Karin de Moraes Oliveira Mariane, Aline de Oliveira Kaizer Uiara, Freire Jannuzzi Fernanda, Ceretta Oliveira Henrique, Maria Costa Alexandre Neusa, Gallani Maria-Cecília, Moreira São-João Thaís, Estevam Cornélio Marilia, Cunha Matheus Rodrigues Roberta
School of Nursing, Universidade Estadual de Campinas - Unicamp, São Paulo, Brazil.
Technical School of Campinas, Universidade Estadual de Campinas - Unicamp, São Paulo, Brazil.
Health Psychol Behav Med. 2025 Jul 9;13(1):2525181. doi: 10.1080/21642850.2025.2525181. eCollection 2025.
Non-adherence to medication therapy in type 2 diabetes mellitus (DM2) is prevalent. Theoretical models have been used to identify the proximal determinants of behavior.
To identify the direct psychosocial predictors of adherence to insulin therapy based on Theory of Planned Behavior (TPB), among outpatients with DM2.
Longitudinal and predictive study, whose data was collected at baseline and 3-month follow-up. At baseline ( = 119), sociodemographic and clinical data, self-reported measures of insulin adherence, psychosocial variables of TPB and glycated hemoglobin (A1C) were collected. At 3-month follow-up ( = 70), measurements of insulin adherence and A1C were again measured. Multiple linear regression, via generalized linear models and Multiple Poisson regression, with robust variance analysis were used, for quantitative and categorical outcomes, respectively.
One point in the Intention score led to a mean increase of 12.5% in the proportion of insulin doses, and there was a mean increase of 25% in the probability of the person taking insulin every day or practically every day. Attitude was a predictor of Intention. The moderation analysis demonstrated that higher levels of Perceived Behavioral Control weakened the effect of Attitude on Intention.
The results showed that Intention was predictor of behavioral measure of adherence and the proportion of insulin doses. Attitude was predictor of Intention and Perceived Behavioral Control moderated the effect of Attitude and Subjective Norm on Intention. These findings highlight the importance of developing interventions that prioritize motivational strategies to enhance insulin adherence in the clinical practice. However, future studies with larger sample sizes and the inclusion of belief assessments are recommended to optimize the understanding of the psychosocial determinants of insulin adherence among outpatients with DM2.
2型糖尿病（DM2）患者中药物治疗依从性不佳的情况普遍存在。理论模型已被用于识别行为的近端决定因素。
基于计划行为理论（TPB），确定DM2门诊患者胰岛素治疗依从性的直接社会心理预测因素。
纵向预测性研究，在基线和3个月随访时收集数据。在基线时（n = 119），收集社会人口学和临床数据、自我报告的胰岛素依从性测量、TPB的社会心理变量和糖化血红蛋白（A1C）。在3个月随访时（n = 70），再次测量胰岛素依从性和A1C。分别使用广义线性模型的多元线性回归和具有稳健方差分析的多元泊松回归，用于定量和分类结果。
意向得分增加1分导致胰岛素剂量比例平均增加12.5%，每天或几乎每天使用胰岛素的概率平均增加25%。态度是意向的预测因素。调节分析表明，较高水平的感知行为控制削弱了态度对意向的影响。
结果表明，意向是依从性行为测量和胰岛素剂量比例的预测因素。态度是意向的预测因素，感知行为控制调节了态度和主观规范对意向的影响。这些发现突出了在临床实践中制定优先考虑动机策略以提高胰岛素依从性的干预措施的重要性。然而，建议未来进行更大样本量的研究并纳入信念评估，以优化对DM2门诊患者胰岛素依从性社会心理决定因素的理解。
