BASELINE ADHERENCE SEVERITY, BEHAVIORAL DOMAINS, DISC ASSESSMENT, AND PREDICTORS OF RESPONSE TO PATIENT COUNSELLING IN DIABETES MELLITUS, HYPERTENSION, AND TUBERCULOSIS: A PROSPECTIVE INTERVENTIONAL STUDY

Abstract

Background: Medication adherence is an evolving behavior influenced by information, habit, symptom interpretation, health convictions, communication style, and behavioral tendencies. Although counselling has been shown to improve adherence in chronic disease, relatively little is understood about which adherence domains are most responsive, which groups of patients benefit most, whether response varies by baseline adherence severity, and how behavioral profiling tools such as DISC assessment may support patient-specific counselling. The present study assessed changes in adherence domains in patients with diabetes mellitus (DM), hypertension (HTN), and tuberculosis (TB), with baseline behavioral profiling using DISC assessment. Methods: This study was a prospective interventional study of 387 adult patients undergoing long-term treatment for DM (n=161), HTN (n=153), or TB (n=73). Baseline measures included a socioeconomic classification (Kuppuswamy scale) and a behavioral profiling (DISC assessment). DISC assessment was performed to characterize broad behavioral tendencies that may influence communication preference, medication-taking behavior, receptivity to counselling, and self-management practices. A six-item study specific Morisky-derived adherence composite comprising information on forgetfulness, carelessness, symptom driven discontinuation, knowledge of long-term treatment benefit, and refill discipline was used to assess adherence. Following the baseline evaluation, structured patient counselling was provided. Follow-up adherence was reassessed on day 60 (±10 days). Non-parametric paired and between-group analyses were conducted; multivariable linear regression was used to identify independent predictors of adherence change. Results: Overall adherence went from 2.33±1.59 at baseline to 4.75±1.28 at follow-up (Wilcoxon p<0.0001; effect size r=0.707). Knowledge of long-term treatment benefit had the highest absolute item-level gain (+49.1 percentage points), followed by carelessness (+43.9 points), forgetfulness (+41.6 points), and timely refill behavior (+39.0 points). Poor baseline adherence significantly improved the mean score by a value of 3.94±1.29 compared to moderate adherence of 1.05±1.37; while good baseline adherence showed a ceiling effect ( 1.83±2.23; Kruskal-Wallis H=253.082, p<0.0001). Patients with diabetes had more absolute improvement than HTN and TB patients (H=93.837; p<0.0001). Baseline adherence score was the only independent change predictor maintained (β=-1.237, 95% CI −1.368 to −1.105; p<0.0001) using adjusted analysis. DISC assessment was introduced to be an exploratory behavioural profiling tool that may be useful for interpreting counselling receptivity and possibility for counseling personalization, although DISC category was not established as an independent predictor of adherence change in the present analysis. Conclusion: Structured patient counselling led to significant short-term benefits for medication adherence improvements, especially among low baseline adherence patients and in patients with diabetes. Counselling seemed to work via improved treatment understanding and correction of routine behavioral lapses. Baseline adherence severity may be the most clinically relevant marker in identifying adherence interventions. DISC assessment could serve as an additional behavioral framework for modifying communication and counselling style, but further DISC-stratified analysis is required to find its independent predictive value.