Diabetes-related patients’ profile and strategy in improving their knowledge and adherence: A mixed method study
DOI:
https://doi.org/10.46542/pe.2024.241.678687Keywords:
Adherence, Diabetes mellitus, Pharmacist, Pharmacy service model, Primary healthcareAbstract
Background: Effective education and information during diabetes patients’ treatment to enhance their knowledge could impact their medication adherence to improve therapeutic outcomes. This study aims to explore diabetes-related patient profiles, including knowledge, adherence, and medication nonadherence factors among diabetic patients. Also, it explores the implemented pharmacists' strategies to raise knowledge and adherence.
Methods: This study had two phases. The first phase focused on diabetic patients, assessing their profiles, knowledge about diabetes, medication adherence, and factors contributing to nonadherence. The second phase examined pharmacists' strategies to improve patients' knowledge and adherence. Using a mixed-methods design, participants were recruited from primary healthcare in Yogyakarta. Medication adherence was measured with a four-item Morisky, Green, and Levine Medication Adherence Scale (MGLS), while knowledge was assessed using a 10-item adapted questionnaire from the Diabetes Knowledge Questionnaire (DKQ-24).
Results: This study enrolled 104 patients and 24 pharmacists. Most patients (40.4%) had low knowledge of disease and medication related to diabetes. A quarter of the participants (26%) exhibited poor adherence. Almost all of the pharmacists have developed strategies to enhance patients’ knowledge and adherence (95.8%), providing drug information services and medication control cards.
Conclusion: Improving patient knowledge, addressing non-adherence, and standardising pharmacists' strategies are necessary, alongside developing a comprehensive service model to enhance therapeutic outcomes.
References
Al Assaf, S., Zelko, R., & Hanko, B. (2022). The effect of interventions led by community pharmacists in primary care for adults with type 2 diabetes mellitus on therapeutic adherence and HbA1c levels: A systematic review. International Journal of Environmental Research and Public Health, 19(10), 6188. https://doi.org/10.3390/ijerph19106188
Alodhaib, G., Alhusaynan, I., Mirza, A., & Almogbel, Y. (2021). Qualitative exploration of barriers to medication adherence among patients with uncontrolled diabetes in Saudi Arabia. Pharmacy, 9(1), Article 1. https://doi.org/10.3390/pharmacy9010016
AlShayban, D. M., Naqvi, A. A., Alhumaid, O., AlQahtani, A. S., Islam, Md. A., Ghori, S. A., Haseeb, A., Ali, M., Iqbal, M. S., Elrggal, M. E., Ishaqui, A. A., Mahmoud, M. A., Khan, I., & Jamshed, S. (2020). Association of disease knowledge and medication adherence among out-patients with type 2 diabetes mellitus in Khobar, Saudi Arabia. Frontiers in Pharmacology, 11, 60. https://doi.org/10.3389/fphar.2020.00060
Arif, R., Khan, A. Z., Hammad, M., Ghani, U., Vaddepalli, R., & Sanker, V. (2023). Current practices and perceived role of community pharmacists in type 2 diabetes services in Pakistan. Cureus, 15(4), e37311. https://doi.org/10.7759/cureus.37311
Bindu Murali, A., Boban, B., Karoor Shanmughan, A., Marimuthu, K., Ramakrishnan Sreelatha, A., & Xavier, A. (2016). Medication therapy management (MTM): An innovative approach to improve medication adherence in diabetics. Drug Metabolism and Personalized Therapy, 31(3), 151–155. https://doi.org/10.1515/dmpt-2016-0016
Bou-Saba, A. W., Kassak, K. M., & Salameh, P. R. (2022). The current trends and challenges towards good community pharmacy practice and the way forward. Exploratory Research in Clinical and Social Pharmacy, 6, 100152. https://doi.org/10.1016/j.rcsop.2022.100152
Chin, S. S., Lau, S. W., Lim, P. L., Wong, C. M., & Ujang, N. (2023). Medication adherence, its associated factors and implication on glycaemic control in patients with type 2 diabetes mellitus: A cross-sectional study in a Malaysian primary care clinic. Malaysian Family Physician, 18, 14. https://doi.org/10.51866/oa.88
Cramer, J. A. (2004). A systematic review of adherence with medications for diabetes. Diabetes Care, 27(5), 1218–1224. https://doi.org/10.2337/diacare.27.5.1218
Hsieh, M.-H., Chen, Y.-C., Ho, C.-H., & Lin, C.-Y. (2022). Validation of Diabetes Knowledge Questionnaire (DKQ) in the Taiwanese population—Concurrent validity with diabetes-specific quality of life questionnaire module. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 15, 2391–2403. https://doi.org/10.2147/DMSO.S369552
Huddlestone, L., Turner, J., Eborall, H., Hudson, N., Davies, M., & Martin, G. (2020). Application of normalisation process theory in understanding implementation processes in primary care settings in the UK: A systematic review. BMC Family Practice, 21, 52. https://doi.org/10.1186/s12875-020-01107-y
International Diabetes Federation. (2021). IDF diabetes atlas tenth edition. https://diabetesatlas.org/
Kassahun, T., Gesesew, H., Mwanri, L., & Eshetie, T. (2016). Diabetes related knowledge, self-care behaviours and adherence to medications among diabetic patients in Southwest Ethiopia: A cross-sectional survey. BMC Endocrine Disorders, 16(1), 28. https://doi.org/10.1186/s12902-016-0114-x
Kristina, S. A., Putri, L. R., Riani, D. A., Ikawati, Z., & Endarti, D. (2019). Validity of self-reported measure of medication adherence among diabetic patients in Indonesia. International Research Journal of Pharmacy, 10(7), 144–148. https://doi.org/10.7897/2230-8407.1007234
Laparidou, D., Botan, V., Law, G. R., Rowan, E., Smith, M. D., Brewster, A., Spaight, R., Mountain, P., Dunmore, S., James, J., Roberts, L., Khunti, K., & Siriwardena, A. N. (2022). People with diabetes and ambulance staff perceptions of a booklet-based intervention for diabetic hypoglycaemia, “Hypos can strike twice”: A mixed methods process evaluation. BMC Emergency Medicine, 22, 21. https://doi.org/10.1186/s12873-022-00583-y
Lemeshow, S. (1990). Adequacy of sample size in health studies. John Wiley & Sons Ltd.
Ligita, T., Wicking, K., Francis, K., Harvey, N., & Nurjannah, I. (2019). How people living with diabetes in Indonesia learn about their disease: A grounded theory study. PLoS ONE, 14(2), e0212019. https://doi.org/10.1371/journal.pone.0212019
Mays, N., & Pope, C. (2000). Assessing quality in qualitative research. BMJ, 320(7226), 50–52. https://doi.org/10.1136/bmj.320.7226.50
National Institute for Health and Care Excellence. (2012, November 30). Appendix H: Methodology checklist: qualitative studies. NICE. https://www.nice.org.uk/process/pmg6/resources/the-guidelines-manual-appendices-bi-2549703709/chapter/appendix-h-methodology-checklist-qualitative-studies
Phoosuwan, N., Ongarj, P., & Hjelm, K. (2022). Knowledge on diabetes and its related factors among the people with type 2 diabetes in Thailand: A cross-sectional study. BMC Public Health, 22(1), 2365. https://doi.org/10.1186/s12889-022-14831-0
Polonsky, W. H., & Henry, R. R. (2016). Poor medication adherence in type 2 diabetes: Recognizing the scope of the problem and its key contributors. Patient Preference and Adherence, 10, 1299–1307. https://doi.org/10.2147/PPA.S106821
Presley, B., Groot, W., & Pavlova, M. (2019). Pharmacy-led interventions to improve medication adherence among adults with diabetes: A systematic review and meta-analysis. Research in Social and Administrative Pharmacy, 15(9), 1057–1067. https://doi.org/10.1016/j.sapharm.2018.09.021
Rao, D., & Shiyanbola, O. O. (2022). Best practices for conducting and writing mixed methods research in social pharmacy. Research in Social & Administrative Pharmacy, 18(1), 2184–2192. https://doi.org/10.1016/j.sapharm.2021.04.015
Ridhayani, F. (2020). Study of compliance and reasons for non-compliance in diabetes mellitus patients at Yogyakarta city health centers. [Undergraduate thesis, Universitas Gadjah Mada]. https://etd.repository.ugm.ac.id/penelitian/detail/186100
Rodis, J. L., Sevin, A., Awad, M. H., Porter, B., Glasgow, K., Hornbeck Fox, C., & Pryor, B. (2017). Improving chronic disease outcomes through medication therapy management in federally qualified health centers. Journal of Primary Care & Community Health, 8(4), 324–331. https://doi.org/10.1177/2150131917701797
Rooney, M. R., Rawlings, A. M., Pankow, J. S., Echouffo Tcheugui, J. B., Coresh, J., Sharrett, A. R., & Selvin, E. (2021). Risk of progression to diabetes among older adults With prediabetes. JAMA Internal Medicine, 181(4), 511–519. https://doi.org/10.1001/jamainternmed.2020.8774
Saibi, Y., Romadhon, R., & Nasir, N. M. (2020). The compliance on their medication of type 2 diabetes mellitus patients in the public health center in East Jakarta. Jurnal Farmasi Galenika (Galenika Journal of Pharmacy), 6(1), 94–103. https://doi.org/10.22487/j24428744.2020.v6.i1.15002
Salsabila, F. A. (2020). Study of knowledge level and clinical outcomes in diabetes mellitus patients in Yogyakarta city health center. [Undergraduate thesis, Universitas Gadjah Mada]. https://etd.repository.ugm.ac.id/penelitian/detail/186146
Sendekie, A. K., Netere, A. K., Kasahun, A. E., & Belachew, E. A. (2022). Medication adherence and its impact on glycemic control in type 2 diabetes mellitus patients with comorbidity: A multicenter cross-sectional study in Northwest Ethiopia. PLOS ONE, 17(9), e0274971. https://doi.org/10.1371/journal.pone.0274971
Singh, M. V., & Dokun, A. O. (2023). Diabetes mellitus in peripheral artery disease: Beyond a risk factor. Frontiers in Cardiovascular Medicine, 10. https://doi.org/10.3389/fcvm.2023.1148040
Singh, R., Kumari, P., Prashar, A., Sardana, O., & Singh, V. (2022). Assessment of medication adherence among type-2 diabetes mellitus in a tertiary care hospital of North India. Environmental Science and Pollution Research, 29, 24951–24955. https://doi.org/10.1007/s11356-021-17434-1
Tadesse, Y. B., Sendekie, A. K., Mekonnen, B. A., Denberu, F. G., & Kassaw, A. T. (2023). Pharmacists’ medication counseling practices and knowledge and satisfaction of patients with an outpatient hospital pharmacy service. Inquiry: The Journal of Medical Care Organization, Provision and Financing, 60. https://doi.org/10.1177/00469580231219457
Trusda, S. A. D., Purbaningsih, W., Budiman, B., & Fitriadi, S. S. N. (2021). Characteristics of patients with type 2 diabetes mellitus in Al-Ihsan Regional General Hospital. Global Medical and Health Communication, 9(2), Article 2. https://doi.org/10.29313/gmhc.v9i2.8123
Upamali, S., & Rathnayake, S. (2023). Perspectives of older people with uncontrolled type 2 diabetes mellitus towards medication adherence: A qualitative study. PloS One, 18(8), e0289834. https://doi.org/10.1371/journal.pone.0289834
von Elm, E., Altman, D. G., Egger, M., Pocock, S. J., Gøtzsche, P. C., Vandenbroucke, J. P., & STROBE Initiative. (2008). The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies. Journal of Clinical Epidemiology, 61(4), 344–349. https://doi.org/10.1016/j.jclinepi.2007.11.008
Wijayanti, D. (2022). The effect of health education on knowledge of the prevention of diabetes mellitus. Babali Nursing Research, 3(1), 23‒29. https://doi.org/10.37363/bnr.2022.3176
Zairina, E., Nugraheni, G., Sulistyarini, A., Mufarrihah, Setiawan, C. D., Kripalani, S., & Lestari, S. I. (2022). Factors related to barriers and medication adherence in patients with type 2 diabetes mellitus: A cross-sectional study. Journal of Diabetes and Metabolic Disorders, 21(1), 219–228. https://doi.org/10.1007/s40200-021-00961-6
