Social and Administrative Sciences, School of Pharmacy, University of Wisconsin-Madison.
Associate Scientist, Sonderegger Research Center, School of Pharmacy, University of Wisconsin-Madison.
Am J Health Behav. 2020 Mar 1;44(2):257-270. doi: 10.5993/AJHB.44.2.13.
In this study, we conducted a longitudinal evaluation of changes in medication adherence and the role of psychosocial and interpersonal factors in these changes among Blacks with type 2 diabetes mellitus (T2DM), and determined barriers and facilitators of T2DM medication adherence. We used an explanatory sequential mixed methods design for a sample of 287 black adult patients with T2DM in Wisconsin. Two surveys quantitatively evaluated changes in medication adherence, psychosocial factors, and interpersonal factors over time. We conducted 10 semi-structured qualitative interviews to explore participants' perceptions of these changes. Data integration of the quantitative and qualitative findings elucidated barriers and facilitators of medication adherence. Increased adherence was significantly correlated with less concerns about medicines (r = -0.31), higher self-efficacy (r = 0.47), lesser depressive symptoms (r = -0.26), and lesser negative illness perceptions (r = -0.26) at both baseline and follow-up. Patient perceptions of adherence changes included adherence motivators, social support, and complex medication regimens. Integration showed that barriers and facilitators both existed in individuals who had an increase or a decrease in adherence over time. Specific beliefs of Blacks towards T2DM medications must be addressed to improve their adherence. Interventions must be tailored using interpersonal factors.
在这项研究中，我们对 287 名威斯康星州的黑人 2 型糖尿病（T2DM）患者进行了纵向评估，以了解他们的药物依从性变化以及社会心理和人际因素在这些变化中的作用，并确定 T2DM 药物依从性的障碍和促进因素。我们使用解释性顺序混合方法设计对样本进行了研究。两项调查定量评估了药物依从性、社会心理因素和人际关系因素随时间的变化。我们进行了 10 次半结构化定性访谈，以探讨参与者对这些变化的看法。定量和定性研究结果的综合分析阐明了药物依从性的障碍和促进因素。在基线和随访时，较高的依从性与对药物的担忧较少（r = -0.31）、自我效能较高（r = 0.47）、抑郁症状较少（r = -0.26）和负面疾病认知较少（r = -0.26）呈显著相关。患者对依从性变化的看法包括依从性动机、社会支持和复杂的药物治疗方案。综合分析表明，在随时间依从性增加或减少的个体中，障碍和促进因素同时存在。必须解决黑人对 T2DM 药物的特定信念，以提高他们的依从性。必须根据人际因素对干预措施进行调整。
