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. 2018 Aug:142:374-384.
doi: 10.1016/j.diabres.2018.05.046. Epub 2018 Jun 4.

Assessing barriers to diabetes medication adherence using the Information-Motivation-Behavioral skills model

Lyndsay A Nelson  1 , Kenneth A Wallston  2 , Sunil Kripalani  3 , Lauren M LeStourgeon  1 , Sarah E Williamson  1 , Lindsay S Mayberry  4
Affiliations

Assessing barriers to diabetes medication adherence using the Information-Motivation-Behavioral skills model

Lyndsay A Nelson et al. Diabetes Res Clin Pract. 2018 Aug.

Abstract

Aims: Medication nonadherence is a prevalent and costly problem among patients with type 2 diabetes. Applications of theory can inform and improve adherence promotion interventions. We used a new assessment based on the Information-Motivation-Behavioral skills (IMB) model of adherence to assess patient-reported barriers and test the theoretical model.

Methods: Participants (N = 237) completed a card sorting task to identify barriers to adherence, a survey, and a hemoglobin A1c (HbA1c) test. We identified the most commonly reported adherence barriers and examined associations between patient characteristics and barriers mapped onto each of the IMB constructs. We used structural equation modeling to test the IMB model and determine if barriers as reported on this measure predict patients' self-reported diabetes medication adherence and, in turn, HbA1c levels.

Results: The most frequently reported barriers were forgetting doses, thinking brand name medicine works better than generic medicine, not seeing immediate benefit, and feeling burned out with taking diabetes medicine. Younger age and lower health literacy were associated with higher barrier scores for all IMB model constructs. Information and social motivation barriers affected adherence via behavioral skills barriers (indirect effects -0.19, CI [-0.33, -0.09] and -0.24, CI [-0.37, -0.14], respectively). The IMB barrier constructs explained 44% of the variance in diabetes medication adherence which, in turn, was significantly associated with and explained 8% of the variance in HbA1c (both p < .001).

Conclusions: Results suggest this assessment task can identify patient-specific barriers to diabetes medication adherence. Interventions targeting patient-specific barriers using this assessment could improve adherence and HbA1c.

Keywords: Behavioral change; Disparities research; Glycemic control; Health disparities; IMB model; Medication adherence; Type 2 diabetes.

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Conflict of interest statement

Duality of Interest

K.A.W. is on the Advisory Board of EdLogics, Inc. No other potential conflicts of interest relevant to this article were reported.

Figures

Figure 1.
Figure 1.
Estimated model of diabetes medication adherence using patient-reported barriers from an assessment based on the Information-Motivation-Behavioral skills model.
See this image and copyright information in PMC

References

    1. Kirkman MS, Rowan-Martin MT, Levin R, Fonseca VA, Schmittdiel JA, Herman WH, et al. Determinants of adherence to diabetes medications: Findings from a large pharmacy claims database. Diabetes Care. 2015;38:604–9. PMID: 10.2337/dc14-2098. - DOI - PMC - PubMed
    1. Capoccia K, Odegard PS, Letassy N. Medication adherence with diabetes medication: A systematic review of the literature. Diabetes Educ 2016;42:34–71. PMID: 10.1177/0145721715619038. - DOI - PubMed
    1. Mayberry LS, Bergner EM, Chakkalakal RJ, Elasy TA, Osborn CY. Self-care disparities among adults with type 2 diabetes in the USA. Curr Diab Rep 2016;16:113 PMID: 10.1007/s11892-016-0796-5. - DOI - PMC - PubMed
    1. Rolnick SJ, Pawloski PA, Hedblom BD, Asche SE, Bruzek RJ. Patient characteristics associated with medication adherence. Clin Med Res 2013;11:54–65. PMID: 10.3121/cmr.2013.1113. - DOI - PMC - PubMed
    1. Berkowitz SA, Seligman HK, Choudhry NK. Treat or eat: Food insecurity, cost-related medication underuse, and unmet needs. Am J Med 2014;127:303–10 e3. PMID: 10.1016/j.amjmed.2014.01.002. - DOI - PubMed