Evaluation of diabetes mellitus medication-taking behavior among first- and second-generation Australians of Chinese heritage: A nationwide cross-sectional study

Abstract

Aim: To investigate the association of health literacy, illness perceptions, and beliefs about medications on medication-taking behavior among first- and second-generation Australians of Chinese heritage living with type 2 diabetes mellitus (T2DM).

Method: A nationwide cross-sectional online survey of (N = 455) of whom 196 responded, was conducted among adults (≥18 years) with T2DM of Chinese heritage residing in Australia. Participants were recruited via direct invitation (national registry and specialist clinic). Data collection utilized four validated questionnaires: The Brief Medication Questionnaire, Beliefs about Medicines Questionnaire Specific (BMQ-Specific), Brief Illness Perception 9 Questionnaire (BIPQ), and a 12-item short-form health literacy (HL) questionnaire (HLS-SF12). Bivariate and multivariate analyses were conducted to explore the factors associated with medication-taking.

Results: Overall, 27 % of participants reported missing diabetes medication(s) in the past week, with access barriers most cited (38 %), followed by belief (27 %) and recall (24 %) barriers. Median scores for health literacy, illness perception and beliefs about medications showed problems with health literacy (General Health Literacy Index, median [IQR] =31.94 [26.39ꟷ38.89], a moderate threat to illness perception (BIPQ:= 38.56 ± 10.52) and higher perceived necessity of taking diabetes medications relative to concern (BMQ-Specific Necessity: = 3.80 [3.20-4.20]; BMQ-Specific Concern: = 3.00 [2.50-3.67]). Better medication-taking was seen in people with high necessity beliefs and with low concerns in the use of medications. Health literacy and illness perceptions were not significantly associated with medication-taking behavior.

Conclusion: Medication beliefs play a role in sub-optimal medication-taking behavior among Chinese adults with T2DM. Increased attention needs to be placed on examining and enhancing understanding of diabetes medications while addressing concerns among individuals of Chinese backgrounds to better understand the complexities of medication-taking behavior. Culturally relevant clinical discussion and structured diabetes education may support the development of health promoting medication beliefs potentially supporting optimal medication-taking behavior.

Keywords: Australia; Chinese; Medication therapy management; Medication-taking; Missed medications; Type 2 diabetes.

Fig. 1

Participant recruitment process. Abbreviations: HL—SF12, The Health Literacy Survey Short-Form 12; BIPQ, Brief Illness Perception Questionnaire; BMQ-Specific, Beliefs about Medicines Questionnaire-Specific, BMQ, Brief Medication Questionnaire; NDSS, National Diabetes Services Scheme; EH, Eastern Health.

Fig. 2

Comparative analysis of socio-demographic factors, health literacy index, illness perceptions and beliefs about medications between locally and nationally recruited Chinese adults with type 2 diabetes mellitus residing in Australia. P value <0.05 denotes statistical difference between the two groups.

Appendix 1.Directed Acyclic Graph (DAGs)