Self-regulation and compliance to type I and type II diabetes medication
Nell, Jeanette Christina
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Diabetes mellitus is a complex disease that requires constant patient compliance to diet, life style, glucose level monitoring and medication. Non-compliance to medication can be associated with the development of complications, avoidable hospitalization, disease progression, premature disability and death. Noncompliance is also very costly and therefore compliance to medication regimens is very important. A promising, yet under-explored approach to compliance is self-regulation. Self-regulation refers to the process of goal setting and striving. Self- regulation has specifically been associated with success in reaching one’s goals. The key self-regulation processes include goal establishment, planning, striving towards a goal and revising it. Although a large number of studies have been conducted on compliance related to diabetes, there is a lack of research findings from a self-regulation perspective. The aim of this study is to investigate the relationship between self-regulation and patient compliance to type I and type II medication. Specific aims are (a) to determine whether there is a significant difference in the mean self-regulation scores for participants high and low in compliance and (b) to determine whether there are significant differences in the mean self-regulation scores between compliant and non-compliant participants within different gender and age groups. The participants consisted of an availability sample of 50 (31 female and 19 male) type I and type II diabetes patients collecting their medication at the Clicks Pharmacy in Potchefstroom and Trans 50 retirement villages in Pretoria, Bloemfontein and Kimberley. The ages of the participants ranged between 20 and 87 years. Compliance was measured by investigating the participants’ repeat scripts as well as the Clicks Medication Therapy Management Questionnaire (MTM-Q), developed in 2009 by pharmacists at Clicks to measure patients’ self-report of compliance. Self-regulation was measured with the Shortened Self-Regulation Questionnaire (SSRQ) (Carey, Neal, & Collins, 2004). The study used the factor structure proposed by Potgieter and Botha (2009), based on a factor analysis of the SSRQ in the South-African context. Data capturing and analysis was done in consultation with the Statistical Consultation Services of the North-West University. A total number of 28 (56%) participants in this study were classified as compliant, which is lower than compliance figures reported in most international studies. Differences between compliant and non-compliant participants were primarily noted with regard to Mindful Awareness, Monitoring and Decision making. No differences were noted between any of the groups regarding Learning from mistakes, Perseverance, or Self-evaluation. Compliant participants in the total, female and older groups scored higher on Mindful Awareness than non-compliant participants. For older participants, this difference was practically significant. Compliant participants in the female and older group also obtained higher scores on Monitoring, with the difference in the female group practically significant. Surprisingly, non-compliant female participants scored higher on Decision Making than compliant female participants. Compliant and non-compliant male and younger participants, however, did not differ on any of the self-regulation factors. The study emphasizes the fact that diabetes is perceived as a significant challenge to the current goals of the patient. Subsequently, this study confirms, to a large extent, the importance of self-regulation in compliance to type I and type II diabetes medication, providing support for international studies that emphasise the importance of behavioural factors in diabetes. Mindfulness and Monitoring emerged as important factors in this study, and was explained in relation to compliance as a challenge to one’s perceptual awareness and ability to continuously generate feedback regarding one’s health status. The reason for gender and age related differences in the relationship between compliance and self-regulation, however, is not totally clear and needs to be explored in further research. An important limitation of the study is the small sample size that was used. Future research should explore the trends emerging from this study in larger, random samples.
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