(PS6-A14) Impacts of COVID-19 Pandemic on Appraisal and Adherence to Recommended Health Actions for Individuals with Type II Diabetes and Hypertension

Emergency and disaster situations may have a substantial influence on the extent to which people with chronic medical conditions are able to adhere to their treatment plans, and an essential first step in emergency and disaster preparedness is to develop a theoretical map specifying the possible ways in which patients perceive emergencies and disasters as influencing their ability to adhere to treatment plans. This can be accomplished by identifying themes in patient perceptions during the onset of the COVID pandemic. Patients with chronic health conditions such as type II diabetes (T2D) and hypertension need to follow treatment regimens that involve exercise, diet, and medication. Current research indicates that, during the COVID pandemic, these patients experienced increased difficulty in adhering to these treatment regimens (Franco, 2021; Shimels et al., 2021), however patient responses to the pandemic are certain to be heterogeneous (Mancini, 2020), and it is possible that there are ways in which the pandemic may have facilitated adherence in some areas for some people. Given the limited research in this area, there is a risk that existing studies are based on self-report scales that fail to capture the salient ways in which patients experienced the pandemic as affecting them. It is important to understand how COVID-19 has impacted appraisals of recommended health actions and adherence for T2D and hypertension so that treatment planning, intervention development and dissemination within these populations can be tailored to address predictors of health attitudes, adherence and non-adherence in the time of COVID-19.

This study included 74 patients with type II diabetes (39.2%) and/or hypertension (79.7%) that were participating in an online, longitudinal study of treatment adherence and that answered at least one open-response question regarding how COVID-19 affected their health behaviors in 2020 or 2021. To provide a longitudinal exposition of the heterogeneity in appraisals attributed to COVID-19 and outcomes of health behavior adherence, we utilized a grounded theory approach to conduct content and narrative analyses of these participant responses. This revealed ten themes which were determined to reflect three higher order categories of variables that impact appraisal and, consequently, adherence: affective variables (anxiety depression), extrinsic motivation/external locus of causality, and social variables (social interaction, enacted social support). Adherence was positively associated with affect regulation, integrated regulation, and relational regulation, and thus, facilitated by increased decisional control, autonomy and goal-attainment, and social support/interaction (respectively) during the pandemic. Non-adherence was characterized by dysregulation across these three paradigms. Heterogeneity and changes in appraisal overtime were often determined by individuals’ abilities to have regulatory needs met despite novel barriers to healthcare access and utilization during the pandemic.