Commonsense illness beliefs, adherence behaviors, and hypertension control among African Americans

The impact of elexacaftor/tezacaftor/ivacaftor on cystic fibrosis health-related quality of life and decision-making about daily treatment regimens: a mixed methods exploratory study

Background

Elexacaftor/tezacaftor/ivacaftor (ETI) has reduced many symptoms of cystic fibrosis (CF).

Objectives

We sought to identify the impact of ETI on both symptoms and treatment decisions among adults with CF.

Design

Participants were enrolled in a cross-sectional study. Surveys were sent via a RedCap link. Semistructured interviews were administered remotely via Microsoft Teams. Interviews were audio recorded and professionally transcribed.

Methods

We assessed Cystic Fibrosis Questionnaire-Revised (CFQ-R) subscales for physical, respiratory, emotion, and treatment, and analyzed semistructured interviews covering CF treatment regimens and daily living. Quantitative and qualitative results were analyzed separately and via a mixed-methods convergence coding matrix.

Results

Twenty-four adults with CF taking ETI were included. CFQ-R subscale scores (mean scores/standard deviation) were physical (82.1/22.8), respiratory (83.7/11.2), emotion (65.3/14.2), and treatment (57.5/20.1). Three themes about decision-making for non-ETI-treatments emerged: (1) How I'm feeling, (2) Not noticing a difference, and (3) Uncertainty about long-term impact of modifying treatment regimens, and we found participants weighed each of these factors in their treatment decisions. Key findings from mixed-methods analysis show that among individuals experiencing higher CFQ-R scores for physical and respiratory compared to emotion and treatment, there were statements indicating that while those participants were experiencing better physical health, many continued their burdensome treatment regimens.

Conclusion

With little long-term data on the impact of reducing non-ETI treatments, participants weighed how they were feeling, treatment efficacy beliefs, and risk tolerance when making treatment decisions.

Determining the coronavirus awareness of the Turkish society and the anxiety stress levels

The aim of the study is to determine the awareness of the Turkish society in COVID-19, and determine the anxiety stress levels. Research two months after the start of the outbreak in Turkey has reached 2163 individuals completed the online platform. The Integrated Anxiety Stress Scale significantly changed according to age, gender, marital status and working status after the pandemic. According to the results of multiple binary logistic regression analysis, individuals aged 50 and over, female gender, being single and not working after the pandemic for anxiety; female gender, being married, and post-pandemic study were found to be risk factors for Covid awareness. It is recommended that epidemic awareness studies and information sharing on controlled healing measures are planned considering the anxiety levels.

Experience of suffering in patients with hypertension: a qualitative analysis of in-depth interview of patients in a university hospital in Seoul, Republic of Korea

OBJECTIVE

To describe the suffering experienced by patients with hypertension, not only regarding symptoms, but also suffering in a social context.

DESIGN

A qualitative analysis of semi-structured interview data. Interviews were audio-recorded and transcribed verbatim. A descriptive approach was taken by exploring patient accounts and presenting their experiences and perspectives.

SETTING

Cardiology clinic in a university hospital (Samsung Medical Center, Seoul, Republic of Korea).

PARTICIPANTS

Patients with hypertension and without serious comorbidities who had been followed-up at a cardiology clinic of a training university hospital.

RESULTS

Nineteen men and women (male:female=12:7) were interviewed. The mean age was 44 years, and the average hypertension duration was 4 years. All 19 patients reported symptoms allegedly to be associated with hypertension. Anxiety about blood pressure fluctuation and hypertension complications, dislike of antihypertensive medication and associated labelling effect, family stress and refusal to be enrolled in life insurance were commonly found among patients' interviews. Relatively younger (≤50 years of age), actively working patients experienced stigmatisation and discrimination in the workplace.

CONCLUSION

The illness experience of patients with hypertension consists of suffering associated with threatened or damaged self-identity at the individual and social level. Medical professionals should have more awareness of the suffering of these patients to improve the quality of care. An education programme with proper focus on the elements of patients' suffering may help to alleviate it.

Potential influences of religiosity and religious coping strategies on people with diabetes

Diabetes is a significant health issue that threatens patients’ overall wellbeing and quality of life. Critical public health concerns center on creating the best approach for diabetes management. Patients and caregivers have different approaches to diabetes management; however, this and the associated physiological, physical and mental health issues remain challenging. This review explores the potential influences of religiosity and religious coping strategies on people with diabetes. This study used a literature review approach to investigate how religiosity and religious coping strategies can influence the effective management of diabetes among patients. Based on the literature search, the researchers were able to identify and cite published papers that were analyzed using the descriptive-narrative analysis. An important goal of the descriptive-narrative analysis was to provide descriptions of the selected literature and take implications from the literature. The results of studies reviewed show some religious coping strategies for managing chronic diseases such as diabetes. The studies did establish a relationship between religiosity and diabetes management and suggest that religious coping strategies could positively impact the management of diabetes; however, they reported some adverse effects. Hence, we propose a pathway for the development of religion-oriented interventions and support framework for the management of diabetes.

Sağlık Bilimleri Öğrencilerinin Covid-19’a Yönelik Bilgi Düzeyleri ve Sağlık Davranışlarına Etkisinin İncelenmesi

Amaç: Araştırmanın amacı sağlık bilimleri öğrencilerinin COVID-19 salgını ile ilgili bilgi düzeylerini saptamak ve sağlık davranışları üzerindeki etkisini incelemektir. Gereç ve Yöntemler: Çalışma, çevrimiçi anket yöntemi ile bir üniversitenin Sağlık Bilimleri Fakültesi ve Sağlık Hizmetleri Meslek Yüksekokuluna kayıtlı 345 öğrenci ile yapılmıştır. Çalışma verileri, Ocak-Şubat 2021 tarihlerinde on-line anket formu kullanılarak toplanmıştır. Anket formu katılımcıların demografik özelliklerine dair soruların yanı sıra sağlık bilgi düzeyi; COVID-19 salgınına yönelik sağlık davranışına etkisi olmak üzere 24 sorudan oluşmaktadır. Veri analizinde, tanımlayıcı istatistik testleri ile sayı, yüzde dağılımları, ortalama ve standart sapma değerleri hesaplanmıştır. Grup içi ortalamalarının karşılaştırılmasında One-Way Anova testi kullanılmıştır. Bulgular: Çalışmaya katılan öğrencilerin yaş ortalaması 21.65±3.35 olup % 79.7’si kadındır. Katılımcıların %74.21’i COVID-19 hakkında 2019 öncesi bilgisinin olmadığı, %91.3’ünün kendisi veya ailesinden birilerinin COVID-19’a yakalanması konusunda endişe duyduğu, %86.37’si pandemi sürecinin bulaşıcı hastalıkları önlemeye yönelik aşı uygulaması konusunda farkındalık kazandırdığını, %63.2 ‘si pandemi sürecinde ellerinizi yıkama süresinde değişiklik olduğunu, % 76.8’i televizyon kanallarında yer alan haberlerden bilgi edindiğini bildirdi. COVID-19 öncesi-sonrası günlük uyku ,sıvı alımı gibi sağlık davranışları arasında istatistiksel olarak ileri düzeyde anlamlı farklılık olduğu saptanmıştır (p

COVID-19 pandemic experiences of secondary school students in Turkey

This study aims at identifying secondary school students' life experiences during the coronavirus (covid-19) pandemic time. With the concept of life experiences used throughout the research; Students' views on their daily routines during the pandemic, changes in their lives, the precautions they take against the epidemic and their continuing education practices are expressed. Phenomenology, which is an approach to qualitative research, was adopted in this study. The study data were gathered through semi-structured interviews and analysed via content analysis. This study was carried out with a study group composed of students who were attending a state school in Turkey and who were included in the scope of lockdown. The study group was determined by criterion sampling, which is one of the purposeful sampling methods. The study group consisted of 20 students, 14 girls and 6 boys. Students' age ranged from 14 to 16 years old. Students are in the 7th and 8th grades of secondary school. According to the content analysis carried out within the framework of this study, secondary school students interpret covid-19 as unhealthiness and unusualness, they spend time at home indulging in academic pastime, daily routine and free time activities. They take necessary precautionary measures regarding hygiene, interpersonal contact and nourishment in order to protect themselves from covid-19 virus. As a result of the covid-19 pandemic, students' daily routines and perceptions have changed, and they have experienced positive and negative emotions in the face of these changes. They tend to receive social support, participate in leisure activities and use personal coping strategies to manage negative emotions and thoughts caused by the Covid-19 pandemic. The participant students have positive and negative thoughts about the distance education conducted during the pandemic time, and they have some suggestions as to education and protection from the virus in order to spend the pandemic days more healthily.

Lay beliefs about the causes and treatment of depression: Tests of measurement models and associations

BACKGROUND

There is reason to expect beliefs about depression's causes and treatment to influence use of psychotherapy, but the literature is marked by theoretical, methodological, and empirical inconsistencies. This study assessed the factorial validity of measures of beliefs about depression's causes and formal treatment versus self-management. It also tested the links of causal attributions to general treatment/self-management beliefs and endorsement of specific interventions.

METHODS

The revised Illness Perception Questionnaire (IPQ-R) adapted for depression was administered online to a non-patient, U.S. sample (N = 319).

RESULTS

Confirmatory factor analyses yielded three causal dimensions, Environmental Stressors, Biological Factors, and Personal Attributes, and two control dimensions, (Formal) Treatment and Personal. Both models fit irrespective of whether respondents believed they had ever experienced depression. A structural equation model (SEM) showed a positive relationship for Environmental and Biological attributions, and an inverse relationship for Personal attributions, in predicting general preferences for Formal Treatment. A second SEM, focusing on specific interventions, linked Environmental causation to endorsement of psychotherapy, dietary changes, and self-help, and Biological causation to endorsement of medication and exercise, with Personal causation inversely associated with endorsement of psychotherapy.

LIMITATIONS

A cross-sectional, correlational design precludes causal inferences. Potential sociocultural influences were not assessed.

CONCLUSIONS

Modifications to the IPQ-R suggested by this study improved its psychometric properties, validated its distinction between Treatment and Personal Control beliefs, and supported examination of both general and specific beliefs about ways to deal with depression. Relationships linking cause and treatment beliefs warrant further investigation as potential intervention targets to increase treatment utilization.

Statin-use and perceptions of high cholesterol as predictors of healthy lifestyle behaviours in Nigerians

It is unclear how statin-use influences the adoption of healthy lifestyle choices. It is important to understand the nature of this relationship as this could facilitate targeted public health interventions which could help promote a healthy lifestyle, curb the rise of non-communicable diseases, and facilitate overall health. This study aimed to explore whether statin-use influenced the adoption of healthy lifestyle choices by changing the way urban and semi-urban Nigerians thought about their high cholesterol and their future risk of cardiovascular disease. Structured questionnaires were used to compare the lifestyle behaviours, perceptions of high cholesterol and future risk of cardiovascular disease of statin users and non-statin users recruited in urban and a semi-urban Nigeria. In-depth, face-to-face interviews were used to further explore the relationship between statin-use and the adoption of healthy lifestyle choices, and explore the influence of personal and social factors on this relationship. The odds of adopting a low-fat diet increased as perceived statin-effectiveness increased (OR = 2.33, p<0.05), demonstrating a synergistic relationship between statin-use and the adoption of healthy of lifestyle choices. In addition to this synergistic association, at interview, two other relationships were found between statin use and the adoption of healthy lifestyle choices: an antagonistic relationship fuelled by a strong perception of statin effectiveness and a perceived inability to make healthy lifestyle changes, which favoured statin-use, and an antagonistic relationship fuelled by congruous cause-control beliefs and concerns about medication-use which favoured the adoption of healthy lifestyle choices. The odds of adopting a low-fat diet was 5 times greater in urban dwellers than in semi-urban dwellers (p<0.01). Statin-use influenced the adoption of healthy lifestyle choices in three different ways, which require exploration at clinical consultation. Gender, social obligations, and physical environment also influenced statin-use and the adoption of healthy lifestyle choices.

The Illness Belief Network Questionnaire: Development and Evaluation of a Psychosomatic Assessment Tool

Objective: Patients’ beliefs and emotions toward an illness can influence their coping responses, illness behaviors, adherence to treatment, quality of life, and even the psychoneuroimmune responses. The aim of present study was to develop and validate a novel questionnaire assessing both rational and irrational beliefs of patients regarding their illness.

Method: In a cross sectional methodological study, the items of the Illness Belief Network (IBN) were developed regarding patients and clients’ opinions about and attribution of their disease extracted from 400 clinical interviews and were coded based on Leventhal’s self-regulation model. An expert panel coded the items. A total of 400 patients with different medical conditions completed the questionnaire. Participants additionally rated the Illness Perceptions Questionnaire in its revised form (IPQ-R) to assess convergent validity. Construct validity was examined by conducting exploratory and confirmatory factor analysis. The Cronbach alpha and Intracluster Correlation Coefficient (ICC) were used for examining Internal consistency and test-retest reliability of the IBN.

Results: The IBN questionnaire was finalized with 84 items, and the results of factor analysis revealed 5 factors: psychosocial causes, environmental causes, control, meaning, and consequence/timeline; extracted factors were confirmed by confirmatory factor analysis. Cronbach’s α coefficient for scale was 0.92 and it ranged from 0.79 to 0.89 for the subscales. IBN indicated excellent test-retest reliability results based on ICC 0.842(95%CI: 0.798-0.846). The correlation coefficients of all items exceeded the prespecified acceptable value of 0.40, indicating satisfactory item discriminant validity, and correlation between IBN and IPQ-R subscales were statistically significant (all p values < 0.01), indicating acceptable convergent validity.

Conclusion: The IBN questionnaire is a valid and reliable phenomenological, non-judging, and clinical tool to assess patient’s rational and irrational or faith-based beliefs about the illness. This tool can be used to improve doctor-patient communication by exploring the complex nature of human thinking.

The contributions of hypertension diagnosis and blood pressure control to subjective life expectancy in a representative sample of older U.S. adults

OBJECTIVES

High blood pressure (BP) or hypertension, a major risk factor for death and disease, is pervasive among older adults. While reducing BP to targeted levels can prevent adverse outcomes, rates of successful BP control remain suboptimal, and it is unclear whether older adults recognize its proven benefits. The current study sheds light on older adults' beliefs about the consequences of hypertension and benefits of BP control by examining how their self-reports of hypertension diagnosis and BP control, as well as measured BP, contribute to subjective life expectancy (SLE), their perceived probability of surviving to a target age.

METHODS

In a representative sample of U.S. adults ages 50-89 from the 2006-2014 Health and Retirement Study (n=18,979 respondents), we analyze SLE using generalized linear regression.

RESULTS

Diagnosed hypertension is associated with lower SLE, regardless of measured BP. Among diagnosed hypertensives, those who self-report controlled BP expect to live longer than those who do not. Finally, about one in ten older adults have high measured BP but have never been diagnosed with hypertension, and most diagnosed hypertensives with uncontrolled measured BP self-report their BP as controlled.

DISCUSSION

Older adults appear to recognize the harmful effects of hypertension and the benefits of BP control, but often lack knowledge of their own hypertension and BP control statuses. Health communications should continue to stress the value of BP control, although improvements may require increased hypertension awareness and BP monitoring.

The Effect of Contextualized Racial and Gendered Stressors, Social Support, and Depression on Hypertension Illness Perceptions and Hypertension Medication Adherence in Young African American Women With Hypertension

BACKGROUND

Poor adherence to hypertensive medication has been suggested to be a major contributor to uncontrolled hypertension (HTN) in African Americans. The impact that social determinants have on the various patient-level factors, including HTN beliefs, mental well-being, and social support, may provide insight into the development and tailoring of culturally targeted interventions, thus improving adherence.

OBJECTIVE

The aim of this study was to examine the relationships of exposures to contextualized racial and gendered stressors, social support, and depressive symptoms with HTN illness perceptions and blood pressure (BP) medication adherence.

METHODS

Participants (N = 85) were hypertensive African-American women aged 18 to 45 years (mean [SD], 39.2 [5.4] years) recruited from the community setting and outpatient medical clinics in a large metropolitan city. Hypertension illness beliefs were assessed using the 8-item Brief Illness Perception Questionnaire ("How much does your blood pressure affect your life?") and medication adherence was assessed with the 7-item Adherence to Refills and Medication Scale ("How often do you forget to take your BP medicine?"). Logistic regression analyses were performed to examine the associations with medication adherence and linear regression analyses were performed to examine the associations of continuous variables and HTN illness perceptions.

RESULTS

The sample was predominantly nonadherent (81.2%). In the adjusted multivariable regression model, systolic BP (odds ratio, 0.95; P = .05) and the "Consequence" dimension of HTN beliefs (odds ratio, 0.76; P = .02) were associated with medication adherence. In the adjusted linear regression model, systolic BP (β = 0.22, P < .01) and depressive symptoms (β = 1.11, P < .01) were associated with HTN illness beliefs.

CONCLUSIONS

Assessing beliefs and the mental well-being before initiating BP medications is essential for adherence and BP control.

Adherence to Hypertension Medications and Lifestyle Recommendations among Underserved African American Middle-Aged and Older Adults

Background: For African American middle-aged and older adults with hypertension, poor adherence to medication and lifestyle recommendations is a source of disparity in hypertension outcomes including higher rates of stroke in this population relative to whites. Aims: To study demographic, social, behavioral, cognitive, and medical predictors of adherence to medication and lifestyle recommendations among underserved African American middle-aged and older adults with hypertension. Methods: This was a community-based cross-sectional survey in South Los Angeles with 338 African American middle-aged and older adults with hypertension who were 55 years or older. Age, gender, continuity of care, comorbidity, financial difficulty, self-rated health, depression, educational attainment, adherence knowledge, and adherence worries were the independent variables. Data was analyzed using linear regression with two outcomes, namely, adherence to medication (measured by the first 9 items of the Blood Pressure Self-Care Scale) and adherence to lifestyle recommendations (measured by the second 9 items of the Blood Pressure Self-Care Scale). Results: There were about twice more females than males, with a total mean age of 70 years (range 55–90 years). Various demographic, social, behavioral, and medical factors predicted adherence to medication but not adherence to lifestyle recommendations. Females with hypertension with higher continuity of care, less financial strain, higher knowledge, less negative general beliefs, and concerns about antihypertensive medications had higher adherence to antihypertensive medications. The presence of depressive symptoms, reduced knowledge, and disease management worries were associated with a reduced adherence to lifestyle recommendations. Conclusions: There seem to be fewer demographic, social, behavioral, cognitive, and medical factors that explain adherence to lifestyle recommendations than adherence to medication in economically disadvantaged underserved African American middle-aged and older adults with hypertension. More research is needed on factors that impact adherence to lifestyle recommendations of African American middle-aged and older adults with hypertension.

High Blood Pressure Medication Adherence Among Urban, African Americans in the Midwest United States

Hypertension is a chronic condition that disproportionately affects African Americans. Managing high blood pressure (HBP) requires adherence to daily medication. However, many patients with hypertension take their HBP medication inconsistently, putting them at heightened risk of heart disease. Researchers have shown that these health risks are greater for African Americans than for Caucasians. In this article, we examine barriers and facilitators of medication adherence among urban African Americans with hypertension. We interviewed 24 African Americans with hypertension (58.5% women, average age 59.5 years) and conducted a comprehensive thematic analysis. Twenty-two barriers and 32 facilitators to medication adherence emerged. Barriers included side effects and forgetting while facilitators included reminders, routines, and social support. Using this data, we developed a diagram of theme connectedness of factors that affect medication adherence. This diagram can guide multi-level HBP intervention research that targets African Americans to promote medication adherence, prevent heart disease, and reduce ethnic and racial health disparities.

Medication adherence in the older adults with chronic multimorbidity: a systematic review of qualitative studies on patient's experience

PURPOSE

Medication non-adherence represents a socially relevant challenge, particularly when interlinked to multiple chronic diseases and polypharmacy. Non-adherence rates affect treatment efficacy and increase health care costs. The aim of the study was to identify factors influencing medication adherence in the older adults through a systematic review of qualitative studies on patients' experience.

METHODS

Two electronic databases were searched for qualitative studies on medication adherence in chronic diseases (hypertension, heart disease, COPD, asthma) involving people aged 65 + . The systematic review was performed according to the PRISMA statement guidelines, employing theoretical frameworks of the ABC Taxonomy of patient adherence and Three Factor model of determinants of behaviour.

RESULTS

The initial database search identified 1234 records, of which 39 studies were considered eligible. Most of the studies focused on hypertension and were conducted in English-speaking countries. According to the ABC Taxonomy, Persistence and Implementation were the most often considered phases. Considering the Three Factor model, the most often reported themes were Information and Strategies upon being adherent. Stemming from the review findings and the patients' narratives, a new integrated model was proposed. It reports the patient's decisional flowchart describing barriers and facilitators (personal, social and environmental) to adherence.

CONCLUSION

Medication adherence is a complex and multifaceted process. The implementation of theoretical frameworks along with a patient-centred perspective may provide clinicians with useful suggestions for clinical practice, enhancing the patient's ability to adhere.

The associations among illness perceptions, resilient coping, and medication adherence in young adult hypertensive black women

Hypertension, a modifiable risk factor of cardiovascular disease, is largely responsible for the disproportionate morbidity and mortality in black women. Black women 20 years of age and older have a higher prevalence of HTN compared to white women (44% vs 28%). Poor adherence and non-adherence to hypertensive medications have been strongly indicated as a primary contributor to the early onset of disparity in cardiovascular disease morbidity and mortality experienced by black people. The purpose of this study was to examine medication adherence in black women relative to sociodemographic, clinical, cultural context, psychosocial, cognitive, and behavioral factors. This was a prospective, descriptive cross-sectional study of N = 85, hypertensive black women, with mean age of 39 ± 5.4 years, 18-45 years of age. Variables and measures included: sociodemographic characteristics, clinical, adverse social stressors, psychosocial, cognitive-behavioral factors, and medication adherence. Descriptive statistics, correlations, multivariate logistic regressions, and moderation analysis were tested. 81.2% (n = 69) of the sample was categorized as non-adherent. SBP was the only clinical covariate associated with HTN medication adherence. HTN illness perceptions, composite score, resilient coping, depressive symptoms, exposure to lifetime gender, and racial stressors, were not associated with HTN medication adherence. Using multivariate logistic regression, decreased SBP and lower scores on the "Consequence" dimension of the HTN illness perception scale were associated with medication adherence (χ2  = 10.53, P = .001). Adherence was associated with both the "Consequence" and "Identity" dimensions of the HTN illness perception scale indicating the need and importance for clinicians to have open and honest communication regarding HTN and its treatment in facilitating adherence.

Home remedy use and influenza vaccination among African American and white adults: An exploratory study

Racial disparities in influenza vaccination persist between African American and White adults. It is critical to explore the reasons behind this disparity, which may be linked to the use of "folk" or home remedies for illness prevention and treatment. For this study, The GfK Group was contracted to conduct a nationally-representative survey (n = 819 African American and 838 White respondents). Respondents were asked about behaviors, attitudes, and risk perception related to the influenza vaccine, as well as frequency of home remedy use. Results were analyzed using adjusted logistic regression with 95% confidence intervals. In comparison to those who never use home remedies, those who use home remedies often or almost always were less likely to get vaccinated for influenza (respectively, OR = 0.70, CI 0.49, 0.99; OR = 0.27, CI 0.15, 0.49), less likely to be in favor of the vaccine (OR = 0.47, CI 0.33, 0.67; OR = 0.19, CI 0.10, 0.34), less likely to trust the vaccine (OR = 0.42, CI 0.29, 0.61; OR = 0.34, CI 0.20, 0.61), and more likely to perceive higher risk of vaccine side effects (OR = 1.79, CI 1.19, 2.68; OR = 4.00, CI 2.38, 6.73). These associations did not vary by race. Home remedy users may hold negative views toward the influenza vaccine, such that a combination of little trust in the vaccine process, and overestimation of risk associated with the vaccine itself, may contribute to vaccine refusal. Health care professionals can use these findings to tailor advice toward individuals with a preference for home remedy use to allay fears and correct misconceptions surrounding influenza and its vaccine.

Practice and predictors of self-care behaviors among ambulatory patients with hypertension in Ethiopia

BACKGROUND

Despite the benefits of evidence-based self-care behaviors in the management of hypertension, hypertensive patients have low rate of adherence to the recommended self-care behaviors. Studies related to self-care behaviors among hypertensive patients are limited in Ethiopia.

OBJECTIVE

To assess the rate of adherence to self-care behaviors and associated factors among hypertensive patients.

METHOD

A cross-sectional study was conducted at the cardiac clinic of Ayder comprehensive specialized hospital among ambulatory hypertensive patients. Self-care behaviors were assessed using an adopted Hypertension Self-Care Activity Level Effects (H-SCALE). Data were collected through patient interview and review of medical records. Binary logistic regression analysis was performed to identify predictors of self-care behaviors.

RESULT

A total of 276 patients were included in the study. The majority of the participants were nonsmokers (89.9%) and alcohol abstainers (68.8%). Less than half of the participants were adherent to the prescribed antihypertensive medications (48.2%) and recommended physical activity level (44.9%). Moreover, only 21.45% and 29% were adherent to weight management and low salt diet recommendations, respectively. Our finding indicated that rural resident (adjusted odds ratio [AOR]: 0.45, 95% confidence interval [CI]: 0.21-0.97), comorbidity (AOR: 0.16, 95% CI: 0.08-0.31), and negative medication belief (AOR: 0.25, 95% CI: 0.14-0.46) were significantly associated with medication adherence. Female sex (AOR: 0.46, 95% CI: 0.23-0.92), old age (AOR: 0.19, 95% CI: 0.06-0.60) and lack of knowledge on self-care behaviors (AOR: 0.13, 95% CI: 0.03-0.57) were significantly associated with adherence to weight management. Female sex (AOR: 1.97, 95% CI: 1.03-3.75) and lack of knowledge on self-care (AOR: 0.07, 95% CI: 0.03-0.16) were significantly associated with adherence to alcohol abstinence. Female sex (AOR: 6.33, 95% CI: 1.80-22.31) and khat chewing (AOR: 0.08, 95% CI: 0.03-0.24) were significantly associated with non-smoking behavior. There was also a significant association between female sex and physical activity (AOR: 0.22, 95% CI: 0.12-0.40).

CONCLUSION

The rate of adherence to self-care behaviors particularly weight management, low salt intake, physical exercise, and medication intake was low in our study. Elders, females, khat chewers, rural residents, and patients with negative medication belief, comorbidity, and inadequate knowledge of SCBs were less adherent to self-care behaviors compared to their counterparts. Therefore, health care providers should pay more emphasis to patients at risk of having low self-care behaviors.

Conceptual Model of Medication Adherence in Older Adults with High Blood Pressure-An Integrative Review of the Literature

BACKGROUND

Medication adherence (MA) is the most important controlling factor of high blood pressure (HBP). There are a few MA models, but they have not been successful in predicting MA completely. Thus, this study aimed to expand a conceptual model of MA based on an ecological approach.

METHODS

An integrative review of the literature based on theoretical and empirical studies was completed. Data source comprised: Medline (including PubMed and Ovid), ISI, Embase, Google scholar, and internal databases such as Magiran, Google, SID, and internal magazines. Primary English and Persian language studies were collected from 1940 to 2018. The steps of study included: (a) problem identification, (b) literature review and extracting studies, (c) appraising study quality, (d) gathering data, (e) data analysis using the directed content analysis, (f) concluding.

RESULTS

Thirty-six articles were finally included and analyzed. After analysis, predictors of MA in older adults with hypertension were categorized into personal, interpersonal, organizational, and social factors. Although the personal factors have the most predictors in sub-categories of behavioral, biological, psychological, knowledge, disease, and medication agents, social, organizational and interpersonal factors can have indirect and important effects on elderly MA.

CONCLUSION

There are many factors influencing MA of elderly with HBP. The personal factor has the most predictors. The designed model of MA because of covering all predictor factors, can be considered as a comprehensive MA model. It is suggested that future studies should select factors for study from all levels of the model.

Posttraumatic stress disorder and nonadherence to medications prescribed for chronic medical conditions: A meta-analysis

BACKGROUND

Patients with posttraumatic stress disorder (PTSD) are at increased risk for adverse consequences from comorbid medical conditions. Nonadherence to medications prescribed to treat those comorbid conditions may help explain this increased risk. We sought to determine the association between PTSD and medication nonadherence and whether it varied according to the type of event inducing the PTSD.

METHODS

Prospective observational cohort or cross-sectional studies relating PTSD and nonadherence among adults prescribed medications for a chronic medical illness were identified by searching MEDLINE, EMBASE, PsycINFO, the Cochrane Library, CINAHL, SCOPUS, and the PILOTS Database and by hand-searching bibliographies from selected articles. Individual estimates of odds ratios were pooled using random effects meta-analysis with inverse variance weighting. Articles were pooled separately according to whether PTSD was induced by a medical versus non-medical event.

OUTCOMES

Sixteen articles comprising 4483 patients met eligibility criteria. The pooled effect size of the risk of PTSD to medication nonadherence was OR 1.22 (95% CI, 1.06-1.41). Among the 6 studies of medical event-induced PTSD, the OR was 2.08 (95% CI, 1.03-4.18); p = 0.04. Among the 8 studies in which PTSD was not induced by a medical event, the OR was 1.10 (95% CI, 0.99-1.24); p = 0.09.

INTERPRETATION

Patients with PTSD were more likely to be nonadherent to medications prescribed for chronic medical conditions - an association that may exist specifically when PTSD was induced by a medical event. Medications may serve as aversive reminders among survivors of acute medical events, magnifying avoidance behaviors characteristic of PTSD.

FUNDING

NHLBI.

Elevated blood pressure and illness beliefs: a cross-sectional study of emergency department patients in Jamaica

BACKGROUND

Elevated blood pressure (BP) is common among emergency department (ED) patients. While some data exist on the association between ED BP and hypertension (HTN) in the USA, little is known about this relationship in Afro-Caribbean nations. The aim of the study was to evaluate the relationship between elevated systolic BP in the ED and a previous diagnosis of HTN, accounting for potential factors that could contribute to poor HTN control among those with a previous diagnosis: socioeconomic status, health-seeking behavior, underlying HTN illness beliefs, medication adherence, and perceived adherence self-efficacy.

METHODS

This was a cross-sectional survey over 6 weeks, from November 19 through December 30, 2014. Those surveyed were non-critically ill or injured adult ED patients (≥ 18 years) presenting to an Afro-Caribbean hospital. Descriptive statistics were derived for study patients as a whole, by HTN history and by presenting BP subgroup (with systolic BP ≥ 140 mmHg considered elevated). Data between groups were compared using chi-square and t tests, where appropriate.

RESULTS

A total of 307 patients were included: 145 (47.2%) had a prior history of HTN, 126 (41.4%) had elevated BP, and 89 (61.4%) of those presenting with elevated blood pressure had a previous diagnosis of HTN. Those with less formal education were significantly more likely to present with elevated BP (52.1 vs. 28.8% for those with some high school and 19.2% for those with a college education; p = 0.001). Among those with a history of HTN, only 56 (30.9%) had a normal presenting BP. Those with a history of HTN and normal ED presenting BP were no different from patients with elevated BP when comparing the in duration of HTN, medication compliance, location of usual follow-up care, and HTN-specific illness beliefs.

CONCLUSIONS

In this single-center study, two out of every five Jamaican ED patients had elevated presenting BP, the majority of whom had a previous diagnosis of HTN. Among those with a history of HTN, 60% had an elevated presenting BP. The ED can be an important location to identify patients with chronic disease in need of greater disease-specific education. Further studies should evaluate if brief interventions provided by ED medical staff improve HTN control in this patient population.

Health-promoting behaviors and quality of life in older adults with hypertension as compared to a community control group

Hypertension (HTN) related to health-promoting behaviors (HPB) and quality of life (QOL) in older Chinese has not been clearly identified. We sought to compare the HPB and QOL of elderly adults (aged ≥60) living with HTN in China to a community normotensive control group. Using multistage stratified cluster sampling, a sample of 543 elderly people with HTN and 550 with normotension were randomly selected and asked to complete questionnaires. The Chinese version of the Health Promoting Lifestyle Profile (HPLP-IICR) and The World Health Organization Quality of life-BREF instrument (WHOQOL-BREF) were used to evaluate the HPB and QOL of elderly adults. As compared to the normotensive elderly, the hypertensive elderly showed significantly lower scores in their spiritual growth and health management (both P < 0.05), but not in the other three domains. Also, the participants with HTN showed significantly lower scores in the QOL overall and physical health (both P < 0.05), but not in other factors, as compared to the participants without HTN. Each HPLP-IICR domain score among the elderly with or without HTN were significantly correlated with their QOL scores (all P < 0.01). It is suggested that more attention should be paid to improving the spiritual growth and health management of HBP, and thus the overall quality of life among hypertensive patients.

Illness Perceptions and Health Behaviors of Black Women

The Common Sense Model of Illness Representations proposes that representations or perceptions of illness drive health behaviors. The purpose of this study was to explore the relationships between hypertension representations, exercise, and dietary behaviors in hypertensive black women (N = 204, aged 18-65 years). Regression results revealed that perceiving hypertension as chronic and perceiving it a result of environmental causes were inversely related to moderate-intensity physical activity (β = -.15 [P = .05] and β = -.25 [P = .05], respectively). Having more emotional responses to hypertension (β = .23, P = .05) was related to moderate-intensity physical activity and more fruit and vegetable consumption (β = .28, P = .05). These findings suggest that hypertension representations can interfere with recommended lifestyle changes among black women. Assessing hypertension representations and implementing measures to clarify misperceptions of hypertension among black women may lead to better blood pressure control and health outcomes.

MAHILA: a protocol for evaluating a nurse-delivered mHealth intervention for women with HIV and psychosocial risk factors in India

Background

Women living with HIV are vulnerable to a variety of psychosocial barriers that limit access and adherence to treatment. There is little evidence supporting interventions for improving access and treatment adherence among vulnerable groups of women in low- and middle-income countries. The Mobile Phone-BasedApproach forHealthImprovement,Literacy andAdherence (MAHILA) trial is assessing the feasibility, acceptability and preliminary efficacy of a novel, theory-guided mobile health intervention delivered by nurses for enhancing self-care and treatment adherence among HIV-infected women in India.

Methods/Design

Women (n = 120) with HIV infection who screen positive for depressive symptoms and/or other psychosocial vulnerabilities are randomly assigned in equal numbers to one of two treatment arms: treatment as usual plus the mobile phone intervention (experimental group) or treatment as usual (control group). In addition to treatment as usual, the experimental group receives nurse-delivered self-care counselling via mobile phone at fixed intervals over 16 weeks. Outcome measures are collected at baseline and at 4, 12, 24 and 36 weeks post-baseline. Outcomes include antiretroviral treatment adherence, HIV-1 RNA, depressive symptoms, illness perceptions, internalized stigma and quality of life.

Discussion

The MAHILA trial will provide information about how a mobile health counselling intervention delivered by non specialist nurses may improve access to care and support the adherence and clinical outcomes of women with HIV infection living in low- and middle-income countries such as India.

Trial registration

NCT02319330 (First received: July 30, 2014; Last verified: January 2016)

Self-Care Behaviors and Related Factors in Hypertensive Patients

BACKGROUND

An assessment of an individual's hypertension self-care behavior may provide clinicians and practitioners with important information regarding how to better control hypertension.

OBJECTIVES

The objective of this study was to investigate the self-care behaviors of hypertensive patients.

PATIENTS AND METHODS

This cross-sectional study was conducted in 2014 in a sample of 1836 patients of both genders who had been diagnosed with hypertension in urban and rural health centers in the Kohgiluyeh Boyerahmad Province in southern Iran. They were randomly selected and were invited to participate in the study. Self-care activities were measured using the H-hypertension self-care activity level effects.

RESULTS

The mean age of the respondents was 63 (range: 30 - 92), and 36.1% reported adherence to the recommended levels of medication; 24.5% followed the physical activity level guidelines. Less than half (39.2%) met the criteria for practices related to weight management, and adherence to low-salt diet recommendations was also low (12.3%). Overall, 86.7% were nonsmokers, and 100% abstained from alcohol. The results of a logistic regression indicated that gender was significantly associated with adherence to physical activity (OR = 0.716) and non-smoking (OR = 1.503) recommendations; that is, women were more likely to take part in physical activity than men. There was also a significant association between age and adherence to both a low-salt diet (OR = 1.497) and medication (OR = 1.435).

CONCLUSIONS

Based on our findings, it is crucial to implement well-designed educational programs to improve hypertension self-care behaviors.

African Americans' Perceptions of Adherence to Medications and Lifestyle Changes Prescribed to Treat Hypertension

More than 80 million Americans have hypertension (HTN), and African Americans (AAs) are disproportionately affected. AAs also have lower rates of adherence to HTN treatment. It is important to understand AAs' perceptions of adherence to develop effective interventions. The aim of this study is to examine AAs' perceptions of adherence to medications and lifestyle changes prescribed to treat HTN. In this qualitative study, we used purposive sampling to recruit Southern AAs with HTN aged 21 and older from a free, faith-based clinic. We recorded individual, in-person interviews about perceptions related to adherence to treatment of HTN and analyzed verbatim transcripts using content analysis and constant comparison. We also conducted medical record audits. Twenty-nine AAs participated (52% female, 38% were <50 years of age, 52% had taken anti-HTN medications for ≥5 years). Audits indicated that 65% had uncontrolled HTN during the previous year. Two main themes included causes of HTN and ways to improve blood pressure. Perceived causes of HTN included diet, stress, unhealthy actions, genes, and obesity. Ways to improve HTN included using cultural treatments "passed down," increasing exercise, reducing stress, and losing weight. Many reported using home remedies to control HTN, including drinking pickle juice. More than half of this sample had uncontrolled HTN. They identified influences of culture on perceptions of adherence including causes and treatment of HTN, and possibly detrimental home remedies. It is imperative that clinicians identify culturally appropriate interventions for this high-risk group.

Access to Care, Treatment Ambivalence, Medication Nonadherence, and Long-Term Mortality Among Severely Hypertensive African Americans: A Prospective Cohort Study

African Americans living in poor neighborhoods bear a high burden of illness and early mortality. Nonadherence may contribute to this burden. In a prospective cohort study of urban African Americans with poorly controlled hypertension, mortality was 47.6% over a median follow-up of 6.1 years. Patients with pill-taking nonadherence were more likely to die (hazard ratio, 1.80; 95% confidence interval [CI], 1.18-2.76) after adjustment for potential confounders. With regard to factors related to nonadherence, poor access to care such as difficulty paying for medications was associated with prescription refill nonadherence (odds ratio [OR], 4.12; 95% CI, 1.88-9.03). Pill-taking nonadherence was not associated with poor access to care; however, it was associated with factors related to treatment ambivalence including lower hypertension knowledge (OR, 2.97; 95% CI, 1.39-6.32), side effects (OR, 3.44; 95% CI, 1.47-8.03), forgetfulness (OR, 3.62; 95% CI, 1.78-7.34), and feeling that the medications do not help (OR, 2.78; 95% CI, 1.09-7.09). These data suggest that greater access to care is a necessary but insufficient remedy to the disparities experienced by urban African Americans with hypertension. To achieve its full promise, health reform must also address treatment ambivalence.

Predictors of self-reported adherence to antihypertensive medicines: a multinational, cross-sectional survey

BACKGROUND

Nonadherence to antihypertensive medicines limits their effectiveness, increases the risk of adverse health outcome, and is associated with significant health care costs. The multiple causes of nonadherence differ both within and between patients and are influenced by patients' care settings.

OBJECTIVES

The objective of this article was to identify determinants of patient nonadherence to antihypertensive medicines, drawing from psychosocial and economic models of behavior.

METHODS

Outpatients with hypertension from Austria, Belgium, England, Germany, Greece, Hungary, The Netherlands, Poland, and Wales were recruited to a cross-sectional online survey. Nonadherence to medicines was assessed using the Morisky Medication Adherence Scale (primary outcome) and the Medication Adherence Rating Scale. Associations with adherence and nonadherence were tested for demographic, clinical, and psychosocial factors.

RESULTS

A total of 2595 patients completed the questionnaire. The percentage of patients classed as nonadherent ranged from 24% in The Netherlands to 70% in Hungary. Low age, low self-efficacy, and respondents' perceptions of their illness and cost-related barriers were associated with nonadherence measured on the Morisky Medication Adherence Scale across several countries. In multilevel, multivariate analysis, low self-efficacy (odds ratio = 0.73; 95% confidence interval 0.70-0.77) and a high number of perceived barriers to taking medicines (odds ratio = 1.70; 95% confidence interval 1.38-2.09) were the main significant determinants of nonadherence. Country differences explained 11% of the variance in nonadherence.

CONCLUSIONS

Among the variables measured, patients' adherence to antihypertensive medicines is influenced primarily by their self-efficacy, illness beliefs, and perceived barriers. These should be targets for interventions for improving adherence, as should an appreciation of differences among the countries in which they are being delivered.

Predicting adherence to medications using health psychology theories: a systematic review of 20 years of empirical research

OBJECTIVES

This review sought to identify the empirical evidence for the application of models from sociocognitive theory, self-regulation theory, and social support theory at predicting patient adherence to medications.

METHODS

A systematic review of the published literature (1990-2010) using MEDLINE, EMBASE, Cochrane Library, CINAHL, and PsychINFO identified studies examining the application of health psychology theory to adherence to medication in adult patients. Two independent reviewers extracted data on medication, indication, study population, adherence measure, theory, model, survey instruments, and results. Heterogeneity in theoretical model specification and empirical investigation precluded a meta-analysis of data.

RESULTS

Of 1756 unique records, 67 articles were included (sociocognitive = 35, self-regulation = 21, social support = 11). Adherence was most commonly measured by self-report (50 of 67). Synthesis of studies highlighted the significance (P ≤ 0.05) of self-efficacy (17 of 19), perceived barriers (11 of 17), perceived susceptibility (3 of 6), necessity beliefs (8 of 9), and medication concerns (7 of 8).

CONCLUSIONS

The results of this review provide a foundation for the development of theory-led adherence-enhancing interventions that could promote sustainable behavior change in clinical practice.

Emotional representation of tuberculosis with stigma, treatment delay, and medication adherence in Russia

This descriptive cross-sectional study aimed to explore emotional representation and illness coherence, the understanding a person has about an illness which helps them make sense of the experience, in Russians with tuberculosis. In a secondary analysis of questionnaires from 105 Russians treated for pulmonary tuberculosis, social isolation and disease consequences were predictors of negative emotions related to tuberculosis and accounted for 49 percent of the variance. Participants who scored higher on illness coherence were less likely to experience negative emotions. Development of programs to help patients understand tuberculosis and to manage emotional responses and stigma is suggested.

Illness beliefs in African Americans with hypertension

Guided by Leventhal's common sense model of illness representations, this study examined the relationship between hypertension beliefs and self-care behaviors necessary for blood pressure (BP) control in a sample of 111 community-dwelling African Americans with hypertension. Participants completed the revised Illness Perception Questionnaire, BP Self-Care Scale, and a demographic data sheet, and had BP measured. Analyses revealed that beliefs about the causes of hypertension differed by gender and educational level. Stress-related causal attributions accounted for 34.7% of the variance in hypertension beliefs. Participants who believed stress or external factors caused hypertension were less likely to engage in healthy self-care behaviors (e.g., keeping doctor visits, eating low-salt, low-fat diets). Results suggest that patients who are nonadherent with hypertension self-care recommendations may hold hypertension beliefs that are not consistent with the medically endorsed views of this disease. To more effectively treat and control BP, providers should assess patients' hypertension beliefs.

Changing behavior in senior housing residents: testing of phase I of the PRAISEDD-2 intervention

PURPOSE

Programs focused on health related behaviors implemented in senior centers, senior housing or churches have not been strongly successful in showing significant improvement in cardiovascular disease (CVD) prevention behaviors or important clinical outcomes such as decreasing blood pressure. The purpose of this study was to consider the feasibility and preliminary efficacy of phase I of the PRAISEDD-2 intervention. PRAISEDD-2 was implemented to increase physical activity, adherence to heart healthy diets and antihypertensive and/or lipid lowering medications.

METHOD

This was a single site pre post intervention trial. The 12 week phase I activities included education, motivational interventions and exercise classes two times per week implemented by a lay trainer and nurse.

RESULTS

A total of 29 residents were recruited from a single senior housing facility. The majority was Black or African American, female and had at least a high school education. The average age of participants was 74 years of age. At the end of phase I, participants had stronger outcome expectations for exercise, decreased fat and salt intake and decreased pain. There was a non-significant improvement in time spent in physical activity and distance walked in 6 minutes.

CONCLUSION

Phase I of the PRAISEDD-2 intervention was feasible based on adherence to study design, training of the interventionists, delivery and receipt, and there was some support for efficacy across some study outcomes.

Stroke survivors' endorsement of a "stress belief model" of stroke prevention predicts control of risk factors for recurrent stroke

Perceptions that stress causes and stress-reduction controls hypertension have been associated with poorer blood pressure (BP) control in hypertension populations. The current study investigated these "stress-model perceptions" in stroke survivors regarding prevention of recurrent stroke and the influence of these perceptions on patients' stroke risk factor control. Stroke and transient ischemic attack survivors (N=600) participated in an in-person interview in which they were asked about their beliefs regarding control of future stroke; BP and cholesterol were measured directly after the interview. Counter to expectations, patients who endorsed a "stress-model" but not a "medication-model" of stroke prevention were in better control of their stroke risk factors (BP and cholesterol) than those who endorsed a medication-model but not a stress-model of stroke prevention (OR for poor control=.54, Wald statistic=6.07, p=.01). This result was not explained by between group differences in patients' reported medication adherence. The results have implications for theory and practice, regarding the role of stress belief models and acute cardiac events, compared to chronic hypertension.

The impact of PRAISEDD on adherence and initiation of heart health behaviors in senior housing

OBJECTIVE

Building on prior theoretical work and research, we developed a community-based intervention, People Reducing Risk And Improving Strength through Exercise, Diet, and Drug Adherence (PRAISEDD), a three-phase program which was implemented in 2009. The purpose of this study was to report on Phase III, the Inoculation Phase, of the PRAISEDD program and explore participant experiences.

DESIGN AND SAMPLE

This was a descriptive, qualitative study focused on exploring participation in heart healthy PRAISEDD classes. Ten residents participated in the focus group, all of whom attended at least one PRAISEDD session.

MEASURES

Qualitative data were obtained at the end of the 12 months during which Phase III was implemented. Descriptive data were gathered to describe the number of initial PRAISEDD participants and the number of new participants who came to classes.

RESULTS

Nine codes were identified and reduced to two themes: motivators to participate in exercise classes; and factors that decrease willingness to participate. The Phase III monthly PRAISEDD inoculation classes were attended by 10-12 residents, the majority of whom participated in Phase I of PRAISEDD.

CONCLUSION

We were able to engage new participants in classes during Phase III, and qualitative findings provided important recommendations for future work.

The Relationship Between Social Support and Adherence to Healthy Lifestyle Among Patients With Coronary Artery Disease in the North of Jordan

Numerous studies have shown that social support improves health behaviors in patients with coronary artery disease (CAD). The purpose of this study was to examine the relationship between adherence to a healthy lifestyle, and social support and selected sociodemographics among patients with CAD. Cross-sectional descriptive design was used. A convenient sample of 153 patients with CAD was recruited from the cardiac clinic in an educational hospital in the north of Jordan. One hundred and thirty-three patients completed the interview. Social support was the most significant predictor— t(124) = 9.51, p < .001—which explained 60% of variance in adherence to a healthy lifestyle. Providing patients with adequate social support improves adherence to a healthy lifestyle. More attention should be given to the elderly and patients with low income to enhance adherence to a healthy lifestyle. The applications of this study in practice provide a guide for nursing clinical assessment of social support for patients facing CAD.

Enhancing adherence of antihypertensive regimens in hypertensive African-Americans: current and future prospects

Patient adherence to antihypertensive medication is an important strategy for blood pressure control in hypertensive patients. However, rates of antihypertensive medication adherence among hypertensive African-Americans are unacceptably low. This article examines the current understanding of patient, clinical, provider and healthcare system factors associated with medication adherence in hypertensive African-Americans. Studies demonstrated that patient and clinical factors, such as self-efficacy and depression, are consistently associated with medication adherence in hypertensive African-Americans patients. Provider communication shows promise as a correlate of medication adherence, but more research on provider and healthcare system factors are still needed. The authors recommend that interventions targeted at increasing medication adherence among hypertensive African-Americans focus on self-efficacy. It is also imperative that clinicians screen hypertensive patients for depression and treat, if necessary.

Examining the association of health literacy and health behaviors in African American older adults: does health literacy affect adherence to antihypertensive regimens?

Health literacy is the degree to which individuals have the capacity to obtain, process, and understand the health information needed to make appropriate health decisions. The health behaviors of African American adults with inadequate health literacy skills affect their health outcomes. This study examined the association of health literacy and adherence behaviors in African American older adults (N = 121) with hypertension using a descriptive correlational design. Health literacy was measured using the Rapid Estimate of Adult Literacy in Medicine survey, and adherence was measured using the Hill-Bone Compliance Scale. Most of the participants were functioning with inadequate health literacy. No statistically significant association was found between health literacy and adherence, but regression analysis showed that age and health status significantly predicted adherence: Those who were younger and reported poor or fair health status were less likely to adhere to treatment.

Asthma beliefs are associated with medication adherence in older asthmatics

BACKGROUND

Empirical research and health policies on asthma have focused on children and young adults, even though asthma morbidity and mortality are higher among older asthmatics.

OBJECTIVE

To explore the relationship of asthma-related beliefs and self-reported controller medication adherence in older asthmatics.

DESIGN

An observational study of asthma beliefs and self-management among older adults.

PARTICIPANTS

Asthmatics ages ≥ 60 years (N = 324, mean age 67.4 ± 6.8, 28 % white, 32 % black, 30 % Hispanic) were recruited from primary care practices in New York City and Chicago.

MAIN MEASURES

Self-reported controller medication adherence was assessed using the Medication Adherence Report Scale. Based on the Common Sense Model of Self-Regulation, patients were asked if they believe they only have asthma with symptoms, their physician can cure their asthma, and if their asthma will persist. Beliefs on the benefit, necessity and concerns of treatment use were also assessed. Multivariate logistic regression was used to examine the association of beliefs with self-reported medication adherence.

KEY RESULTS

The majority (57.0 %) of patients reported poor adherence. Poor self-reported adherence was more common among those with erroneous beliefs about asthma illness and treatments, including the "no symptoms, no asthma" belief (58.7 % vs. 31.7 %, respectively, p < 0.001), "will not always have asthma" belief (34.8 % vs. 12.5 %, p < 0.001), and the "MD can cure asthma" belief (21.7 % vs. 9.6 %, p = 0.01). Adjusting for illness beliefs, treatment beliefs and demographics, patients with a "no symptoms, no asthma" belief had lower odds of having good self-reported adherence (odds ratio [OR] 0.45, 95 % confidence interval [CI] 0.23-0.86), as did those with negative beliefs about the benefits (OR 0.73, 95 % CI 0.57-0.94) and necessity (OR 0.89, 95 % CI 0.83-0.96) of treatment.

CONCLUSIONS

Illness and treatment beliefs have a strong influence on self-reported medication adherence in older asthmatics. Interventions to improve medication adherence in older asthmatics by modifying illness and treatment beliefs warrant study.

Post-traumatic stress disorder and medication adherence: results from the Mind Your Heart study

BACKGROUND

Patients with post-traumatic stress disorder (PTSD) are at increased risk for adverse outcomes from comorbid medical conditions. Medication non-adherence is a potential mechanism explaining this increased risk.

METHODS

We examined the association between PTSD and medication adherence in a cross-sectional study of 724 patients recruited from two Department of Veterans Affairs Medical Centers between 2008 and 2010. PTSD was assessed using the Clinician Administered PTSD Scale. Medication adherence was assessed using a standardized questionnaire. Ordinal logistic regression models were used to calculate the odds ratios (ORs) for medication non-adherence in patients with versus without PTSD, adjusting for potential confounders.

RESULTS

A total of 252 patients (35%) had PTSD. Twelve percent of patients with PTSD reported not taking their medications as prescribed compared to 9% of patients without PTSD (unadjusted OR 1.85, 95% CI 1.37-2.50, P<0.001). Forty-one percent of patients with PTSD compared to 29% of patients without PTSD reported forgetting medications (unadjusted OR 1.90, 95% CI 1.44-2.52, P<0.001). Patients with PTSD were also more likely to report skipping medications (24% versus 13%; unadjusted OR 2.01, 95% CI 1.44-2.82, P<0.001). The association between PTSD and non-adherence remained significant after adjusting for demographics, depression, alcohol use, social support, and medical comorbidities (adjusted OR 1.47, 95% CI 1.03-2.10, P=0.04 for not taking medications as prescribed and 1.95, 95% CI 1.31-2.91, P=0.001 for skipping medications).

CONCLUSIONS

PTSD was associated with medication non-adherence independent of psychiatric and medical comorbidities. Medication non-adherence may contribute to the increased morbidity and mortality observed in patients with PTSD.

Freedom of choice and adherence to the health regimen for African Americans with hypertension

The prevalence of hypertension in African Americans exceeds that of all other racial/ethnic groups in the world. Hypertension in African Americans is less likely to be controlled and this problem is further complicated by failure to adhere to prescribed hypertension management regimens. Oftentimes, health care providers give African American patients with hypertension multiple health "rules" to follow that may arouse reactance behaviors: that is, patients may choose to do the opposite of what they are told to do. The theory of psychological reactance offers a framework for understanding the relationship between freedom of choice and adherence to hypertension regimens in African Americans.

A community and culture-centered approach to developing effective cardiovascular health messages

OBJECTIVE

Little is known about how best to target cardiovascular health promotion messages to minorities. This study describes key lessons that emerged from a community and culture-centered approach to developing a multimedia, coronary heart disease (CHD) patient education program (PEP) for medically underserved South Asian immigrants.

METHODS

The prototype PEP integrated the surface structures (e.g. language) and deeper structures (e.g. explanatory models (EMs), values) of South Asians' socio-cultural context. Seven focus groups and 13 individual interviews were used to investigate South Asians' reactions and obtain qualitative feedback after viewing the culturally targeted PEP. Qualitative data were organized into emergent thematic constructs.

RESULTS

Participants (n=56) mean age was 51 years and 48 % were Hindi speakers. Community members had a strong, negative reaction to some of the targeted messages, "This statement is a bold attack. You are pin-pointing one community." Other important themes emerged from focus groups and interviews about the PEP: 1) it did not capture the community's heterogeneity; 2) did not sufficiently incorporate South Asians' EMs of CHD; and 3) did not address economic barriers to CHD prevention. Feedback was used to revise the PEP.

CONCLUSION

A community and culture-centered approach to developing cardiovascular health promotion messages revealed tensions between the researcher's vantage point of "cultural targeting" and the community's perceptions and reactions to these messages. Engaging communities in every phase of message design, incorporating their EMs, recognizing community heterogeneity, and addressing economic and structural barriers, are critical steps to ensuring that health promotion messages reach their intended audience and achieve true cultural appropriateness.

Factors associated with medication adherence in hypertensive blacks: a review of the literature

BACKGROUND

Rates of medication adherence are low among hypertensive blacks despite numerous interventions to increase their adherence.

PURPOSE

The aim of the study was to conduct a systematic review of the literature to understand the factors associated with medication adherence in hypertensive blacks.

METHODS

A systematic computer search of qualitative and quantitative studies that examined factors associated with medication adherence in hypertensive blacks from 1966 to 2010 was performed. Studies were excluded if medication adherence was not either the primary or secondary outcome variable.

RESULTS

Studies (n = 18) were cross-sectional or qualitative, measured adherence via self-report, and conducted in low-income blacks. Factors that were associated with medication adherence were self-efficacy, depression, patient-provider communication, and healthcare system related.

CONCLUSIONS

Findings from existing studies should be interpreted with caution because of their methodological limitations. Longitudinal studies with heterogeneous samples of hypertensive blacks are imperative so that targeted interventions can be developed for this vulnerable population.

CLINICAL IMPLICATIONS

Even though there are methodological limitations associated with existing studies, clinicians may want to consider some of the factors that were associated with medication adherence in this systematic review as they provide care for hypertensive blacks. Given that self-efficacy and patient-provider communication are modifiable factors, they can be the focus of interventions to increase medication adherence. Finally, clinicians may want to screen their hypertensive patients for depression and treat, if necessary.

A framework to evaluate the cultural appropriateness of intervention research

Marked racial disparities exist in the prevalence, mortality, and treatment of asthma, between African American and White children and adolescents, despite increases in intervention trials to improve asthma outcomes. Yet, interventions to improve African American children's health must be culturally appropriate. To date, limited frameworks are available to decide whether an intervention tested with a targeted minority population employs a culturally appropriate design. In this article, we applied Bernal, Bonilla, and Bellido's ecological validity model to examine the cultural appropriateness of 12 randomized controlled trials of asthma self-management interventions published from 2000 to 2010. Most frequently met criteria were culturally appropriate methods of development and/or adaptation of interventions and inclusion of theoretical models. Least often met criteria were incorporating metaphors pertinent to participants and application of the language dimension. Based on this analysis, it is clear that an overarching framework is needed to guide the development of culturally targeted interventions.

The practitioner proposes a treatment change and the patient declines: what to do next?

OBJECTIVE

This study describes how pain practitioners can elicit the beliefs that are responsible for patients' judgments against considering a treatment change and activate collaborative decision making.

METHODS

Beliefs of 139 chronic pain patients who are in treatment but continue to experience significant pain were reduced to 7 items about the significance of pain on the patient's life. The items were aggregated into 4 decision models that predict which patients are actually considering a change in their current treatment.

RESULTS

While only 34% of study participants were considering a treatment change overall, the percentage ranged from 20 to 70, depending on their ratings about current consequences of pain, emotional influence, and long-term impact. Generalized linear model analysis confirmed that a simple additive model of these 3 beliefs is the best predictor.

CONCLUSION

Initial opposition to a treatment change is a conditional judgment and subject to change as specific beliefs become incompatible with patients' current conditions. These beliefs can be elicited through dialog by asking 3 questions.

Patient factors, but not provider and health care system factors, predict medication adherence in hypertensive black men

The problem of medication adherence is pronounced in hypertensive black men. However, factors influencing their adherence are not well understood. This secondary analysis of the ongoing Counseling African Americans to Control Hypertension (CAATCH) randomized clinical trial investigated the patient, provider, and health care system factors associated with medication adherence among hypertensive black men. Participants (N=253) were aged 56.6±11.6 years, earned <$20,000 yearly (72.7%), and almost one half were on Medicaid (44%). Mean systolic blood pressure was 148.7±15.8 mm Hg and mean diastolic blood pressure was 92.7±9.8 mm Hg. Over one half of participants (54.9%) were nonadherent. In a hierarchical regression analysis, the patient factors that predicted medication adherence were age, self-efficacy, and depression. The final model accounted for 32.1% of the variance (F=7.80, df 10, 165, P<.001). In conclusion, age, self-efficacy, and depression were associated with antihypertensive medication adherence in black men followed in Community/Migrant Health Centers. Age is a characteristic that may allow clinicians to predict who may be at risk for poor medication adherence. Depression can be screened for and treated. Self-efficacy is modifiable and its implications for practice would be the development of interventions to increase self-efficacy in black men with hypertension.