Empirical validation of the information-motivation-behavioral skills model of diabetes medication adherence: a framework for intervention

Lindsay S Mayberry, Chandra Y Osborn, Lindsay S Mayberry, Chandra Y Osborn

Abstract

Objective: Suboptimal adherence to diabetes medications is prevalent and associated with unfavorable health outcomes, but it remains unclear what intervention content is necessary to effectively promote medication adherence in diabetes. In other disease contexts, the Information-Motivation-Behavioral skills (IMB) model has effectively explained and promoted medication adherence and thus may have utility in explaining and promoting adherence to diabetes medications. We tested the IMB model's hypotheses in a sample of adults with type 2 diabetes.

Research design and methods: Participants (N = 314) completed an interviewer-administered survey and A1C test. Structural equation models tested the effects of diabetes medication adherence-related information, motivation, and behavioral skills on medication adherence and the effect of medication adherence on A1C.

Results: The IMB elements explained 41% of the variance in adherence, and adherence explained 9% of the variance in A1C. As predicted, behavioral skills had a direct effect on adherence (β = 0.59; P < 0.001) and mediated the effects of information (indirect effect 0.08 [0.01-0.15]) and motivation (indirect effect 0.12 [0.05-0.20]) on adherence. Medication adherence significantly predicted glycemic control (β = -0.30; P < 0.001). Neither insulin status nor regimen complexity was associated with adherence, and neither moderated associations between the IMB constructs and adherence.

Conclusions: The results support the IMB model's predictions and identify modifiable and intervenable determinants of diabetes medication adherence. Medication adherence promotion interventions may benefit from content targeting patients' medication adherence-related information, motivation, and behavioral skills and assessing the degree to which change in these determinants leads to changes in medication adherence behavior.

Figures

Figure 1
Figure 1
An IMB model of diabetes medication adherence, adapted from Fisher et al. (12) and Amico et al. (18). Solid lines indicate an effect between constructs, and the dashed line indicates a feedback loop in which health outcomes affect future levels of adherence information and motivation, which in turn affect adherence behavioral skills and subsequent diabetes medication adherence and health outcomes.
Figure 2
Figure 2
An empirical test of the IMB model of diabetes medication adherence using SEM with standardized path coefficients and bootstrapped bias-corrected P values. +P < 0.08; *P ≤ 0.05; ***P < 0.001. n = 309.

References

    1. Cramer JA. A systematic review of adherence with medications for diabetes. Diabetes Care 2004;27:1218–1224
    1. Ho PM, Rumsfeld JS, Masoudi FA, et al. Effect of medication nonadherence on hospitalization and mortality among patients with diabetes mellitus. Arch Intern Med 2006;166:1836–1841
    1. Aikens JE, Piette JD. Longitudinal association between medication adherence and glycaemic control in type 2 diabetes. Diabet Med 2013;30:338–344
    1. Viswanathan M, Golin CE, Jones CD, et al. Interventions to improve adherence to self-administered medications for chronic diseases in the United States: a systematic review. Ann Intern Med 2012;157:785–795
    1. Piette JD, Weinberger M, McPhee SJ, Mah CA, Kraemer FB, Crapo LM. Do automated calls with nurse follow-up improve self-care and glycemic control among vulnerable patients with diabetes? Am J Med 2000;108:20–27
    1. Rosen MI, Rigsby MO, Salahi JT, Ryan CE, Cramer JA. Electronic monitoring and counseling to improve medication adherence. Behav Res Ther 2004;42:409–422
    1. Skaer TL, Sclar DA, Markowski DJ, Won JK. Effect of value-added utilities on prescription refill compliance and Medicaid health care expenditures—a study of patients with non-insulin-dependent diabetes mellitus. J Clin Pharm Ther 1993;18:295–299
    1. Cherry JC, Moffatt TP, Rodriguez C, Dryden K. Diabetes disease management program for an indigent population empowered by telemedicine technology. Diabetes Technol Ther 2002;4:783–791
    1. Wolever RQ, Dreusicke M, Fikkan J, et al. Integrative health coaching for patients with type 2 diabetes: a randomized clinical trial. Diabetes Educ 2010;36:629–639
    1. Bogner HR, de Vries HF. Integrating type 2 diabetes mellitus and depression treatment among African Americans: a randomized controlled pilot trial. Diabetes Educ 2010;36:284–292
    1. Campbell M, Fitzpatrick R, Haines A, et al. Framework for design and evaluation of complex interventions to improve health. BMJ 2000;321:694–696
    1. Fisher JD, Fisher WA, Amico KR, Harman JJ. An Information-Motivation-Behavioral Skills model of adherence to antiretroviral therapy. Health Psychol 2006;25:462–473
    1. Kalichman SC, Cherry J, Cain D. Nurse-delivered antiretroviral treatment adherence intervention for people with low literacy skills and living with HIV/AIDS. J Assoc Nurses AIDS Care 2005;16:3–15
    1. Mannheimer SB, Morse E, Matts JP, et al. Terry Beirn Community Programs for Clinical Research on AIDS Sustained benefit from a long-term antiretroviral adherence intervention. Results of a large randomized clinical trial. J Acquir Immune Defic Syndr 2006;43(Suppl. 1):S41–S47
    1. Pearson CR, Micek MA, Simoni JM, et al. Randomized control trial of peer-delivered, modified directly observed therapy for HAART in Mozambique. J Acquir Immune Defic Syndr 2007;46:238–244
    1. Fisher JD, Amico KR, Fisher WA, et al. LifeWindows Team Computer-based intervention in HIV clinical care setting improves antiretroviral adherence: the LifeWindows Project. AIDS Behav 2011;15:1635–1646
    1. Kalichman SC, Rompa D, DiFonzo K, et al. HIV treatment adherence in women living with HIV/AIDS: research based on the Information-Motivation-Behavioral Skills model of health behavior. J Assoc Nurses AIDS Care 2001;12:58–67
    1. Amico KR, Toro-Alfonso J, Fisher JD. An empirical test of the Information, Motivation and Behavioral Skills model of antiretroviral therapy adherence. AIDS Care 2005;17:661–673
    1. Amico KR, Barta W, Konkle-Parker DJ, et al. The Information-Motivation-Behavioral Skills model of ART adherence in a Deep South HIV+ clinic sample. AIDS Behav 2009;13:66–75
    1. Starace F, Massa A, Amico KR, Fisher JD. Adherence to antiretroviral therapy: an empirical test of the Information-Motivation-Behavioral Skills model. Health Psychol 2006;25:153–162
    1. Osborn CY, Rivet Amico K, Fisher WA, Egede LE, Fisher JD. An Information-Motivation-Behavioral Skills analysis of diet and exercise behavior in Puerto Ricans with diabetes. J Health Psychol 2010;15:1201–1213
    1. Osborn CY, Amico KR, Cruz N, et al. A brief culturally tailored intervention for Puerto Ricans with type 2 diabetes. Health Educ Behav 2010;37:849–862
    1. Rubin RR. Adherence to pharmacologic therapy in patients with type 2 diabetes mellitus. Am J Med 2005;118(Suppl. 5A):27S–34S
    1. Duru OK, Gerzoff RB, Selby JV, et al. Identifying risk factors for racial disparities in diabetes outcomes: the Translating Research into Action for Diabetes (TRIAD) study. Med Care 2009;47:700–706
    1. Mann DM, Ponieman D, Leventhal H, Halm EA. Predictors of adherence to diabetes medications: the role of disease and medication beliefs. J Behav Med 2009;32:278–284
    1. Mayberry LS, Osborn CY. Family support, medication adherence, and glycemic control among adults with type 2 diabetes. Diabetes Care 2012;35:1239–1245
    1. Heisler M, Faul JD, Hayward RA, Langa KM, Blaum C, Weir D. Mechanisms for racial and ethnic disparities in glycemic control in middle-aged and older Americans in the health and retirement study. Arch Intern Med 2007;167:1853–1860
    1. Hertz RP, Unger AN, Lustik MB. Adherence with pharmacotherapy for type 2 diabetes: a retrospective cohort study of adults with employer-sponsored health insurance. Clin Ther 2005;27:1064–1073
    1. Behling O, Law KS. Translating questionnaires and other research instruments: Problems and solutions. In Quantitative Applications in the Social Sciences. Lewis-Beck M, Ed. Thousand Oaks, Sage, 2000, p. 1–70
    1. Arnold CL, Rademaker A, Bailey SC, et al. Literacy barriers to colorectal cancer screening in community clinics. J Health Commun 2012;17(Suppl. 3):252–264
    1. McPherson ML, Smith SW, Powers A, Zuckerman IH. Association between diabetes patients’ knowledge about medications and their blood glucose control. Res Social Adm Pharm 2008;4:37–45
    1. Farmer A, Kinmonth AL, Sutton S. Measuring beliefs about taking hypoglycaemic medication among people with Type 2 diabetes. Diabet Med 2006;23:265–270
    1. Fernandez S, Chaplin W, Schoenthaler AM, Ogedegbe G. Revision and validation of the medication adherence self-efficacy scale (MASES) in hypertensive African Americans. J Behav Med 2008;31:453–462
    1. Toobert DJ, Hampson SE, Glasgow RE. The summary of diabetes self-care activities measure: results from 7 studies and a revised scale. Diabetes Care 2000;23:943–950
    1. Mayberry LS, Gonzalez JS, Wallston KA, Kripalani S, Osborn CY. The ARMS-D out performs the SDSCA, but both are reliable, valid, and predict glycemic control. Diabetes Res Clin Pract 2013;102:96–104
    1. Kline RB. Principles and Practices of Structural Equation Modeling. New York, NY, The Guilford Press, 2005
    1. Kennedy L, Herman WH, GOAL A1C Study Team Glycated hemoglobin assessment in clinical practice: comparison of the A1cNow point-of-care device with central laboratory testing (GOAL A1C Study). Diabetes Technol Ther 2005;7:907–912
    1. Chernick MR. Bootstrap Methods: A Practitioner's Guide . 2nd ed New York, Wiley, 2008
    1. Glasgow RE, Toobert DJ. Social environment and regimen adherence among type II diabetic patients. Diabetes Care 1988;11:377–386
    1. Chan JC, Gagliardino JJ, Baik SH, et al. IDMPS Investigators Multifaceted determinants for achieving glycemic control: the International Diabetes Management Practice Study (IDMPS). Diabetes Care 2009;32:227–233

Source: PubMed

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