Types 2 Diabetes: Do Health Beliefs Play a Role in Medication Adherence?

Research Paper Title

The association between health beliefs and medication adherence among patients with type 2 diabetes.


Type 2 diabetes is a major risk factor for cardiovascular disease and microvascular complications. Approximately 20.5% of adults between the ages of 20-79 are diagnosed with type 2 diabetes in Saudi Arabia. Non-adherence with type 2 diabetes medications is an established contributor to higher prevalence in other countries. No published studies have used a theoretical framework to explain or predict medication-taking behaviour in Saudi Arabian type 2 diabetes (T2D) patients.

Therefore, the purpose of this study was to investigate type 2 diabetes medication adherence using a theoretical framework, the Health Belief Model (HBM). The specific objectives were to:

  • Assess self-report of medication-taking in a Saudi T2D convenience sample;
  • Investigate self-reported HBM constructs for T2D, its complications, and medication-taking in Healhthis sample; and
  • Test the ability for self-reported health beliefs to predict specific medication-taking behaviors among the sample.


A cross-sectional study was conducted in a convenience sample at an outpatient pharmacy in Saudi Arabia. Adult type 2 diabetes patients on at least one prescribed diabetes medication, who were cognitively capable, and came themselves for prescription pickup, were eligible to participate. Patients completed a questionnaire or were interviewed. Data were collected for demographics, medical history, self-reported medication adherence, and type 2 diabetes medication-taking HBM items. Three measures collected self-report of medication adherence: new multi-dimensional adherence measure (MDAM), previously validated stage of change, and medication-taking recall- 7days (MTR-7). Descriptive statistics were generated and regression analyses were used to explain self-report of adherence.


Just over half (54%) of the 220 participants were male, mean age was 52 ± 11.2 years, and most (59%) had less than high school education. Approximately 58% were on oral medications only and the rest were on either insulin alone or a combination of oral and insulin; 16.7% reported knowing their haemoglobin A1C (A1C).

For adherence, most reported taking the prescribed dose every time taken; however:

  • 60% were not taking it the prescribed number of times per day; and
  • 50%, not the prescribed time of day (interval).

Over 40% reported low adherence on stage of change and MTR-7. Perceived susceptibility, perceived medication benefits, and self-efficacy were significant HBM predictors for medication adherence (R2 = 0.42).


The MDAM has research and practice potential because it evaluates sub-behaviors of medication-taking separately and as a score. Patient perceptions and beliefs should be assessed as part of a patient-centered medication adherence intervention.


Alatawi, Y.M., Kavookjian, J., Ekong, G., & Alrayees, M.M. (2016) The Association between Health Beliefs and Medication Adherence among Patients with Type 2 Diabetes. Research in Social and Administrative Pharmacy. 12(6), pp.914-925. doi: 10.1016/j.sapharm.2015.11.006. Epub 2015 Nov 22.


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