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Chen Y, Gao J, Lu M. Medication adherence trajectory of patients with chronic diseases and its influencing factors: A systematic review. J Adv Nurs 2024; 80:11-41. [PMID: 37408103 DOI: 10.1111/jan.15776] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 06/16/2023] [Accepted: 06/26/2023] [Indexed: 07/07/2023]
Abstract
AIMS To synthesize the published studies on medication adherence trajectories among patients with chronic diseases and identify the influencing factors. DESIGN Systematic review. DATA SOURCES Medline (Ovid), Embase (Ovid) and Web of Science core collection were searched from database inception to 1 July 2022. REVIEW METHODS Potentially eligible articles were independently screened by three reviewers using set inclusion and exclusion criteria. The Joanna Briggs Institute critical appraisal checklist for cohort studies was used to appraise the quality of the included articles. Three reviewers independently evaluated the quality, extracted data and resolved differences by consensus. Results were presented using descriptive synthesis, and the prevalence of recategorised medication adherence trajectories was calculated from the published data. RESULTS Fifty studies were included. Medication adherence trajectories among patients with chronic diseases were synthesized into six categories: adherence, non-adherence, decreasing adherence, increasing adherence, fluctuating adherence and moderate adherence. Low and moderate evidence showed that (1) patient-related factors, including age, sex, race, marital status and mental status; (2) healthcare team and system-related factors, including healthcare utilization, insurance and primary prescriber specialty; (3) socioeconomic factors including education, income and employment status; (4) condition-related factors including complications and comorbidities and (5) therapy-related factors including the number of medications, use of other medications, and prior medication adherence behaviours were factors influencing the medication adherence trajectory. Marital status and prior medication adherence behaviour were the only influencing factors with moderate evidence of an effect. CONCLUSION The medication adherence trajectory among patients with chronic diseases varied widely. Further studies are warranted to determine contributory factors. IMPLICATIONS FOR THE PROFESSION Healthcare providers should be aware that patients' medication adherence has different trajectories and should take appropriate measures to improve patients' medication adherence patterns. PATIENT OR PUBLIC CONTRIBUTION None. As a systematic review, patients and the public were not involved.
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Affiliation(s)
- Yu Chen
- School of Nursing, Fudan University, Shanghai, China
| | - Jing Gao
- Clinical Research Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Minmin Lu
- School of Nursing, Fudan University, Shanghai, China
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Muiruri C, van den Broek-Altenburg EM, Bosworth HB, Cené CW, Gonzalez JM. A Quantitative Framework for Medication Non-Adherence: Integrating Patient Treatment Expectations and Preferences. Patient Prefer Adherence 2023; 17:3135-3145. [PMID: 38077791 PMCID: PMC10706576 DOI: 10.2147/ppa.s434640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 11/21/2023] [Indexed: 02/12/2024] Open
Abstract
Introduction Medication non-adherence remains a significant challenge in healthcare, impacting treatment outcomes and the overall effectiveness of medical interventions. This article introduces a novel approach to understanding and predicting medication non-adherence by integrating patient beliefs, efficacy expectations, and perceived costs. Existing theoretical models often fall short in quantifying the impact of barrier removal on medication adherence and struggle to address cases where patients consciously choose not to follow prescribed medication regimens. In response to these limitations, this study presents an empirical framework that seeks to provide a quantifiable model for both individual and population-level prediction of non-adherence under different scenarios. Methods We present an empirical framework that includes a health production function, specifically applied to antihypertensive medications nonadherence. Data collection involved a pilot study that utilized a double-bound contingent-belief (DBCB) questionnaire. Through this questionnaire, participants could express how efficacy and side effects were affected by controlled levels of non-adherence, allowing for the estimation of sensitivity in health outcomes and costs. Results Parameters derived from the DBCB questionnaire revealed that on average, patients with hypertension anticipated that treatment efficacy was less sensitive to non-adherence than side effects. Our derived health production function suggests that patients may strategically manage adherence to minimize side effects, without compromising efficacy. Patients' inclination to manage medication intake is closely linked to the relative importance they assign to treatment efficacy and side effects. Model outcomes indicate that patients opt for full adherence when efficacy outweighs side effects. Our findings also indicated an association between income and patient expectations regarding the health of antihypertensive medications. Conclusion Our framework represents a pioneering effort to quantitatively link non-adherence to patient preferences. Preliminary results from our pilot study of patients with hypertension suggest that the framework offers a viable alternative for evaluating the potential impact of interventions on treatment adherence.
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Affiliation(s)
- Charles Muiruri
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | | | - Hayden B Bosworth
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Crystal W Cené
- University of California San Diego Health, San Diego, CA, USA
| | - Juan Marcos Gonzalez
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
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Ekpezu AO, Wiafe I, Oinas-Kukkonen H. Predicting Adherence to Behavior Change Support Systems Using Machine Learning: Systematic Review. JMIR AI 2023; 2:e46779. [PMID: 38875538 PMCID: PMC11041458 DOI: 10.2196/46779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 09/20/2023] [Accepted: 10/28/2023] [Indexed: 06/16/2024]
Abstract
BACKGROUND There is a dearth of knowledge on reliable adherence prediction measures in behavior change support systems (BCSSs). Existing reviews have predominately focused on self-reporting measures of adherence. These measures are susceptible to overestimation or underestimation of adherence behavior. OBJECTIVE This systematic review seeks to identify and summarize trends in the use of machine learning approaches to predict adherence to BCSSs. METHODS Systematic literature searches were conducted in the Scopus and PubMed electronic databases between January 2011 and August 2022. The initial search retrieved 2182 journal papers, but only 11 of these papers were eligible for this review. RESULTS A total of 4 categories of adherence problems in BCSSs were identified: adherence to digital cognitive and behavioral interventions, medication adherence, physical activity adherence, and diet adherence. The use of machine learning techniques for real-time adherence prediction in BCSSs is gaining research attention. A total of 13 unique supervised learning techniques were identified and the majority of them were traditional machine learning techniques (eg, support vector machine). Long short-term memory, multilayer perception, and ensemble learning are currently the only advanced learning techniques. Despite the heterogeneity in the feature selection approaches, most prediction models achieved good classification accuracies. This indicates that the features or predictors used were a good representation of the adherence problem. CONCLUSIONS Using machine learning algorithms to predict the adherence behavior of a BCSS user can facilitate the reinforcement of adherence behavior. This can be achieved by developing intelligent BCSSs that can provide users with more personalized, tailored, and timely suggestions.
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Affiliation(s)
- Akon Obu Ekpezu
- Oulu Advanced Research on Service and Information Systems, Department of Information Processing Science, University of Oulu, Oulu, Finland
| | - Isaac Wiafe
- Department of Computer Science, University of Ghana, Accra, Ghana
| | - Harri Oinas-Kukkonen
- Oulu Advanced Research on Service and Information Systems, Department of Information Processing Science, University of Oulu, Oulu, Finland
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Neter E, Miller A. Using an Intervention Mapping Approach to Improve Adherence to Disease-Modifying Treatment in Multiple Sclerosis. Int J MS Care 2023; 25:206-213. [PMID: 37720261 PMCID: PMC10503812 DOI: 10.7224/1537-2073.2022-018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
BACKGROUND Up to 50% of individuals with multiple sclerosis (MS) who are prescribed disease-modifying treatments (DMTs) do not take them as advised. Although many studies report on DMT adherence rate, few studies report on interventions involving individuals with MS. The current paper describes the development of an intervention aimed at improving adherence to DMTs among identified nonadherent individuals with MS. METHODS An intervention was developed using an Intervention Mapping approach, recommendations from reviews on medication adherence, and input from individuals with MS. Its content was determined by theories of health behavior (specifically, a perceptions and practicalities approach), empirical evidence collected among the specific target population (an observational "needs assessment" stage [n = 186]), and other studies. RESULTS A personalized intervention was tailored to the reasons for nonadherence, uncovered during the observational needs assessment stage, to be delivered sequentially by a neurologist and a psychologist. After the intervention objectives were identified, components of the intervention were set: psychoeducation and ways of coping with adverse effects; modification of unhelpful treatment beliefs (such modifications were found predictive of adherence in the observational phase of the study); improving confidence and self-efficacy; and developing strategies for remembering to take DMTs. These components were embedded within motivational interviewing. CONCLUSIONS Intervention Mapping was useful in developing an intervention grounded both in the theoretical approach of perceptions and practicalities and in empirical evidence from the literature and the target sample; concurrently, identifying determinants that the intervention did not address. The effectiveness of the intervention-which could potentially improve adherence among individuals with MS-needs to be examined.
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Affiliation(s)
- Efrat Neter
- From the Behavioral Sciences Department, Ruppin Academic Center, Emeq Hefer, Israel (EN)
- Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel (EN)
| | - Ariel Miller
- Multiple Sclerosis Center and Neuroimmunology Unit, Carmel Medical Center, Haifa, Israel (AM)
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Costa S, Biscaia JL, Horta MR, Romano S, Guerreiro J, Heudtlass P, Cary M, Romão M, Teixeira Rodrigues A, Miranda A, Martins AP, Bento AS, Pereira J, Mateus C, Helling DK. Real-World Effectiveness in Hypertension and Hyperlipidemia Collaborative Management between Pharmacies and Primary Care in Portugal: A Multicenter Pragmatic Controlled Trial (USFarmácia ®). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6496. [PMID: 37569036 PMCID: PMC10418740 DOI: 10.3390/ijerph20156496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 06/09/2023] [Accepted: 07/03/2023] [Indexed: 08/13/2023]
Abstract
There is evidence of the efficacy of collaborative health interventions with pharmacies and primary care providers but little of its real-world effectiveness. We aimed to assess the effectiveness and discuss the design and challenges of hypertension and hyperlipidemia management between pharmacies and primary care providers using real-world data exchange between providers and experimental bundled payment. This was a pragmatic, quasi-experimental controlled trial. We collected patient-level data from primary care prescription claims and Electronic Medical Record databases, a pharmacy claims database, and patient telephone surveys at several time points. The primary outcomes were changes in blood pressure and total cholesterol. We used matched controls with difference-in-differences estimators in a Generalized Linear Model (GLM) and controlled interrupted time series (CITS). We collected additional data for economic and qualitative studies. A total of 6 Primary Care Units, 20 pharmacies, and 203 patients entered the study. We were not able to observe significant differences in the effect of intervention vs. control. We experienced challenges that required creative strategies. This real-world trial was not able to show effectiveness, likely due to limitations in the primary care technology which affected the sample size. It offers, however, valuable lessons on methods, strategies, and data sources, paving the way for more real-world effectiveness trials to advance value-based healthcare.
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Affiliation(s)
- Suzete Costa
- NOVA National School of Public Health (ENSP), Universidade NOVA de Lisboa, 1600-560 Lisboa, Portugal
- Institute for Evidence-Based Health (ISBE), 1649-028 Lisboa, Portugal
- Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal
| | - José Luís Biscaia
- USF São Julião da Figueira, Agrupamento dos Centros de Saúde (ACeS) do Baixo Mondego, 3080-134 Figueira da Foz, Portugal
| | - Maria Rute Horta
- Centre for Medicines Information and Health Interventions (CEDIME), Infosaúde, Associação Nacional das Farmácias, 1249-069 Lisboa, Portugal
| | - Sónia Romano
- Centre for Health Evaluation & Research (CEFAR), Infosaúde, Associação Nacional das Farmácias, 1249-069 Lisboa, Portugal
| | - José Guerreiro
- Centre for Health Evaluation & Research (CEFAR), Infosaúde, Associação Nacional das Farmácias, 1249-069 Lisboa, Portugal
| | - Peter Heudtlass
- Centre for Health Evaluation & Research (CEFAR), Infosaúde, Associação Nacional das Farmácias, 1249-069 Lisboa, Portugal
| | - Maria Cary
- Centre for Health Evaluation & Research (CEFAR), Infosaúde, Associação Nacional das Farmácias, 1249-069 Lisboa, Portugal
| | - Mariana Romão
- Centre for Health Evaluation & Research (CEFAR), Infosaúde, Associação Nacional das Farmácias, 1249-069 Lisboa, Portugal
| | - António Teixeira Rodrigues
- Centre for Health Evaluation & Research (CEFAR), Infosaúde, Associação Nacional das Farmácias, 1249-069 Lisboa, Portugal
| | - Ana Miranda
- Registo Oncológico Nacional, Instituto Português de Oncologia de Lisboa Francisco Gentil, 1099-023 Lisboa, Portugal
| | - Ana Paula Martins
- Institute for Evidence-Based Health (ISBE), 1649-028 Lisboa, Portugal
- Pharmacy, Pharmacology & Health Technologies, Faculdade de Farmácia, Universidade de Lisboa, 1649-003 Lisboa, Portugal
| | - Ana Sofia Bento
- USF São Julião da Figueira, Agrupamento dos Centros de Saúde (ACeS) do Baixo Mondego, 3080-134 Figueira da Foz, Portugal
| | - João Pereira
- NOVA National School of Public Health (ENSP), Universidade NOVA de Lisboa, 1600-560 Lisboa, Portugal
- Public Health Research Centre (PHRC/CISP), Comprehensive Health Research Centre (CHRC), 1600-560 Lisboa, Portugal
| | - Céu Mateus
- Health Economics at Lancaster, Division of Health Research, Lancaster University, Lancaster LA1 4YX, UK
| | - Dennis K. Helling
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Denver, CO 80045, USA
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Stewart SJF, Moon Z, Horne R. Medication nonadherence: health impact, prevalence, correlates and interventions. Psychol Health 2023; 38:726-765. [PMID: 36448201 DOI: 10.1080/08870446.2022.2144923] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 11/01/2022] [Accepted: 11/02/2022] [Indexed: 12/05/2022]
Abstract
Nonadherence to medicines is a global problem compromising health and economic outcomes for individuals and society. This article outlines how adherence is defined and measured, and examines the impact, prevalence and determinants of nonadherence. It also discusses how a psychosocial perspective can inform the development of interventions to optimise adherence and presents a series of recommendations for future research to overcome common limitations associated with the medication nonadherence literature. Nonadherence is best understood in terms of the interactions between an individual and a specific disease/treatment, within a social and environmental context. Adherence is a product of motivation and ability. Motivation comprises conscious decision-making processes but also from more 'instinctive', intuitive and habitual processes. Ability comprises the physical and psychological skills needed to adhere. Both motivation and ability are influenced by environmental and social factors which influence the opportunity to adhere as well as triggers or cues to actions which may be internal (e.g. experiencing symptoms) or external (e.g. receiving a reminder). Systematic reviews of adherence interventions show that effective solutions are elusive, partly because few have a strong theoretical basis. Adherence support targeted at the level of individuals will be more effective if it is tailored to address the specific perceptions (e.g. beliefs about illness and treatment) and practicalities (e.g. capability and resources) influencing individuals' motivation and ability to adhere.
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Affiliation(s)
- Sarah-Jane F Stewart
- Centre for Behavioural Medicine, Research Department of Practice and Policy, UCL School of Pharmacy, University College London, London, UK
| | - Zoe Moon
- Centre for Behavioural Medicine, Research Department of Practice and Policy, UCL School of Pharmacy, University College London, London, UK
| | - Rob Horne
- Centre for Behavioural Medicine, Research Department of Practice and Policy, UCL School of Pharmacy, University College London, London, UK
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Elston Lafata J, Nguyen B, Staresinic C, Johnson M, Gratie D, Muluneh B. Interpersonal communication-, education- and counselling-based interventions to support adherence to oral anticancer therapy: a systematic review. J Oncol Pharm Pract 2023; 29:358-369. [PMID: 35048768 DOI: 10.1177/10781552211073576] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background. Many factors contribute to oral anti-cancer therapy adherence, including counselling and educational support. Objective. We systematically review the literature evaluating the effectiveness of interpersonal communication-, counselling- and education-based interventions on patient adherence to oral anticancer therapy. Methods. Using search terms pertaining to medication adherence, oral anticancer therapy, and communication, education, and counselling, we conducted a systematic search for full-text, original research articles prior to 3/13/20. Two reviewers independently reviewed each paper for inclusion and charted study information. Results. Twenty-four articles were included. All considered the use of oral anticancer therapy between two defined time points. Four studies also considered the length of time a patient persisted on therapy. Half (n = 12) of the studies reported a statistically significant relationship between the intervention and medication adherence, with no consistent pattern among intervention structure/content and effectiveness. Programmes offering in-person counselling and those targeting patients with chronic myeloid leukemia (CML), tended to report positive findings. Most studies faced substantial risk of bias, and only two reported using a behavioural theory to guide interventional content. Conclusions. Findings highlight the infancy of evidence base and need for rigorous and large-scale studies grounded in established behavioural theories to advance patient-targeted educational and counselling practices supporting adherence to oral anti-cancer therapy.
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Abbas S, Kermode M, Khan MD, Denholm J, Adetunji H, Kane S. What Makes People With Chronic Illnesses Discontinue Treatment? A Practice Theory Informed Analysis of Adherence to Treatment among Patients With Drug-Resistant Tuberculosis in Pakistan. Int J Health Policy Manag 2023; 12:6576. [PMID: 37579474 PMCID: PMC10125133 DOI: 10.34172/ijhpm.2022.6576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 12/27/2022] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Non-adherence to treatment is a frequently observed phenomenon amongst those on long-term treatment for chronic illnesses. This qualitative study draws upon the tenets of 'practice theory' to reveal what shapes patients' ability to adhere to the demanding treatment for drug-resistant tuberculosis (DR-TB) at three treatment sites in Khyber-Pakhtunkhwa (KP) province of Pakistan. METHODS This qualitative study involved observation of service provision over a period of nine months of stay at, and embedment within the three treatment sites and in-depth interviews with 13 service providers and 22 patients who became non-adherent to their treatment. RESULTS Consistent with the extensive research based on the barriers and facilitator approach, both patients, and providers in our study also talked of patients' doubts about diagnosis and treatment efficacy, side-effects of drugs, economic constraints, unreliable disbursements of monetary incentive, attitude of providers and co-morbidities as reasons for non-adherence to treatment. Applying a practice theory perspective yielded more contextualised insights; inadequate help with patients' physical complaints, unempathetic responses to their queries, and failure to provide essential information, created conditions which hindered the establishment and maintenance of the 'practice' of adhering to treatment. These supply-side gaps created confusion, bred resentment, and exacerbated pre-existing distrust of public health services among patients, and ultimately drove them to disengage with the TB services and stop their treatment. CONCLUSION We argue that the lack of supply-side 'responsiveness' to patient needs beyond the provision of a few material inputs is what is lacking in the existing DR-TB program in Pakistan. We conclude that unless Pakistan's TB program explicitly engages with these supply side, system level gaps, patients will continue to struggle to adhere to their treatments and the TB program will continue to lose patients. Conceptually, we make a case for reimagining the act of adherence (or not) to long-term treatment as a 'Practice.'
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Affiliation(s)
- Shazra Abbas
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Michelle Kermode
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | | | - Justin Denholm
- Department of Infectious Diseases, University of Melbourne, Melbourne, VIC, Australia
| | - Hamed Adetunji
- Faculty of Public Health & Health Informatics, Umm Al Qura University, Makkah Almukarramah, Saudi Arabia
| | - Sumit Kane
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
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Tavoian D, Craighead DH. Deep breathing exercise at work: Potential applications and impact. Front Physiol 2023; 14:1040091. [PMID: 36711016 PMCID: PMC9877284 DOI: 10.3389/fphys.2023.1040091] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 01/04/2023] [Indexed: 01/15/2023] Open
Abstract
Hypertension is a major contributor to cardiovascular disease and daily deep breathing exercise (DBE) is a promising intervention to reduce blood pressure and stress in adults. DBE is simple, time-efficient, and does not require specialized equipment, allowing participation in a wide variety of settings. The workplace is an ideal setting to implement DBE at the national level for several reasons, including a large proportion of waking hours spent in the workplace, high levels of sedentary time at work, prevalence of work-related stress, and regular breaks throughout the day potentially reducing worker error. While the degree of adherence to daily workplace DBE will be the responsibility of the individual, employers and managers can (and should) do much to remove barriers to participation. Specifically, this could include: implementing regular short breaks or classes to perform DBE throughout the day, covering subscription costs for smartphone applications that guide DBE, and creating incentive programs for continuing DBE participation. Implementing DBE in the workplace is a pragmatic approach to provide a low-cost blood pressure and stress reduction therapy to a substantial portion of the adult population in the US, at least 50% of whom have high blood pressure.
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Affiliation(s)
- Dallin Tavoian
- Arizona Respiratory Neurophysiology Laboratory, Department of Physiology, University of Arizona College of Medicine, Tucson, AZ, United States,*Correspondence: Dallin Tavoian,
| | - Daniel H. Craighead
- Integrative Physiology of Aging Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, United States
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Meraz R, Osteen K, McGee JS, Noblitt P, Viejo H. Applying Stress and Coping Theory to Understand Diuretic Adherence Experiences in Persons with Heart Failure. West J Nurs Res 2023; 45:67-77. [PMID: 35711104 DOI: 10.1177/01939459221106122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Despite the benefits of diuretics for treating the symptoms of heart failure (HF), patients may report side effects and intentionally not adhere to diuretic regimens. Positive internal motivators, such as positive emotions, may benefit individuals in their adaptation to medication-related stress. However, there has been limited study of these potential motivators in those with HF. Using a descriptive qualitative approach, 82 adults taking diuretics for HF were interviewed. This study applied stress and coping theory to understand the diuretic-taking experiences of patients with HF. Data analysis revealed three themes: (a) diuretics are bothersome, (b) staying positive in the mid of hardship, and (c) adapting to endure. Findings suggest that adherent participants stayed positive amid the perceived hardship, maintaining resilient and grateful attitudes. Adherent participants adapted to bothersome diuretic effects and utilized creative strategies. More research is needed to understand the relationships between resilience, adaptive coping, and diuretic adherence.
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Affiliation(s)
- Rebecca Meraz
- Baylor University Louise Herrington School of Nursing, Dallas, TX, USA
| | - Kathryn Osteen
- Baylor University Louise Herrington School of Nursing, Dallas, TX, USA
| | | | - Paul Noblitt
- Baylor Scott & White Medical Center, Irving, TX, USA
| | - Henry Viejo
- Baylor Scott & White Heart and Vascular Hospital, Fort Worth, TX, USA
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11
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Qualitative study of user perspectives and experiences of digital inhaler technology. NPJ Prim Care Respir Med 2022; 32:57. [PMID: 36550136 PMCID: PMC9780314 DOI: 10.1038/s41533-022-00320-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 11/22/2022] [Indexed: 12/24/2022] Open
Abstract
Electronic monitoring devices (EMDs) have been trialled in interventions to improve inhaled corticosteroid adherence and clinical outcomes. This study sought to understand the perceptions and experiences of EMD end-users. Participants recruited into a six-month EMD study were invited to a semi-structured interview. Interviews were audio-recorded, transcribed verbatim and analysed using the framework approach. Twenty-eight participants (68% female, median age 47) were interviewed. Individuals described feeling responsible for their asthma control. Recent attacks motivated a desire to maintain control. Study participation led to increased awareness of asthma status and medication use. Several individuals were open to integrating digital monitoring data with other mHealth inputs, perceiving the potential to enhance communication with clinicians and empower self-management. Openness to data sharing was tied to expectations of transparent data use. Data supported integrating beliefs and habit formation to achieve behaviour change. There was a willingness for an integrated, platform-based approach to digital self-management.
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Berset AE, Epstein JN, Hommel KA, Brinkman WB. Examining the Unified Theory of Behavior Change Constructs Among Adolescents Taking Attention-Deficit/Hyperactivity Disorder Medicine: A Longitudinal Study. Acad Pediatr 2022; 23:762-772. [PMID: 36202295 DOI: 10.1016/j.acap.2022.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 08/31/2022] [Accepted: 09/29/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To quantitatively validate the preintention factors, behavioral intentions, and implementation factors and examine the relationships theorized by the Unified Theory of Behavior Change (UTBC) model among adolescents with attention-deficit/hyperactivity disorder (ADHD). METHODS We conducted longitudinal analyses of data from 40 adolescents with ADHD, aged 11 to 15 years old, and their parents, including self-report of UTBC constructs using standardized measures. We collected pharmacy dispensing records for adolescents for the 4 months that followed. We used bivariate correlations to examine relationships between medication continuity, behavioral intentions, preintention factors, and the implementation factors. We conducted paired sample t-tests to compare adolescent and parent responses on UTBC items. RESULTS Adolescents (mean [standard deviation {SD}] age = 13.3 [1.2] years, 75% male, 77.5% non-Hispanic Black, 90% publicly insured) reported a mean total ADHD symptom score = 29.8/54 (SD = 10.94) and mean total impairment score = 18.7/52 (SD = 10.90) and had a mean percentage of days covered with medicine over 4 months = 0.21 (range = 0-0.97). Adolescent intention to take ADHD medicine every school day was significantly related to adolescents' subsequent medication continuity (r = 0.37, P < .05). Adolescent self-concept/image and confidence taking ADHD medicine were the most important factors related to the intention to take ADHD medicine every school day. Adolescents reported less belief and intention to take ADHD medicine and more barriers to taking ADHD medicine compared to their parents. CONCLUSION The UTBC model shed light on factors related to subsequent medication use, providing a plausible mechanism for additional research to intervene to promote future medication continuity.
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Affiliation(s)
- Anne E Berset
- Division of General & Community Pediatrics, Cincinnati Children's Hospital Medical Center (AE Berset and WB Brinkman), Cincinnati, Ohio; Ms Berset is now with the Department of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
| | - Jeffery N Epstein
- Department of Pediatrics, University of Cincinnati College of Medicine (JN Epstein, KA Hommel, and WB Brinkman), Cincinnati, Ohio; Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center (JN Epstein and KA Hommel), Cincinnati, Ohio
| | - Kevin A Hommel
- Department of Pediatrics, University of Cincinnati College of Medicine (JN Epstein, KA Hommel, and WB Brinkman), Cincinnati, Ohio; Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center (JN Epstein and KA Hommel), Cincinnati, Ohio
| | - William B Brinkman
- Division of General & Community Pediatrics, Cincinnati Children's Hospital Medical Center (AE Berset and WB Brinkman), Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine (JN Epstein, KA Hommel, and WB Brinkman), Cincinnati, Ohio
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Green SMC, French DP, Graham CD, Hall LH, Rousseau N, Foy R, Clark J, Parbutt C, Raine E, Gardner B, Velikova G, Moore SJL, Buxton J, Smith SG. Supporting adjuvant endocrine therapy adherence in women with breast cancer: the development of a complex behavioural intervention using Intervention Mapping guided by the Multiphase Optimisation Strategy. BMC Health Serv Res 2022; 22:1081. [PMID: 36002831 PMCID: PMC9404670 DOI: 10.1186/s12913-022-08243-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 06/21/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Adjuvant endocrine therapy (AET) reduces the risk of breast cancer recurrence and mortality. However, up to three-quarters of women with breast cancer do not take AET as prescribed. Existing interventions to support adherence to AET have largely been unsuccessful, and have not focused on the most salient barriers to adherence. This paper describes the process of developing four theory-based intervention components to support adherence to AET. Our aim is to provide an exemplar of intervention development using Intervention Mapping (IM) with guidance from the Multiphase Optimisation Strategy (MOST). METHODS Iterative development followed the six-stage IM framework with stakeholder involvement. Stage 1 involved a literature review of barriers to adherence and existing interventions, which informed the intervention objectives outlined in Stage 2. Stage 3 identified relevant theoretical considerations and practical strategies for supporting adherence. Stage 4 used information from Stages 1-3 to develop the intervention components. Stages 1-4 informed a conceptual model for the intervention package. Stages 5 and 6 detailed implementation considerations and evaluation plans for the intervention package, respectively. RESULTS The final intervention package comprised four individual intervention components: Short Message Service to encourage habitual behaviours surrounding medication taking; an information leaflet to target unhelpful beliefs about AET; remotely delivered Acceptance and Commitment Therapy-based guided self-help to reduce psychological distress; and a website to support self-management of AET side-effects. Considerations for implementation within the NHS, including cost, timing and mode of delivery were outlined, with explanation as to how using MOST can aid this. We detail our plans for the final stage of IM which involve feasibility testing. This involved planning an external exploratory pilot trial using a 24-1 fractional factorial design, and a process evaluation to assess acceptability and fidelity of intervention components. CONCLUSIONS We have described a systematic and logical approach for developing a theoretically informed intervention package to support medication adherence in women with breast cancer using AET. Further research to optimise the intervention package, guided by MOST, has the potential to lead to more effective, efficient and scalable interventions.
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Affiliation(s)
- Sophie M. C. Green
- grid.9909.90000 0004 1936 8403Leeds Institute of Health Sciences, University of Leeds, Clarendon Way, Leeds, LS2 9NL UK
| | - David P. French
- grid.5379.80000000121662407Manchester Centre for Health Psychology, University of Manchester, Manchester, UK
| | - Christopher D. Graham
- grid.4777.30000 0004 0374 7521Department of Psychology, Queen’s University Belfast, Belfast, UK
| | - Louise H. Hall
- grid.9909.90000 0004 1936 8403Leeds Institute of Health Sciences, University of Leeds, Clarendon Way, Leeds, LS2 9NL UK
| | - Nikki Rousseau
- grid.9909.90000 0004 1936 8403Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Robbie Foy
- grid.9909.90000 0004 1936 8403Leeds Institute of Health Sciences, University of Leeds, Clarendon Way, Leeds, LS2 9NL UK
| | - Jane Clark
- grid.443984.60000 0000 8813 7132St. James’s University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Catherine Parbutt
- grid.443984.60000 0000 8813 7132St. James’s University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Erin Raine
- grid.9909.90000 0004 1936 8403Leeds Institute of Health Sciences, University of Leeds, Clarendon Way, Leeds, LS2 9NL UK
| | - Benjamin Gardner
- grid.13097.3c0000 0001 2322 6764Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Galina Velikova
- grid.443984.60000 0000 8813 7132Leeds Institute of Medical Research at St James’s, University of Leeds, St James’s University Hospital, Leeds, UK ,grid.443984.60000 0000 8813 7132Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, St James’s University Hospital, Leeds, UK
| | - Sally J. L. Moore
- grid.9909.90000 0004 1936 8403Leeds Institute of Health Sciences, University of Leeds, Clarendon Way, Leeds, LS2 9NL UK
| | - Jacqueline Buxton
- grid.9909.90000 0004 1936 8403Leeds Institute of Health Sciences, University of Leeds, Clarendon Way, Leeds, LS2 9NL UK
| | | | - Samuel G. Smith
- grid.9909.90000 0004 1936 8403Leeds Institute of Health Sciences, University of Leeds, Clarendon Way, Leeds, LS2 9NL UK
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14
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Chan A, De Simoni A, Wileman V, Holliday L, Newby CJ, Chisari C, Ali S, Zhu N, Padakanti P, Pinprachanan V, Ting V, Griffiths CJ. Digital interventions to improve adherence to maintenance medication in asthma. Cochrane Database Syst Rev 2022; 6:CD013030. [PMID: 35691614 PMCID: PMC9188849 DOI: 10.1002/14651858.cd013030.pub2] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Asthma is the most common chronic lung condition worldwide, affecting 334 million adults and children globally. Despite the availability of effective treatment, such as inhaled corticosteroids (ICS), adherence to maintenance medication remains suboptimal. Poor ICS adherence leads to increased asthma symptoms, exacerbations, hospitalisations, and healthcare utilisation. Importantly, suboptimal use of asthma medication is a key contributor to asthma deaths. The impact of digital interventions on adherence and asthma outcomes is unknown. OBJECTIVES To determine the effectiveness of digital interventions for improving adherence to maintenance treatments in asthma. SEARCH METHODS We identified trials from the Cochrane Airways Trials Register, which contains studies identified through multiple electronic searches and handsearches of other sources. We also searched trial registries and reference lists of primary studies. We conducted the most recent searches on 1 June 2020, with no restrictions on language of publication. A further search was run in October 2021, but studies were not fully incorporated. SELECTION CRITERIA We included randomised controlled trials (RCTs) including cluster- and quasi-randomised trials of any duration in any setting, comparing a digital adherence intervention with a non-digital adherence intervention or usual care. We included adults and children with a clinical diagnosis of asthma, receiving maintenance treatment. DATA COLLECTION AND ANALYSIS We used standard methodological procedures for data collection. We used GRADE to assess quantitative outcomes where data were available. MAIN RESULTS We included 40 parallel randomised controlled trials (RCTs) involving adults and children with asthma (n = 15,207), of which eight are ongoing studies. Of the included studies, 30 contributed data to at least one meta-analysis. The total number of participants ranged from 18 to 8517 (median 339). Intervention length ranged from two to 104 weeks. Most studies (n = 29) reported adherence to maintenance medication as their primary outcome; other outcomes such as asthma control and quality of life were also commonly reported. Studies had low or unclear risk of selection bias but high risk of performance and detection biases due to inability to blind the participants, personnel, or outcome assessors. A quarter of the studies had high risk of attrition bias and selective outcome reporting. We examined the effect of digital interventions using meta-analysis for the following outcomes: adherence (16 studies); asthma control (16 studies); asthma exacerbations (six studies); unscheduled healthcare utilisation (four studies); lung function (seven studies); and quality of life (10 studies). Pooled results showed that patients receiving digital interventions may have increased adherence (mean difference of 14.66 percentage points, 95% confidence interval (CI) 7.74 to 21.57; low-certainty evidence); this is likely to be clinically significant in those with poor baseline medication adherence. Subgroup analysis by type of intervention was significant (P = 0.001), with better adherence shown with electronic monitoring devices (EMDs) (23 percentage points over control, 95% CI 10.84 to 34.16; seven studies), and with short message services (SMS) (12 percentage points over control, 95% CI 6.22 to 18.03; four studies). No significant subgroup differences were seen for interventions having an in-person component versus fully digital interventions, adherence feedback, one or multiple digital components to the intervention, or participant age. Digital interventions were likely to improve asthma control (standardised mean difference (SMD) 0.31 higher, 95% CI 0.17 to 0.44; moderate-certainty evidence) - a small but likely clinically significant effect. They may reduce asthma exacerbations (risk ratio 0.53, 95% CI 0.32 to 0.91; low-certainty evidence). Digital interventions may result in a slight change in unscheduled healthcare utilisation, although some studies reported no or a worsened effect. School or work absence data could not be included for meta-analysis due to the heterogeneity in reporting and the low number of studies. They may result in little or no difference in lung function (forced expiratory volume in one second (FEV1)): there was an improvement of 3.58% predicted FEV1, 95% CI 1.00% to 6.17%; moderate-certainty evidence); however, this is unlikely to be clinically significant as the FEV1 change is below 12%. Digital interventions likely increase quality of life (SMD 0.26 higher, 95% CI 0.07 to 0.45; moderate-certainty evidence); however, this is a small effect that may not be clinically significant. Acceptability data showed positive attitudes towards digital interventions. There were no data on cost-effectiveness or adverse events. Our confidence in the evidence was reduced by risk of bias and inconsistency. AUTHORS' CONCLUSIONS Overall, digital interventions may result in a large increase in adherence (low-certainty evidence). There is moderate-certainty evidence that digital adherence interventions likely improve asthma control to a degree that is clinically significant, and likely increase quality of life, but there is little or no improvement in lung function. The review found low-certainty evidence that digital interventions may reduce asthma exacerbations. Subgroup analyses show that EMDs may improve adherence by 23% and SMS interventions by 12%, and interventions with an in-person element and adherence feedback may have greater benefits for asthma control and adherence, respectively. Future studies should include percentage adherence as a routine outcome measure to enable comparison between studies and meta-analysis, and use validated questionnaires to assess adherence and outcomes.
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Affiliation(s)
- Amy Chan
- Centre for Behavioural Medicine, Department of Practice and Policy, UCL School of Pharmacy, University College London, London, UK
- School of Pharmacy, The University of Auckland, Auckland, New Zealand
- Asthma UK Centre for Applied Research, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Anna De Simoni
- Wolfson Institute of Population Health, Centre for Primary Care Asthma UK Centre for Applied Research, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Vari Wileman
- Centre for Behavioural Medicine, Department of Practice and Policy, UCL School of Pharmacy, University College London, London, UK
| | - Lois Holliday
- Wolfson Institute of Population Health, Centre for Primary Care Asthma UK Centre for Applied Research, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Chris J Newby
- Research Design Service, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Claudia Chisari
- Centre for Behavioural Medicine, Department of Practice and Policy, UCL School of Pharmacy, University College London, London, UK
| | - Sana Ali
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Natalee Zhu
- School of Pharmacy, The University of Auckland, Auckland, New Zealand
| | | | | | - Victoria Ting
- School of Pharmacy, The University of Auckland, Auckland, New Zealand
| | - Chris J Griffiths
- Asthma UK Centre for Applied Research, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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15
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Socio-cognitive determinants affecting insulin adherence/non-adherence in late adolescents and young adults with type 1 diabetes: a systematic review protocol. J Diabetes Metab Disord 2022; 21:1207-1215. [PMID: 35673417 PMCID: PMC9167269 DOI: 10.1007/s40200-022-01054-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 05/09/2022] [Indexed: 11/04/2022]
Abstract
Objective This systematic review aims to investigate the key socio-cognitive determinants associated with adherence/non-adherence to insulin treatment in late adolescents and young adults in the age range of 17–24 years with T1D. Methods A pre-specified search strategy will be used to search for studies in the electronic databases and citation indexes: PubMed, EMBASE, Web of Science, and PsycINFO. Two researchers will screen the title and the abstract independently, then will read and critically appraise the full text of each included study. A third independent reviewer will resolve disagreements in data extraction until consensus. Data will be extracted using the Population, Exposure, Outcomes, Study characteristics framework. Study selection will follow the updated guideline for reporting systematic reviews (PRISMA 2020) and will take place from 15 October 2021 to 1 January 2022. The methodological quality and risk of bias of the observational studies will be assessed by the JBI Critical Appraisal Checklist for Cohort and JBI Critical Appraisal Checklist for Analytical Cross Sectional Studies. Results A qualitative narrative synthesis will present the characteristics and the quality of studies and the outcomes of concern. Conclusion Based on the contemporary literature, this review will synthesize the evidence on the socio-cognitive determinants associated with adherence/non-adherence to insulin treatment in late adolescents and young adults in the age range of 17–24 years with T1D. The findings will help design patient-centered interventions to promote adherence to insulin in this age group, guide patients’ consultations and diabetes self-management education (DSME) programs. Protocol registration: PROSPERO ID: CRD42021233074.
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16
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Te Kampe R, Boonen A, Jansen TL, Elling JM, Flendrie M, van Eijk-Hustings Y, Janssen M, van Durme C, de Vries H. Development and usability of a web-based patient-tailored tool to support adherence to urate-lowering therapy in gout. BMC Med Inform Decis Mak 2022; 22:95. [PMID: 35392890 PMCID: PMC8991610 DOI: 10.1186/s12911-022-01833-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 03/28/2022] [Indexed: 01/09/2023] Open
Abstract
Background The aim of this study is to develop and assess usability of a web-based patient-tailored tool to support adherence to urate-lowering therapy (ULT) among gout patients in a clinical setting.
Methods The content of the tool was based on the Integrated Change (I-Change) model. This model combines various socio-cognitive theories and assumes behavioral change is a result of becoming aware of the necessity of change by integrating pre-motivational, motivational, and post-motivational factors. An expert group (five gout experts, three health services researchers, and one health behavior expert) was assembled that decided in three meetings on the tool’s specific content (assessments and personalized feedback) using information from preparatory qualitative studies and literature reviews. Usability was tested by a think aloud approach and validated usability questionnaires.
Results The I-Change Gout tool contains three consecutive sessions comprising 80 questions, 66 tailored textual feedback messages, and 40 tailored animated videos. Navigation through the sessions was determined by the patients’ intention to adapt suboptimal ULT adherence. After the sessions, patients receive an overview of the personalized advices and plans to support ULT adherence. Usability testing among 20 gout patients that (ever) used ULT and seven healthcare professionals revealed an overall score for the tool of 8.4 ± 0.9 and 7.7 ± 1.0 (scale 1–10). Furthermore, participants reported a high intention to use and/or recommend the tool to others. Participants identified some issues for further improvement (e.g. redundant questions, technical issues, and text readability). If relevant, these were subsequently implemented in the I-Change Gout tool, to allow further testing among the following participants. Conclusion This study provides initial support for the usability by patients and healthcare professionals of the I-Change Gout tool to support ULT adherence behavior.
Supplementary Information The online version contains supplementary material available at 10.1186/s12911-022-01833-6.
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Affiliation(s)
- Ritch Te Kampe
- Division of Rheumatology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands. .,Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands. .,Department of Rheumatology, VieCuri Medical Center, Venlo, The Netherlands.
| | - Annelies Boonen
- Division of Rheumatology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.,Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Tim L Jansen
- Department of Rheumatology, VieCuri Medical Center, Venlo, The Netherlands
| | - Jan Mathis Elling
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.,Department of Health Promotion, Maastricht University, Maastricht, The Netherlands
| | - Marcel Flendrie
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Yvonne van Eijk-Hustings
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Matthijs Janssen
- Department of Rheumatology, VieCuri Medical Center, Venlo, The Netherlands
| | - Caroline van Durme
- Division of Rheumatology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.,Centre Hospitalier Chrétien, Liège, Belgium
| | - Hein de Vries
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.,Department of Health Promotion, Maastricht University, Maastricht, The Netherlands
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17
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Exploring a New Theoretical Model to Explain the Behavior of Medication Adherence. PHARMACY 2022; 10:pharmacy10020043. [PMID: 35448702 PMCID: PMC9025348 DOI: 10.3390/pharmacy10020043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/25/2022] [Accepted: 03/28/2022] [Indexed: 01/25/2023] Open
Abstract
Medication adherence is essential for optimal therapeutic outcomes. However, non-adherence with long-term therapy is at 50%. Several theoretical models have identified several key factors that could explain medication adherence. Though numerous interventions have been developed based on these theoretical models, the success rates with interventions are not the best. This paper proposes a new Hierarchical Model for Medication Adherence. In this model, we propose medication adherence as a five-tier model with medication adherence as the desirable behavior on the top of the pyramid. From the bottom of the hierarchy upwards, the skills/beliefs/behaviors to be achieved are: health literacy, belief in illness (impacted by perceived susceptibility and severity of illness), belief in medicines (impacted by treatment satisfaction), and self-efficacy (impacted by social support). The model further proposes that each individual will achieve or already have these skills/beliefs/behaviors at various levels. Screening patients for these benchmarks will enable providers to decide where to target interventions.
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18
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Gasteiger C, Petrie KJ. Moving forward: Implementing health psychology research to improve patient acceptance of biosimilars. Res Social Adm Pharm 2022; 18:3860-3863. [PMID: 35339394 DOI: 10.1016/j.sapharm.2022.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/22/2022] [Accepted: 03/17/2022] [Indexed: 12/25/2022]
Abstract
As more biosimilars enter the pharmaceutical market, patient acceptance remains a significant barrier to their uptake. Psychological factors, such as negative expectations, are important causes of patient hesitancy. As a result, patients can develop nocebo responses following a transition, discontinue biosimilar treatment early, or have poor adherence. These negative outcomes may offset some of the cost-saving potential of biosimilars. Key healthcare professionals such as pharmacists, physicians, and nurses already play a noteworthy role in educating and transitioning patients. However, given the psychological aspect of biosimilar acceptance, it is logical for healthcare professionals and researchers to draw on research and theory from health psychology. This commentary outlines how a multidisciplinary approach can add to the understanding of the mechanisms behind patient resistance to biosimilars and help engage patients in the transitioning process. It also explores how health psychology strategies that have been successful in similar areas can be translated to help conduct more effective transitions. Future directions in research are discussed.
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Affiliation(s)
- Chiara Gasteiger
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
| | - Keith J Petrie
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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19
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Heller MK, Chapman SCE, Horne R. Beliefs About Medicines Predict Side-Effects of Placebo Modafinil. Ann Behav Med 2022; 56:989-1001. [PMID: 35512392 DOI: 10.1093/abm/kaab112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Patients receiving placebo in clinical trials often report side-effects (nocebo effects), but contributing factors are still poorly understood. PURPOSE Using a sham trial of the cognition-enhancing "smart pill" Modafinil we tested whether medication beliefs and other psychological factors predicted detection and attribution of symptoms as side-effects to placebo. METHODS Healthy students (n = 201) completed measures assessing beliefs about medication, perceived sensitivity to medicines, negative affectivity, somatization, and body awareness; 66 were then randomized to receive Deceptive Placebo (told Modafinil-given placebo, 67 to Open Placebo (told placebo-given placebo, and 68 to No Placebo. Memory and attention tasks assessed cognitive enhancement. Nocebo effects were assessed by symptom checklist. RESULTS More symptoms were reported in the Deceptive Placebo condition (M = 2.65; SD = 2.27) than Open Placebo (M = 1.92; SD = 2.24; Mann-Whitney U = 1,654, z = 2.30, p = .022) or No Placebo (M = 1.68; SD = 1.75, Mann-Whitney U = 1,640, z = 2.74, p = .006). Participants were more likely to attribute symptoms to Modafinil side-effects if they believed pharmaceuticals to be generally harmful (incidence rate ratio [IRR] = 1.70, p = .019), had higher perceived sensitivity to medicines (IRR = 1.68, p = .011), stronger concerns about Modafinil (IRR = 2.10, p < .001), and higher negative affectivity (IRR = 2.37, p < .001). CONCLUSIONS Beliefs about medication are potentially modifiable predictors of the nocebo effect. These findings provide insight into side-effect reports to placebo and, potentially, active treatment.
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Affiliation(s)
- Monika K Heller
- Centre for Behavioural Medicine, UCL School of Pharmacy, UCL, Tavistock Square, WC1H 9JP, London, UK
| | - Sarah C E Chapman
- Centre for Behavioural Medicine, UCL School of Pharmacy, UCL, Tavistock Square, WC1H 9JP, London, UK.,Department of Pharmacy & Pharmacology, University of Bath, Claverton Down Road, Bath, UK
| | - Rob Horne
- Centre for Behavioural Medicine, UCL School of Pharmacy, UCL, Tavistock Square, WC1H 9JP, London, UK
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20
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Eziefula C, Shah FT, Anie KA. Promoting Adherence to Iron Chelation Treatment in Beta-Thalassemia Patients. Patient Prefer Adherence 2022; 16:1423-1437. [PMID: 35698633 PMCID: PMC9188463 DOI: 10.2147/ppa.s269352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 03/29/2022] [Indexed: 01/19/2023] Open
Abstract
Thalassaemia is one of the commonest inherited genetic disorders world-wide with around 25,000 births of the most severely affected transfusion dependent children annually. Patients with transfusion dependent thalassaemia require regular blood transfusions to maintain life but because of this will develop iron overload. To remove the excess iron, patients are required to take iron chelation therapy (ICT). ICT requires lifelong adherence to treatment to prevent end organ damage from developing. Many of these preventable complications make adherence to therapy more complex for patients. In this review, we focus on two commonly encountered patient scenarios and discuss how different psychological models and a relational theory can be used to understand and support adherence to treatment.
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Affiliation(s)
- Chinea Eziefula
- Camden & Islington NHS Foundation Trust, London, UK
- Psychology Services, Whittington Health NHS Trust, London, UK
| | - Farrukh T Shah
- Department of Haematology, Whittington Health NHS Trust, London, UK
- Medical Director for Transfusion, NHSBT, London, UK
- Correspondence: Farrukh T Shah, Department of Haematology, Whittington Health, Magdala Avenue, London, N19 5NF, Tel +44 0207 288 5144, Email
| | - Kofi A Anie
- London North West University Healthcare NHS Trust, London, UK
- Imperial College London, London, UK
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21
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Effect of a Smart Pill Bottle Reminder Intervention on Medication Adherence, Self-efficacy, and Depression in Breast Cancer Survivors. Cancer Nurs 2022; 45:E874-E882. [PMID: 34661562 PMCID: PMC9584037 DOI: 10.1097/ncc.0000000000001030] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Globally, breast cancer has been identified as the most common cancer among women. The clinical efficacy of adjuvant oral antiestrogen therapy-including tamoxifen and aromatase inhibitors-has been proven to be clinically efficacious for breast cancer survivors. However, medication adherence for these therapies remains suboptimal among breast cancer survivors. OBJECTIVE The aim of this study was to evaluate the effect of a reminder intervention-a smart pill bottle paired with the Pillsy mobile application-on medication adherence, medication self-efficacy, and depression, among breast cancer survivors who were undergoing oral antiestrogen therapy. METHODS This study is a randomized controlled trial. Sixty-one women were allocated to an experimental group (n = 31) and the control group (n = 30). The experimental group received the reminder intervention of a smart pill bottle for 4 weeks. Study outcomes were identified as medication adherence, medication self-efficacy, and depression. RESULTS Fifty-seven women completed the follow-up measurement. Significant differences in favor of the experimental group were noted for medication adherence ( P = .004) and medication self-efficacy ( P = .004). There was no statistically significant difference between the 2 groups with regard to depression ( P = .057). CONCLUSIONS Reminder intervention using smart pill bottles was effective in improving medication adherence and medication self-efficacy among breast cancer survivors undergoing oral antiestrogen therapy. IMPLICATIONS FOR PRACTICE A smart pill bottle method of intervention can be a useful reminder strategy to improve medication adherence among breast cancer survivors.
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22
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Lisum K, Waluyo A, Nursasi AY. Treatment Adherence among Tuberculosis patients: A Concept Analysis. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.7849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND OF THE STUDY: The principal difficulty of long-term tuberculosis (TB) treatment is patient nonadherence. During pandemic, nonadherence of TB treatment affects mortality since TB patients are more vulnerable with Covid-19.
AIM OF THE STUDY: The purpose of this concept analysis was to clarify and analyze the concept of treatment adherence. METHODOLOGY: Analysis concept was conducted using the Walker and Avant’s method from relevant studies published by EBSCO, PubMed, ProQuest, Wiley Online Library, and Springer between 2003 - 2021.
RESULTS: Five attributes characterizing the concept of treatment adherence from thirteen articles were identified: individual behavior, relationship, mutual participation, shared decision making, and agreement.
CONCLUSION: This concept analysis revealed that TB treatment adherence involves many aspects, including the patient, family, society, health care professionals, and policy. These findings help to understand the contribution of major attributes, thereby promoting the body of knowledge on TB and contributing to its elimination during COVID-19 pandemic.
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23
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Parwati NM, Bakta IM, Januraga PP, Wirawan IMA. A Health Belief Model-Based Motivational Interviewing for Medication Adherence and Treatment Success in Pulmonary Tuberculosis Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413238. [PMID: 34948846 PMCID: PMC8701142 DOI: 10.3390/ijerph182413238] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/10/2021] [Accepted: 12/12/2021] [Indexed: 11/16/2022]
Abstract
Medication adherence behavior plays a central role in the success of tuberculosis (TB) treatment. Conventional motivation is not optimal in strengthening long-term medication adherence. A motivational interviewing (MI) communication motivation model based on the Health Belief Model (HBM) was designed with the main objective of improving medication adherence and treatment success. This study used an experimental design with a randomized posttest-only control group design. The intervention and control groups consisted of 107 TB patients each, who were selected by random cluster sampling. The study was conducted from November 2020 to June 2021 at 38 public health centers in Bali Province. The HBM-based MI model intervention was given in seven counseling sessions, pill count percentages were used to measure medication adherence, and treatment success was based on sputum examination results. Logistic regression was used to assess the effect of the intervention on medication adherence and treatment success. Logistic regression analysis showed that MI-based HBM and knowledge were the most influential variables for increasing medication adherence and treatment success. Medication adherence was 4.5 times greater (ARR = 4.51, p = 0.018) and treatment success was 3.8 times greater (ARR = 3.81, p < 0.038) in the intervention group compared to the control group, while the secondary outcome of knowledge of other factors together influenced medication adherence and treatment success. The conclusion is that the HBM-based MI communication motivation model creates a patient-centered relationship by overcoming the triggers of treatment barriers originating from the HBM construct, effectively increasing medication adherence and treatment success for TB patients, and it needs further development by involving families in counseling for consistent self-efficacy of patients in long-term treatment.
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Affiliation(s)
- Ni Made Parwati
- Doctoral Study Program, Medical Faculty, Udayana University, Denpasar 80361, Indonesia
- Correspondence:
| | - I Made Bakta
- Department of Internal Medicine, Medical Faculty, Udayana University, Denpasar 80234, Indonesia;
| | - Pande Putu Januraga
- School of Public Health, Udayana University, Denpasar 80234, Indonesia; (P.P.J.); (I.M.A.W.)
| | - I Made Ady Wirawan
- School of Public Health, Udayana University, Denpasar 80234, Indonesia; (P.P.J.); (I.M.A.W.)
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Fumero A, Marrero RJ, Peñate W, Bethencourt JM, Barreiro P. Adherence to Oral Contraception in Young Women: Beliefs, Locus of Control, and Psychological Reactance. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111308. [PMID: 34769824 PMCID: PMC8582819 DOI: 10.3390/ijerph182111308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/21/2021] [Accepted: 10/26/2021] [Indexed: 12/15/2022]
Abstract
Background: There is a high dropout rate of oral contraceptive pills (OCP), mainly due to a lack of adherence to treatment. The aim of this study was to identify the psychological processes and attitudes toward medication involved in adherence to OCP, depending on the prescription, to avoid unintended pregnancies (AUP) or gynecological problems (GP). Methods: This cross-sectional study was conducted by asking 689 young women in the fertile period, mean age 23.41 (SD = 5.90), to complete questionnaires related to attitudes, beliefs, psychological reactance, locus of control, and adherence to contraceptive medication. Descriptive analyses and a binary logistic regression were performed. Results: The results confirmed that different beliefs and psychological processes were involved in adherence to oral contraception, based on women’s reasons for taking contraceptive medication. More psychological processes were involved in non-adherence in the AUP group than in the GP group. Psychological reactance contributed most to explaining non-adherence in women who used the OCP to prevent unintended pregnancies. Conversely, women with gynecological problems reported difficulties in adherence, mainly due to their beliefs about contraceptive pills. Conclusions: These findings indicate that attitudes toward medication and psychological processes can play an important role in adherence to OCP, including reasons for using the pill. Identifying the psychological factors and beliefs linked with contraception could guide health professionals to provide counseling to women, thus increasing their adherence to medication and maximizing their health and well-being.
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Affiliation(s)
- Ascensión Fumero
- Departmento de Psicología Clínica, Psicobiología y Metodología, Facultad de Psicología, Campus de Guajara, Universidad de La Laguna, 38200 San Cristóbal de Tenerife, Spain; (R.J.M.); (W.P.); (J.M.B.)
- Correspondence:
| | - Rosario J. Marrero
- Departmento de Psicología Clínica, Psicobiología y Metodología, Facultad de Psicología, Campus de Guajara, Universidad de La Laguna, 38200 San Cristóbal de Tenerife, Spain; (R.J.M.); (W.P.); (J.M.B.)
| | - Wenceslao Peñate
- Departmento de Psicología Clínica, Psicobiología y Metodología, Facultad de Psicología, Campus de Guajara, Universidad de La Laguna, 38200 San Cristóbal de Tenerife, Spain; (R.J.M.); (W.P.); (J.M.B.)
| | - Juan M. Bethencourt
- Departmento de Psicología Clínica, Psicobiología y Metodología, Facultad de Psicología, Campus de Guajara, Universidad de La Laguna, 38200 San Cristóbal de Tenerife, Spain; (R.J.M.); (W.P.); (J.M.B.)
| | - Pedro Barreiro
- Servicio Canario de la Salud, 38071 San Cristóbal de Tenerife, Spain;
- Gabinete Mente y Salud, 38003 San Cristóbal de Tenerife, Spain
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Wang R, Zhou C, Wu Y, Sun M, Yang L, Ye X, Zhang M. Patient empowerment and self-management behaviour of chronic disease patients: A moderated mediation model of self-efficacy and health locus of control. J Adv Nurs 2021; 78:1055-1065. [PMID: 34643959 DOI: 10.1111/jan.15077] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 08/18/2021] [Accepted: 09/26/2021] [Indexed: 11/28/2022]
Abstract
AIMS To explore the role of self-efficacy (SE) in the effect of patient empowerment on self-management behaviours among patients with chronic illness and to investigate the moderating effect of three types of health locus of control (HLC) in this moderated mediation model. DESIGN Cross-sectional design. METHODS Data were collected in a general tertiary hospital, and a sample of 254 patients was recruited between August and October 2020. The effect of moderation and mediation was tested by the PROCESS macro (Model 4 and Model 8) for SPSS 25.0 by Hayes using 5000 bootstrap samples. RESULTS Self-efficacy significantly mediated the relationship between patient empowerment and self-management behaviour with a 95% confidence interval excluding zero. The chance HLC demonstrated a moderating effect, and the interaction effect on SE and self-management behaviour was significant. CONCLUSION Patient empowerment may improve confidence and adherence to self-management among people with chronic illness, and such benefits were conditional on the HLC of patients. IMPACT This study addresses the relationship between patient empowerment and self-management behaviour in patients with different personality characteristics. This result indicated that classifying the type of HLC may enable the identification of subgroups of patients who may subsequently benefit from patient empowerment. In a patient-centred programme, nurses and other healthcare professionals correctly identifying patients' HLC type and understanding the implications and then providing appropriate health care plans for patients with different health beliefs may be useful to tailor the decision-making process.
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Affiliation(s)
- Run Wang
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, PR China.,School of Nursing, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Chunlan Zhou
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Yanni Wu
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Meihua Sun
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Lixiao Yang
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Xiaoling Ye
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Mi Zhang
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, PR China
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A qualitative exploration of the impact of knowledge and perceptions about hypertension in medication adherence in Middle Eastern refugees and migrants. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2021; 3:100038. [PMID: 35480607 PMCID: PMC9030275 DOI: 10.1016/j.rcsop.2021.100038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 06/19/2021] [Accepted: 06/21/2021] [Indexed: 11/21/2022] Open
Abstract
Background Objectives Methods Results Conclusion
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An Adaptable Framework for Factors Contributing to Medication Adherence: Results from a Systematic Review of 102 Conceptual Frameworks. J Gen Intern Med 2021; 36:2784-2795. [PMID: 33660211 PMCID: PMC8390603 DOI: 10.1007/s11606-021-06648-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 01/28/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To summarize the available conceptual models for factors contributing to medication adherence based on the World Health Organization (WHO)'s five dimensions of medication adherence via a systematic review, identify the patient groups described in available conceptual models, and present an adaptable conceptual model that describes the factors contributing to medication adherence in the identified patient groups. METHODS We searched PubMed®, Embase®, CINAHL®, and PsycINFO® for English language articles published from inception until 31 March 2020. Full-text original publications in English that presented theoretical or conceptual models for factors contributing to medication adherence were included. Studies that presented statistical models were excluded. Two authors independently extracted the data. RESULTS We identified 102 conceptual models, and classified the factors contributing to medication adherence using the WHO's five dimensions of medication adherence, namely patient-related, medication-related, condition-related, healthcare system/healthcare provider-related, and socioeconomic factors. Eight patient groups were identified based on age and disease condition. The most universally addressed factors were patient-related factors. Medication-related, condition-related, healthcare system-related, and socioeconomic factors were represented to various extents depending on the patient group. By systematically examining how the WHO's five dimensions of medication adherence were applied differently across the eight different patient groups, we present a conceptual model that can be adapted to summarize the common factors contributing to medication adherence in different patient groups. CONCLUSION Our conceptual models can be utilized as a guide for clinicians and researchers in identifying the facilitators and barriers to medication adherence and developing future interventions to improve medication adherence. PROTOCOL REGISTRATION PROSPERO Identifier: CRD42020181316.
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Aldan G, Helvaci A, Ozdemir L, Satar S, Ergun P. Multidimensional factors affecting medication adherence among patients with chronic obstructive pulmonary disease. J Clin Nurs 2021; 31:1202-1215. [PMID: 34309101 DOI: 10.1111/jocn.15976] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/23/2021] [Accepted: 07/05/2021] [Indexed: 11/26/2022]
Abstract
AIMS AND OBJECTIVES This study aimed to investigate the effects of socioeconomic-, patient-, treatment-, condition- and health system-related factors on medication adherence in patients with chronic obstructive pulmonary disease (COPD). BACKGROUND Medication adherence is essential for the management of chronic diseases. The World Health Organization created a Multidimensional Adherence Model (MAM) and showed that medication adherence is affected by a combination of numerous factors. DESIGN A descriptive correlational study was conducted. METHODS A total of 114 patients with COPD were included. Data were collected on five dimensions based on the MAM framework. Medication adherence, self-efficacy and symptoms were evaluated using the Adherence to Refills and Medications Scale-7 (ARMS-7), COPD Self-Efficacy Scale (CSES) and COPD Assessment Test (CAT), respectively. The data were analysed using descriptive statistics, correlational statistics and structural equation modelling. The STROBE checklist was used. RESULTS The ARMS-7 scores were associated with the body mass index of patients (F = 4.245, p = .017), smoke pack-years (r = .277, p = .004) and the CSES total score (β = -0.249, p = .002) in patient-related factors. The ARMS-7 score was not associated with socio-economic and health system-related factors. The ARMS-7 score showed a significant correlation between COPD diagnosis duration (r = -.276, p = .003) and the total number of drugs (r = -.215, p = .022) in treatment-related factors. The ARMS-7 scores were associated with the number of comorbid illnesses of patients with COPD in condition-related factors (F = 3.533, p = .033). CONCLUSION This study showed that medication adherence in COPD was mostly affected by patient-, treatment- and condition-related factors. RELEVANCE TO CLINICAL PRACTICE Healthcare professionals should establish training and counselling programs to increase the medication adherence level of patients, particularly for patients who are newly diagnosed, require multiple drugs and have comorbid diseases or low self-efficacy.
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Affiliation(s)
- Goncagul Aldan
- Faculty of Health Sciences, Nursing Department, Yüksek İhtisas University, Ankara, Turkey
| | - Aylin Helvaci
- Faculty of Nursing, Medical Nursing Department, Hacettepe University, Ankara, Turkey
| | - Leyla Ozdemir
- Faculty of Nursing, Medical Nursing Department, Hacettepe University, Ankara, Turkey
| | - Seher Satar
- Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Pinar Ergun
- Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
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Zahmatkeshan N, Rakhshan M, Zarshenas L, Kojuri J, Khademian Z. The Effect of Applying the Information-Motivation-Behavioral Skills Model on Treatment Adherence in Patients with Cardiovascular Disease: A Quasi-Experimental Study. INTERNATIONAL JOURNAL OF COMMUNITY BASED NURSING AND MIDWIFERY 2021; 9:225-237. [PMID: 34222543 PMCID: PMC8242410 DOI: 10.30476/ijcbnm.2021.88987.1563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 04/18/2021] [Accepted: 04/27/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Non-adherence complicates the management of patients with cardiovascular disease. This study aimed to determine the effect of applying the information-motivation-behavioral skills (IMB) model on the treatment adherence among these patients. METHODS This quasi-experimental study was conducted on 112 patients with cardiovascular disease in Nemazee and Al-zahra hospitals in Shiraz, Iran, from October 2019 to July 2020. Eligible patients were selected and divided into intervention and control groups. The intervention was based on an integration of IMB model constructs and included 10 motivational-educational sessions for three months, followed by telephone consultations for six months. Data were collected before, and three and six months after the end of the motivational-educational sessions using adherence questionnaire in patients with chronic diseases, and adherence in chronic disease scale for medication adherence. Data were analyzed using SPSS 22, and descriptive statistics, chi-square, independent t-test, and repeated measure ANOVA were performed. P<0.05 was considered significant. RESULTS The intervention and control groups were homogenous based on demographic characteristics. Repeated measure ANOVA findings revealed an increasing trend in the mean scores of the intervention group in treatment adherence from 51.10±3.20 at baseline to 66.40±5.50 three months and 73.80±6.80 six months after the end of the intervention (P<0.001). Furthermore, based on repeated measure ANOVA findings, the mean score of the intervention group in medication adherence significantly increased from 20.10+3 at baseline to 24.10+2.40 three months and 24.50+3.20 six months after the end of the intervention (P<0.001). CONCLUSION Applying the IMB model promoted adherence to treatment and medication among patients with cardiovascular disease. Therefore, such interventions are recommended for these patients.
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Affiliation(s)
- Nasrin Zahmatkeshan
- Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahnaz Rakhshan
- Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ladan Zarshenas
- Department of Nursing, School of Nursing and Midwifery, Community Based Psychiatric Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Javad Kojuri
- Clinical Education Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Khademian
- Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
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Almeida TDCF, Sousa MMD, Gouveia BDLA, Olinda RAD, Freire MEM, Oliveira SHDS. Instrument to evaluate the behavioral intention of hypertensive people when taking anti-hypertensives. Rev Bras Enferm 2021; 74:e20200192. [PMID: 33787791 DOI: 10.1590/0034-7167-2020-0192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 08/04/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to build and analyze the validity of an instrument to assess the behavioral intention of individuals with hypertension to take antihypertensive pills. METHODS methodological study based on the theory of planned behavior, developed in three stages: preparation of the instrument, validation of content and pre-test with the target audience. The content has been validated by six experts. The Content Validity Index was applied. RESULTS five nurses and one psychologist participated, with experiences in systemic arterial hypertension and/or planned behavior theory. The first version of the instrument contained 40 items. After analysis, the second version originated, with 36 items. 100% agreement was obtained for the scope of the constructions. The pre-test showed clarity and understanding of the items by the target audience. CONCLUSIONS the instrument is a reliable and innovative technological product for use in populations with systemic arterial hypertension and beliefs similar to those identified in the surveyed group.
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Chong CC, Redzuan AM, Sathar J, Makmor-Bakry M. Patient Perspective on Iron Chelation Therapy: Barriers and Facilitators of Medication Adherence. J Patient Exp 2021; 8:2374373521996958. [PMID: 34179377 PMCID: PMC8205330 DOI: 10.1177/2374373521996958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Nonadherence to iron chelation therapy (ICT) remains a long-standing and serious issue in thalassemia, especially in resource-constrained developing countries. Barriers and facilitators of adherence to ICT in transfusion-dependent thalassemia (TDT) adult patients in Malaysia are not completely understood. This qualitative study explored factors affecting adherence to ICT among TDT adult patients at a public tertiary hospital in Malaysia. Data were collected through 21 semistructured in-depth interviews conducted among purposively sampled patients using a pretested interview guide. All interviews were audio-recorded and transcribed verbatim. Data were analyzed manually using thematic analysis method and managed using Atlas.Ti software. The most frequently discussed subthemes of barriers to adherence included patient-related factors, medications-related factors, sociocultural-related factors, environmental context and resources, and patient–health care provider relationship factors. The facilitators to adherence included having insights of their illness, prevailing sources of motivation emphasizing on strong self-efficacy, low medication burden, and having enabling environment. This study has identified barriers and facilitators that are unique to Malaysian thalassemic adults related to medication adherence. Options for future multifaceted interventions are suggested.
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Affiliation(s)
- Chia Chee Chong
- Faculty of Pharmacy, Centre of Quality Management of Medicines, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Adyani Md Redzuan
- Faculty of Pharmacy, Centre of Quality Management of Medicines, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Jameela Sathar
- Hematology Department, Hospital Ampang, Pandan Mewah, Ampang, Selangor, Malaysia
| | - Mohd Makmor-Bakry
- Faculty of Pharmacy, Centre of Quality Management of Medicines, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Quast LF, Gutiérrez-Colina AM, Cushman GK, Rea KE, Eaton CK, Lee JL, George RP, Blount RL. Adherence Barriers for Adolescent and Young Adult Transplant Recipients: Relations to Personality. J Pediatr Psychol 2021; 45:540-549. [PMID: 32291448 DOI: 10.1093/jpepsy/jsaa017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 02/21/2020] [Accepted: 02/28/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Much of the extant literature on adherence barriers has focused on modifiable factors (e.g., knowledge, social support); however, less is known about how barriers may be associated with relatively stable constructs, such as personality traits. The current study examines associations between personality (i.e., agreeableness, conscientiousness, neuroticism) and adherence barriers in a group of adolescent and young adult (AYA) solid organ transplant recipients. Demonstrating associations between barriers and personality may help in understanding why barriers are stable over time. Additionally, different personality traits may relate to different types of barriers. METHODS The sample included 90 AYAs (Mage = 17.31; SD = 2.05; 58% male) who received a kidney (n = 36), liver (n = 29), or heart (n = 25) transplant at least 1 year prior to study enrollment. AYAs completed the Agreeableness, Conscientiousness, and Neuroticism scales from the NEO Five-Factor Inventory and the Adolescent Medication Barriers Scale (AMBS). RESULTS Lower levels of agreeableness and conscientiousness and higher levels of neuroticism were related to higher self-reported barrier scores (AMBS; r's = .31- .53, p's < .001). The relations differed by personality factor and barrier type. CONCLUSION Adherence barriers showed medium to large associations with personality traits that are known to be relatively stable. Our findings indicate that the temporal stability of barriers to adherence may be due in part to their association with relatively enduring personality characteristics.
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Affiliation(s)
| | - Ana M Gutiérrez-Colina
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
| | | | | | | | - Jennifer L Lee
- Emory University School of Medicine.,Children's Healthcare of Atlanta
| | - Roshan P George
- Emory University School of Medicine.,Children's Healthcare of Atlanta
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Dima AL, Allemann SS, Dunbar-Jacob J, Hughes DA, Vrijens B, Wilson IB. TEOS: A framework for constructing operational definitions of medication adherence based on Timelines-Events-Objectives-Sources. Br J Clin Pharmacol 2020; 87:2521-2533. [PMID: 33220097 DOI: 10.1111/bcp.14659] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 10/08/2020] [Accepted: 11/03/2020] [Indexed: 01/27/2023] Open
Abstract
AIMS Managing adherence to medications is a priority for health systems worldwide. Adherence research is accumulating, yet the quality of the evidence is reduced by various methodological limitations. In particular, the heterogeneity and low accuracy of adherence measures have been highlighted in many literature reviews. Recent consensus-based guidelines advise on best practices in defining adherence (ABC) and reporting of empirical studies (EMERGE). While these guidelines highlight the importance of operational definitions in adherence measurement, such definitions are rarely included in study reports. To support researchers in their measurement decisions, we developed a structured approach to formulate operational definitions of adherence. METHODS A group of adherence and research methodology experts used theoretical, methodological and practical considerations to examine the process of applying adherence definitions to various research settings, questions and data sources. Consensus was reached through iterative review of discussion summaries and framework versions. RESULTS We introduce TEOS, a four-component framework to guide the operationalization of adherence concepts: (1) describe treatment as four simultaneous interdependent timelines (recommended and actual use, conditional on prescribing and dispensing); (2) locate four key events along these timelines to delimit the three ABC phases (first and last recommended use, first and last actual use); (3) revisit study objectives and design to fine-tune research questions and assess measurement validity and reliability needs, and (4) select data sources (e.g., electronic monitoring, self-report, electronic healthcare databases) that best address measurement needs. CONCLUSION Using the TEOS framework when designing research and reporting explicitly on these components can improve measurement quality.
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Affiliation(s)
- Alexandra L Dima
- Health Services and Performance Research (HESPER EA 7425), University Claude Bernard Lyon 1, Lyon, France
| | - Samuel S Allemann
- Pharmaceutical Care Research Group, University of Basel, Basel, Switzerland
| | | | - Dyfrig A Hughes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, North Wales, UK
| | - Bernard Vrijens
- AARDEX Group & Department of Public Health Liège University, Liège, Belgium
| | - Ira B Wilson
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
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Liddelow C, Mullan B, Boyes M, McBride H. A Qualitative Application of Temporal Self-Regulation Theory to Understand Adherence to Simple and Complex Medication Regimens. Healthcare (Basel) 2020; 8:healthcare8040487. [PMID: 33207611 PMCID: PMC7711536 DOI: 10.3390/healthcare8040487] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/09/2020] [Accepted: 11/12/2020] [Indexed: 12/03/2022] Open
Abstract
Medication adherence is a global health concern, and variables of temporal self-regulation theory (TST) have been shown to be important in improving adherence. This qualitative study aims to explore how TST can help explain medication adherence in people’s daily lives, and whether there are differences in the adherence to simple and complex medication regimens. Twenty-nine participants from Australia engaged in semi-structured interviews based on TST (intention, behavioural prepotency, self-regulation), and other variables important to adherence. Interviews were analysed using thematic analysis. Six themes were identified (Routines, External Supports, Cost, Sense of Agency, Adverse Outcomes, and Weighing Up Pros and Cons), with partial support for TST (specifically intention, past behaviour, cues and planning). Four themes not related to TST were also identified. Individuals with more complex medication regimens spoke of the importance of routines, planning, and knowledge-seeking, whereas those with simpler regimens spoke of the importance of visual cues. TST may be useful for identifying some variables important in medication adherence, however, additional factors were also identified. For simple regimens, future research should focus on the manipulation of visual cues. For complex regimens, health professionals should consider supporting the use of medication management apps to assist in planning and ensuring a consistent routine.
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Xu HY, Yu YJ, Zhang QH, Hu HY, Li M. Tailored Interventions to Improve Medication Adherence for Cardiovascular Diseases. Front Pharmacol 2020; 11:510339. [PMID: 33364935 PMCID: PMC7751638 DOI: 10.3389/fphar.2020.510339] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 09/21/2020] [Indexed: 12/12/2022] Open
Abstract
Over the past half-century, medical research on cardiovascular disease (CVD) has achieved a great deal; however, medication adherence is unsatisfactory. Nearly 50% of patients do not follow prescriptions when taking medications, which limits the ability to maximize their therapeutic effects and results in adverse clinical outcomes and high healthcare costs. Furthermore, the effects of medication adherence interventions are disappointing, and tailored interventions have been proposed as an appropriate way to improve medication adherence. To rethink and reconstruct methods of improving medication adherence for CVD, the literature on tailored interventions for medication adherence focusing on CVD within the last 5 years is retrieved and reviewed. Focusing on identifying nonadherent patients, detecting barriers to medication adherence, delivering clinical interventions, and constructing theories, this article reviews the present state of tailored interventions for medication adherence in CVD and also rethinks the present difficulties and suggests avenues for future development.
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Affiliation(s)
- Hai-Yan Xu
- Department of Military Psychology, School of Psychology, Army Medical University, Chongqing, China
| | - Yong-Ju Yu
- Department of Social Work, School of Sociology and Law, Sichuan International Studies University, Chongqing, China
| | - Qian-Hui Zhang
- Department of Foreign Languages, School of Basic Medicine, Army Medical University, Chongqing, China
| | - Hou-Yuan Hu
- Department of Cardiology, Southwest Hospital, Army Medical University, Chongqing, China
| | - Min Li
- Department of Military Psychology, School of Psychology, Army Medical University, Chongqing, China
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Thompson E, Broadbent J, Fuller‐tyszkiewicz M, Bertino MD, Staiger PK. Post‐intervention treatment adherence for chronic pain patients may depend on psychological factors. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/cp.12150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Emma Thompson
- School of Psychology, Deakin University, Melbourne, Victoria, Australia,
| | - Jaclyn Broadbent
- School of Psychology, Deakin University, Melbourne, Victoria, Australia,
| | | | - Melanie D. Bertino
- School of Psychology, Deakin University, Melbourne, Victoria, Australia,
- The Pain Management Program, The Victorian Rehabilitation Centre, Melbourne, Victoria, Australia,
| | - Petra K. Staiger
- School of Psychology, Deakin University, Melbourne, Victoria, Australia,
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Sainsbury K, Walburn J, Foster L, Morgan M, Sarkany R, Weinman J, Araujo-Soares V. Improving photoprotection in adults with xeroderma pigmentosum: personalisation and tailoring in the 'XPAND' intervention. Health Psychol Behav Med 2020; 8:543-572. [PMID: 34040885 PMCID: PMC8114353 DOI: 10.1080/21642850.2020.1840379] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 10/18/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Individualised behaviour change interventions can result in greater effects than one-size-fits-all approaches. Factors linked to success include dynamic (vs. static) tailoring, and tailoring on behaviour, multiple theoretical variables, and participant characteristics. XP is a very rare (∼100 UK patients) genetic disease, involving an inability to repair ultraviolet radiation (UVR)-induced damage, resulting in skin cancers and eye damage from an early age, and mean life expectancy of 32-years. Management involves rigorous UVR photoprotection, which is often inadequate, and no interventions have been published. UK-based care is personalised and delivered by a multidisciplinary team at the National XP Service in London. Following an intensive, mixed-methods formative phase with patients diagnosed with XP (n-of-1, qualitative interviews, objective UVR measurement, cross-sectional survey) and relevant stakeholder consultation (clinical and patient/public teams), the 'XPAND' intervention was developed. This paper describes the comprehensive and novel tailoring and personalisation processes used to deliver the intervention. METHODS XPAND consists of core and personalised modules targeting cue-based (time of day, weather, symptoms), belief-based (motivation, priority), self-regulatory (effort, barriers, planning), and emotional (stress, self-consciousness, mental exhaustion) factors, social support, disclosure, habit, and willingness, using appropriately-matched BCTs. A-priori, phase I data and a baseline profiling questionnaire (data sources) were used to allocate modules to participants ('personalisation') and to adapt module content ('tailoring'). Iterative decisions about delivery were based on patient response to feedback, identification of additional barriers (e.g. reasons for varying protection across contexts), and emergence of new barriers as improvements in protection were attempted or achieved (e.g. appearance concerns). CONCLUSIONS Dynamic multi-level personalisation and tailoring based on mixed-methods in XPAND allowed for insights and decision-making not possible with cross-sectional quantitative or qualitative methods alone. Data collection and allocation/adaptation methods may be of use in other rare conditions where small patient numbers mean that within-participant, individual-level delivery is well-suited and feasible.
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Affiliation(s)
- Kirby Sainsbury
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - Jessica Walburn
- School of Cancer & Pharmaceutical Sciences, King’s College London, London, UK
| | - Lesley Foster
- XP NCG Service, Guy’s and St. Thomas’ Hospital NHS Foundation Trust, London, UK
| | - Myfanwy Morgan
- School of Cancer & Pharmaceutical Sciences, King’s College London, London, UK
| | - Robert Sarkany
- XP NCG Service, Guy’s and St. Thomas’ Hospital NHS Foundation Trust, London, UK
| | - John Weinman
- School of Cancer & Pharmaceutical Sciences, King’s College London, London, UK
| | - Vera Araujo-Soares
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
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Hatah E, Rahim N, Makmor-Bakry M, Mohamed Shah N, Mohamad N, Ahmad M, Haron NH, Sze Hwe C, Tan Meng Wah A, Hassan F, Shaik Rahmat S, Robert SA, Abdullah N. Development and validation of Malaysia Medication Adherence Assessment Tool (MyMAAT) for diabetic patients. PLoS One 2020; 15:e0241909. [PMID: 33157549 PMCID: PMC7647074 DOI: 10.1371/journal.pone.0241909] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 10/22/2020] [Indexed: 11/29/2022] Open
Abstract
Medication non-adherence remains a significant barrier in achieving better health outcomes for patients with chronic diseases. Previous self-reported medication adherence tools were not developed in the context of the Malaysia population. The most commonly used tool, MMAS-8, is no longer economical because it requires a license and currently every form used is charged. Hence, there is a need to develop and validate a new medication adherence tool. The Malaysia Medication Adherence Assessment Tool (MyMAAT) was developed by a multidisciplinary team with expertise in medication adherence and health literacy. The face and content validities of the MyMAAT was established by a panel of experts. A total of 495 patients with type 2 diabetes were recruited from the Ministry of Health facilities consisting of five hospitals and five primary health clinics. A test-retest was conducted on 42 of the patients one week following their first data collection. Exploratory factor analysis was performed to evaluate the validity of the MyMAAT. The final item for MyMAAT was compared with SEAMS, HbA1c%, Medication Possession ratio (MPR) score, and pharmacist’s subjective assessment for its hypothesis testing validity. The MyMAAT-12 achieved acceptable internal consistency (Cronbach’s alpha = 0.910) and stable reliability as the test-retest score showed good to excellent correlation (Spearman’s rho = 0.96, p = 0.001). The MyMAAT has significant moderate association with SEAMS (Spearman’s rho = 0.44, p = < 0.001) and significant relationship with HbA1c (< 8% and ≥ 8%) (χ2(1) = 13.4, p < 0.001), MPR (χ2(1) = 13.6, p < 0.001) and pharmacist’s subjective assessment categories (χ2(1) = 31, p < 0.001). The sensitivity of MyMAAT-12, tested against HbA1c% was 72.9% while its specificity was 43%. This study demonstrates that the MyMAAT-12 together with other methods of assessment may make a better screening tool to identify patients who were non-adherence to their medications.
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Affiliation(s)
- Ernieda Hatah
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, Malaysia
- * E-mail:
| | - Nadiah Rahim
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, Malaysia
| | - Mohd Makmor-Bakry
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, Malaysia
| | - Noraida Mohamed Shah
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, Malaysia
| | - Noraini Mohamad
- Pharmaceutical Care Branch, Pharmacy Practice and Development Division, Pharmaceutical Services Programme, Ministry of Health Malaysia, Jalan Universiti, Petaling Jaya, Selangor, Malaysia
| | - Mahadir Ahmad
- Health Psychology Programme, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, Malaysia
| | - Nor Hasni Haron
- Pharmaceutical Care Branch, Pharmacy Practice and Development Division, Pharmaceutical Services Programme, Ministry of Health Malaysia, Jalan Universiti, Petaling Jaya, Selangor, Malaysia
| | - Choe Sze Hwe
- Pharmaceutical Care Branch, Pharmacy Practice and Development Division, Pharmaceutical Services Programme, Ministry of Health Malaysia, Jalan Universiti, Petaling Jaya, Selangor, Malaysia
| | - Angeline Tan Meng Wah
- Pharmaceutical Care Branch, Pharmacy Practice and Development Division, Pharmaceutical Services Programme, Ministry of Health Malaysia, Jalan Universiti, Petaling Jaya, Selangor, Malaysia
| | - Fahmi Hassan
- Pharmaceutical Care Branch, Pharmacy Practice and Development Division, Pharmaceutical Services Programme, Ministry of Health Malaysia, Jalan Universiti, Petaling Jaya, Selangor, Malaysia
| | - Shakirin Shaik Rahmat
- Pharmaceutical Care Branch, Pharmacy Practice and Development Division, Pharmaceutical Services Programme, Ministry of Health Malaysia, Jalan Universiti, Petaling Jaya, Selangor, Malaysia
| | - Sarah Ann Robert
- Pharmacy Department, Universiti Kebangsaan Malaysia Medical Center, Jalan Ya’acob Latiff, Bandar Tun Razak, Cheras, Kuala Lumpur, Malaysia
| | - Noraidatulakma Abdullah
- UKM Medical Molecular Biology Institute (UMBI), Universiti Kebangsaan Malaysia, Jalan Ya’acob Latiff, Bandar Tun Razak, Cheras, Kuala Lumpur, Malaysia
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Development of a self-management intervention to improve tamoxifen adherence in breast cancer survivors using an Intervention Mapping framework. Support Care Cancer 2020; 29:3329-3338. [PMID: 33118106 PMCID: PMC8062369 DOI: 10.1007/s00520-020-05850-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 10/21/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Up to 50% of women prescribed tamoxifen do not take it as prescribed for the full duration, which increases risk of recurrence and mortality. The current paper describes the development of a self-management intervention aiming to improve adherence in breast cancer survivors taking tamoxifen. METHODS The intervention was developed following an Intervention Mapping approach. The content of the intervention was determined by theories of health behaviour and empirical evidence. Development was an iterative process involving input from expert researchers, clinicians and patient representatives. RESULTS The intervention was designed to improve both intentional and unintentional non-adherence. Key features included modifying unhelpful illness and treatment beliefs, improving confidence for coping with side effects and developing strategies for remembering to take tamoxifen. CONCLUSION Intervention Mapping proved a useful tool for developing an intervention which is grounded in theory and empirical evidence. The intervention has the potential to improve adherence in breast cancer survivors but needs to be trialled before the effectiveness of the intervention can be determined.
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Abstract
Medication is the most frequent treatment intervention, and its success depends on patients taking their medicines in line with their prescribed regimen to yield the full benefit of the treatment. Adherence is especially difficult to ensure in those with multimorbidity, who take multiple medications to manage their conditions. Non-adherence is costly for the health service, both through wastage and increased ill health. Non-adherence may be intentional or non-intentional, and many factors affect an individual's compliance with a medication regimen. There are a variety of aids that may be helpful; however, the interaction with a health professional is very important, both for understanding the reason for non-adherence and for promoting adherence.
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Affiliation(s)
- Alison While
- Emeritus Professor of Community Nursing, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College, London
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Marrero RJ, Fumero A, de Miguel A, Peñate W. Psychological factors involved in psychopharmacological medication adherence in mental health patients: A systematic review. PATIENT EDUCATION AND COUNSELING 2020; 103:2116-2131. [PMID: 32402489 DOI: 10.1016/j.pec.2020.04.030] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 04/16/2020] [Accepted: 04/25/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Psychopharmacological medication adherence is essential for psychiatric patients' treatment and well-being. OBJECTIVE This review aimed to identify psychological factors related to health control that have been linked to psychopharmacological medication adherence in psychiatric patients. METHODS A literature search was performed through the databases Medline, PubMed, PsycINFO, and Google Scholar to identify relevant studies published before October 15th, 2019. Articles published in peer-reviewed journals that analyzed the psychological factors of health belief and health control involved in psychopharmacological medication adherence in a psychiatric population were included. RESULTS The search identified 124 potentially relevant papers, 29 of which met the eligibility criteria. The final sample was 222 adolescents, most with a diagnosis of attention deficit/hyperactivity disorder (ADHD), and 6139 adults diagnosed especially with schizophrenia spectrum disorder, bipolar disorder, or depressive disorder. Results suggested that medication adherence is associated with health beliefs and psychological variables, such as self-efficacy and locus of control. Family support was also positively related to medication adherence. CONCLUSION Psychopharmacological medication adherence requires a consideration of multicausality, which depends on sociodemographic, clinical, and psychological factors. PRACTICE IMPLICATIONS These findings should be considered in the development and implementation of psychological interventions focused on self-control and family support.
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Affiliation(s)
- Rosario J Marrero
- Dept. of Clinical Psychology, Psychobiology and Methodology, Universidad de La Laguna Campus de Guajara, 38200, Tenerife, Spain.
| | - Ascensión Fumero
- Dept. of Clinical Psychology, Psychobiology and Methodology, Universidad de La Laguna Campus de Guajara, 38200, Tenerife, Spain
| | - Adelia de Miguel
- Dept. of Clinical Psychology, Psychobiology and Methodology, Universidad de La Laguna Campus de Guajara, 38200, Tenerife, Spain
| | - Wenceslao Peñate
- Dept. of Clinical Psychology, Psychobiology and Methodology, Universidad de La Laguna Campus de Guajara, 38200, Tenerife, Spain
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McLoughlin A, Bennett K, Cahir C. Developing a model of the determinants of medication nonadherence in older community-dwelling patients. Ann Behav Med 2020; 53:942-954. [PMID: 30870558 DOI: 10.1093/abm/kaz004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Medication nonadherence is associated with adverse health outcomes in older populations. The aim of this study was to develop a model that describes the relationship between the determinants of nonadherence, per the World Health Organization (WHO) model of nonadherence and the necessity-concerns framework (NCF) and nonadherence in a cohort of older community-dwelling patients. A retrospective cohort study of 855 community-dwelling patients aged ≥70 years from 15 practices. Medication nonadherence was assessed by (i) medication possession ratio (MPR < 80%) and (ii) the median MPR across all drugs dispensed. Patient questionnaires, interviews, and medical records measured the determinants of nonadherence per the WHO and NCF frameworks. Confirmatory factor analysis (CFA) was undertaken to generate the model of best fit. Two structural equation models (SEM) were developed to evaluate the relationship between the WHO factors, the NCF, and nonadherence (Model 1: MPR < 80%, Model 2: median MPR). The CFA produced a reasonable fit (χ2(113) = 203, p < .001; root mean square error of approximation = 0.03; comparative fit index = 0.98, and weighted root mean square residual = 0.97) and adequate internal consistency (r = .26-.40). SEM analysis (Model 1) showed a significant direct relationship between patient-related (β = 0.45, p < .01), socioeconomic (β = 0.20, p < .01), and therapy-related factors (β = -0.27, p < .01) and nonadherence (MPR < 80%). Similar results were found for Model 2 (median MPR). There was a significant direct relationship between medication concerns (β = -0.13, p < .01) and nonadherence. Therapy-related (β = -0.04, p < .05) and patient-related factors (β = -0.06, p < .05) also had a significant mediating effect on nonadherence through medication concerns. Health care professionals need to address medication concerns and management of adverse effects in older populations to improve adherence and clinical outcomes.
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Affiliation(s)
- Affraic McLoughlin
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Kathleen Bennett
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Caitriona Cahir
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin 2, Ireland
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Saghayi M, Greenberg J, O'Grady C, Varno F, Hashmi MA, Bracken B, Matwin S, Lazar SW, Hashmi JA. Brain network topology predicts participant adherence to mental training programs. Netw Neurosci 2020; 4:528-555. [PMID: 32885114 PMCID: PMC7462432 DOI: 10.1162/netn_a_00136] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 03/02/2020] [Indexed: 11/04/2022] Open
Abstract
Adherence determines the success and benefits of mental training (e.g., meditation) programs. It is unclear why some participants engage more actively in programs for mental training than others. Understanding neurobiological factors that predict adherence is necessary for understanding elements of learning and to inform better designs for new learning regimens. Clustering patterns in brain networks have been suggested to predict learning performance, but it is unclear whether these patterns contribute to motivational aspects of learning such as adherence. This study tests whether configurations of brain connections in resting-state fMRI scans can be used to predict adherence to two programs: meditation and creative writing. Results indicate that greater system segregation and clustering predict the number of practice sessions and class participation in both programs at a wide range of network thresholds (corrected p value < 0.05). At a local level, regions in subcortical circuitry such as striatum and accumbens predicted adherence in all subjects. Furthermore, there were also some important distinctions between groups: Adherence to meditation was predicted by connectivity within local network of the anterior insula and default mode network; and in the writing program, adherence was predicted by network neighborhood of frontal and temporal regions. Four machine learning methods were applied to test the robustness of the brain metric for classifying individual capacity for adherence and yielded reasonable accuracy. Overall, these findings underscore the fact that adherence and the ability to perform prescribed exercises is associated with organizational patterns of brain connectivity.
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Affiliation(s)
- Marzie Saghayi
- Department of Anesthesia, Pain Management, and Perioperative Medicine, Dalhousie University, NSHA, Halifax, Canada
| | | | - Christopher O'Grady
- Department of Anesthesia, Pain Management, and Perioperative Medicine, Dalhousie University, NSHA, Halifax, Canada
| | - Farshid Varno
- Faculty of Computer Science, Dalhousie University, Halifax, Canada
| | | | | | - Stan Matwin
- Faculty of Computer Science, Dalhousie University, Halifax, Canada
| | - Sara W Lazar
- Harvard Medical School, Mass General Hospital, Boston, MA, USA
| | - Javeria Ali Hashmi
- Department of Anesthesia, Pain Management, and Perioperative Medicine, Dalhousie University, NSHA, Halifax, Canada
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Matvienko-Sikar K, Terwee CB, Gargon E, Devane D, Kearney PM, Byrne M. The value of core outcome sets in health psychology. Br J Health Psychol 2020; 25:377-389. [PMID: 32609948 DOI: 10.1111/bjhp.12447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
| | - Caroline B Terwee
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, The Netherlands
| | - Elizabeth Gargon
- MRC North West Hub for Trials Methodology Research, Department of Biostatistics, University of Liverpool, UK
| | - Declan Devane
- School of Nursing and Midwifery & Trials Methodology Research Network, National University of Ireland, Galway, Ireland
| | | | - Molly Byrne
- School of Psychology, National University of Ireland, Galway, Ireland
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Revista Digital Internacional de Psicología y Ciencia Social | Volumen 6 | Número 2 | Julio-Diciembre 2020 | Desafíos contemporáneos en educación y salud. REVISTA DIGITAL INTERNACIONAL DE PSICOLOGÍA Y CIENCIA SOCIAL 2020. [DOI: 10.22402/j.rdipycs.unam.6.2.2020.327.245-526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
El actual número se titula “Desafíos contemporáneos en educación y salud” y nos permite conocer acerca de los temas de interés para algunos investigadores y la manera en que se han abordado para su estudio. De manera coincidente este número ha sido trabajado en tiempos de pandemia, donde también nos hemos enfrentado a retos ante las nuevas condiciones para adaptarnos a nuevas formas de trabajo, mayoritariamente a distancia y por ahora a lo que parece ser “la nueva normalidad”, y con ello, en algunos meses, estaremos leyendo trabajos que surjan de estos momentos históricos mundiales, sus implicaciones, problemas, alcances y tal vez sus repercusiones.
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Chan AHY, Cooper V, Lycett H, Horne R. Practical Barriers to Medication Adherence: What Do Current Self- or Observer-Reported Instruments Assess? Front Pharmacol 2020; 11:572. [PMID: 32477110 PMCID: PMC7237632 DOI: 10.3389/fphar.2020.00572] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 04/15/2020] [Indexed: 12/27/2022] Open
Abstract
Introduction Practical adherence barriers (e.g., medication frequency) are generally more amenable to intervention than perceptual barriers (e.g., beliefs). Measures which assess adherence barriers exist, however these tend to measure a mix of factors. There is a need to identify what practical barriers are captured by current measures. Aim To identify and synthesise the practical adherence barriers which are assessed by currently available self- or observer-report adherence measures. Methods A search for systematic reviews of self- or observer-report report adherence measures was conducted. Three electronic databases (Embase, Ovid Medline, and PsycInfo) were searched using terms based on adherence, adherence barriers and measures. Systematic reviews reporting on adherence measures which included at least one self- or observer-report questionnaire or scale were included. Adherence measures were extracted and coded on whether they addressed perceptual or practical barriers, or both. Practical items were then analysed thematically. Results Following screening of 272 initial abstracts, 20 full-text papers were reviewed. Four were excluded after full-text review, leaving 16 systematic reviews for data extraction. From these, 187 different adherence measures were extracted and coded, and 23 unique measures were identified as assessing practical barriers and included in the final analysis. Seven key themes were identified: formulation; instructions for use; issues with remembering; capability—knowledge and skills; financial; medication supply and social environment. Conclusion Existing adherence measures capture a variety of practical barriers which can be grouped into seven categories. These findings may be used to inform the development of a measure of practical adherence barriers.
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Affiliation(s)
- Amy Hai Yan Chan
- Centre of Behavioural Medicine, Department of Practice and Policy, University College London, London, United Kingdom.,School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Vanessa Cooper
- Centre of Behavioural Medicine, Department of Practice and Policy, University College London, London, United Kingdom
| | - Helen Lycett
- Spoonful of Sugar Ltd, UCL-Business Spin-out Company, London, United Kingdom
| | - Rob Horne
- Centre of Behavioural Medicine, Department of Practice and Policy, University College London, London, United Kingdom
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Rosenberg SM, Petrie KJ, Stanton AL, Ngo L, Finnerty E, Partridge AH. Interventions to Enhance Adherence to Oral Antineoplastic Agents: A Scoping Review. J Natl Cancer Inst 2020; 112:443-465. [PMID: 31899790 PMCID: PMC7225676 DOI: 10.1093/jnci/djz244] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 11/11/2019] [Accepted: 12/23/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND As new targeted oral antineoplastic therapies have emerged in recent years, the development of effective strategies that promote optimal adherence to cancer medication regimens has become an important priority. METHODS We conducted a scoping literature review to search for English language articles published through July 15, 2019, to identify studies that reported the testing and/or evaluation of interventions to improve adherence to oral antineoplastic agents. RESULTS A total of 56 articles were selected for review. Of the studies evaluated, 14 were randomized trials. All interventions except two targeted adult patients. Thirty-three studies enrolled fewer than 100 patients. Most interventions were education- and counseling-based and centered on provision of information about the drug and strategies to manage side effects. Only eight studies used an mHealth tool and/or text messages to target nonadherence. Among studies with a comparison sample, fewer than one-half (44.7%) reported statistically significant improvements in adherence or persistence associated with the intervention; however, some pharmacist-directed programs, particularly those that integrated monitoring or routine follow-up with a provider, did demonstrate efficacy. CONCLUSION Although the development of adherence-promoting interventions for oral antineoplastic therapies has increased recently, few have been rigorously tested. The nascent literature suggests those that are pharmacist directed and use regular monitoring show promise, though additional prospective studies are needed. Study methodology, population selection, and potential challenges that may be encountered in the implementation and dissemination phases should be considered when developing new interventions to address nonadherence to oral antineoplastic treatment.
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Affiliation(s)
| | - Keith J Petrie
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Annette L Stanton
- Jonsson Comprehensive Cancer Center, Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
- Department of Psychiatry/Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Lan Ngo
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Emma Finnerty
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Ann H Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
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Owens C, Hubach RD, Lester JN, Williams D, Voorheis E, Reece M, Dodge B. Assessing determinants of pre-exposure prophylaxis (PrEP) adherence among a sample of rural Midwestern men who have sex with men (MSM). AIDS Care 2020; 32:1581-1588. [PMID: 32338061 DOI: 10.1080/09540121.2020.1757021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Pre-exposure prophylaxis (PrEP) efficacy in preventing HIV among gay, bisexual, and other men who have sex with men (MSM) is dependent upon adherence. Little is known about the PrEP adherence experiences among MSM who live in rural areas of the US. This qualitative study was informed by a modified version of Straussian Grounded Theory. Thirty-four 34 rural Midwestern MSM participated in telephone interviews that assessed their PrEP adherence factors. Overall, participants adhered to the PrEP regimen, ranging from missing none to a couple of doses per month. Participants had high self-efficacy (competence) and self-reliance (autonomy) in taking PrEP daily. Participants incorporated PrEP into their already existing routines. Participants were motivated to adhere to prevent HIV acquisition and be financially responsible. All participants mentioned their PrEP provider discussed the importance of adherence with PrEP's effectiveness, but future patient-provider PrEP adherence communication varied among participants. Future PrEP adherence interventions should address counseling strategies that leverage these constructs to support pill taking. Future research should explore patient-provider conversations surrounding PrEP adherence to inform provider- and patient-level interventions.
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Affiliation(s)
- Christopher Owens
- Center for Sexual Health Promotion, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
| | - Randolph D Hubach
- Center for Rural Health, Center for Health Sciences, Oklahoma State University, Tulsa, OK, USA
| | - Jessica Nina Lester
- Deparmtent of Counseling and Educational Psychology, School of Education, Indiana University, Bloomington, IN, USA
| | - Deana Williams
- Center for Sexual Health Promotion, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
| | - Eva Voorheis
- Center for Sexual Health Promotion, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
| | - Michael Reece
- Department of Social and Public Health, College of Health Sciences and Professions, Ohio University, Athens, OH, USA
| | - Brian Dodge
- Center for Sexual Health Promotion, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
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The Relationship Among Health Beliefs, Depressive Symptoms, Medication Adherence, and Social Support in African Americans With Hypertension. J Cardiovasc Nurs 2020; 34:44-51. [PMID: 30273259 DOI: 10.1097/jcn.0000000000000519] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND African Americans are disproportionately affected by hypertension and have lower medication adherence when compared to other racial groups. Antecedent factors such as beliefs surrounding hypertension, the presence or absence of social support, and depressive symptoms have not been extensively studied collectively in relation to hypertension medication adherence in African Americans. OBJECTIVE To determine the associations among demographic and clinical factors, depressive symptoms, hypertension beliefs, and social support with blood pressure medication adherence in middle-aged African American adults with a diagnosis of hypertension. METHODS A cross-sectional study of (N = 120) African Americans (mean age, 49 years; 22.5% men) with a current diagnosis of metabolic syndrome, including hypertension, who reported having and taking a prescribed blood pressure-lowering medication were included. Descriptive statistics, bivariate correlation analysis, and logistic regression using odds ratio were used to examine the effects of high blood pressure beliefs, social support, and depression on medication adherence. RESULTS A small but significant relationship was found between medication adherence and number of comorbidities (r = 0.19, P = .04). In a multivariate regression model, after controlling for gender, comorbidities remained associated with medication adherence (β = 0. 77, P = .04). Depressive symptoms, high blood pressure beliefs, and social support did not have a significant relationship with medication adherence. CONCLUSIONS Multiple comorbidities may have a positive impact upon medication adherence. Further study is needed in a larger sample of African Americans who have a diagnosis of hypertension in addition to other comorbidities requiring medication management.
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Shahin W, Kennedy GA, Cockshaw W, Stupans I. The role of refugee and migrant migration status on medication adherence: Mediation through illness perceptions. PLoS One 2020; 15:e0227326. [PMID: 31923264 PMCID: PMC6953853 DOI: 10.1371/journal.pone.0227326] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 12/17/2019] [Indexed: 01/20/2023] Open
Abstract
Background Illness perceptions may vary between different populations. This raises the question as to whether refugees and migrants of the same ethnic background have different perceptions. Understanding differences may have a significant impact on enhancing medication adherence in these groups. Objective The study examined the associations and differences between illness perceptions, and medication adherence in hypertensive Middle Eastern migrants and refugees. Methods Middle Eastern refugees and migrants (≥30 years old), with hypertension were recruited from Arabic community groups in Australia and asked to complete a cross-sectional survey. The survey consisted of basic socio-demographic and clinical profile, self-reported illness perceptions, and self-reported medication adherence. The outcome measure was the Medication Adherence Questionnaire. Simple mediation modelling was applied to examine the role of illness perceptions as a mediator between different migration statuses, and medication adherence. Results A total of 320 participants were recruited; 168 refugees, and 152 migrants. Educational level was found to be positively significantly associated with medication adherence in refugees, p = 0.003, while employed migrants were more likely to report higher adherence to hypertensive medication, p = 0.005. In both groups, there was a significant association between illness perceptions and medication adherence p = 0.0001. Significant differences were found between both groups regarding adherence and illness perceptions variables. Refugees had more negative illness perceptions and were less adherent than migrants. Illness perception was a mediator in the relationship between migration status and medication adherence; the unstandardized indirect effect was 0.24, and the 95% confidence interval ranged from (0.21–0.36). Conclusions To achieve better adherence to medications in vulnerable populations such as refugees, illness perceptions need to be understood, and differentiated from other populations, such as migrants from similar backgrounds. Patients’ education about illnesses and medications should be specific and targeted to each population. Interventional studies are recommended to modify refugees’ and migrants’ illness perceptions, to enhance medication adherence and wellbeing.
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Affiliation(s)
- Wejdan Shahin
- School of Health & Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
- * E-mail:
| | - Gerard A. Kennedy
- School of Health & Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Wendell Cockshaw
- School of Health & Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Ieva Stupans
- School of Health & Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
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