Mohammadi Shiva, Khorami Bahareh, Seyedtabib Maryam, Najafpour Zhila
Department of Health care Management, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
Department of Biostatistics and Epidemiology, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
PLoS One. 2025 Sep 25;20(9):e0332235. doi: 10.1371/journal.pone.0332235. eCollection 2025.
Medication adherence is a determinant of managing chronic disease. Failure to adhere to treatment can result in disease progression, increased hospitalizations, and a higher risk of complications and mortality. This study aimed to determine the level of medication adherence in older adults with type 2 diabetes based on the Health Action Process Approach (HAPA).
This study is a descriptive-analytical cross-sectional study that was conducted on 179 older adults with type 2 diabetes. Data were collected using the Morisky Medication Adherence Scale (MMAS-8-Item) and the HAPA questionnaire. We used the chi-square test to compare adherence to medication by demographic characteristics and multiple binary logistic regression analysis to predict factors related to medication adherence based on the HAPA dimensions.
A total of 179 participants (87 men and 92 women) with a mean age of 64.65 ± 4.99 years were enrolled. Low medication adherence was reported by 62% of participants. No significant associations were found between socio-demographic factors (gender, marital status, education, employment, and income) and adherence levels. Logistic regression analysis revealed that smoking (OR = 4.309, 95% CI [1.18, 15.67], p = 0.027) and perceived barriers to adherence (OR = 1.036, 95% CI [1.01, 1.06], p = 0.001) were significantly associated with increased odds of medication non-adherence. Conversely, higher recovery self-efficacy (OR = 0.924, 95% CI: 0.86-0.99, p = 0.027) and coping planning (OR = 0.963, 95% CI: 0.93-0.99, p = 0.022) were associated with reduced odds of non-adherence. The most common self-reported reasons for suboptimal adherence were lack of affordability (17.5%), lack of family support (10%), and poor understanding of the disease (9.4%).
This study highlights that older people had suboptimal adherence to medication. Smoking and perceived barriers were significant risk factors, increasing the likelihood of poor adherence. Conversely, higher levels of recovery self-efficacy and coping planning served as protective factors, reducing the risk of non-adherence. Policymakers and planners should consider the mentioned factors in designing interventions to change behavior for chronic diseases like diabetes.
药物依从性是慢性病管理的一个决定因素。不坚持治疗会导致疾病进展、住院次数增加以及并发症和死亡风险升高。本研究旨在基于健康行动过程方法（HAPA）确定2型糖尿病老年患者的药物依从性水平。
本研究是一项描述性分析横断面研究，对179名2型糖尿病老年患者进行了研究。使用Morisky药物依从性量表（MMAS-8项）和HAPA问卷收集数据。我们使用卡方检验按人口统计学特征比较药物依从性，并使用多元二元逻辑回归分析根据HAPA维度预测与药物依从性相关的因素。
共纳入179名参与者（87名男性和92名女性），平均年龄为64.65±4.99岁。62%的参与者报告药物依从性较低。社会人口学因素（性别、婚姻状况、教育程度、就业情况和收入）与依从性水平之间未发现显著关联。逻辑回归分析显示，吸烟（OR = 4.309，95% CI [1.18, 15.67]，p = 0.027）和感知到的依从性障碍（OR = 1.036，95% CI [1.01, 1.06]，p = 0.001）与药物不依从几率增加显著相关。相反，较高的康复自我效能感（OR = 0.924，95% CI：0.86 - 0.99，p = 0.027）和应对计划（OR = 0.963，95% CI：0.93 - 0.99，p = 0.022）与不依从几率降低相关。自我报告的依从性欠佳的最常见原因是负担不起（17.5%）、缺乏家庭支持（10%）和对疾病了解不足（9.4%）。
本研究强调老年人药物依从性欠佳。吸烟和感知到的障碍是显著的风险因素，增加了依从性差的可能性。相反，较高水平的康复自我效能感和应对计划是保护因素，降低了不依从的风险。政策制定者和规划者在设计干预措施以改变糖尿病等慢性病的行为时应考虑上述因素。
