3. Estimates suggest that, in the year 2000, 171
million people of all ages worldwide had
their blood glucose levels in the diabetes
range. (Vijayakumar, Arun, & Kutty, 2009)
Over the next 30 years the global
prevalence of diabetes mellitus is projected
to increase by over 100 percent. This will
raise the global burden of diabetes mellitus
to 366 million by the year 2030 (Wild et al,
2004).
4. In the Philippines, the situation couldn’t be
more paralleled. According to a survey
conducted by the Philippine
Cardiovascular Outcome Study regarding
diabetes here in the country, 1 out of every
5 adult Filipinos is diabetic (Pazzibugan,
2008). It also shows that three out of five
adults are at risk of developing diabetes if
they won’t change their lifestyle.
5. Moreover, as the prevalence of diabetes
increases, the proportion of young people
with diabetes also increases. The rapidly
increasing prevalence of Type 2 Diabetes
in the youth is highlighted by studies in the
Asian populations in native lands and in
migrant countries (Ramachandra et al,
2012).
6. Since diabetes is a chronic disease, it may
directly or indirectly affect the individual’s
health status and job performance
regardless of the type of work. The
increased prevalence among younger
individuals suggests that diabetes will
become more common in the working-age
population. Consequently, employment
and work productivity of individuals with
diabetes are important issues for patients,
families, employers, and policy makers
(Tunceli et al, 2005).
7. Several studies have found negative
associations between diabetes and
employment outcomes (Ng, Jacobs, &
Johnson, 2001). Diabetes can affect
employment in a number of ways. First,
diabetes complications may prevent
working entirely or increase absenteeism
for those who work (Julius, Gross, &
Hanefeld, 1993). Second, productivity while
at work may also be impaired (Lavigne et
al, 2003).
8. Third, individuals with diabetes may face
employment discrimination. In some cases,
especially because of the risk of
hypoglycemia, employers may restrict
access to the jobs designated as safety
sensitive (Kraut et al, 2001) or discriminate
against individuals with diabetes because
of their concerns about low productivity
(Matsushima et al, 1993).
9. Diabetic Lifestyle for it to be successful must
include changing diet, increasing physical
activity, improving the living environment,
and at most points compliance to medical
and pharmacologic therapies.
Pharmacologic therapy is needed to
achieve certain desired outcomes for the
patient. These desired outcomes are part of
the overall objective for diabetes
management.
10. However, despite all the best intentions and
efforts on the part of the healthcare
professionals, those outcomes might not be
achievable if the patients are non-
compliant (Jin et al, 2008). Several studies
were conducted in order to know the
possible impact of therapeutic non-
compliance in different countries. In
general, an estimated compliance rate for
long-term therapies was between 40% to
50% while the short-term therapies were
between 70% to 80% (DiMatteo, 1995).
11. The above example illustrates the need to
know the contributing factors that affect
drug compliance among diabetic patients
and the extent of the problem, in order to
address the issue of therapeutic non-
compliance. This could serve as
enlightenment for the diabetic employees
about the factors that can affect their
compliance in their regimen.
12. Moreover, there is a lack of available study
concerning factors that affects drug
compliance of diabetic patients in the
workplace. The results that can be
obtained from this study can add-up to the
knowledge that would improve better care
management among Health care providers
and can contribute to the body of existing
data about the topic for education and
research. In addition, this could help
employers in the future planning and
implementation of health policies in the
workplace.
13. The main objective of this study is to identify
factors that affect drug compliance of type
II diabetic patients in an occupational
setting, specifically in a manufacturing and
bottling company situated in Canlubang
Laguna, Philippines. Specifically, it aims to
determine the association of drug
compliance between the profile of the
respondents and their health status.
14. Moreover, this study aims to determine if the
identified factors such as Psychological;
Social; Health Care Provider and Medical
System; and Disease and Treatment affects
drug compliance of diabetic patients in an
occupational setting.
15. However, this study would only focus on
employees diagnosed to have type 2
diabetes; working in a
manufacturing/bottling company.
Furthermore, the focus of the study is those
diabetic employees that are currently
taking oral anti-diabetic agents without
taking insulin preparations and was
diagnosed with the disease for not less
than three years.
16. The limitation of the study is that it would
focus more on the pharmacologic
adherence and not on other diabetic
managements such as diet and exercise
modifications. In addition, this study would
not conduct any laboratory or diagnostic
procedures relative to diabetic assessment
such as Fasting Blood Sugar and HbA1c.
This study is deemed to be conducted for
eight (months) duration.
18. Diabetes is a chronic disease that occurs
either when the pancreas does not
produce enough insulin or when the body
cannot effectively use the insulin it
produces. Insulin is a hormone that
regulates blood sugar. Hyperglycemia, or
raised blood sugar, is a common effect of
uncontrolled diabetes and over time leads
to serious damage to many of the body's
systems, especially the nerves and blood
vessels (World Health Organization, 2011).
19. I. Diabetes: Basic Facts
Type 1 diabetes (previously known as insulin-
dependent, juvenile or childhood-onset) is
characterized by deficient insulin production
and requires daily administration of insulin.
The cause of type 1 diabetes is not known
and it is not preventable with current
knowledge. Symptoms include excessive
excretion of urine (polyuria), thirst
(polydipsia), constant hunger, weight loss,
vision changes and fatigue. These symptoms
may occur suddenly.
20. Type 2 diabetes (formerly called non-insulin-
dependent or adult-onset) results from the
body’s ineffective use of insulin. Type 2
diabetes comprises 90% of people with
diabetes around the world, and is largely
the result of excess body weight and
physical inactivity. Symptoms may be similar
to those of Type 1 diabetes, but are often
less marked. As a result, the disease may be
diagnosed several years after onset, once
complications have already arisen. Until
recently, this type of diabetes was seen only
in adults but it is now also occurring in
children.
21. Gestational diabetes is hyperglycemia with
onset or first recognition during pregnancy.
Symptoms of gestational diabetes are
similar to Type 2 diabetes. Gestational
diabetes is most often diagnosed through
prenatal screening, rather than reported
symptoms.
22. Impaired glucose tolerance (IGT) and
impaired fasting glycemia (IFG) are
intermediate conditions in the transition
between normality and diabetes. People
with IGT or IFG are at high risk of progressing
to type 2 diabetes,although this is not
inevitable (World Health Organization, 2011).
23. II. Components of Diabetes
Treatment
Treatment for diabetes mellitus involves
restoring blood glucose to or near normal
levels in all patients. The American Diabetes
Association (ADA) recommends a treatment
target for diabetes that includes a
glycosylated hemoglobin (HbA1c) level <7%
and optimal blood glucose levels obtained
before meals should be in the range of 70–
130 mg/dl, while levels taken 1–2 hours after
beginning a meal should be lower than 180
mg/dl.
24. In order to achieve maximum treatment
gains, patient involvement and cooperation
is a must. Self-management of diabetes
involves frequent self-monitoring of blood
glucose, along with dietary modifications,
exercise, education, and medication
administration.
25. Self-care management is necessary to
improve one’s health and reduce the risk of
having diabetes-related complications.
Failure to control blood glucose adequately
can have immediate and long-term effect.
To avoid complication and maintain
acceptable blood glucose level, one must
follow a self-care regimen that includes right
diet, exercising, blood glucose monitoring,
and medication.
26. A. Dietary modifications and Exercise
Dietary modifications and exercise
initiation are essential components of
diabetes self-management. The American
Diabetes Association recommends 1550-
1650 calories per day that include
breakfast, lunch, dinner, and two snacks.
Calories are spaced throughout the day
between meals and snacks.
27. Recommendations includes having a
moderate intake of carbohydrates (45-50%
of Calories)reduction in saturated fats and
trans fat; having less than 200 mg per day of
cholesterol; keeping sodium to less than
1500 mg per day and increase in fiber
intake of more than 25mg.
28. In a randomized lifestyle intervention trial
conducted by Kang et. al in 2010, results
showed that continuous lifestyle intervention
for two years is more effective at improving
risk factors than one year intervention. In this
study, the intervention program consists of
motivating the participant to correct
imbalances in their lifestyle voluntarily by
providing practical advice through dietary
modification and increasing their physical
activity.
29. Dietary recommendations of 1400-2200
calories per day was followed and about
200-300 kcal/day were burnt through brisk
walking of 10-30 min a day and other
endurance exercises (Kang et.al, 2010).
30. B. Blood glucose monitoring
Another important component of diabetes
self-management is the monitoring of
glycemic status. Results of blood glucose
are used to assess the efficacy of therapy
as well as to provide information regarding
necessary adjustments to nutritional therapy
and medication.
31. The A1C or HbA1c (Glycated hemoglobin)
test measures an individual’s average blood
glucose control for the past 2 to 3 months. It
can be done twice a year for patients with
controlled blood glucose level and more
frequent for those who are unable to cope
with the normal blood glucose level. It
recommends the goal of therapy as an
HbA1c of <7%, and recommends that
treatment be reevaluated when HbA1c
exceeds 8% (American Diabetes
Association).
32. C. Medication
Modifications to diet and exercise are an
initial and conservative treatment for type 2
DM, but many patients require
pharmacologic intervention to maintain
glycemic control. Only type 2 diabetic
patients can use pills or oral antidiabetic
medication in managing their blood glucose
because the pancreatic beta cells aren’t
functioning at a minimum level in type 1
diabetes(Nursing Pharmacology made
Incredibly Easy, 2005). These pills work best
when used with meal planning and exercise
(American Diabetes Association).
33. As stated in the Merck Manual of Medical
Information (2003), there are several types of
Antidiabetic medication. Sulfonylureas (for
example, glyburide) and meglitinides (for
example, repaglinide) stimulate the
pancreas to produce more insulin (insulin
secretagogues). Biguanides (for
example, metformin) and thiazolidinediones
(for example, rosiglitazone) do not affect the
release of insulin but increase the body's
response to it (insulin sensitizers). Doctors may
prescribe one of these drugs alone or with a
sulfonylurea drug.
34. Another class of drug is the glucosidase
inhibitors, such as acarbose, which work by
delaying absorption of glucose in the
intestine. The drugs are sometimes taken
only once a day, in the morning, although
some people need two or three doses.
More than one type of oral drug may be
used if one is not adequate. If oral
antihyperglycemic drugs cannot control
blood sugar levels well enough, insulin
injections alone or in combination with the
oral drugs may be needed.
35. III. Prevalence: International and
Local
Diabetes mellitus is a serious and increasing
global health problem (Detaille et. al, 2005).
Projected increase in the global prevalence
of type 2 diabetes suggests that its
treatment and prevention could become
one of the major health challenges of the
21st century (Oberlinner & Neumann, 2007).
36. In The United States, diabetes is becoming a
serious threat with significant increases
projected. This increase will drain healthcare
and financial resources and government
and community services, and will negatively
impact quality of life. In 2004, an estimated
3.4 million people died from consequences
of high blood sugar and more than 80% of
diabetes deaths occur in low- and middle-
income countries (World Health
Organization, 2011).
37. In the Philippines, a survey conducted by
the Philippine Cardiovascular Outcome
Study on Diabetes Mellitus in 2007 showed
that “3 out of 5 adults are already diabetic
or on the verge of diabetes unless they
change their lifestyles.” This result is very
alarming and needs to be addressed.
Meanwhile, no data on the prevalence of
diabetes among Filipino children have been
made.
38. With this in mind, effects of Diabetes overall
could not be denied. The disease in itself
brought with it challenges not only to the
patient but to his family and the society. The
medical care costs associated with
diabetes create a considerable economic
burden for patients, family, and society.
Productivity losses from diabetes have been
estimated to be almost half of the medical
cost. As the prevalence of diabetes has
increased, so too have the associated
economic burdens (Tuncelli et. al, 2005).
39. IV. Diabetes and Workplace
This challenge has been extended to the
occupational setting as well- becoming an,
“increasingly prevalent and burdensome
disease in working populations” (Oberlinner
& Neumann, 2007).
40. For some, diabetes in the workplace seems
to have a negative connotation to those
who have it. It was a common practice to
restrict individuals with diabetes from certain
jobs or classes of employment solely
because of the diagnosis of the diabetes or
the use of insulin, without regard to an
individual’s abilities or circumstances
(American Diabetes Association, 2009).
41. For the lucky others, employers
accommodate employees with diabetes
and may even produce some changes to
accommodate the diabetic needs. Many of
the accommodations that employees with
diabetes need on a day-to-day basis are
those that allow them to manage their
diabetes in the workplace as they would
elsewhere. There are usually simple
accommodations that can be provided
without any cost to the employer, and
should cause little or no disruption in the
workplace (American Diabetes Association,
2009).
43. A. Differentiating Adherence
versus Compliance
The increasing prevalence and chronic
nature of diabetes implies that continuity
of care and self-management should be
an important factor on the management
of this disease (Detaille, 2005).
44. However, with all the accommodations and
all said and done, Diabetes and its course
still largely depends on the individual and
his/her therapeutic compliance. Hence,
therapeutic compliance in any setting –
“has been a topic of clinical concern since
1970s due to the widespread nature of non-
compliance therapy” (Jin & Sklar, 2008).
45. Generally speaking, it was estimated that the
compliance rate of long-term medication
therapies was between 40% and 50% while
the rate of compliance for short-term therapy
is between 70% and 80% based on the studies
by Jin et al in 2008. Moreover, Jin et al added
that More than 20 studies published in the
past few years found that compliance with
oral medication for type 2 diabetes mellitus
ranged from 65% to 85%.
46. With the growing prevalence of Diabetes in
the workplace setting, it is therefore
important to assess the factors that might
affect non compliance among employees.
To address this issue, it is of first and utmost
importance to have a clear and
acceptable definition of compliance. In
healthcare, the most commonly used
definition of compliance is patient’s
behaviors (in terms of taking medication,
following diets, or executing lifestyle
changes) coincide with the health care
providers’ recommendations for health and
advice.
47. Thus, therapeutic non-compliance occurs
when an individual’s health seeking or
maintenance behavior lacks congruence
with the recommendations as prescribed by
healthcare provider (Jin & Sklar, 2008).
48. A few debates have been made on whether
non-compliance is the proper word to use to
describe this phenomenon. Some years ago,
diabetes educators argued that the term
“adherence” be used preferentially instead
of “compliance” and the tem “non-
adherence” be substituted for “non-
compliance”. The rationale for this proposal
was that the term “non compliance” implies
a series of negative value judgments about
the patients as people. Instead, the term
“non-adherence” was thought to imply
description of a failure to follow medical
prescription without bias toward the patient
as a person.
49. In addition, specific studies have noted that
non-adherence may entail various
components that may relate to flaws in the
process of care and that do not entail a
failure on the part of the patient (Leichter,
2005). Although there are slight differences
between these terms, in clinical practice,
these terms are used interchangeably (Jin &
Sklar, 2008).Furthermore, much of the
medical community has never adopted this
concept, and in many other areas of clinical
practice, the term “non-compliance”
remains the standard (Leichter, 2005).
50. B. Compliance about Self-Care
Management
Majority of patients with diabetes can
significantly reduce the chances of
developing long-term complications by
improving self-care activities. Despite this
fact, compliance or adherence to these
activities has been found to be low in some
studies (Wabe et. al, 2011). Several studies
conducted and showed many contributing
factors that affects compliance in diabetic
patients.
51. 1. Factors Related to Compliance
To improve patient compliance, it is very
important to understand why
noncompliance occurs. A substantial
literature has documented a number of
factors related to diabetes regimen
compliance problems. It is helpful to
consider demographic, psychological, and
social factors, as well as health care
provider, medical system, and disease- and
treatment-related factors (Khan et. al, 2012;
Jin et. al, 2008; Wabe et.al, 201, Delamater
et.al, 2006).
52. a. Demographic factors
Demographic factors such as age,
gender, ethnicity, level of education, and
socio-economic status are associated with
medication compliance (Patel et. al,
2010,Verghari et. al, 2010, Kaylango et. al,
2008).
53. Factors such as sex and educational level
appeared to be associated in non-
adherence rate in Mulago Hospital, Uganda
while age, marital status, and occupation of
the respondent were not significantly
associated with non-adherence (Kaylango
et.al, 2008).
54. In 2010, Patel and colleagues studied 3,169
patients with type 2 DM in North Carolina.
A retrospective cohort study was done and
consists of patients aged 18-44 years, 45-
64years, and 65+ years who were newly
starting medication from July 2001- June
2002. In order to determine the medication
adherence of the patients, the researchers
utilized medication possession ratio using
prescription refill patterns. Result showed
that a better medication adherence is
associated with increased age.
55. In an experimental study conducted across
mainland U.S. and Hawaii, 2,155 adults with
impaired glucose tolerance participated
and were randomly assigned to either
metformin or matched placebo treatment
arm, Walker et.al (2006) reported that age,
gender and ethnicity is associated with
medication adherence. The middle-aged
and older age-groups (aged 45–59 and ≥60
years) had significantly greater adherence
in both metformin and placebo groups
than younger participants (aged 25–44
years).
56. The metformin group, as expected, had
lower adherence than the placebo group
in each age category, presumably
because of its gastrointestinal side effects.
Women were significantly less adherent
than men in the metformin group only (68
vs. 74%, P= 0.01). Among ethnicity/racial
groups, there were significant differences in
rates of adherence, with Caucasians
having the highest rates of adherence in
both arms.
57. In a Mexican cross-sectional study,
educational level was associated with
treatment adherence (Martinez et.al 2008).
Similar result showed with Khan’s group in
2012, but in the research made by Park’s
group in Korea (2010), they did not detect
this association.
58. Some studies have found an association
between socio-economic status and
adherence. Leichter (2005) states that there
are multiple issues that contribute to
whether a diabetic patient adheres to the
prescribed treatment – cost is one. A study
on Cost-related Nonadherence to
medications among patients with diabetes
and chronic pain by Kurlander et al
supports this statement.
59. Patients’ income was significantly
associated with adherence behavior.
Compared with higher income patients,
lower-income patients were three times as
likely to cut back on both medication types
(13.1%) and selectively on chronic pain
medications (2.4%) but only slightly more
likely to cut back on their diabetes
medications (14.6%) (Kurlander et. al, 2009).
60. b. Psychological factors
Psychological factors are also linked with
regimen compliance. Appropriate health
beliefs, such as perceived seriousness of
diabetes, vulnerability to complications, and
the efficacy of treatment, can predict better
adherence, (Skinner et. al, 2001; Guthrie et.
al, 2003, Park et. al, 2010).
61. Patients adhere well when the treatment
regimen makes sense to them, when it seems
effective, when they believe the benefits
exceed the costs, when they feel they have
the ability to succeed at the regimen, and
when their environment supports regimen-
related behaviors(Guthrie et. al, 2003).
62. c. Social factors
The presence of family members and the
quality of relationship with the diabetic
patient play an important role in managing
their health. Studies have shown that low
levels of conflict, high levels of cohesion and
organization, and good communication
patterns are associated with better regimen
adherence (Delamater et. al, 2001).
63. This study is also supported by the results
obtained by Garay-Sevilla et. al. In their
paper, they claimed that adherence to
medication and diet in NIDDM patients are
strongly associated with social support from
spouse and family members.
64. d. Health care provider and medical
system factors
Physicians and nurse practitioners working
in teams can improve both diabetes
patient care and clinical outcomes. Nurses
who provide support to their diabetic
patients increase the chance of improving
their health status through counseling and
health education (Kang et.al 2010).
Another study showed that having regular,
frequent contact with patients by
telephone promoted regimen adherence
and achieved improvements in A1c
compared with print intervention.
65. It was also noted that greater intensity of
the intervention (6 calls) was associated
with greater improvement in A1C (Walker
et. al, 2011). In January 2012, a recent
study revealed that telephone coaching is
effective lowcost method to improve self
management of diabetes among residents
in three rural Washington counties
(Maclean et.al, 2012).
66. Aside from obtaining support from the
health care providers, the quality of
patientphysician relationship is an
important key determinant in therapeutic
adherence. (Delamater, 2006 & Khan et. al,
2012).
Research has demonstrated that patients
who are satisfied with their relationship with
their health care providers have better
adherence to diabetes regimens.
67. e. Disease- and treatment-related factors
Studies have generally shown that
adherence is influenced by the acute or
chronic health status, varied symptoms,
complexity of medication and lifestyle
changes (Delamater, 2006).
68. According to Khan et. al (2012), there is a
high rate of noncompliance to anti
diabetic treatment and regimen. Factors
associated with noncompliance are
related to appointment schedule, exercise
and diet regimen. Two main reasons why
majority of patients could not make it on
the said appointment are due to
unavailability of transport and forgetfulness.
69. It was also reported that Patientphysician
relationship emerged as an important
factor in compliance. Patients who have
adequate information about the
medication in terms of dose, duration of
action and side effects have fairly high
compliance rate compared to those who
doesn’t understand the information
instructed by the doctor.
70. Complex medication regimens are a
significant barrier to medication adherence.
The use of multiple medications is often
required and beneficial in helping patients
with diabetes achieve optimal blood
glucose, blood pressure, and lipid control
and manage other diabetesrelated
complications and comorbidities. It is not
uncommon for a patient with diabetes to
be appropriately prescribed five or more
medications.
71. Furthermore, studies with diabetic patients
indicate better adherence to simpler
regimens than to more complex ones.
Delamater et. al, (2001) reported that
among the factors associated with
medication adherence, adherence with a
simple prescription is higher than that for a
more complex prescription. This remains true
with the study of Park et. al (2010) where in
adherence with medication of 1
antidiabetic drug per day was higher than
with more than 2 drugs.
73. For the Diabetic Patients in
Occupational Setting
The results of this study can serve as
awareness for the Diabetic Patients in
Occupational setting for them to become
aware of the common factors that might
affect their compliance with the diabetic
therapy regimen. This in turn can serve as
the beginning of possible changes in their
therapeutic compliance and self
knowledge.
74. For the Occupational
Health Professionals
The factors identified by this study can
serve as a guide to Occupational Health
Professionals in dealing with Diabetic
Clients and individualizing their
management towards a successful
medical therapy.
75. For the Health Community
The findings of this research can further add
to the knowledge of individual patient
care. Furthermore, the knowledge obtained
from this research can revolutionize
assessment of the factors in determining
patient compliance in diabetic
management, and probably in any
medical management that involves a
patient.
76. For the researchers
Other researchers can use the results in making
similar investigations. This study will serve as a
springboard for them to begin inquiry. Furthermore,
this could open the interest of researchers,
especially health researchers, to focus their
attention in other aspects of care management
that is outside the clinical area.
77. For the employers
This research can serve as enlightenment to
employers, hiring or currently hiring diabetic
patients. Furthermore, the factors identified
by this research can help employers better
improve the planning and implementation
of certain health policies within their
organization especially in those employees
with lifestylerelated diseases such as
diabetes.
78. In general, the study serves as an
additional input to the body of knowledge
that will broaden our perception about
diabetes and its management.
80. General Objective
The main objective of this study is to
identify factors that affect drug
compliance in a type 2 diabetic patient
in a selected occupational setting.
81. Specific Objectives
1. To determine the association of drug
compliance among diabetic patients in
terms of:
Age, Gender, Marital Status, Educational
Background, Economic Status, Familial
History of DM, and Health Status.
2. To assess whether the patients are
compliant or noncompliant in taking their
medications.
3. To determine the complexity of drug
medication taken by diabetic patients.
83.
FIGURE 1. Factors Related Variables Affecting Drug
Compliance of Diabetic Patients
TYPE II DIABETIC PATIENT
PERSONAL PROFILE
• Age
• Gender
• Civil Status
• Educational
Attainment
• Economic Status
• Health Status
• Complexity of
Pharmacological
regimen
• Psychological Factors
• Social Factors
• Health Care
Provider/Medical
System Factors
• Disease and Treatment-
related Factors
•
DRUG COMPLIANCE
Compliant
or
Non-compliant
84. Fig. 1 shows the relationship of patient’s
personal profile and Health status that may
influence drug compliance. The patient’s
personal profile, health status and drug
compliance are presented and described.
It is assumed that drug compliance is
affected by variations on the personal
profile and health status. Patient can be
compliant or noncompliant. On the other
hand, it is assumed that being compliant or
noncompliant can affect the health status
of the patient and in the same manner
changes in the health status affects
compliance.
87. This study will use the descriptive method. This
method seeks to know the characteristics of
the phenomenon and categorize into some
descriptive terms. This method tends not to
penetrate the data in any interpretative
depth (Sandelowski, 2000).
More specifically, this study is a Descriptive
Correlational study because it will attempt to
describe the relationship between the
independent and dependent variables
identified in the study.
89. This study will focus on Diabetic Patients in
an Occupational Heath Setting,
particularly in a bottling and
manufacturing company located in
Industrial Estate in Canlubang which is a
major industrial zone located in the
province of Laguna, Philippines.
90. The site consists of 425 employees, 320
males and 105 females working in different
plant departments such as Sales, Supply
Chain, Finance, Human Resources,
Logistics and Center of Excellence within
the 2055 years old bracket. All of which
will be screened based on the criteria set
by the researchers for possible inclusion in
the study.
92. Purposive sampling will be utilized for this
study.
Purposive sampling or judgmental is based
on the belief that researcher’s knowledge
about the population can be used to hand
pick sample members (Polit & Beck,
Sampling Designs, 2003).
93. In order to attain homogeneity among the
respondents and to control extraneous
variables, the following criteria were the
basis in selecting the respondents.
94. 1. Diagnosed Diabetic employees working
in a manufacturing/bottling company in
Industrial Estate in Canlubang, Laguna.
2. Is currently taking oral antidiabetic
agents for not less than 3 years.
3. Does not receive any insulin preparation.
4. Has given his/her consent to participate
in the study.
5. Does not have any mental disability or
sensory handicap such as those who are
confused or disoriented during the
interview, blind or deaf.
95. Variables to be investigated
A. Dependent variable
The Dependent variable in this study is the
Compliance of Diabetic patients in
their Pharmacological regimen.
Dependent variable is the variable
hypothesized to depend on or be
caused by another variable (Polit &
Beck, 2004).
96. B. Independent variable
Independent variable is the variable that is
believed to cause or influence the
dependent variable (Polit & Beck, 2004).
The following Independent variables to be
identified in this study are as follows.
1. Personal Profile which includes the
following:
a. Age
b. Gender
c. Civil Status
d. Educational Attainment
e. Economic Status
97. f. Familial History of Diabetes Mellitus
2. Health Status of the Employees based
on:
a. Familial History of Diabetes
b. Length of time with Diabetes Mellitus
3. Complexity of Pharmacological regimen
4. Psychological Factors
5. Social Factors
6. Health Care Provider/Medical System
Factors
7. Disease and Treatment-related Factors
98. e. Economic Status
f. Familial History of Diabetes Mellitus
2. Health Status of the Employees based
on:
a. Length of time with Diabetes Mellitus
b. Presence of other chronic/lifestyle
diseases.
3. Complexity of Pharmacological regimen
4. Number of Medicines Taken per day.
100. The researcher will first prepare letters to be
addressed to the human Resources
Department or the Plant Manager or any
authorized head of the Manufacturing and
bottling company in Industrial Estate. Upon
approval, the researcher will personally go
to the plant clinic to identify the targeted
population which is the Diabetic patients. If
the site has no plant clinic, the researchers
would go on the site and ask employees
on who among them are diagnosed
diabetic patients. Based on the identified
employees, the researchers would decide
if the following employees fit the criteria of
this research.
101. Upon identification of the respondents that
fits the criteria, a survey tool would be
given for the employees to answer. An
explanation on the purpose of the study will
be given as well.
After finishing the questionnaire, the
researchers collect the questionnaires with
an assurance that the answers would be
treated with utmost confidentiality.
103. For this study, the researcher will be using a
questionnaire or SAQ (self-administered
questionnaire). The questionnaire will
address three keys areas: a determination
of perceived medication adherence,
personal profile and identification of
factors affecting compliance.
104. To test the perceived drug compliance of
the respondents, the researcher will adapt
the Morisky Medication Adherence
Questionnaire. It consists of an 8-item
questions that determine whether the
respondents have low, medium or high
adherence rate.
The questionnaire will consist of the
following sections:
105. a. A cover letter seeking for the
respondent’s consent in participating in the
study as well as assuring them of anonymity
and confidentiality of data and informing
them that there is no right or wrong answer;
b. A set of questions pertaining to the
respondents personal profile and health
status and;
c. A set of questions related to the
different types of factors affecting drug
compliance.
107. The researchers will be using SPPS for faster
and more accurate results. Through this,
the values for the following statistical
measures will be obtained.
1. Frequency and Percentage Distribution-
these tools will enable the researchers to
present summary distributions of data in
categories of values expressing the
frequency and percentage of
occurrence.
108. 2. Mean – the most widely used measure of
the central tendency. Mean is a
numerical value that in some sense
represents the central value of a set of
numbers. Mean is the sum of all scores,
divided by the number of scores.
Weighted mean can be best defined or
explained by illustrating its process of
calculation.
109. Weighted mean is solved using the following
formula:
Weighted mean is very useful tool in summarizing
the responses of respondents from a survey
questionnaire.
∑(XW)
Wtd = –––––––
∑W
Where:
Wtd is the weighted mean.
X is the individual score or value
W is the weight
∑(XW) is the sum of the products of X and
W.
∑W is the sum of the weights.
110. 3. Standard deviation- shows how much
variation or "dispersion" exists from the
average (mean, or expected value). A
low standard deviation indicates that the
data points tend to be very close to
the mean, whereas high standard
deviation indicates that the data points
are spread out over a large range of
values.
111. 4. Correlational Coefficient (r) – this tool will
be used to test the hypothesis of the
study. It measures the extent or strength
of relationship between 2 numerical
variables based on a correlation
coefficient that ranges from 0 to + 1. The
closer the value to 1 the stronger the
relationship between 2 variables while
the closer it is to zero, the more unrelated
the variables are.
112. The SPSS package will simplifies further data
analysis as it readily determines whether
the computed r is significant or not at
specified level of significance.
114. 7 8 9 10 11 12 1 2 3 4 5
1. Literature review
2. Designing materials
3. Learning how to use method
4. Designing questionnaire
5. Finding participants
7. Analyzing data
8. Submission of thesis proposal
9. Fine tune research question and
methodology
10. Prepare research tools in detail
11. Make contacts for
questionnaires/Running tests
12. Data collection
13. Data analysis
14. Writing up of thesis
15. Thorough proof-reading by an
adviser
16. Revision, editing, and printing of
thesis
17. Submission of thesis
18. Thesis defense
Activities
2012 2013
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Kaan Tuncelli, C. B., & Lafata, &. J. (2005). The Impact of Diabetes on Employment and
Work Productivity.
Kang J., C. S. (2010). Effects of a continuous diabetes lifestyle intervention program in
male workers in korea. Diabetes Research and Clinical Practice , 26-33.
Kaylango J., O. E. (2008). Non-adherence to diabetes treatment at Mulago Hospital in
Uganda: Prevalence and Associated Factors. African Health Sciences , 67-73.
Khan. (2012). Factors Contributing to Non-Compliance Among Diabetics attending
Primary Health Care Centers in the Al Hasa District of Saudi Arabia.
Khan. (2012). Factors Contributing to Non-Compliance among Diabetics attending
Primary Health Centers in the Al Hasa District of Saudi Arabia.
Kurlander, J. E., Merr, E. A., & Krein, S. (2009, September 3). Cost-Related
Nonadherence to Medications Among Patients With Diabtes and Chronic Pain.
Diabetes Care 2009 Vol. 32 no. 12 , 2143-2148.
Leichter, S. B. (2005). Outpatient Care of Diabetes More Efficient: Analyzing
Noncompliance. Clinical Diabetes Vol. 23 No. 4 , 187-190.
Maclean L., W. J. (2012). Telephone Coaching to Improve Diabetes Self-Management
for Rural Residents. Clinical Diabetes , 13-16.
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Park K., K. J. (2010). Factors that Affect Medication Adherence in Elderly Patients with
the Diabetes Mellitus. Korean Diabetes Journal , 55-65.
Patel. (2010). Medication Adherence in Low Income Elderly Type 2 Diabetes Patients: A
retrospective Cohort Study.
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Polit, D. F., & Beck, C. T. (2004). Key Concepts and Terms in Qualitative and Quantitative
Research. In D. F. Polit, & C. T. Beck, Nursing Research: Principles and Methods Seventh
Edition (pp. 29-31). New York: Lippinocott Williams & Wilkins.
Polit, D. F., & Beck, C. T. (2003). Sampling Designs. In D. F. Polit, & C. T. Beck, Nursing
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Sandelowski, M. (2000). What happened to qualitative description? In Research in
Nursing & Health (pp. 334-340).
Skinner C., H. S. (2001). Personal Models of Diabetes in Relation to Self-Care, Well-Being,
and Glycemic Control. Diabetes Care , 828-833.
(2003). The Merck Manual of Medical Information. Merck & Co.,Inc.
Wabe N., A. M. (2011). Medication adherence in diabetes mellitus and self
management practices among type-2 diabetics in Ethiopia. North American Journal of
Medical Sciences , 418-423.
Walker E., S. C. (2011). Results of a Successful Telephonic Intervention to Improve
Diabetes Control in Urban Adults. Diabetes Care , 2-7.
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Insulin Dependent Diabetes Mellitus. Joumal of Diabetes and Its Complications , 81-86.
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121. Jin, J., & Sklar, G. E. (2008). Factors Affecting Therapeutic Compliance: A review from
the patient's perspective. Therapeutics and Clinical Risk Management . Callaghan,
Australia: Dove Medical Press Limited.
Jin, J., Sklar, G. E., Oh, V. M., & Li, S. C. (2008). Factors affecting therapeutic
comliance: A review from the patient's perspective. Callaghan, Australi: Dove
Medical Press Limited.
Kaan Tuncelli, C. B., & Lafata, &. J. (2005). The Impact of Diabetes on Employment
and Work Productivity.
Kang J., C. S. (2010). Effects of a continuous diabetes lifestyle intervention program in
male workers in korea. Diabetes Research and Clinical Practice , 26-33.
Kaylango J., O. E. (2008). Non-adherence to diabetes treatment at Mulago Hospital
in Uganda: Prevalence and Associated Factors. African Health Sciences , 67-73.
Khan. (2012). Factors Contributing to Non-Compliance Among Diabetics attending
Primary Health Care Centers in the Al Hasa District of Saudi Arabia.
Khan. (2012). Factors Contributing to Non-Compliance among Diabetics attending
Primary Health Centers in the Al Hasa District of Saudi Arabia.
Kurlander, J. E., Merr, E. A., & Krein, S. (2009, September 3). Cost-Related
Nonadherence to Medications Among Patients With Diabtes and Chronic Pain.
Diabetes Care 2009 Vol. 32 no. 12 , 2143-2148.
Leichter, S. B. (2005). Outpatient Care of Diabetes More Efficient: Analyzing
Noncompliance. Clinical Diabetes Vol. 23 No. 4 , 187-190.
Maclean L., W. J. (2012). Telephone Coaching to Improve Diabetes Self-Management
for Rural Residents. Clinical Diabetes , 13-16.
122. Martinez Y., P.-A. R.-P. (2008, July 30). Quality of life associated with treatment
adherence in patients with type 2 diabetes: A cross-sectional study. BMC Health
Services Research.
Nursing Pharmacology Made Incredibly Easy! (2005). lippincott Williams & Wilkins.
Oberlinner, C., & Neumann, S. (2007). Screening for Pre-Diabetes and Diabetes in the
workplace. Oxford Journals of Occupational Medicine , 41-45.
Park K., K. J. (2010). Factors that Affect Medication Adherence in Elderly Patients with
the Diabetes Mellitus. Korean Diabetes Journal , 55-65.
Patel. (2010). Medication Adherence in Low Income Elderly Type 2 Diabetes Patients: A
retrospective Cohort Study.
Pazzibugan, D. (2008, November 11). Diabetes Rising among Filipinos. Philippine Daily
Inquirer .
Polit, D. F., & Beck, C. T. (2004). Key Concepts and Terms in Qualitative and
Quantitative Research. In D. F. Polit, & C. T. Beck, Nursing Research: Principles and
Methods Seventh Edition (pp. 29-31). New York: Lippinocott Williams & Wilkins.
Polit, D. F., & Beck, C. T. (2003). Sampling Designs. In D. F. Polit, & C. T. Beck, Nursing
Research, Principles and Methods 7th Edition (pp. 292-295). Lippincott, Williams &
Wilkins.
Sandelowski, M. (2000). What happened to qualitative description? In Research in
Nursing & Health (pp. 334-340).
Skinner C., H. S. (2001). Personal Models of Diabetes in Relation to Self-Care, Well-Being,
and Glycemic Control. Diabetes Care , 828-833.
(2003). The Merck Manual of Medical Information. Merck & Co.,Inc.
123. Wabe N., A. M. (2011). Medication adherence in diabetes mellitus and self-management
practices among type-2 diabetics in Ethiopia. North American Journal of Medical
Sciences , 418-423.
Walker E., S. C. (2011). Results of a Successful Telephonic Intervention to Improve Diabetes
Control in Urban Adults. Diabetes Care , 2-7.
World Diabetes Foundation. (2012, March 15). Diabetes Facts. Retrieved 15 2012, June,
from World Diabetes Foundation: http://www.worlddiabetesfoundation.or/composite-
35.htm
