Influence of patients' disease knowledge and beliefs about medicines on medication adherence: findings from a cross-sectional survey among patients with type 2 diabetes mellitus in Palestine

The Effects of Diverse Interventions on Diabetes Management Among Arabs With Diabetes: A Systematic Review

AIM

To identify, describe, and critically evaluate the effects of various interventions on diabetes management outcomes among Arabs with diabetes.

DESIGN

A systematic review.

DATA SOURCES

The search was conducted across three databases: PubMed, CINAHL and the Cochrane Collaboration in December 2023.

REVIEW METHODS

Screening involved randomised controlled trials and nonrandomised studies that focused on the effects of interventions on diabetes management among Arab with diabetes. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist guided the review process. Two researchers independently applied eligibility criteria. Data extraction captured key study details, and methodological quality was assessed using Downs and Black's checklist. This review is registered with the International Prospective Register of Systematic Reviews (PROSPERO; registration number CRD42024555668).

RESULTS

Thirty-five articles were reviewed, yielding 65 outcomes. Effective interventions included personalised care, patient-centred education and direct patient contact through lifestyle modifications, advice, feedback, motivational conversations and calls. These approaches improved haemoglobin A1c, fasting blood glucose, physical activity and medication adherence. Conversely, nonpersonalised remote monitoring and social media interventions showed no significant improvements. Notably, tailored nutritional and physical activity advice positively impacted body mass index and systolic blood pressure among Arab women with diabetes.

CONCLUSION

The findings underscore the effectiveness of personalised care and direct patient contact in optimising diabetes management among Arabs with diabetes.

IMPACT

This review highlights the importance of prioritising direct patient contact over remote methods such as social media in interventions on diabetes management among Arabs with diabetes. It emphasises the need for culturally sensitive approaches, particularly for women.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution, as this study constitutes a review of existing research.

Investigation of patients' understanding of fibromyalgia: Results from an online qualitative survey

OBJECTIVE

An important component to effective fibromyalgia treatment is patient education about the condition. While previous educational interventions have been developed, these have not incorporated the lived experiences of patients and may not address common misunderstandings among those who may benefit from these interventions. This study aimed to explore understanding, confusion, and gaps in knowledge about fibromyalgia among those who report a fibromyalgia diagnosis.

METHODS

Participants were recruited via clinic flyers and the social media page of a chronic pain research laboratory. Participants completed an online survey that assessed their knowledge of fibromyalgia via open-ended questions. Responses were analyzed via thematic analysis to identify, analyze, and report themes.

RESULTS

Thirty-eight participants completed the survey (63% female, ages 18-68). Common themes that arose from patients included being unsure of the cause of their fibromyalgia, frustration and confusion about the random/variable nature of symptoms and flares, feeling that their condition was invisible, and desiring more information on available treatments.

CONCLUSION

Participants in this study expressed confusion about many aspects of fibromyalgia and a desire for more understanding from others in their life about this condition.

PRACTICE IMPLICATIONS

Future interventions would benefit from tailoring fibromyalgia education to the specific knowledge and lived experiences of patients.

Non-adherence to Anti-diabetic Prescriptions Among Type 2 Diabetes Mellitus Patients in the Kurdistan Region of Iraq

BACKGROUND

Treatment adherence is a primary key in controlling diabetes disease. The study aims to determine the prevalence of treatment adherence in type 2 diabetes mellitus (T2DM) patients, investigate the potential influence of adherence on elevated blood glucose levels, and identify the key factors which play a role in non-adherence to the prescribed drugs.

METHOD

A cross-sectional study method was utilized to collect data from all T2DM patients at the Diabetic and Endocrine Centre and Shar Hospital in Sulaymaniyah city in the Kurdistan region of Iraq from February 2022 to April 2022. The data collection was performed through a structured questionnaire. The prevalence of drug adherence was assessed using the Morisky Medication-Taking Adherence Scale (4-item), and the glycated hemoglobin test (A1C) was used to determine the blood glucose level.

RESULT

A total of 300 participants were studied, and more than half of them (192; 64%) revealed that they did not adhere to their anti-diabetic medications. Non-adherence was significantly associated with higher A1C. Several barriers to non-adherence were identified as multiple medications, feeling the dose given is high, lack of finance, and side effects by 209 (70%), 116 (39%), 113 (38%), and 103 (34%), respectively.

CONCLUSION

The current study's result revealed that most T2DM patients have no adherence to their medication. This non-adherence is significantly linked to higher A1C levels, emphasizing the critical role of medication compliance in managing diabetes effectively. The study also sheds light on the multiple barriers such as taking multiple prescriptions, the perception that the dose is excessive, lack of finances, and experiencing side effects, which contribute to non-adherence among diabetes patients. These findings underscore the need for healthcare providers to address these barriers and develop tailored strategies to enhance medication adherence among individuals with diabetes.

Factors affecting medication adherence in patients using oral chemotherapy: A descriptive study

INTRODUCTION

The utilization of oral chemotherapy agents for cancer treatment has witnessed a steady rise in recent years. The pivotal determinant for the success of oral chemotherapy lies in the adherence of cancer patients to the prescribed treatment. This study aims to explore oral chemotherapy adherence and identify factors influencing medication adherence among cancer patients.

METHODS

A total of 103 cancer patients participated in this descriptive study. Data were collected using the Oral Chemotherapy Adherence Scale, the Turkish Translation of the Beliefs about Medicines Questionnaire (BMQ-T) and The Functional Living Index-Cancer.

RESULTS

Of the participants, 66% reported good adherence to oral chemotherapy. Key findings indicate that access to health services (β = -1.473, p = 0.009), cancer stage (β = -1.570, p = 0.015) and the BMQ-T subscale of General Overuse (β = .696, p = 0.041) were independent predictors of medication adherence.

CONCLUSION

The study observed medication non-adherence in one-third of patients undergoing oral chemotherapy. Primary contributors to non-adherence included difficulties in accessing health services, advanced cancer stage and the belief that drugs are over-recommended by doctors. These results underscore the need for a heightened focus on preventable factors, such as improving access to health services and addressing beliefs about drug overuse, to enhance medication adherence in patients receiving oral chemotherapy.

Global Dilemma and Needs Assessment Toward Achieving Sustainable Development Goals in Controlling Leishmaniasis

Leishmaniasis is a disease of poverty that imposes a devastating medical, social, and economic burden on over 1 billion people nationwide. To date, no in-depth study to analyze the major global challenges and needs assessment has been carried out. This investigation aimed to explore a comprehensive narrative review of leishmaniasis's main challenges and initially highlight obstacles that might impede the implementation of control measures. Also, we propose a specific list of priorities for needs assessment. The presence of socioeconomic factors, multiple clinical and epidemiological forms, various Leishmania species, the complexity of the life cycle, the absence of effective drugs and vaccines, and the lack of efficient vector and reservoir control make this organism unique and sophisticated in playing a tangled role to react tricky with its surrounding environments, despite extensive efforts and implementation of all-inclusive former control measures. These facts indicate that the previous strategic plans, financial support, and basic infrastructures connected to leishmaniasis surveillance are still insufficient. Strengthening the leishmaniasis framework in a context of accelerated programmatic action and intensification of cross-cutting activities along with other neglected tropical diseases (NTDs) is confidently expected to result in greater effectiveness, cost-benefit, and fruitful management. Sensitive diagnostics, effective therapeutics, and efficacious vaccines are vital to accelerating advancement toward elimination, and reducing morbidity/mortality and program costs. Collective actions devoted by all sectors and policy-makers can hopefully overcome technical and operational barriers to guarantee that effective and coordinated implementation plans are sustained to meet the road map for NTDs 2021- 2030 goals.

A Systematic Review and Classification of Factors Influencing Diabetic Foot Ulcer Treatment Adherence, in Accordance With the WHO Dimensions of Adherence to Long-Term Therapies

PURPOSE

Effective treatment of diabetic foot ulcers (DFUs) involves a multidisciplinary treatment plan to promote wound healing and prevent complications. Given the lack of consensus data on the factors affecting patient adherence, a systematic review was performed to identify and classify factors according to the WHO Dimensions of Adherence to Long-Term Therapies.

METHODS

Six hundred and forty-three articles from PubMed, Embase, and Scopus were reviewed. The inclusion criteria included qualitative and quantitative studies which discussed factors affecting patient adherence to DFU treatment, had study populations that comprised patients with either prior history of or existing DFU, and had either prior history of DFU treatment or were currently receiving treatment. Factors, and associated measures of adherence, were extracted and organized according to the WHO Dimensions of Adherence to Long-Term Therapies.

RESULTS

Seven quantitative and eight qualitative studies were included. Eleven patient-related factors, seven condition-related factors, three therapy-related factors, five socioeconomic factors, and five health system-related factors were investigated by the included studies. The largest proportion of factors studied was patient-related, such as patient insight on DFU treatment, patient motivation, and patient perception of DFU treatment. There was notable overlap in the range of discussed factors across various domains, in the socioeconomic (including social support, income, social and cultural acceptability of DFU therapy, cost) and therapy-related domains (including duration of treatment, offloading footwear, and reminder devices). Different studies found that specific factors, such as gender and patients having a low internal locus of control, had differing effects on adherence on different cohorts.

CONCLUSION

Current literature presents heterogeneous findings regarding factors affecting patient adherence. It would be useful for future studies to categorize factors as such to provide more comprehensive understanding and personalized care to patients. Further research can be done to explore how significant factors can be addressed universally across different cohort populations in different cultural and socioeconomic contexts.

The mediating effect of self-efficacy on the relationship between social support and medication adherence in adults with type 2 diabetes

Objective

To evaluate the status of medication adherence in diabetic patients and its effective factors.

Methods

A cross-sectional descriptive study was conducted with 170 diabetic patients in Iran. Participants were assessed for medication adherence, self-efficacy, and social support. Descriptive statistics, bivariate analyses, and multiple stepwise regression were conducted to explore predictors for medication adherence.

Results

Regression analysis showed that 48% of medication adherence changes stemmed from the four variables including social support, self-efficacy, income, and education levels, (R2adj = 0.480, F = 39.943, p < 0.001). According to the model, the highest effects were related to income level (β = 0.332, t = 5.493, p ⩽ 0.001) and self-efficacy (β = 0.330, t = 4.789, p ⩽ 0.001), respectively. Based on the final model, only the social support variable showed no significant relationship with adherence (β = 0.002, t = 0.032, p = 0.947).

Conclusion

Social support and self-efficacy were related to medication adherence in diabetic patients, and social support can improve medication adherence in patients with diabetes by affecting self-efficacy. Healthcare workers who interact with individuals with diabetes should take into account the factors mentioned above when designing health promotion interventions to address the needs of these individuals.

Assessment of Alternative Medicine Use, Costs, and Predictors of Medication Adherence among Diabetes Mellitus Patients in Palestine

BACKGROUND

Diabetes Mellitus (DM) is considered the fourth leading cause of death in Palestine, with a prevalence of 9.1% in patients aged 20-79 years, and has increased to 20.6% in 2020.

AIMS

This study aims to estimate DM costs, compare DM total health care cost among patient characteristics and DM management (e.g. anti-diabetic medications and alternative medicine), as well as assess MA and its predictors including patient characteristics, DM management, alternative medicine use, and DM costs.

METHODS

A cross-sectional study was conducted for the past one year among 479 diabetic patients, selected by convenience sampling and snowball sampling methods via electronic post of an online questionnaire, including a web link to the questionnaire page in a Google Form via email or public social media pages and applications. Data on patients' socio-demographic and clinical characteristics, medication profile, use of medicinal plants as alternative medicine, costs, and Medication Adherence (MA) were collected. The Statistical Package for Social Sciences (SPSS v. 25) was used to perform a descriptive, Kolmogorov-Smirnov test, univariate analysis, Mann-Whitney or Kruskal- Wallis test, multiple linear regression, binary logistic regression, and multiple logistic regression analysis. A p-value < 0.05 was considered statistically significant.

RESULTS

More than half of the participants were male and living in villages (50.7%, 59.1%, respectively). Approximately 51.4% received Oral Hypoglycemic Drugs (OHDs) and only 16.1% received insulin. The participants receiving ≤3 medications daily acquired the highest percentage (55.7%), and less than half received medicinal plants as an alternative medicine for the management of DM. The estimated total DM health care cost per year incurred by patients and family members was Israeli Shekel 988,276 (US Dollar 307,590). More than half of the participants were considered adherent with the Eight-Item Morisky Medication Adherence Scale (MMAS-8) score ≥6. It is noteworthy that the use of alternative medicine was significantly associated with total health care cost and MA. Furthermore, DM duration was significantly associated with MA. These results are worth taking into consideration.

CONCLUSION

This study reflects the need for strengthening the patient-health care professionals' relationship, and to enhance the role of preventive education, and the importance of awareness about MA, DSCMBs, and the use of alternative medicine based on evidence-based strategies to improve MA, glycemic control, meanwhile reducing the costs incurred by patients and family members.

How do hospital providers perceive and experience the information-delivery process? A qualitative exploratory study

Objective

To explore how professionals deal with informing their patients and how they experience the process per se, in order to deepen understanding of the issues involved and to identify areas of focus for improvement.

Methods

Semi-structured qualitative interviews were conducted with 13 hospital professionals at Lausanne University Hospital, Switzerland.

Results

Information includes feedback, practical information, patient condition, treatment/process of care, and educational material. Information-delivery is a process that involves informing the patient then checking patient reception of the information. The main expected outcome is patient action. Providers can feel trapped, guilty, inadequate, powerless, disenchanted when the process fails to achieve its expected purpose.

Conclusions

Informing and checking strategies are not implemented optimally, and providers could benefit from guidance in order to decrease discomfort and become more proficient at delivering information.

Innovation

Addressing the information-delivery process per se provides us with a novel insight into the complexity of the process and contributes to identifying essential ingredients of future innovative training programs for providers at large.

Validation and Psychometric Evaluation of Diabetes Literacy, Numeracy, and Knowledge Tools in the Arabic Context

PURPOSE

The purpose of this study was to validate the Literacy Assessment for Diabetes (LAD), the Diabetes Numeracy Test (DNT), and the Simplified Diabetes Knowledge Test (DKT) in the Arabic language and context.

METHODS

Three hundred eighty four, ≥18-year-old patients with type 1, type 2, or gestational diabetes mellitus were recruited from 3 endocrinology clinics in the United Arab Emirates. Exploratory factor analysis using principal component was performed. Achieved scores were compared using Pearson bivariate correlation.

RESULTS

All 60 LAD items loaded on 1 factor accounting for 66.7% of the variance, with internal consistency α = .991. Average score = 68.7%. Nineteen out of 26 items were retained on the DNT and grouped into 4 factors, prescription reading and directions, proper dose coverage, nutrition, and insulin, with good internal consistency (α = .721). Average score = 73.2%. All 20 DKT items loaded on 3 factors accounting for 41.2% of the variance, causes and consequences of the high blood sugar level, prevention of the disease, and misconceptions about diabetes self-management, with good internal consistency (α = .799). Average score = 71.9%. A moderate and significant correlation between the DKT and DNT (r = .56, P < .001) was observed.

CONCLUSIONS

Three tools to assess diabetes literacy, numeracy, and knowledge were psychometrically tested to establish their validity and reliability in the Arabic language and context. The tools could be used to assess patient skills and competence in navigating the health care system and managing their diabetes.

Association of health anxiety, fatalism and medication adherence among geriatric clients: An exploratory study

OBJECTIVES

This study explored the relationship between health anxiety, fatalistic beliefs, and medication adherence among geriatric clients. Also, it determines the extent to which health anxiety and fatalism can predict the variance in medication adherence among the same population of geriatric clients.

DESIGN

A cross-sectional analytical survey on 200 eligible participants using the Arabic Version of the Short Health Anxiety Inventory, Fatalism Scale, and Morisky Medication Adherence Scale-8 items.

RESULTS

The study found a statistically significant negative relationship between the studied geriatric clients' fatalism and health anxiety and their medication adherence (r = -0.160, - 0.187, and P = 0.024, 0.008), respectively.

CONCLUSION

This study highlights the importance of considering psychological factors such as health anxiety and fatalistic beliefs in addressing medication adherence among geriatric clients. By addressing these factors, healthcare providers can develop more effective strategies to improve medication adherence and ultimately improve the health outcomes of geriatric clients.

Adherence to levothyroxine treatment among patients with hypothyroidism in Oman: a national cross-sectional study

OBJECTIVE

Hormone replacement therapy with levothyroxine is considered the treatment of choice for hypothyroidism; however, non-adherence is a major contributor to poor treatment outcomes. This study aimed to evaluate levels of drug adherence (DA) to levothyroxine therapy among Omani adults with hypothyroidism and to explore related sociodemographic and clinical factors.

METHODS

A national, multi-center, cross-sectional survey was carried out from August to December 2021 at 18 primary healthcare centers across all governorates of Oman. A total of 415 Omani adults were recruited. Data were collected using a pre-tested, Arabic-language questionnaire completed by trained researchers during face-to-face interviews with the participants. Level of DA was determined using the 8-item Morisky Medication Adherence Scale (MMAS-8).

RESULTS

A total of 400 Omani adults participated in the study (response rate: 96.4%). The mean age was 41.9 ± 12.4 years old (range: 18-78 years) and 90.3% were female. According to their MMAS-8 scores, 157 (39.2%), 139 (34.8%), and 104 (26.0%) participants demonstrated low, medium, and high DA, respectively. No significant correlations were observed between level of DA and any sociodemographic or clinical characteristics, including age, gender, education, duration of treatment, and family history of thyroid disease (p > 0.050).

CONCLUSIONS

Only a quarter of Omani patients with hypothyroidism reported high levels of adherence to levothyroxine treatment, likely as a result of lack of awareness of the disease and the importance of maintaining an euthyroid state. Further studies using more objective measures of DA are recommended to determine correlates of non-compliance to levothyroxine therapy among Omani patients.

Medication Adherence and its Predictors among Type 2 Diabetes Mellitus Patients: A Cross-Sectional Study

Medication adherence is vital in managing noncommunicable diseases like diabetes. Illness perception and an individual's knowledge regarding the disease may influence medication adherence. The present study aimed to assess the prevalence and predictors of medication adherence among type 2 diabetic patients. A cross-sectional study was conducted among 400 diabetes mellitus patients attending an outdoor patient department (OPD) of a tertiary care hospital in North India. Brief Medication Questionnaire (BMQ) and Brief Illness Perception Questionnaire (B-IPQ) were used to study medication adherence and illness perception, respectively. Descriptive and analytic statistics were computed using Epi Info software for Windows (CDC, Atlanta, GA, USA). The prevalence of medication adherence was 79.5% (82/400). The odds of medication adherence increased with higher age (odds ratio [OR] = 1.8 [1.1-2.9]) and more duration of illness (OR = 1.8 [1.0-3.2]) Patients having good knowledge of diabetes were more likely to adhere to medications. [OR=1.8(1.1-3.1). Diabetes medicine-adherent patients had a higher perceived understanding of the disease, felt having lesser negative consequences, and were less concerned about the illness than their counterparts. A high proportion adhered to diabetes medication. The guiding factors to further improve medication adherence are age, duration of illness, illness perception, and knowledge regarding the disease.

Medication self-management in predominantly African American and Caribbean American people with epilepsy: The role of medication beliefs and epilepsy knowledge

INTRODUCTION

Suboptimal medication adherence is common in people with epilepsy (PWE) and disproportionally prevalent among racially/ethnically diverse patients. Understanding reasons and risks of suboptimal adherence is critical to developing interventions that reduce negative health outcomes. This cross-sectional study characterized common barriers to medication self-management, prevalence of negative medication beliefs, and gaps in epilepsy knowledge among predominantly African American and Caribbean American PWE and examined their interrelationships.

MATERIALS AND METHODS

Sixty-three PWE (Age = 42.1 ± 13.2; 60% female; 79% Black; 19% Hispanic/Latino) completed validated self-report questionnaires about medication self-management, medication beliefs, and epilepsy knowledge. Correlations and t-tests examined interrelationships.

RESULTS

Four barriers to medication self-management were common, including not taking antiseizure medications at the same time every day, forgetting doses, not planning refills before running out, and spreading out doses when running low. More than half the sample believed medications were overused by prescribers. Nearly one-third believed medications were harmful, and nearly a quarter believed their antiseizure medications were minimally necessary with almost half reporting elevated concerns about negative consequences of antiseizure medications. Poorer medication self-management was associated with stronger beliefs that medications in general are harmful/overused by prescribers. Individuals who were "accepting" of their antiseizure medications (i.e., high perceived necessity, low concerns) were less likely to spread out time between doses when running low compared to non-accepting counterparts. Knowledge gaps related to the cause of seizures/epilepsy, chronicity of epilepsy treatment, and seizure semiology/diagnosis were common. Nevertheless, epilepsy knowledge was unrelated to medication self-management and medication beliefs.

CONCLUSIONS

In these PWE, the most prevalent reasons for suboptimal medication self-management were behaviorally mediated and potentially modifiable. Negative medication beliefs and misconceptions about epilepsy and its treatment were common. Results further suggest that interventions addressing negative medication beliefs will be more effective than knowledge-based psychoeducation alone to improve medication self-management in this patient population.

Understanding reasons and determinants of medication non-adherence in community-dwelling adults: a cross-sectional study comparing young and older age groups

BACKGROUND

Medication non-adherence has become a striking problem among patients with chronic diseases worldwide. However, literature on prevalence, reasons and factors associated with medication non-adherence in Singapore general population is still lacking. This study aimed to (1) estimate the prevalence of intentional and unintentional medication non-adherence in young (aged 21-64 years) and older adults (aged ≥ 65 years), respectively; (2) identify and compare the main reasons for non-adherence; and (3) examine the association between potential factors and non-adherence in each group.

METHODS

This study sampled 1,528 community-dwelling adults on medications (young adults:766, older adults: 762) from a cross-sectional population health survey conducted in the northern and central regions of Singapore in 2018/2019. Self-reported medication non-adherence and its reasons were collected using a modified questionnaire and compared between the two groups. Multiple logistic regressions were conducted to examine the association between potential factors (e.g., social-demographic factors, smoking and drinking status, presence of diabetes, hypertension, or dyslipidaemia, and presence of depressive symptoms) and medication non-adherence in each group.

RESULTS

The prevalence of non-adherence was 38.4% and 22.3% in young and older adults, respectively, with young adults reporting higher unintentional and intentional non-adherence rates than older adults. "Afraid of developing drug dependence" was the most common reason in both groups (young:74.8% vs. old:73.5%). Compared to young adults (3.7%), "Not understanding medication labels" was more prevalent in older adults (8.8%). Presence of depressive symptoms was associated with non-adherence in both young (odds ratio [95% confidence interval]: 3.00 [1.79, 5.05]) and older adults (4.16 [2.31, 7.51]). Being employed (2.92 [1.76, 4.84]) and taking ≥ 2 medications (1.42 [1.04, 1.95]) had positive association while personal income of SGD1,000-4,000 (0.53 [0.36, 0.77]) and current smoking (0.61 [0.39, 0.95]) had inverse association with non-compliance in young adults. Diagnosis of diabetes, hypertension, or dyslipidaemia (2.63 [1.25, 5.53]) was associated with higher odds of non-compliance in older adults.

CONCLUSIONS

Young adults had higher prevalence of medication non-adherence than older adults. The main reasons for non-adherence reported by young and older adults were generally comparable. Presence of depressive symptoms was a risk factor of medication non-adherence in both groups.

Relationship Between Medication Literacy and Beliefs Among Persons with Type 2 Diabetes Mellitus in Guangdong, China

Purpose

To establish the relationship between medication literacy and medication beliefs among persons with type 2 diabetes mellitus (T2DM).

Patients and methods

A cross-sectional survey of 246 patients with T2DM was conducted between April and November 2022 at a tertiary hospital in Dongguan City, Guangdong Province, China. Subsequently, these patients were administered the General Information Questionnaire, the Chinese version of Medication Literacy Assessment Scale, and the Chinese version of Beliefs about Medicines Questionnaire-Specific via survey.

Results

The medication literacy score of patients with T2DM was 7.82±3.007, and the medication beliefs score was 2.26±4.011. The Pearson correlation analysis revealed a statistically significant but weakly positive correlation (r = 0.271, P < 0.001) between medication literacy and beliefs among patients diagnosed with T2DM. However, there was no significant correlation found between medication literacy and necessity (r = -0.021, P > 0.05), while a lowly negative correlation was observed between medication literacy and concerns (r = -0.307, P < 0.001). Moreover, the multiple linear regression analysis indicated that medication literacy, age, education level, and duration of medication usage were all significant factors influencing patients' medication beliefs (all P < 0.05). Together, these variables accounted for 15.3% of the total variance observed in the regression equation.

Conclusion

The study found a positive correlation between medication literacy and beliefs, and a negative correlation between medication literacy and concerns. These results indicate that enhancing medication literacy can improve medication adherence among individuals with T2DM by reducing concerns and strengthening medication beliefs.

Socio-personal factors affecting adherence to treatment in patients with type 2 diabetes: A systematic review and meta-analysis

PURPOSE

The purpose of study was to identify the socio-personal factors affecting adherence to the treatment of patients with type 2 diabetes.

METHODS

Cross-sectional articles were extracted from databases such as Web of Science, PubMed, Elsevier. A meta-analysis was performed using integrated odds ratios (OR) and 95% confidence interval (CIs) for age, BMI, depression, educational level, gender, employment status, marital status, smoking status. STATA 12.0 was used to estimate pooled RR in definite subgroups. The quality of the studies included was evaluated using the STROBE checklist.

RESULTS

Thirty-one studies out of 7407 extracted articles were finally selected for the meta-analysis. The results showed that younger people had a 17% higher risk than older people, smokers had a 22% higher risk than non-smokers, and the employed had a 15% higher risk of non-adherence to treatment.

CONCLUSION

In conclusion, older age, smoking and employment can lead to non-adherence to T2D treatment. Interventions are suggested to be made besides common health care considering the socio-personal features on type 2 diabetes patients' treatment adherence.

The information needs of people with degenerative cervical myelopathy: A qualitative study to inform patient education in clinical practice

BACKGROUND

Individuals with lifelong illnesses need access to adequate information about their condition to make optimal health decisions. Degenerative Cervical Myelopathy (DCM) is the most common form of spinal cord dysfunction in adults worldwide. Its chronic and debilitating nature, varied impact, clinical trajectory, and management options necessitate appropriate informational support to sustain effective clinical and self-directed care strategies. However, before clinicians can meet patients' information needs, they must first have an understanding of their baseline requirements. This study explores the information needs of people with DCM (PwCM). In doing so, it provides a starting point for the development of patient education and knowledge management strategies in clinical practice.

METHODS

Semi-structured interviews with PwCM were conducted using an interview guide. Interviews were audio-recorded and transcribed verbatim. Thematic analysis according to Braun and Clarke's six-phase approach was used to analyse the data. Findings were reported according to the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines.

RESULTS

Twenty PwCM (65% female, 35% male), with ages ranging from 39 to 74 years old participated in the interviews. The findings indicated that the provision of information to PwCM during clinical interactions varies. Accordingly, PwCM's information needs were broad-ranging, as was the nature of the information they found useful. Three main themes were identified (1) Variation in the provision of information to PwCM during clinical interactions, (2) Variations in the information needs of PwCM, and (3) Information that PwCM find useful.

CONCLUSION

Efforts must turn to adequately educating patients at the time of the clinical encounter. A comprehensive and consistent patient-centered information exchange in DCM is necessary to achieve this.

Helicobacter pylori treatment knowledge, access and barriers: A cross-sectional study

BACKGROUND

Helicobacter pylori (Hp) is among the most common bacterial infections in the world and one of the most common infectious agents linked to malignancy, gastric cancer (GC). Within the US there is high disparity in the rates of Hp infection and associated diseases. Hp infection is treatable, and knowledge may influence screening and treatment seeking behaviors.

MATERIALS AND METHODS

In this cross-sectional study of 1042 respondents recruited from the Online Amazon MTurk platform, we sought to assess baseline knowledge of Hp and to gain insight into barriers related to Hp care.

RESULTS

Just over half (52.3%) reported some prior knowledge of Hp with 11.7% (n = 122) reporting being treated for Hp themselves and 21.4% reporting family members diagnosed with Hp. Of respondents reporting prior treatment, 95 (78%) reported GI upset and 27 (21%) reported not completing medications. Specific to Hp and GC, 70% indicated that a belief that the treatment was worse than the symptoms would affect their willingness to seek care, while 81% indicated knowing Hp can cause GC would affect their treatment decisions and knowing their gastric symptoms were caused by Hp would affect their willingness to receive care.

CONCLUSIONS

Knowledge of Hp in this US sample of online respondents is low and self-reported difficulties with treatment compliance is high. Increasing awareness of this infection and addressing the challenges to treatment compliance could potentially reduce rates of Hp antibiotic resistance and progression to GC or other complications of Hp infection.

The relationship between diabetes-related knowledge and kidney disease knowledge, attitudes, and practices: a cross-sectional study

BACKGROUND

Diabetes mellitus (DM) is one of the main noncommunicable diseases encountered in primary health care clinics. DM is considered one of the most common causes of chronic kidney disease (CKD). In this study, we aimed to assess the knowledge, attitudes, and practices (KAP) of patients with DM on the early detection and prevention of CKD, determine its relationship with other variables, and examine the relationship between KAP scores for the prevention and early detection of CKD and the Michigan Diabetic Knowledge Test.

METHODS

We collected data from 2 Nablus primary healthcare centers using a questionnaire that contains three sections: sociodemographic section, questions related to DM, and CKD screening index, which is formed of three scales. We used the Michigan Diabetic Knowledge Test (MDKT) to assess the knowledge of diabetic patients.

RESULTS

The study was carried out among 386 diabetic patients with a mean age of 57.62 ± 12.4 years (ranging from 28 to 90). The median (interquartile range) was 11 (8-14) for the knowledge scale, 56 (52-59) for the attitude scale, and 30 (26-33) for the practice scale. In the multiple linear regression, only patients under 55 years old (p = 0.012), with normal BMI (p = 0.030), high educational level (p < 0.001), high monthly income (p = 0.020), and MDKT test score (p = 0.007) were significantly associated with higher knowledge score. Furthermore, patients who were over or equal to 55 years old (p = 0.007), had a high monthly income (p = 0.016), used a single oral diabetic drug (p = 0.003), had a total number of medications less than 4 (p = 0.010), and had a high knowledge and MDKT test were significantly associated with a higher attitude score. Finally, a patient with normal BMI (p = 0.002), city residency (p = 0.034), high educational level (p = 0.003), less frequent tobacco use (p < 0.001), last HbA1c (p = 0.023) and greater knowledge, attitude, and MDKT score were significantly associated with better practices toward CKD prevention and early detection.

CONCLUSION

Regarding KAP analysis, higher practice scores for the prevention and early detection of CKD were significantly associated with patients with normal BMI, being city residents, high educational level, less tobacco use, last HbA1c below 7, and higher knowledge, attitude, and MDKT score.

Health literacy levels in patients with type 2 diabetes in an affluent Gulf country: a cross-sectional study

OBJECTIVES

To identify health literacy levels in patients with type 2 diabetes mellitus in the United Arab Emirates (UAE).

INTERVENTION

Nationwide cross-sectional survey.

SETTING AND PARTICIPANTS

Individuals with type 2 diabetes mellitus attending outpatient diabetes clinics in all emirates of the UAE were surveyed between January 2019 and May 2020. Out of 832 patients approached, 640 met the inclusion criteria and agreed to participate.

OUTCOME VARIABLES

The outcome variable of interest was the health literacy level, which was measured using the Eastern-Middle Eastern Adult Health Literacy 13 Questionnaire. The association of health literacy level with age, gender and education was conducted using the Χ² test.

RESULTS

Only 11% of respondents had adequate health literacy levels. Age and education were directly correlated with health literacy levels. Patients under age 50 years had statistically significant higher rates of marginal (106 of 238, 44.5%) and adequate literacy (67 of 238, 28.2%, p<0.001) than the older population. Participants with bachelor's or postgraduate degrees also had significantly higher adequate health literacy levels (24 of 79, 30.4%, p<0.001).

CONCLUSIONS

The low health literacy levels found in outpatients with diabetes may be a major challenge to optimising diabetes care in the UAE. In addition to health services strategies, targeted educational and behavioural interventions for the older population and those with less formal education are necessary.

Trend and factors associated with anemia among women reproductive age in Ethiopia: A multivariate decomposition analysis of Ethiopian Demographic and Health Survey

BACKGROUND

In developing countries like Ethiopia, anemia is a public health problem. Unfortunately, the progress of anemia reduction has been slow. Although the issue of anemia has received considerable critical attention nowadays, trends and factors associated with anemia among women of reproductive age have not been explored in Ethiopia.

OBJECTIVE

This study aimed to determine trends and factors associated with anemia among women of reproductive age in Ethiopia from 2005 to 2016.

METHOD

Data from three consecutive Ethiopian Demographic and Health Survey (EDHS) from 2005-2016 were analyzed in this study. EDHS is a two-stage cluster sampling survey. Data were weighted to correct sampling bias in all surveys. A total of 46,268 samples were analyzed using a fixed effect model. For a measure of proportion, differences and slopes were computed. Bivariate and multivariable logistic regression analyses were done to identify predictors of the trend of anemia among women. Adjusted odds ratio (AOR) with a 95% Confidence Interval(CI) was computed, and the p-value < 0.05 is considered significant.

RESULT

Prevalence of anemia among women was 68%, 20.3%, and 27.3% in 2005, 2011 and 2016, respectively. The trend of anemia was reduced by 47.7 percentage points from 2005 to 2011; however, it increased by 7% points again from 2011 in 2016. Lack of mobile phones (AOR = 1.4, 95%CI, 1.2,1.6), Afar women (AOR = 1.5, 95%CI, 1.1,2.3) and Somali women (AOR = 1.5, 95%CI, 1.1,1.9) were associated with anaemia among women. On the contrary, the history of heavy menstruation in the last six months (AOR = 0.9; 95%CI, 0.85,0.98) was a factor negatively associated with anemia in 2005. In 2011, single women (AOR = 0.8,95%CI,0.7,0.9), watching TV less than once per wk (AOR = 0.9,95%CI,0.7,0.95), watching TV at least once per week (AOR = 0.8,95%CI,0.7,0.98) were variables associated with anemia. On the contrary, widowed women (AOR = 1.7,95%CI,1.4,2.0) were affected by anemia. In 2016, the richest women (AOR = 0.7, 95%CI, 0.6,0.8) and single (AOR = 0.8, 95%CI, 0.7,0.9) were affected little by anemia. Women of traditional belief followers (AOR = 2.2,95%CI,1.6,2.9) were more highly influenced by anemia than their counterparts.

CONCLUSION

The prevalence of anemia declined rapidly from 2005 to 2011, and increased from 2011 to 2016. Stakeholders should develop policies and programs to enhance the socio-demographic status of women and basic infrastructure for the community. Furthermore, they should design strategies for extensive media coverage of the prevention of anemia. The federal government should balance the proportion of anemia among regions by ensuring health equality.

Self-Efficacy as Moderator and Mediator Between Medication Beliefs and Adherence in Elderly Patients with Type 2 Diabetes

PURPOSE

Poor antidiabetic medication adherence remains a great barrier to effective diabetes self-management among aging adults. This study investigates the mediation and moderation effects of self-efficacy on the relationship between medication beliefs and adherence in elderly patients with type 2 diabetes.

METHODS

This cross-sectional study evaluated a sample of 309 hospitalized elderly patients who completed the assessment of medication beliefs, self-efficacy for medication uses and medication adherence in a tertiary hospital in Shanghai, China. A bootstrapping sampling method and hierarchical moderator regression analysis were used to verify the hypothesis of mediation and moderation effects of self-efficacy on the relationship between medication beliefs and adherence.

RESULTS

Self-efficacy for medication use acted as a moderator (B=-0.063, t=-2.215, p=0.028) and partial mediator (CI_{total effect}=4.5-16.63, p=0.001; CI_indirect=1.524-5.323, p=0.014; CI_direct=2.151-11.817, p=0.001) on the relationship between general harm medication beliefs and medication adherence. Participants with lower general harm medication beliefs may develop higher self-efficacy, which, in turn, results in a higher level of medication adherence, and higher self-efficacy may attenuate the negative effect of high general harm medication beliefs on medication adherence.

CONCLUSION

Self-efficacy for medication use not only mediated the relationship between general harm beliefs about medication and medication adherence, but moderated it negatively. The findings of this study indicate an opportunity to improve the prognosis of elderly Chinese patients with type 2 diabetes through improved medication adherence by strengthening factors such as self-efficacy for appropriate medication use and general harm beliefs about medication.

General Public's knowledge, awareness, and perception of Cardiometabolic diseases: data from a Singapore study population

Background

Health literacy and illness perception play crucial roles in tackling the cardiometabolic disease epidemic. We aim to compare the attitudes, knowledge, self-perceived risks and actions taken, between individuals with and without metabolic risk factors (MFs).

Methods

From 5 June to 5 October 2022, participants of the general public were invited to complete a self-administered questionnaire. MF status was defined as the presence of hypertension, hyperlipidemia, diabetes mellitus and/or current/previous smoking. Participants were assessed based on four categories (knowledge-based, attitude-based, perceived risk, and action-based) of questions pertaining to four cardiometabolic diseases - diabetes mellitus, hypertension, hyperlipidemia, and non-alcoholic fatty liver disease.

Results

A total of 345 participants were enrolled, of whom 34.5% had at least one MF. Compared to those without MFs, participants with MFs had lower knowledge scores, but higher perceived risk scores across all cardiometabolic diseases. The largest knowledge gap pertained to hypertension-related questions. After adjustment, linear regression demonstrated that the presence of MFs (β:2.752, 95%CI: 0.772-4.733, p = 0.007) and higher knowledge scores (β:0.418, 95%CI: 0.236-0.600, p < 0.001) were associated with higher perceived risk. Despite increased perceived risk in those with MFs, this translated to only few increased self-reported preventive actions, when compared to those without MFs, namely the reduction in red meat/processed food consumption (p = 0.045) and increase in fruits/vegetables consumption (p = 0.009).

Conclusion

This study identified a vulnerable subpopulation living with MFs, with high perceived risks, and discordant levels of knowledge and preventive actions taken. Nationwide efforts should be channeled into addressing the knowledge-to-action gap.

Evaluating a serious game to improve childhood cancer patients' treatment adherence

Objective

Childhood cancer patients need to have good treatment adherence. Unfortunately, treatment non-adherence often occurs due to high side-effect burdens of treatment and the lack of knowledge of one's illness and treatment. Therefore, a serious game intervention based on the Protection Motivation Theory (PMT) was designed and developed to motivate childhood cancer patients to undergo treatment and to motivate them to undergo treatment, perform daily self-care and educate them about their illness.

Methods

Childhood cancer patients (6–17 years old) and their caregivers were recruited in a multi-centre, single-arm intervention in Malaysia. A total of 24 child-caregiver dyads have completed the study. This study used PMT-based surveys to collect quantitative data regarding children's motivation to adhere to treatment and perform daily self-care. Additionally, a 20-question multiple-choice quiz was used to determine children's knowledge levels. These surveys were conducted pre-test and post-test. Children's and caregivers' feedback were also gathered post-test as qualitative data.

Results

The results showed that overall, the children's intention to undergo cancer treatment had increased significantly. A significant increase in the intention to perform daily self-care was found among younger children, while older children showed significant improvement in their cancer knowledge levels. The post-test feedback suggested that the game was liked by both children and caregivers and it provided various benefits to children with cancer.

Conclusions

Findings suggest that the intervention has the potential to improve childhood cancer patients’ motivation for treatment adherence and daily self-care, in addition to educating them about cancer and treatment.

SPUR: psychometric properties of a patient-reported outcome measure of medication adherence in type 2 diabetes

INTRODUCTION

Poor medication adherence is associated with worsening patient health outcomes and increasing healthcare costs. A holistic tool to assess both medication adherence and drivers of adherence behaviour has yet to be developed. This study aimed to examine SPUR, a multifactorial patient-reported outcome measure of medication adherence in patients living with type 2 diabetes, with a view to develop a suitable model for psychometric analysis.Furthermore, the study aimed to explore the relationship between the SPUR model and socio-clinical factors of medication adherence.

RESEARCH DESIGN AND METHODS

The study recruited 378 adult patients living with type 2 diabetes from a mix of community and secondary-care settings to participate in this non-interventional cross-sectional study. The original SPUR-45 tool was completed by participants with other patient-reported outcome measures for comparison, in addition to the collection of two objective adherence measures; HbA1c and the medication possession ratio (MPR).

RESULTS

Factor and reliability analysis conducted on SPUR-45 produced a revised and more concise version (27-items) of the tool, SPUR-27, which was psychometrically assessed. SPUR-27 observed strong internal consistency with significant correlations to the other psychometric measures (Beliefs about Medication Questionnaire, Diabetes Treatment Satisfaction Questionnaire, Medicine Adherence Rating Scale) completed by participants. Higher SPUR-27 scores were associated with lower HbA1c values and a higher MPR, as well as other predicted socio-clinical factors such as higher income, increased age and lower body mass index.

CONCLUSIONS

SPUR-27 demonstrated strong psychometric properties. Further work should look to examine the test-retest reliability of the model as well as examine transferability to other chronic conditions and broader population samples. Overall, the initial findings suggest that SPUR-27 is a reliable model for the multifactorial assessment of medication adherence among patients living with type 2 diabetes.

Evaluation of antipsychotic medication adherence and its relation to negative and positive psychiatric symptoms

Objectives

The aim of this study was to assess antipsychotic medication adherence and its relation to Psychiatric symptoms in a sample of patients with schizophrenia in Palestine.

Methods

Patients were recruited from the governmental psychiatry clinic in Ramallah in a cross-sectional study. The self-reported Morisky–Green–Levine (MGL) scale was used to measure patients’ adherence. Psychiatric symptoms were measured using the expanded Brief Psychiatric Rating Scale (BPRS-E).

Key findings

Of the 130 participants in the study, 78 (60%) were men and mean age was 41.8 ± 9.8 years 70 (53.8%). of the sample participants were classified as low-adherent while 60 (46.2%) of patients classified as high adherent. That negative symptom scores of high adherence group are significantly lower than low adherence group (12.5 vs. 15.0, P = 0.002) and lower depression anxiety scores (18.3 vs. 22.1, P &lt; 0.001) indicated that high adherence group had lower depression, anxiety, social isolation, anxiety and suicidal ideation symptoms than low-adherence group. The multivariate regression model demonstrated that four variables remain significant and associated with nonadherence; no formal education (OR = 2.11; CI: 0.8–3.8; P = 0.04), age (OR = 2.88; CI: 1.2–4.4; P = 0.01), having comorbidity (OR = 3.2; CI: 1.9–4.3; P = 0.01) and having higher negative symptoms scores (OR = 2.5; CI: 1.2–3.9; P = 0.03); as they are positively correlated to nonadherence.

Conclusion

Medication nonadherence was significant, and it was linked to poor psychiatric outcomes and adherence scores were unaffected by medication-related variables.

Factors related to barriers and medication adherence in patients with type 2 diabetes mellitus: a cross-sectional study

Purpose

Evidence has shown that 50% of patients, including type 2 diabetes mellitus (DM), are non-adherent to the prescribed antidiabetic medication regimen. Some barriers lead to nonadherence in people with DM type 2. The study aimed to identify factors related to adherence in patient with DM and to assess the correlation between barriers to adherence type 2 DM patients.

Methods

The cross-sectional study was conducted in 63 primary healthcare centers in Surabaya, Indonesia. Patients with DM type 2 were recruited between April and September 2019 using convenient sampling technique. Ethics approval was obtained (80/EA/KEPK/2019).

Results

A total of 266 patients with type 2 DM participated in this study. Of the respondents, 201 (75.2%) were female. Unwanted drug effects, changes in medication regimens, and refilling the prescription when the drugs run out were most reported factors that affected adherence. Spearman correlations and linear regression tests were used to examine the relationship between barriers to medication adherence, and education with medication adherence. A significant difference was observed between the level of education and adherence (p = 0.031). The results showed an association between barriers to medication and adherence to medication (r = 0.304; p < 0.001) which was confirmed in regression analysis (R = 0.309, R square = 0.095, p <0.001).

Conclusions

Barriers to adherence are common and affect adherence to therapy. It is essential to expand the roles of health care professionals in the community to include counseling, barrier-monitoring, education, and problem-solving to improve patient medication adherence.

Perceptions of patients on factors affecting diabetes self-management among type 2 diabetes mellitus (T2DM) patients in Fiji: A qualitative study

Introduction

Optimal glycemic control can be achieved when patients are adherent to self-management behaviours such as healthy diet, physical activity, monitoring of blood glucose, reducing the risk factors, ability to solve problems and healthy coping. In light of limited studies conducted, this study aimed to explore patient's perceptions on factors affecting diabetes self-management among Type 2 Diabetes Mellitus (T2DM) patients of Labasa, Fiji.

Materials and methods

A qualitative study was employed to obtain data using semi-structured interviews conducted amongst T2DM patients attending clinics in 3 randomly selected health facilities in Labasa, Fiji from 15th March to 5th April 2021. Non probability purposive sampling was used to recruit 30 T2DM patients. The data was collected using semi-structured open ended questionnaires. Thematic analysis was used for data analysis. This was done by closely examining the transcribed data to identify common themes such as ideas, topic and pattern that come up repeatedly, followed by reviewing themes, defining it and naming them.

Result

Five themes emerged including; awareness on diabetes, perceptions towards diabetes mellitus, social support and diabetes self-management, challenges in diabetes self-management, and cultural beliefs and practices. The findings of the study demonstrated lack of knowledge and attitude towards definition of diabetes and its complications. The self-management practices amongst patients were insufficient. There was poor financial support and lack of social support among patients.

Conclusion

The results of this study highlighted various factors such as poor knowledge of diabetes and its complications, inadequate family support, financial burden and strong cultural beliefs and social norms affecting diabetes self-management. This study informs the need to identify the factors affecting diabetes self-management among T2DM patients.

Knowledge of COVID-19 and its prevention among rural residents in Fuqing, China

Objectives

Rural areas are the weakest place for epidemic prevention and control, yet few studies have specifically conducted surveys in rural areas. The purpose of this study is to assess rural residents’ knowledge of the COVID-19 and its prevention in China.

Methods

A cross-sectional survey study containing 1,426 samples was conducted in Fuqing, China to assess rural residents’ knowledge of the COVID-19 and its prevention. Logistic regression was used to identify potential differences in participants’ knowledge of COVID-19 and its prevention and control in different population subgroups.

Results

The mean and median of residents’ knowledge of COVID-19 was 5.53 and 6 points, respectively. The mean and median of residents’ knowledge related to self-protection against COVID-19 was 10.34 and 11 points, respectively. Older adults (AOR_45–59 = 2.26, 95% CI 1.20 to 4.27; AOR_60-69 = 3.13, 95% CI 1.63 to 5.98; AOR_≥70 = 4.68, 95% CI 2.35 to 9.33) were more deficient in knowledge of COVID-19. Those who were better educated and with a higher average annual household income were less likely to be deficient in the knowledge of COVID-19 and knowledge of self-protection against COVID-19. Moreover, those who were single, divorced, or widowed (AOR = 1.67, 95% CI 1.13 to 2.46) were more deficient in the knowledge of self-protection against COVID-19.

Conclusions

Our study suggests that when facing a pandemic like COVID-19, the key is to inform the public to understand simple and effective self-protection measures. Therefore, we call on the governments to give priority to publicity and education on self-prevention measures for the targeted populations and regions. This is most evident among the vulnerable groups like those who were unmarried, elderly, and those with low education or low income. Similar suggestions may be of use in other countries as well.

Effects of Physicians' Information Giving on Patient Outcomes: a Systematic Review

BACKGROUND

Providing diagnostic and treatment information to patients is a core clinical skill, but evidence for the effectiveness of different information-giving strategies is inconsistent. This systematic review aimed to investigate the reported effects of empirically tested communication strategies for providing information on patient-related outcomes: information recall and (health-related) behaviors.

METHODS

The databases MEDLINE, Embase, PsycINFO (Ovid), Cochrane Central Register of Controlled Trials, and relevant bibliographies were systematically searched from the inception to April 24, 2020, without restrictions, for articles testing information-giving strategies for physicians (PROSPERO ID: CRD42019115791). Pairs of independent reviewers identified randomized controlled studies with a low risk of selection bias as from the Cochrane risk of bias 2 tool. Main outcomes were grouped into patient information recall and behavioral outcomes (e.g., alcohol consumption, weight loss, participation in screening). Due to high heterogeneity in the data on effects of interventions, these outcomes were descriptively reported, together with studies', interventions', and information-giving strategies' characteristics. PRISMA guidelines were followed.

RESULTS

Seventeen of 9423 articles were included. Eight studies, reporting 10 interventions, assessed patient information recall: mostly conducted in experimental settings and testing a single information-giving strategy. Four of the ten interventions reported significant increase in recall. Nine studies assessed behavioral outcomes, mostly in real-life clinical settings and testing multiple information-giving strategies simultaneously. The heterogeneity in this group of studies was high. Eight of the nine interventions reported a significant positive effect on objectively and subjectively measured patients' behavioral outcomes.

DISCUSSION

Using specific framing strategies for achieving specific communication goals when providing information to patients appears to have positive effects on information recall and patient health-related behaviors. The heterogeneity observed in this group of studies testifies the need for a more consistent methodological and conceptual agenda when testing medical information-giving strategies.

TRIAL REGISTRATION

PROSPERO registration number: CRD42019115791.

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Thai Patients' Drug Safety Knowledge and Perceptions Relating to Different Forms of Written Medicine Information: A Comparative Study

PURPOSE

The aim of the study was to evaluate the medication safety knowledge, quality of the written medicine information (WMI), and perceptions of taking the medicines in patients receiving package inserts (PIs) in comparison with patient information leaflets (PILs).

METHODS

A cross-sectional, comparative study was conducted from December 2020 to May 2021 at two university hospitals in Thailand. Outpatients who visited the pharmacy departments and were prescribed one of the three medicines: atorvastatin, celecoxib, or metformin were randomly selected by a permuted block randomization. The medication safety knowledge was measured using a set of validated and closed questions. The quality of the WMI was measured by the Consumer Information Rating Form (CIRF). Satisfaction with information and perceptions of the benefits and risks of medications were rated by the participants using a visual analog scale (0 to 10).

RESULTS

Of the 1150 invited patients, 750 completed the questionnaires (65.2%). A higher proportion of respondents with high level of medication safety knowledge was found in those reading the PILs than the PIs (44.5% and 20.8%, respectively). The type of leaflet received was a significant predictor of the high knowledge level (p < 0.001). The mean CIRF scores were significantly higher among those reading the PILs than the PIs (p < 0.001). Patients reading the PILs were also more satisfied with the information and had more positive perceptions of the benefits from taking medicines and intention to adhere than those reading the PIs. Patients' perceptions of risks after reading both leaflets were moderate (median score = 5.0), with the PIL group having slightly more concern about risks than the PI group.

CONCLUSION

The PILs showed superior effectiveness to the PIs in enhancing knowledge about medication safety, providing greater satisfaction with the information, and positive perceptions of benefit and intention to comply with the medications. PILs should be provided more frequently to patients receiving medicines than PIs.

Associated Factors and Pharmacists' Role in Medication Adherence and Glycemic Control : A Study in Outpatients With Diabetes at Hue University Hospital, Vietnam

Objective: To evaluate medication adherence, associated factors, and the role of pharmacists in adherence and outcome treatments in outpatients with diabetes at Hue University Hospital. Type 2 diabetes (T2DM) is a chronic illness that requires daily treatment. Poor adherence to antidiabetic medication can have negative consequences for patients. Data on medication adherence and programs to improve adherence for patients with diabetes in Vietnam are lacking. Methods: A pre-post study was conducted on 354 outpatients diagnosed with T2DM at Hue University Hospital. Participants were interviewed, counseled, and educated by a pharmacist once. The researchers assessed medication adherence levels and glycemic outcomes before and around three months after the intervention. Results: The prevalence of achieving adherence before the intervention was 65.0%. Factors associated with achieving medication adherence were medication regimen (P = 0.001) and controlled glycemic target (P < 0.001). The most common nonadherence behavior was forgetting to take antidiabetic medication. After the intervention, the prevalence of achieving adherence rose to 74.6%, and patients reported that they were more likely to remember to take antidiabetic medications (with statistical significance). The prevalence of achieving the glycemic target (both glycated hemoglobin and fasting plasma glucose) rose from 21.8% (before the intervention) to 31.1% (after the intervention). Conclusions: A significant proportion of patients did not achieve medication adherence. Medication adherence is associated with better glycemic outcomes. The role of pharmacists in patient education, medication counseling, and reminding is beneficial in terms of improving adherence levels and glycemic outcomes.

Impact of Personal, Cultural and Religious Beliefs on Medication Adherence among Patients with Chronic Diseases at University Hospital in Northwest Ethiopia

BACKGROUND

Subjective beliefs about chronic disease conditions and their drug management are among factors determining adherence to medications that are amenable to interventions. Patient-level factors such as personal, cultural, and religious beliefs about diseases, and medication use may have a significant impact on medication adherence. The purpose of this study was to assess the impact of personal, cultural and religious beliefs on medication adherence behavior among patients with chronic follow-up.

PATIENTS AND METHODS

An institutional-based cross-sectional study design was conducted among chronic ambulatory patients from July to August 2021. The data was collected through an interviewer administered questionnaire. Initially stratified sampling technique was used to include proportional participants from different disease conditions, and systematic random sampling was employed to enroll eligible patients from each subgroup. Descriptive statistics such as frequencies and percentages were computed for categorical variables and mean with (standard deviation ±SD) used for continuous variables. Logistic regression model was employed to determine variable with poor adherence. A 95% confidence interval with P-value ≤0.05 was used to declare statically significance.

RESULTS

Among the 404 participants, more than half (51%) were males. The mean (±SD) age of the patients was 47.8 ± 14.8 years. Patients with strong belief in the harm of medications were found 4 times more likely to have poor medication adherence than those with weak belief in the harm of medications (AOR = 4.027, 95% CI:1.232-13.161, P = 0.021). In contrast, having strong personal belief regarding the necessity of medications were found to be less likely to have poor medication adherence (AOR = 0.368, 95% CI: 0.220-0.615, P < 0.001).

CONCLUSION

This study generalized that most of the patients were poor adherent to their medications. Personal beliefs were found to influence medication adherence of the patients. Future studies could be needed to explore and identify how these factors affect patients' medication adherence.

eHealth Literacy and Beliefs About Medicines Among Taiwanese College Students: Cross-sectional Study

Background

Good eHealth literacy and correct beliefs about medicines are beneficial for making good health care decisions and may further influence an individual's quality of life. However, few studies have discussed these two factors simultaneously. Moreover, gender differences are associated with health literacy and beliefs about medicines. Therefore, it is important to examine the multiple relationships between college students’ eHealth literacy and beliefs about medicines, as well as gender differences.

Objective

This study aims to (1) examine the multiple relationships between eHealth literacy and beliefs about medicines and (2) analyze gender differences in eHealth literacy and beliefs about medicines with Taiwanese college students.

Methods

We used a paper-and-pencil questionnaire that included age, gender, 3-level eHealth literacy, and beliefs about medicines to collect data. In total, 475 data points were obtained and analyzed through independent t tests and canonical correlation analyses.

Results

The t test (t₄₇₃=3.73; P<.001; t₄₇₃=–2.10; P=.04) showed that women had lower functional eHealth literacy and more specific concerns about medicines than men. Canonical correlation analyses indicated that the first and second canonical correlation coefficients between eHealth literacy and beliefs about medicines reached a significant level, implying that a multivariate relationship indeed existed.

Conclusions

These findings reveal that women in Taiwan have lower functional eHealth literacy and stronger concerns about medicines than men. In addition, students with higher eHealth literacy have more positive perceptions of and beliefs about medicines.

Experiences of the Patients with Behcet's Syndrom from Adherence to Treatment: A Qualitative Content Analysis

Background

Adherence to treatment plays an important role in the effectiveness of treatment in patients with Behcet's Syndrome (BS). An in-depth understanding of the experiences of patients with BS will help to improve the patients' management. The present qualitative study aimed to explore the experiences of patients with BS from adherence to treatment.

Methods

This qualitative study was conducted during February-September 2019 at Shahid Motahari Behcet's Clinic in Shiraz, Iran. Data were collected through eight unstructured observations and 22 individual in-depth semi-structured interviews with 20 participants (15 patients with BS, three family members, and two rheumatologists). Data analysis was performed simultaneously with data collection, using the conventional content analysis as proposed by Graneheim and Lundman. Data were managed using MAXQDA 10 software.

Results

Data analysis resulted in 21 sub-categories, seven categories, and three themes. The themes included barriers to treatment adherence (inability to cope with treatment and challenges in access to health care), facilitators of treatment adherence (incentives, receiving support, and striving to adapt to illness), and missing aspects of the treatment program (inadequate patient education and the neglect of lifestyle modification).

Conclusion

The barriers to and facilitators of treatment adherence as well as the missing aspects of the treatment program of patients with BS were identified. Adherence to treatment is not only determined by the patients, but also affected by the support system and relies upon the existing context and the nature of the treatment plan. These parameters should be considered during patient management to effectively promote treatment adherence.

Using an exploratory sequential mixed methods design to adapt an Illness Perception Questionnaire for African Americans with diabetes: the mixed data integration process

Background

Although qualitative methods have been used to develop quantitative behavioral health measurements, studies rarely report on the exact development process of these questionnaires. In this methodological paper, we highlight the procedure of a mixed data integration process in using qualitative data to create quantitative questionnaire items.

Methods

We used an exploratory sequential mixed methods study design to culturally adapt the Illness Perception Questionnaire-Revised (IPQ-R) and address the sociocultural contexts of African Americans with type 2 diabetes. Forty African Americans with type 2 diabetes taking oral diabetes medication completed the qualitative focus groups and 170 participants completed the quantitative phase (surveys). Using the ‘building approach’ to integration, qualitative themes from the focus groups were matched to survey domains based on the self-regulatory model. Qualitative themes assessing perceptions of diabetes among African Americans were used to develop new survey items for a culturally adapted IPQ-R, as well as adapt original survey items.

Results

Important themes included the effect on friend/family relationships, lifestyle changes, food experiences (consequences domain), importance of medications (treatment control), comparisons with family members (illness coherence), fear, future worries, and anger (emotional representations). A new domain, ‘sociocultural influences’ was added to the adapted questionnaire based on qualitative themes of race and racism on provider roles, personal control, and community influences. Merging and integration of the qualitative and quantitative phases, (reported via a joint display) showed evidence of congruence between the illness perceptions from the qualitative focus groups and scores on the survey items.

Conclusion

The use of mixed methods allowed for the development of a robust and patient-centered questionnaire. Future research should consider psychometric testing of the adapted IPQ-R, so that it may be used in addressing illness perceptions among African Americans.

Exploring variables associated with medication non-adherence in patients with type 2 diabetes mellitus

OBJECTIVE

This study aims to assess medication adherence and explore its predictors in outpatients with type 2 diabetes.

METHOD

This cross-sectional study collected socio-demographics, disease-related information, and different biomedical variables for type 2 diabetes patients attending a Jordanian Diabetes center. The four-item medication adherence scale (4-IMAS) and the beliefs about medications questionnaire (BMQ) which includes necessity and concerns were used. Stepwise backward quartile regression models were conducted to evaluate variables associated with the Necessity and Concerns scores. Stepwise ordinal regression was conducted to evaluate variables associated with adherence.

RESULTS

287 diabetic patients participated in the study. Almost half of the participants (46.5%) reported moderate adherence and 12.2% reported low adherence. Significant predictors of the adherence were necessity score (OR = 14.86, p <0.01), concern score (OR = 0.36, p <0.05), and frequency of medication administration (OR = 0.88, p- <0.01). Education was a significant predictor of Necessity and Concerns scores (β = 0.48, -0.2, respectively).

CONCLUSION

Simplifying the medication regimen, emphasizing medication necessity and overcoming medication concerns should be targeted in future diabetes intervention programs to improve medication adherence and hence glycemic control among diabetic patients.

Contribution of faculties of pharmacy in Arab countries to pharmacy practice research: a bibliometric analysis (1990-2020)

OBJECTIVE

To provide an overview of pharmacy practice research by faculties of pharmacy in the Arab region using a bibliometric methodology.

METHOD

Relevant articles were retrieved from SciVerse Scopus. The search strategy was developed to retrieve all articles published in pharmacy practice journals and those with specific keywords such as 'clinical pharmacy', 'community pharmacy', 'hospital pharmacy', 'pharmacy education' and 'pharmacy practice'. The country affiliation function was used to limit the results to the Arab region.

KEY FINDINGS

The search strategy found 1496 articles authored by 8210 researchers and disseminated through 337 journals. Research on pharmacy practice produced by faculties of pharmacy in the Arab region (1) has experienced a steep growth over the last decade; (2) is mainly published by scholars in Saudi Arabia, Jordan, Qatar and the United Arab Emirates; (3) has benefited from non-Arab scholars affiliated with faculties of pharmacy in the Arab Gulf; (4) has benefited from international collaborations, specifically with researchers in the UK and Malaysia; (5) has mainly addressed seven research topics: adverse drug reactions and pharmacovigilance, medication adherence, self-medication, patient counselling, pharmacy education, perception of physicians towards pharmacists; (6) has shown a relationship between institutional funding and research output and (7) has shown the highest number of readers for topics related to polypharmacy, over-the-counter medications, self-medications, medication adherence and pharmacist intervention in disease management.

CONCLUSION

Pharmacy practice research in Arab countries has witnessed a steep rise in the last decade, partially due to international research collaboration.

Tested communication strategies for providing information to patients in medical consultations: A scoping review and quality assessment of the literature

OBJECTIVES

To systematize the scientific knowledge of empirically tested strategies for verbally providing medical information in patient-physician consultations.

METHODS

A scoping review searching for terms related to physician, information, oral communication, and controlled study. Four pairs of reviewers screened articles. For each selected study, we assessed the quality and summarized aspects on participants, study, intervention, and outcomes. Information provision strategies were inductively classified by types and main categories.

RESULTS

After screening 9422 articles, 39 were included. The methodological quality was moderate. We identified four differently used categories of strategies for providing information: cognitive aid (n = 13), persuasive (n = 8), relationship- (n = 3), and objectivity-oriented strategies (n = 4); plus, one "mixed" category (n = 11). Strategies were rarely theoretically derived.

CONCLUSIONS

Current research of tested strategies for verbally providing medical information is marked by great heterogeneity in methods and outcomes, and lack of theory-driven approaches. The list of strategies could be used to analyse real life communication.

PRACTICE IMPLICATIONS

Findings may aid the harmonization of future efforts to develop empirically-based information provision strategies to be used in clinical and teaching settings.

College students' knowledge and management of food allergies

This study explored predictors of food allergy management in college students, including participants' reported allergy severity, history of allergic reactions, and allergy knowledge. Further, we compared allergy knowledge in participants with food allergy to a matched sample of college students without food allergy. Method: Participants were recruited from a larger nationwide study of knowledge and attitudes toward food allergy in college students, with purposeful oversampling of students with food allergies. Participants completed measures assessing their food allergy(ies), symptoms, history of reactions, and current allergy management behaviors. Participants with food allergies and control participants without food allergies completed a measure of food allergy knowledge. Results: Hierarchical regression revealed that food allergy knowledge accounted for an additional 20% of variance in students' allergy management behaviors, above and beyond severity and allergic reactions, R²=.39, F(3,48)=10.09, p<.001. There was not a statistically significant difference in food allergy knowledge between participants with food allergy and matched controls, t(49)=-1.85, p=.07, 95% CI=-1.42 to 0.06. Conclusions: This study suggests allergy knowledge is an important factor in food allergy management. Knowledge significantly predicted food allergy management behaviors above and beyond food allergy severity and recent food allergy reactions. College students with food allergies did not demonstrate greater knowledge than controls, suggesting a need for psychoeducational intervention to target college students' allergy knowledge as they transition to independent allergy management.

Health Literacy, Processing Capacity, Illness Knowledge, and Actionable Memory for Medication Taking in Type 2 Diabetes: Cross-Sectional Analysis

BACKGROUND

Patient knowledge about the purpose of medications is crucial to ensure safe and correct use, so it is an important index of adherence in patients with chronic illness.

OBJECTIVE

We examined how health literacy and its components (processing capacity and knowledge about illness) influence memory for medication purposes.

DESIGN

We conducted a cross-sectional study to examine memory for medication purposes in relation to health literacy, processing capacity, and illness knowledge among patients with diabetes in outpatient clinics.

PARTICIPANTS

Six hundred seventy-four adults who were diagnosed with type II diabetes mellitus, age 40 years or older, taking 5 or more current medications, native speakers of English, and with glycosylated hemoglobin (HbA1c) of 6.0 or more, were recruited to the study.

MAIN MEASURES

We included measures of processing capacity, illness knowledge, health literacy, and actionable memory for medication taking (memory for medication purpose).

KEY RESULTS

Results suggested an association between health literacy and both processing capacity and health knowledge, with some evidence that knowledge can compensate for limited processing capacity in order to maintain health literacy. Furthermore, health literacy was associated with memory for medication purposes, with processing capacity and health knowledge partly mediating this association. This pattern of results supports the process-knowledge model of health literacy.

CONCLUSIONS

Our findings establish the role of health literacy in medication taking, in relation to broader cognitive abilities and knowledge. Implications for improving the learning of medication purpose among diverse older adults with chronic illness are discussed.

TRIAL REGISTRATION

NIH trial registry number: NCT01296633.

"I try the one that they say is good." - factors influencing choice of health care provider and pathways to diabetes care for Syrian refugees in Lebanon

Background

Navigating health systems in host countries can be a challenge for refugees, particularly in a multi-provider system such as Lebanon. Syrian refugees in Lebanon face a high burden of Non-Communicable Diseases (NCDs) including diabetes mellitus. Evidence on how refugees navigate the health system is essential to improve provision of NCD services. We conducted a qualitative study amongst Syrian diabetes patients visiting Médecins Sans Frontières (MSF) clinics in one urban and one rural setting in Lebanon to explore factors influencing choice of and pathways to diabetes care.

Methods

In-depth interviews were conducted with male and female adult participants with DM type 1 or type 2 who were receiving treatment at MSF clinics. Participants were recruited using convenience sampling. Interviews were conducted in Arabic and directly transcribed and translated into English. Data were coded in NVivo and analyzed using an inductive thematic approach.

Results

A total of 29 in-depth interviews were conducted with 13 men and 16 women. Knowledge and understanding of diabetes management differed among participants. Syrian refugees in Lebanon gathered information about health services for diabetes largely from social networks of family and peers rather than through formal means. Pathways to care included different combinations of providers such as clinics, pharmacists and informal providers.

Conclusions

Syrian refugees with diabetes in Lebanon face considerable challenges in navigating the health care system due to their vulnerable status and limited knowledge of the host country systems. To ensure access to care for diabetes, efforts need to be made to support patients’ orientation in the Lebanese health system.

Knowledge and practice on medication adherence among Type II diabetes mellitus patients

This study aimed to survey the level of knowledge and practice on medication adherence among Type II diabetes mellitus (DM) patients. A cross-sectional study was conducted with a total of 220 DM patients by using a convenience sampling method. It was found that 64.5% of studied participants have a high level of knowledge with good practice toward medication adherence. There was a significant association between sociodemographic characteristics with the level of knowledge and practice toward medication adherence. This study finding provides information to health care providers to improve their patient's care by playing their important role in promoting the importance of knowledge on medication adherence for a better quality of life to the DM patients. Not only a physician but also the nurse could enhance health education for their patient on medication adherence during the follow-up appointment.

Relationship between beliefs about medicines and adherence in elderly patients with cardiovascular and respiratory diseases: A cross-sectional study in Romania

OBJECTIVES

The aim of this study was to explore elderly patients' beliefs about medicines in general, and specific towards their treatment and the relationship between beliefs and adherence.

METHODS

A cross-sectional study was performed by administering a questionnaire developed to meet the study's objectives. Elderly patients were recruited from three different settings.

RESULTS

167 patients agreed to participate to our study, having a mean age of 73 years. Patients were aware of the necessity for treatment, but they also showed concern over the potential for the adverse outcomes. Only 15% of the patients were completely accepting their treatment having high necessity and low concerns, while 40% were ambivalent, having high necessity beliefs, but also high concerns, with 89% being adherent in this group. Overall, higher adherence was significantly correlated with higher necessity and with higher necessity-concern differential.

CONCLUSION

Patients beliefs have an impact on adherence, thus patients' concerns and necessities should be addressed in order to improve adherence and treatment outcome.

PRACTICE IMPLICATIONS

Higher necessity positively influenced adherence to treatment, suggesting the fact that healthcare professionals could improve patients' adherence by outlining and educating the patients on the necessity of the treatment, while also managing patients' concerns.

The magnitude of non-adherence and contributing factors among adult outpatient with Diabetes Mellitus in Dilla University Referral Hospital, Gedio, Ethiopia

INTRODUCTION

The global prevalence of Diabetes Mellitus (DM) has increased alarmingly over the last two decades. On top of this, the issues of non-adherence to the prescribed medicines further fuel the DM- related complications to become one of the top causes of mortality and morbidity. Despite the considerable efforts in addressing the poor adherence issues, there are still plenty of problems ahead of us yet to be addressed. The objective of this study was to determine the extent of non-adherence and its contributing factors among diabetic patients attending the medical Referral clinic of Dilla University Referral Hospital.

METHODS

The institutional-based descriptive cross-sectional study was carried out among patients with diabetes mellitus attending the medical referral clinic of Dilla University Referral Hospital. A systematic random sampling method was used to recruit study participants, and tool was adopted to assess for adherence. A pretested semi-structured questionnaire was used to collect information on factors influencing non-adherence to the diabetic medications, and in-depth interview questionnaire was used for key informant interviews for the qualitative part. Data analysis was carried out using SPSS-20.

RESULTS

The overall prevalence of non-adherence to diabetic treatment regimen among the study participants was 34.0%. The study revealed that cost of transport to the hospital and taking alcohol were significantly associated with non-adherence to the diabetic treatment regimen with the (AOR = 6.252(13.56, 28.822); p < 0.000) and (AOR = 13.12(8.06, 44.73); p<0.002) respectively.

CONCLUSIONS

The study revealed that significant numbers of participants were non-adherent to the Diabetes Mellitus treatment regimens. Intensive counseling, and health education on the importance of good adherence and negative consequences of poor adherence need to be discussed with the patients before starting the medications, and amidst follow up.

The effect of acculturation and harm beliefs on medication adherence on Middle Eastern hypertensive refugees and migrants in Australia

Background Different populations have different levels of acculturation, and beliefs about medications. Little is known about the differences between refugees and migrants regarding these various beliefs. Adherence to medications is influenced by many factors, including individuals' characteristics, acculturation, and their perceptions about medications. Having a thorough understanding of these beliefs contributes to understanding medication adherence in refugee and migrant populations. Objectives To evaluate the differences between Middle Eastern refugees and migrants in Australia regarding acculturation, beliefs about medications, and medication adherence, and to evaluate the association of acculturation and beliefs about medications and natural remedies with medication adherence. Setting Participants were recruited from various community groups and English language learning centres in Australia. Arabic Facebook community groups were also used to recruit participants for this study. Method A total of 320 Middle Eastern refugees and migrants with hypertension completed Arabic or English versions of the general Beliefs about Medicine Questionnaire (BMQ)-harm scale, a question about beliefs in natural remedies, six items about acculturation and the Medication Adherence Questionnaire. Two models of multiple mediation were applied. The first model examined the role of acculturation, length of residency, beliefs about natural remedies, and harm beliefs as mediators between migration status and medication adherence. The second model identified the role of acculturation, and beliefs about natural remedies as mediators between migration status and medication harm beliefs. Main outcome measure Medication adherence, harm beliefs about medication, acculturation, and beliefs about natural remedies. In addition, the differences between refugees and migrants regarding these beliefs and medication adherence. Results Differences were found between refugees and migrants for medication adherence and medication beliefs. Refugees were likely to have more harm beliefs towards medicine and were less acculturated than migrants (p = 0.0001). They were also less likely to adhere to medications (p = 0.0001), and perceived natural remedies to be safer than Western medications (p = 0.0001). Perceiving medications as harmful substances, and beliefs in natural remedies were mediators in the relationship between migration status and medication adherence. Beliefs in natural remedies and acculturation were mediators in the relationship between migration status and harm beliefs. Conclusion Beliefs about medications and natural remedies, and acculturation in refugees and migrants need to be better understood to enhance medication adherence and potentially overall health outcomes.

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

Background

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

Methods

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

Results

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

Conclusions

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