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Title: Type 2 diabetes patients and their body weight : a mixed methods study investigating beliefs, attitudes, and adherence to their medicines over time
Author: Psarou, A.
ISNI:       0000 0004 6496 6218
Awarding Body: University of Liverpool
Current Institution: University of Liverpool
Date of Award: 2017
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Background: Type 2 diabetes [T2D] is a chronic, debilitating condition often associated with obesity. People with T2D rarely fully comply with their medication regime whether it is tablets or injections. Yet, weight gain is a common side effect of most diabetes medicines and, therefore, can be problematic for patients already overweight. Study Aim: To measure how expectations, beliefs and attitudes towards different diabetes treatments change over time focusing on medicines which cause weight loss, weight gain or are weight neutral. To investigate the impact of this belief/attitude change on adherence, and explore ideas for future interventions which improve both diabetes management and adherence. Methods: A mixed methods observational study was conducted in parallel with a systematic review. Individuals self-completed validated questionnaires (n=190) and selected purposively to be interviewed (n=24/190) before and three months after a change in treatment. A change was defined as the addition of, or a change to, a new glucose-lowering or anti-obesity drug to the patient's current therapy. Results: The systematic review identified that T2D patients go through a constant self-evaluation as a result of daily emotional and cognitive experiences with their condition and medicines. However, weight loss was not perceived as strategy in managing diabetes. The questionnaires and interviews revealed that patients' views of their medicines and the severity of their condition changes over time. Overall they were ambivalent about the effectiveness of their diabetes treatment, whilst most were concerned about their body weight. Although there was evidence of reluctance to make treatment changes and a desire to stop them, most patients appeared to accept new medicines if they portray a dual purpose, particularly if they help weight loss and/or in reduction medication number or doses. Nevertheless, despite significantly positive appraisals at 3-month follow-up from participants prescribed medicines promoting weight loss, 70% of the whole group had suboptimal adherence levels. Adherence was influenced by perceptions of medicine's effectiveness, concerns and convenience, experience of side effects and self-efficacy levels. Interviewees who had an established routine and took their medicines in conjunction with other events, such as self-monitoring of blood glucose, were classified as highly adherent. Yet, perceptions of blood glucose and lack/excessive self-monitoring could hinder appropriate management of diabetes and weight loss. Whilst health professionals, family and other people with T2D can have both a positive and negative impact on individual's perceptions and treatment adherence, interviewees valued most the support they received from their health care team, particularly if this was intensive, diverse and timely. Conclusion: Study findings demonstrate that the needs and desired outcomes of T2D patients change over time after a treatment change, but the new medicine's weight-effect does not influence adherence. Instead, patients could benefit from NHS services that give support in increasing confidence levels in taking medicines as well as exploring medicines concerns and adherence, through the use of the visual models developed in this study.
Supervisor: Wilding, J. ; Cooper, H. Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral