Predicting Noninsulin Antidiabetic Drug Adherence Using a Theoretical Framework Based on the Theory of Planned Behavior in Adults With Type 2 Diabetes: A Prospective Study

The mediating role of health literacy in the relationship between self-care and planned behavior against Covid-19

BACKGROUND

Planned behaviors and self-care against the coronavirus are two important factor in controlling its spread and self-care behaviors depend on the level of health literacy. This research was conducted to determine the mediating role of health literacy in the relationship between elements of planned behavior and self-care in dealing with the Covid-19.

METHODS

In this descriptive-analytical quantitative study, the sample size was calculated using Cochrane's formula and considering a p-value of 0.51, α = 0.05, and d = 0.05, and 313 students were selected based on stratified and random method. To gather data and assess various aspects of variables, a questionnaires were utilized, focusing on health literacy, self-car and planned behavior. The relationship between the variables was examined by SPSS version 26 and via descriptive statistics, including the mean and standard deviation, and inferential statistics such as Pearson's correlation coefficient (P = 0.05), path analysis, and determining the standard coefficients between self-care and planned behavior, mediated by the indicators of the health literacy.

RESULTS

A significant difference was found between the level of health literacy of women and men. The comparison of the mean health literacy and self-care behavior in terms of other variables did not show any significant difference. Meanwhile, the comparison of health status control behaviors, hand washing, and mask use did not show any significant difference between the two groups. A positive and significant correlation was found between self-care behaviors, attitude, subjective norms, perceived behavioral control, and behavioral intention. The relationship of health literacy and psychological variables of attitude, subjective norms, and perceived behavioral control with self-care against COVID-19 was significant.

CONCLUSION

The direct and significant impact of health literacy on individuals' self-care behaviors against the coronavirus was not observed. However, health literacy did have a significant effect on subjective norms. This finding is important because subjective norms significantly influenced individuals' behavioral intention, which in turn had a significant effect on self-care behaviors against the coronavirus. Thus, health literacy played a mediating role in this relationship. Furthermore, attitude emerged as the strongest predictor of behavioral intention, exerting a direct effect. Conversely, perceived behavioral control did not directly and significantly affect students' self-care behaviors.

Assessment of Medication Adherence Among Patients With Hypertension and Diabetes Mellitus in a Tertiary Healthcare Center: A Descriptive Study

Introduction Effective management of diabetes and hypertension requires a comprehensive approach, including dietary adjustments, physical activity, routine screening for complications, and adherence to medication. Proper adherence to pharmacotherapy is essential for maintaining glycemic control and managing blood pressure. Non-adherence can result in increased complications, higher healthcare costs, and greater morbidity and mortality. This study aimed to evaluate the sociodemographic profile and medication adherence among adults with diabetes and hypertension, focusing on those undergoing treatment. The objective was to determine the extent of adherence and identify factors that influence adherence among patients with type 2 diabetes mellitus (T2DM) and hypertension. Methods A community-based study was conducted on patients with T2DM and/or hypertension in both rural and urban areas of Bhopal, specifically those attending JK Hospital, Bhopal, Madhya Pradesh, India. Participants were selected using a simple random sampling method. Medication adherence was assessed using the eight-item Morisky Medication Adherence Scale (MMAS-8), a validated tool for measuring patient adherence behavior. Results The study included 300 participants, of whom 68% (n=204) were male and 32% (n=96) were female. The average age of the participants was 57.52±10.3 years. Among the 300 patients, 9% (n=27) had high adherence to medication, 24.7% (n=74) had moderate adherence, and 66.3% (n=199) had low adherence. Conclusions Effective strategies must include targeted patient education on medication costs, side effects, and the long-term benefits of adherence. Integrating technological aids like smartphone apps may enhance adherence. Patients who adhere closely to their regimens are more likely to achieve better control over blood pressure and glycated hemoglobin (HbA1c) levels, underscoring the critical importance of adherence in managing chronic conditions effectively.

Effects of Framed Mobile Messages on Beliefs, Intentions, Adherence, and Asthma Control: A Randomized Trial

We aimed to examine the effects of framed mobile messages (messages emphasizing losses or gains because of a behavior) on young adults' beliefs about their daily Inhaled Corticosteroids (ICS), intentions to take their ICS, adherence, and asthma control. College students (18-29 years) who owned a mobile phone and had a diagnosis of asthma with a prescription for an ICS were recruited. Participants (n = 43) were randomized to receive either gain- or loss-framed mobile messages three times per week for eight weeks. Engagement rates with messages were calculated. Outcomes included beliefs, intentions, adherence, and asthma control. Data collection was performed at baseline, week 4, and week 8. Mixed-design ANOVA assessed whether outcomes improved differentially from baseline to week eight between gain- and loss-framed groups. Twenty-two participants were randomly assigned to the gain-framed group and 21 to the loss-framed group. There was a 100% retention rate. The engagement rate with the text messages was 85.9%. There was a significant difference in participants' intentions to take medication and asthma control from baseline. There were no significant changes in other outcomes from baseline. There was no difference in changes in all outcomes between participants receiving gain- versus loss-framed messages. Framed mobile messages improved young adults' asthma control and intentions to take their medication as prescribed.

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.

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.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Medication adherence among the elderly: applying grounded theory approach in a developing country

BACKGROUND

Medication adherence is an important concept particularly among the elderly that can, directly and indirectly, affect the health system's costs and the elderly's health, quality of life, and functional abilities. This study aimed to determine the model of medication adherence among the Iranian elderly using the grounded theory approach.

METHODS

The concept of medication adherence and the determination of its process among the elderly is a multidisciplinary social issue that can be affected by many contextual factors. Grounded theory with the approach of Strauss and Corbin (2004) was applied to determine the customized model. Data triangulation occurred through semi-structured interviews, observation, field notes, and memoing. Open coding, selective coding, and axial coding were applied to analyze the data.

RESULTS

Delinquency in the medication use among the elderly was caused by factors such as doubtfulness, fear of complications, not following the patients by the physicians, and negative others and medical staff's impacts. During the process of medication adherence, the patient's lack of knowledge, lack of sufficient education, inappropriate and restricted lifestyle, difficult living conditions, and social pressures imposed on individuals could exacerbate and worsen the delinquency in medication adherence. It should not be neglected that some other factors such as lack of an effective supervision system, lack of supportive organizations, stakeholders' market-based behaviors, consumption inconvenience, consumption stress, hopelessness, and misunderstanding could also aggravate the delinquency.

CONCLUSIONS

Although the proposed theory and model were customized and context-based for the Iranian elderly, in general, making positive changes in the process of adherence to the medication use among the elderly requires scientific and basic management and planning of its factors. It should be noted that making these changes requires some interventions in and cooperation of all levels of the country's health system, from the Ministry of Health and Medical Education to the individual level of the elderly.

Determinants affecting medication adherence in the elderly: A qualitative study

OBJECTIVE

Due to high rates of irrational use of medicines and low rates of medication adherence among older Iranian patients, this study aimed to explore the determinants of medication adherence in the elderly.

METHODS

This qualitative study was conducted in 2019 via 20 semi-structured interviews with a purposeful sample of elderly people and health-care personnel. Transcript data were analyzed applying thematic analysis. MAXQDA10 was used for thematic analysis and presenting a thematic map.

RESULTS

Two main themes appeared as the main determinants of medication adherence: individual determinants and external determinants. Other results show that there were six sub-themes and 23 main categories in this regard. The sub-themes were as follows: consumption disorder, consumption acceptance, delinquency, forgetfulness, sociocultural factors, and others' impacts.

CONCLUSIONS

Different individual and external factors can affect elderly people's medication adherence. Considering the significance of this issue for the health of elderly people and the whole community, positive changes are needed to manage the medication-adherence process. Basic and scientific planning, appropriate interventions, and comprehensive collaboration among all health-system levels are required for implementing such changes.

Development of the Adherence to Healthy Behaviors Scale

Adherence to healthy behaviors is a protective factor in the disease progression of chronic kidney disease (CKD). Measuring adherence can lead to the recognition of unhealthy behaviors and the suggestion of programs to prevent poor health outcomes. An assessment measurement for patients with CKD not requiring dialysis was developed and psychometrically tested. A convenience sample (n = 330) of patients with CKD attending a nephrology clinic in southern Taiwan completed the 13-item Adherence to Healthy Behaviors Scale (AHBS). A principal axis factor analysis and a parallel analysis demonstrated a three-factor structure accounting for 47.16% of the total variance. Confirmatory factor analysis indicated a good model fit. The criterion-related validity was adequate (r = .51; p < .000), with a Cronbach's alpha of .70; the test-retest reliability demonstrated good stability (r = .70; p < .000). The AHBS is a valid, reliable instrument to assess adherence to healthy behaviors among patients with CKD.

Perspectives of pregnant women, family members and health professionals on medication adherence in Nigeria

ABSTRACT Nigeria has the highest burden of mother-to-child transmission of human immunodeficiency virus (HIV) worldwide. Pregnant women living with HIV in Nigeria face challenges adhering to antiretroviral therapy (ART). We explored the perspectives of pregnant women living with HIV, family members, friends and health professionals to understand adherence to ART. Pregnant women, family members, friends and health professionals recruited from four HIV treatment sites in Nigeria participated in semi-structured interviews and focus groups. Thematic analysis was conducted and themes and sub-themes were mapped against the Theory of Planned Behaviour comprising behavioural, normative and control beliefs. Overall, 74 participants took part in the study. Common behavioural beliefs comprised maintaining the mother's and unborn child's health and success of having HIV-negative children from previous pregnancies. Common normative beliefs involved partner and family support for medication taking and medication refill visits. Common control beliefs comprised fear of discrimination and stigmatisation. Results showed that adherence to ART in pregnancy is intricate. Hence, before interventions are developed to change adherence behaviours in pregnant women tailored strategies should be devised that address the salient beliefs that influence adherence during pregnancy.

The study of eye care behaviors in patients with type 2 diabetes

INTRODUCTION

The purpose of present study was to investigate eye care behaviors based on the BASNEF model and Health Locus of Control (HLOC) in patients with type 2 diabetes(T2D).

METHODS

This cross-sectional analytical study was carried out on 150 patients with T2D in Iran in 2019. The subjects were selected using simple random sampling. The data collection tools included demographic, eye self-care behavior inventory based on BASNEF model and health locus of control whose validity and reliability were confirmed. Data analysis was carried out using Independent samples-t test ANOVA, and linear regression in SPSS ver. 24.

RESULT

The results of linear regression showed that knowledge, attitude, subjective norms, enabling factors, internal HLOC, chance HLOC and external HLOC were able to predict 17% of intention to eye self-care behaviors (P < 0.001) and attitude was the strongest construct in predicting intention of eye care behavior in patients with T2D (P < 0.05). In this study, most people had internal HLOC and mean (± SD) of their internal construct was 27.42(± 2.73). Also, the enabling factors construct showed a significant correlation with the internal HLOC (r = 0.283) and behavioral intention (r = 0.348) (P < 0.001).

CONCLUSION

The results of this study showed that attitude and enabling factors are effective constructs in predicting the intention to perform preventive behaviors of ocular complications in T2D patients. Therefore, it is recommended to organize training classes, access resources, and educational information, facilitate access to physicians for eye examinations, create new skills for care and prevention of ocular complications.

Effect of an 'implementation intention' intervention on adherence to oral anti-diabetic medication in Brazilians with type 2 diabetes

OBJECTIVE

To evaluate the effects of an implementation intention intervention on adherence to an oral anti-diabetic medication regime, diabetes-related distress and on glycemic control in patients with type 2 diabetes mellitus.

METHODS

A randomized, parallel-group, single-center controlled trial was conducted among adults with type 2 diabetes being managed at the primary care level. The intervention group (IG, n = 45) received an 'implementation intention' intervention; the control group (CG, n = 45) received standard care. Primary outcomes were the taking of oral anti-diabetic medication, global adherence and level of glycated hemoglobin. The secondary outcome was diabetes-related distress. Data were gathered at baseline and after 15 weeks.

RESULTS

The IG showed improvements in adherence to an oral anti-diabetic medication regime (p < 0.0001), glycemic control (p < 0.0001) and diabetes-related distress (p < 0.0001) relative to the CG.

CONCLUSIONS

The implementation intention intervention enhanced adherence to an oral anti-diabetic medication regime, which had positive effects on blood glucose levels and diabetes-related distress.

PRACTICE IMPLICATIONS

Adherence to an oral anti-diabetic medication regime can decrease blood glucose levels and diabetes-related distress and thus reduce complications of type 2 diabetes.

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.