Table 1.
Information, Motivation, and Behavioral skills (IMB) barriers to medication adherence for patients with type 2 diabetes mellitus identified through a literature review.
| Identified barriers to diabetes medication adherence | Sample | No. of text messages addressing barrier |
|
| Information |
|
|
|
|
|
Not understanding what medication is for | AAa and NHWb [48] | 20 |
|
|
Not understanding why medication regimens change | NHW [49] | 22 |
|
|
Not taking medication when feeling well | AA [50,51] | 16 |
|
|
Seeing no immediate benefit from taking medication | Racially Diverse [52] | 16 |
|
|
Believing generic medication is not as good as proprietary drugs | AA and NHW [53] | 16 |
|
|
Believing medication is not important | AA [50] | 14 |
|
|
Believing it is acceptable to skip doses or stop medication | Racially Diverse [54] | 16 |
|
|
Believing that regularly taking medication will not help control blood glucose levels or prevent complications | Racially Diverse [52,55] | 15 |
| Personal motivation |
|
|
|
|
|
Believing medication is harmful | AA and NHW [53] | 23 |
|
|
Taking medication is unpleasant | AA and NHW [48] | 17 |
|
|
Fear of side effects | AA and NHW [48] | 20 |
|
|
Worried about consequences of long-term use | Racially Diverse [55] | 19 |
|
|
Worried about medication causing weight gain | Racially Diverse [56] | 15 |
|
|
Believing that consequences of diabetes are predetermined and therefore inevitable | Racially Diverse [57] | 15 |
|
|
Burnout (ie, tired of taking medication) | Racially Diverse [55,56] | 15 |
|
|
Fear of side effects related to insulin injectionc | Racially Diverse [58] | 21 |
| Social motivation |
|
|
|
|
|
Not being supported by family or friends to take medications | AA [59], Racially Diverse [60,61] |
16 |
|
|
Help with adherence from family or friends leads to conflict. | Racially Diverse [60] | 16 |
|
|
Family or friends give annoying reminders to take medication | Racially Diverse [62] | 17 |
|
|
Feeling judged by others because you take medication | Racially Diverse [63,64] | 16 |
|
|
Close others are disapproving of or do not value taking medications | Racially Diverse [58] | 14 |
|
|
Feeling embarrassed when taking medication | Racially Diverse [58] | 22 |
|
|
Family priorities make it difficult to take medication regularly | AA [65], Racially Diverse [32,55] |
18 |
|
|
Family or friends give inaccurate information about medication | AA [65], Racially Diverse [62] |
20 |
|
|
Feeling judged by others because you take insulinc | Racially Diverse [63] | 22 |
|
|
Embarrassed to take insulin in publicc | Racially Diverse [58] | 13 |
| Behavioral skills |
|
|
|
|
|
Regimen is too complex | NHW [49], Racially Diverse [56], AA and NHW [48] | 17 |
|
|
Taking medication disrupts routine/life | Racially Diverse [55,57] | 15 |
|
|
Hard to read medication labels | Racially Diverse [31] | 17 |
|
|
Difficulty asking provider about medication-related problems | AA and NHW [48] | 18 |
|
|
Forgetting to take doses | AA [50,66], Racially Diverse [31,52,54,55,57], NHW [49], AA and NHW [48] | 14 |
|
|
Cost of medication | AA [50], NHW [49], Racially Diverse [31,52], AA and NHW [53] | 16 |
|
|
Forgetting to get refills. | AA [50] | 14 |
|
|
Difficulty getting refills (eg, transportation, finding a pharmacy that carries prescription and/or offers affordable options) | Racially Diverse [31,52] | 19 |
|
|
Not taking insulin because it interferes with daily activitiesc | Racially Diverse [58] | 22 |
|
|
Not knowing how to manage pain when injecting insulinc | Racially Diverse [58] | 15 |
aAA: African American.
bNHW: non-Hispanic white.
cOnly assessed among participants who were prescribed insulin.