From Compliance to Adherence in Diabetes Self-Care: Examining the Role of Patient’s Potential for Mindful Non-Adherence and Physician-Patient Communication

Abstract

Purpose To examine factors that facilitate an understanding of the relationship between two important, and often interchangeably used, concepts in diabetes management: compliance and adherence. Design A cross-sectional survey. Setting Online data collection. Subjects 365 respondents at least 18 years of age and currently in treatment for diabetes. Measures We measured patients’ compliance, adherence, mindfulness, and perceptions about physician-patient communication, as well as their demographic characteristics. Analysis A moderated mediation analysis was conducted to examine the conditioned indirect effect of compliance on adherence. Results The direct effect of compliance on adherence was positive and significant (β = .378, SE = .073, P < .05, BootCI [.234, .521]), but the compliance-adherence association was also partially mediated by patient’s potential for mindful non-adherence. A higher level of compliance increased potential for mindful non-adherence (β = .716, SE = .082, P < .05, BootCI [.555, .876]), and, in turn, the increased potential for mindful non-adherence reduced adherence (β = −.107, SE = .045, P < .05, BootCI [–.196, −.018]). This detrimental mediating effect of potential for mindful non-adherence was contingent on the perceived quality of physician-patient communication (index = .076, SE = .038, 95% BootCI [.003, .153]), indicating that the positive perception significantly reduced the negative mediating effect of potential for mindful non-adherence on adherence. Conclusion Given that patients with diabetes are involved in a complex self-care, an established partnership and collaboration between patient and doctor is essential to promoting adherence; when the treatment coincides with the patient’s beliefs and needs, mindful non-adherence is less likely to occur.