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Calderon-Ramirez PM, Huamani-Merma E, Mirano-Ortiz-de-Orue MG, Fernandez-Guzman D, Toro-Huamanchumo CJ. Factors associated with poor adherence to medication in patients with diabetes and hypertension in Peru: findings from a pooled analysis of six years of population-based surveys. Public Health 2024; 231:108-115. [PMID: 38653015 DOI: 10.1016/j.puhe.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 02/27/2024] [Accepted: 03/12/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE To evaluate the factors associated with poor medication adherence in patients with DM and HTN in Peru. STUDY DESIGN A cross-sectional study. METHODS We analyzed data from the Peruvian Demographic and Family Health Survey from 2014 to 2019. Adjusted prevalence ratios (aPR) and their respective 95% confidence intervals (CI) were estimated to determine the factors associated with poor medication adherence. RESULTS We included 15,184 participants with a known diagnosis of DM and HTN. The frequency of poor medication adherence was 37.1%, with 36.7% among individuals with HTN and 29.2% among individuals with DM. Those belonging to age groups above 30 years (aPR: 0.77; 95% CI: 0.74-0.80, for the group ≥ 60 years) had a lower frequency of poor medication adherence. Meanwhile, being male (aPR: 1.03; 95% CI: 1.01-1.05), lacking health insurance (aPR: 1.08; 95% CI: 1.05-1.10), belonging to lower wealth quintiles (aPR: 1.12; 95% CI: 1.08-1.17, for the first quintile), and living in the mountain region (aPR: 1.09; 95% CI: 1.06-1.12) were associated with a higher frequency of poor medication adherence. These findings were consistent when stratifying by the type of disease. CONCLUSION This study showed that poor medication adherence is common in patients with HTN and DM in Peru and is associated with sociodemographic factors, highlighting the importance of public health approaches to improve adherence.
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Affiliation(s)
| | - Edson Huamani-Merma
- Universidad Nacional de San Antonio Abad del Cusco, Escuela Profesional de Medicina Humana, Asociación Científica de Estudiantes de Medicina Humana del Cusco (ASOCIEMH CUSCO), Cusco, Peru
| | - Mayu Gabriel Mirano-Ortiz-de-Orue
- Universidad Nacional de San Antonio Abad del Cusco, Escuela Profesional de Medicina Humana, Asociación Científica de Estudiantes de Medicina Humana del Cusco (ASOCIEMH CUSCO), Cusco, Peru
| | | | - Carlos J Toro-Huamanchumo
- OBEMET Center for Obesity and Metabolic Health, Lima, Peru; Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru; Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
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Studer CM, Linder M, Pazzagli L. A global systematic overview of socioeconomic factors associated with antidiabetic medication adherence in individuals with type 2 diabetes. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2023; 42:122. [PMID: 37936205 PMCID: PMC10631092 DOI: 10.1186/s41043-023-00459-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/21/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND Antidiabetic medication adherence is a key aspect for successful control of type 2 diabetes mellitus (T2DM). This systematic review aims to provide an overview of the associations between socioeconomic factors and antidiabetic medication adherence in individuals with T2DM. METHODS A study protocol was established using the PRISMA checklist. A primary literature search was conducted during March 2022, searching PubMed, Embase, Web of Science, as well as WorldCat and the Bielefeld Academic Search Engine. Studies were included if published between 1990 and 2022 and included individuals with T2DM. During primary screening, one reviewer screened titles and abstracts for eligibility, while in the secondary screening, two reviewers worked independently to extract the relevant data from the full-text articles. RESULTS A total of 15,128 studies were found in the primary search, and 102 were finally included in the review. Most studies found were cross-sectional (72) and many investigated multiple socioeconomic factors. Four subcategories of socioeconomic factors were identified: economic (70), social (74), ethnical/racial (19) and geographical (18). The majority of studies found an association with antidiabetic medication adherence for two specific factors, namely individuals' insurance status (10) and ethnicity or race (18). Other important factors were income and education. CONCLUSIONS A large heterogeneity between studies was observed, with many studies relying on subjective data from interviewed individuals with a potential for recall bias. Several socioeconomic groups influencing medication adherence were identified, suggesting potential areas of intervention for the improvement of diabetes treatment adherence and individuals' long-term well-being.
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Affiliation(s)
- Christian Ming Studer
- Department of Chemistry and Applied Biosciences, Institute for Pharmaceutical Sciences, ETH Zurich, Zurich, Switzerland
| | - Marie Linder
- Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Laura Pazzagli
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
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Eghtedari M, Goodarzi-Khoigani M, Shahshahani MS, Javadzade H, Abazari P. Is Web-Based Program Effective on Self-Care Behaviors and Glycated Hemoglobin in Patients with Type 2 Diabetes: A Randomized Controlled Trial. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2023; 28:723-729. [PMID: 38205411 PMCID: PMC10775860 DOI: 10.4103/ijnmr.ijnmr_59_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 07/22/2023] [Accepted: 07/23/2023] [Indexed: 01/12/2024]
Abstract
Background Diabetes Self-Management Education and Support (DSMES) as a framework focuses on seven self-care behaviors. Moreover, technology-assisted self-care education is increasingly suggested for patients with Type 2 Diabetes Mellitus (T2DM). Therefore, we examined the effect of a web-based program on self-care behaviors and glycated hemoglobin values in patients with diabetes mellitus. Materials and Methods This randomized controlled clinical trial was conducted at Alzahra Hospital in Isfahan, Iran, between April and November 2020 and included 70 patients with T2DM. Data were collected using a questionnaire that included a demographic information section and a diabetes self-management section with 21 questions on a Likert scale. Fasting blood samples (2.50 ml) were collected before and after the interventions to measure HbA1c levels. The study intervention involved a web-based program that included multimedia educational content (such as videos, lectures, educational motion graphics, text files, posters, and podcasts) presented in seven sections based on DSMES over a 21-day period with monitoring by an instructor. Results The mean scores for healthy eating (F = 3.48, p = 0.034) and medication adherence (F = 6.70, p < 0.001) significantly increased in the interventional group, while the mean scores for being active, monitoring, reducing risks, problem-solving, and healthy coping did not significantly change. Additionally, the mean differences in HbA1c values significantly improved in the interventional group compared to the control (F = 5,1, p = 0.026). Conclusions A web-based program in accordance with DSMES improved HbA1c levels and increased scores for healthy eating and medication adherence in patients with T2DM. However, further research with larger sample sizes and qualitative interviews is needed.
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Affiliation(s)
- Maryam Eghtedari
- Department of Community Health Nursing, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masoomeh Goodarzi-Khoigani
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Sadat Shahshahani
- Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Homamodin Javadzade
- Department of Health Education and Health Promotion, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Parvaneh Abazari
- Department of Adult Health, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
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Lovelina L, Mukherjee P, Kumar V, Abraham S, Rahman S, Pricilla RA. A Survey on Factors Affecting Knowledge and Satisfaction with Care Among Persons with Diabetes Mellitus in an Urban Health Centre and its Outreach Clinics in South India. J ASEAN Fed Endocr Soc 2023; 38:41-49. [PMID: 38045659 PMCID: PMC10692441 DOI: 10.15605/jafes.038.02.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 12/16/2022] [Indexed: 12/05/2023] Open
Abstract
Objective To determine the level of knowledge and factors affecting knowledge and satisfaction with diabetes care among persons with diabetes at urban health centre (UHC) and community health worker (CHW)-led outreach clinics (ORC) in South India. Methodology A cross-sectional study was carried out using a structured questionnaire. One hundred patients at the UHC and 200 patients at the ORC were included. Results Patients with DM of more than eight years, with co-morbidities and maintained on insulin had good knowledge at the UHC. At the ORC, participants who received education beyond the primary level and belonging to non - Hindu religion had higher knowledge. Patients at the ORC experienced better satisfaction in terms of waiting time for appointments, consultation, registration system and counselling. At the UHC, those who received primary education or those with lower educational attainment had better satisfaction. Overall, knowledge (p = 0.03) and satisfaction (p = 0.00001) of diabetes care was better at the ORC than at the UHC. Conclusions Our study found better knowledge and satisfaction with diabetes care at the ORC than at the UHC. Whether or not the difference can be attributed to CHW-based clinics in the community needs to be further elucidated.
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Affiliation(s)
- Lerisha Lovelina
- Department of Family Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Pavan Mukherjee
- Low Cost Effective Care Unit, Christian Medical College, Vellore, Tamil Nadu, India
| | - Vijaya Kumar
- Low Cost Effective Care Unit, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sunil Abraham
- Department of Family Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sajitha Rahman
- Department of Family Medicine, Christian Medical College, Vellore, Tamil Nadu, India
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Shahabi N, Hosseini Z, Aghamolaei T, Ghanbarnejad A, Behzad A. Application of Pender's health promotion model for type 2 diabetes treatment adherence: protocol for a mixed methods study in southern Iran. Trials 2022; 23:1056. [PMID: 36578044 PMCID: PMC9795658 DOI: 10.1186/s13063-022-07027-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 12/15/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Type 2 diabetes (T2D) mellitus treatment as a chronic disease requires adequate adherence to treatment including controlling blood glucose levels and lifestyle management. The aim of this study is to investigate the factors affecting of adherence to T2D treatment from the perspective of patients and design an intervention program based on Pender's health promotion model (HPM) to increase T2D treatment adherence in Bandar Abbas, a city located in the south of Iran. METHODS This mixed method study will consist of qualitative stage, questionnaire design and a randomized, open-label, parallel-group interventional study based on HPM in southern Iran. Sampling for qualitative stage will continue until reaching the saturation. In the intervention stage, participants will be 166 T2D patients referring to the Bandar Abbas Diabetes Clinic will be randomized into intervention and control groups (allocation 1:1). After identifying the factors affecting adherence to treatment in T2D patients by qualitative study and literature review, a questionnaire based on HPM will be designed. In the next stage, 10 sessions of intervention for the intervention group will be designed. To evaluate the effect of the intervention, intervention and control groups will be tested for hemoglobin A1c (HbA1c) before and 3 months after the intervention. DISCUSSION This designed study is a program for improving treatment adherence in T2D based on the HPM model and contributes to a better understanding of effective factors in adherence to treatment in T2D patients. The results of this project can be used for macro-diabetic planning. TRIAL REGISTRATION This study is registered on the Iranian Registry of Clinical Trials (IRCT20211228053558N1: https://www.irct.ir/trial/61741 ) and first release date of 17th March 2022.
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Affiliation(s)
- Nahid Shahabi
- Student Research Committee, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Zahra Hosseini
- Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
| | - Teamur Aghamolaei
- Cardiovascular Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Amin Ghanbarnejad
- Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Ahmad Behzad
- Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
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Mita T, Katakami N, Takahara M, Kawashima M, Wada F, Akiyama H, Morita N, Kidani Y, Yajima T, Shimomura I, Watada H. Changes in Treatment Satisfaction Over 3 Years in Patients With Type 2 Diabetes After Initiating Second-line Treatment. J Clin Endocrinol Metab 2022; 107:2424-2432. [PMID: 35857060 PMCID: PMC9387712 DOI: 10.1210/clinem/dgac420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT J-DISCOVER is a prospective observational cohort study aiming to understand the current management of patients with early-stage type 2 diabetes mellitus (T2DM) in Japan, enrolling patients initiating second-line treatment. OBJECTIVE The current analysis examined the change in treatment satisfaction during the study period and factors affecting this change among patients in J-DISCOVER. METHODS We used data from the J-DISCOVER study, in which 1798 patients with T2DM aged ≥ 20 years were enrolled from 142 sites across Japan. Treatment satisfaction was assessed using the Diabetes Treatment Satisfaction Questionnaire (DTSQ). RESULTS The mean DTSQ treatment satisfaction score increased from 25.9 points at baseline to 27.3 points at 6 months, which was maintained through 36 months. Among the baseline characteristics examined, higher baseline DTSQ treatment satisfaction scores (P < 0.0001), older age (≥ 75 vs < 65 years, P = 0.0096), living alone (P = 0.0356), and type of facility (clinics vs hospitals, P = 0.0044) had a significantly negative impact on the changes in DTSQ treatment satisfaction scores. Improvement in mean glycated hemoglobin (HbA1c) from baseline (7.7%) to 36 months (7.1%) was associated with positive changes in the DTSQ treatment satisfaction score (P = 0.0003). CONCLUSION Changes in DTSQ treatment satisfaction scores were related to HbA1c improvement, suggesting that the management strategy was appropriately planned for each patient. The results also suggest that the availability of social support for patients with T2DM who are elderly or living alone may be an important factor affecting treatment satisfaction, adherence, and clinical outcomes.
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Affiliation(s)
- Tomoya Mita
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Naoto Katakami
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Mitsuyoshi Takahara
- Department of Diabetes Care Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | | | | | | | | | | | - Toshitaka Yajima
- Correspondence: Toshitaka Yajima, M.D., Ph.D., Medical Affairs, AstraZeneca K.K., 3-1 Ofukacho, Kita-ku, Osaka 530-0011, Japan.
| | - Iichiro Shimomura
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Hirotaka Watada
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
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González-Saldivar G, Millan-Alanis JM, González-González JG, Sánchez-Gómez RA, Obeso-Fernández J, McCoy RG, Maraka S, Brito JP, Ospina NS, Oyervides-Fuentes S, Rodríguez-Gutiérrez R. Treatment burden and perceptions of glucose-lowering therapy among people living with diabetes. Prim Care Diabetes 2022; 16:568-573. [PMID: 35466069 PMCID: PMC9357113 DOI: 10.1016/j.pcd.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/20/2022] [Accepted: 04/12/2022] [Indexed: 11/21/2022]
Abstract
AIMS Address treatment burden and general perceptions of pharmacological treatment in patients with diabetes. METHODS We surveyed adult patients with diabetes cared for in a tertiary academic medical center about: i) knowledge about the impact of glucose-lowering medication use on diabetes control and complications, ii) common beliefs about natural medicine and insulin use, iii) attitudes towards glucose-lowering medications, iv) burden of treatment, v) general knowledge of diabetes pharmacological treatment, and vi) perceptions of shared decision-making. RESULTS Two hundred-four participants completed the survey. While most (90%) agreed that adherence to medication would control diabetes and improve quality of life, 30-40% were not certain that it would translate to fewer disease complications. About one of three thought medications could be harmful (29.4%). Over 50% agreed or was unsure that natural remedies were as good/better than prescribed medications. About 30% acknowledged difficulties taking their diabetes medications and monitoring blood glucose, and over 50% were concerned about treatment costs. Nearly 30% denied receiving a detailed explanation from their clinician regarding their disease and is treatment. CONCLUSIONS Our results highlight the importance of patient education regarding pharmacological treatment for diabetes, and eliciting sources of distress and treatment burden among patients with diabetes.
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Affiliation(s)
- Gerardo González-Saldivar
- Endocrinology Division, Department of Internal Medicine, University Hospital "Dr. José E. González", Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Juan Manuel Millan-Alanis
- Endocrinology Division, Department of Internal Medicine, University Hospital "Dr. José E. González", Universidad Autónoma de Nuevo León, Monterrey, Mexico; Plataforma INVEST Medicina UANL KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - José Gerardo González-González
- Endocrinology Division, Department of Internal Medicine, University Hospital "Dr. José E. González", Universidad Autónoma de Nuevo León, Monterrey, Mexico; Plataforma INVEST Medicina UANL KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Raymundo A Sánchez-Gómez
- Endocrinology Division, Department of Internal Medicine, University Hospital "Dr. José E. González", Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Javier Obeso-Fernández
- Endocrinology Division, Department of Internal Medicine, University Hospital "Dr. José E. González", Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Rozalina G McCoy
- Division of Community Internal Medicine, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA; Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, 200 First Street SW, Rochester, MN 55905, USA
| | - Spyridoula Maraka
- Division of Endocrinology and Metabolism, Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA; Medicine Service,Central Arkansas Veterans Healthcare System, Little Rock, AR, USA; Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Juan P Brito
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA; Division of Diabetes, Endocrinology, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Naykky Singh Ospina
- Division of Endocrinology, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Stephie Oyervides-Fuentes
- Endocrinology Division, Department of Internal Medicine, University Hospital "Dr. José E. González", Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - René Rodríguez-Gutiérrez
- Endocrinology Division, Department of Internal Medicine, University Hospital "Dr. José E. González", Universidad Autónoma de Nuevo León, Monterrey, Mexico; Plataforma INVEST Medicina UANL KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, Mexico; Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
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Świątoniowska-Lonc N, Kołtuniuk A, Jankowska-Polańska B. Psychometric Properties of the Treatment Satisfaction with Medicines Questionnaire (SATMED-Q) in Patients with Diabetes, Arterial Hypertension and Heart Failure. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031088. [PMID: 35162111 PMCID: PMC8834327 DOI: 10.3390/ijerph19031088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/13/2022] [Accepted: 01/17/2022] [Indexed: 02/05/2023]
Abstract
Background: Satisfaction with medicines is crucial in indicating patient experiences with the treatment which impact medicine adherence and compliance. Aim: The aim of this research was to adopt a general measure of patients’ satisfaction with medicines, the Treatment Satisfaction with Medicines Questionnaire (SATMED-Q), to the Polish language (BMQ-PL). Materials and Methods: A total of 197 patients qualified for the research, with the following diagnoses: type 2 diabetes (n = 42), hypertension (n = 55) and heart failure (n = 100), aged 64.73 (SD = 13.27). The criterion-related validity was determined with the use of a Polish version of the Adherence to Refills and Medications Scale. Confirmatory and exploratory factor analyses were used. Results: The respondents’ mean score was 73.63 (SD = 18.42). Cronbach’s alpha for the entire instrument was 0.847. All items of the questionnaire were found to have a positive item–total correlation. A multifactorial linear regression model showed that a significant (p ˂ 0.05) independent variable increasing the SATMED-Q score for the whole group was educational level (vocational education R = 14.576; secondary education R = 14.055; higher education R = 19.372) and low adherence (R = −1.384) was a decreasing variable. Conclusions: The present findings indicate a high level of reliability and validity of the translated SATMED-Q questionnaire, fully comparable to that of the original. The questionnaire can be used for the assessment of satisfaction with medicines among Polish patients.
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Affiliation(s)
- Natalia Świątoniowska-Lonc
- Division of Internal Medicine Nursing, Faculty of Health Science, Wroclaw Medical University, 51-618 Wroclaw, Poland;
- Center for Research and Innovation, 4th Military Teaching Hospital, 50-981 Wroclaw, Poland;
- Correspondence:
| | - Aleksandra Kołtuniuk
- Division of Internal Medicine Nursing, Faculty of Health Science, Wroclaw Medical University, 51-618 Wroclaw, Poland;
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