Using the transtheoretical model’s stages of change to predict medication adherence in patients with type 2 diabetes mellitus in a primary health care setting

  • Yara Arafat
  • Mohamed Izham Mohamed IbrahimEmail author
  • Ahmed Awaisu
  • Stephen Colagiuri
  • Yaw Owusu
  • Donald E. Morisky
  • Mudather AlHafiz
  • Ahmed Yousif
Research Article



Qatar is currently experiencing a worrying increase in the prevalence of diabetes mellitus (DM). One of the most common reasons for uncontrolled DM is non-adherence to medications. The socio-behavioral intervention has proven effective in some chronic illnesses.


To assess the stages of change (SOC) and medication adherence scores of type 2 diabetes mellitus (T2DM) patients visiting primary healthcare institutions in Qatar, and to evaluate the cause and effect relationship between SOC and adherence to antidiabetic medications.


The 8-item Morisky Medication Adherence Scale (MMAS-8) was used to assess medication adherence, and a 2-item SOC questionnaire was utilized to classify the SOC. The analysis to determine if the SOC could predict medication adherence while controlling for demographic characteristics, total number of prescribed medications and disease duration was done using hierarchical multiple regression.


The final analysis included 387 patients. In relation to medication adherence, majority of the patients were in the maintenance stage (76.7%), followed by the preparation stage (14.7%), the action stage (3.9%), the contemplation stage (3.4%) and the precontemplation stage (1.3%). Most of the patients were in high adherence towards antidiabetic medications (50.3%) followed by low level (26.4%) and medium level (23.3%). SOC was significant and positively predicted medication adherence, which accounted for around 58 to 60% (p < 0.001) while controlling for covariates.


SOC was significant and positively predicted medication adherence. The study recommends that the SOC questionnaire could potentially be used to identify patients at risk for low adherence.


Stages of change Transtheoretical model Diabetes mellitus Medication adherence Primary care 



Use of the ©MMAS is protected by US copyright and registered trademark laws. Permission for use is required. A license agreement is available from: Donald E. Morisky, 294 Lindura Court, Las Vegas, NV 89138-4632;

The researchers would like to thank the Qatar Primary Health Care Corporation and staff at both primary healthcare setting for their support and cooperation throughout the study.

The manuscript was sent to American Journal of Expert for English Language service editing and was covered under the research grant.


This work was supported by the Qatar University [grant number QUUG-CPH-CPH-14/15–5].

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Dr. Morisky is the developer/owner of the copyrighted and trademarked protected Morisky Medication Adherence Scale and sells MMAS licenses and consulting services through MMAS Research LLC, 14725 NE 20th St., Bellevue, Washington 98,007. Dr. Morisky was not involved in the data collection or analysis.

Ethical approval

The study was approved by the Institutional Review Boards of Primary Health Care Corporation and Qatar University.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Clinical Pharmacy and Practice Section, College of PharmacyQatar UniversityDohaQatar
  2. 2.Boden InstituteUniversity of SydneySydneyAustralia
  3. 3.Department of Community Health SciencesUCLA Fielding School of Public HealthLos AngelesUSA
  4. 4.Pharmacy DepartmentMesaimeer Healthcare CenterDohaQatar
  5. 5.Pharmacy DepartmentWestbay Healthcare CenterDohaQatar

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