Improving Medication Adherence among Underserved Patients with Type 2 Diabetes

描述（由申请人提供）：大约三分之一的糖尿病患者不坚持服药。不依从性在低收入、种族/少数民族2型糖尿病（T2DM）患者中更为常见，并且是血糖控制不良、住院、死亡率和较高医疗费用的一个强有力的独立预测因子。以理论为基础的依从性促进干预比理论的、特别的方法更有效，并且对于不依从性风险最高的患者是必要的。一个经过验证的理论模型，信息-动机-行为技能（IMB）模型，已经为艾滋病和高血压患者提供了有效的药物依从性促进干预措施，并且应该为糖尿病患者的依从性干预措施提供信息。此外，广泛可用的技术，如移动电话，提供了一种手段，向广泛的患者，包括低收入，种族/少数民族高风险的不依从提供依从性干预措施。这项研究的目的是

DESCRIPTION (provided by applicant): Approximately 1 in 3 persons with diabetes are nonadherent to their medications. Nonadherence is more common among low income, racial/ethnic minorities with type 2 diabetes (T2DM), and is a strong, independent predictor of poor glycemic control, hospitalizations, mortality, and higher healthcare costs. Theory-based adherence promotion interventions are more effective than atheoretical, ad hoc approaches, and are needed for patients at highest risk of nonadherence. A well-validated theoretical model, the Information-Motivation-Behavioral Skills (IMB) model, has informed effective medication adherence promotion interventions for patients with HIV and hypertension, and should inform adherence interventions in diabetes. Moreover, widely available technologies, such as mobile phones, offer a means to deliver adherence interventions to a broad range of patients, including low income, racial/ethnic minorities at high risk of nonadherence. The goal of this research is to use the IMB model to inform the content and functionality of a mobile phone- delivered medication adherence promotion intervention, ensure intervention content is clearly communicated (i.e., uses simplified text and plain language), and evaluate intervention effects on adherence and glycemic control among a low income adults with T2DM receiving primary care at Federally Qualified Health Centers (FQHCs). The Specific Aims and Research Strategy include: (1) improving the content and functionality of an existing mobile phone-delivered medication adherence promotion to be consistent with the IMB model and clear health communication strategies, and testing for usability and acceptability with 36 patients before evaluating the intervention's effect on outcomes; (2) performing a randomized controlled trial with 500 patients at two FQHCs to test the effect of the intervention on subjective and objective measures of medication adherence, other self-care behaviors and glycemic control at 3, 6, 12, and 15 months, and test whether the IMB mechanisms mediate intervention effects on adherence, test whether adherence mediates intervention effects on glycemic control, and test whether health literacy, numeracy, depression, and/or insulin status moderate intervention effects; and (3) develop recommendations for implementing and evaluating mobile phone-delivered interventions for low-income patients by conducting focus groups with intervention patients and clinic staff to identify the contextual influences on acceptance and effectiveness of the intervention. This interdisciplinary research will greatly enhance our understanding of how to address social-cognitive barriers to adherence among high-risk patients with diabetes, how to leverage mobile devices to support high- risk patient populations in general; and how to better design interventions to improve services for low income, racially/ethnically diverse patients, as well as other high-risk groups. Knowledge gained form this work may also inform interventions to reduce disparities in adherence, glycemic control, and other diabetes outcomes.