Short communicationPatient adoption of an internet based diabetes medication tool to improve adherence: A pilot study
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.
Section snippets
Procedure
Patients were recruited at a family medicine clinic and a pharmacy in eastern North Carolina. Patients were eligible for the study if they were: (a) age 18 or older, (b) diagnosed with type 2 diabetes, (c) taking at least one oral and/or injectable medication(s) for diabetes, (d) English-speaking, (e) non-adherent to their diabetes medicines on a Visual Analog Scale (VAS) [19], and (f) African American or White. Approval was obtained from the University of North Carolina and the East Carolina
Results
Baseline data included problems that patients experienced, self-efficacy, adherence, beliefs about medications, and depressive symptoms (Table 2, Table 3). Table 2 presents the demographics of the 51 study participants (of 74 screened, for a 69% response rate). Seventeen patients refused because they did not have interest in participating, 3 patients because they did not have time, 1 because he/she found it too confusing to manage, 1 because he/she worked nights, and 1 did not give a reason.
Discussion
In this pilot study, MYDM showed potential to improve self-efficacy and reduce self-reported problems with taking diabetes medications in a sample of rural, mainly African American patients. Concerns about medications declined in tandem with improved self-efficacy. Although not statistically significant, adherence, self-efficacy, and number of problems showed trends in the expected direction based on the IMB model. Since misconceptions about diabetes are very common [25], effective
Conflicts of interest
The authors have no conflict of interest. All authors have contributed to, read, and approved the final article.
Informed consent and patient details
The authors confirm all patient/personal identifiers have been removed or disguised so the patient/person(s) described are not identifiable and cannot be identified through the details of the story.
Acknowledgments
This study was funded by the UNC Center for Diabetes Translation Research to Reduce Health Disparities, supported by Grant Number P30DK093002 from the National Institute of Diabetes and Digestive and Kidney Diseases. The project described was supported by the National Center for Advancing Translational Sciences (NCATS), National Institutes of Health, through Grant Award Number 1UL1TR001111. The content is solely the responsibility of the authors and does not necessarily represent the official
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