Predictors of treatment adherence in patients with type 2 diabetes: a cross-sectional study in Southern Iran based on Pender's Health Promotion Model using structural equation modelling.

Abstract

Treatment adherence in type 2 diabetes (T2D) is an important factor in optimal diabetes control and prevention of mortality. The present study aimed to determine the predictability of Pender's Health Promotion Model (HPM) constructs in T2D treatment adherence behaviour. The present cross-sectional and analytical study was conducted from November 2022 to January 2023. The present study was conducted in Bandar Abbas, a city in Hormozgan Province, in the south of Iran. The participants included 396 patients with T2D with medical records in the Hormoz Diabetes Clinic. Based on their record number, the participants were selected for inclusion in the study through a random systematic sampling. The data collection instruments included a demographic questionnaire and a researcher-made questionnaire based on HPM constructs. The questionnaire was valid and reliable, achieving Cronbach's alpha coefficients ranging from 0.609 to 0.798 across various constructs. The questionnaires were completed face to face. Pearson's correlation test, path analysis and structural equation modelling were conducted using SPSS V.23, and STATA V.15. This study was conducted before intervention (pre-results). As the path analysis showed, perceived self-efficacy (β=0.23, p<0.001), treatment adherence experiences (β=0.26, p<0.001), immediate competing demands and preferences (β=-0.15, p<0.001) and commitment to plan of action (β=0.24, p<0.001) could significantly predict the treatment adherence behaviour. The results of indirect path analysis showed that the total effect of perceived benefits (β=0.24, p<0.001), perceived barriers (β=-0.14, p=0.002), perceived self-efficacy (β=0.32, p<0.001) on commitment to plan of action was statistically significant. Through the mediation of commitment to plan of action, they could predict the treatment adherence behaviour. In light of the present findings, it can be concluded that the proposed model of T2D treatment adherence behaviour has an acceptable fit. Commitment to plan of action, treatment adherence experiences, perceived self-efficacy and immediate competing demands and preferences are the main predictors of T2D treatment adherence behaviour. It is recommended that educational interventions focus on these constructs. This study is registered on the Iranian Registry of Clinical Trials (IRCT20211228053558N1).