Improving Medication Adherence Among Older Adults With Hypertension And Diabetes Mellitus Through Structured Education Supported By Stevia Sweetened Tea At Posyandu Lansia 9a Mojosongo, Surakarta

Gunawan Pamudji Widodo; Lucia Vita Inandha Dewi; Imam Prayitno; Salmaa Arifah Chofsoh

doi:10.63922/ijevss.v5i03.5960

Gunawan Pamudji Widodo Master's Programme in Pharmacy, Universitas Setia Budi, Surakarta, Indonesia
Lucia Vita Inandha Dewi Master's Programme in Pharmacy, Universitas Setia Budi, Surakarta, Indonesia
Imam Prayitno Master's Programme in Pharmacy, Universitas Setia Budi, Surakarta, Indonesia
Salmaa Arifah Chofsoh Master's Programme in Pharmacy, Universitas Setia Budi, Surakarta, Indonesia

DOI: https://doi.org/10.63922/ijevss.v5i03.5960

Keywords: medication adherence, older adults, medication counselling, MARS-5, Posyandu for older adults, stevia

Abstract

Medication non-adherence remains an important barrier to chronic disease management among older adults, while routine monitoring of medication-taking behaviour is not always integrated into community-based services for older adults. This community service programme aimed to improve medication adherence among older adults with hypertension and diabetes mellitus at Posyandu Lansia 9A Mojosongo, Surakarta, through structured education, individual counselling, and the introduction of Stevia Sweetened Tea as a habit-linked educational aid. A pre-experimental one-group pretest-posttest design involved 30 participants recruited through total sampling. Adherence was measured using the five-item Medication Adherence Report Scale (MARS-5), while the beverage contained 54.05% black tea and 45.95% stevia based on a published Response Surface Methodology model. All participants completed the programme. All MARS-5 items met the item-total correlation criterion (r = 0.641-0.866; p < 0.001), with good internal consistency (alpha = 0.809 pre-programme; alpha = 0.813 post-programme). The mean score increased from 17.47 ± 2.53 to 20.80 ± 2.54, yielding a mean difference of 3.33 points (95% CI 2.76-3.91; t(29) = 11.87; p < 0.001; Cohen's d = 2.17). This corresponded to a 19.1% relative increase and attainment of 83.2% of the maximum score. Substitution of the beverage composition into the reference equation produced an estimated alpha-amylase inhibition of 14.59%; this value was a literature-based extrapolation rather than a laboratory result. The increased adherence score followed the integrated programme, although causality and the contribution of each component cannot be established because the evaluation lacked a control group and relied on self-report.

References

Alfian, R., & Putra, A. M. P. (2017). Uji validitas dan reliabilitas kuesioner Medication Adherence Report Scale (MARS) terhadap pasien diabetes mellitus. Jurnal Ilmiah Ibnu Sina: Ilmu Farmasi dan Kesehatan, 2(2), 176–183.
Budianta, T. D. W., & Utomo, A. R. (2023). Case study: Optimization of antidiabetic properties of stevia black tea brewing. International Advanced Research Journal in Science, Engineering and Technology, 10(6), 613–618. https://doi.org/10.17148/IARJSET.2023.106103
Budianta, T. D. W., Utomo, A. R., & Raharjo, S. J. (2020a). Optimization of concentration of stevia leaves (Stevia rebaudiana Bert.) and black tea: Study on phytochemical composition and antioxidant activity of mixed stevia–black tea solution. IOP Conference Series: Earth and Environmental Science, 472, 012010.
Budianta, T. D. W., Utomo, A. R., & Raharjo, S. J. (2020b). Sensory evaluation of brewed black tea (Camellia sinensis sp.) and stevia (Stevia rebaudiana Bert.) leaves: Threshold of phenolic bitterness consumer preference test. International Advanced Research Journal in Science, Engineering and Technology, 7(1).
Chan, A. H. Y., Horne, R., Hankins, M., & Chisari, C. (2020). The Medication Adherence Report Scale: A measurement tool for eliciting patients’ reports of nonadherence. British Journal of Clinical Pharmacology, 86(7), 1281–1288. https://doi.org/10.1111/bcp.14193
Conn, V. S., Hafdahl, A. R., Cooper, P. S., Ruppar, T. M., Mehr, D. R., & Russell, C. L. (2009). Interventions to improve medication adherence among older adults: Meta-analysis of adherence outcomes among randomized controlled trials. The Gerontologist, 49(4), 447–462. https://doi.org/10.1093/geront/gnp037
Cross, A. J., Elliott, R. A., Petrie, K., Kuruvilla, L., & George, J. (2020). Interventions for improving medication-taking ability and adherence in older adults prescribed multiple medications. Cochrane Database of Systematic Reviews, 2020(5), CD012419. https://doi.org/10.1002/14651858.CD012419.pub2
Horne, R., & Weinman, J. (1999). Patients’ beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness. Journal of Psychosomatic Research, 47(6), 555–567.
Kesehatan, B. K. P. (2024). Prevalensi, dampak, serta upaya pengendalian hipertensi dan diabetes di Indonesia: Lembar fakta Survei Kesehatan Indonesia 2023. Kementerian Kesehatan Republik Indonesia.
Kini, V., & Ho, P. M. (2018). Interventions to improve medication adherence: A review. JAMA, 320(23), 2461–2473. https://doi.org/10.1001/jama.2018.19271
Cahyani, P. D., Nur, S., Yunisawijayanti, aini, & Aulia, Z. F. (2026). Pembelajaran Partisipatif Melalui Posyandu Lansia: Participatory Learning through an Elderly Posyandu: Strengthening the Capacity of Older Adults Based on Active Ageing in Suryowijayan Village, Gedongkiwo. 4(1). https://doi.org/10.22146/parikesit.v4i1.27370
Nieuwlaat, R., Wilczynski, N., Navarro, T., Hobson, N., Jeffery, R., Keepanasseril, A., Agoritsas, T., Mistry, N., Iorio, A., Jack, S., Sivaramalingam, B., Iserman, E., Mustafa, R. A., Jedraszewski, D., Cotoi, C., & Haynes, R. B. (2014). Interventions for enhancing medication adherence. Cochrane Database of Systematic Reviews, 2014(11), CD000011. https://doi.org/10.1002/14651858.CD000011.pub4
Nishiumi, S., Bessyo, H., Kubo, M., Aoki, Y., Tanaka, A., Yoshida, K.-I., & Ashida, H. (2010). Green and black tea suppress hyperglycemia and insulin resistance by retaining the expression of glucose transporter 4 in muscle of high-fat diet-fed C57BL/6J mice. Journal of Agricultural and Food Chemistry, 58(24), 12916–12923. https://doi.org/10.1021/jf102840w
Osterberg, L., & Blaschke, T. (2005). Adherence to medication. New England Journal of Medicine, 353(5), 487–497.
Pousinho, S., Morgado, M., Falcão, A., & Alves, G. (2016). Pharmacist interventions in the management of type 2 diabetes mellitus: A systematic review of randomized controlled trials. Journal of Managed Care & Specialty Pharmacy, 22(5), 493–515. https://doi.org/10.18553/jmcp.2016.22.5.493
Santschi, V., Chiolero, A., Colosimo, A. L., Platt, R. W., Taffé, P., Burnier, M., Burnand, B., & Paradis, G. (2014). Improving blood pressure control through pharmacist interventions: A meta-analysis of randomized controlled trials. Journal of the American Heart Association, 3, e000718. https://doi.org/10.1161/JAHA.113.000718
Singla, R., Singla, N., & Jaitak, V. (2019). Stevia rebaudiana targeting α-amylase: An in-vitro and in-silico mechanistic study. Natural Product Research, 33(4).
Tan, J. P., Cheng, K. K. F., & Siah, R. C.-J. (2019). A systematic review and meta-analysis on the effectiveness of education on medication adherence for patients with hypertension, hyperlipidaemia and diabetes. Journal of Advanced Nursing, 75(11), 2478–2494. https://doi.org/10.1111/jan.14025
Thakkar, J., Kurup, R., Laba, T.-L., Santo, K., Thiagalingam, A., Rodgers, A., Woodward, M., Redfern, J., & Chow, C. K. (2016). Mobile telephone text messaging for medication adherence in chronic disease: A meta-analysis. JAMA Internal Medicine, 176(3), 340–349. https://doi.org/10.1001/jamainternmed.2015.7667
Zomahoun, H. T. V, Guénette, L., Grégoire, J.-P., Lauzier, S., Lawani, A. M., Ferdynus, C., Huiart, L., & Moisan, J. (2017). Effectiveness of motivational interviewing interventions on medication adherence in adults with chronic diseases: A systematic review and meta-analysis. International Journal of Epidemiology, 46(2), 589–602. https://doi.org/10.1093/ije/dyw273