Development of a Medication Compliance Determinant Instrument for Low-Middle Literate Patients with Type 2 Diabetes Mellitus

Ivans Panduwiguna, Rani Sauriasari, Ratu Ayu D Sartika, Woro Riyadina, Fransiskus Samuel Renaldi


Diabetes, a leading cause of 6.7 million deaths in 2021, poses a significant challenge despite existing interventions. Non-adherence to treatment remains a barrier to diabetes management. However, a comprehensive instrument to assess medication adherence determinants in diabetes patients’ population in Indonesia with low-medium literacy levels and following the sociocultural characteristics of Indonesian society has been lacking. This study aimed to develop and evaluate a valid and reliable instrument for measuring medication adherence in type 2 diabetes mellitus patients based on the Borg and Gall model. Through the input of an expert panel, a valid and reliable instrument was developed, which comprised 21 questions and encompassed all medication adherence determinants, with a CVR and CVI value of 1 and a final Cronbach’s alpha value of 0.731. This instrument is still being tested and needs to be implemented in the right and wider population to obtain more accurate results.


compliance; determinants; development; type 2 diabetes mellitus; questionnaire

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  1. International Diabetes Federation. IDF Diabetes Atlas Ninth edition 2019. Brussels: International Diabetes Federation; 2019.

  2. Pusat Data dan Informasi Kementerian Kesehatan Republik Indonesia. Infodatin Tetap Produktif, Cegah, dan Atasi Diabetes Mellitus. Jakarta: Kementerian Kesehatan Republik Indonesia; 2020.

  3.Ningrum WA, Muthoharoh A, Qoyimah M. Analisis Biaya Pengobatan Pasien Diabetes Mellitus Rawat Jalan Di RSUD Kraton Pekalongan.Pena J Ilmu Pengetah Teknol. 2019; 33 (1): 15-21.

  4. Dyah RI, Wahyono D, Andayani TM. Analisis Biaya Terapi Pasien Diabetes Melitus Rawat Inap. J. Manaj. Dan Pelayanan Farm. J. Manag. Pharm. Pract. 4, 55–62 (2014).

  5. Badan Penelitian dan Pengembangan Kesehatan. Hasil Utama Riskesdas 2018. Jakarta: Kementerian Kesehatan Republik Indonesia; 2018.

  6. Bulu A, Wahyuni TD, Sutriningsih A. Hubungan Antara Tingkat Kepatuhan Minum Obat Dengan Kadar Gula Darah Pada Pasien Diabetes Melitus Tipe II. Nurs News J Ilmu Keperawatan. 2019; 4 (1): 181-189.

  7. Renaldi FS, Riyadina W, Qamar M, Sauriasari R. Interpersonal Relationship and Its Effect on Treatment Compliance in Patients with Type-2 Diabetes Mellitus. Pharm Sci Res. 2021; 8 (1): 37-46.

  8. Cahyadi H, Prayitno AA, Setiawan E. Reliabity and Validity of Adherence to Refill and Medication Scale (ARMS) in Indonesian Geriatric Population with Diabetes. In: IAGG Asia/Oceania, 19-22 October 2015, Chiang Mai, Thailand.

  9. Demirtaş A, Akbayrak N. Development of an assessment scale for treatment compliance in type 2 Diabetes Mellitus in Turkish population: Psychometric evaluation. Int J Nurs Sci. 2017; 4 (3): 244-251.

  10. Makkulawu A, Setiadi AP, Rahardjo TBW, Setiawan E. Analisis Profil dan Faktor-Faktor yang Memengaruhi Perilaku Kepatuhan Pengobatan untuk Pasien Diabetes Mellitus Lanjut Usia. J Kefarmasian Indonesia. 2019; 9 (2): 114–125.

  11. Effendi H, Hendriyani Y. Pengembangan Model Blended Learning Interaktif dengan Prosedur Borg and Gall. In: International Seminar on Education (ISE) 2nd, 20-21 October 2016, Padang, Indonesia.

  12. Hendarto P, Maridi M, Prayitno BA. Validity of guided inquiry-based modules on digestive system to improve argumentation skill. J Pendidik Biol Indonesia. 2019; 5 (1): 127-140.

  13. Mokhlesi S, Simbar M, Ramezani Tehrani F, et al. Quality of life questionnaire for women with gestational diabetes mellitus (GDMQ-36): Development and psychometric properties. BMC Pregnancy Childbirth. 2019; 19 (1): 454.

  14. Pezeshki MZ, Shadman A, Alizadeh M, et al. Validity and Reliability of the Questionnaire for Assessing Women's Reproductive History in Azar Cohort Study. J Caring Sci. 2017; 6 (2): 183-186.

  15. Rodrigues IB, Adachi JD, Beattie KA, MacDermid JC. Development and validation of a new tool to measure the facilitators, barriers and preferences to exercise in people with osteoporosis. BMC Musculoskelet Disord. 2017; 18 (1): 540.

  16. Aminde LN, Tindong M, Ngwasiri CA, et al. Adherence to antidiabetic medication and factors associated with non-adherence among patients with type-2 diabetes mellitus in two regional hospitals in Cameroon. BMC Endocr Disord. 2019; 19 (1): 35.

  17. Fernandez-Lazaro CI, García-González JM, Adams DP, et al. Adherence to treatment and related factors among patients with chronic conditions in primary care: A cross-sectional study. BMC Fam Pract. 2019; 20 (1): 132.

  18. Wibowo MINA, Yasin NM, Kristina SA, Prabandari YS. Systematic Review: Determinan Faktor yang Memengaruhi Kepatuhan Pengobatan Pasien Diabetes Tipe 2 di Indonesia. Media Penelit Pengemb Kesehat. 2021; 31 (4): 281–300.

  19. A P, Bd A, Wm Z, et al. Knowledge, Attitudes, Practices and Health Beliefs toward Leptospirosis among Urban and Rural Communities in Northeastern Malaysia. Int J Environ Res Public Health. 2018; 15 (11): 2425.

  20. Vluggen S, Hoving C, Schaper NC, de Vries H. Exploring beliefs on diabetes treatment adherence among Dutch type 2 diabetes patients and healthcare providers. Patient Educ Couns. 2018; 101 (1): 92-98.

  21. Fitriani Y, Pristianty L, Hermansyah A. Pendekatan Health Belief Model (HBM) untuk Menganalisis Kepatuhan Pasien Diabetes Melitus Tipe 2 dalam Menggunakan Insulin. Pharm J Farm Indonesia Pharm J Indonesia. 2019; 16 (2): 167–177.

  22. Almira N. Faktor-faktor yang Berhubungan dengan Perilaku Kepatuhan Minum Obat Anti Diabetes pada Penderita Diabetes Melitus Tipe 2 di Puskesmas Teluk Dalam Banjarmasin. 2022.

  23. Putri AH, Setiani LA, Nurdin NM. Analisis Faktor-Faktor yang Mempengaruhi Kepatuhan Penggunaan Obat Pasien Diabetes MellitusTipe 2 di Rumah Sakit PMI Kota Bogor. Proc Mul Pharm Conf. 2021; 13 (1): 41-48.

  24. Alqathama A, Alluhiabi G, Baghdadi H, et al. Herbal medicine from the perspective of type II diabetic patients and physicians: What is the relationship? BMC Complement Med Ther. 2020; 20 (1): 65.

  25. Meshesha SG, Yeshak MY, Gebretekle GB, et al. Concomitant Use ofHerbal and Conventional Medicines among Patients with Diabetes Mellitus in Public Hospitals of Addis Ababa, Ethiopia: A Cross-Sectional Study. Evid Based Complement Alternat Med. 2020; 2020: 4871459.

  26. Utomo AW, Annisaa E, Antari AL, Armalina D. The use of herbal medicines in patients with type-2 diabetes mellitus in Indonesia. Sains Med J Kedokt Kesehat. 2022; 13 (1): 12–17.

  27. Marpaung V, Trimawang Aji YG, Yenny. Overview of Diet in Diabetes Mellitus Patients at Cempaka Putih Public Health Center, Jakarta. JKM. 2022; 9 (2): 67-71.

  28. Padmasari S, Azizah FN, Larasati N. Edukasi Home Pharmacy Care terhadap Kepatuhan dan Kontrol Glukosa Darah pada Pasien Diabetes Melitus. J Sains Farm Klin. 2021; 8 (2): 182–189.

  29. Wahyuni KI, Rohmah MK, Setyawati H. Evaluasi Edukasi Personal dalam Pemahaman HBA1c dan Kualitas Hidup Pasien DM Tipe 2 di Sidoarjo. J Pharmascience. 2021; 8: 132–143.

  30. Adhikary G, Shawon MSR, Ali MW, et al. Factors influencing patients' satisfaction at different levels of health facilities in Bangladesh: Results from patient exit interviews. PLoS One. 2018; 13 (5): e0196643.

  31. Maulina E, Titin T, Candramila W. Student’s worksheet with guided inquiry approach on sub materials of endocrine system enriched with reducing process of diabetic blood sugar levels. Bioma J Ilm Biol.2022; 11 (2): 201-214. DOI: 10.26877/bioma.v11i2.11637

  32. Estofany F, Sitoayu L, Ronitawati P, et al. Testing of the "Gizinesia" Website as an Educational Media for Diabetes Mellitus Patients. IJMABER. 2023; 4 (4): 1365-1367.

  33. Tavassolmand SS, Montazeri A, Madadizadeh F, et al. Translation and validation of the Persian version of diabetic foot ulcer scale short form(DFS-SF). Int Wound J. 2023; 20 (3): 822-830.

  34. Winzap P, Davies A, Klingenberg R, et al. Diabetes and baseline glucose are associated with inflammation, left ventricular function and short- and long-term outcome in acute coronary syndromes: Role of the novel biomarker Cyr 61. Cardiovasc Diabetol. 2019; 18 (1): 142.

  35. Alghodaier H, Jradi H, Mohammad NS, Bawazir A. Validation of a diabetes numeracy test in Arabic. PLoS One. 2017; 12 (5): e0175442.

  36. Davoodi M, Jahanbani E, Khiavi FF, Nadaf M. Designing a Questionnaire to Measure Factors Affecting Utilization of Services for Diabetics in Health Centers Based on Social Marketing Model. Health Technol Assess Act. 2021; 5 (2).

  37. Svedbo Engström M, Leksell J, Johansson UB, et al. New Diabetes Questionnaire to add patients' perspectives to diabetes care for adults with type 1 and type 2 diabetes: nationwide cross-sectional study of construct validity assessing associations with generic health-related quality of life and clinical variables. BMJ Open. 2020; 10 (11): e038966.

  38. Wibowo MINA, Yasin NM, Kristina SA, Prabandari YS. A Systematic Review on Self-Reported Questionnaires to Assess Medication Adherence in Diabetic Patients. Malaysia J Public Health Med. 2021; 21 (2): 359–373.



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