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Adherence to therapeutic regimens is a major challenge among people with Type 2 diabetes mellitus to achieve glycemic control. This study aimed to examine the factors influencing adherence to therapeutic regimens among 200 people with Type 2 diabetes at an Outpatient Department in two Yangon General Hospitals. Hierarchical multiple regression analysis showed the participants had good adherence to their therapeutic regimens. However, their adherence to specific diet, physical exercise, and blood glucose monitoring was lower than adherence to medication and foot care. The prevalence of poor glycemic control (71%) was significantly higher in this study. Analysis indicated patients with better family support, good patient-healthcare provider relationship, better self-efficacy and fewer comorbidities were better adhered to therapeutic regimens accounted for 71.9% of the variability in adherence behavior (R2 = 0.719, F)1,194) = 72.98, p < 0.001). Therefore, the study recommends nurses and other healthcare providers consider five predictors to develop effective family-based interventions that empower people with Type 2 diabetes mellitus to improve their adherence to therapeutic regimens.
Ali, S. M., & Jusoff, K. (2009). Barriers to optimal control of Type 2 diabetes in Malaysian Malay patients. Global Journal of Health Science, 1(2), 106-118.
Al-Qazaz, H. K., Sulaiman, S. A., Hassali, M. A., Shafie, A. A., Sundram, S., … Saleem, F. (2011). Diabetes knowledge, medication adherence and glycemic control among patients with Type 2 diabetes. International Journal of Clinical Pharmacy, 33(6), 1028-1035. doi: 10.1007/s11096- 011-9582-2
American Diabetes Association. (2014). Diagnosis and classification of diabetes mellitus. Diabetes Care 2014, 37(Supplement 1), S81-S90. doi: https:// doi.org/10.2337/dc14-S081
Aziz, A., Durmais, L., & Barbe, J. (2013). Health Canada's evaluation of the use of glycemic index claims on food labels, American Journal of Clinical Nutrition, 98(2), 269-274.
Boas, L.C.G.V., Foss, M.C., Freitas, M.C.F.D., & Pace, A.E. (2012). Relationship among social support, treatment adherence and metabolic control of diabetes mellitus patients. Rev. Latino-Am. Enfermagem, 20(1), 52-58.
Brodaty, H., Pond, D., Kemp, N.M., Luscombe, G., Harding, L., Berman, K., … Huppert, F.A. (2002). The GPCOG: a new screening test for dementia designed for general practice. Journal of the American Geriatrics Society, 50(3), 530-534.
Brundisini, F., Vanstone, M., Hulun, D., Dejean, D., & Giacomini, M. (2015). Type 2 diabetes patients’ and providers’ differing perspectives on non-medication adherence: a qualitative meta-synthesis. BMC Health Services Research, (2015)15:516.
Chalson, M. E., Pompei, P., Ales, K.L., & Mackenzie, C.R. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. Journal of Chronic Diseases, 40(5), 373-383. doi: 10.1016/0021-9681(87)90171-8
Charity, K. W., Kumar, A. M. V., Hinderaker, S. G., Chinnakali, P., Pastakia, S. D., & Kamano, J. (2016). Do diabetes mellitus patients adhere to self-monitoring of blood glucose (SMBG) and is this associated with glycemic control? Experiences from a SMBG program in western Kenya. Diabetes Research and Clinical Practice, 112(2016), 37-43. doi: https:// dx.doi.org/ 10. 1016/ j.diabres.2015.11.006
Chen, S. L., Tsa, J C., & Chou, K.R. (2011). Illness perceptions and adherence to therapeutic regimens among patients with hypertension: a structural modeling approach. International Journal of Nursing Studies, 48(2), 235-245. doi: 10.1016/j.ijnurstu.2010.07.005
Cooke, C. E., Lee, H.Y., Tong, Y. P., & Haines, S. T. (2010). Persistence with injectable antidiabetic agents in members with Type 2 diabetes in a commercial managed care organization. Current Medical Research and Opinion, 26(1), 231-238. doi: 10.1185/03007990903421994
deVries, S. T. D., Keers, J. C., Visser, R., Zeeuw, D. D., Haaijer-Ruskamp, F.M., Voorham, J., … Denig, P. (2014). Medication beliefs, treatment complexity, and non-adherence to different drug classes in patients with Type 2 diabetes. Journal of Psychosomatic Research, 76(2), 134-138.
Delamater, A. M. (2006). Improving patient adherence. Clinical Diabetes, 24(2), 71-77.
DiMatteo, M. R. (2004). Variations in patients' adherence to medical recommendations: a quantitative review of 50 years of research. Med Care, 42: 200-209.
Ebrahim, Z., Villier, A. D., & Ahmed, T. (2014). Factors that influencing adherence to dietary guidelines: a qualitative study on the experiences of patients with Type 2 diabetes attending a clinic in Cape Town. Journal of Endocrinology, Metabolism and Diabetes of South Africa, 19(2), 78-84.
Ei-Sandar-Oo. (2012). Treatment seeking behaviors of diabetic patients in Hmawbi township, Yangon region, Master’s thesis in public health, University of Public Health, Yangon.
Galassi, J. P., Schanberg, R., & Ware, W. B. (1992). The patient reactions assessment: A brief measure of the quality of the patient-provider medical relationship. Psychological Assessment, 4, 346-351.
Garcia, A. A., Villagomez, E. T., Brown, S. A., Kouzekanani, K., & Hanis, C.L. (2001). The Starr county diabetes education study: Development of Spanish-language diabetes knowledge questionnaire. Diabetes Care, 24(1), 16-21.
Garcıa-Perez, L. E., Alvarez, M., Dilla, T., Gil-Guille, V., & Orozco-Beltran, D. (2013). Adherence to therapies in patients with Type 2 diabetes. Diabetes Ther (2013) 4,175–194.
Han-Win, Than-Than-Aye, Theingi-Thwin, Ko-Ko, Moh-Moh-Htay, Moh-Moh-Hlaing, …Khin-Thidar-Wai. (2013). Quality of life and compliance among Type 2 diabetes patients attending the diabetic clinic at North Okkalapa General Hospital. The Myanmar Health Research Science Journal, 25(3), 178-182.
International Diabetes Federation. (2015). IDF Diabetes Atlas-7th Edition: Key Messages. www.diabetes atlas.org/key-message.html.
Jackson, I. L., Adibe, M.O., Okonta, M. J., & Ukwe, C. V. (2015). Medication adherence in Type 2 diabetes patients in Nigeria. Diabetes Technology & Therapeutics, 17(6), 398-404.
Jin, J., Sklar, G.E., Oh, V. M. S., & Li, S.C. (2008). Factors affecting therapeutic compliance: A review from the patient’s perspective. Therapeutics and Clinical Risk Management, 4(1), 269-286.
Kardas, P., Lewek, P., & Matyjaszczyk, M. (2013). Determinants of patient adherence: a review of systematic reviews. Frontiers in Pharmacoogyl, 4(91), 1-16. doi: 10.3389/fphar.2013.00091
Koprulu, F., Bader, R. J., Hassan, N. A., Alduelkarem, A. R., & Mahmood, D. A. (2014). Evaluation of adherence to diabetes treatment in Northern region of United Arab Emirates. Tropical Journal of Pharmaceutical Research, 13(6), 989-995.
Lin, W. Y., Yang, W. S., Lee, L. T., Chen, C. Y., Liu, C. S., Lin, C. C., & Huang, K. C. (2006). Insulin resistance, obesity, and metabolic syndrome among non-diabetic pre- and post-menopausal women in North Taiwan. International Journal of Obesity, 30, 912-917. doi:10.1038/sj.ijo.0803240
Lynn, M. R. (1986). Determination and quantification of content validity. Nursing Research, 35(6), 382- 385.
Manan, M. M., Husin, A. R., Alkhoshaiban, A. S., Al-Worafi, Y. M. A., & Ming, L. C. (2014). Interplay between oral hypoglycemic medication adherence and quality of life among elderly Type 2 diabetes mellitus patients. Journal of Clinical Diagnosis Research, 8(12), JC05-JC09.
Mandewo, W., Dodge, E. E., Chideme-Munodawafa, A., &Mandewo, G. (2014). Non-adherence to treatment among diabetic patients attending outpatients clinic at Mutare Provincial Hospital, Manicaland province, Zimbabwe. International Journal of Scientific & Technology Research, 3(9), 66-86.
Mandpe, A.S., Pandit, V.A., Dawane, J.S., & Patel, H.R. (2014). Correlation of disease knowledge with adherence to drug therapy, blood sugar levels and complications associated with disease among Type 2 diabetic patients. Journal of Diabetes and metabolism, 5(5). doi: 10.4172/ 2155-6156.1000369
Maneesriwongul, W., & Dixon, J.K. (2004). Instrument translation process: a method review. Journal of Advanced Nursing, 48(2), 175-186.
Mayberry, L. S., & Osborn, C. Y. (2012). Family support, medication adherence, and glycemic control among adults with Type 2 diabetes. Diabetes Care, 35(6), 1239–1245. doi: https://doi.org/10.2337/dc11-2103
NiMhurchadha, S., & Sayers, J. (2014). Modelling patient behaviour to improve self-management in diabetes. Atlantis Healthcare. Retrieved from https://bit.ly/Diabetes-webcast.
Nwaokoro, J. C. et al. (2014). Problem associated with treatment compliance among Type 2 diabetic patients at a tertiary health institution in Nigeria. African Journal of diabetes Medicine, 22(24).
Parajuli, J., Saleh, F., Thapa, N., & Ali, L. (2014). Factors associated with non-adherence to diet and physical activity among Nepalese Type 2 diabetes patients; a cross sectional study. BioMed Central Research Notes, 7, 758.doi: https:// doi.org/10.1186/1756-0500-7-758
Pourghaznein, T., Ghaffari, F., Hasanzadeh, F., & Chamanzari, H. (2013). The relationship between health beliefs and medication adherence in patients with Type 2 diabetes: A correlation-cross sectional study. Life Science Journal, 10(4s), 38-46.
Rafii, F., Fatemi, N. S., Danielson, E., Johansson, C. M., & Modanloo, M. (2014). Compliance to treatment in patients with chronic illness: A concept exploration. Iran Journal of Nurses and Midwifery Research, 19(2), 159 -167
Rolnick, S. J., Pawloski, P. A., Hedblom, B. D., Asche, S. E., & Bruzek, R. J. (2013). Patient characteristics associated with medication adherence. Clinical Medicine & Research, 11(2), 54-65. doi: 10.3121/cmr.2013.1113
Roy, N. T., Sajith, M., & Bansode, M.P. (2017). Assessment of factors associated with low adherence to pharmacotherapy in elderly patients. Journal of Young Pharmacists, 9(2), 272-276. doi: 10.5530/jyp.2017.9.53
Saleh, F., Mumu, S. J., Ara, F., Hafez, M. A., & Ali, L. (2014). Non-adherence to self-care practices & medication and health related quality of life among patients with Type 2 diabetes: a cross-sectional study. BMC Public Health, 14.431. doi: 10.1186/1471-2458-14-431
Sanal, T. S., Nair, N. S., & Adhikari, P. (2011). Factors associated with poor control of Type 2 diabetes mellitus: A systematic review and Meta-analysis. Journal of Diabetology, 3(1).
Sandhi-Wynn-Nyunt, Howteerakul, N., Suwannapong, N., & Rajatanun, T. (2010). Self-efficacy, Self-care behaviors and Glycemic control among Type 2 diabetes patients two private clinics in Yangon, Myanmar. The Southeast Asian Journal of Tropical Medicine and Public Health, 41(4), 943-951.
Shrestha, S. S., Sharkya, R., Karmacharya, B. M., & Thapa, P. (2013). Medication adherence to hypoglycemic agents among Type 2 diabetes patients and their clinical outcomes with special reference to fasting blood sugar and glycosylated haemoglobin level. Kathmandu University Medical journal, 43(3), 226-232.
Sonsona, J. B. (2014). Factors influencing diabetes self-management of Filipino Americans with Type 2 diabetes mellitus: A holistic approach. Walden Dissertations and Doctoral Studies, Walden University.
Sturt, J., Hearnshaw, H., & Wakelin, M. (2010). Validity and reliability of the DMSES UK; a measure of self-efficacy for Type 2 diabetes self-management. Primary Health Care Research and Development, 1-8.
Tabasi, K. H., Madarshahian, F., Nikoo, M., Hassanabadi, M., & Mahmoudirad, G. (2014). Impact of family support improvement behaviors on antidiabetic medication adherence and cognition in Type 2 diabetic patients. Journal of Diabetes Metabolic Disorder,13, 113. doi: 10.1186/s40200-014-0113-2
Teklay, G., Hussien, J., & Tesfaye, D. (2013). Non-adherence and associated factors among Type 2 diabetic patients at Jimma University specialized hospital, Southwest Ethiopia. Journal of Medical Sciences, 13(7): 578-584.
Than-Than-Aye, Moe-Wint-Aung, & Ei-Sandar-Oo. (2014). Diabetes mellitus in Myanmar: Socio-cultural challenges and strength. Journal of Social Health and Diabetes, 2(1), 9-13.
Tint-Swe-Latt, Ko-Ko-Zaw & Ko-Ko., et al. (2015). Report on national survey of diabetes mellitus and risk factors for non-communicable diseases in Myanmar in 2014. Ministry of Health, Myanmar.
Tiv, M., Viel, J. F., Mauny, F., Eschwege, E., Weill, A., & Fournier, C., ...Penfornis, A. (2012). Medication adherence in Type 2 diabetes: The ENTRED study 2007, a French population-based study. PLoS ONE, 7(3): e32412. doi: 10.1371/ journal. pone. 0032412
Toobert, D. J., Hampson, S. E., & Glasgow, R. E. (2000). The Summary of diabetes self-care activities measure: Results from seven studies and revised scale. Diabetes Care, 23(7), 943-950.
Tovar, E., Rayens, M. K., Gokun, Y., & Clark, M. (2013). Mediators of adherence among adults with comorbid diabetes and depression: The role of self-efficacy and social support. Journal of Health Psychology, 20(11), 1405-1415. doi: https://dx.doi.org/ 10.1177/ 1359105313512514
Vermeire, E., Royen, P. V., Coenen, S., Wens, J., & Denekens, J. (2003). The adherence of Type 2 diabetes patients to their therapeutic regimens: a qualitative study from the patient’s perspective. Practical Diabetes Int July/August 2003, 20(6), 209-214.
Villier, L., & Halabi, J. O. (2015). Treatment adherence among diabetes mellitus type II patients at ambulatory clinics in the western region of Saudi Arabia: Descriptive correlational study. International Journal of Research in Nursing, 6(2), 30-41.
Wabe, N. T., Angamo, M. T., & Hussein, S. (2011). Medication adherence in diabetes mellitus and self management practices among type-2 diabetics in Ethiopia. North American Journal of Medical Sciences, 3(9), 418–423.
Worku, A., Abebe, S. M., & Wassie, M. M. (2015). Dietary practice and associated factors among Type 2 diabetes patient: a cross sectional hospital-based study, Addis Ababa, Ethiopia. SpringerPlus Journal, 4(15). doi: 10.1186/s40064-015-0785-1
World Health Organization. (2003). Adherence for long-term therapies. Geneva, Switzerland: World Health Organization.
Xu, Y., Toobert, D., Savage, C., Pan, W., & Whitmer, K. (2010). Factors influencing diabetes self-management in Chinese people with Type 2 diabetes. Research in Nursing and Health, 31(6), 613-625.