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Information-Motivation-Behavioral model may improve diabetes medication adherence
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The Information-Motivation-Behavioral skills model of medication adherence, traditionally used to conceptualize HIV medication adherence, also is applicable to diabetes and may be used to improve medication compliance in this population, according to recent findings.
In the study, researchers evaluated 314 adults with type 2 diabetes who presented for outpatient care at a federally qualified health center in Nashville, Tenn., between June 2010 and November 2012. During this appointment, the patients underwent an in-office HbA1c test.
Patients also completed interviewer-administered questionnaires before or after their clinic appointment.
The five-item Diabetes Medication Knowledge Questionnaire (DMKQ) was utilized to evaluate medication compliance information. This questionnaire evaluates the patient’s knowledge of the name, purpose, dosing schedule, adverse effects and proper handling of a missed dose of a diabetes medication in their regimen. The researchers administered the DMKQ for each diabetes medication the patients were taking. Motivation for adherence was analyzed using the Medicines for Diabetes Questionnaire, which assesses patient attitudes toward taking diabetes medications. Compliance behavior was evaluated using the revised Medication Adherence Self-Efficacy Scale, which measures adherence self-efficacy.
Each of these factors, which comprise the Information-Motivation-Behavioral (IMB) skills model of adherence, were analyzed in terms of their effect on medication adherence, glycemic control, subjective health and objective health.
The researchers found that the IMB elements accounted for 41% of the variations in adherence, and adherence accounted for 9% of variations in HbA1c. In keeping with IMB model predictions, there was a direct correlation between behavioral skills and adherence (beta=0.59; P<.001), and behavioral skills were found to be a mediator between the effect of information and motivation on adherence. Compliance with medication was a significant predictor of glycemic control (beta=20.3; P<.001). There was no correlation seen between insulin status or complexity of regimen with adherence, and neither of these mediated the link between IMB elements and medication compliance.
Based on these findings, the researchers said information, motivation and behavioral skills should be considered important targets for ensuring diabetes compliance.
“Motivation may be enhanced by targeting negative or false beliefs about adherence, juxtaposing consequences of nonadherence with a patient’s goals and interests, and teaching patients how to elicit support for adherence,” the researchers wrote. “Intervention content that helps patients identify strategies to adhere in a variety of situations may increase adherence behavioral skills.”
Disclosure: The researchers report no relevant financial disclosures.
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