Adherence to Insulin Therapy Among Children with Type 1 Diabetes: Reliability and Validity of the Arabic Version of the 4-Item Morisky Medication Adherence Scale

Cross-cultural adaptation and psychometric evaluation of the urdu version of the morisky, greene, and levine medication adherence scale (MGLS-4) for major depressive disorder patients

In Pakistan, Major depressive disorder (MDD) contributes significantly to the mental health burden. It is crucial to understand patients' medication adherence status for developing a strategy for improving adherence and treatment outcomes. Therefore, a valid and reliable tool in the local Urdu language is required. The Morisky, Greene, and Levine Medication Adherence Scale (MGLS-4) is a reliable, valid and straightforward instrument to assess medication-taking behavior. The valid and reliable Urdu translation of MGLS-4 can fill this gap within the local context. Therefore, the present study aims to validate the Urdu Morisky, Green and Levine Adherence Scale (UMGLS-4) for MDD patients. This was a quantitative, cross-sectional validation study for Pakistani MDD patients. Reliability was measured using Cronbach's α and for test-retest reliability intraclass correlation coefficient (ICC) was calculated. Validity was assessed through face validity, content validity, construct validity, and convergent validity with the Drug Attitude Inventory (DAI-10). Descriptive and inferential statistical analyses were carried out to demonstrate adherence level and statistical significance, respectively. Linear regression was applied to find the association between the UGMLS-4 score and demographic characteristics. The UMGLS-4 demonstrated high reliability (Cronbach's α = 0.829) and a significant strong ICC (x = 0.601, p < 0.01) was detected. Exploratory factor analysis (EFA) revealed a single-factor structure explaining 66.084% of the variance. Confirmatory factor analysis (CFA) confirmed good model fit (GFI = 0.950, AGFI = 0.920, NFI = 0.930, RMSEA = 0.050, SRMSR = 0.055). Medication adherence was observed to be high in 39.1% of patients, moderate in 28.6%, and poor in 32.3%. Significant associations were found between adherence scores and gender, educational attainment, and occupational status (p < 0.005) with education predicting adherence (B = 0.301, p < 0.000), indicating the scale's robustness in detecting adherence variations among Urdu-speaking MDD patients. The UMGLS-4 is a reliable and valid tool for assessing medication adherence in Pakistani MDD patients, effectively capturing adherence variations across demographic variables.

Medication adherence and persistence in children and adolescents with attention deficit hyperactivity disorder (ADHD): a systematic review and qualitative update

Low medication-adherence and persistence may reduce the effectiveness of ADHD-medication. This preregistered systematic review (PROSPERO CRD42020218654) on medication-adherence and persistence in children and adolescents with ADHD focuses on clinically relevant questions and extends previous reviews by including additional studies. We included a total of n = 66 studies. There was a lack of consistency in the measurement of adherence/persistence between studies. Pooling the medication possession ratios (MPR) and using the most common adherence definition (MPR ≥ 80%) indicated that only 22.9% of participants had good adherence at 12-month follow-up. Treatment persistence on medication measured by treatment duration during a 12-month follow-up averaged 170 days (5.6 months). Our findings indicate that medication-adherence and persistence among youth with ADHD are generally poor and have not changed in recent years. Clinicians need to be aware that various factors may contribute to poor adherence/persistence and that long-acting stimulants and psychoeducational programs may help to improve adherence/persistence. However, the evidence to whether better adherence/persistence contributes to better long-term outcomes is limited and requires further research.

Predicting medication adherence among children with epilepsy: Application of the protection motivation theory

PURPOSE

Based on the protection motivation theory (PMT), which is an extension of the health belief model that takes the "reward" brought by behavior in the long-term process as a consideration factor and considering the influence of environmental and social factors on behavior patterns, this cross-sectional study evaluated medication adherence among children with epilepsy using structural equation modeling.

METHODS

Children with epilepsy from pediatric neurology clinics were consecutively sampled at West China Second Hospital of Sichuan University from July 2021 to January 2024. According to PMT, we designed the 23-item questionnaire, which included seven factors, namely severity, susceptibility, external return, internal returns, self-efficacy, reaction efficiency, and reaction cost. Medication adherence was assessed using the Morisky Medication Adherence Scale. The reliability and validity of the scale were tested by confirmatory factor analysis, and path analysis was used to conduct hypothesis testing and calculate standardized path coefficients.

RESULTS

We enrolled 1357 children with epilepsy (mean age, 8.36 ± 4.04 years). Younger age, being an only child, caregivers' unemployment, and comorbidities were associated with high medication adherence scores. The designed scale of PMT displayed good reliability and validity. Through path analysis of the structural equation model, self-efficacy, susceptibility, and severity exerted significant positive effects on adherence, and external return, internal returns, and reaction cost had significant negative effects on adherence.

CONCLUSIONS

Medication adherence in children with epilepsy is relatively poor. PMT can explain and predict the medication adherence behavior and behavior intention of patients with epilepsy. It is recommended to increase the health education, personalize medication guidance, and provide telephone interventions to caregivers of children with epilepsy to enhance medication adherence and further improve therapeutic efficacy.

The prevalence of adherence to insulin therapy in patients with diabetes: A systematic review and meta-analysis

BACKGROUND

Adherence to insulin therapy is crucial to achieving good glycemic control for patients with type 1 diabetes (T1D) or type 2 diabetes (T2D). A comprehensive estimation of adherence to insulin therapy in patients with diabetes is currently lacking.

OBJECTIVE

To explore the prevalence of adherence to insulin therapy in patients with both T1D and T2D.

METHODS

A systematic search was performed using the following databases: PubMed, EMBASE, Cochrane CENTRAL, and ProQuest Dissertation and Theses from the inception of each database to August 2023. Cross-sectional studies were included if they met the following criteria: (1) conducted in patients with T1D or T2D; (2) reported adherence to insulin therapy. The Joanna Briggs Institute (JBI) critical appraisal checklist for studies reporting prevalence data was used to assess the quality of included studies. Pooled estimates of the prevalence of adherence to insulin were calculated as a percentage together with a 95 % confidence interval (95%CI) using a random-effect model. All analyses were conducted using STATA 15 (College Station, Texas, United States); PROSPERO (CRD42022322323).

RESULTS

Search results yielded 14,914 articles, of these 57 studies with a total of 125,241 patients met the inclusion criteria. The overall estimated prevalence of adherence to insulin therapy in both types of diabetes was 55.37 % (95%CI: 48.55 %-62.19 %). The adherence for T1D was 52.63 % (95 % CI: 37.37 %-67.87 %), whereas the adherence for T2D was 52.55 % (95 % CI: 43.08 %-62.01 %). The prevalence of adherence in lower middle-income countries was 56.79 % (95 % CI: 27.85 %-85.74 %).

CONCLUSIONS

The overall prevalence of adherence to insulin therapy was remarkably low. This requires attention from healthcare practitioners and policymakers to implement appropriate strategic approaches to improve adherence to insulin therapy.

Treatment access barriers and medication adherence among children with epilepsy in western China: A cross-sectional study

PURPOSE

This study aimed to evaluate treatment access barriers and medication adherence among children with epilepsy and explore the influencing factors.

METHODS

This cross-sectional study consecutively sampled children with epilepsy from pediatric neurology clinics at West China Second Hospital of Sichuan University from October 2022 to April 2023. The scale used to assess treatment access barriers was self-designed and medication adherence was assessed with the Morisky Medication Adherence Scale. Multivariate linear or logistic regression analyses were used to determine influencing factors.

RESULTS

This study included 1,847 children with epilepsy. The majority of caregivers of participating children had treatment access barriers, especially for making appointments, obtaining diagnosis and examination results, and response from the care team (scores > 3). Younger age of children, difficulty paying medical expenses, comorbidities, higher frequency of seizures in the past month, and attitude toward seizures were associated with high treatment access barriers scores. Poor medication adherence was observed in 38 % (702/1,847) of the sample. Age, being an only child, place of residence, annual medical expense, being newly diagnosed, and comorbidities were associated with medication adherence.

CONCLUSIONS

Among children with epilepsy, there is high demand for disease treatment but medication adherence is relatively low, and there are a range of influencing factors. We suggest medical personnel strengthen health education and regular follow-ups to improve medication adherence and meet treatment needs in this population.

Blood pressure control and its associated factors among patients with heart failure in Jordan

Uncontrolled blood pressure (BP) has been associated with increased risk of cardiovascular events including heart failure. This study aimed to explore the factors associated with poor BP control among patients with heart failure at two major outpatient cardiology clinics in Jordan. Variables including socio-demographics, biomedical variables, in addition to disease and medication characteristics were collected using medical records and custom-designed questionnaire. The validated 4-item Medication Adherence Scale was used to assess medication adherence. Binary logistic regression analysis was conducted to explore the significant and independent predictors of poor BP control. Regression analysis results revealed that being not satisfied with the prescribed medication (OR = 2.882; 95% CI: 1.458-5.695; P < 0.01), reporting moderate medication adherence (OR = 0.203; 95% CI: 22 0.048-0.863; P < 0.05), not receiving digoxin (OR = 3.423; 95% CI: 1.346-8.707; P < 0.05), and not receiving aldosterone antagonist (OR = 2.044; 95% CI: 1.038-4.025; P < 0.05) were associated with poor BP control. Future interventions should focus on increasing medication satisfaction and enhancing medication adherence, in order to improve BP control among patients with heart failure.

Health-related quality of life and its associated factors in patients with chronic obstructive pulmonary disease

OBJECTIVE

The present study aimed to evaluate HRQOL and to explore the factors associated with poor HRQOL among patients with COPD.

METHODS

In the present cross-sectional study, the validated St George's Respiratory Questionnaire for COPD patients (SGRQ-C) was used to evaluate HRQOL among 702 patients with COPD at two major hospitals in Jordan in the period between January and April 2022. Quantile regression analysis was used to explore the factors associated with HRQOL among the study participants.

RESULTS

According to SGRQ-C, the HRQOL of the study participants was greatly impaired with a total SGRQ of 55.2 (34-67.8). The highest impairment in the HRQOL was in the impact domain with a median of 58.7 (29-76.3). Increased number of prescribed medications (β = 1.157, P<0.01), older age (β = 0.487, P<0.001), male gender (β = 5.364, P<0.01), low education level (β = 9.313, P<0.001), low and moderate average income (β = 6.440, P<0.05, and β = 6.997, P<0.01, respectively) were associated with poorer HRQOL. On the other hand, being married (β = -17.122, P<0.001), living in rural area (β = -6.994, P<0.01), non-use of steroids inhalers (β = -3.859, P<0.05), not receiving long acting muscarinic antagonists (LAMA) (β = -9.269, P<0.001), not receiving LABA (β = -8.243, P<0.001) and being adherent to the prescribed medications (β = -6.016, P<0.001) were associated with improved HRQOL. Furthermore, lower disease severity (stage A, B, and C) (β = -23.252, -10.389, and -9.696 respectively, P<0.001), and the absence of comorbidities (β = -14.303, P<0.001) were associated with better HRQOL.

CONCLUSIONS

In order to maximize HRQOL in patients with COPD, future COPD management interventions should adopt a multidisciplinary approach involving different healthcare providers, which aims to provide patient-centered care, implement personalized interventions, and improve medication adherence, particularly for patients who are elderly, males, have low socioeconomic status, receive multiple medications and have multiple comorbid diseases.

Mukattash T, Alefishat EA. Glycemic control and its associated factors among diabetic heart failure outpatients at two major hospitals in Jordan

Patients with heart failure (HF) are generally at higher risk of developing type 2 diabetes and having uncontrolled blood glucose. Furthermore, the prevalence of uncontrolled blood glucose in patients with HF is largely unknown. Identifying the factors associated with poor blood glucose control is a preliminary step in the development of effective intervention programs. The current cross-sectional study was conducted at two major hospitals to explore the factors associated with blood glucose control among patients with heart failure and type 2 diabetes. In addition to sociodemographic, medical records were used to collect medical information and a validated questionnaire was used to evaluate medication adherence. Regression analysis showed that poor medication adherence (OR = 0.432; 95%CI 0.204-0.912; P<0.05) and increased white blood cells count (OR = 1.12; 95%CI 1.033-1.213; P<0.01) were associated with poor glycemic control. For enhancing blood glucose control among patients with HF and diabetes, future intervention programs should specifically target patients who have high WBC counts and poor medication.

Insulin Adherence in Adolescents with Type 1 Diabetes Mellitus

Adherence to medication, especially insulin, is a key contributor to diabetes treatment outcomes. Lack of adherence is common among patients with type 1 diabetes mellitus (T1DM) ranging from 23% to 77%, with a higher frequency in developing countries. Poor adherence results in worse glycaemic control and increased mortality and morbidity due to diabetes complications. The objective of this study is to discuss insulin adherence among adolescents with T1DM. The review was conducted through search engines such as PubMed, Medline, Embase and Google Scholar. Search terms used were 'type 1diabetes mellitus', 'insulin dependent diabetes mellitus', 'Juvenile diabetes mellitus', 'adherence', 'compliance', 'non adherence', 'barriers', 'omission', 'medical adherence', 'adolescents', 'teenagers' and 'insulin'. T1DM is challenging for adolescents due to its lifelong treatment regimens. Educational programmes and specific interventions which can improve affordability, accessibility and administration of insulin should be implemented to improve insulin adherence among adolescents.

Health-related quality of life and its associated factors among outpatients with heart failure: a cross-sectional study

BACKGROUND

Heart Failure (HF) is a chronic disease associated with life-limiting symptoms that could negatively impact patients' health-related quality of life (HRQOL). This study aimed to evaluate HRQOL and explore the factors associated with poor HRQOL among patients with HF in Jordan.

METHODS

This cross-sectional study used the validated Arabic version of the Minnesota Living with Heart Failure Questionnaire to assess HRQOL in outpatients with HF visiting cardiology clinics at two public hospitals in Jordan. Variables were collected from medical records and custom-designed questionnaires, including socio-demographics, biomedical variables, and disease and medication characteristics. Ordinal regression analysis was used to explore variables associated with poor HRQOL among HF patients.

RESULTS

Ordinal regression analysis showed that the number of HF medications (P < 0.05) and not taking a loop diuretic (P < 0.05) significantly increased HRQOL, while the number of other chronic diseases (P < 0.05), stage III/IV of HF (P < 0.01), low monthly income (P < 0.05), and being unsatisfied with the prescribed medications (P < 0.05) significantly decreased HRQOL of HF patients.

CONCLUSIONS

Although the current study demonstrated low HRQOL among patients with HF in Jordan, HRQOL has a considerable opportunity for improvement in those patients. Variables identified in the present study, including low monthly income, higher New York Heart Association (NYHA) classes, a higher number of comorbidities, and/or taking a loop diuretic, should be considered in future intervention programs, aiming to improve HRQOL in patients with HF.

Factors associated with lipid control in outpatients with heart failure

Background

Dyslipidemia is common among patients with heart failure, and it negatively impacts clinical outcomes. Limited data regarding the factors associated with poor lipid control in patients with HF patients. Therefore, this study aimed to evaluate lipid control and to explore the factors associated with poor lipid control in patients with HF.

Methods

The current cross-sectional study was conducted at outpatient cardiology clinics at two major hospitals in Jordan. Variables including socio-demographics, biomedical variables, in addition to disease and medication characteristics were collected using medical records and custom-designed questionnaire. Medication adherence was assessed using the validated 4-item Medication Adherence Scale. Binary logistic regression analysis was conducted to explore significant and independent predictors of poor lipid control among the study participants.

Results

A total of 428 HF patients participated in the study. Results showed that 78% of the participants had poor lipid control. The predictors that were associated with poor lipid control included uncontrolled BP (OR = 0.552; 95% CI: 0.330-0.923; P < 0.05), higher Hb levels (OR = 1.178; 95% CI: 1.013-1.369; P < 0.05), and higher WBC (OR = 1.133; 95% CI: 1.031-1.246; P < 0.05).

Conclusions

This study revealed poor lipid control among patients with HF. Future intervention programs should focus on blood pressure control in order to improve health outcomes among HF patients with dyslipidemia.

Medication Adherence and Its Associated Factors Among Outpatients with Heart Failure

Background

Poor adherence to heart failure (HF) medications represents a major barrier to achieve the desired health outcomes in those patients.

Objective

To assess medication adherence and to explore the factors associated with medication non-adherence among patient with HF in Jordan.

Methods

The current cross-sectional study was conducted at the outpatient cardiology clinics at two main hospitals in Jordan from August 2021 through April 2022. Variables including socio-demographics, biomedical variables, in addition to disease and medication characteristics were collected using medical records and custom-designed questionnaire. Medication adherence was assessed using the 4-item Morisky Medication Adherence Scale. Multinomial logistic regression analysis was performed to identify the factors that are significantly and independently associated with medication non-adherence.

Results

Of the 427 participating patients, 92.5% had low to moderate medication adherence. Results of the regression analysis revealed that that patients who had higher education level (OR=3.36; 95% CI 1.08-10.43; P=0.04) and were not suffering from medication-related side effects (OR=4.7; 95% CI 1.91-11.5; P=0.001) had significantly higher odds of being in the moderate adherence group. Patients who were taking statins (OR=16.59; 95% CI 1.79-153.98; P=0.01) or ACEIs/ ARBs (OR=3.95; 95% CI 1.01-15.41; P=0.04) had significantly higher odds of being in the high adherence group. Furthermore, Patients who were not taking anticoagulants had higher odds of being in the moderate (OR=2.77; 95% CI 1.2-6.46; P=0.02) and high (OR=4.11; 95% CI 1.27-13.36; P=0.02) adherence groups when compared to patients who were taking anticoagulants.

Conclusion

The poor medication adherence in the present study sheds the light on the importance of implementing intervention programs which focus on improving patients' perception about the prescribed medications particularly for patients who have low educational levels, receive an anticoagulant, and do not receive a statin or an ACEI/ ARB.