Patients' beliefs about adherence to oral antidiabetic treatment: a qualitative study

Barriers and facilitators to type 2 diabetes management among slum-dwellers: A systematic review and qualitative meta-synthesis

Background and Aims

The prevalence of type 2 diabetes (T2D) is on the rise worldwide, especially in developing countries. There is a significant difference between the slum-dwellers and other urban dwellers in terms of T2D incidence rate and access to healthcare services. This review aimed to identify barriers and facilitators to T2D management among slum-dwellers.

Methods

A systematic review was conducted to identify barriers and facilitators to T2D management from January 1, 2002 to May 30, 2022. We searched MEDLINE via PubMed, Scopus, Web of Sciences, and Google Scholar. The inclusion criteria were: qualitative or mixed-methods research, published in English, focused on slum-dwellers and T2D or its complications, and assessed barriers and facilitators to T2D management among slum-dwellers. Quality appraisal was conducted using the QATSDD critical appraisal tool. A thematic approach was used for data analysis and synthesis.

Results

A total of 17 articles were included in this review. Three analytical themes were identified: (1) Individual factors consisting of four themes: lifestyle behaviors, informational, psychological, and financial factors; (2) Health system factors consisting of three themes: patient education processes, financial protection, and service delivery; and (3) Contextual factors consisting of three themes: family support, social support, and environmental factors.

Conclusion

Our review disclosed that the individual, health system, and context influence T2D management among slum-dwellers. Policymakers can use the findings of this review to reduce barriers and augment facilitators to improve healthcare utilization and self-care management among patients with T2D in slums.

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.

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.

Prevalence and reasons influenced medication non-adherence among diabetes patients: A mixed-method study

Objectives

This study aimed to identify the prevalence of medication non-adherence (MNA) and to explore the reasons that influenced MNA among diabetes patients.

Design

This study used the explanatory mixed-method design. Phase one comprised of a cross-sectional study followed by phase two of a qualitative study.

Setting

This study took place at two public hospitals in the Klang Valley, Malaysia.

Participants

About 427 diabetes patients were recruited and 399 of them completed the study. The inclusion criteria were those with age more than 18 years and above, Malaysian citizen, able to understand Malay or English, and were diagnosed with diabetes mellitus for more than one year. The exclusion criteria were those with an intellectual disability and pregnant women. Phase two involved 12 participants recruited from non-adherent patients in phase one of the study.

Results

About 46.6% of the patients failed to adhere to the medication. Malays (OR: 1.66, 95%CI: 1.09 to 2.51, p = 0.017), single/widow or divorced (OR: 1.79, 95%CI: 1.05 to 3.05, p = 0.031) and poor HbA1c (OR: 2.57, 95% CI: 1.61 to 4.10, p =  < 0.01) were associated with medication non-adherence. Five main categories emerged as the reasons for medication non-adherence, including perceived benefit of Complementary and Alternative medicine, attitude towards drawback of western medication, poor healthcare providers and patients' relationship, undesirable emotional response towards medication intake, as well as restraints in daily routine and cognitive function.

Conclusions

There are many reasons for patients' non-adherence to their anti-diabetes medication. These findings are important in identifying the factors that influenced non-adherence to recommend reliable patient-centred care strategies in improving medication non-adherence among patients with diabetes.

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.

A review of factors influencing non-adherence to oral antineoplastic drugs

PURPOSE

Adherence to oral antineoplastic drugs is a complex phenomenon, and knowledge about the reasons that people with cancer do not adhere to their prescriptions is essential to inform adherence-related support in clinical and research contexts. This study aims to provide an up-to-date summary of the key reasons for non-adherence to oral antineoplatic drugs (OAD) in people with cancer.

METHODS

Electronic databases Medline, Embase, Emcare, and PsychINFO were searched for systematic reviews and studies published between January 2010 and March 2018. Data was analyzed and extracted by two independent reviewers.

RESULTS

Three systematic reviews and two studies were included in the review. Key factors for non-adherence were classified as either modifiable or non-modifiable factors. Side effects, forgetfulness, and poor knowledge about OAD were identified as modifiable factors while co-payment, age, regimen complexity. and time since diagnosis were identified as non-modifiable factors. Most of the included studies focused on breast cancer and chronic myeloid leukemia (CML) patients. Low methodological quality and different adherence cut-off rates were observed in the included literature.

CONCLUSIONS

More research with rigorous methodology and diverse cancer types is needed to increase evidence on the reasons for OAD non-adherence. However, findings from this study may serve to aid in drafting guidelines and suitable interventions for adherence-related support to OAD users.

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.

Osteoporosis management in Australian general practice: an analysis of current osteoporosis treatment patterns and gaps in practice

Background

Among Australians aged 50 and over, an estimated 1 in 4 men and 2 in 5 women will experience a minimal trauma fracture during their remaining lifetime. Effective fracture prevention is hindered by substantial undertreatment, even of patients who clearly warrant pharmacological therapy. Poor adherence to osteoporosis treatment is also a leading cause of repeat fractures and hospitalisation. The aim of this study was to identify current osteoporosis treatment patterns and gaps in practice in Australia, using general practice data, and to explore general practitioners’ (GPs’) attitudes to osteoporosis treatment and their views on patient factors affecting osteoporosis management.

Methods

The study was conducted in two phases. Phase 1 was a longitudinal retrospective cohort study which utilised data from MedicineInsight – a national general practice data program that extracts longitudinal, de-identified patient data from clinical information systems (CISs) of participating general practices. Phase 2 included semi-structured, in-depth telephone interviews with a sample of MedicineInsight practice GPs. Data were analysed using an inductive thematic analysis method informed by the theory of planned behaviour.

Results

A diagnosis of osteoporosis was recorded in 12.4% of patients over the age of 50 years seen in general practice. Of those diagnosed with osteoporosis, almost a quarter were not prescribed osteoporosis medicines. From 2012 to 17, there was a progressive increase in the number of denosumab prescriptions, while prescriptions for bisphosphonates and other osteoporosis medicines decreased. More than 80% of patients who ceased denosumab treatment had no subsequent bisphosphonate prescription recorded. Interviews with GPs revealed beliefs and attitudes that may have influenced their intentions towards prescribing and osteoporosis management.

Conclusions

This study suggests that within the Australian general practice setting, osteoporosis is underdiagnosed and undertreated. In addition, it appears that most patients who ceased denosumab treatment had no record of subsequent antiresorptive therapy, which would place them at risk of further fractures. The study supports the need for the development of clinical education programs addressing GP knowledge gaps and attitudes, and the implementation of specific interventions such as good reminder/recall systems to avoid delays in reviewing and treating patients with osteoporosis.

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.

Psychosocial determinants of adherence to oral antidiabetic medication among people with type 2 diabetes

AIMS AND OBJECTIVES

The aim of this study was to identify the psychosocial determinants of adherence to oral antidiabetic medication, according to the Theory of Planned Behaviour (TPB).

BACKGROUND

Appropriate adherence to oral antidiabetic medication contributes to long-term glycaemic control. However, glycaemic control is often poor in people with type 2 diabetes, mainly due to the poor adherence to oral antidiabetic agents.

DESIGN

Prospective study with 2 waves of data collection, based on STROBE checklist was conducted. One hundred and fifty-seven adults with type 2 diabetes, in chronic use of oral antidiabetic agents, composed the sample. At baseline, self-reported measures of medication adherence (proportion and global evaluation of adherence) and of metabolic control (glycated haemoglobin) of diabetes were obtained.

METHODS

The TPB main constructs (attitude, subjective norm and perceived control) and related beliefs were measured. Adherence and metabolic control measurements were obtained in a two-month follow-up (n = 157).

RESULTS

Attitude and subjective norm, together, explained 30% of the variability in intention; their underlying belief-based measures (behavioural and normative beliefs) explained 28% of the variability in intention. In addition, intention predicted behaviour at follow-up. However, when added to the prediction model, past behaviour was the only explanatory factor of adherence behaviour.

CONCLUSION

Adherence behaviour to oral antidiabetic medication was predicted by intention, which, in turn, was determined by attitude and subjective norm. In order to promote adherence to oral antidiabetic agents, health professionals should include motivational strategies as well as strategies targeted to attitude and subjective norm when designing interventions.

RELEVANCE TO CLINICAL PRACTICE

The nonadherence to antidiabetic medication contributes to lack of control of diabetes and ensuing complications. The comprehension of the factors explaining the variability in medication adherence can inform the design of theory-based interventions aimed at promoting this behaviour.

Impact of Diabetes Perceptions on Medication Adherence in Japan

Background: Patients’ perception of diabetes mellitus is one of the psychosocial factors influencing diabetic behavior. This patients’ perception of the disease is a mental image formed from the experience of patients with type 2 diabetes mellitus and reportedly reflects the aspect of recuperation. We investigated the relationship between changes in the patients’ perception of the disease and medication adherence, as influenced by the active involvement of community pharmacists. Methods: A prospective cohort study that used patient registry based in community pharmacies was conducted in patients with type 2 diabetes using oral antidiabetic agents at a pharmacy in Ishikawa Prefecture in Japan. Patients responded to the questionnaire at the time of enrollment and at the end of the one-year intervention period. The pharmacist confirmed the patient's medication status and treatment problems via telephone calls at least once every two weeks for one year. Main outcome measures: Type 2 diabetes patients’ perception of the disease related to medication adherence. Results: The study enrolled 113 patients. Among the seven diabetes image factors, “Living an orderly life” and “Feeling of fear” were significantly associated with medication adherence. “Feeling of neglect of health” was significantly associated at the subscale level. Conclusion: All the three factors related to medication adherence indicated self-care ability. To enhance the self-care ability of the patient, pharmacists should assist in self-care interventions for the patients.

Psychological predictors of adherence to oral hypoglycaemic agents: an application of the ProMAS questionnaire

Objectives: This study aimed to identify psychological predictors of oral hypoglycaemic agent (OHA) adherence and to compare adherence rates between a novel and well-known instrument, i.e. the Probabilistic Medication Adherence Scale (ProMAS) and Medication Adherence Report Scale (MARS-5).Design and main outcome measures: A longitudinal study design was applied with surveys at baseline and 6-month follow-up. At baseline, OHA adherence using the ProMAS and MARS-5, socio-cognitive determinants and demographics were assessed. At follow-up, the ProMAS was applied as outcome measure, on which socio-cognitive determinants and demographics were regressed using linear regression analysis.Results: The baseline and follow-up sample included 304 and 231 participants, respectively. When applying cut-off points of ≥15 for the ProMAS and ≥23 for the MARS-5, 47.4 and 89.5% adhered to their OHAs. Consistent predictors of better adherence comprised a low education, lower severity perceptions, and higher self-efficacy and intention. After correcting for baseline adherence, a low education and higher self-efficacy remained significant adherence predictors.Conclusions: Compared to the MARS-5, ProMAS data was less skewed, similar to objectively collected data, and yielded insights in a broader spectrum of (non)-adherence behaviours. Results stress the need for adherence improving interventions which particularly should target higher educated patients and patients with low self-efficacy, low intention and high severity perceptions.

Beliefs about medicines as mediators in medication adherence in type 2 diabetes

AIMS

This study analysed whether beliefs about medicines mediated the relationship between illness representations and medication adherence.

BACKGROUND

Adherence to medication is required in diabetes treatment, contributing to decreased blood glycaemic levels. The knowledge and perception of patients about diabetes as well as the beliefs about medicines are considered to be key factors for medication adherence.

DESIGN

The study used a cross-sectional design that included 387 patients recently diagnosed with type 2 diabetes.

METHODS

Participants were assessed, between 2010 and 2013, and answered the Medication Adherence Scale, the Beliefs about Medicines Questionnaire, and the Brief Illness Perception Questionnaire.

RESULTS

The results of the path analysis showed that beliefs about medicines had a mediating role on self-report medication adherence with the exception of beliefs about specific concerns with medicines. Therefore, both general beliefs and specific needs about medicines mediated the relationship between diabetes consequences and self-report medication adherence as well as between treatment control and self-report medication adherence. Needs about medicines mediated the relationship between personal control and self-report medication adherence.

CONCLUSION

Health professionals should target beliefs about medicines besides illness representations regarding medication adherence. The current study may help optimize adherence to medication in early-diagnosed type 2 diabetes patients.

Associations of different adherences in patients with type 2 diabetes mellitus

PURPOSE

The objective of our cross-sectional study is to explore the adherence behavior of patients with type 2 diabetes mellitus (T2DM) by examining the association between the various types of adherence. The success of diabetic therapy partly relies on patient motivation, psych-odemographic variables (self-efficacy, health literacy, and health locus of control [HLOC]), and adherence. The aim of our research was to explore the attitudes of T2DM patients toward medication and lifestyle therapy, thus gaining a deeper insight into the role of adherence-determining parameters in disease management.

PATIENTS AND METHODS

The sample for the present study consisted of 113 T2DM inpatients (75 women and 38 men) with a mean age of 60.56 years (SD=12.94, range: 20-85 years) diagnosed with T2DM for an average of 13 years (SD=8.23). Participants completed the Diabetes Adherence Questionnaire conceptualized by the research team in accordance with the mapping of psychological and psychosocial parameters. We examined the associations between variables using Spearman's rank correlation. Multivariate regression analysis was used to examine predictive variables for adherent behavior. In addition, we attempted to examine factors with a negative effect on adherence using factor analysis.

RESULTS

Based on our results, a high level of medication adherence negatively correlated with lifestyle adherence. Multivariate regression analysis showed that blood glucose monitoring adherence is mostly predicted by social-external HLOC, diabetes self-efficacy, and internal HLOC, while dietary adherence is predicted by the patient's self-efficacy and duration of the illness. Additionally, understanding and following the diabetes treatment were significantly associated with dietary adherence and high levels of patient self-efficacy, while health literacy was mostly predicted by internal HLOC.

CONCLUSION

Adherence to medication, diet, glucose monitoring, and physical exercise showed different levels in T2DM patients and were in association with psychodemographic factors.

Factors Impacting Adherence to Diabetes Medication Among Urban, Low Income Mexican-Americans with Diabetes

Mexican-Americans carry a high burden of type 2 diabetes and are disproportionately affected by diabetes related mortality and morbidity. Poor adherence to medication is an important barrier to achieving metabolic control and contributes to adverse health outcomes and health disparities. Little is known about barriers and facilitators to medication adherence among Mexican-Americans with diabetes. This is a qualitative study of semi-structured interviews with a sample of 27 adults (25 Mexican-Americans and 2 Latinos of other origin) with self-reported type 2 diabetes who were recruited as part of a church-based, randomized controlled trial for diabetes self-management education in a low-income, immigrant neighborhood of Chicago. Face-to-face, in-depth interviews were conducted (one in English and 26 in Spanish), audio-recorded, transcribed verbatim, and professionally translated. Systematic qualitative methods were used to analyze interviews. All 27 participants were Latino, and 25 were of Mexican descent. Participants' mean age was 57 years, 81% were female, 69% had an annual income less than $20,000 and 48% had no health insurance. Mean A1C level was 8.6% and mean systolic blood pressure was 125 mmHg. The majority of participants (85%) reported using oral diabetes medication and 35% reported taking insulin. 76% reported being affiliated with one of the two partnering catholic churches based in the South Lawndale neighborhood of Chicago, also known as Little Village. Concerns regarding effectiveness and negative impact of diabetes medication were prevalent and expressed by 13 (48%) of 27 participants. Dissatisfaction with ineffective provider communication and not being able to pay for medication were other important barriers to adherence and were expressed by 7% and 11% of participants, respectively. Family support, for example, family members assisting in organizing medications in boxes and reminding participants to take them, was reported by 15% of participants and emerged as an important facilitator to medication adherence. There is a gap in research on factors influencing adherence to diabetes medication among Mexican-Americans. Our study suggests that concerns regarding negative impact of diabetes medication and concerns regarding effectiveness are prevalent barriers to adherence. These barriers can be addressed through educational efforts targeting patients and clinicians by specifically including content on beliefs that lead to poor adherence in diabetes self-management interventions for patients and continuing medical education for providers and by developing interventions that engage family members as a support system for medication adherence.

Evaluation of medication adherence among Lebanese diabetic patients

Background:

Diabetes type 2 is considered one of the main public health concerns. Lack of adherence to treatment leads to poor therapeutic outcome, poor glycemic control, and high risk for developing diabetes complications.

Objectives:

The aim of this study is to evaluate adherence to oral antidiabetic medication in Diabetes type 2 Lebanese patients, and to evaluate factors leading to low adherence.

Methods:

A cross-sectional study was conducted in outpatients endocrinology clinics of two hospitals and four private clinics located in Beirut-Lebanon. Data was collected using a well-structured questionnaire by trained pharmacists. Adherence level was measured by the Lebanese Medication Adherence Scale (LMAS-14). Bivariate and multivariate analyses were conducted using SPSS version 20.

Results:

Overall, 245 patients were included in the study with the majority being females (54.3%) and obese (47.8%). Only 29% of the participants had controlled glycemia (HbA1c <7%) with 31.8% of subjects had high adherence to their medication compared to 68.2% with low adherence. Increased working hours/day was associated with a decrease in adherence to oral antidiabetic medication (OR=0.31; 95% CI 0.11:0.88; p=0.029). Other factors significantly associated with decreased adherence to treatment were forgetfulness, high drug costs, complex treatment regimens, experiencing side effects, and perception of treatment inefficacy. Postponing physician office visits also decreased the probability of being adherent to oral antidiabetic medication (OR=0.36; 95% CI 0.15:0.86; p=0.022). Skipping or doubling the dose in case of hypo/hyperglycemia and the sensation of treatment burden also decreased medication adherence (OR=0.09; 95% CI 0.02:0.34; p=0.001, and OR=0.04; 95% CI 0.01:0.13; p<0.001 respectively).

Conclusions:

Adherence to oral antidiabetic medication is low for Lebanese patients, which leads to a poor glycemic control and increases the diabetes complications. Intervention programs including patient education strategies are essential to improve medication adherence.

Overcoming barriers to the use of metformin: patient and provider perspectives

BACKGROUND

Metformin is the first-line treatment for type 2 diabetes mellitus. Observational studies show lower rates of use than would be expected from clinical guidelines.

OBJECTIVE

We undertook a qualitative study of barriers to metformin use from the patient and provider perspective.

DESIGN

Patient focus group, patient individual interviews, provider interviews, and chart review. Purposive sampling of patients and providers in New York State.

PARTICIPANTS

Seven one-on-one patient interviews, one focus group with 13 patients, 10 provider interviews, and manual review of 1259 charts.

APPROACH

Grounded theory.

RESULTS

Both providers and patients cited potential health benefits as strong reasons to take metformin and describe it as the first-line drug for diabetes. Patients and providers both cited gastrointestinal side effects as the primary barrier to metformin use. Patients described adapting to these side effects and taking metformin at a time that minimizes them. In contrast, providers emphasized dose titration and the use of extended-release formulation as tools for minimizing side effects but were uncertain about the effectiveness of these strategies.

CONCLUSION

Metformin is positively viewed by patients and providers, but gastrointestinal side effects are a barrier to its use. There is some consensus on basic measures to improve its tolerability, but these measures are not consistently applied and lack evidence establishing their effectiveness. Pragmatic clinical trial research on optimal dose, formulation, and counseling for new metformin users should be considered.

Medication adherence among patients with Type 2 diabetes: A mixed methods study

Objective

Oral hypoglycemic agents (OHAs) are highly effective in managing Type 2 diabetes if taken appropriately. This study assessed adherence to OHAs among patients with Type 2 diabetes and explored factors associated with adherence behaviour.

Research design and methods

Mixed methods were used comprising a cross-sectional study using the Arabic version of the Morisky Medication Adherence Scale followed by semi-structured interviews using the Theoretical Domain Framework to explore key determinants of adherence.

Results

The cross-sectional study included 395 patients of whom 40% achieved a high level of OHA adherence. Lower adherence was associated with younger age (Odds Ratio (OR) 1.084; 95% CI 1.056 to 1.112), higher numbers of non-OHAs (OR 0.848; 95% CI 0.728 to 0.986) and higher HbA1c levels (OR 0.808; 95% CI 0.691 to 0.943). Semi structured interviews based on the Theoretical Domain Framework were completed with 20 patients and identified a wide range of factors potentially associated with OHA adherence, particularly behavioural related factors (e.g. scheduling medication intake, ability to develop a habitual behaviour), social influences (e.g. acting as a role model, the effect of family support), and gaps in knowledge about diabetes and its management with OHAs.

Conclusions

This unique mixed-methods study has highlighted possible reasons for the low levels of OHA adherence in this patient population. Whilst the theoretically-derived determinants of behaviour illustrate the complexities associated with OHA adherence, they also provide a robust underpinning for future intervention(s) development to improve adherence and maximise patient health outcomes.

Utilizing the common sense model to explore African Americans' perception of type 2 diabetes: A qualitative study

Illness perceptions, which are likely influenced by patients' cultural contexts, are associated with disease self-management and adherence. African American patients perceptions of type 2 diabetes is not well understood and no known studies has used a comprehensive evidence-based theoretical framework to explore what AAs with type 2 diabetes know, believe, and think about type 2 diabetes. Understanding perceptions of an illness shared by a group of people will be useful in developing culturally-appropriate interventions targeted to the needs of the community. The purpose of this study is to explore African Americans' perceptions of type 2 diabetes based on the common sense model of illness and self-regulation. Using a phenomenology qualitative approach and purposive sampling, 40 African American men and women, age 45-60 years old with diagnosed type 2 diabetes at least one year prior, and who took at least one prescription diabetes medication, participated in six semi-structured 90-minute focus groups conducted in a private space. Qualitative content analysis was conducted to explore African Americans beliefs about type 2 diabetes. Participants expressed that historical issues, e.g., slavery, healthcare providers, the government, and God influenced how they developed diabetes. Participants reported a loss of autonomy, a change of their identity as an employee, a social individual and sexual person, as well as anger and frustration due to having diabetes. Diabetes made the African American family bonding experience of eating difficult, and the disease diminished their cultural experiences. Concerns about diabetes ranged from fear of death and amputations to the inability to prevent the disease among their children/grandchildren. Participants perceived that medications, faith in God, and positive thinking about survival helped control diabetes. Conclusions: Improved diabetes self-management and medication adherence may depend on the meaning African Americans attach to diabetes, available psychosocial support for managing diabetes, and African Americans experience with diabetes.

Using the theory of planned behavior to investigate community pharmacists' beliefs regarding engaging patients about prescription drug misuse

INTRODUCTION

Opioid misuse causes over 50,000 deaths in America each year. Prescription drug monitoring program (PDMP) databases serve as a useful decision analysis tool in managing patients with known or potential opioid use disorder (OUD). To date, however, little research has sought to determine how pharmacists use PDMPs to engage patients with potential OUD.

OBJECTIVES

To elicit modal salient beliefs of community pharmacists regarding their willingness to engage patients (i.e., provide interventional counseling) with suspected controlled substance misuse as identified from reviewing PDMP data.

METHODS

Focus groups were conducted among Texas community pharmacists using the theory of planned behavior as a theoretical framework. Open-ended questions were used to capture behavioral beliefs, normative beliefs and control beliefs associated with pharmacists' engagement. Qualitative analysis using ATLAS.ti software was conducted to identify modal salient beliefs elicited by at least 20% of the study sample.

RESULTS

A total of 31 community pharmacists participated. Fifteen behavioral beliefs, thirteen normative beliefs and eleven control beliefs were identified as modal salient beliefs. The most prevalent behavioral belief was the disadvantage associated with patient confrontations. Pharmacists also believed that engaging patients may cause loss of customers/business but may help patients receive appropriate counseling. When asked about their normative beliefs, pharmacists identified regulatory agencies (e.g., pharmacy boards, law enforcement) and family/friends of patients as groups of individuals who influence their willingness to refer. Time required for counseling was found to be the most commonly cited control belief.

CONCLUSION

The results illustrate some of the challenges faced by community pharmacists when considering engagement of patients with misuse of prescription opioids. Addressing these barriers to patient engagement is critical to increasing pharmacists' willingness to engage patients with potential OUD.

A randomized controlled trial on the effect of behavioral strategies for adherence to oral antidiabetic drugs: study protocol

BACKGROUND

Non-adherence to oral antidiabetics drugs (OADs) has been a common problem and may contribute to poor glycemic control.

AIM

To describe an experimental study protocol that aims at implementing and evaluating the effect of the "action planning and coping planning" interventions on medication adherence to OADs in patients with type 2 diabetes mellitus (T2DM) in follow-up at primary care services.

DESIGN

A randomized controlled trial.

METHODS

Two groups (intervention and control) will be followed over a period of 105 days. The intervention group will receive a combination of the "action planning" and "coping planning" intervention strategies. There will be in-person meetings and phone calls to reinforce the intervention. The control group will receive the usual care from the health unit.

CONCLUSIONS

It is hoped that this study will help health professionals to improve their approach with patients who have T2DM in relation to medication adherence.

Psychosocial factors associated with adherence to non-insulin antidiabetes treatments

AIMS

To discern psychosocial factors of non-insulin antidiabetes drug (NIAD) adherence.

METHODS

A cross-sectional study based on the theory of planned behavior (TPB). Adults with type 2 diabetes (T2D) who were members of Diabète Québec, a provincial association of persons with diabetes, and were prescribed at least one NIAD were invited to complete a web-based questionnaire. We measured variables ascertaining TPB constructs and other factors potentially associated with NIAD adherence (e.g., habit, social support, and mental health). NIAD adherence was assessed using the 8-item Morisky Medication Adherence Scale. Factors were identified using a multivariate logistic regression model.

RESULTS

In our study, 901 participants (373 women; 515 retired; mean age: 62.7 years) with T2D for a mean of 10 years, completed the questionnaire. Participants exhibited a high intention to adhere to their NIAD treatment (mean score=5.8/6), positive attitudes toward adherence (mean score=5.5/6), and elevated perceived behavioral control in taking their medication (mean score=5.7/6). Only 405 (45%) participants reported high adherence (score=8/8). Perceived behavioral control, habit, older age, no perceived side effects, a longer period since T2D diagnosis and a lower number of NIAD daily doses were significantly associated with adherence (p<0.05).

CONCLUSION

We identified several factors that may be modified for NIAD adherence and thereby provided insight into future adherence-enhancing intervention targets.

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

PURPOSE

The objective of this study was to identify, using the theory of planned behavior (TPB), patients' beliefs about taking oral antidiabetic drugs (OADs) as prescribed, and to measure the correlations between beliefs and medication adherence.

PATIENTS AND METHODS

We performed a cross-sectional study of type 2 diabetic patients using structured questionnaires in a Chinese tertiary hospital. A total of 130 patients were enrolled to be interviewed about TPB variables (behavioral, normative, and control beliefs) relevant to medication adherence. Medication adherence was assessed using the eight-item Morisky Medication Adherence Scale (MMAS-8). Spearman's rank correlation was used to assess the association between TPB and MMAS-8. Logistic regression analysis was performed to examine the relationship between different variables and MMAS-8, with statistical significance determined at P<0.05.

RESULTS

From 130 eligible Chinese patients with an average age of 60.6 years and a male proportion of 50.8%, a nonsignificant relationship between behavioral, normative, and the most facilitating control beliefs and OAD adherence was found in our study. Having the OADs on hand (P=0.037) was the only facilitating control belief associated with adherence behavior. Being away from home or eating out (P=0.000), not accepting the disease (P=0.000), ignorance of life-long drug adherence (P=0.038), being busy (P=0.001), or poor memory (P=0.008) were control belief barriers found to be correlated with poor adherence. TPB is the only important determinant influencing OAD adherence among all the factors (P=0.011).

CONCLUSION

The results indicate that the TPB model could be used to examine adherence to OADs. One facilitating control belief, and most of the barrier control beliefs of TPB were related to medication adherence among Chinese type 2 diabetes inpatients. It will be helpful to understand patients' self-medication and provide methods to develop instruments for identifying factors that influence OAD adherence.

Factors associated with medication information in diabetes care: differences in perceptions between patients and health care professionals

PURPOSE

This qualitative study in patients with type 2 diabetes and health care professionals (HCPs) aimed to investigate which factors they perceive to enhance or impede medication information provision in primary care. Similarities and differences in perspectives were explored.

METHODS

Eight semistructured focus groups were conducted, four with type 2 diabetes patients (n=25) and four with both general practitioners (n=13) and health care assistants (n=10). Sessions were audio and video recorded, transcribed verbatim, and subjected to computer-aided qualitative content analysis.

RESULTS

Diabetes patients and HCPs broadly highlighted similar factors as enablers for satisfactory medication information delivery. Perceptions substantially differed regarding impeding factors. Both patients and HCPs perceived it to be essential to deliver tailored information, to have a trustful and continuous patient-provider relationship, to regularly reconcile medications, and to provide tools for medication management. However, substantial differences in perceptions related to impeding factors included the causes of inadequate information, the detail required for risk-related information, and barriers to medication reconciliation. Medication self-management was a prevalent topic among patients, whereas HCPs' focus was on fulfilling therapy and medication management responsibilities.

CONCLUSION

The findings suggest a noteworthy gap in perceptions between information provision and patients' needs regarding medication-related communication. Medication safety and adherence may be improved if HCPs collaborate more closely with diabetes patients in managing their medication, in particular by incorporating the patients' perspective. Health care systems need to be structured in a way that supports this process.