Medication non-adherence occurs in an average of 50% of Type 2-Diabetes Mellitus (DM) patients and is associated with poor health outcomes and quality of life. Psychological interventions designed from health models can improve medication adherence and treatment outcomes. This study will apply the Necessity-Concerns Framework (NCF) which explains how adherence is influenced by the patient’s belief in their personal need for the treatment (Necessity beliefs) and concerns about their medicines.
After obtaining ethical approval, the intervention will be carried out among adult (>18 years) type-2 DM patients from two tertiary health institutions in Jos, Nigeria. A minimum sample size of 264 with an 80% chance of detecting statistical significance will be determined. Allocation of participants will be done randomly (every other patient) into the intervention and control groups as they are being recruited. For both groups, data will be collected at baseline and month 2. The control group will receive routine/usual care, while the intervention group will in addition receive reinforced medication education and adherence counseling (MEAC), a structured educational program designed from the NCF, which uses the Belief about Medicines questionnaire-BMQ to tailor the support. The intervention domains include diabetes knowledge, respondent’s perception of diabetes disease and anti-diabetic medicines, perceived sensitivity to medicines, dietary and medication adherence, quality of life, and emotional status. Emotional counseling, aimed at behavioral change will be administered to the intervention group, especially to those who are discouraged and/or expressed negative emotions due to type-2 DM disease during the study period. The cognitive intervention will be based on the ability to recognize symptoms, identify the need for medication adherence, side effects, and self-care that includes dietary and lifestyle adjustments. Adherence will be assessed using the Medication Adherence Report Scale-MARS_5. The intervention will be written in the form of a structured questionnaire administered by trained health workers and research assistants. Data will be collated and analyzed appropriately using descriptive statistics, paired T and Mann Whitney U tests. The primary treatment outcome measure will be fasting blood glucose. It is expected that medication adherence, treatment outcome and quality of life will improve after the intervention.