Communicative Pathways Predicting Adherence in Type II Diabetic Patients: A Mediation Analysis

ABSTRACT

Type II diabetes is a chronic health condition and its successful management requires effective patient-provider communication. Responding to a call to model pathways between provider communication and patient health outcomes, this study tested four models of type II diabetic patient adherence with four mediators. Given the complex nature of type II diabetic care, patient adherence was conceptualized as wellness, screening, medication, and treatment adherence. Mediators included patient understanding, agreement, trust, and motivation. A sample of U.S. patients with type II diabetes patients who were both under the care of a medical provider and taking medication for their type II diabetes completed online surveys (n = 793). Findings indicated that the relationships between patient-centered communication and adherence outcomes were mediated by proximal outcomes. The results contribute to the understanding of patient-centered communication, adherence behaviors, and proximal outcomes of patient understanding, agreement, trust, and motivation. Findings indicate that relationships between patient-centered communication and wellness adherence is mediated by patient motivation, patient-centered communication and screening adherence is mediated by patient agreement, trust, and motivation, and patient-centered communication and treatment adherence is mediated by patient agreement, trust, and motivation. The discussion addresses theoretical and practical implications and directions for future research.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1. This study consisted of two phases. Phrase I consisted of unpublished qualitative interviews with type II diabetic patients. Interviews resulted in the identification of four proximal outcomes (understanding, agreement, trust, and motivation) as the most important outcomes from the communication.

2. For conceptualization of patient agreement see Chakrabarti’s (2014) discussion of medication concordance and the European Patients Forum (2015).

3. A pilot study of a separate sample (n = 100) was conducted to test the measurement structure using CFAs. Results from the pilot study and analysis of the measurement structure are available from the first author. Additionally, criterion validity of these adapted measures was established in the pilot study and current study through examination of correlation matrices.

4. The MOS General Adherence Scale was developed for the Medical Outcomes Study by the RAND Healthcare. The instrument can be used without licensing and is free of charge. Information can be accessed at https://www.rand.org/health-care/surveys_tools/mos/patient-adherence.html.

5. Hayes’s (2018) explains that partial and complete mediation are empty concepts insofar as a, “partial mediation is a celebration of a misspecified model” (p. 120) and complete mediation is sample size dependent, lacks a theoretical meaning, and suggests that no other possible mediating variables exist. Hayes recommends that hypotheses are stated without the terms partial or complete, and results should indicate that mediation did or did not occur.

6. Full demographic information (including patient income levels, insurance type, provider type, frequency of blood sugar monitoring is available from corresponding author.

Additional information

Funding

This work was supported by the Brian Lamb School of Communication [Lamb School Research Grant] and the [Purdue Research Foundation] at Purdue University.