The relationships between patient activation, patient-physician relationship, and patient engagement and medication adherence: model research on the mediating role.

backgroundMedication adherence remains a critical problem in the treatment of type 2 diabetes (T2D); however, research on this issue is still limited. For this reason, further scientific, academic, and societal efforts are needed to optimize treatment, slow disease progression, and improve adherence. The aim of this research was to examine the associations between the activation levels (PAM-13) of patients with type 2 diabetes (T2D) their relationships with doctors (PDRQ-9), and medication adherence (MARS-5), and to investigate the mediating role of patients’ health engagement (PHE-S) in this associations. Additionally, the mediating role of PDRQ-9 in the relationship between PAM-13 and MARS-5 was analyzed.

methodsThis single-center, quantitative, cross-sectional study included 431 patients with type 2 diabetes who attended the Internal Medicine Polyclinic of Ankara 29 Mayıs State Hospital between 20 November 2023 and 20 February 2024. The Patient Activation Measurement, the Patient-Doctor Relationship Scale, the Medication Adherence Report Scale, and the Patient Health Engagement Scale were used to collect data. Path analysis (mediation analysis) was performed to examine the theoretical relationships between the variables.

resultsThe reliability of the scales was evaluated with Cronbach’s alpha (α) and Omega (ω) tests. (PAM-13 α: 0.80, ω: 0.82, PDRQ-9 α: 0.90, ω: 0.91, MARS-5 α: 0.72, ω: 0.82, PHE-S α: 0.83, ω: 0.84). The goodness of fit indices of the established research models are within excellent or acceptable reference ranges. (first model: CMIN/df = 2.25, RMSEA=0.05, CFI and IFI = 0.90, TLI= 0.89, AGFI= 0.86, GFI= 0.88, RMR= 0.03; second model: CMIN/df = 1.90, RMSEA=0.04, CFI and IFI = 0.91, TLI= 0.90, AGFI= 0.86, GFI= 0.87, RMR= 0.03). Both PAM-13 (β = 0.20, SE=0.07, CR = 2.65, p< .05) and PDRQ-9 (β = 0.12, SE=0.04, CR = 2.87, p< .05) were positively and significantly associated with MARS-5. Additionally, the study showed that the association between PAM-13 and MARS-5 was stronger when PDRQ-9 was included as a mediator (direct association: 0.144, indirect association: 0.025, total association: 0.169 p< .05). In the second model, both PAM-13 (β = 0.172, SE=0.07, CR = 2.46, p< .05) and PDRQ-9 (β = 0.140, SE=0.06, CR = 2.22, p< .05) were positively and significantly associated with PHE-S. PDRQ-9 showed a total association of 0.122 units with PHE-S and 0.136 units with MARS-5 (0.132 direct association and 0.004 indirect association through PHE-S). PAM-13 showed a total association of 0.148 units with MARS-5 (0.139 direct association and 0.009 indirect association through PHE-S). In contrast, the direct association between PHE-S and medication adherence (MARS-5) was weak and not statistically significant (β = 0.03, p = .60); Therefore, PHE did not demonstrate a mediating role in the proposed model.

conclusionsIn conclusion, this study (specifically in patients with type 2 diabetes) emphasizes the importance of patient activation level and the patient-doctor relationship among the key determinants of medication adherence. Therefore, integrating patient activation and the patient-doctor relationship into healthcare delivery is essential for improving medication adherence. Despite its clinical importance, research focusing on medication adherence in T2D populations is limited. Therefore, more comprehensive scientific, academic, and societal efforts are needed to improve medication adherence, optimize disease control, and limit the progression of T2D.In addition to this, To maximize medication adherence in T2D patients, increasing awareness of both the activation level and the importance of the relationship with the doctor and developing solution policies to eliminate existing obstacles by acting together with stakeholders are recommended.