Patient adoption of an internet based diabetes medication tool to improve adherence: A pilot study

Highlights

• A video intervention improved patients’ self-efficacy in managing type 2 diabetes.

• Seventy-three percent watched at least one module after the initial visit.

• Videos were especially helpful for low literate patients.

• Video interventions may help address common barriers to diabetes self-management.

Abstract

Objective

To investigate the effect of a video intervention, Managing Your Diabetes Medicines, on patient self-efficacy, problems with using medication, and medication adherence in a rural, mostly African American population.

Methods

Patients selected their problem areas in medication use and watched one of nine 2-min videos with a research assistant at a clinic or pharmacy and were given an access code to watch all the videos at their convenience. Outcomes were measured at baseline and 3-month follow-up.

Results

Fifty-one patients were enrolled; 84% were African American and 80% were female (mean age: 54 years). Seventy-three percent watched at least one module after the initial visit. Improved self-efficacy was associated with a decrease in concerns about medications (r = −0.64). Low literate patients experienced greater improvement in self-efficacy than more literate patients (t = 2.54, p = 0.02). Patients’ mean number of problems declined from 6.14 to 5.03. The number of patients with high or medium adherence rose from 33% at baseline to 43% at 3-month follow-up.

Conclusions

A practical, customized video intervention may help improve patient self-efficacy, reduce problems with medication use, and improve medication adherence in diabetes patients.

Practice implications

Providers should consider implementing technology-based interventions in the clinic to address common problems that patients have with self-management.

Introduction

Diabetes affects 25.8 million Americans [1], and disproportionately affects African Americans, who are less likely to adhere to their medications, and thus control their diabetes, than White patients [2], [3], [4], [5]. Because poor medication understanding and low adherence are common [6], [7], medication management is a critical self-management skill for patients with diabetes [8].

Providers often lack adequate time to educate and motivate patients to take their diabetes medications [9]. Moreover, restrictions on insurance coverage for diabetes self-management education [10] and lack of access to health care necessitate that self-management interventions expand to non-clinical settings. Therefore, we developed a video-based intervention called Managing Your Diabetes Medicines (MYDM) using the “Information-Motivation-Behavioral Skills Model” (IMB; Fig. 1) that posits that a better informed, more motivated patient with requisite behavior skills is more likely to initiate and maintain health-promoting behaviors, like taking medications [11], as studies of the IMB model show [12], [13].

Videos can be delivered online using smartphones. Among smartphone users, minorities, those with no college experience, and lower-income users report that their phone is their main source of Internet access [14], with African Americans using mobile phones for a wider range of activities than Whites [15], [16]. The present intervention was designed to be culturally-informed to maximize usability among limited literacy African American and White patients who are at-risk for poorer health outcomes than more literate patients [17], [18].

The purpose of this pilot study was to: (1) gather input from White and African American patients with diabetes who are having difficulty adhering to their medicines about how to modify and improve our intervention, and (2) evaluate whether patient exposure to the intervention is associated with an increase in patient medication self-efficacy, a decrease in the number of reported problems in using diabetes medicines, and an increase in self-reported adherence to diabetes medications at 3 months.