Investigation of Barriers and Facilitators to Medication Adherence in Patients With Type 2 Diabetes Across Different Health Literacy Levels: An Explanatory Sequential Mixed Methods Study.

Yen-Ming Huang,Olayinka O Shiyanbola

doi:10.3389/fphar.2021.745749

Yen-Ming Huang, Olayinka O Shiyanbola

Open Access

https://doi.org/10.3389/fphar.2021.745749

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Abstract

Type 2 diabetes (T2D) incurs tremendous healthcare costs associated with various complications due to poor blood sugar control. Medication adherence, which is correlated with patients’ health literacy, should be consistently practiced to achieve optimal control of blood sugar. A comprehensive understanding of 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. To understand barriers and facilitators to medication adherence in people with T2D across different health literacy levels, the Health Literacy Pathway Model was used to identify the psychosocial and communication factors that may influence medication adherence. This mixed methods study used an explanatory sequential design, including a quantitative survey followed by qualitative semi-structured interviews. Two hundred and five participants completed the survey questionnaire, and 23 participants completed semi-structured interviews. Confirmed by quantitative and qualitative data, having stronger self-efficacy and fewer concerns about medications, as well as experiencing fewer perceived barriers to medication-taking, are necessary for better medication adherence among those with low adherence. Our findings will be useful to tailor interventions for diabetes care through addressing concerns among low-adherent patients with low health literacy and emphasizing self-efficacy and perceived barriers to medication adherence among all low-adherent patients with T2D.

Highlights

Diabetes has been the 7th leading cause of death in the United States for decades, affecting 10.5% of the United States adult population in 2018 (Centers for Disease Control and Prevention, 2020)
We focused on medication adherence instead of persistence, which describes the degree to which an individual continues taking medications for the prescribed duration (Cramer et al, 2008) A facilitator was defined as any situational or individual factor identified by study participants that improves adherence to the diabetes medications as prescribed
Following the Health Literacy Pathway (HLP) model, this study focused on factors that are associated with both health literacy and medication adherence at individual and interpersonal levels (Figure 2)

Summary

Introduction

Diabetes has been the 7th leading cause of death in the United States for decades, affecting 10.5% of the United States adult population in 2018 (Centers for Disease Control and Prevention, 2020). The management of diabetes incurs remarkable economic burden because of its complications and adverse outcomes largely attributed to poor blood sugar control (Rhee et al, 2005). The World Health Organization (WHO) emphasizes medication adherence - the extent to which individuals take medications as prescribed with respect to the timing, dose, and frequency during the prescribed length of time (Osterberg and Blaschke, 2005) - is the primary attribute to optimal patient health outcomes (Sabaté, 2003). Increasing the effectiveness of adherence interventions will have a far greater impact on public health than any improvement in specific medical treatments (Sabaté, 2003)

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