Planning of a multimodal intervention program to improve adherence to the therapeutic regime amongst the patients with type 2 diabetes residing in the rural area of Bonab

Abstract

Abstract Introduction: The World Health Organization calls diabetes as a silent epidemic. There are various reports on the diabetic patients medication adherence and its complications in Iran. Most of them indicate non adherence medication, which results in a doubling of the complications and costs, so the aim of this study was to design a multimodal intervention program to improve adherence to therapeutic regimens in patients with type 2 diabetes. Methods: This study was an Interventional field trial study. The study participants were selected from 4 rural health centers of Bonab city. They were randomly assigned to control and intervention groups. Demographic, MMAS8-Item, CULIG and Stage of Change questionnaires were completed before and 6 months after the interventions, as well as glycosylated hemoglobin level (HbA1c) measured. Interventions included training sessions, phone short message, telephone follow-up, and peer groups. Collected data were analyzed by SPSS V. 22 and P values <0.05 were considered significant. Results: After interventions in the intervention group the percentage of patients with high adherence increased from 24.3% to 62.6% and the mean score of medication adherence increased from 5.76 ± 1.84 to 7.24 ± 1.21. There was no statistically significant difference in mean of HbA1C after the intervention between the two groups. The effect of training sessions was more than other methods in encourage the participants in intervention group to fully adhere to the treatment regimen. Before interventions, 51.97% of participants were in the precontemplation stage in terms of drug use behavior while this rate has changed to 13% after intervention. Conclusion: The results of this study showed that multimodal interventions can be effective on increasing medication adherence. Also, these interventions in the change stages made individuals move toward the action stage, while they did not change the mean HbA1c. Keywords: Type 2 diabetes, multimodal intervention, medication adherence