Predictors of adherence to diabetes medications: the role of disease and medication beliefs

• Published in: Journal of behavioral medicine 2009-06, Vol.32 (3), p.278-284
• Main Authors: Mann, Devin M., Ponieman, Diego, Leventhal, Howard, Halm, Ethan A.
• Format: Article
• Language: English
• Subjects: Adherence; Atherosclerosis; Biological and medical sciences; Cardiovascular disease; Care and treatment; Chronic Disease - drug therapy; Chronic Disease - psychology; Chronic illnesses; Complications and side effects; Depression; Development and progression; Diabetes; Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - psychology; Diabetes. Impaired glucose tolerance; Diabetics; Drug therapy; Drugs; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Family Medicine; Female; Fundamental and applied biological sciences. Psychology; General Practice; Health beliefs; Health Knowledge, Attitudes, Practice; Health Psychology; Humans; Hypoglycemic Agents - administration & dosage; Illness and personality; Internal medicine; Interviews as Topic; Logistic Models; Male; Medical sciences; Medication Adherence - psychology; Medicine; Medicine & Public Health; Middle Aged; Minority & ethnic groups; Multivariate Analysis; Odds Ratio; Patient compliance; Patient outcomes; Personality, behavior and health; Psychology and medicine; Psychology. Psychoanalysis. Psychiatry; Psychology. Psychophysiology; Questionnaires; Risk factors; Self Efficacy; Selfmanagement; Surveys and Questionnaires; Type 2 diabetes
• ISSN: 0160-7715; 1573-3521
• DOI: 10.1007/s10865-009-9202-y

Despite the effectiveness of drug therapy in diabetes management high rates of poor adherence persist. The purpose of this study was to identify potentially modifiable patient disease and medication beliefs associated with poor medication adherence among people with diabetes. A cohort of patients with diabetes was recruited from an urban primary-care clinic in New York City. Patients were interviewed in English or Spanish about: disease beliefs, medication beliefs, regimen complexity, diabetes knowledge, depression, self-efficacy, and medication adherence (Morisky scale). Logistic regression was used to identify multivariate predictors of poor medication adherence (Morisky > 1). Patients ( n  = 151) had diabetes for an average of 13 years with a mean HgA1C of 7.6 (SD 1.7). One-in-four (28%) were poor adherers to their diabetes medicines. In multivariate analyses, predictors of poor medication adherence were: believing you have diabetes only when your sugar is high (OR = 7.4;2–27.2), saying there was no need to take medicine when the glucose was normal (OR = 3.5;0.9–13.7), worrying about side-effects of diabetes medicines (OR = 3.3;1.3–8.7), lack of self-confidence in controlling diabetes (OR = 2.8;1.1–7.1), and feeling medicines are hard to take (OR = 14.0;4.4–44.6). Disease and medication beliefs inconsistent with a chronic disease model of diabetes were significant predictors of poor medication adherence. These suboptimal beliefs are potentially modifiable and are logical targets for educational interventions to improve diabetes self-management.