Patient-Related Factors Affecting Type 2 Diabetes Medication Non-Adherence: A Comprehensive Review of BMI, Knowledge Levels, Treatment Concerns, and Self-Efficacy

Emily Milla-Amekor *

Ghana Standards Authority, P.O. Box MB 245, Accra, Ghana and Department of Public Health and Nutrition, Livingstone International University of Tourism Excellence & Business Management (LIUTEBM) Ibex Hill, Lusaka, Republic of Zambia.

Ebenezer Ato Ewusie

Department of Public Health and Nutrition, Livingstone International University of Tourism Excellence & Business Management (LIUTEBM) Ibex Hill, Lusaka, Republic of Zambia and Ghana Institute of Management and Public Administration (GIMPA), School of Public Service and Governance. Department of Development Policy, P.O. Box AH 50, Achimota, Greater Accra Region, Ghana and Metropolitant Research and Education Bureau, P. O. Box LA 123, La-Accra, Ghana.

*Author to whom correspondence should be addressed.


Abstract

The persistent issue of non-adherence to medications in patients diagnosed with type 2 diabetes has far-reaching implications, affecting not only the health outcomes for individual patients but also exacerbating the overall financial burden of healthcare systems. This article aims to provide a comprehensive review of a spectrum of factors that influence adherence to diabetic medications, thus extending the discourse beyond a mere attribution of responsibility to patients. In particular, the study looks at how factors like BMI, disease knowledge, treatment worries, and self-efficacy are linked to non-adherence.

The review substantiates that deficits in disease-specific knowledge and lower levels of self-efficacy are significantly correlated with medication non-adherence. Concurrently, elevated BMI values and apprehensions regarding treatment were also found to have an adverse effect on adherence, although the magnitude of their influence was comparatively less pronounced. Consequently, the incorporation of these identified variables into customised treatment regimens is strongly advocated. Interventional strategies, such as educational modules designed to enhance the understanding of the disease, coupled with psychological support mechanisms aimed at elevating self-efficacy, emerged as viable solutions to the persistent issue of medication non-adherence. Moreover, pre-emptively addressing concerns related to treatment options and accounting for BMI when prescribing medications offer additional pathways to improve medication compliance rates.

The paper reinforces the imperative for a multidimensional patient-centered healthcare model. By meticulously identifying and addressing the multifaceted factors that contribute to medication non-adherence, healthcare practitioners could optimise health outcomes, mitigate complications, and thus effectuate substantial reductions in healthcare costs associated with type 2 diabetes.

Keywords: Patient-related factors, type 2 diabetes, medication non-adherence


How to Cite

Milla-Amekor , E., & Ewusie, E. A. (2023). Patient-Related Factors Affecting Type 2 Diabetes Medication Non-Adherence: A Comprehensive Review of BMI, Knowledge Levels, Treatment Concerns, and Self-Efficacy. Asian Journal of Medicine and Health, 21(11), 44–60. https://doi.org/10.9734/ajmah/2023/v21i11918

Downloads

Download data is not yet available.

References

American Diabetes Association. Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes-2020. Diabetes Care. 2020;43(Suppl 1):S98–110.

Polonsky WH, Henry RR. Poor medication adherence in type 2 diabetes: recognizing the scope of the problem and its key contributors. Patient Prefer Adherence. 2016;10:1299–307.

Singh S, Shankar P, Kumar DS, Nath R, Sachan A, Dixit R. Importance of Pharmacotherpeutic adherence. World Journal of Pharmacy and Pharmaceutical Sciences. 2015;876.

Abate TW. Medication non-adherence and associated factors among diabetes patients in Felege Hiwot Referral Hospital, Bahir Dar city administration, Northwest Ethiopia. BMC Res Notes. 2019;12(1):175.

Almadhoun M, Alagha H. Assessment of Medication Adherence and its Association with Glycemic Control among Type-2 Diabetes Mellitus Patients in Gaza–Palestine. 2018 Jul 12;

Azharuddin M, Adil M, Sharma M, Gyawali B. A systematic review and meta-analysis of non-adherence to anti-diabetic medication: Evidence from low- and middle-income countries. Int J Clin Pract. 2021;75(11):e14717.

Oluma A, Mosisa G, Abadiga M, Tsegaye R, Habte A, Abdissa E. Predictors of Adherence to Self-Care Behavior Among Patients with Diabetes at Public Hospitals in West Ethiopia. Diabetes, Metabolic Syndrome and Obesity. 2020;13:3277–88.

Wabe NT, Angamo MT, Hussein S. Medication adherence in diabetes mellitus and self management practices among type-2 diabetics in Ethiopia. N Am J Med Sci. 2011;3(9):418–23.

Chauke GD, Nakwafila O, Chibi B, Sartorius B, Mashamba-Thompson T. Factors influencing poor medication adherence amongst patients with chronic disease in low-and-middle-income countries: A systematic scoping review. Heliyon. 2022;8(6):e09716.

Hla LSP, Pongthavornkamol K, Wattanakitkrileart D, Orathai P. Factors Influencing Adherence to Therapeutic Regimens among People with Type 2 Diabetes Mellitus in Yangon, Myanmar. Journal of Population and Social Studies [JPSS]. 2018;26(4):262–80.

Hall GL, Heath M. Poor Medication Adherence in African Americans Is a Matter of Trust. J Racial and Ethnic Health Disparities. 2021;8(4):927–42.

Adhikari M, Devkota HR, Cesuroglu T. Barriers to and facilitators of diabetes self-management practices in Rupandehi, Nepal- multiple stakeholders’ perspective. BMC Public Health. 2021;21(1): 1269.

Frier A, Devine S, Barnett F, Dunning T. Utilising clinical settings to identify and respond to the social determinants of health of individuals with type 2 diabetes—A review of the literature. Health & Social Care in the Community. 2020;28(4):1119–33.

Aminde LN, Tindong M, Ngwasiri CA, Aminde JA, Njim T, Fondong AA, et al. Adherence to antidiabetic medication and factors associated with non-adherence among patients with type-2 diabetes mellitus in two regional hospitals in Cameroon. BMC Endocrine Disorders. 2019;19(1):35.

Bossman IF, Dare S, Oduro BA, Baffour PK, Hinneh TK, Nally JE. Patients’ knowledge of diabetes foot complications and self-management practices in Ghana: A phenomenological study. PLOS ONE. 2021;16(8):e0256417.

Haughtigan K, Jones MS, Main ME, Groves EA, Joyce M. A Community-Based Educational Intervention: Increasing Medication Adherence in Rural Older Adults. Journal of Community Health Nursing. 2023;0(0):1–7.

van Netten JJ, Seng L, Lazzarini PA, Warnock J, Ploderer B. Reasons for (non-)adherence to self-care in people with a diabetic foot ulcer. Wound Repair and Regeneration. 2019;27(5):530–9.

Kvarnström K, Westerholm A, Airaksinen M, Liira H. Factors Contributing to Medication Adherence in Patients with a Chronic Condition: A Scoping Review of Qualitative Research. Pharmaceutics. 2021;13(7):1100.

Tuobenyiere J, Mensah GP, Korsah KA. Patient perspective on barriers in type 2 diabetes self-management: A qualitative study. Nursing Open. 2023;1–11.

Chew BH, Hassan NH, Sherina MS. Determinants of medication adherence among adults with type 2 diabetes mellitus in three Malaysian public health clinics: a cross-sectional study. Patient Prefer Adherence. 2015;9:639–48.

Sharma A. Differentials in Medication Non-adherence in India: Does Place of Living Matter? In: Biloria N, Sebag G, Robertson H, editors. The Empathic City: An Urban Health and Wellbeing Perspective [Internet]. Cham: Springer Nature Switzerland; 2023 [cited 2023 Jul 13]. p. 241–56. (S.M.A.R.T. Environments).

Available from: https://doi.org/10.1007/978-3-031-32840-4_11

Lauffenburger JC, Haff N, McDonnell ME, Solomon DH, Antman EM, Glynn RJ, et al. Exploring patient experiences coping with using multiple medications: A qualitative interview study. BMJ Open. 2021;11(11): e046860.

Gibson CA, Mount RR, Lee J, Backes JM. Identifying patient perceptions and attitudes regarding statin-associated diabetes mellitus: a mixed-methods study. Future Cardiology. 2022;18(10):817–28.

Abdullah NF, Khuan L, Theng CA, Sowtali SN. Prevalence and reasons influenced medication non-adherence among diabetes patients: A mixed-method study. J Diabetes Metab Disord. 2022;21(2):1669–78.

Świątoniowska N, Sarzyńska K, Szymańska-Chabowska A, Jankowska-Polańska B. The role of education in type 2 diabetes treatment. Diabetes Research and Clinical Practice. 2019;151:237–46.

Yusuff KB, Obe O, Joseph BY. Adherence to anti-diabetic drug therapy and self management practices among type-2 diabetics in Nigeria. Pharm World Sci. 2008;30(6):876–83.

Kassahun T, Eshetie T, Gesesew H. Factors associated with glycemic control among adult patients with type 2 diabetes mellitus: a cross-sectional survey in Ethiopia. BMC Research Notes. 2016;9(1):78.

Hu FB. Globalization of Diabetes: The role of diet, lifestyle, and genes. Diabetes Care. 2011;34(6):1249–57.

Lima JEBF, Moreira NCS, Sakamoto-Hojo ET. Mechanisms underlying the pathophysiology of type 2 diabetes: From risk factors to oxidative stress, metabolic dysfunction, and hyperglycemia. Mutation Research/Genetic Toxicology and Environmental Mutagenesis. 2022;874–875:503437.

Yaribeygi H, Maleki M, Sathyapalan T, Jamialahmadi T, Sahebkar A. Obesity and Insulin Resistance: A Review of Molecular Interactions. Current Molecular Medicine. 2021;21(3):182–93.

Marcum ZA, Zheng Y, Perera S, Strotmeyer E, Newman AB, Simonsick EM, et al. Prevalence and correlates of self-reported medication non-adherence among older adults with coronary heart disease, diabetes mellitus, and/or hypertension. Research in Social and Administrative Pharmacy. 2013;9(6):817–27.

Puhl RM, Heuer CA. Obesity Stigma: Important Considerations for Public Health. Am J Public Health. 2010;100(6):1019–28.

Bakan G, Inci FH. Predictor of self-efficacy in individuals with chronic disease: Stress-coping strategies. Journal of Clinical Nursing. 2021;30(5–6):874–81.

Shakya D. Self-efficacy among patients with chronic diseases and its associated factors. Journal of Kathmandu Medical College. 2018 Dec 31;7(3):82–8.

Ratcliffe D, Ellison N. Obesity and Internalized Weight Stigma: A Formulation Model for an Emerging Psychological Problem. Behavioural and Cognitive Psychotherapy. 2015;43(2):239–52.

Alzahrani A, Alghamdi A, Alqarni T, Alshareef R, Alzahrani A. Prevalence and predictors of depression, anxiety, and stress symptoms among patients with type II diabetes attending primary healthcare centers in the western region of Saudi Arabia: a cross-sectional study. International Journal of Mental Health Systems. 2019;13(1):48.

Świątoniowska-Lonc N, Tański W, Polański J, Jankowska-Polańska B, Mazur G. Psychosocial Determinants of Treatment Adherence in Patients with Type 2 Diabetes – A Review. Diabetes, Metabolic Syndrome and Obesity. 2021 Dec 31;14:2701–15.

Vieira JFF, Santos P. Medication adherence in type 2 diabetes mellitus patients: a cross-sectional study. Revista Portuguesa de Medicina Geral e Familiar. 2020 Apr 29;36(2):104–12.

Pettersen TR, Fridlund B, Bendz B, Nordrehaug JE, Rotevatn S, Schjøtt J, et al. Challenges adhering to a medication regimen following first-time percutaneous coronary intervention: A patient perspective. International Journal of Nursing Studies. 2018 Dec 1;88:16–24.

Phelan SM, Burgess DJ, Yeazel MW, Hellerstedt WL, Griffin JM, van Ryn M. Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obesity Reviews. 2015;16(4):319–26.

Gudzune KA, Beach MC, Roter DL, Cooper LA. Physicians build less rapport with obese patients. Obesity. 2013;21(10):2146–52.

Puhl RM, Latner JD, King KM, Luedicke J. Weight bias among professionals treating eating disorders: Attitudes about treatment and perceived patient outcomes. International Journal of Eating Disorders. 2014;47(1):65–75.

Abrams LM, Look K, Shiyanbola O. Relationships Between Chronic Illness, Body Mass Index, and Patient-Provider Communication. Health Communication. 2023 Jun 5;0(0):1–8.

Wu SFV, Huang YC, Lee MC, Wang TJ, Tung HH, Wu MP. Self-efficacy, self-care behavior, anxiety, and depression in Taiwanese with type 2 diabetes: A cross-sectional survey. Nursing & Health Sciences. 2013;15(2):213–9.

Caperon L, Arjyal A, C PK, Kuikel J, Newell J, Peters R, et al. Developing a socio-ecological model of dietary behaviour for people living with diabetes or high blood glucose levels in urban Nepal: A qualitative investigation. PLOS ONE. 2019;14(3):e0214142.

Marciano L, Camerini AL, Schulz PJ. The Role of Health Literacy in Diabetes Knowledge, Self-Care, and Glycemic Control: a Meta-analysis. J Gen Intern Med. 2019;34(6):1007–17.

Ali M, Alemu T, Sada O. Medication adherence and its associated factors among diabetic patients at Zewditu Memorial Hospital, Addis Ababa, Ethiopia. BMC Research Notes. 2017;10(1):676.

Venkatesan M, Dongre AR, Ganapathy K. A Community-Based Study on Diabetes Medication Nonadherence and its Risk Factors in Rural Tamil Nadu. Indian Journal of Community Medicine. 2018; 43(2):72–6.

Neto JAC, Costa LA, Estevanin GM, Bignoto TC, Vieira CIR, Pinto FAR, et al. Functional Health Literacy in chronic cardiovascular patients. Ciênc saúde coletiva. 2019;24:1121–32.

Al-Qazaz HK, Sulaiman SA, Hassali MA, Shafie AA, Sundram S, Al-Nuri R, et al. Diabetes knowledge, medication adherence and glycemic control among patients with type 2 diabetes. Int J Clin Pharm. 2011;33(6):1028–35.

Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, Nauck M, et al. Management of Hyperglycemia in Type 2 Diabetes, 2015: A Patient-Centered Approach: Update to a Position Statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2014;38(1):140–9.

Strain WD, Cos X, Hirst M, Vencio S, Mohan V, Vokó Z, et al. Time to do more: Addressing clinical inertia in the management of type 2 diabetes mellitus. Diabetes Research and Clinical Practice. 2014;105(3):302–12.

Foley L, Larkin J, Lombard-Vance R, Murphy AW, Hynes L, Galvin E, et al. Prevalence and predictors of medication non-adherence among people living with multimorbidity: a systematic review and meta-analysis. BMJ Open. 2021;11(9):e044987.

Pickus GM. Time-Limited Dynamic Psychotherapy and Psychopharmacology: An Integration [Internet]. [Azusa, California]: Azusa Pacific University; 2022 [cited 2023 Sep 12]. Available from: https://www.proquest.com/openview/e31146f556626b77ee18cec3ef1dc1b7/1?pq origsite=gscholar&cbl=18750&diss=y

Yap CC, Tam CL, Muniyandy S, Kadirvelu A. Personal Attributions, Emotion Managements, Social Supports, and Diabetes Knowledge in Diabetes Self-care Adherence. Public Health. 2015; 7(6).

Chen AMH, Yehle KS, Albert NM, Ferraro KF, Mason HL, Murawski MM, et al. Relationships between health literacy and heart failure knowledge, self-efficacy, and self-care adherence. Research in Social and Administrative Pharmacy. 2014;10(2):378–86.

Bailey SC, Brega AG, Crutchfield TM, Elasy T, Herr H, Kaphingst K, et al. Update on Health Literacy and Diabetes. Diabetes Educ. 2014;40(5):581–604.

Krass I, Schieback P, Dhippayom T. Adherence to diabetes medication: a systematic review. Diabetic Medicine. 2015;32(6):725–37.

Mikhael EM, Hassali MA, Hussain SA. Effectiveness of Diabetes Self-Management Educational Programs For Type 2 Diabetes Mellitus Patients In Middle East Countries: A Systematic Review. Diabetes, Metabolic Syndrome and Obesity. 2020;13:117–38.

Neuhauser L. Integrating participatory design and health literacy to improve research and interventions. Information Services & Use. 2017;37(2):153–76.

Ha Dinh TT, Bonner A, Clark R, Ramsbotham J, Hines S. The effectiveness of the teach-back method on adherence and self-management in health education for people with chronic disease: a systematic review. JBI Evidence Synthesis. 2016;14(1):210.

Howard T, Ahluwalia R, Papanas N. The Advent of Artificial Intelligence in Diabetic Foot Medicine: A New Horizon, a New Order, or a False Dawn? The International Journal of Lower Extremity Wounds. 2021;15347346211041866.

Rosen JM, Adams LV, Geiling J, Curtis KM, Mosher RE, Ball PA, et al. Telehealth’s New Horizon: Providing Smart Hospital-Level Care in the Home. Telemedicine and e-Health. 2021;27(11):1215–24.

Senbekov M, Saliev T, Bukeyeva Z, Almabayeva A, Zhanaliyeva M, Aitenova N, et al. The Recent Progress and Applications of Digital Technologies in Healthcare: A Review. International Journal of Telemedicine and Applications. 2020;2020:e8830200.

Holmen H, Torbjørnsen A, Wahl AK, Jenum AK, Småstuen MC, Årsand E, et al. A Mobile Health Intervention for Self-Management and Lifestyle Change for Persons With Type 2 Diabetes, Part 2: One-Year Results From the Norwegian Randomized Controlled Trial RENEWING HEALTH. JMIR mHealth and uHealth. 2014;2(4):e3882.

Bosworth H. Improving Patient Treatment Adherence: A Clinician’s Guide [Internet]. New York: Springer; 2010 [cited 2022 Jul 6]. 69–89. Available:https://link.springer.com/book/10.1007/978-1-4419-5866-2

Abed MA, Himmel W, Vormfelde S, Koschack J. Video-assisted patient education to modify behavior: A systematic review. Patient Education and Counseling. 2014;97(1):16–22.

Cork T, White S. Exploring community pharmacists’ use of health literacy interventions in their everyday practice. Research in Social and Administrative Pharmacy. 2022;18(11):3948–52.

Hersh L, Salzman B, Snyderman D. Health Literacy in Primary Care Practice. afp. 2015;92(2):118–24.

Selvan C, Lathia T, Chawak S, Katdare P, Nayak R, Chittem M. The Weight of Words: Indian Physicians’ Perspectives on Patient Communication to Promote Diabetes Adherence. Indian J Endocrinol Metab. 2021;25(5):395–401.

Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K. Low Health Literacy and Health Outcomes: An Updated Systematic Review. Ann Intern Med. 2011;155(2):97–107.

Castro EM, Van Regenmortel T, Vanhaecht K, Sermeus W, Van Hecke A. Patient empowerment, patient participation and patient-centeredness in hospital care: A concept analysis based on a literature review. Patient Education and Counseling. 2016;99(12):1923–39.

Epstein RM, Street RL. The Values and Value of Patient-Centered Care. The Annals of Family Medicine. 2011;9(2):100–3.

Klinovszky A, Papp-Zipernovszky O, Buzás N. Building a House of Skills—A Study of Functional Health Literacy and Numeracy among Patients with Type 2 Diabetes in Hungary. International Journal of Environmental Research and Public Health. 2021;18(4):1547.

Al Sayah F, Majumdar SR, Egede LE, Johnson JA. Associations Between Health Literacy and Health Outcomes in a Predominantly Low-Income African American Population with Type 2 Diabetes. Journal of Health Communication. 2015;20(5):581–8.

Siddharthan T, Rabin T, Canavan ME, Nassali F, Kirchhoff P, Kalyesubula R, et al. Implementation of Patient-Centered Education for Chronic-Disease Management in Uganda: An Effectiveness Study. PLOS ONE. 2016;11(11):e0166411.

Mahan SJ, Mahammad MM. Beliefs about medicine among sample of Iraqi Type 2 Diabetic Patients in Karbala. Iraq: Across sectional study. J Popl Ther Clin Pharmacol. 2022;29(04):310–9.

Mostafavi F, Alavijeh FZ, Salahshouri A, Mahaki B. The psychosocial barriers to medication adherence of patients with type 2 diabetes: a qualitative study. BioPsychoSocial Medicine. 2021;15(1):1.

Winkley K, Upsher R, Polonsky WH, Holmes-Truscott E. Psychosocial aspects and contributions of behavioural science to medication-taking for adults with type 2 diabetes. Diabetic Medicine. 2020;37(3): 427–35.

Zelikovsky N, Nelson E. Illness perceptions and beliefs about medication: impact on health-related quality of life in adolescent kidney transplant recipients. Pediatric Transplantation. 2021;25(3):e13988.

Wei L, Champman S, Li X, Li X, Li S, Chen R, et al. Beliefs about medicines and non-adherence in patients with stroke, diabetes mellitus and rheumatoid arthritis: a cross-sectional study in China. BMJ Open. 2017;7(10):e017293.

García-Pérez LE, Álvarez M, Dilla T, Gil-Guillén V, Orozco-Beltrán D. Adherence to Therapies in Patients with Type 2 Diabetes. Diabetes Ther. 2013;4(2):175–94.

Medi R, Mateti U, Kanduri K, Konda S. Medication adherence and determinants of non-adherence among south Indian diabetes patients. Journal of Social Health and Diabetes. 2015;03(01):048–51.

Alves-Conceição V, Rocha KSS, Silva FVN, Silva ROS, Silva DT da, Lyra-Jr DP de. Medication Regimen Complexity Measured by MRCI: A Systematic Review to Identify Health Outcomes. Ann Pharmacother. 2018;52(11):1117– 34.

Jude EB, Malecki MT, Gomez Huelgas R, Prazny M, Snoek F, Tankova T, et al. Expert Panel Guidance and Narrative Review of Treatment Simplification of Complex Insulin Regimens to Improve Outcomes in Type 2 Diabetes. Diabetes Ther. 2022;13(4):619–34.

Jaam M, Hadi MA, Kheir N, Mohamed Ibrahim MI, Diab MI, Al-Abdulla SA, et al. A qualitative exploration of barriers to medication adherence among patients with uncontrolled diabetes in Qatar: integrating perspectives of patients and health care providers. Patient Preference and Adherence. 2018;12:2205–16.

Brunton SA. Blame and Shame: The Stigma of Diabetes. Clinical Diabetes. 2022 Jan 1;40(1):9.

Hammad M, Noor D, Sulaiman S. The effect of patient’s adherence on HBA1C control. Archives of Medical and Pharmaceutical Sciences Research (AMPSR). 2017;1:30–5.

Mongkhon P, Ashcroft DM, Scholfield CN, Kongkaew C. Hospital admissions associated with medication non-adherence: a systematic review of prospective observational studies. BMJ Qual Saf. 2018;27(11):902–14.

Kuntz JL, Safford MM, Singh JA, Phansalkar S, Slight SP, Her QL, et al. Patient-centered interventions to improve medication management and adherence: A qualitative review of research findings. Patient Education and Counseling. 2014;97(3):310–26.

McMullen CK, Safford MM, Bosworth HB, Phansalkar S, Leong A, Fagan MB, et al. Patient-Centered Priorities for Improving Medication Management and Adherence. Patient Educ Couns. 2015;98(1):102–10.

McDowell I. Theoretical Models of Health Behavior. In: McDowell I, editor. Understanding Health Determinants: Explanatory Theories for Social Epidemiology [Internet]. Cham: Springer International Publishing; 2023 [cited 2023 Aug 14]. p. 253–306. Available from: https://doi.org/10.1007/978-3-031-28986-6_6

Murray A. Measure Development and Validation of a Self-Efficacy Scale for Advance Care Planning. Open Access Dissertations [Internet]. 2019 Jan 1; Available from: https://digitalcommons.uri.edu/oa_diss/843

Bandura A. Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review. 1977;84(2):191–215.

Xie Z, Liu K, Or C, Chen J, Yan M, Wang H. An examination of the socio-demographic correlates of patient adherence to self-management behaviors and the mediating roles of health attitudes and self-efficacy among patients with coexisting type 2 diabetes and hypertension. BMC Public Health. 2020;20(1):1227.

Aljasem LI, Peyrot M, Wissow L, Rubin RR. The Impact of Barriers and Self-Efficacy on Self-Care Behaviors in Type 2 Diabetes. Diabetes Educ. 2001 May;27(3): 393–404.

Forouhi NG, Misra A, Mohan V, Taylor R, Yancy W. Dietary and nutritional approaches for prevention and management of type 2 diabetes. BMJ. 2018 Jun 13;361:2234.

Sokol MC, McGuigan KA, Verbrugge RR, Epstein RS. Impact of Medication Adherence on Hospitalization Risk and Healthcare Cost. Medical Care. 2005;43(6):521–30.

Gherman A, Schnur J, Montgomery G, Sassu R, Veresiu I, David D. How Are Adherent People More Likely to Think? A Meta-Analysis of Health Beliefs and Diabetes Self-Care. Diabetes Educ. 2011;37(3):392–408.

Doyle EA, Page A, Nagel K. Psychosocial Challenges of Diabetes. In: Tamborlane WV, editor. Diabetes in Children and Adolescents: A Guide to Diagnosis and Management [Internet]. Cham: Springer International Publishing; 2021 [cited 2023 Aug 14]. p. 155–61. (Contemporary Endocrinology). Available from: https://doi.org/10.1007/978-3-030-64133-7_15

Bos-Touwen I, Schuurmans M, Monninkhof EM, Korpershoek Y, Spruit-Bentvelzen L, Graaf IE van der, et al. Patient and Disease Characteristics Associated with Activation for Self-Management in Patients with Diabetes, Chronic Obstructive Pulmonary Disease, Chronic Heart Failure and Chronic Renal Disease: A Cross-Sectional Survey Study. PLOS ONE. 2015;10(5):e0126400.

Cavanaugh K, Wallston KA, Gebretsadik T, Shintani A, Huizinga MM, Davis D, et al. Addressing Literacy and Numeracy to Improve Diabetes Care: Two randomized controlled trials. Diabetes Care. 2009;32(12):2149–55.

Vervloet M, Linn AJ, van Weert JCM, de Bakker DH, Bouvy ML, van Dijk L. The effectiveness of interventions using electronic reminders to improve adherence to chronic medication: a systematic review of the literature. Journal of the American Medical Informatics Association. 2012;19(5):696–704.

Joosten EAG, DeFuentes-Merillas L, de Weert GH, Sensky T, van der Staak CPF, de Jong CAJ. Systematic Review of the Effects of Shared Decision-Making on Patient Satisfaction, Treatment Adherence and Health Status. Psychotherapy and Psychosomatics. 2008;77(4):219–26.

Chen WC, Kuo CC, Lin CC, Wu CC. A preliminary study on the effects of the Peer-Led Self-Management (PLSM) program on self-efficacy, self-management, and physiological measures in older adults with diabetes: A block randomized controlled trial. Geriatric Nursing. 2021;42(2):386–96.