Beliefs and psychosocial determinants factors of adherence to oral

Author(s)

Fernanda Freire Jannuzzi

• Document type: Doctoral Thesis
• Press: Campinas, SP.
• Institution: Universidade Estadual de Campinas (UNICAMP). Faculdade de Enfermagem
• Defense date: 2014-07-30

Examining board members

Roberta Cunha Matheus Rodrigues; Carla Regina de Souza Teixeira; Mavilde da Luz Gonçalves Pedreira; Maria Cecilia Bueno Jayme Gallani; Maria Helena de Melo Lima

• Advisor: Roberta Cunha Matheus Rodrigues

Abstract

Adherence to oral antidiabetic agents is essential for the metabolic control of diabetes and can prevent or delay the onset of complications of the disease. This study aims to identify the beliefs and psychosocial determinants factors of adherence to oral antidiabetic agents. It was based on the theoretical framework of the Theory of Planned Behavior. This study included patients with type 2 diabetes using oral antidiabetic agents, in outpatient care. This is study consists of two phases. First step: a methodological study to raise beliefs related to the behavior of adhering to oral antidiabetic agents, as well as the construction and validation of an instrument to identify psychosocial determinants of behavior. The beliefs were raised with 17 diabetic patients through interviews guided by the application of semi-structured instrument created based on theory model assumptions and additional variable. The interviews were recorded, transcribed and submitted to content analysis. These findings subsidized the construction of instrument to identify psychosocial determinants of behavior, which was submitted to content validity. The reliability of the instrument was assessed for internal consistency and for stability of the measure. The reliability of the instrument (internal consistency and temporal stability) and construct validity was assessed. Second step: predictive, quantitative, longitudinal research to raise the behavior determinants to adhere to oral antidiabetic agents with 157 patients. Data collection consisted of two phases: at the initial approach (T0) and two months later (T1). At T0 sociodemographic and clinical variable, subjective measure of behavior to adhere to oral antidiabetic agents, self-reported measures of medication adherence (adherence proportion and global evaluation of adherence) and metabolic control of diabetes were obtained. We also identified the psychosocial variables associated with medication adherence behavior: Intention, Attitude, Subjective Norm and Perceived Behavioral Control, through the application of the instrument developed and validated in the first phase. At T1 were again obtained subjective measure of the behavior, self-reported medication adherence and metabolic control of diabetes. Data were submitted to descriptive statistical analysis; reliability; correlation between psychosocial variables and behavior; mean comparison; linear and logistic regression. Emerged behavioral beliefs related to advantages and disadvantages of using medication such as possibility of preventing of diabetes complications, avoid or delay the use of insulin and perception of side effects. It was evident that the children and the doctor are important social referents influencing medication adherence. Among the factors that facilitate adherence stood out the free drug access and taking of medications associated to temporal markers. The therapeutic complexity, on the other hand, was seen as a factor that hinders the adherence. Understanding the way to use of drugs and forgetting impact the perception of the ability to adhere to oral antidiabetic agents. In the study of intention predictors, it was observed that Attitude and Subjective Norm together better explained the variation of Intention (30%). Intention contributed to increase the chances of behavior adoption. The Past Behavior, when added to the prediction model, was the only explanatory factor of adherence. The findings contribute to better understanding of this phenomenon allowing the construction of interventions that are effective in improving adherence to the proposed treatment of the diabetic patient (AU)

• FAPESP's process: 12/05224-1 - Beliefs and psychosocial determinants of adherence to oral antidiabetic agents
• Grantee: Fernanda Freire Jannuzzi
• Support Opportunities: Scholarships in Brazil - Doctorate