Adherence to Long-Term Therapies - Evidence for Action
(2003; 211 pages) View the PDF document
Table of Contents
View the documentPreface
View the documentAcknowledgements
View the documentScientific writers
View the documentIntroduction
View the documentTake-home messages
Open this folder and view contentsSection I - Setting the scene
Open this folder and view contentsSection II - Improving adherence rates: guidance for countries
Close this folderSection III - Disease-Specific Reviews
Open this folder and view contentsChapter VII - Asthma
Open this folder and view contentsChapter VIII - Cancer (Palliative care)
Open this folder and view contentsChapter IX - Depression
Close this folderChapter X - Diabetes
View the document1. Introduction
View the document2. Treatment of diabetes
View the document3. Definition of adherence
View the document4. Prevalence of adherence to recommendations for diabetes treatment
View the document5. Correlates of adherence
View the document6. Interventions
View the document7. Methodological and conceptual issues in research on adherence to treatment for diabetes
View the document8. Conclusions
View the document9. References
Open this folder and view contentsChapter XI - Epilepsy
Open this folder and view contentsChapter XII - Human immunodeficiency virus and acquired immunodeficiency syndrome
Open this folder and view contentsChapter XIII - Hypertension
Open this folder and view contentsChapter XIV - Tobacco smoking cessation
Open this folder and view contentsChapter XV - Tuberculosis
Open this folder and view contentsAnnexes
Open this folder and view contentsWhere to find a copy of this book
 

7. Methodological and conceptual issues in research on adherence to treatment for diabetes

In a review of methodological and conceptual issues relevant to measuring adherence in patients with diabetes, Johnson (127) suggested that the prevalence of adherence may vary across the different components of the diabetes regimen and the patient's lifespan, during the course of the disease, as well as between populations of patients with diabetes (i.e. type 1 and type 2). Johnson also noted the conceptual problems encountered in defining and measuring adherence including:

- the absence of explicit adherence standards against which a patient's behaviour can be compared;

- inadvertent nonadherence attributable to miscommunication between patient and provider and deficits in the knowledge or skills of the patient;

- the behavioural complexity of the diabetes regimen; and

- the confounding of compliance with diabetes control.


Furthermore, the multiplicity of measurements used to assess adherence (i.e. health status indicators; provider ratings; behavioural observations; permanent products, and patient self-reports, including behaviour ratings, diaries and 24-hour recall interviews) also makes comparison of studies troublesome. Johnson concluded that a measurement method should be selected on the basis of reliability, validity, non-reactivity, sensitivity to the complexity of the diabetes regimen behaviours and measurement-independence from the indicators of health status. Glasgow et al. (30) also noted the methodological shortcomings of studies on diabetes self-care correlates, the lack of clear conceptualizations and the failure to differentiate between regimen adherence, self-care behaviour and metabolic control, as well as the empirical - atheoretical nature of many studies that lacked a comprehensive model or theory.

The present review of studies reported from 1980 to 2001, has revealed that research on adherence to treatment for diabetes yields some inconsistent findings. These inconsistent results may have several causes including variability in:

- research designs (e.g. longitudinal as opposed to cross-sectional studies) and study instruments;

- sampling frames employed for study recruitment;

- the use of general measures (e.g. general stress) as opposed to more specific ones (e.g. diabetes-specific stress);

- sample sizes (in some studies the small samples used decreased the likelihood of detecting significant associations between the variables); and

- lack of control of potentially confounding variables.

to previous section
to next section
 
 
The WHO Essential Medicines and Health Products Information Portal was designed and is maintained by Human Info NGO. Last updated: October 7, 2014