The relationships between illness and treatment perceptions with adherence to diabetes self-care: A comparison between Arabic-speaking migrants and Caucasian English-speaking patients
Introduction
Poor adherence to treatment recommendations among patients with type 2 diabetes (T2DM) is a global phenomenon with a considerable negative impact on health outcomes [1]. Suboptimal adherence can lead to: increased morbidity and mortality, lower quality of life, and unnecessary intensification of treatment [2], [3]. A recent US study of 4926 adults with diabetes showed that, despite considerable public health efforts, the proportion achieving glycated haemoglobin (HbA1c), blood pressure, and LDL cholesterol recommendations increased only from 1.7% to 18.8% between 1988 and 2010. Non-Hispanic blacks and Mexican Americans were less likely to meet HbA1c and LDL goals compared with Caucasians [4]. Ethnic minority groups residing in upper middle and high income western countries have higher non-adherence rates, worse glycaemic control, higher diabetes-related morbidity and mortality rates, and poorer outcomes compared with the general population [5].
Assessing illness and treatment beliefs around diabetes has been suggested as a key approach to address the challenge of poor adherence and sub-optimal glycaemic control [6]. Evidence suggests that both illness perceptions and treatment beliefs drive patients’ self-care behaviours, including medication adherence, and predicts glycaemic control [6]. Furthermore, intervention studies addressing patients’ negative diabetes illness and treatment perceptions have demonstrated benefits in self-care behaviours and key health outcomes including glycaemic control [7], [8], [9].
For healthcare providers to elicit, understand and address patients’ treatment beliefs that influence their medication-taking behaviours, the Necessity–Concerns Framework has been suggested as an effective model [10]. According to this framework, patients’ beliefs about medications are categorised into two types: adherence-enhancing beliefs (perceived necessity and advantages of prescribed treatment) and adherence-reducing beliefs (perceived harms, risks, and barriers to treatment) [11]. In diabetes, numerous studies across different healthcare settings have reported significant association between patients’ treatment perceptions and their medication-taking behaviours [12], [13], [14]. Illness perceptions developed from the Common Sense Model of self-regulation (CSM), have been associated with adherence to diet, exercise, blood glucose monitoring, and clinic attendance [15], [16], [17]. Previous studies demonstrate that patients who believed in their own ability to control diabetes reported better self-care behaviours (diet, exercise, and glucose testing) and had better HbA1c levels than those who did not [18], [19], [20], [21]. The vast majority of previous studies on illness and treatment perceptions have been conducted among Caucasian populations and only a few studies have focused on specific ethnic minority groups. Compared with the general population, ethnic minority groups are known to have different illness and treatment perceptions [22], [23], [24].
No previous studies have examined either treatment and illness perceptions or their influence on adherence to self-care behaviours in Arabic-speaking immigrant populations with diabetes, despite the extremely high prevalence of diabetes in these populations [25], [26]. It remains unclear how diabetes illness and treatment perceptions of Arabic-speaking communities compare with those in Caucasian society. This study extends previous research by investigating differences in diabetes illness and treatment perceptions between Arabic-speaking immigrants and Caucasian English-speaking people with T2DM. It also examines the relationships between these beliefs and adherence to diabetes self-care activities. Currently, no evidence-based intervention has yet been developed that can be used to target negative illness and treatment perceptions for this less studied ethnic minority group. This work will identify whether different treatment approaches are necessary for Arabic-speaking people and will inform the development of such a model.
Section snippets
Study design and setting:
This cross-sectional study was conducted at various settings in the Melbourne metropolitan area and in rural Victoria, Australia. Participants in the Melbourne metropolitan area were recruited through diabetes outpatient clinics at three major hospitals, ten general medical practices and five community support groups. For the rural arm of the study, participants were recruited in Shepparton, Victoria through diabetes outpatient clinics at a major rural hospital and its affiliated satellite
Results
Results are presented as descriptive statistics, and as correlations between diabetes illness and treatment perceptions, and adherence to self-care activities.
Discussion
This large, multi-centre cross-section study is the first to investigate relationships between participants’ illness and treatment beliefs and adherence behaviours in Arabic-speaking immigrants (ASP) and Caucasian English-speaking people (ESP) with T2DM.
Of particular significance was the finding that compared to ESPs, ASPs had significantly poorer adherence levels to all aspects of diabetes self-management: diet, exercise, blood glucose testing and foot-care. This is consistent with findings of
Conclusion
This is the first study to provide a quantitative compassion of illness and treatment perceptions in Arabic-speaking migrants and Caucasian English-speaking patients with T2DM. It has showed that Arabic-speaking immigrants’ illness and treatment perceptions about diabetes health were significantly different from their ESPs counterparts. ASPs were less-adherent to all aspects of diabetes self-management. Negative illness and treatment perceptions, of ASB participants, were strongly and
Conflict of interest statement
All the authors have read and approved the manuscript. The authors declare that they have no financial or other competing interests in relation to their work.
Funding
This research was supported by an internal grant from the Centre for Medicine Use and Safety, Monash University.
Acknowledgments
Authors are very grateful for all participants for taking the time to complete the questionnaire. Special thanks to Lisa Roberts and Rebecca O’Gorman from Austin Health and Rhonda Marino from Goulburn Valley Health for their help in patient recruitment.
References (46)
- et al.
Predicting self-care behaviours of patients with type 2 diabetes: the importance of beliefs about behaviour, not just beliefs about illness
J Psychosom Res
(2013) - et al.
Illness representations among patients with type 2 diabetes and their partners: relationships with self-management behaviors
J Psychosom Res
(2007) - et al.
Assessing patients’ participation and quality of decision-making: insights from a study of routine practice in diverse settings
Patient Educ Couns
(2004) - et al.
The mediating role of health beliefs in the relationship between depressive symptoms and medication adherence in persons with diabetes
Res Soc Adm Pharm
(2005) - et al.
The brief illness perception questionnaire
J Psychosom Res
(2006) - et al.
Patients’ beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness
J Psychosom Res
(1999) - et al.
Understanding different beliefs held by adherers, unintentional nonadherers, and intentional nonadherers: application of the necessity–concerns framework
J Psychosom Res
(2008) - et al.
Adherence to therapies in patients with type 2 diabetes
Diab Ther
(2013) - et al.
Effect of medication nonadherence on hospitalization and mortality among patients with diabetes mellitus
Arch Intern Med
(2006) - et al.
Impact of medication adherence on hospitalization risk and healthcare cost
Med Care
(2005)
The prevalence of meeting A1C, blood pressure, and LDL goals among people with diabetes, 1988–2010
Diab Care
Culturally appropriate health education for type 2 diabetes mellitus in ethnic minority groups
Cochrane Database Syst Rev
Illness perceptions and glycaemic control in diabetes: a systematic review with meta-analysis
Diab Med
Psychological family intervention for poorly controlled type 2 diabetes
Am J Manag Care
Effectiveness of the diabetes education and self management for ongoing and newly diagnosed (DESMOND) programme for people with newly diagnosed type 2 diabetes: cluster randomised controlled trial
BMJ
Self-monitoring of blood glucose changed non-insulin-treated type 2 diabetes patients’ beliefs about diabetes and self-monitoring in a randomized trial
Diab Med
Understanding patients’ adherence-related beliefs about medicines prescribed for long-term conditions: a meta-analytic review of the necessity–concerns framework
PLOS ONE
Diabetic patients’ medication underuse, illness outcomes, and beliefs about antihyperglycemic and antihypertensive treatments
Diab Care
Patient and physician factors associated with adherence to diabetes medications
Diab Educ
Role of illness and medication perceptions on adherence to medication in a group of Iranian patients with type 2 diabetes
J Diab
Adherence to asthma medication: the role of illness representations
Psychol Health
The illness perceptions and treatment beliefs of individuals with severe haemophilia and their role in adherence to home treatment
Psychol Health
Changing illness perceptions after myocardial infarction: an early intervention randomized controlled trial
Psychosom Med
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