Social relationships and patient perceptions of adherence to type 2 diabetes and hypertension treatment : a longitudinal study.
The current project examined factors likely to produce within-person change in patient adherence perceptions (perceived adherence behavior as well as benefit and burden attitudes) to understand possible mechanisms for improving patient adherence to treatment regimens for type 2 diabetes and hypertension. Utilizing the National Institute of Health’s Science of Behavior Change framework (Nielsen et al., 2018), a new model was proposed including four categories of social factors which have exhibited meaningful change over time and potential for intervention, which are well-defined and distinct, and which may be assessed with a high degree of psychometric precision. Three specific aims were explored pertaining to this model. The first aim was to decompose the total effects in order to distinguish the most promising immediate within-person effects from more stable or unfolding contextual effects (which are summed to calculate between-person effects). The second aim was to determine to what degree these within-person effects are explained by the potential mediating variable of subjective stress. The third aim was to examine the robustness of these direct (within-person and contextual) and indirect (within-person) effects in the full theoretical model including all variables. In order to examine these aims, 167 people with type 2 diabetes and/or hypertension were recruited online to complete a series of six monthly assessments. All four social factors had at least one small immediate within-person association with either perceived adherence or perceived benefit, and there were contextual associations involving alliance, confusion, and positive interactions with adherence perceptions. There were two indirect, within-person paths partially mediated by subjective stress (both of which involved negative interpersonal interactions). Most within-person effects remained significant in the full model. Clarifying questions regarding associations between adherence perceptions and self-reported adherence to different regimen components (medication, diet, and exercise) as well as associations with patient wellness outcomes (quality of life and symptom control) were investigated. These results suggest that patient-practitioner and close interpersonal relationships may provide meaningful paths to understand and improve adherence in these chronic conditions.