Health Literacy, Mental Health, and Clinical Factors as Predictors of Medication Adherence in Iranian Adolescents with Type 1 Diabetes: A Cross-Sectional Study

Articles in Press

Document Type : Original Article

Authors

1 Department of Pharmacoeconomics and Pharmaceutical Management, TeMS.C., Islamic Azad University, Tehran, Iran.

2 Department of Psychology and Education of Exceptional Children, Faculty of Psychology and Education, University of Tehran, Tehran, Iran

Abstract

Background and Objective: Type 1 diabetes (T1D) remains one of the most important global public health burdens, particularly for adolescents. The successful management of T1D is dependent on several factors, one of which is adherence to prescribed medications (in addition to health literacy (HL) and mental health), areas that are significantly underexplored in Iranian adolescents. 

Material and Methods: This cross-sectional study was conducted from December 2023 to May 2024 in Tehran, Iran. Using convenience sampling, 379 literate adolescents aged 10–18 years with type 1 diabetes (without psychiatric disorders or related medications) were recruited through diabetes associations, pediatric endocrinologists, diabetologists, social media groups, online channels, physician referrals, and diabetes organizations. Data were collected via a web-based questionnaire using validated Persian versions of the following instruments: the 8-item Morisky Medication Adherence Scale (MMAS-8) for medication adherence, the Health Literacy Measure for Adolescents (HELMA) for health literacy, and the 12-item General Health Questionnaire (GHQ-12) for mental health.

Results: Adolescents with comorbidities showed higher medication adherence. Higher health literacy was significantly associated with better adherence (B = 0.012, OR = 1.012, P = 0.001). Use of insulin pens (P = 0.001) and experiencing medication side effects (P = 0.014) were also linked to improved adherence. GHQ-12 scores indicated that better mental health (P = 0.012), presence of positive mental health symptoms (P = 0.001), and fewer symptoms of mental disorders (P = 0.002) correlated with higher adherence, although mental health variables did not remain significant in stepwise logistic regression. Demographic factors (age, sex, parental education, income), diabetes duration, and insulin injection frequency showed no association with nonadherence (all P > 0.05).

Conclusion: In Iranian adolescents with T1D, higher health literacy and certain clinical factors (comorbidities and insulin pen use) were significantly associated with better medication adherence. These findings highlight the need for targeted interventions, including educational programs to enhance health literacy, routine mental health screening and support, and improved access to user-friendly insulin delivery devices (e.g., pens), which could be integrated into clinical practice and health policy in Iran.

Keywords

Acknowledgements: The authors would like to express their gratitude to all the adolescents with type 1 diabetes and their families who participated in this study and made this research possible.


Availability of Data and Materials: The datasets generated and/or analyzed during the current study are not publicly available due to privacy and confidentiality restrictions but are available from the corresponding author upon reasonable request.


Conflicts of interest: The authors declare that they have no Conflicts of interest.


Consent for publication: Not applicable.


Ethical Approval and consent to participate: All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments. The study was approved by the Ethics Committee of Islamic Azad University (Protocol number: IR.IAU.PS.REC.1402.268). For participants under 15 years of age, written informed consent was obtained from their parents or legal guardians. Additionally, all adolescents provided written assent to confirm their voluntary participation.


Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.


Author Contributions: PGh and SGh conceptualized and designed the study. ZSMV collected the data. RA, SGh and PGh analyzed and interpreted the patient data. ZSMV and SO drafted the manuscript. All authors read and approved the final manuscript.

 

Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/

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