The effectiveness of an intervention designed based on health action process approach on diet and medication adherence among patients with type 2 diabetes: a randomized controlled trial

Abstract

Background Diabetes is a major cause of worldwide morbidity and mortality. Diet and medication non-adherence are common among individuals with diabetes, making glycemic control difficult to attain. This study aimed to evaluate an intervention designed based on Health Action Process Approach (HAPA) to improve adherence to diet and medication among patients with type 2 diabetes in Tehran, Iran. Methods The study was a randomized controlled trial. A total of 248 patients with type 2 diabetes who had low diet and medication adherence were randomly allocated into two intervention (n = 124) and control (n = 124) groups. Intervention group received educational intervention during three months. HAPA constructs, diet and medication adherence, and Hemoglobin A1c (HbA1c) levels were assessed at baseline, one month and six months after the intervention. Mixed Model Analysis was used to compare between and within group changes in the outcomes. Results There was a statistically significant improvement in HbA1c levels after six months (7.77 ± 1.36% vs. 8.07 ± 1.52%, 95% CI, p < 0.001). Diet and medication adherence, intention, task self-efficacy, coping self-efficacy, recovery self-efficacy, action and coping planning, barriers, benefits and perceived social support were significantly improved one month and six months after the intervention (p < 0.001). Conclusion Our intervention designed based on health action process approach led to improvements in diet and medication adherence, and HbA1c among the patients within one and six months. Trial registration: IRCT, IRCT20151208025431N4. Registered 10 March 2018, https://fa.irct.ir

The Effect of Educational Intervention on Dietary Adherence among Type 2 Diabetics in Zahedan: Using the Health Action Process Approach

“…Self-e cacy is essential both in the stage of intention formation and behavior change. The results of the study by Ranjbaran et al (10) and other studies showed the signi cance of coping self-e cacy after the intervention, which was consistent with our results (12,13). However, the results of studies by Ghisi et al (28)and Miller et al (27) were not consistent with the results of our study.…”

“…The results showed the achievement of the set objectives related to the barriers. Moreover, holding group classes, discussing problems related to non-adherence to the diet, and following up by phone calls to remove barriers have been effective, which was consistent with Ranjbaran et al (10,12,13) but was not consistent with Charkazy et al (33). and Rothman et al (34).…”

“…Furthermore, the signi cance of risk perception and outcome expectancies were factors contributing to the increase in patients' intention. Some studies also showed that behavioral intention increased signi cantly after the intervention (10,12,13,26). Other studies were not consistent with our study, which could be due to the difference in the target group and the length of the follow-up period for the constructs of the HAPA model (27,28).…”

“…The motivational phase includes risk perception, outcome expectancies, and action self-e cacy, leading to a behavioral intention (12). The volition phase includes coping self-e cacy, recovery self-e cacy, action planning and coping planning, which leads to actual health behavior and is applied to bridge the gap between intentions and behaviors (12). At this stage, the change must be planned, initiated, and maintained, and relapses must be managed.…”

Data mining approaches for type 2 diabetes mellitus prediction using anthropometric measurements

“…The International Diabetes Federation reports that the global prevalence of diabetes in adults in 2021 was 536.6 million people, and it is estimated that it will rise to 783.2 million in 2045 3 . In Iran, a 14.3% prevalence of T2DM was reported in 2019, 4 this has emerged as a great concern, not only because of the numbers but also because of microvascular or macrovascular complications caused by T2DM 5 . It should be emphasized that one out of nine deaths occur due to diabetes 6 .…”