title: The association between health beliefs and medication adherence among patients with type 2 diabetes.
abstract: Type 2 diabetes is a major risk factor for cardiovascular disease and microvascular complications. Approximately 20.5% of adults between the ages of 20-79 are diagnosed with type 2 diabetes in Saudi Arabia. Nonadherence with type 2 diabetes medications is an established contributor to higher prevalence in other countries. No published studies have used a theoretical framework to explain or predict medication-taking behavior in Saudi Arabian type 2 diabetes (T2D) patients.
  
  
  
  The purpose of this study was to investigate type 2 diabetes medication adherence using a theoretical framework, the Health Belief Model (HBM). The specific objectives were to 1) assess self-report of medication-taking in a Saudi T2D convenience sample; 2) investigate self-reported HBM constructs for T2D, its complications, and medication-taking in this sample, and 3) test the ability for self-reported health beliefs to predict specific medication-taking behaviors among the sample.
  
  
  
  A cross-sectional study was conducted in a convenience sample at an outpatient pharmacy in Saudi Arabia. Adult type 2 diabetes patients on at least one prescribed diabetes medication, who were cognitively capable, and came themselves for prescription pickup, were eligible to participate. Patients completed a questionnaire or were interviewed. Data were collected for demographics, medical history, self-reported medication adherence, and type 2 diabetes medication-taking HBM items. Three measures collected self-report of medication adherence: new multi-dimensional adherence measure (MDAM), previously validated stage of change, and medication-taking recall- 7days (MTR-7). Descriptive statistics were generated and regression analyses were used to explain self-report of adherence.
  
  
  
  Just over half (54%) of the 220 participants were male, mean age was 52 ± 11.2 years, and most (59%) had less than high school education. Approximately 58% were on oral medications only and the rest were on either insulin alone or a combination of oral and insulin; 16.7% reported knowing their hemoglobin A1C (A1C). For adherence, most reported taking the prescribed dose every time taken; however, 60% were not taking it the prescribed number of times per day and 50%, not the prescribed time of day (interval). Over 40% reported low adherence on stage of change and MTR-7. Perceived susceptibility, perceived medication benefits, and self-efficacy were significant HBM predictors for medication adherence (R2= 0.42).
  
  
  
  The MDAM has research and practice potential because it evaluates sub-behaviors of medication-taking separately and as a score. Patient perceptions and beliefs should be assessed as part of a patient-centered medication adherence intervention.
authors.affiliation: Department of Health Outcomes Research and Policy, Auburn University, 020 James E. Foy Hall, 282 W. Thach Avenue, Auburn, AL 36849-5506, USA; Clinical Pharmacy Department, Umm Al-Qura University, Al-Abidiyya, P.O. Box: 13174, Makkah 21955, Saudi Arabia. Electronic address: yma0002@auburn.edu.
authors.forename: Yasser M
authors.initials: YM
authors.lastname: Alatawi
authors.affiliation: Department of Health Outcomes Research and Policy, Auburn University, 020 James E. Foy Hall, 282 W. Thach Avenue, Auburn, AL 36849-5506, USA.
authors.forename: Jan
authors.initials: J
authors.lastname: Kavookjian
authors.affiliation: Department of Health Outcomes Research and Policy, Auburn University, 020 James E. Foy Hall, 282 W. Thach Avenue, Auburn, AL 36849-5506, USA.
authors.forename: Gladys
authors.initials: G
authors.lastname: Ekong
authors.affiliation: Pharmacy Department, King Salman Armed Forces Hospital in Northwest Region, 7761 Military Area, Tabuk 47512-5644, Saudi Arabia.
authors.forename: Meshari M
authors.initials: MM
authors.lastname: Alrayees
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D012529:Saudi Arabia; D020377:Self Efficacy; D057566:Self Report; D011795:Surveys and Questionnaires; D016903:Drug Monitoring
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin
keywords: Health Belief Model; Medication adherence; Saudi Arabia; Type 2 diabetes