Using the transtheoretical model’s stages of change to predict medication adherence in patients with type 2 diabetes mellitus in a primary health care setting

Abstract

Background Qatar is currently experiencing a worrying increase in the prevalence of diabetes mellitus (DM). One of the most common reasons for uncontrolled DM is non-adherence to medications. The socio-behavioral intervention has proven effective in some chronic illnesses. Objectives To assess the stages of change (SOC) and medication adherence scores of type 2 diabetes mellitus (T2DM) patients visiting primary healthcare institutions in Qatar, and to evaluate the cause and effect relationship between SOC and adherence to antidiabetic medications. Methods The 8-item Morisky Medication Adherence Scale (MMAS-8) was used to assess medication adherence, and a 2-item SOC questionnaire was utilized to classify the SOC. The analysis to determine if the SOC could predict medication adherence while controlling for demographic characteristics, total number of prescribed medications and disease duration was done using hierarchical multiple regression. Results The final analysis included 387 patients. In relation to medication adherence, majority of the patients were in the maintenance stage (76.7%), followed by the preparation stage (14.7%), the action stage (3.9%), the contemplation stage (3.4%) and the precontemplation stage (1.3%). Most of the patients were in high adherence towards antidiabetic medications (50.3%) followed by low level (26.4%) and medium level (23.3%). SOC was significant and positively predicted medication adherence, which accounted for around 58 to 60% (p < 0.001) while controlling for covariates. Conclusions SOC was significant and positively predicted medication adherence. The study recommends that the SOC questionnaire could potentially be used to identify patients at risk for low adherence.

Illness Perception, Coping, and Self-Care Adherence Among Adults With Type 2 Diabetes

“…The SOC model may explain how these changes occur over time and could be the reason for increased self-care adherence among individuals having diabetes for more than 6 years compared to those having diabetes for 6 months-3 years. A study conducted by Arafat et al (2019) reported an association between diabetes duration, SOC, and medication adherence among people with T2D, results that are consistent with the current study findings.…”

“…This may be the reason individuals with diabetes for more than 3-6 years do not differ in their self-care adherence from those with diabetes for 6 months-3 years and over 6 years. However, this finding is contrasted by a study (Arafat et al, 2019) that reported a positive correlation between disease duration and self-care adherence.…”

Monitoramento avançado de enfermagem: pacientes de risco na atenção primária

“…O monitoramento de usuários do sistema de saúde pode ser uma estratégia que contribui para mudanças oportunas e que facilita o estabelecimento de metas de colaboração direta com os pacientes ao se desenvolver planos de cuidado centrado nas necessidades do paciente 1 . Portanto, acredita-se que essa estratégia seja promissora, para aumentar a capacidade de autogerenciamento de doenças crônicas não transmissíveis, como o diabetes mellitus e a hipertensão arterial, sendo de suma importância na melhoria da qualidade de vida relacionada à saúde, na adesão a práticas de exercício e na adesão medicamentosa 2 .…”

A pharmacist health coaching trial evaluating behavioural changes in participants with poorly controlled hypertension

“…The TTM produces favourable health outcomes by encouraging participants to move forward through the SOC. [ 21 , 22 ] Pharmacists currently use the SOC approach to assist participants with smoking cessation [ 23 , 24 ], but as far as can be determined from the literature, they have not yet applied the model to other health behaviours.…”