therapeutic adherence through health-promoting programs and prescription of personalized therapies could be an effective strategy to reduce the risk of complications.

Effect of Pharmacist-Led Interventions on Medication Adherence and Glycemic Control in Type 2 Diabetic Patients: A Study from the Chinese Population

PURPOSE

Medication adherence plays an important role in glycemic control in type 2 diabetes mellitus (T2DM) self-management. To analyze the factors influencing medication adherence in T2DM patients and the effect of pharmacist-led interventions, we conducted a study in Beijing, China.

PATIENTS AND METHODS

T2DM patients with hypoglycemic drugs for at least 6 months were enrolled. A pharmacist-led survey was conducted followed by individualized interventions for those non-adherent patients monthly within 3 months. FPG, HbA1c, and 2hPG were measured as the comprehensive glycemic control. Medication adherence was determined according to the patient's self-reported compliance with prescribed medication during the last 3 months.

RESULTS

A total of 763 T2DM patients were included. The average age was 63.26±11.89 years, with 363 males. After pharmacist intervention, the patients with good adherence increased from 34.21% to 39.06%, while poor adherence decreased from 32.5% to 24.5% (p < 0.001). The average adherence score was a significant increase (p < 0.001) from 27.846±4.185 to 29.831±7.065. Furthermore, our study demonstrated that pharmacist-led interventions significantly increased glycemic control (FPG from 42.33% to 53.60%, p < 0.001; 2hPG from 41.68% to 48.75%, p = 0.005; HbA1c from 24.12% to 29.23%, p = 0.024). The results found that body mass index (OR 0.643, 95% CI 0.437-0.945), use of medications empirically (occasionally (OR=3.066, 95% CI 2.069-4.543); often (OR=2.984, 95% CI 1.107-8.044)), following the doctor's advice to visit (OR 2.129, 95% CI 1.079-4.202) and lifestyle compliance (OR 2.835, 95% CI 1.094-7.346) were the independent risk factors of non-adherence (p < 0.05), the area under the ROC curve was 0.716.

CONCLUSION

Self-reported medication adherence and glycemic control in T2DM patients were poor which can be improved by pharmacist-led interventions. Interventions should focus on empirical medication behavior, non-adherence to lifestyle, and failure to follow the doctor's advice. The recall bias with self-reported results needs further objective data to verify.

Psychosocial factors related to the behavioral intention of people with type 2 diabetes using insulin

OBJECTIVES

to analyze the psychosocial factors correlated with the behavioral intention of people with Type 2 Diabetes Mellitus (T2DM) towards insulin use.

METHODS

a cross-sectional study; a validated instrument based on the Theory of Planned Behavior was used to identify the direct measures (attitude, subjective norm and perceived control), indirect measures (behavioral, normative and control beliefs) and behavioral intention for the use of insulin. Descriptive analysis and Spearman's correlation were performed for data analysis.

RESULTS

a total of 211 individuals participated in the study, with a positive median of behavioral intention. Attitude, normative and behavioral beliefs were the psychosocial factors that presented a significant correlation (r=0.16, r=-0,15 and r=0.25, respectively; p<0.05) with the intention.

CONCLUSIONS

there is a positive behavioral intention in the use of insulin by people with T2DM. Attitude, normative beliefs and behavioral beliefs have a low magnitude correlation with the intention of people with T2DM to use insulin.

Factors affecting nonadherence to treatment among type 2 diabetic patients with limited health literacy: Perspectives of patients, their families, and healthcare providers

BACKGROUND

Treatment adherence is one of the behaviors associated with type 2 diabetes that predicts whether it will be successfully treated or develop complications and become uncontrolled. This study aimed to determine factors affecting nonadherence to treatment among diabetic patients with limited health literacy from the perspectives of patients, their families, and healthcare providers.

MATERIALS AND METHODS

This qualitative study with a content analysis approach was conducted on 84 eligible type 2 diabetes patients with limited health literacy and poor adherence to treatment, as well as their families and healthcare providers using a purposive sampling method, in Kerman city in 2021. Interviews were conducted using a semistructured interview guide with a broad, open-ended question to provide a general history of the disease separately. The interviewer asked participants to identify the perceived barriers to treatment nonadherence. Each interview lasted 45-60 min. MAXQDA version 20 and inductive content analysis were used to code and analyze extracted data.

RESULTS

Four major themes emerged from the patients' perspectives as "financial problems," "individual factors," "problems related to medication availability," and "healthcare providers' poor practices." Two major themes were classified from the perspective of patients' families as "financial problems" and "Individual factors," and four major themes were identified from the viewpoint of healthcare providers including "financial problems," "individual factors," "scarcity and medication availability," and "poor practice of the healthcare provider." These mentioned barriers were confirmed regarding treatment nonadherence among study participants.

CONCLUSION

Study findings revealed different factors of treatment nonadherence among diabetic patients with limited health literacy. Therefore, these factors should be considered in tailoring promotive educational and supportive interventions. Considering the importance of adherence to treatment patients, planning empowerment family-based interventions focusing on health literacy improvement seems necessary.

Factors associated with treatment adherence to treatment among in patients with type 2 diabetes in Iran: A cross-sectional study

Introduction

Diabetes is a chronic metabolic disorder that affects millions of people worldwide. Adherence to treatment is a key determinant to proper management. This study aimed to assess the factors associated treatment adherence in patients with type 2 diabetes.

Materials and methods

We conducted this cross-sectional study on 704 patients with type 2 diabetes referred to three diabetes clinics in Kerman, Iran. We used treatment adherence questionnaire and functional communicative critical health literacy (FCCHL) to collect data and descriptive statistics, as well as Pearson correlation coefficient and multivariate regression analysis to analyze data. Significance level was <0.05.

Results

The study results showed that health literacy, HbA1c, and income were main predictors of diabetes treatment adherence. The patients' adherence increased as their health literacy increased. The patients' HbA1c decreases as their adherence increased. We found a 2.54-point increase in the treatment adherence score for those with sufficient income and a 0.76-point increase in the treatment adherence score for those with relatively sufficient income compared with those with insufficient income.

Conclusion

We found several factors affecting diabetes treatment adherence. Planning theory-based interventions can be helpful to improve the determinants.

Assessment of medication adherence among type-2 diabetes mellitus in a tertiary care hospital of North India

Study was conducted utilizing a confirmed medication adherence scale to measure the socio-demographic profile, self-care, and medication adherence among Type-2 Diabetes Mellitus (T2DM) patients. The Fisher exact test was used to calculate the level of significance (P) using SPSS (Statistical Package for Social Sciences) Version 21.0. The research presented in this paper uses statistical evidence to assess the numerous aspects that may be linked to medication adherence. A prospective observational study was undertaken on participants visiting the outpatient department for 6 months at a North Indian tertiary care hospital to investigate the pattern and quality of life associated with T2DM. The study examined those who had T2DM for more than 2 years. At the time of the visit, subjects were interviewed using socio demographic information and a structured verified questionnaire. Fisher exact test was used to identify the parameters that were linked to medication adherence, with P0.05 being regarded statistically significant. A total of 350 T2DM outpatients were followed up on, with a male-to-female ratio of 1:0.95. A 13-item medication adherence scale was created and tested, revealing that approximately 32% of participants demonstrated high adherence to anti-diabetic drugs (score = 13). The P value was obtained using Fisher exact test for educational status, occupation, marital status, and the quantity and kind of anti-diabetic drugs was found to be 0.05. Only 32% of the respondents took their diabetes medication as prescribed, indicating the need to improve adherence among T2DM patients. The quantity and kind of anti-diabetic drugs, as well as the patients' educational status, occupation, and marital status, all demonstrated a statistically significant relationship with medication adherence.

Exploring of Determinants Factors of Anti-Diabetic Medication Adherence in Several Regions of Asia - A Systematic Review

BACKGROUND

The determinants of medication adherence in people with diabetes may differ between populations of an area due to social environment, cultural beliefs, socioeconomic conditions, education, and many other factors differences.

OBJECTIVE

Therefore, this study aims to explore, identify and classify the determinants of medication adherence in several Asian regions.

METHODS

A systematic literature review was conducted to gain insight into the determinants of medication adherence. Seven relevant databases (EBSCO, ProQuest, PubMed, ScienceDirect, Scopus, Wiley, dan Taylor and Francis) and hand searching methods were conducted from January 2011 to December 2020. Keywords were compiled based on the PICO method. The selection process used the PRISMA guidelines based on inclusion, and the quality was assessed using Crowe's critical assessment tool. Textual summaries and a conceptual framework model of medication adherence were proposed to aid in the understanding of the factors influencing medication adherence.

RESULTS

Twenty-six articles from countries in several Asian regions were further analyzed. Most studies on type 2 diabetes patients in India used the MMAS-8 scale, and cross-sectional study is the most frequently used research design. The medication adherence rate among diabetic patients was low to moderate. Fifty-one specific factors identified were further categorized into twenty-three subdomains and six domains. Furthermore, the determinants were classified into four categories: inconsistent factors, positively related factors, negatively related factors, and non-associated factors. In most studies, patient-related factors dominate the association with medication adherence. This domain relates to patient-specific demographics, physiological feelings, knowledge, perceptions and beliefs, comorbidities, and other factors related to the patient. Several limitations in this review need to be considered for further research.

CONCLUSION

Medication adherence to diabetic therapy is a complex phenomenon. Most determinants produced disparate findings in terms of statistical significance. The identified factors can serve various goals related to medication adherence. Policymakers and health care providers should consider patient-related factors.

Content Validity of a Questionnaire Based on the Theory of Planned Behavior to Assess the Psychosocial Determinants of Insulin Adherence

OBJECTIVES

To verify the content validity of questions of an insulin adherence questionnaire based on the Theory Planned Behavior in outpatients with type 2 diabetes mellitus.

METHODS

The instrument was derived from a tool created to evaluate psychosocial determinants of adherence to oral antidiabetics medications in the Brazilian context, and was submitted for evaluation by a committee of experts and members of the target population. The item-level content validity index, the scale-level content validity index averaging calculation method, and the modified kappa coefficient were used to evaluate agreement among specialists. The comprehensibility of the instrument by members of the target population was qualitatively analyzed.

RESULTS

The item-level content validity index was found to be lower than desired in 6 of the 20 items analyzed. Of these, one item was modified and 5 were excluded after the comprehensibility evaluation by members of the target population; one item from the perceived control scale was excluded. Content validation resulted in an instrument with 14 items, distributed in the domains intention (4 items), attitude (3 items), perceived norm (4 items), and perceived control (4 items) scales.

CONCLUSIONS

The findings support good evidence of the content validity of the instrument for use among people with type 2 diabetes mellitus receiving insulin therapy.

Effect of patients beliefs about medications on adherence to drugs in diabetic patients attending family medicine outpatient clinic in Ismailia, Egypt

Background

Adherence affected by many factors in the patient or in the treatment. One of these factors is beliefs about medicine, which is modifiable. This study aimed to assess the effect of beliefs about medicines on adherence to medications in diabetic patients.

Methods

It is a cross-sectional descriptive-analytic study, conducted between March 2019 and June 2019, in Family medicine outpatient clinic, Suez Canal University, Egypt. A consecutive sample of diabetic patients presented to the clinic in the period of study was included until fulfilling sample size (82 patients). They filled validated questionnaires of the Morisky Medication Adherence Scale, Beliefs about Medicine, and socio-demographic characteristics.

Results

About half of the patients were non-adherent (54.9%). The necessity beliefs mean was 18.6, while the median was 20, concerns beliefs mean was 14.2, while the median was 14, overuse beliefs mean was 12.2, while the median was 13, finally mean and median of harm score was 11.0. There was a statistically significant relationship between age, education, concern, and harm score with adherence (p = 0.04, 0.02, < 0.001, and 0.03). Age was a positive predictor of adherence; and concern beliefs score was a negative predictor of adherence.

Conclusions

Physicians should inquire about their patient medication beliefs and its effect on patient adherence to discover and solve concerns of diabetic patients to improve non-adherence.

Beliefs related to insulin use in people with Type 2 Diabetes Mellitus

OBJECTIVES

to identify the beliefs of people with Type 2 Diabetes Mellitus related to insulin use.

METHODS

a descriptive, cross-sectional, quantitative-qualitative study based on Theory of Planned Behavior and performed with 32 participants using insulin. The data were analyzed and grouped into categories by beliefs similarity, counted from the frequencies.

RESULTS

118 behavioral, 60 normative and 97 control beliefs were issued. Among the behavioral beliefs, there was an advantage in keeping the diabetes under control and disadvantage, the pain of being pierced by the application of insulin. Regulations highlighted the children as referents who support the treatment. In control beliefs, it was observed that the application of insulin appears as easiness and difficulty to the treatment.Conclusions: the study will support the construction of a psychometric scale to measure the determinants of insulin use, revealing particularities for the structuring of educational interventions that contribute to adherence of the treatment verified in adequate glycemic control.

Beliefs related to oral antidiabetic use among individuals with diabetes

Abstract Objective: To identify beliefs related to oral antidiabetic use among individuals with type 2 diabetes mellitus, based on the Theory of Planned Behavior. Method: This is a descriptive, quantitative and qualitative study conducted with 32 participants using oral antidiabetic drugs. Data was collected through an open question tool and analyzed by number of emissions and content. Results: Among the behavioral beliefs, the following stand out: (a) as an advantage, to keep diabetes controlled; and (b) as disadvantages, gastric pain and discomfort, nausea and diarrhea. In the normative beliefs, family stood out as a social referent (children, mother and siblings). As for the control beliefs, taking the tablets with water and the size of the tablets stood out as practicalities and difficulties, respectively, in relation to the oral therapy follow-up. Conclusion and implications for practice: It was possible to identify the beliefs regarding the behavior of taking oral antidiabetics that will contribute to foster educational strategies with the potential to strengthen the positive beliefs and to revert the negative ones, in favor of adherence to drug therapy, glycemic control and quality of life.

Mediating Effect Of The Motivation For Medication Use On Disease Management And Medication Adherence Among Community-Dwelling Patients With Schizophrenia

BACKGROUND

Nearly half of patients with schizophrenia do not adhere to the long-term medical treatment needed to manage their disease. Programs to promote medication adherence include promotion of motivation as a critical element to influence task performance.

PURPOSE

This study investigated the mediating effect of motivation for medication use on disease management and medication adherence in schizophrenia.

METHODS

This cross-sectional, descriptive correlational study enrolled a convenience sample of 373 community-dwelling patients with schizophrenia in the northern and central regions of Taiwan. Data were collected with questionnaires and a series of validated assessment tools. Hierarchical regression was used to analyze the mediating effect of motivation for medication use on disease management and medication adherence.

RESULTS

The medication adherence rate of the patients was 47.2%. The mediating effect of motivation for medication use on therapeutic alliance and medication adherence was 50%, whereas that on insight and medication adherence was 41% and that on medical social support and medication adherence was 72%.

CONCLUSION

Developing a medication motivation care model may be more effective than promoting therapeutic alliance, insight, or medical social support for promoting medication adherence. It also had greater impact on preventing relapses of community-dwelling patients with schizophrenia.

Understanding older adults' medication decision making and behavior: A study on over-the-counter (OTC) anticholinergic medications

BACKGROUND

Older adults purchase and use over-the-counter (OTC) medications with potentially significant adverse effects. Some OTC medications, such as those with anticholinergic effects, are relatively contraindicated for use by older adults due to evidence of impaired cognition and other adverse effects.

OBJECTIVE

To inform the design of future OTC medication safety interventions for older adults, this study investigated consumers' decision making and behavior related to OTC medication purchasing and use, with a focus on OTC anticholinergic medications.

METHODS

The study had a cross-sectional design with multiple methods. A total of 84 adults participated in qualitative research interviews (n = 24), in-store shopper observations (n = 39), and laboratory-based simulated OTC shopping tasks (n = 21). Simulated shopping participants also rank-ordered eight factors on their importance for OTC decision making.

RESULTS

Findings revealed that many participants had concerns about medication adverse effects, generally, but were not aware of age-related risk associated with the use of anticholinergic medications. Analyses produced a map of the workflow of OTC-related behavior and decision making as well as related barriers such as difficulty locating medications or comparing them to an alternative. Participants reported effectiveness, adverse effects or health risks, and price as most important to their OTC medication purchase and use decisions. A persona analysis identified two types of consumers: the habit follower, who frequently purchased OTC medications and considered them safe; and the deliberator, who was more likely to weigh their options and consider alternatives to OTC medications.

CONCLUSION

A conceptual model of OTC medication purchase and use is presented. Drawing on study findings and behavioral theories, the model depicts dual processes for OTC medication decision making - habit-based and deliberation-based - as well as the antecedents and consequences of decision making. This model suggests several design directions for consumer-oriented interventions to promote OTC medication safety.