Adherence Therapy Intervention for People with Type 2 Diabetes

Abstract

Background: Adults with type 2 diabetes (T2D) mellitus encounter several challenges during treatment, including inconsistent medication taking. Many interventions addressing medication taking and treatment plans are safe and effective; however, none is more effective than others. Adherence therapy (AT), a brief structured psychological intervention, is a promising candidate for improving medication taking in people with T2D. The primary aim of this PhD thesis was to establish the feasibility of a randomised controlled trial of AT in the Middle Eastern context. Methods: This thesis consists of five studies adopting different methodologies. Two systematic reviews focusing on people with T2D were conducted; the first was on adherence interventions, and the second was on the effectiveness of AT in improving the consistency of medication taking. Considering the Middle Eastern context, a cultural adaptation study and a feasibility trial of AT for people with T2D were conducted. Finally, qualitative research as a component of the feasibility trial was performed. Results: A range of adherence interventions was identified during the first systematic review, but none was the most effective. No trials met the inclusion criteria. However, for the second systematic review, four trials evaluating interventions with components similar to AT were identified. These components were positively associated with improved medication use and sticking to treatment plans for diabetes. Culturally, AT was shown to be generally appropriate in the Middle Eastern context, but modifications are needed to improve its acceptability and effectiveness. Finally, a full-scale trial of AT in people with T2D was shown to be feasible after adopting the recommended amendments. Conclusions: This study contributes to knowledge by establishing a sound scientific basis for conducting a randomised controlled trial of AT; however, the protocol for such a trial conducted within a Middle Eastern context requires careful consideration.