Mayberry Lindsay S, Osborn Chandra Y
http://orcid.org/0000-0002-0654-4151.
Diabetes Care. 2014;37(5):1246-53. doi: 10.2337/dc13-1828. Epub 2014 Mar 5.
Suboptimal adherence to diabetes medications is prevalent and associated with unfavorable health outcomes, but it remains unclear what intervention content is necessary to effectively promote medication adherence in diabetes. In other disease contexts, the Information-Motivation-Behavioral skills (IMB) model has effectively explained and promoted medication adherence and thus may have utility in explaining and promoting adherence to diabetes medications. We tested the IMB model's hypotheses in a sample of adults with type 2 diabetes.
Participants (N = 314) completed an interviewer-administered survey and A1C test. Structural equation models tested the effects of diabetes medication adherence-related information, motivation, and behavioral skills on medication adherence and the effect of medication adherence on A1C.
The IMB elements explained 41% of the variance in adherence, and adherence explained 9% of the variance in A1C. As predicted, behavioral skills had a direct effect on adherence (β = 0.59; P < 0.001) and mediated the effects of information (indirect effect 0.08 [0.01-0.15]) and motivation (indirect effect 0.12 [0.05-0.20]) on adherence. Medication adherence significantly predicted glycemic control (β = -0.30; P < 0.001). Neither insulin status nor regimen complexity was associated with adherence, and neither moderated associations between the IMB constructs and adherence.
The results support the IMB model's predictions and identify modifiable and intervenable determinants of diabetes medication adherence. Medication adherence promotion interventions may benefit from content targeting patients' medication adherence-related information, motivation, and behavioral skills and assessing the degree to which change in these determinants leads to changes in medication adherence behavior.
糖尿病药物治疗依从性欠佳的情况普遍存在，且与不良健康结局相关，但尚不清楚有效促进糖尿病药物治疗依从性需要哪些干预内容。在其他疾病背景下，信息-动机-行为技能（IMB）模型已有效解释并促进了药物治疗依从性，因此可能有助于解释和促进糖尿病药物治疗的依从性。我们在2型糖尿病成年患者样本中检验了IMB模型的假设。
参与者（N = 314）完成了由访谈员实施的调查和糖化血红蛋白（A1C）检测。结构方程模型检验了与糖尿病药物治疗依从性相关的信息、动机和行为技能对药物治疗依从性的影响，以及药物治疗依从性对糖化血红蛋白的影响。
IMB模型要素解释了41%的依从性变异，而依从性解释了9%的糖化血红蛋白变异。如预期的那样，行为技能对依从性有直接影响（β = 0.59；P < 0.001），并介导了信息（间接效应0.08 [0.01 - 0.15]）和动机（间接效应0.12 [0.05 - 0.20]）对依从性的影响。药物治疗依从性显著预测了血糖控制情况（β = -0.30；P < 0.001）。胰岛素使用状况和治疗方案复杂性均与依从性无关，且二者均未调节IMB模型各要素与依从性之间的关联。
研究结果支持IMB模型的预测，并确定了糖尿病药物治疗依从性的可改变和可干预的决定因素。促进药物治疗依从性的干预措施可能受益于针对患者药物治疗依从性相关信息、动机和行为技能的内容，并评估这些决定因素的变化在多大程度上导致药物治疗依从性行为的改变。
