The document discusses a quality improvement project that aims to improve medication adherence among type 2 diabetic patients receiving home healthcare. It will evaluate the effectiveness of implementing resources from the New York City Department of Health and Mental Hygiene Medication Adherence Project (MAP). A quantitative methodology will be used to compare pre-and post-implementation medication adherence rates. Nurses will provide MAP resources to patients over 4 weeks and record adherence data in electronic medical records. The project intends to help patients better manage their condition and reduce healthcare costs.

1. Improving Medication Adherence among Type II Home
Healthcare Diabetic Patients
1
Improving Medication Adherence among Type II Home
Healthcare Diabetic Patients
by
Bola Odusola-Stephen
Investigator's Background
The primary investigator is a registered nurse with 18 plus years
experience in home healthcare. Also have experience in dealing
with Type II diabetic patients and medication adherence issues.
Investigator works as a registered nurse in the home healthcare
setting.
3

2. Topic Background
The topic on medication adherence among diabetic home
healthcare patients using the MAP resources was chosen
because there is a continue steady rise in chronic diseases that
has resulted in more patient care options (Polonsky & Henry,
2016).
Home-based healthcare has existed since 1909 (Choi et al.,
2019). Present-day, home-based healthcare is often selected
due to an individual’s personal preferences.
While home-based healthcare is not appropriate for all patients,
Szanton et al. (2016) noted that this care option is best when an
individual’s condition can be managed without admission to a
hospital.
The topic on medication adherence among diabetic home
healthcare patients using the MAP resources was chosen
because there is a continues steady rise in chronic diseases has
resulted in more patient care options (Polonsky & Henry, 2016).
Home-based healthcare has existed since 1909 (Choi et al.,
2019). Present-day, home-based healthcare is often selected
due to an individual’s personal preferences. While home-based
healthcare is not appropriate for all patients, Szanton et al.
(2016) noted that this care option is best when an individual’s
condition can be managed without admission to a hospital.
4
Topic background
There is the need of addressing the lack of adherence to
medication among type II diabetes patients.

3. The project will address the lack of adherence through the
implementation of the MAP resources and evaluate the
effectiveness.
There is the need of addressing the lack of adherence to
medication among type II diabetes patients. The project will
address the lack of adherence through the implementation of the
MAP resources and evaluate the effectiveness.
5
Problem Statement
It is not known if or to what degree the implementation of the
New York City Department of Health and Mental Hygiene
Medication Adherence Project (MAP) resources impact patient
medication adherence rates when compared to current practice
among Type II diabetic home healthcare patients in urban
Texas.
According to the healthcare agency’s electronic health record
(EHR), home healthcare providers documented that ten percent
of diabetic home healthcare patients are not adhering to their
medication regimen.
Medication non-adherence can be ascribed to a lack of drug-
related knowledge, high prescription prices, and a lack of
understanding of the medication regimen. This is why
reinforcing the need for this quality improvement project
(Heath, 2019; Sharma et al., 2020).
Healthcare providers play a key role in medication adherence
and the adherence is improved through introduction for

4. standardized method for healthcare providers to assess patient’s
medication adherence.
Medication adherence for among type II diabetic patients in an
urban healthcare agency in Texas. According to the healthcare
agency’s electronic health record (EHR), home healthcare
providers documented that ten percent of diabetic home
healthcare patients are not adhering to their medication
regimen.
Medication non-adherence can be ascribed to a lack of drug-
related knowledge, high prescription prices, and a lack of
understanding of the medication regimen that is why reinforcing
the need for this quality improvement project (Heath, 2019;
Sharma et al., 2020). Healthcare providers play a key role in
medication adherence and the adherence is improved through
introduction for standardized method for healthcare providers to
assess patient’s medication adherence.
6
Importance of the project
The project would increase type II diabetic patient adherence to
medication that translates to a better treatment outcome and
increase in recovery rate.
The project also assists healthcare providers in effectively
responding to medication questions and patient concerns, as
well as ensuring that patients maintain track of their
prescription regimen, resulting in fewer adverse occurrences.
The project would improve the quality of patient care received
and decrease hospitalization and incurring financial costs.

5. The project would increase the type II diabetic patient
adherence to medication that translates to a better treatment
outcome and increase in recovery rate. The project also assists
healthcare providers in effectively responding to medication
questions and patient concerns, as well as ensuring that patients
maintain track of their prescription regimen, resulting in fewer
adverse occurrences. The project would improve the quality of
patient care received and decrease hospitalization and incurring
financial costs.
7
Theoretical Foundation
This quality improvement project will be guided by Orem's self-
care deficit theory.
The theory was chosen because it assumes that a person must be
self-sufficient and accountable for their own care (Orem, 1985).
Self-care, according to Dorothea Orem's thesis, is an action that
a person does to preserve, restore, or improve their health
(Orem, 1985).
Patients should not be viewed as passive recipients of
healthcare, according to the theory; rather, they should be
viewed as trustworthy, responsible adults who can make
educated decisions and participate actively in their health
treatment (Orem, 1985).

6. This quality improvement project will be guided by Orem's self-
care deficit theory. The theory was chosen because it assumes
that a person must be self-sufficient and accountable for their
own care (Orem, 1985). Self-care, according to Dorothea
Orem's thesis, is an action that a person does to preserve,
restore, or improve their health (Orem, 1985). Patients should
not be viewed as passive recipients of healthcare, according to
the theory; rather, they should be viewed as trustworthy,
responsible adults who can make educated decisions and
participate actively in their health treatment (Orem, 1985).
8
Change model
Roger’s diffusion of innovation theory
Knowledge or awareness
Persuasion or interest
Decision or evaluation
Implementation or trial
Confirmation or adoption (Rogers, 2003)
Diffusion is defined as a social process, which occurs among
individuals in response to knowledge regarding a new strategy
for improving their health (Dearing & Cox, 2018). It is also the
process communicated within a specific timeframe (four weeks)
(Dearing & Cox, 2018). This change model can provide the
primary investigator with methods to share and educate
regarding a new diabetic prevention strategy (Lien & Jiang,
2016).
9
Review of the literature

7. Patient-related factors
The World Health Organization (2017) stated patient related
factors encompass an individual’s resources, knowledge levels,
belief system, perspectives, and expectations.
Type II diabetes management involves not just medication
adherence but observance to monitoring diet and exercise,
follow-up, and self-care (Nduaguba et al., 2017).
Medication adherences
Providers can avoid medication non-adherence by learning
about their patients' needs and providing them with resources to
help them overcome non-adherence.
Non-pharmacological Indicators
All Type II diabetics should consider non-pharmacological
treatment options. Nutrition and exercise may be included in the
measures. Nutritional therapies are essential for a diabetic to
maintain an ideal glucose level (80-120mg).
Intervention
In order to improve adherence in various ways and achieve self-
efficacy among varied patients, it is critical to use techniques
and instruments that are considered effective and acceptable.
Positive family and social support are important factors in
sticking to a diabetic care plan (Rodrguez-Saldana, 2019).
Medication adherences
Providers can avoid medication non-adherence by learning
about their patients' needs and providing them with resources to
help them overcome non-adherence.
Non-pharmacological Indicators
All Type II diabetics should consider non-pharmacological

8. treatment options. Nutrition and exercise may be included in the
measures. Nutritional therapies are essential for a diabetic to
maintain an ideal glucose level (80-120mg).
Intervention
In order to improve adherence in various ways and achieve self-
efficacy among varied patients, it is critical to use techniques
and instruments that are considered effective and acceptable.
Positive family and social support are important factors in
sticking to a diabetic care plan (Rodrguez-Saldana, 2019).
10
Review of the literature
Medical Adherence Project
MAP serves patient populations impacted by several chronic
diseases (Starr & Sacks, 2010). The resources provide practical
tools to help practitioners communicate with patients related to
medication adherence.
Patient Advocacy
Advocacy is a vital aspect in healthcare since it addresses the
needs of the patient who need the utmost help and care, thereby
allowing them to go back to their previous health state
(D’Onofrio et al., 2018).
Advocacy is an aspect that can be referred to as active support,
as well as engagement, that aims to effectively develop a cause
as well as a policy (Mollaoglu, 2018).
Socioeconomic Factors
Socioeconomic-related factors that affect medication adherence
include one’s location of residence, medical costs of treatment,
and finances (Yeam et al., 2018).
Other factors that could influence medication adherence are low
health literacy, education level, lack of social support, living
conditions, and medication costs (Hennessey & Peters, 2019).

9. Medication Cost
Cost-related medication nonadherence (CRMN) is defined as
taking medication then indicated or prescribed due to costs
(Kang et al., 2018).
Social Support
However, Linni et al. (2015) emphasized that social support
must be considered a core component in interventions that
improve the management of Type II diabetic patients.
MAP serves patient populations impacted by several chronic
diseases (Starr & Sacks, 2010). The resources provide practical
tools to help practitioners communicate with patients related to
medication adherence. Advocacy is a vital aspect in healthcare
since it addresses the needs of the patient who need the utmost
help and care, thereby allowing them to go back to their
previous health state (D’Onofrio et al., 2018). Advocacy is an
aspect that can be referred to as active support, as well as
engagement, that aims to effectively develop a cause as well as
a policy (Mollaoglu, 2018). Socioeconomic-related factors that
affect medication adherence include one’s location of residence,
medical costs of treatment, and finances (Yeam et al., 2018).
11
clinical Question
To what degree the implementation of the New York City
Department of Health and Mental Hygiene Medication
Adherence Project (MAP) resources, which include (1) the
questions to ask poster, (2) adherence assessment pad, and (3)
my medications list, impact patient medication adherence rates
when compared to current practice among Type II diabetic home

10. healthcare patients of a home healthcare agency in urban Texas
over four weeks?
Methodology
A quantitative methodology
Numerical data being used (Creswell & Creswell, 2018)
Data presented using figures, graphs, charts, and tables
Will compare the medication adherence rates (pre-
implementation/post-implementation)
A quantitative methodology will be used for this quality
improvement project. According to Creswell and Creswell
(2018), a quantitative methodology is appropriate for projects
that use data in its numerical form. For this project, the data
will be presented using figures, graphs, charts, and tables. This
will allow the readers to compare the medication adherence
rates pre-implementation and post-implementation of the
project.
13
Specifics on Methodology
Variables
Medication adherence, which is the dependent variable explored
in this project, will be measured using data attained through the
project site’s EHR.
The MAP resources, which serve as the independent variables

11. explored in this project, include (1) the Questions to Ask
Poster, (2) an Adherence Assessment Pad, and (3) the My
Medications List.
Participants
The targeted population are home health patients ages 35 to 64
years old. The selected site serves approximately 100 patients
annually.
The inclusion criteria are males and females diagnosed with
Type II diabetes, oral medication or insulin, and home health
patients.
The exclusion criteria are individuals with language or
cognitive deficits and diagnosed with Type I diabetes.
Five registered nurses will help to implement the project. They
are individuals who work full-time and have been employed
over a year.
Medication adherence, which is the dependent variable explored
in this project, will be measured using data attained through the
project site’s EHR.
The MAP resources, which serve as the independent variables
explored in this project, include (1) the Questions to Ask
Poster, (2) an Adherence Assessment Pad, and (3) the My
Medications List.
Participants
The targeted population are home health patients ages 35 to 64
years old. The selected site serves approximately 100 patients
annually. The inclusion criteria are males and females

12. diagnosed with Type II diabetes, oral medication or insulin, and
home health patients. The exclusion criteria are individuals with
language or cognitive deficits and diagnosed with Type I
diabetes. Five registered nurses will help to implement the
project. They are individuals who work full-time and have been
employed over a year.
14
Reliability and Validity
Reliability refers to the consistency of instrument measuring
something (Creswell & Creswell, 2018).
If the same results occur regularly by using the same procedures
under the same conditions, the measurement is reliable
(Creswell & Creswell, 2018).
For this project, the MAP toolkit reliability was confirmed by
inter-rater reliability (Starr & Sacks, 2010).
The observers noted the same results associated with using the
instrument, which aligned with the literature findings regarding
collecting data for medication adherence rates.
Validity conveys how accurate a method is measured (Creswell
& Creswell, 2018).
If the method measures what it should and the findings
correspond closely, it is considered valid. There are four types
of validity are constructs, content, face, and criterion (Creswell
& Creswell, 2018).
For this project, construct and face validity is applicable to the
instrument.

13. Reliability refers to the consistency of instrument measuring
something (Creswell & Creswell, 2018). If the same results
occur regularly by using the same procedures under the same
conditions, the measurement is reliable (Creswell & Creswell,
2018). Validity conveys how accurately a method is measured
(Creswell & Creswell, 2017). If the method measures what it
should and the findings correspond closely, it is considered
valid. There are four types of validity are constructs, content,
face, and criterion (Creswell & Creswell, 2018). For this
project, construct and face validity is applicable to the
instrument.
15
Data Collection Methods
Once the Grand Canyon University IRB gave approval
During week one, the nurses will provide the patients with
informed consent, answer questions related to the project, a
five-item demographic survey, and a pre-MAP survey.
The second to fourth week, the nurses will examine the patient’s
medication list and adherence (ten minutes).
Each week the nurses will record the medication adherence
information in the patient’s electronic medical record.
During week one, the nurses will provide the patients with
informed consent, answer questions related to the project, a
five-item demographic survey, and a pre-MAP survey. The
second to fourth week, the nurses will examine the patient’s
medication list and adherence (ten minutes). Each week the
nurses will record the medication adherence information in the
patient’s electronic medical record.
16

14. Data Analysis
Data extracted from Cradle
Solution
s documentation software
Medication adherence rates for comparative and implementation
groups
Chi-square analysis used
The facility uses Cradle