Validation of Diabetes Mellitus Patient Behavior Questionnaire in Primary Health Care Service

This study aimed to develop and validation a questionnaire as measurement instrument for knowledge and adherence behavior of DM patients in primary health care. Cross sectional study design was conducted in diabetes mellitus patient. Inclusion criteria were patients in the age group 18-65 years, diagnosed with DM, receiving at least one oral antidiabetic medication. Questionnaire questions for behavioral item were developed based on Diabetes Mellitus management guidelines and references to previous studies. Evaluation and validation by expert was carried out on diabetes mellitus experts and clinical psychologists. The pilot study was conducted on 10 healthy patients and 10 patients with diabetes who enrolled inclusion criteria. Questionnaire validation test was conducted with 41 DM outpatient at PKU Muhammadiyah Hospital in Yogyakarta. Collecting data by interviewing patients based on questionnaire. Statistical analysis was performed using SPSS with Pearson correlation coefficients for validation test and Cronbach alpha coefficients for reliability test of the questionnaire. Adherence behavior questionnaire consists of 12 question items, which are divided into three domains: cognitive, affective, and psychomotor domains. Validation results showed 12 valid items where the pearson correlation value was>0.308 (n=41). Cronbach alpha as reliability test results showed 0.78. This result showed a questionnaire were valid and reliable in Diabetes Mellitus patients. This instrument would be use in primary health care for measuring adherence behavior of DM patients

Validation of behaviour measurement instrument of patients with diabetes mellitus and hypertension

Non-adherence to the treatment of chronic diseases such as hypertension and Diabetes Mellitus (DM) is a major obstacle in achieving patient therapy targets and quality of life of patients. A comprehensive approach involving pharmacists counselling has shown influences on changes in health behaviour and patient compliance. Behaviour changes in patients are one of the parameters to assess the effectiveness of counselling and education by pharmacists. Therefore, it is necessary to develop questionnaires of behaviour change measurement in DM-hypertension patients. This study aims to develop a measurement instrument in the form of questionnaires in assessing the behaviour change of DMhypertension patients. Preparation of question items from the questionnaire research instrument refers to some guidelines and previous research references. Test of questionnaire instrument valid was done with expert validation, followed by pilot testing on 10 healthy respondents, and 10 DM-hypertension patients included in the inclusion criteria. Furthermore, field validation test was conducted on 37 patients who had undergone outpatient care at the PKU Muhammadiyah Yogyakarta City Hospital and The Gading Clinic in Yogyakarta. The inclusion criteria were male and female patients, aged 18-65, diagnosed with type 2 diabetes with hypertension who received oral antidiabetic drugs and antihypertensives, and who were not illiterate and co-operative. The data were collected by questionnaire interviews by a standardized pharmacist. The result of validation test using Person correlation shows the value of 0.33. The results of the questionnaire validation test on 37 patients showed 5 items of invalid questions with the value of r <0.33, e: questions 2, 3, 6, 10 and 11, while the other 10 questions show the value of Pearson correlation > 0.33. The reliability value is shown from the Cronbach’s alpha value of 0.722 (> 0.6), implying that the questionnaire is reliable for DMhypertension patients. This Behavioural change questionnaire can be used on DM-hypertension patients, and an FGD approach is required for the development of factors affecting this questionnaire. Keywords: DM-hypertension, behaviour, compliance, validation, reliabilit

Counseling and Motivational Short Text Messages Increase Adherence and Behavioral Changes in Patient with Hypertension

Background: Patients with hypertension often fail to achieve treatment goals of controlling their blood pressure, hence they fall onto the condition of uncontrolled hypertension. In addition to counseling and patient-education programme, an enhanced methods of intervention is needed by pharmacist to increase patient adherence and commitment in taking antihypertension medicine. Motivational intervention has not been widely used by pharmacist in conducting pharmaceutical care to patients. Objective: This research is aimed to understand the effect of motivational counseling and short text messages (SMS) with adherence and behavioral changes in outpatient with hypertension at PKU Muhammadiyah Hospital Bantul, Yogyakarta. Methods: Sixty patients who meet the inclusion criteria was divided into two groups, which were experimental group (n=30) who received motivational counseling and SMS, and control group (n=30) who received usual care. Data was collected by interviews, behavioral questionaire, adherence questionaire using Morisky Medication Adherence Scale (MMAS), and blood pressure measurement according to the medical record. Results: Trans theoretical model (TTM) was used in this research. Stages of behavioral changes were divided into pre-contemplation, contemplation, preparation, and action. Result showed that pharmacist intervention, using motivational counseling and SMS as reminder, contribute to an increase of patient adherence and action stage of behavioral changes in the experimental group by 50% compared to 20% in the control group (p=0,035). Increase of adherence as much as 83,33% was seen in experimental group (p=0,000). A bigger decrease of systolic and diastolic blood pressure (SBP/DBP) was also seen in the experimental group compared to control group (SBP=15,37 vs 1,27mmHg), (DBP=6,73 vs 0,43 mmHg) on their second visits. Conclusion: Based on these results, it can be concluded that motivational counseling with SMS as a reminder and motivation by pharmacists in hypertensive patients give a positive influence on behavioral changes that improve adherence, and increase of systolic and diastolic blood pressure control

Tingkat Kepatuhan Antihipertensi Dan Pengontrolan Tekanan Darah Pasien Rawat Jalan RS PKU Muhammadiyah Bantul, YOGYAKARTA Yang Mendapatkan Brief Counseling-5a Dan SMS Motivasional

Antihypertensive therapy requires adherence therapy to achieve therapeutic targets such as controlling blood pressure both systolic and diastolic blood pressure. Pharmacists in counseling interventions have been developed in the form of brief Counseling - 5A and SMS reminders. But the relationship between adherence and blood pressure control is still studied and both of them are related to many factors that can affect. The aim of this study was to determine the relationship of the level of compliance antihypertensive therapy and control of blood pressure (systolic and diastolic) hypertension patients in outpatient PKU Muhammadiyah Bantul, Yogyakarta who get Brief counseling - 5A and SMS motivation.Patients who met the inclusion criteria were divided into 2 groups, the treatment group (n = 30) who received Brief counseling - 5A and SMS motivation, and the control group (n = 30) who received usual care (conventional counseling). Data were collected by interviews using questionnaires compliance of Morisky Medication Adherence Scale (MMAS), the value of blood pressure is taken from the medical record. Correlation between level of adherence and blood pressure control have been analyzed using Fisher test. The results showed the treatment group with categories adherent patients (n=25) was increase in blood pressure control by 36.67% compared with the control group of patients adherent category (n=6) only 6.67% that has control of the blood pressure on post study. In contrast to patient with adherent category, who had uncontrolled blood pressure are 46.67% (treatment group) compared to the control group 13.33% on the post study. Patients categories of non-adherent but is having control of blood pressure showed 3.33% (treatment group) and 26.67% (control group) on the post study. Although the rate of compliance in the treatment group was higher than control group on the second visit, but there was no significant relation between the level of compliance and controlling blood pressure both in control group (p=1.000) and intervention group (p=0.622) on the second visit (post). The rate of compliance and blood pressure control of patients with hypertensive was low. There were many factors such as poor of knowledge, drugs side effect, poly pharmacy, which related with level of compliance. There was no correlation between antihypertensive compliance and blood pressure control in hypertensive patients ambulatory PKU Muhammadiyah Bantul Hospital, who get Brief counseling – 5A and SMS motivation. Therefore it is necessary to do further research to identify factors that influence to improve patients' awareness in the management of hypertension

TINGKAT KEPATUHAN ANTIHIPERTENSI DAN PENGONTROLAN TEKANAN DARAH PASIEN RAWAT JALAN RS PKU MUHAMMADIYAH BANTUL, YOGYAKARTA YANG MENDAPATKAN BRIEF COUNSELING-5A DAN SMS MOTIVASIONAL

Abstract: Antihypertensive therapy requires adherence therapy to achieve therapeutic targets such as controlling blood pressure both systolic and diastolic blood pressure. Pharmacists in counseling interventions have been developed in the form of brief Counseling - 5A and SMS reminders. But the relationship between adherence and blood pressure control is still studied and both of them are related to many factors that can affect. The aim of this study was to determine the relationship of the level of compliance antihypertensive therapy and control of blood pressure (systolic and diastolic) hypertension patients in outpatient PKU Muhammadiyah Bantul, Yogyakarta who get Brief counseling - 5A and SMS motivation.Patients who met the inclusion criteria were divided into 2 groups, the treatment group (n = 30) who received Brief counseling - 5A and SMS motivation, and the control group (n = 30) who received usual care (conventional counseling). Data were collected by interviews using questionnaires compliance of Morisky Medication Adherence Scale (MMAS), the value of blood pressure is taken from the medical record. Correlation between level of adherence and blood pressure control have been analyzed using Fisher test. The results showed the treatment group with categories adherent patients (n=25) was increase in blood pressure control by 36.67% compared with the control group of patients adherent category (n=6) only 6.67% that has control of the blood pressure on post study. In contrast to patient with adherent category, who had uncontrolled blood pressure are 46.67% (treatment group) compared to the control group 13.33% on the post study. Patients categories of non-adherent but is having control of blood pressure showed 3.33% (treatment group) and 26.67% (control group) on the post study. Although the rate of compliance in the treatment group was higher than control group on the second visit, but there was no significant relation between the level of compliance and controlling blood pressure both in control group (p=1.000) and intervention group (p=0.622) on the second visit (post). The rate of compliance and blood pressure control of patients with hypertensive was low. There were many factors such as poor of knowledge, drugs side effect, poly pharmacy, which related with level of compliance. There was no correlation between antihypertensive compliance and blood pressure control in hypertensive patients ambulatory PKU Muhammadiyah Bantul Hospital, who get Brief counseling – 5A and SMS motivation. Therefore it is necessary to do further research to identify factors that influence to improve patients’ awareness in the management of hypertension. Keywords: hypertension, compliance, blood pressure, Brief Counseling–5