Skip to main content

Advertisement

SpringerLink
Log in

Predictors of adherence to diabetes medications: the role of disease and medication beliefs

  • Published:
Journal of Behavioral Medicine Aims and scope Submit manuscript

Abstract

Despite the effectiveness of drug therapy in diabetes management high rates of poor adherence persist. The purpose of this study was to identify potentially modifiable patient disease and medication beliefs associated with poor medication adherence among people with diabetes. A cohort of patients with diabetes was recruited from an urban primary-care clinic in New York City. Patients were interviewed in English or Spanish about: disease beliefs, medication beliefs, regimen complexity, diabetes knowledge, depression, self-efficacy, and medication adherence (Morisky scale). Logistic regression was used to identify multivariate predictors of poor medication adherence (Morisky > 1). Patients (n = 151) had diabetes for an average of 13 years with a mean HgA1C of 7.6 (SD 1.7). One-in-four (28%) were poor adherers to their diabetes medicines. In multivariate analyses, predictors of poor medication adherence were: believing you have diabetes only when your sugar is high (OR = 7.4;2–27.2), saying there was no need to take medicine when the glucose was normal (OR = 3.5;0.9–13.7), worrying about side-effects of diabetes medicines (OR = 3.3;1.3–8.7), lack of self-confidence in controlling diabetes (OR = 2.8;1.1–7.1), and feeling medicines are hard to take (OR = 14.0;4.4–44.6). Disease and medication beliefs inconsistent with a chronic disease model of diabetes were significant predictors of poor medication adherence. These suboptimal beliefs are potentially modifiable and are logical targets for educational interventions to improve diabetes self-management.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  • Aikens, J. E., Nease, D. E., Jr, Nau, D. P., Klinkman, M. S., & Schwenk, T. L. (2005). Adherence to maintenance-phase antidepressant medication as a function of patient beliefs about medication. Annals of Family Medicine, 3, 23. doi:10.1370/afm.238.

    Article  PubMed  Google Scholar 

  • Aikens, J. E., & Piette, J. D. (2009). Diabetic patients’ medication underuse, illness outcomes, and beliefs about antihyperglycemic and antihypertensive treatments. Diabetes Care, 32(1), 19–24.

    Article  PubMed  Google Scholar 

  • American Diabetes Association. (2008a). Standards of medical care in diabetes–2008. Diabetes Care, 31, S12–S54. doi:10.2337/dc08-S012.

    Article  Google Scholar 

  • American Diabetes Association. (2008b). The economic costs of diabetes in the US in 2007. Diabetes Care, 31, 1–20. doi:10.2337/dc08-S001.

    Article  Google Scholar 

  • Barnes, L., Moss-Morris, R., & Kaufusi, M. (2004). Illness beliefs and adherence in diabetes mellitus: A comparison between Tongan and European patients. The New Zealand Medical Journal, 117, U743.

    PubMed  Google Scholar 

  • Brewer, N., Chapman, G., Brownlee, S., & Leventhal, E. (2002). Cholesterol control, medication adherence and illness cognition. British Journal of Health Psychology, 7, 433–447. doi:10.1348/135910702320645408.

    Article  PubMed  Google Scholar 

  • Broadbent, E., Petrie, K. J., Main, J., & Weinman, J. (2006). The brief illness perception questionnaire. Journal of Psychosomatic Research, 60, 631–637. doi:10.1016/j.jpsychores.2005.10.020.

    Article  PubMed  Google Scholar 

  • Cerkoney, K. A., & Hart, L. K. (1980). The relationship between the health belief model and compliance of persons with diabetes mellitus. Diabetes Care, 3, 594–598. doi:10.2337/diacare.3.5.594.

    Article  PubMed  Google Scholar 

  • Chao, J., Nau, D. P., Aikens, J. E., & Taylor, S. D. (2005). The mediating role of health beliefs in the relationship between depressive symptoms and medication adherence in persons with diabetes. Research in Social & Administrative Pharmacy, 1, 508–525. doi:10.1016/j.sapharm.2005.09.002.

    Article  Google Scholar 

  • Cramer, J. A. (2004). A systematic review of adherence with medications for diabetes. Diabetes Care, 27, 1218–1224. doi:10.2337/diacare.27.5.1218.

    Article  PubMed  Google Scholar 

  • DiMatteo, M. R. (2004). Variations in patients’ adherence to medical recommendations: A quantitative review of 50 years of research. Medical Care, 42, 200–209. doi:10.1097/01.mlr.0000114908.90348.f9.

    Article  PubMed  Google Scholar 

  • Gazmararian, J. A., Kripalani, S., Miller, M. J., Echt, K. V., Ren, J., & Rask, K. (2006). Factors associated with medication refill adherence in cardiovascular-related diseases: A focus on health literacy. Journal of General Internal Medicine, 21, 1215–1221. doi:10.1111/j.1525-1497.2006.00591.x.

    Article  PubMed  Google Scholar 

  • Guillausseau, P. J. (2003). Influence of oral antidiabetic drugs compliance on metabolic control in type 2 diabetes. A survey in general practice. Diabetes & Metabolism, 29, 79–81. doi:10.1016/S1262-3636(07)70011-3.

    Article  Google Scholar 

  • Halm, E. A., Mora, P., & Leventhal, H. (2006). No symptoms, no asthma: the acute episodic disease belief is associated with poor self-management among inner-city adults with persistent asthma. Chest, 129, 573–580. doi:10.1378/chest.129.3.573.

    Article  PubMed  Google Scholar 

  • Horne, R., & Weinman, J. (1999). Patients’ beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness. Journal of Psychosomatic Research, 47, 555–567. doi:10.1016/S0022-3999(99)00057-4.

    Article  PubMed  Google Scholar 

  • Horne, R., Weinman, J., & Hankins, M. (1999). The beliefs about medicines questionnaire: The development and evaluation of a new method for assessing the cognitive representation of medication. Psychology & Health, 14, 1–24. doi:10.1080/08870449908407311.

    Article  Google Scholar 

  • Krapek, K., King, K., Warren, S. S., George, K. G., Caputo, D. A., Mihelich, K., et al. (2004). Medication adherence and associated hemoglobin A1c in Type 2 diabetes. The Annals of Pharmacotherapy, 38, 1357–1362. doi:10.1345/aph.1D612.

    Article  PubMed  Google Scholar 

  • Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9. Validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–613. doi:10.1046/j.1525-1497.2001.016009606.x.

    Article  PubMed  Google Scholar 

  • Krousel-Wood, M., Thomas, S., Muntner, P., & Morisky, D. (2004). Medication adherence: A key factor in achieving blood pressure control and good clinical outcomes in hypertensive patients. Current Opinion in Cardiology, 19, 357–362. doi:10.1097/01.hco.0000126978.03828.9e.

    Article  PubMed  Google Scholar 

  • Leventhal, H., Brissette, I., & Leventhal, E. (2003). The common sense models of self-regulation of health and illness. London: Taylor & Francis Books, Ltd.

    Google Scholar 

  • Mann, D. M., Allegrante, J. P., Natarajan, S., Halm, E. A., & Charlson, M. (2007). Predictors of adherence to statins for primary prevention. Cardiovascular Drugs and Therapy, 21, 311–316. doi:10.1007/s10557-007-6040-4.

    Article  PubMed  Google Scholar 

  • Morisky, D., Green, L., & Levine, D. (1986). Concurrent and predictive validity of a self-reported measure of medication adherence. Medical Care, 24, 67–74. doi:10.1097/00005650-198601000-00007.

    Article  PubMed  Google Scholar 

  • Moss-Morris, R., Weinman, J., Petrie, K., Horne, R., Cameron, L., & Buick, D. (2002). The revised illness perception questionnaire (IPQ-R). Psychology & Health, 17, 1–16. doi:10.1080/08870440290001494.

    Article  Google Scholar 

  • Nagasawa, M., Smith, M. C., Barnes, J. H., Jr, & Fincham, J. E. (1990). Meta-analysis of correlates of diabetes patients’ compliance with prescribed medications. The Diabetes Educator, 16, 192–200. doi:10.1177/014572179001600309.

    Article  PubMed  Google Scholar 

  • National Diabetes Information Clearinghouse. National Diabetes Statistics: NIDDK. (2007). National diabetes statistics fact sheet: General information and national estimates on diabetes in the United States. US: National Institute of Health. http://diabetes.niddk.nih.gov/dm/pubs/statistics/index.htm.

  • Osterberg, L., & Blaschke, T. (2005). Adherence to medication. The New England Journal of Medicine, 353, 487–497. doi:10.1056/NEJMra050100.

    Article  PubMed  Google Scholar 

  • Phatak, H. M., & Thomas, J., I. I. I. (2006). Relationships between beliefs about medications and nonadherence to prescribed chronic medications. The Annals of Pharmacotherapy, 40, 1737–1742. doi:10.1345/aph.1H153.

    Article  PubMed  Google Scholar 

  • Rieckmann, N., Kronish, I. M., Haas, D., Gerin, W., Chaplin, W. F., Burg, M. M., et al. (2006). Persistent depressive symptoms lower aspirin adherence after acute coronary syndromes. American Heart Journal, 152, 922–927. doi:10.1016/j.ahj.2006.05.014.

    Article  PubMed  Google Scholar 

  • Ross, S., Walker, A., & MacLeod, M. (2004). Patient compliance in hypertension: Role of illness perceptions and treatment beliefs. Journal of Human Hypertension, 18, 607–613. doi:10.1038/sj.jhh.1001721.

    Article  PubMed  Google Scholar 

  • Searle, A., Wetherell, M. A., Campbell, R., Dayan, C., Weinman, J., & Vedhara, K. (2008). Do patients’ beliefs about type 2 diabetes differ in accordance with complications: An investigation into diabetic foot ulceration and retinopathy. International Journal of Behavioral Medicine, 15, 173–179. doi:10.1080/10705500802212940.

    Article  PubMed  Google Scholar 

  • Sud, A., Kline-Rogers, E. M., Eagle, K. A., Fang, J., Armstrong, D. F., Rangarajan, K., et al. (2005). Adherence to medications by patients after acute coronary syndromes. The Annals of Pharmacotherapy, 39, 1792–1797. doi:10.1345/aph.1G249.

    Article  PubMed  Google Scholar 

  • Walker, E. A., Molitch, M., Kramer, M. K., Kahn, S., Ma, Y., Edelstein, S., et al. (2006). Adherence to preventive medications: Predictors and outcomes in the diabetes prevention program. Diabetes Care, 29, 1997–2002. doi:10.2337/dc06-0454.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors thank Jessica Lorenzo, MPH, Julian Baez, John Marcel and Manuel Vilchez for their work throughout this project. Data from this study were presented at the bi-annual International Congress of Behavioral Medicine (August 25, 2008; Tokyo, Japan). This study was funded by the National Institute on Aging (R24 AG023958) and the Center for the Study of Health Beliefs and Behaviors. Disclosure The authors have no relevant conflict of interest to disclose.

Author information

Authors and Affiliations

  1. Division of General Internal Medicine, Mount Sinai School of Medicine, 1 Gustave Levy Place, Box 1087, New York, NY, 10029, USA

    Devin M. Mann, Diego Ponieman & Ethan A. Halm

  2. Department of Psychology, Rutgers University, New Brunswick, NJ, USA

    Howard Leventhal

Authors
  1. Devin M. Mann
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Diego Ponieman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Howard Leventhal
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ethan A. Halm
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Devin M. Mann.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mann, D.M., Ponieman, D., Leventhal, H. et al. Predictors of adherence to diabetes medications: the role of disease and medication beliefs. J Behav Med 32, 278–284 (2009). https://doi.org/10.1007/s10865-009-9202-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10865-009-9202-y

Keywords

Search

Navigation