Patient factors associated with diabetes medication adherence at different health literacy levels: a cross-sectional study at a family medicine clinic

ABSTRACT

Background

Type 2 diabetes (T2D) incurs tremendous health costs associated with various complications due to poor diabetes control. Medication adherence, which is correlated with patients’ health literacy, should be consistently practiced achieving optimal diabetes control. A deeper understanding of the specific communication and psychosocial factors related to medication-taking behaviors across different levels of health literacy among people with T2D will guide the development of effective interventions and strategies to enhance medication adherence.

Objectives

This cross-sectional study aimed to identify salient patient factors associated with diabetes medication adherence across different levels of health literacy.

Methods

A questionnaire was administered via a face-to-face approach with 205 participants at a family medicine clinic. Study participants were all above 20 years of age with T2D, were prescribed at least one oral diabetes medication, and understood English. The questionnaire assessed participants’ health literacy, self-efficacy for medication use, beliefs in medicines, patient-provider communication, perceived barriers to medication adherence, and self-reported medication adherence. Separate analysis of covariance was used to compare the mean scores of patient factors related to medication adherence across people with different health literacy levels.

Results

The mean age of participants was 61 years old, and the majority of the participants were female (57%), White (75%), and college educated (62%). Thirty-three percent of the participants had adequate health literacy, but only 43% of them reported high adherence to their diabetes medications. Analysis of covariance showed that having stronger self-efficacy (P < 0.001), lower concern beliefs about medication (P = 0.047), and fewer perceived barriers to medication-taking (P < 0.001), are necessary for better medication adherence.

Conclusion

Findings suggest that practitioners should address concern beliefs among low-adherent patients with low health literacy, help improve self-efficacy, and address perceived barriers to medication adherence among all low-adherent patients to optimally support patients’ diabetes care.

KEYWORDS:

• Health literacy
• medication adherence
• patient factor
• type 2 diabetes

Author contributions

Yen-Ming Huang designed the study, conducted data analysis and interpretation, and wrote the initial draft of the manuscript. Olayinka O. Shiyanbola contributed to study concept, data interpretation, and critical revision of manuscript. Hsun-Yu Chan assisted in data analysis and the preparation of the manuscript. Paul D. Smith contributed to data collection process and interpretation, and critically revised the manuscript. All authors approved the final version of the manuscript.

Acknowledgments

The authors would like to thank Anya Beric, Ayomi Nwaka, and Stephanie Benton for their help with data collection process. We would also like to acknowledge the participating medicine clinic and clinic staff involved in this study. Portions of this work were presented at the American Pharmacist Association Meeting in Seattle, Washington on 23 March 2019.

Declaration of interest

The authors declare no conflicts of interests.

Reviewers disclosure

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

The study was supported by the Sonderegger Research Center Dissertator Award and the Joseph Wiederholt Fellowship.