TY - JOUR
T1 - Effectiveness and Content Analysis of Interventions to Enhance Oral Antidiabetic Drug Adherence in Adults with Type 2 Diabetes
T2 - Systematic Review and Meta-Analysis
AU - Vignon Zomahoun, Hervé Tchala
AU - de Bruin, Marijn
AU - Guillaumie, Laurence
AU - Moisan, Jocelyne
AU - Grégoire, Jean Pierre
AU - Pérez, Norma
AU - Vézina-Im, Lydi Anne
AU - Guénette, Line
N1 - We thank Frederic Bergeron, information scientist, for assistance in search strategies. We thank American Journal Experts for editing the text.
Source of financial support: This study was funded by the Laval University Chair on Adherence to Treatments. This Chair is supported by nonrestricted grants from AstraZeneca Canada, Merck Canada, Sanofi Canada, and Pfizer Canada and from the Prends soin de toi program (a Quebec provincial program for the improvement of public health).
PY - 2015/6
Y1 - 2015/6
N2 - Objectives: To estimate the pooled effect size of oral antidiabetic drug (OAD) adherence-enhancing interventions and to explore which of the behavior change techniques (BCTs) applied in the intervention groups modified this pooled intervention effect size. Methods: We searched relevant studies published until September 3, 2013, on MEDLINE, Embase, PsycInfo, the Cochrane Library, CINAHL, Current Contents Connect, and Web of Science. Selected studies were qualitatively synthesized, and those of at least medium quality were included in the meta-analysis. A random-effects model was used to pool effectiveness (Hedges's g) and to examine heterogeneity (Higgins I 2). We also explored the influence on the pooled effectiveness of unique intervention BCTs (those delivered to the intervention groups but not control groups in a trial) by estimating their modifying effects. Results: Fourteen studies were selected for the qualitative synthesis and 10 were included in the meta-analysis. The pooled effectiveness of the interventions was 0.21 (95% confidence interval -0.05 to 0.47; I 2 = 82%). Eight unique BCTs were analyzed. "Cope with side effects" (P = 0.003) and "general intention formation" (P = 0.006) had a modifying effect on the pooled effectiveness. The pooled effectiveness of the interventions in which "cope with side effects" was applied was moderate (0.64; 95% confidence interval 0.31-0.96; I 2 = 56%). Conclusions: The overall effectiveness of OAD adherence-enhancing interventions that have been tested is small. Helping patients cope with side effects or formulate desired treatment outcomes could have an impact on the effectiveness of OAD adherence-enhancing interventions. Only those interventions that include helping patients to cope with side effects appear to be particularly effective in improving OAD adherence.
AB - Objectives: To estimate the pooled effect size of oral antidiabetic drug (OAD) adherence-enhancing interventions and to explore which of the behavior change techniques (BCTs) applied in the intervention groups modified this pooled intervention effect size. Methods: We searched relevant studies published until September 3, 2013, on MEDLINE, Embase, PsycInfo, the Cochrane Library, CINAHL, Current Contents Connect, and Web of Science. Selected studies were qualitatively synthesized, and those of at least medium quality were included in the meta-analysis. A random-effects model was used to pool effectiveness (Hedges's g) and to examine heterogeneity (Higgins I 2). We also explored the influence on the pooled effectiveness of unique intervention BCTs (those delivered to the intervention groups but not control groups in a trial) by estimating their modifying effects. Results: Fourteen studies were selected for the qualitative synthesis and 10 were included in the meta-analysis. The pooled effectiveness of the interventions was 0.21 (95% confidence interval -0.05 to 0.47; I 2 = 82%). Eight unique BCTs were analyzed. "Cope with side effects" (P = 0.003) and "general intention formation" (P = 0.006) had a modifying effect on the pooled effectiveness. The pooled effectiveness of the interventions in which "cope with side effects" was applied was moderate (0.64; 95% confidence interval 0.31-0.96; I 2 = 56%). Conclusions: The overall effectiveness of OAD adherence-enhancing interventions that have been tested is small. Helping patients cope with side effects or formulate desired treatment outcomes could have an impact on the effectiveness of OAD adherence-enhancing interventions. Only those interventions that include helping patients to cope with side effects appear to be particularly effective in improving OAD adherence.
KW - Adherence
KW - Diabetes
KW - Intervention
KW - Meta-analysis
KW - Oral antidiabetic drug
UR - http://www.scopus.com/inward/record.url?scp=84931563406&partnerID=8YFLogxK
U2 - 10.1016/j.jval.2015.02.017
DO - 10.1016/j.jval.2015.02.017
M3 - Article
AN - SCOPUS:84931563406
VL - 18
SP - 530
EP - 540
JO - Value in Health
JF - Value in Health
SN - 1098-3015
IS - 4
M1 - 1159
ER -
