College of Pharmacy and Allied Health Professions, South Dakota State University , Brookings, SD, USA.
Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University , Taipei City, Taiwan.
Postgrad Med. 2020 May;132(4):328-336. doi: 10.1080/00325481.2020.1749499. Epub 2020 Apr 15.
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.
This cross-sectional study aimed to identify salient patient factors associated with diabetes medication adherence across different levels of health literacy.
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.
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.
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.
由于糖尿病控制不佳，2 型糖尿病（T2D）会导致各种并发症，从而产生巨大的健康成本。药物依从性与患者的健康素养相关，应持续实践以实现最佳的糖尿病控制。深入了解 T2D 患者在不同健康素养水平下与药物使用行为相关的具体沟通和心理社会因素，将指导制定有效的干预措施和策略，以提高药物依从性。
本横断面研究旨在确定与不同健康素养水平的糖尿病药物依从性相关的显著患者因素。
通过在家庭医学诊所进行面对面的方式，对 205 名参与者进行了问卷调查。研究参与者的年龄均在 20 岁以上，患有 T2D，至少服用一种口服糖尿病药物，且能理解英语。问卷评估了参与者的健康素养、药物使用自我效能感、对药物的信念、医患沟通、药物依从性的感知障碍以及自我报告的药物依从性。使用协方差分析分别比较了不同健康素养水平的患者与药物依从性相关的因素的平均得分。
参与者的平均年龄为 61 岁，大多数参与者为女性（57%）、白人（75%）和大学学历（62%）。33%的参与者具有足够的健康素养，但只有 43%的人报告他们高度遵守糖尿病药物治疗方案。协方差分析显示，具有更强的自我效能感（P<0.001）、较低的药物担忧信念（P=0.047）和较少的药物服用感知障碍（P<0.001），是更好的药物依从性所必需的。
研究结果表明，从业者应该解决低健康素养、低依从性患者的担忧信念，帮助提高自我效能感，并解决所有低依从性患者对药物依从性的感知障碍，以最佳地支持患者的糖尿病护理。
