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Besel JM, Insel KC, Williams GC. The Impact of Resilience and Perceived Autonomy Support on Medication Adherence Among Rural Older Adults With Hypertension. J Cardiovasc Nurs 2024; 39:488-498. [PMID: 37934162 DOI: 10.1097/jcn.0000000000001052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
BACKGROUND Adherence to antihypertension medications has been explored in previous studies; however, these studies generally focus on individuals who reside in urban areas. Improved understanding is needed regarding rural older adults who are self-managing medications for hypertension and the motivational factors that may influence adherence. OBJECTIVES The purpose of this study was to examine medication adherence among rural older adults with hypertension and the association with motivational factors as defined in self-determination theory, including quality of motivation (autonomous vs controlled), perceived competence, perceived autonomy support, and basic psychological needs satisfaction. Rural nursing theory was also used to explore the concept of resilience. METHODS This cross-sectional study involved 80 older adults (≥65 years old) self-managing at least 1 prescribed medication for managing their hypertension. Participants ranged in age from 65 to 89 (mean [SD], 74.04 [6.18]) years from rural areas in the northwest. Participants completed a demographic questionnaire, a measure of medication adherence, and questionnaires to assess perceived autonomy support, basic needs satisfaction, autonomous and controlled motivation, perceived competence, and resilience. RESULTS Correlational analysis and multiple regression were used to examine associations and predict adherence. Perceived autonomy support, resilience, cost of medication, and medication regimen complexity were the only variables significantly associated with medication adherence and predicted adherence. Resilience mediated the relationship between perceived autonomy support and medication adherence. CONCLUSIONS Overall, findings indicate high levels of adherence. Interventions that enhance perceptions of autonomy support and resilience may be useful in managing hypertension.
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Ferreira PD, Simoes JA, Velho DC. Adherence to Antihypertensive Therapy and Its Determinants: A Systematic Review. Cureus 2024; 16:e59532. [PMID: 38826951 PMCID: PMC11144025 DOI: 10.7759/cureus.59532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2024] [Indexed: 06/04/2024] Open
Abstract
Hypertension is a globally prevalent condition, and low adherence to antihypertensive therapy is considered one of the main causes of poor blood pressure (BP) control. Non-adherence to antihypertensive treatment is a complex issue that can arise from various factors; however, gaining an understanding of this provides key targets for intervention strategies. This study aimed to provide an overview of the current status and recent developments regarding our understanding of the determinants of patients' adherence to antihypertensives. A systematic review was performed using the electronic databases MEDLINE/PubMed, Web of Science, Scientific Electronic Library Online (SciELO), and "Índex das Revistas Médicas Portuguesas", which included studies published between 2017 and 2021 following the PICOS model: (P) Adult patients with the diagnosis of primary hypertension, using at least one antihypertensive agent; (I) all interventions on both pharmacological and non-pharmacological level; (C) patient's adherence against their non-adherence; (O) changes in adherence to the therapeutic plan; and (S) any study design (except review articles) written in English, French, Spanish or Portuguese. Articles were reviewed by two researchers and their quality was assessed. Subsequently, determinants were classified according to their consistent or inconsistent association with adherence or non-adherence. Only 45 of the 635 reports identified met the inclusion criteria. Adherence was consistently associated with patient satisfaction with communication, patient-provider relationship, their treatment, and use of eHealth and mHealth strategies; a patient's mental and physical health, including depression, cognitive impairment, frailty, and disability, previous hospitalization, occurrence of vital events; drug treatment type and appearance; and unwillingness due to health literacy, self-efficacy, and both implicit and explicit attitudes towards treatment. There were discrepancies regarding the association of other factors to adherence, but these inconsistent factors should also be taken into account. In conclusion, the barriers to adherence are varied and often interconnected between socioeconomic, patient, therapy, condition, and healthcare system levels. Healthcare teams should invest in studying patients' non-adherence motives and tailoring interventions to individual levels, by using a multifaceted approach to assess adherence. Further research is needed to analyze the impact of implicit attitudes, the use of new technological approaches, and the influence of factors that are inconsistently associated with non-adherence, to understand their potential in implementing adherence strategies.
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Affiliation(s)
| | - Jose A Simoes
- Department of Medical Sciences, Faculty of Health Sciences, University of Beira Interior, Covilhã, PRT
| | - Denise C Velho
- Family Medicine, ULS de Leiria, USF Santiago, Leiria, PRT
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Lan L, Hai P, Luo J, Li R, Wang Y. Medical behaviours and medication adherence of older hypertensive patients in different medical insurance programs in Beijing, China: a cross-sectional study. BMC Geriatr 2023; 23:878. [PMID: 38124122 PMCID: PMC10734068 DOI: 10.1186/s12877-023-04476-y] [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: 05/04/2023] [Accepted: 11/10/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Grassroots medical institutions are the primary "battlefield" of hypertension management based on hierarchical diagnosis and treatment policies in China. There is a considerable difference in the insured population and reimbursement ratio between different medical insurance programs. The management of hypertension directly affects the development trend of cardiovascular and cerebrovascular diseases. METHODS To understand the difference between different medical insurance programs regarding the management of older hypertensive patients, all outpatients aged 60 and above with hypertension in the basic medical insurance database of Beijing, China, from April 1, 2019, to January 31, 2020, were included. Medical behaviours included patients' choice of hospital level, type of hospital, number of hospitals visited, grassroots medical institutions and cross-district visits. Medication adherence was evaluated by calculating the medication possession ratio of antihypertensive medications. First, we adopted a statistical description for medical behaviours and medication adherence. Then, multivariate logistic regression was used to analyse the influencing factors of medication adherence. RESULTS This study included 1.29 million patients with Urban Employee Basic Medical Insurance (UEBMI) and 0.31 million patients with Urban‒Rural Resident Basic Medical Insurance (URRBMI). The proportions of patients with UEBMI who chose tertiary hospitals, comprehensive hospitals, grassroots medical institutions and cross-district visits were 25.84%, 56.09%, 57.34% and 39.32%, respectively, while those of patients with URRBMI were 11.14%, 60.59%, 81.28% and 6.07%, respectively. The medication adherence rates of men and women taking one medication were 61.04% and 55.86%, respectively. UEBMI patients who took their medication accounted for 62.36%, while only 40.27% of URRBMI patients adhered to their medication. The percentages of young-old, old-old and oldest-old patients who took their antihypertensive medications were 58.05%, 59.09% and 56.78%, respectively. The adherence to taking ≥ 2 medications (35.47%) was lower than that to taking one medication (58.33%). The medication adherence rates of patients with UEBMI and URRBMI for taking ≥ 2 medications were 37.21% and 27.45%, respectively. CONCLUSIONS Patients with UEBMI were more inclined to choose tertiary hospitals and cross-district visits than patients with URRBMI. The adherence of patients with UEBMI was better than that of patients with URRBMI in China.
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Affiliation(s)
- Lan Lan
- IT Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Pengcheng Hai
- Department of Internal Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Jiawei Luo
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, 610044, China
| | - Rui Li
- IT Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.
- Chinese Institute for Brain Research, Beijing, 100070, China.
- National Center for Neurological Disorders, Beijing, 100070, China.
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, 100070, China.
- China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China.
- Beijing Laboratory of Oral Health, Capital Medical University, Beijing, 100070, China.
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, 100070, China.
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Liddelow C, Mullan B, Boyes M, Ling M. Can temporal self-regulation theory and its constructs predict medication adherence? A systematic review and meta-analysis. Health Psychol Rev 2023; 17:578-613. [PMID: 36154853 DOI: 10.1080/17437199.2022.2127831] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 09/19/2022] [Indexed: 11/04/2022]
Abstract
The relationships between temporal self-regulation theory (TST) constructs (intention, behavioural prepotency and self-regulatory capacity) and medication adherence should be established before further applying the theory to adherence. Searches of PsychINFO, Medline, EMBASE, CINAHL and Web of Science were conducted in 2019 (updated November 2021). Studies had to be original quantitative research, assessed the relationship between one of the constructs and adherence in one illness, and used an adult population. The risk of bias was assessed using the NHLBI Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Three meta-analyses were conducted using R. Moderation analyses were also conducted. A total of 57 articles (60 studies) with 13,995 participants were included, with 7 studies included in more than one analysis. Results identified significant correlations between intention (r = .369, [95% CI: .25, .48]), behavioural prepotency (r = .332, [95% CI: .18, .48]), self-regulatory capacity (r = .213, [95% CI: .10, .32]) and adherence. There was some evidence of publication bias and no significant moderators. No studies explored the interactions in the theory, so whilst the constructs adequately predict adherence, future research should apply the theory to adherence in a specific illness to assess these relationships. Pre-registered on Prospero: CRD42019141395.
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Affiliation(s)
- Caitlin Liddelow
- School of Population Health, Curtin University, Perth, Australia
- Global Alliance for Mental Health and Sport, School of Psychology, University of Wollongong, Wollongong, Australia
| | - Barbara Mullan
- School of Population Health, Curtin University, Perth, Australia
- EnAble Institute, Curtin University, Perth, Australia
| | - Mark Boyes
- School of Population Health, Curtin University, Perth, Australia
- EnAble Institute, Curtin University, Perth, Australia
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Pan Q, Zhang C, Yao L, Mai C, Zhang J, Zhang Z, Hu J. Factors Influencing Medication Adherence in Elderly Patients with Hypertension: A Single Center Study in Western China. Patient Prefer Adherence 2023; 17:1679-1688. [PMID: 37484738 PMCID: PMC10361084 DOI: 10.2147/ppa.s418246] [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: 04/21/2023] [Accepted: 07/08/2023] [Indexed: 07/25/2023] Open
Abstract
Purpose To develop and empirically test a conceptual model that explains the factors influencing antihypertensive medication adherence behavior in elderly patients in a city in western China. Patients and Methods The conceptual model was based on the Theory of Planned Behavior and the Health Belief Model and was empirically tested using cross-sectional survey data from Nanchong City, a city in western China, collected between October and December 2020. Data were analyzed using structural equation modeling. Results Behavioral intentions were the main predictor of medication adherence behavior (path coefficient of 0.353). Perceived benefits and perceived barriers directly (path coefficient = 0.201 and -0.150, respectively), and indirectly (path coefficient = 0.118 and -0.060) through behavioral intentions, influenced medication adherence behavior. Perceived susceptibility (path coefficient = 0.390) and perceived severity (path coefficient = 0.408) influenced behavioral attitudes, which influenced behavioral intentions (path coefficient = 0.298). Conclusion The conceptual model demonstrates a robust ability to predict and explain medication adherence behavior among elderly patients with hypertension, facilitating the adoption and maintenance of changes in adherence behavior and the potential for preventing disease progression and improving quality of life.
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Affiliation(s)
- Qiuyu Pan
- Medical College, Tibet University, Lhasa, Tibet, 850000, People’s Republic of China
- School of Public Health, North Sichuan Medical College, Nanchong, Sichuan, 637100, People’s Republic of China
| | - Cheng Zhang
- Policy Research Room 2, Sichuan Health Development Research Center, Chengdu, Sichuan, 610042, People’s Republic of China
| | - Lansicheng Yao
- Foreign Affairs Office, North Sichuan Medical College, Nanchong, Sichuan, 637100, People’s Republic of China
| | - Chenyao Mai
- Medical College, Tibet University, Lhasa, Tibet, 850000, People’s Republic of China
| | - Jinpeng Zhang
- School of Public Health, Weifang Medical University, Weifang, Shandong, 261053, People’s Republic of China
| | - Zhitong Zhang
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, M5T 3M7, Canada
| | - Jun Hu
- School of Management, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, 250355, People’s Republic of China
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Bentum-Micah G, Cai L, Ahoto AT. Observation of covid-19 safety protocols by persons with chronic health conditions in Ghana: The influence of health belief model. Acta Psychol (Amst) 2023; 236:103928. [PMID: 37121072 PMCID: PMC10133890 DOI: 10.1016/j.actpsy.2023.103928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/15/2023] [Accepted: 04/25/2023] [Indexed: 05/02/2023] Open
Abstract
Covid-19 has brought distortion to health delivery globally and made it challenging to seek healthcare, but persons with chronic health conditions who require continuous medical attention have suffered the most as all attention at the medical front was directed to covid-19 related issues. The study explores how the five primary constructs of the health belief model were used to drive adherence to covid-19 preventive protocols among persons with chronic health conditions in Ghana. A quantitative technique was used for data collection and analyses. SPSS version 21 and AMOS version 21 were used to analyze data. Hierarchical regression from SPSS were used to examine the influences of health belief model constructs on chronic patients' adherence to covid-19 preventive protocols. The study's finding indicates that perceived susceptibility, severity, and self-efficacy influence adherence to covid-19 protocols among persons with chronic conditions. While perceived benefits and perceived barriers though they have negative and positive influences on adherence, they were not statistically significant. Perceived self-efficacy has a negative influence on the perceived barrier and a positive influence on perceived benefit. Gender has positive influence on Perceived susceptibility. The study's outcome indicated that persons with chronic health conditions need special arrangements to ease their access to healthcare during outbreaks. Hence, public health professionals need to educate chronic patients on how to practice the covid-19 preventive protocols and support them with covid-19 preventive materials to increase their self-efficacy to adhere to covid-19 protocols.
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Affiliation(s)
| | - Lianya Cai
- College of Teacher Education, Zhejiang Normal University, Jinhua 321004, PR China.
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Tan PPS, Sandhu RS, Zain SM, Hall D, Tan NC, Lim HM, Daud F, Pung YF. Health motivations and perceived barriers are determinants of self-care behaviour for the prevention of hypertension in a Malaysian community. PLoS One 2022; 17:e0278761. [PMID: 36477162 PMCID: PMC9728916 DOI: 10.1371/journal.pone.0278761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 11/22/2022] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Self-care behaviour is fundamental in preventing hypertension in the general population. According to the Health Belief Model, health beliefs and perceptions influence the success in adopting disease prevention strategies. While factors influencing hypertension self-care behaviour have been examined previously in patient populations, they have not been assessed in the general community. METHODS This was a cross-sectional study conducted between 12 June 2020 to 26 July 2021. An online survey was administered via email and social media to Malaysians in the Selangor and Kuala Lumpur communities. Respondents were over 18 years old, without a formal diagnosis of hypertension. The survey evaluated hypertension knowledge, Health Belief Model constructs, self-care behaviour frequency, and motivators and barriers to self-care behaviour. Multiple linear regression was performed to determine the main predictors of self-care behaviour, and descriptive statistics were used to characterise motivators and barriers of each self-care behaviour. RESULTS Only health motivations (β = 0.217, p < 0.001) and perceived barriers (β = 0.571, p < 0.001) significantly influenced self-care behaviour. Maintaining a healthy diet, regular physical activity and blood pressure checks need to be improved in the community, particularly in reducing salt and calorie intake. Lack of time, limited choices and laziness are the biggest challenges that need to be tackled in adopting a healthy diet and an active lifestyle in the community. Many are ignorant towards their health status, therefore, do not prioritize blood pressure screenings, suggesting a need to enhance community blood pressure checks for early diagnosis of hypertension. CONCLUSION AND IMPLICATIONS Motivations and barriers were the main determinants of self-care behaviour in the Selangor and Kuala Lumpur community. Targeting these aspects of self-care behaviour should be considered when developing interventions and education programmes tailored to local cultural, environmental and personal factors, to more effectively reduce the hypertension prevalence and burden.
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Affiliation(s)
- Paulina Pei Suu Tan
- School of Pharmacy, University of Nottingham Malaysia, Semenyih, Selangor, Malaysia
| | - Ryand Singh Sandhu
- School of Pharmacy, University of Nottingham Malaysia, Semenyih, Selangor, Malaysia
| | - Shamsul Mohd Zain
- Department of Pharmacology, University Malaya, Kuala Lumpur, Malaysia
| | - Deborah Hall
- Department of Psychology, Heriot-Watt University Malaysia, Putrajaya, Malaysia
| | - Ngiap Chuan Tan
- Department of Research, SingHealth Polyclinics, Singapore, Singapore
| | - Hooi Min Lim
- Department of Primary Care Medicine, University Malaya Medical Centre, University of Malaya, Kuala Lumpur, Malaysia
| | - Faiz Daud
- Department of Community Health, University Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Yuh-Fen Pung
- School of Pharmacy, University of Nottingham Malaysia, Semenyih, Selangor, Malaysia
- * E-mail:
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Chow HW, Chen KL. Development of an Air Pollution Risk Perception Questionnaire for Running Race Runners Based on the Health Belief Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11419. [PMID: 36141690 PMCID: PMC9517284 DOI: 10.3390/ijerph191811419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 08/12/2022] [Accepted: 09/07/2022] [Indexed: 06/16/2023]
Abstract
An increasing number of individuals participate in running races worldwide; however, running in the presence of air pollution poses health risks to runners. Therefore, developing a valid and reliable instrument is imperative to assess runners' beliefs and perceptions regarding risks and health behaviors. This study developed a comprehensive questionnaire based on the health behavior model and relevant literature. The questionnaire was tested with 310 responses from individuals with running race experiences in Taiwan. Tests of the measurement model were conducted using reliability and confirmatory factor analysis. The results reveal that the questionnaire consists of eight constructs: perceived susceptibility, perceived severity, perceived benefits, perceived barriers, perceived self-efficacy, cues to action, health behavior intention, and awareness of air quality. The 31 items jointly accounted for 72.71% of the observed variance. All eight factors have good internal consistency, convergent, and discriminant validity with acceptable model fit indexes. Additionally, a valid translated English version of the questionnaire is provided for future research, sports agencies, or governments to explore factors that affect, or interact with, risk while running under air pollution conditions to develop management strategies.
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Asefa A, Midaksa G, Qanche Q, Wondimu W, Nigussie T, Bogale B, Birhanu F, Asaye Z, Mohammed N, Yosef T. Does the perception of HIV risk among Female sex workers affect HIV prevention behavior? application of the Health Belief Model (HBM). BMC Public Health 2022; 22:1646. [PMID: 36042424 PMCID: PMC9427084 DOI: 10.1186/s12889-022-14046-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 08/17/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND High prevalence of Human Immune virus/Acquired immunodeficiency syndrome (HIV/AIDS) in Female Sex Workers (FSWs) is identified as a bottleneck in fighting against HIV/AIDS. To this end, the international community planned a strategy of 'Ending inequality' and 'Ending the AIDS epidemic' by 2030. This could not be achieved without due attention to FSWs. Thus, this study attempted to assess HIV prevention behavior and associated factors among FSWs in Dima district of Gambella region, Ethiopia by using the Health Belief Model. METHODS A community-based cross-sectional study was conducted from March to May 2019 among 449 FSWs selected using the snowball sampling technique. Socio-demographic features, knowledge about HIV, attitude toward HIV prevention methods, and Health Belief Model (HBM) constructs (perceived susceptibility to and severity of HIV, perceived barriers, and benefits of performing the recommended HIV prevention methods, self-efficacy, and cues to practice HIV prevention methods) were collected using face to face interview. Data were entered into Epi-data 3.1 and analyzed using SPSS version 23. Bivariable and multivariable binary logistic regression analysis was done to identify the association between dependent and independent variables. P-value < 5% with 95 CI was used as a cutoff point to decide statistical significance of independent variables. RESULTS In this study, 449 FSWs participated making a response rate of 98.90%. Of these, 64.8% had high HIV prevention behavior. Age (AOR = 1.911, 95% CI: 1.100, 3.320), knowledge of HIV (AOR = 1.632, 95% CI: 1.083, 2.458), attitude towards HIV prevention methods (AOR = 2.335, 95% CI: 1.547, 3.523), perceived barriers (AOR = .627, 95% CI: .423, .930), and self-efficacy (AOR = 1.667, 95% CI: 1.107, 2.511) were significantly associated with high HIV prevention behavior. CONCLUSION The study identified that about two third of FSWs practiced the recommended HIV prevention methods. Age of respondents, knowledge of HIV, favorable attitude towards the recommended HIV prevention methods, high self-efficacy, and low perceived barrier were associated with high HIV prevention behavior. Therefore, focusing on these factors would be instrumental for improving effectiveness of the ongoing HIV prevention efforts and attaining the 'Sustainable Development Goals of 'Ending inequality' and 'Ending the AIDS epidemic' by 2030.
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Affiliation(s)
- Adane Asefa
- School of Public Health, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan Aman, Ethiopia
| | - Gachana Midaksa
- School of Public Health, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan Aman, Ethiopia.
| | - Qaro Qanche
- School of Public Health, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan Aman, Ethiopia
| | - Wondimagegn Wondimu
- School of Public Health, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan Aman, Ethiopia
| | - Tadesse Nigussie
- Department of Public Health, College of Health Science, Salale University, Salale, Ethiopia
| | - Biruk Bogale
- School of Public Health, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan Aman, Ethiopia
| | - Frehiwot Birhanu
- School of Public Health, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan Aman, Ethiopia
| | - Zufan Asaye
- Department of Statistics, College of Natural and Computational Science, Mizan-Tepi University, Tepi, Ethiopia
| | - Nuredin Mohammed
- Department of Nursing, College of Medicine and Health Science, Mizan Tepi University, Mizan Aman, Ethiopia
| | - Tewodros Yosef
- School of Public Health, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan Aman, Ethiopia
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Predictors of Nonadherence to Medications among Hypertensive Patients in Ghana: An Application of the Health Belief Model. Int J Hypertens 2022; 2022:1418149. [PMID: 36059589 PMCID: PMC9433278 DOI: 10.1155/2022/1418149] [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: 01/09/2022] [Revised: 06/04/2022] [Accepted: 06/28/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction. Hypertension (HPT) is recognized as a significant public health problem worldwide from a health and economic perspective. This study determined predictors of nonadherence to HPT medications in Ghana using the health belief model. Methods. A cross-sectional descriptive survey employing a quantitative approach was conducted among HPT patients who routinely attend clinics at selected hospitals in the Brong Ahafo region of Ghana. Respondents (n = 399) were recruited using a multistage sampling technique. Results. The prevalence of nonadherence was 63.7% (n = 254). Nonadherence to hypertension medication was associated with lower education status (
). In logistic regression analysis, patients with high “perceived susceptibility” and “perceived severity” were more likely to forfeit their HPT medication schedules, while patients with high “perceived barriers” and “cues to action” were less likely to skip their medication. Conclusion. The present study suggests a plausible path to improving medication adherence in this population. Given the high prevalence of nonadherence, policymakers need to urgently design tailor-made health promotion interventions to ensure optimal health outcomes.
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Zareban I, Araban M, Rohani MR, Karimy M, Zamani-Alavijeh F, Babanejad M, Stein LAR. High blood pressure self-care among hypertensive patients in Iran: a theory-driven study. J Hum Hypertens 2022; 36:445-452. [PMID: 33077805 DOI: 10.1038/s41371-020-00429-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 09/17/2020] [Accepted: 10/05/2020] [Indexed: 11/09/2022]
Abstract
High blood pressure is becoming a universal epidemic for both developed and developing countries; it is one of the main public health problems all over the world. This research was conducted to assess blood pressure self-care among hypertensive patients in Iran. This cross-sectional analytic study was conducted on 527 patients with hypertension recruited from Zarandieh, Iran in 2018. Data were gathered using questionnaires assessing socio-demographic information, social support, health belief model (HBM) constructs (perceived benefits to healthy behavior, barriers to healthy behavior, perceived disease threat, self-efficacy to engage in healthy behavior, and cues to action), and self-care activities to address blood pressure. A stepwise multiple linear regression analysis was used to determine factors associated with self-care behaviors. Overall, 512 patients (215 men and 297 women) participated in this study. Participants who were married, and more educated engaged in more self-care behaviors. At least one-half of the patients (47.6%) demonstrated a moderate level of self-care behaviors with a mean score of self-care equal to 9.32 ± 3.6 (out of 18). All the elements of HBM and social support were significant predictors of self-care behaviors and self-efficacy was the strongest predictor, followed (in descending order) by perceived barriers, social support, perceived disease threat, and perceived benefits. Health education based on HBM, enhanced with attention to social support, may help patient enact healthier behaviors to reduce blood pressure.
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Affiliation(s)
- Iraj Zareban
- Health Promotion Research Center, Zahedan of University Medical Sciences, Zahedan, Iran
| | - Marzieh Araban
- Department of Health Education and Promotion, Public Health School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad Reza Rohani
- Internal Medicine Department, Faculty of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Mahmood Karimy
- Ph.D. of Health Education Promotion, Department of Public Health, Faculty of Health, Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran.
| | - Fereshteh Zamani-Alavijeh
- Ph.D. of Health Education Promotion, Department of Public Health, Faculty of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehran Babanejad
- Ph.D. of Health Education Promotion, Department of Public Health, Faculty of Health, Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - L A R Stein
- Department of Social & Behavioral Sciences, Brown University School of Public Health, Providence, RI, USA.,Department of Behavioral Health, Developmental Disabilities & Hospitals, Cranston, RI, USA.,Rhode Island Training School, Department of Children, Youth & Families, Cranston, RI, USA.,Department of Psychology, University of Rhode Island, South Kingstown, RI, USA
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Ge P, Liu ST, Xu SX, Zhang JZ, Lai YJ, Fu RC, Ke XY, Zhao J, Bian Y, Wu YB. The Influence of Parents on Medication Adherence of Their Children in China: A Cross-Sectional Online Investigation Based on Health Belief Model. Front Public Health 2022; 10:845032. [PMID: 35493366 PMCID: PMC9046660 DOI: 10.3389/fpubh.2022.845032] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 03/23/2022] [Indexed: 11/26/2022] Open
Abstract
Objective To explore the influence of parents on the medication adherence of their children. Study Design A cross-sectional online investigation. Methods A questionnaire with 41 questions was designed based on the health belief model (HBM) distributed and collected online in 28 cities around China through multi-stage stratified sampling. The reliability of the questionnaire was assessed with Cronbach's α coefficient and split-half reliability, and its validity was evaluated with exploratory factor analysis and content validity index. The structural equation model (SEM) was constructed to explore the relationship between the parents' health beliefs and their children's medication adherence. Subgroup analysis was conducted to study the differences between parents with different demographic characteristics (male and female, rural and urban). Results 573 questionnaires were included for analysis, with an effective rate of 62.97%. The Cronbach'α coefficient of the questionnaire was 0.821 > 0.6, the split-half reliability was 0.651 > 0.6, the I-CVI of each dimension were >0.78, and the S-CVI/AVE (I-CVI average) was 0.95 > 0.9. The result of the questionnaire exploratory factor analysis met the standard. According to the SEM, self-efficacy (λ = 0.177), perceived susceptibility (λ = −0.244), and perceived severity (λ = 0.243) were direct influencing factors of children's medication adherence. In the subgroup analysis, the model established by each subgroup was consistent with the model established by the overall sample. The absolute values of females' perceived susceptibility, severity, and self-efficacy for their children's medication adherence path coefficients were higher than males'. Conclusion Parents' perceived severity and self-efficacy may positively impact on their children's medication adherence, while parents' susceptibility to children's medication non-adherence may negatively impact on children's medication adherence. Objective constraints, perceived barriers, and benefits may in directly impact on children's medication adherence. Women's health beliefs appear to have a more significant impact on their children's medication adherence than men's. It may be an effective strategy to increase their children's medication adherence by improving parents' health beliefs. Medical staff should explain medication adherence knowledge to the parents of children, and inform the children of the possible consequences of non-adherence with medication, to improve the subjective perception of parents on the severity of children's non-adherence with medication, and improve parents' self-efficacy in rational medication for children. In addition, attention should be paid to the mental health of the parents, and more social and psychological support.
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Affiliation(s)
- Pu Ge
- Institute of Chinese Medical Sciences, University of Macau, Macau, China
- State Key Laboratory of Quality Research in Chinese Medicine, University of Macau, Macau, China
- Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Macau, China
| | - Si-tong Liu
- School of Pharmacy, Peking University, Beijing, China
| | - Shu-xian Xu
- School of Pharmacy, Shenyang Pharmaceutical University, Shenyang, China
| | - Jin-zi Zhang
- College of Humanities and Social Sciences, Harbin Medical University, Harbin, China
| | - Yong-jie Lai
- Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Run-chen Fu
- School of Pharmacy, Shandong First Medical University, Taian, China
| | - Xin-yu Ke
- Institute of Chinese Medical Sciences, University of Macau, Macau, China
- State Key Laboratory of Quality Research in Chinese Medicine, University of Macau, Macau, China
- Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Macau, China
| | - Juan Zhao
- The Fourth Hospital of Harbin, Harbin, China
| | - Ying Bian
- Institute of Chinese Medical Sciences, University of Macau, Macau, China
- State Key Laboratory of Quality Research in Chinese Medicine, University of Macau, Macau, China
- Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Macau, China
- *Correspondence: Ying Bian
| | - Yi-bo Wu
- School of Public Health, Peking University, Beijing, China
- Yi-bo Wu
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Zhu X, Peng B, Yi Q, Liu J, Yan J. Prediction Model of Immunosuppressive Medication Non-adherence for Renal Transplant Patients Based on Machine Learning Technology. Front Med (Lausanne) 2022; 9:796424. [PMID: 35252242 PMCID: PMC8895304 DOI: 10.3389/fmed.2022.796424] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 01/27/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives Predicting adherence to immunosuppressive medication (IM) is important to improve and design future prospective, personalized interventions in Chinese renal transplant patients (RTPs). Methods A retrospective, multicenter, cross-sectional study was performed in 1,191 RTPs from October 2020 to February 2021 in China. The BAASIS was used as the standard to determine the adherence of the patients. Variables of the combined theory, including the general data, the HBM, the TPB, the BMQ, the PSSS and the GSES, were used to build the models. The machine learning (ML) models included LR, RF, MLP, SVM, and XG Boost. The SHAP method was used to evaluate the contribution of predictors to predicting the risk of IM non-adherence in RTPs. Results The IM non-adherence rate in the derivation cohort was 38.5%. Ten predictors were screened to build the model based on the database. The SVM model performed better among the five models, with sensitivity of 0.59, specificity of 0.73, and average AUC of 0.75. The SHAP analysis showed that age, marital status, HBM-perceived barriers, use pill box after transplantation, and PSSS-family support were the most important predictors in the prediction model. All of the models had good performance validated by external data. Conclusions The IM non-adherence rate of RTPs was high, and it is important to improve IM adherence. The model developed by ML technology could identify high-risk patients and provide a basis for the development of relevant improvement measures.
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Affiliation(s)
- Xiao Zhu
- Nursing Department of Third Xiangya Hospital of Central South University, Changsha, China
- Research Center of Chinese Health Ministry on Transplantation Medicine Engineering and Technology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Bo Peng
- Research Center of Chinese Health Ministry on Transplantation Medicine Engineering and Technology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - QiFeng Yi
- Nursing School of Central South University, Changsha, China
- Nursing Department of Third Xiangya Hospital of Central South University, Changsha, China
- *Correspondence: QiFeng Yi
| | - Jia Liu
- Nursing School of Central South University, Changsha, China
- Nursing Department of Third Xiangya Hospital of Central South University, Changsha, China
- Research Center of Chinese Health Ministry on Transplantation Medicine Engineering and Technology, The Third Xiangya Hospital, Central South University, Changsha, China
- Jia Liu
| | - Jin Yan
- Nursing School of Central South University, Changsha, China
- Nursing Department of Third Xiangya Hospital of Central South University, Changsha, China
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14
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Wan J, Wu Y, Ma Y, Tao X, Wang A. Predictors of poor medication adherence of older people with hypertension. Nurs Open 2022; 9:1370-1378. [PMID: 35094495 PMCID: PMC8859025 DOI: 10.1002/nop2.1183] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 12/12/2021] [Accepted: 01/09/2022] [Indexed: 11/16/2022] Open
Abstract
Aims To explore the risk factors for poor medication adherence in older people with hypertension. Design A cross‐sectional study. Methods Participants were administered with a self‐report questionnaire about their demographic characteristics; additionally, their four‐item Morisky Medication Adherence Scale scores were calculated. The STROBE checklist was applied as the reporting guideline for this study (File S1). Results Univariate analysis indicated that the following five factors were statistically significantly associated with medication adherence: education level (χ2 = 8.073, p = .045), co‐living (χ2 = 11.364, p = .010), hypertension complications (χ2 = 10.968, p = .001), admission blood pressure (χ2 = 8.876, p = .003), and falls (χ2 = 6.703, p = .010). Multivariable binary logistic regression analysis showed that there were four statistically significant predictors, such as people who lived with spouses and offspring (OR = 3.004, p = .017), and those who had high admission blood pressure (OR = 1.910, p = .003) had a greater risk of poor medication adherence, whereas those without hypertension complications (OR = 0.591, p = .026) and those without falls (OR = 0.530, p = .046) had a lower risk. Relevance to clinical practice We believe that these findings contribute to the identification of high‐risk people with poor adherence, allowing nurses to identify people with poor adherence in a timely manner, and pay attention to the people's medication.
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Affiliation(s)
- Jingjing Wan
- Department of Graduate School Wannan Medical College Wuhu China
| | - Yinyin Wu
- Department of Graduate School Wannan Medical College Wuhu China
| | - Yuan Ma
- Department of Graduate School Wannan Medical College Wuhu China
| | - Xiubin Tao
- Nursing Department at First Affiliated Hospital of Wannan Medical College Wuhu China
| | - Anshi Wang
- Department of Public Health Wannan Medical College Wuhu China
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15
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Wadhahi AA, Garvey L, Edward KL, Beasley C. The lived experience of adherence to asthma medication in young adults (18-34 years). J Asthma 2021; 59:2475-2490. [PMID: 34902272 DOI: 10.1080/02770903.2021.2018706] [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: 10/19/2022]
Abstract
BACKGROUND Adherence to asthma medications is commonly poor and is the primary cause for anticipated worsening health outcomes for patients with asthma. Worldwide, qualitative investigations that examine the adherence of young adults (18-34 years) to their asthma medication are limited. METHOD This study used a phenomenological research approach to explicate the experience of asthma medication adherence as described by young adults. Data were collected using semi-structured in-depth video interviews conducted with participants aged between 18 and 34 years to elicit their lived experience with adherence to asthma medication. Data from the interviews were transcribed and analyzed using the Edward and Welch (1) extension of Colaizzi's approach to phenomenology. RESULTS Results yielded four main themes related to the phenomenon of adherence that emerged from the analysis. The themes were: Having a plan; Having knowledge about your medication and asthma triggers; Being responsible with asthma medication; and Health belief. CONCLUSION According to the findings, for young people adhering to asthma medication is a process that depends on four vital aspects: (A) plan, (B) knowledge, (C) responsibility, and (D) belief. If young adults with asthma received individualized written asthma plans and have adequate knowledge about this plan, developing the correct health belief is likely to result. Hence, this can lead to a greater responsibility to manage their asthma to the recommended adherence level.
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Affiliation(s)
- Amal Al Wadhahi
- Faculty of Health, Art and Design, Swinburne University of Technology, Melbourne, Australia
| | - Loretta Garvey
- Department of Health Professions, Swinburne University of Technology, Melbourne, Australia
| | - Karen-Leigh Edward
- Faculty of Health, Art and Design, Swinburne University of Technology, Melbourne, Australia.,Swinburne University of Technology, Melbourne, Australia.,School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Carolyn Beasley
- Department of Media and Communication, School of Social Sciences, Media, Film and Education, Swinburne University of Technology, Melbourne, Australia
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16
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Mirakzadeh AA, Karamian F, Khosravi E, Parvin F. Analysis of Preventive Behaviors of Rural Tourism Hosts in the Face of COVID-19 Pandemic: Application of Health Belief Model. Front Public Health 2021; 9:793173. [PMID: 35004596 PMCID: PMC8733247 DOI: 10.3389/fpubh.2021.793173] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 12/03/2021] [Indexed: 11/13/2022] Open
Abstract
The novel coronavirus (COVID-19) is one of the most severe public health crises in recent history. Therefore, in order to prevent the spread of COVID-19 and its negative effects on the health of rural tourist hosts and the rural community, it is necessary to pay attention to the conservation and health behaviors of rural tourist hosts. This study was conducted with the purpose of analyzing preventive behaviors of rural tourism hosts in the face of COVID-19 pandemic with the application of the health belief model (HBM) that is one of the most widely used models to study behavior to prevent and control diseases. In this study, all 80 tourism hosts of tourism target villages in Kermanshah province (the west of Iran), were studied as study population. A questionnaire was used to collect data which its validity and reliability were confirmed. Structural equation modeling (SEM) using Smart PLS software was used to analyze the data. The results of SEM indicated that perceived severity, perceived susceptibility, self- efficacy, perceived benefits, and cues to action accounted for 56% of the variance of "COVID-19 preventive health behavior" among the hosts of rural tourists in Kermanshah province. Moreover, the perceived susceptibility was the strongest predictor of preventive health behavior, while perceived barriers were not significant on behavior. Therefore, planning based on the HBM with emphasis on increasing awareness to improve and modify the health behavior of rural tourist hosts is recommended.
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Affiliation(s)
- Ali Asghar Mirakzadeh
- Department of Agricultural Extension and Education, Faculty of Agriculture, Razi University, Kermanshah, Iran
| | - Faranak Karamian
- Department of Agriculture Extension and Education, Agricultural College, Razi University, Kermanshah, Iran
| | - Ehsan Khosravi
- Department of Management and Entrepreneurship, Faculty of Social Sciences, Razi University, Kermanshah, Iran
| | - Fatemeh Parvin
- Department of Management and Entrepreneurship, Faculty of Social Sciences, Razi University, Kermanshah, Iran
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17
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Wilkinson R, Garden E, Nanyonga RC, Squires A, Nakaggwa F, Schwartz JI, Heller DJ. Causes of medication non-adherence and the acceptability of support strategies for people with hypertension in Uganda: A qualitative study. Int J Nurs Stud 2021; 126:104143. [PMID: 34953374 DOI: 10.1016/j.ijnurstu.2021.104143] [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: 02/02/2021] [Revised: 09/29/2021] [Accepted: 11/23/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hypertension is the most common non-communicable disease in Uganda and its prevalence is predicted to grow substantially over the next several years. Rates of hypertension control remain suboptimal, however, due in part to poor medication adherence. There is a significant need to better understand the drivers of poor medication adherence for patients with non-communicable diseases and to implement appropriate interventions to improve adherence. OBJECTIVE The purpose of this study was two-fold. First, this study sought to understand what factors support or undermine patients' efforts to adhere to their hypertensive medications at baseline. Second, this study sought to explore the acceptability and feasibility of adherence interventions to both providers and patients. METHODS This study was conducted at a large, urban private hospital in Kampala, Uganda. We conducted key informant interviews with both providers and patients. We explored their beliefs about the causes of medication non-adherence while examining the acceptability of support strategies validated in similar contexts, such as: daily text reminders, educational materials on hypertension, monthly group meetings (i.e. "adherence clubs") led by patients or providers, one-on-one appointments with providers, and modified drug dispensing at the hospital pharmacy. STUDY DESIGN AND PARTICIPANTS Fifteen healthcare providers and forty-two patients were interviewed. All interviews were transcribed, and these transcripts were analyzed using the NVIVO software. We utilized a conventional content analysis approach informed by the Health Belief Model. RESULTS Of the proposed interventions, participants expressed particularly strong interest in adherence clubs and educational materials. Participants drew connections between these interventions and previously underexplored drivers of non-adherence, which included the lack of symptoms from untreated hypertension, fear of medication side effects, interest in traditional herbal medicine, and the importance of family and community support. CONCLUSIONS Both providers and patients at the facility recognized medication non-adherence as a major barrier to hypertension control and expressed interest in improving adherence through interventions that addressed context-specific barriers.
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Affiliation(s)
- Rachel Wilkinson
- Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Place, New York, NY 10029 USA
| | - Evan Garden
- Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Place, New York, NY 10029 USA
| | - Rose Clarke Nanyonga
- Clarke International University, Kawagga Close, off Kalungi Road, Muyenga Block 244, Plot 8244 Bukasa Kyadondo, P.O.Box 7782, Kampala Uganda
| | - Allison Squires
- NYU Rory Meyers College of Nursing, 433 1st Avenue New York, NY 10010 USA
| | - Florence Nakaggwa
- Clarke International University, Kawagga Close, off Kalungi Road, Muyenga Block 244, Plot 8244 Bukasa Kyadondo, P.O.Box 7782, Kampala Uganda
| | | | - David J Heller
- Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Place, New York, NY 10029 USA.
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18
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Haynes SC, Tancredi DJ, Tong K, Hoch JS, Ong MK, Ganiats TG, Evangelista LS, Black JT, Auerbach A, Romano PS. The Effect of Rehospitalization and Emergency Department Visits on Subsequent Adherence to Weight Telemonitoring. J Cardiovasc Nurs 2021; 36:482-488. [PMID: 32398500 PMCID: PMC8091911 DOI: 10.1097/jcn.0000000000000689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Weight telemonitoring may be an effective way to improve patients' ability to manage heart failure and prevent unnecessary utilization of health services. However, the effectiveness of such interventions is dependent upon patient adherence. OBJECTIVE The purpose of this study was to determine how adherence to weight telemonitoring changes in response to 2 types of events: hospital readmissions and emergency department visits. METHODS The Better Effectiveness After Transition-Heart Failure trial examined the effectiveness of a remote telemonitoring intervention compared with usual care for patients discharged to home after hospitalization for decompensated heart failure. Participants were followed for 180 days and were instructed to transmit weight readings daily. We used Poisson regression to determine the within-person effects of events on subsequent adherence. RESULTS A total of 625 events took place during the study period. Most of these events were rehospitalizations (78.7%). After controlling for the number of previous events and discharge to a skilled nursing facility, the rate for adherence decreased by nearly 20% in the 2 weeks after a hospitalization compared with the 2 weeks before (adjusted rate ratio, 0.81; 95% confidence interval: 0.77-0.86; P < .001). CONCLUSIONS Experiencing a rehospitalization had the effect of diminishing adherence to daily weighing. Providers using telemonitoring to monitor decompensation and manage medications should take advantage of the potential "teachable moment" during hospitalization to reinforce the importance of adherence.
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19
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Zhang P, Zhu X, Yan J, Liu J. Identification of Immunosuppressive Medication Nonadherence Factors Through a Combined Theory Model in Renal Transplant Recipients: 6-12. Front Pharmacol 2021; 12:655836. [PMID: 34122077 PMCID: PMC8187913 DOI: 10.3389/fphar.2021.655836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 05/07/2021] [Indexed: 01/23/2023] Open
Abstract
Background: Immunosuppressive medication (IM) nonadherence is associated with poor transplant outcomes. Therefore, it is of great importance to identify predictive factors with IM nonadherence. We aimed to improve the predicted capacity of the theory of planned behavior (TPB) by adding health belief model's (HBM) variables in renal transplant patients (RTPs). Methods: This cross-sectional study distributed questionnaires to patients who had undergone renal transplant and follow-up regularly in the transplant center of Third Xiangya Hospital in China. The self-developed questionnaire collected data in three aspects: general data questionnaire, TPB, HBM-specific questionnaire, and Basel Assessment of Adherence to Immunosuppressive Medications scale. Results: A total of 1,357 of 1,480 patients completed the survey, with a participation rate of 91.69% and IM nonadherence rate of 33.53%. The marital status, household income, preoperative drinking history, the time after transplantation, and religion showed independent predictive factors with IM nonadherence (p < 0.05). Strikingly, adding HBM variables to the TPB theory model significantly increased its prediction ability to IM nonadherence (52%). Also, HBM manifested the highest coefficient of effect (-0.620). Particularly, perceived barriers and perceived seriousness, the variables of the HBM model, played a vital influence on medication nonadherence (-0.284 and 0.256). Conclusion: Our study here reveals the first investigation of the combined effects of the TPB and HBM model on IM nonadherence in Chinese RTPs, which could significantly improve the predictive ability of any single model. Meanwhile, future interventions should be conducted to both increase perceived seriousness and reduce perceived barriers for taking IM, which will effectively decrease IM nonadherence rates and improve transplant outcomes.
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Affiliation(s)
- Pengpeng Zhang
- Department of Transplantation, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Xiao Zhu
- Department of Transplantation, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Jin Yan
- The Nursing Department, the Third Xiangya Hospital of Central South University, Changsha, China
| | - Jia Liu
- Department of Transplantation, The Third Xiangya Hospital of Central South University, Changsha, China.,The Nursing School of Central South University, Changsha, China
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20
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Jiang L, Liu S, Li H, Xie L, Jiang Y. The role of health beliefs in affecting patients' chronic diabetic complication screening: a path analysis based on the health belief model. J Clin Nurs 2021; 30:2948-2959. [PMID: 33951248 PMCID: PMC8453575 DOI: 10.1111/jocn.15802] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/25/2021] [Accepted: 03/29/2021] [Indexed: 02/05/2023]
Abstract
AIMS AND OBJECTIVES To explore the role of health beliefs in affecting patients' chronic diabetic complication (CDC) screening. BACKGROUND Patients' adherence to the guideline-recommended CDC screening was far from optimal. While many demographic and clinical characteristics were documented to influence patients' adherence, psychological profiles, such as health beliefs, were not well studied before. It is crucial to understand how health beliefs affect patients' CDC screening behaviour and thus to provide implications for future intervention programmes. DESIGN A cross-sectional study was conducted. METHODS 785 type 2 diabetes were enrolled from the community health centre in Wuhou District, Chengdu, China. Structured questionnaires were used to collect data regarding the demographic and clinical information, knowledge about CDC, health belief model constructs and CDC screening behaviour. Mediation analysis was performed to explore the mechanisms of health belief model constructs on CDC screening behaviour. The study methods were compliant with the STROBE checklist. RESULTS Knowledge had a significant indirect effect on CDC screening behaviour through perceived susceptibility, perceived benefits, perceived barriers and self-efficiency. Cues to action exerted both significant direct and indirect effects on CDC screening behaviour. The indirect effects of cues to action were exerted through perceived susceptibility, perceived barriers and self-efficiency. CONCLUSION Health beliefs played vital roles in mediating the effects of knowledge and cues to action on patients' CDC screening behaviour. Health beliefs should be assessed and modified through creative educational methods. Strategies aimed at increasing cues to action are also expected to facilitate patients' CDC screening behaviour. RELEVANCE TO CLINICAL PRACTICES The study contributes to the exploration of how health beliefs affect patients' CDC screening behaviour. The results could be used to inspire future community-based intervention programmes.
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Affiliation(s)
- Lingjun Jiang
- West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China.,Department of Cardiothoracic Surgery, Yichang Central People, Hospital, Yichang, China
| | - Suzhen Liu
- West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Hang Li
- West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Linna Xie
- West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Yuan Jiang
- West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China
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21
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Mahmood S, Jalal Z, Hadi MA, Khan TM, Haque MS, Shah KU. Prevalence of non-adherence to antihypertensive medication in Asia: a systematic review and meta-analysis. Int J Clin Pharm 2021; 43:486-501. [PMID: 33515135 DOI: 10.1007/s11096-021-01236-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 01/13/2021] [Indexed: 10/22/2022]
Abstract
Background Hypertension and its associated complications are one of the leading causes of morbidity and mortality in Asia. Racial disparities in terms of treatment outcomes among hypertension patients have been reported in literature with Asian patients resulting in poorer treatment outcomes. Non-adherence to antihypertensive therapy is frequently associated with poor treatment outcomes. Aim of the review The aim of this review was to estimate the prevalence of non-adherence to antihypertensive medications among patients with hypertension residing in Asia. Method PubMed, Google Scholar, MEDLINE, Embase, Scopus, CINHAL and Cochrane library were searched for studies published between 2000 and 2019 involving hypertensive patients. Studies investigating the prevalence of medication non-adherence in Asian countries, rated either good or fair on National Institute of Health quality assessment tool and published in English language were included in our review. Data were extracted by one author and checked by another using a structured and pilot-tested data extraction sheet. A random-effects meta-analysis was performed using STATA version 14.3®. Results Sixty-Six studies from 22 Asian countries including 2,532,582 hypertensive patients were included. Mean (± SD) age of participants was 58(± 6) years. Overall, the estimated prevalence of non-adherence to antihypertensive medication in Asia was 48% (95% CI: 41-54, P = 0.001). The rate of non-adherence was higher among females 49% (95% CI: 41-56, P = 0.001) compared to males 47% (95% CI: 40-53, P = 0.001). As per the region, the highest prevalence of non-adherence was found in South Asia 48% (95% 44-51, P = 0.877) followed by East Asia 45% (31-59, P = 0.001) and the Middle East 41 (95% 30-52, P = 0.001). Similarly, higher rate of non-adherence was observed in low and lower middle-income countries i.e. 50% (95% CI: 47-54, P = 0.220) as compare to upper-middle and high-income countries i.e. 37% (95% CI: 25-49, P = 0.001) and 44% (95% CI: 29-59, P = 0.001) respectively. Conclusion The prevalence of non-adherence to antihypertensive medication is high in Asia. This may partly explain poor treatment outcomes and incidence of higher mortality rate in Asia frequently reported in the literature. There is a need to implement appropriate policies and clinical practices to improve medication adherence.
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Affiliation(s)
- Sajid Mahmood
- Department of Pharmacy, Quaid-E-Azam University, Islamabad, 45320, Pakistan
| | - Zahraa Jalal
- School of Pharmacy, Institute of Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Muhammad Abdul Hadi
- School of Pharmacy, Institute of Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Tahir Mehmood Khan
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Science (UVAS), Lahore, Pakistan
| | - M Sayeed Haque
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Kifayat Ullah Shah
- Department of Pharmacy, Quaid-E-Azam University, Islamabad, 45320, Pakistan.
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22
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Cinar FI, Mumcu Ş, Kiliç B, Polat Ü, Bal Özkaptan B. Assessment of Medication Adherence and Related Factors in Hypertensive Patients: The Role of Beliefs About Medicines. Clin Nurs Res 2020; 30:985-993. [PMID: 33327775 DOI: 10.1177/1054773820981381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Low medication adherence is one of the leading causes that affect the achievement of target levels for hypertension. Identifying modifiable factors associated with low adherence is crucial. This study aims to assess medication adherence and the role of beliefs about medicines on medication adherence among hypertensive patients.This cross-sectional study was conducted with 200 hypertension patients.Data were collected using the Morisky-Green-Levine Medication Adherence Scale, and the Beliefs about Medicines Questionnaire [BMQ-Turkish Translation (BMQ-T)]. It was found that the BMQ-T subscales of Specific Concern (β = 0.358, p = .027) and General Overuse (β = 0.552, p = .011) had an independent predictor effect on medication adherence scores. In this study, the patients who thought that drugs were overused and had concerns about this were seen to be less adherent with the medication. With regard to patients who use antihypertensive drugs but have uncontrolled blood pressure, their beliefs about drugs should not be ignored when evaluating adherence with drug therapy.
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Affiliation(s)
- Fatma Ilknur Cinar
- University of Health Sciences Turkey, Gülhane Faculty of Nursing, Ankara, Turkey
| | - Şule Mumcu
- Bingol University, Faculty of Health Sciences, Bingol, Turkey
| | - Betülay Kiliç
- University of Health Sciences Turkey, Gülhane Faculty of Nursing, Ankara, Turkey
| | - Ülkü Polat
- Gazi University, Faculty of Health Sciences, Department of Nursing, Ankara, Turkey
| | - Bilge Bal Özkaptan
- Sinop University, Faculty of Health Sciences, Department of Nursing, Sinop, Turkey
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Shin J, Chia Y, Heo R, Kario K, Turana Y, Chen C, Hoshide S, Fujiwara T, Nagai M, Siddique S, Sison J, Tay JC, Wang T, Park S, Sogunuru GP, Minh HV, Li Y. Current status of adherence interventions in hypertension management in Asian countries: A report from the HOPE Asia Network. J Clin Hypertens (Greenwich) 2020; 23:584-594. [PMID: 33350024 PMCID: PMC8029547 DOI: 10.1111/jch.14104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/26/2020] [Accepted: 10/27/2020] [Indexed: 11/29/2022]
Abstract
Adherence continues to be the major hurdle in hypertension management. Since the early 2000s, systematic approaches have been emphasized to tackle multi-dimensional issues specific for each regional setting. However, there is little data regarding implementation of adherence interventions in Asian countries. Eleven hypertension experts from eight Asian countries answered questionnaires regarding the use of adherence interventions according to 11 theoretical domain frameworks by Allemann et al. A four-point Likert scale: Often, Sometimes, Seldom, and Never used was administered. Responses to 97 items from 11 domains excluding three irrelevant items were collected. "Often-used" interventions accounted for 5/9 for education, 1/8 for skills, 1/2 for social/professional role and identity, 1/1 for belief about capabilities, 0/3 for belief about consequences, 2/4 for intentions, 2/9 for memory, attention, and decision process, 11/20 for environmental context and resources, 0/2 for social influences, 0/2 for emotion, and 2/2 for behavioral regulation. Most of them are dependent on conventional resources. Most of "Never used" intervention were the adherence interventions related to multidisciplinary subspecialties or formal training for behavioral therapy. For adherence interventions recommended by 2018 ESC/ESH hypertension guidelines, only 1 in 7 patient level interventions was "Often used." In conclusion, conventional or physician level interventions such as education, counseling, and prescription have been well implemented but multidisciplinary interventions and patient or health system level interventions are in need of better implementation in Asian countries.
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Affiliation(s)
- Jinho Shin
- Division of CardiologyDepartment of Internal MedicineHanyang University Medical CenterSeoulSouth Korea
| | - Yook‐Chin Chia
- Department of Medical SciencesSchool of Healthcare and Medical SciencesSunway UniversityBandar SunwayMalaysia
- Department of Primary Care MedicineFaculty of MedicineUniversity of MalayaKuala LumpurMalaysia
| | - Ran Heo
- Division of CardiologyDepartment of Internal MedicineHanyang University Medical CenterSeoulSouth Korea
| | - Kazuomi Kario
- Division of Cardiovascular MedicineDepartment of MedicineJichi Medical University School of MedicineTochigiJapan
| | - Yuda Turana
- School of Medicine and Health SciencesAtma Jaya Catholic University of IndonesiaJakartaIndonesia
| | - Chen‐Huan Chen
- Institute of Public Health and Community Medicine Research CenterNational Yang‐Ming University School of MedicineTaipeiTaiwan
| | - Satoshi Hoshide
- Division of Cardiovascular MedicineDepartment of MedicineJichi Medical University School of MedicineTochigiJapan
| | - Takeshi Fujiwara
- Division of Cardiovascular MedicineDepartment of MedicineJichi Medical University School of MedicineTochigiJapan
| | - Michiaki Nagai
- Department of Internal Medicine, General Medicine and CardiologyHiroshima City Asa HospitalHiroshimaJapan
| | | | - Jorge Sison
- Cardiology SectionDepartment of MedicineMedical Center ManilaManilaPhilippines
| | - Jam Chin Tay
- Department of General MedicineTan Tock Seng HospitalSingaporeSingapore
| | - Tzung‐Dau Wang
- Department of Internal MedicineNational Taiwan University College of MedicineTaipei CityTaiwan
| | - Sungha Park
- Division of Cardiology SeoulCardiovascular HospitalYonsei Health SystemSeoulSouth Korea
| | - Guru Prasad Sogunuru
- MIOT International Hospital ChennaiChennaiIndia
- College of Medical Sciences BharatpurKathmandu UniversityDhulikhelNepal
| | - Huynh Van Minh
- Department of Internal MedicineUniversity of Medicine and PharmacyHue UniversityHue CityVietnam
| | - Yan Li
- Department of HypertensionThe Shanghai Institute of HypertensionRuijin HospitalShanghai Jiaotong University School of MedicineShanghaiChina
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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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A Mixed-Methods Study of the Experiences and Beliefs of Older People With Complex Health Care Needs About Medication Adherence. J Nurs Care Qual 2020; 36:369-375. [PMID: 33079818 DOI: 10.1097/ncq.0000000000000522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Medication adherence is seldom examined in older people from diverse ethnic, cultural, and language backgrounds. PURPOSE The purpose of this study was to explore medication adherence among culturally diverse older people with complex health care needs. METHODS Using a mixed-methods design, a consecutive sample of 40 older people living in a culturally diverse, low socioeconomic area completed the Brief Medication Questionnaire; 12 reporting high medication nonadherence were interviewed. Analyses used descriptive statistics and thematic analyses. RESULTS Participants experienced high medication nonadherence (n = 34, 85%), language barriers (n = 15, 37.5%), financial difficulties (n = 24, 60%), and poor understanding of their medications (n = 34, 85%). Medication nonadherence was attributed to finger dexterity (57.5%), poor vision (85%), and memory problems (87.5%). Interviews revealed 5 themes to explain nonadherence: (1) illness beliefs; (2) experiences of the aging process; (3) challenges for non-English-speaking participants; (4) adherence impediments; and (5) therapeutic relationships. CONCLUSIONS Vulnerable, older people had high medication nonadherence. Targeted interventions may enhance medication adherence in this group.
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Adherence to Antihypertensive Treatment and Associated Factors in Central Ethiopia. Int J Hypertens 2020; 2020:9540810. [PMID: 33149946 PMCID: PMC7603603 DOI: 10.1155/2020/9540810] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 09/28/2020] [Accepted: 10/08/2020] [Indexed: 01/05/2023] Open
Abstract
Background Adherence to treatment is a primary determinant of treatment success. Nonadherence attenuates clinical benefits to the recipients of the treatment. However, monitoring adherence to long treatment regimens is not given due emphasis in low-income contexts. This study aimed to assess adherence to antihypertensive treatment and factors associated with it in Central Ethiopia. Method This is an institution-based cross-sectional study conducted in 4 public hospitals in Central Ethiopia from December 4, 2016, to September 25, 2017. The Morisky Medication Adherence Scale (MMAS-8) was used to assess the level of adherence. The Revised Illness Perception Questionnaire (IPQ-R) was used to assess illness perception. The MMAS-8 score ranges from 0 to 8, a score of 8 reflects high adherence, 6 to 7 medium adherence, and <6 low adherence. Results A total of 989 hypertensive patients participated in the study, of which 36.0% were assessed to have high adherence, 31.7% medium adherence, and 32.3% low adherence. We found that treatment adherence was significantly and positively associated with having family support (AOR: 1.65; 95% CI = 1.23, 2.22), high perception about consequences of hypertension (AOR: 1.51; 95% CI = 1.17, 1.95), and high perception about the severity of the disease (AOR: 1.42; 95% CI = 1.09, 1.86). Conclusion The treatment adherence to antihypertensive medications is low in Central Ethiopia. Engaging family members in the treatment plan and improving patients' understanding of the illness are critical in achieving high adherence to medication in this context.
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Appalasamy JR, Quek KF, Md Zain AZ, Joseph JP, Seeta Ramaiah S, Tha KK. An Evaluation of the Video Narrative Technique on the Self-Efficacy of Medication Understanding and Use Among Post-Stroke Patients: A Randomized-Controlled Trial. Patient Prefer Adherence 2020; 14:1979-1990. [PMID: 33116441 PMCID: PMC7585263 DOI: 10.2147/ppa.s253918] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 07/28/2020] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Self-efficacy is positively associated with medication understanding and use self-efficacy (MUSE) among post-stroke patients. It is also closely related to knowledge, belief, and perception, which vary among people from different socioeconomic backgrounds and cultures. As interventions using video and peer stories have emerged to be successful on behavior modification, this study aimed to explore the effectiveness of video narratives incorporated with Health Belief constructs on MUSE and its associated factors among patients with stroke at a local setting. METHODS A randomized controlled trial (RCT) for 12 months was carried out on patients diagnosed with stroke at Hospital Kuala Lumpur, Malaysia. The RCT recruited up to 216 eligible patients who were requested to return for two more follow-ups within six months. Consented patients were randomized to either standard care or intervention with video narratives. The control of potential confounding factors was ensured, as well as unbiased treatment review with prescribed medications, only obtained onsite. RESULTS AND DISCUSSION A repeated measure of MUSE mean score differences at T0 (baseline), T2 (6th month) and T4 (12th month) for antithrombotic, antihypertensive, and all medication categories indicated significant within and between groups differences in the intervention group (p<0.05). Moreover, this impact was reflected upon continuous blood pressure (BP) monitoring compared to the control group (F (1214) =5.23, p=0.023, ƞ2=0.024). Though BP measure differences were non-significant between the groups (p=0.552), repeated measure analysis displayed significant mean differences between intervention and control group on BP control over time (F (1.344, 287.55) =8.54, P<0.001, ƞ2=0.038). Similarly, the intervention's positive impact was also present with similar trends for knowledge, illness perception, and the belief about medicine. Though significant differences (p<0.05) of all outcome measures gradually decreased between T2 and T4 in the intervention group; nevertheless, these positive findings confirmed that personalized video narratives were able to motivate and influence MUSE and its associated factors among post-stroke patients. The significant improvement in medication-taking self-efficacy and the sustenance of BP monitoring habits among patients in the intervention group strengthened our conceptual framework's practicality.
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Affiliation(s)
- Jamuna Rani Appalasamy
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Kia Fatt Quek
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Anuar Zaini Md Zain
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Joyce Pauline Joseph
- Department of Neurology, Hospital Kuala Lumpur, Ministry of Health, Kuala Lumpur, Malaysia
| | | | - Kyi Kyi Tha
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
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28
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Schneider KJ, Hollenhorst CN, Valicevic AN, Niziol LM, Heisler M, Musch DC, Cain SM, Newman-Casey PA. Impact of the Support, Educate, Empower Personalized Glaucoma Coaching Program Pilot Study on Eye Drop Instillation Technique and Self-Efficacy. Ophthalmol Glaucoma 2020; 4:42-50. [PMID: 32781286 DOI: 10.1016/j.ogla.2020.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/30/2020] [Accepted: 08/03/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE To assess the Support, Educate, Empower (SEE) personalized glaucoma coaching program impact on (1) eye drop instillation technique and (2) eye drop instillation self-efficacy. DESIGN Prospective pre-post pilot study. PARTICIPANTS Patients with a diagnosis of glaucoma or ocular hypertension taking ≥1 glaucoma medication, ≥40 years old, spoke English, self-administered their eye drops, and ≤80% adherent to their glaucoma medication by electronic monitoring. METHODS Eye drop administration was video recorded before the first SEE in-person coaching session, which included teaching eye drop instillation techniques using a motivational interviewing-based approach. At the third and final in-person counseling session 6 months later, eye drop administration was video recorded. Participants' self-efficacy was assessed using the validated Eye Drop Technique Self-Efficacy Scale (EDTSES) survey at baseline and 1 month after completion of the program. Before and after intervention videos were assessed by an observer masked to time point. Before versus after intervention comparisons were made using McNemar's and paired t tests. MAIN OUTCOME MEASURES The main outcome was change in participants' eye drop instillation technique as measured by (1) accuracy of an eye drop landing on the eye, (2) ability to instill an eye drop on the first attempt, and (3) contaminating the bottle by contact with ocular surface, eyelashes, and skin. The secondary outcome measure was before versus after change in the EDTSES score (6 items, each assessed on a 3-point Likert scale, with higher scores indicating better self-efficacy). RESULTS Thirty-nine participants completed the SEE intervention, 38 with before and after EDTSES scores and 31 with video recordings. Six of 31 participants instilling drops outside the eye before intervention improved their technique after intervention, whereas 2 participants worsened (P = 0.157). From before to after intervention, participants demonstrated significant improvement in not touching the ocular surface (P = 0.046), the eyelashes (P = 0.020), or the skin (P = 0.025) with the bottle tip. A significant increase was found in eye drop instillation self-efficacy from an average score of 2.6 (standard deviation [SD], 0.3) to 2.8 (SD, 0.2) on the EDTSES score (P = 0.007). CONCLUSIONS The SEE program significantly decreased eye drop bottle contamination, increased eye drop instillation self-efficacy, and demonstrated an insignificant increase in ability to instill drops successfully and accurately.
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Affiliation(s)
- Kevin J Schneider
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan
| | - Cecilia N Hollenhorst
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan
| | - Autumn N Valicevic
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan
| | - Leslie M Niziol
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan
| | - Michele Heisler
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - David C Musch
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan; Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Stephen M Cain
- Department of Mechanical Engineering, University of Michigan School of Engineering, Ann Arbor, Michigan
| | - Paula-Anne Newman-Casey
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan.
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The use of discrete choice experiments in adherence research: A new solution to an old problem. Res Social Adm Pharm 2020; 16:1487-1492. [PMID: 32111532 DOI: 10.1016/j.sapharm.2020.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 02/18/2020] [Accepted: 02/19/2020] [Indexed: 11/24/2022]
Abstract
Theory can play an important role in providing the framework, and underpinning the design and implementation of interventions to improve medication adherence. Interventions that are grounded in a theory are relatively more effective in improving medication adherence than interventions which do not have a theoretical support. However, a large body of adherence research does not appear to be linked to any theory or model, which therefore may have resulted in interventions that are either ineffective or not sustainable. Interventions that are based on theory have mainly employed socio-behavioural models to explain, and design interventions to address, the complex phenomenon of adherence. Yet, the effectiveness of these interventions is inconclusive, supporting the argument that socio-behavioural models alone have limited applicability in explaining behaviour associated with medication-taking. An important reason for this limitation may be the complex and dynamic nature of adherence. There is a need to include a wide variety of factors in a model and examine adherence in the context of its three phases (initiation, implementation, and discontinuation). One possible way forward is to also examine medication-taking behaviour from an economic perspective, for example, by using a discrete choice experiment (DCE), which provides a different approach to understanding human behaviour about medication-taking and the complexities of decision-making in adhering to medication. DCEs can help in understanding how patients decide to initiate, continue or discontinue taking medication, factors that influence their decision, and the relative importance of those factors, which can assist researchers to prioritise interventions to improve medication adherence. Integration of multiple theories is needed to examine adherence from multiple perspectives and design interventions that are effective and sustainable. This commentary focusses on the pros and cons of some of the commonly used socio-behavioural models in adherence research and suggests a way forward by incorporating DCEs in adherence research.
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Mahmood S, Jalal Z, Hadi MA, Orooj H, Shah KU. Non-Adherence to Prescribed Antihypertensives in Primary, Secondary and Tertiary Healthcare Settings in Islamabad, Pakistan: A Cross-Sectional Study. Patient Prefer Adherence 2020; 14:73-85. [PMID: 32021119 PMCID: PMC6969702 DOI: 10.2147/ppa.s235517] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 12/07/2019] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE This study aimed to assess the prevalence and predictors of non-adherence to antihypertensive medication among patients with hypertension attending various healthcare settings in Islamabad, Pakistan. METHODS A questionnaire-based cross-sectional study was conducted in selected healthcare facilities between September 2017 and December 2018. The study was conducted in primary, secondary and tertiary healthcare settings in Islamabad, Pakistan. Medication adherence was assessed using the eight-item Morisky Medication Adherence Scale (MMAS-8). Sociodemographic and clinical data of recruited patients were collected through a structured questionnaire. Binary logistic regression analysis was performed to determine covariates significantly associated with medication adherence and blood pressure control. RESULTS A total of 776 hypertensive patients were invited and 741 (95%) completed the questionnaire. The mean ± SD age of participants was 53.6±12.6 years; 284 patients (38.3%) had high adherence, 178 (24%) had moderate adherence and 279 (37.7%) were non-adherent to the prescribed antihypertensive therapy. Binary regression analysis revealed that old age (OR 1.783 [95% CI: 1.172-2.712]; P=0.013), being educated (OR 2.018 [95% CI: 1.240-3.284]; P=0.036), entitlement to free medical care (OR 1.369 [95% CI: 1.009-1.859]; P=0.044), treatment duration (OR 2.868 [95% CI: 1.913-4.299]; P=0.001), number of medications (OR 1.973 [95% CI: 1.560-2.495]; P=0.001), presence of any comorbidity (OR 2.658 [95% CI: 1.836-3.848]; P=0.001) and blood pressure control (OR 3.103 [95% CI: 2.268-4.247]; P=0.001) were significantly associated with good adherence. Similarly, age (OR 1.998 [95% CI: 1.313-3.040]; P=0.004), entitlement to free medical care (OR 1.498 [95% CI: 1.116-2.010]; P=0.007), treatment duration (OR 1.886 [95% CI: 1.143-3.113]; P=0.013), presence of any comorbidity (OR 1.552 [95% CI: 1.123-2.147]; P=0.008) and adherence level (OR 3.103 [95% CI: 2.268-4.247]; P=0.001) had significant association with controlled blood pressure. The following were the main reasons for non-adherence to prescribed antihypertensive medication: "don't feel need for regular use" (24.7%), "Carelessness" (13.4%) and "adverse effects" (11.2%). CONCLUSION The prevalence of non-adherence to antihypertensive medications was high in the study population and poor medication adherence could potentially explain poor blood pressure control. Evidence-based targeted interventions on both medication adherence and blood pressure control should be introduced and implemented for better treatment outcomes.
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Affiliation(s)
- Sajid Mahmood
- Department of Pharmacy, Quaid-e-Azam University, Islamabad45320, Pakistan
| | - Zahraa Jalal
- School of Pharmacy, College of Medical and Dental Sciences, Institute of Clinical Sciences, University of Birmingham, Edgbaston, BirminghamB15 2TT, UK
| | - Muhammad Abdul Hadi
- School of Pharmacy, College of Medical and Dental Sciences, Institute of Clinical Sciences, University of Birmingham, Edgbaston, BirminghamB15 2TT, UK
| | - Hasan Orooj
- Directorate of Health Services, Metropolitan Corporation Islamabad, Islamabad, Pakistan
| | - Kifayat Ullah Shah
- Department of Pharmacy, Quaid-e-Azam University, Islamabad45320, Pakistan
- Correspondence: Kifayat Ullah Shah Department of Pharmacy, Quaid-e-Azam University, Islamabad45320, PakistanTel +92-3325542722 Email
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Huberty J, Eckert R, Dueck A, Kosiorek H, Larkey L, Gowin K, Mesa R. Online yoga in myeloproliferative neoplasm patients: results of a randomized pilot trial to inform future research. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 19:121. [PMID: 31174535 PMCID: PMC6556039 DOI: 10.1186/s12906-019-2530-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 05/29/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Myeloproliferative neoplasm (MPN) patients suffer from significant symptoms, inflammation and reduced quality of life. Yoga improves these outcomes in other cancers, but this hasn't been demonstrated in MPNs. The purpose of this study was to: (1) explore the limited efficacy (does the program show promise of success) of a 12-week online yoga intervention among MPN patients on symptom burden and quality of life and (2) determine feasibility (practicality: to what extent a measure can be carried out) of remotely collecting inflammatory biomarkers. METHODS Patients were recruited nationally and randomized to online yoga (60 min/week of yoga) or wait-list control (asked to maintain normal activity). Weekly yoga minutes were collected with Clicky (online web analytics tool) and self-report. Those in online yoga completed a blood draw at baseline and week 12 to assess inflammation (interleukin-6, tumor necrosis factor-alpha [TNF-α]). All participants completed questionnaires assessing depression, anxiety, fatigue, pain, sleep disturbance, sexual function, total symptom burden, global health, and quality of life at baseline, week seven, 12, and 16. Change from baseline at each time point was computed by group and effect sizes were calculated. Pre-post intervention change in inflammation for the yoga group was compared by t-test. RESULTS Sixty-two MPN patients enrolled and 48 completed the intervention (online yoga = 27; control group = 21). Yoga participation averaged 40.8 min/week via Clicky and 56.1 min/week via self-report. Small/moderate effect sizes were generated from the yoga intervention for sleep disturbance (d = - 0.26 to - 0.61), pain intensity (d = - 0.34 to - 0.51), anxiety (d = - 0.27 to - 0.37), and depression (d = - 0.53 to - 0.78). A total of 92.6 and 70.4% of online yoga participants completed the blood draw at baseline and week 12, respectively, and there was a decrease in TNF-α from baseline to week 12 (- 1.3 ± 1.5 pg/ml). CONCLUSIONS Online yoga demonstrated small effects on sleep, pain, and anxiety as well as a moderate effect on depression. Remote blood draw procedures are feasible and the effect size of the intervention on TNF-α was large. Future fully powered randomized controlled trials are needed to test for efficacy. TRIAL REGISTRATION This trial was retrospectively registered with clinicaltrials.gov (ID: NCT03503838 ) on 4/19/2018.
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Affiliation(s)
- Jennifer Huberty
- Exercise Science and Health Promotion, Arizona State University, 500 North 3rd Street Phoenix, Tempe, AZ 85004 USA
| | - Ryan Eckert
- Mays Cancer Center, University of Texas San Antonio MD Anderson, 7979 Wurzbach Road, San Antonio, TX 78229 USA
| | - Amylou Dueck
- Division of Biostatistics, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ 85259 USA
| | - Heidi Kosiorek
- Division of Biostatistics, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ 85259 USA
| | - Linda Larkey
- College of Nursing and Health Innovation, Arizona State University, 550 North 3rd Street, Phoenix, AZ 85004 USA
| | - Krisstina Gowin
- University of Arizona, 1501 North Campbell Avenue, Tucson, AZ 85724 USA
| | - Ruben Mesa
- Mays Cancer Center, University of Texas San Antonio MD Anderson, 7979 Wurzbach Road, San Antonio, TX 78229 USA
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Nursing Interventions on Medication Adherence During Hepatitis C Treatment: Application of Self-Regulation Model. Gastroenterol Nurs 2019; 41:525-531. [PMID: 30489409 DOI: 10.1097/sga.0000000000000362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Hepatitis C virus is a common cause of liver disease nationally and globally. Medication adherence to hepatitis C treatment is important for viral eradication and the prevention of chronic disease. The purpose of this article is to identify a nursing middle-range theory to guide research on the impact of nursing interventions on medication adherence during hepatitis C treatment and to apply the theory to practice by providing examples of the theory application. A gap in the literature is identified as the lack of research using theories or models as a guide to investigate nursing interventions and hepatitis C treatment. The lack of theory-based research may contribute to medication nonadherence. The self-regulation model provides the most complete guide for nursing interventions during hepatitis C treatment. Nursing interventions and hepatitis C research, guided by theory, generate knowledge specific for nursing.
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Lin TY, Chuang ST, Huang SF, Hsu HP, Lu LT, Guo JL. Likelihood of a fecal occult blood test uptake among older adults: comparisons between health professionals and healthcare volunteers based on the health belief model. BMC Geriatr 2019; 19:51. [PMID: 30791892 PMCID: PMC6385387 DOI: 10.1186/s12877-019-1067-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 02/13/2019] [Indexed: 12/27/2022] Open
Abstract
Background Health professionals and healthcare volunteers play a critical role in promoting uptake of the fecal occult blood test (FOBT), which is an effective screening method for colorectal cancer. However, previous studies paid less attention to investigating both groups regarding their intention to undergo the test. This study used the Health Belief Model (HBM) to explore the likelihood of an FOBT uptake among health professionals and healthcare volunteers aged 50 years or older. Methods A cross-sectional survey was conducted at public health centers in a county in northern Taiwan. Health professionals and healthcare volunteers were invited to complete the questionnaires. Overall, 391 valid questionnaires were obtained (response rate = 93.10%). Structural equation modeling was used to examine the associations among the variables based on the HBM. Results The HBM explained 45, 44, and 50% of the variance in the likelihood of undergoing an FOBT in all participants, health professionals, and healthcare volunteers, respectively. The explained variance in healthcare volunteers outweighed that of professionals by 6%. Perceived benefits and self-efficacy significantly affected the likelihood of undergoing an FOBT. Self-efficacy significantly mediated the effects of perceived severity, benefits, and barriers on the likelihood of an FOBT uptake. A borderline significant difference in structural coefficients was found across groups. Conclusions The HBM model was used to examine the likelihood of an FOBT uptake among health professionals and healthcare volunteers, and the results showed that self-efficacy was the optimal predictor of the likelihood of an FOBT uptake, followed by perceived benefits. Future multifactorial interventions to promote FOBT uptake among health professionals and healthcare volunteers aged 50–75 years could include these significant factors.
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Affiliation(s)
- Tsung-Yi Lin
- Department of Health Promotion and Health Education, National Taiwan Normal University, No.162, Sec. 1, He-ping East Road, Taipei, 10610, Taiwan
| | - Shu-Tzu Chuang
- Public Health Bureau, Yilan County, No.287, Sec. 2, Nuzhong Rd, Yilan City, Yilan County, 26051, Taiwan
| | - Su-Fei Huang
- Department of Senior Citizen Service, Mackay Junior College of Medicine, Nursing, and Management, No.92, Shengjing Rd., Beitou District, Taipei, 11260, Taiwan
| | - Hsiao-Pei Hsu
- School of Nursing, National Yang-Ming University, No.155, Sec.2, Li-Nong Street, Taipei, 11221, Taiwan
| | - Li-Ting Lu
- Department of Health Management for Elderly Society, University of Kang Ning, No.137, Alley 75, Sec. 3, Kang Ning Road, Neihu District, Taipei, 11485, Taiwan
| | - Jong-Long Guo
- Department of Health Promotion and Health Education, National Taiwan Normal University, No.162, Sec. 1, He-ping East Road, Taipei, 10610, Taiwan.
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Beliefs of Immunosuppressive Medication Among Chinese Renal Transplant Recipients, as Assessed in a Cross-Sectional Study With the Basel Assessment of Adherence to Immunosuppressive Medications Scale. Transplant Proc 2019; 51:742-748. [PMID: 30979459 DOI: 10.1016/j.transproceed.2018.10.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 10/23/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Adherence to immunosuppressive medication (IM) after renal transplantation is crucial to survival of patient and graft outcomes; whether beliefs about IM adherence and other sociodemographic factors affect IM adherence is debatable. OBJECTIVE This study aimed to examine the beliefs on IM and IM adherence in Chinese renal transplant recipients. METHODS Across-sectional survey was conducted. Self-developed IM beliefs questionnaire guided by health belief model was used to measure IM beliefs. The Basel Assessment of Adherence to Immunosuppressive Medications Scale was used to assess drug adherence. RESULTS The nonadherence rate to IM in 208 renal transplant recipients during outpatient follow-up was 44.2%. There were statistically significant associations between adherence and the marital status (P < .001). Perceived seriousness of not taking IM (P < .001) and perceived barriers of taking IM (P < .001) were significantly associated with IM adherence. After controlling other factors, married marital status, high levels of perceived seriousness of not taking IM, and lower levels of perceived barriers of taking IM (P = .007) were significantly associated with IM adherence. CONCLUSION Marital status and IM beliefs are closely association with IM adherence in Chinese renal transplant recipients.
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Shen Y, Wang T, Gao M, Zhu X, Zhang X, He C, Li Y, Sun X. Effectiveness of low-cost reminder package combined with case-based health education to improve hypertensive patients' medication adherence: a clustered randomized controlled trial. Patient Prefer Adherence 2019; 13:1083-1092. [PMID: 31371926 PMCID: PMC6628963 DOI: 10.2147/ppa.s194667] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 05/30/2019] [Indexed: 01/09/2023] Open
Abstract
PURPOSE Medication adherence (MA) is a key factor for hypertensive patients' blood pressure control and forgetfulness is one of the main reasons that cause medication non-adherence. If effective, low-cost reminder package (LCRP) has great potentials for large-scale promotion. Therefore, this study aims to evaluate the effectiveness of combining LCRP and health education to improve MA among hypertensive patients. PATIENTS AND METHODS A clustered randomized controlled trial was performed in Beijing. A total of 518 hypertensive patients recruited from 8 community health care centers were randomized to receive LCRP combined with case-based health education or usual care. Randomization was performed at community level. Multilevel modeling was used to evaluate the study effect. RESULTS MA scores did not differ significantly at baseline between the intervention group and the control group. The results of multilevel modeling indicated that MA scores increased more in the intervention group, and the intervention effect on MA was 0.287 (95% CI: [0.103, 0.471], P=0.002). Patients' systolic blood pressure (SBP) and diastolic blood pressure (DBP) were not improved (SBP: difference=0.536, 95% CI [-3.207, 4.278]; DBP: difference=-0.927, 95% CI [-3.283, 1.428]). CONCLUSION LCRP combined with case-based health education could significantly improve hypertensive patients' MA.
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Affiliation(s)
- Ying Shen
- School of Public Health, Peking University, Beijing, People’s Republic of China
| | - Taotao Wang
- School of Public Health, Peking University, Beijing, People’s Republic of China
| | - Min Gao
- School of Public Health, Peking University, Beijing, People’s Republic of China
| | - Xiaorou Zhu
- School of Public Health, Peking University, Beijing, People’s Republic of China
| | - Xing Zhang
- School of Public Health, Peking University, Beijing, People’s Republic of China
| | - Chao He
- Department of Health Education, Shunyi Center for Disease Control and Prevention, Beijing, People’s Republic of China
| | - Yindong Li
- Department of Health Education, Shunyi Center for Disease Control and Prevention, Beijing, People’s Republic of China
- Yindong Li Department of Health Education, Shunyi Center for Disease Control and Prevention, Beijing, People’s Republic of China Email
| | - Xinying Sun
- School of Public Health, Peking University, Beijing, People’s Republic of China
- Correspondence: Xinying Sun School of Public Health, Peking University, Beijing, People’s Republic of ChinaTel +86 1 369 121 2050Fax +86 108 280 1743 Email
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Oori MJ, Mohammadi F, Norouzi K, Fallahi-Khoshknab M, Ebadi A. Conceptual Model of Medication Adherence in Older Adults with High Blood Pressure-An Integrative Review of the Literature. Curr Hypertens Rev 2019; 15:85-92. [PMID: 30360745 PMCID: PMC6635648 DOI: 10.2174/1573402114666181022152313] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 10/16/2018] [Accepted: 10/16/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND Medication adherence (MA) is the most important controlling factor of high blood pressure (HBP). There are a few MA models, but they have not been successful in predicting MA completely. Thus, this study aimed to expand a conceptual model of MA based on an ecological approach. METHODS An integrative review of the literature based on theoretical and empirical studies was completed. Data source comprised: Medline (including PubMed and Ovid), ISI, Embase, Google scholar, and internal databases such as Magiran, Google, SID, and internal magazines. Primary English and Persian language studies were collected from 1940 to 2018. The steps of study included: (a) problem identification, (b) literature review and extracting studies, (c) appraising study quality, (d) gathering data, (e) data analysis using the directed content analysis, (f) concluding. RESULTS Thirty-six articles were finally included and analyzed. After analysis, predictors of MA in older adults with hypertension were categorized into personal, interpersonal, organizational, and social factors. Although the personal factors have the most predictors in sub-categories of behavioral, biological, psychological, knowledge, disease, and medication agents, social, organizational and interpersonal factors can have indirect and important effects on elderly MA. CONCLUSION There are many factors influencing MA of elderly with HBP. The personal factor has the most predictors. The designed model of MA because of covering all predictor factors, can be considered as a comprehensive MA model. It is suggested that future studies should select factors for study from all levels of the model.
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Affiliation(s)
| | - Farahnaz Mohammadi
- Address correspondence to this author at Nursing Department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; Tel: +989125003527; E-mail:
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Cho YG. Medication Adherence in Korean Hypertensive Patients. Korean J Fam Med 2018; 39:323-324. [PMID: 30458608 PMCID: PMC6250945 DOI: 10.4082/kjfm.39.6e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Young Gyu Cho
- Corresponding Author: Young Gyu Cho https://orcid.org/0000-0003-1017-8884 Tel: +82-2-2270-0097, Fax: +82-2-2268-0971, E-mail:
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Martin G, Patel N, Grant Y, Jenkins M, Gibbs R, Bicknell C. Antihypertensive medication adherence in chronic type B aortic dissection is an important consideration in the management debate. J Vasc Surg 2018; 68:693-699.e2. [DOI: 10.1016/j.jvs.2017.12.063] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 12/14/2017] [Indexed: 01/09/2023]
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Rahmawati R, Bajorek B. Understanding untreated hypertension from patients' point of view: A qualitative study in rural Yogyakarta province, Indonesia. Chronic Illn 2018; 14:228-240. [PMID: 28669227 DOI: 10.1177/1742395317718034] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives This study aimed to explore perspectives about hypertension from patients who do not take anti-hypertensive medications. Factors that shape their perspectives as well as patients' expectations were also canvassed. Method Individual, face-to-face interviews were conducted with 30 people (≥45 years old) living in rural villages, diagnosed with hypertension, who had not taken any anti-hypertensive medications for at least one year. Interviews were audiotaped, transcribed verbatim and thematically analysed. Results Four themes emerged: (1) alternative medicines for managing high blood pressure; (2) accessing health care services; (3) the need for anti-hypertensive medications; and (4) existing support and patients' expectations. Reluctance to take anti-hypertensive medications was influenced by patients' beliefs in personal health threats and the effectiveness of anti-hypertensive medications, high self-efficacy for taking alternative medicines, the lack of recommendation regarding hypertension treatment, and barriers to accessing supplies of medicines. Conclusion Despite their awareness of being diagnosed with hypertension, patients undervalued visiting a health professional to control their high blood pressure. Health strategies need to consider patients' beliefs, concerns and expectations. Providing an accessible, affordable and adequate supply of hypertension medication is also key to any programs designed to optimise hypertension management.
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Affiliation(s)
- Riana Rahmawati
- 1 Graduate School of Health, Discipline of Pharmacy, The University of Technology Sydney, New South Wales, Australia.,2 Pharmacology Department, Faculty of Medicine, Islamic University of Indonesia, Yogyakarta, Indonesia
| | - Beata Bajorek
- 1 Graduate School of Health, Discipline of Pharmacy, The University of Technology Sydney, New South Wales, Australia.,3 Department of Pharmacy, Royal North Shore Hospital, Sydney, New South Wales, Australia
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Effectiveness of mHealth Interventions in Improving Medication Adherence Among People with Hypertension: a Systematic Review. Curr Hypertens Rep 2018; 20:86. [DOI: 10.1007/s11906-018-0886-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Abegaz TM, Abdela OA, Bhagavathula AS, Teni FS. Magnitude and determinants of uncontrolled blood pressure among hypertensive patients in Ethiopia: hospital-based observational study. Pharm Pract (Granada) 2018; 16:1173. [PMID: 30023028 PMCID: PMC6041209 DOI: 10.18549/pharmpract.2018.02.1173] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Accepted: 06/06/2018] [Indexed: 11/14/2022] Open
Abstract
Background Hypertension is an important public health problem worldwide. There is lack of data on uncontrolled blood pressure in developing countries. Objectives To determine the magnitude and predicting factors of uncontrolled blood pressure in hypertensive patients attending Gondar university hospital, Ethiopia. Methods A hospital-based cross-sectional survey was conducted from July 2015 to March 2016. All hypertensive patients were followed and the blood pressure levels were measured. Binary logistic regression analysis was done to determine the predictors of uncontrolled blood pressure. A p-value of <0.05 was set at priori with 95% confidence interval to test the level of significance. Results Of the total 578 hypertension patients, 543 (93.9%) fulfilled the study criteria and were included in the final analysis. The mean age of the participants was 55.96±14.6 years. Nearly two-third (58.2%) of the participants were females. More than one-tenth (11.4%) of the respondents had uncontrolled blood pressure. High salt intake carried six times more risk of uncontrolled blood pressure. Elderly individuals had lower risk as compared to young age group. However, comorbidities were not related with uncontrolled blood pressure. Conclusions Blood pressure control was relatively high in the hospital studied. High salt intake was strongly linked with uncontrolled blood pressure. Individuals with high salt intake should be followed for their medication experience and disease knowledge.
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Affiliation(s)
- Tadesse M Abegaz
- Department of clinical pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar. Gondar (Ethiopia).
| | - Ousman A Abdela
- Department of Clinical pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar. Gondar, (Ethiopia).
| | - Akshaya S Bhagavathula
- Assistant professor. Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar. Gondar (Ethiopia).
| | - Fitsum S Teni
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, Addis Ababa University. Addis Ababa (Ethiopia).
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Obirikorang Y, Obirikorang C, Acheampong E, Odame Anto E, Gyamfi D, Philip Segbefia S, Opoku Boateng M, Pascal Dapilla D, Brenya PK, Amankwaa B, Adu EA, Nsenbah Batu E, Gyimah Akwasi A, Amoah B. Predictors of Noncompliance to Antihypertensive Therapy among Hypertensive Patients Ghana: Application of Health Belief Model. Int J Hypertens 2018; 2018:4701097. [PMID: 30018819 PMCID: PMC6029446 DOI: 10.1155/2018/4701097] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 05/12/2018] [Accepted: 06/02/2018] [Indexed: 11/22/2022] Open
Abstract
This study determined noncompliance to antihypertensive therapy (AHT) and its associated factors in a Ghanaian population by using the health belief model (HBM). This descriptive cross-sectional study conducted at Kintampo Municipality in Ghana recruited a total of 678 hypertensive patients. The questionnaire constituted information regarding sociodemographics, a five-Likert type HBM questionnaire, and lifestyle-related factors. The rate of noncompliance to AHT in this study was 58.6%. The mean age (SD) of the participants was 43.5 (±5.2) years and median duration of hypertension was 2 years. Overall, the five HBM constructs explained 31.7% of the variance in noncompliance to AHT with a prediction accuracy of 77.5%, after adjusting for age, gender, and duration of condition. Higher levels of perceived benefits of using medicine [aOR=0.55(0.36-0.82),p=0.0001] and cue to actions [aOR=0.59(0.38-0.90),p=0.0008] were significantly associated with reduced noncompliance while perceived susceptibility [aOR=3.05(2.20-6.25), p<0.0001], perceived barrier [aOR=2.14(1.56-2.92), p<0.0001], and perceived severity [aOR=4.20(2.93-6.00),p<0.0001] were significantly associated with increased noncompliance to AHT. Participant who had completed tertiary education [aOR=0.27(0.17-0.43), p<0.0001] and had regular source of income [aOR=0.52(0.38-0.71), p<0.0001] were less likely to be noncompliant. However, being a government employee [aOR=4.16(1.93-8.96), p=0.0002)] was significantly associated increased noncompliance to AHT. Noncompliance to AHT was considerably high and HBM is generally reliable in assessing treatment noncompliance in the Ghanaian hypertensive patients. The significant predictors of noncompliance to AHT were higher level of perceived barriers, susceptibility, and severity. Intervention programmes could be guided by the association of risk factors, HBM constructs with noncompliance to AHT in clinical practice.
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Affiliation(s)
- Yaa Obirikorang
- Department of Nursing, Faculty of Health and Allied Sciences, Garden City University College (GCUC), Kenyasi, Kumasi, Ghana
| | - Christian Obirikorang
- Department of Molecular Medicine, School of Medical Science, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Emmanuel Acheampong
- Department of Molecular Medicine, School of Medical Science, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
- School of Medical and Health Science, Edith Cowan University, Joondalup, Australia
| | - Enoch Odame Anto
- Department of Molecular Medicine, School of Medical Science, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
- School of Medical and Health Science, Edith Cowan University, Joondalup, Australia
| | - Daniel Gyamfi
- Department of Medical Laboratory Technology, Faculty of Allied Health Sciences, KNUST, Ghana
| | - Selorm Philip Segbefia
- Department of Molecular Medicine, School of Medical Science, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Michael Opoku Boateng
- Department of Nursing, Faculty of Health and Allied Sciences, Garden City University College (GCUC), Kenyasi, Kumasi, Ghana
- Department of Nursing, Kintampo Municipal Hospital, Kintampo, Ghana
| | - Dari Pascal Dapilla
- Department of Nursing, Faculty of Health and Allied Sciences, Garden City University College (GCUC), Kenyasi, Kumasi, Ghana
- Department of Nursing, Kintampo Municipal Hospital, Kintampo, Ghana
| | - Peter Kojo Brenya
- Department of Molecular Medicine, School of Medical Science, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Bright Amankwaa
- Department of Molecular Medicine, School of Medical Science, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Evans Asamoah Adu
- Department of Medical Laboratory Technology, Faculty of Allied Health Sciences, KNUST, Ghana
| | - Emmanuel Nsenbah Batu
- Department of Molecular Medicine, School of Medical Science, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | | | - Beatrice Amoah
- Department of Molecular Medicine, School of Medical Science, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
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Lum ZK, Tsou KYK, Lee JYC. Mediators of medication adherence and glycaemic control and their implications for direct outpatient medical costs: a cross-sectional study. Diabet Med 2018. [PMID: 29532548 DOI: 10.1111/dme.13619] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS To investigate the effects of diabetes-related distress and perception of hyperglycaemia on self-reported medication adherence and glycaemic control, as measured by HbA1c , and to compare the cost outcomes in patients with sub-optimally vs uncontrolled Type 2 diabetes mellitus. METHODS We conducted a retrospective cross-sectional study that involved the review of a chronic disease database in Singapore. Data on clinical characteristics, diabetes-related distress, perception of hyperglycaemia, self-reported medication adherence and costs were obtained from the database. Mediation analyses were conducted using a linear regression-based approach. A final path model was built to illustrate the sequential mediating effects of diabetes-related distress and perception on the association of medication adherence and HbA1c concentration. RESULTS Diabetes-related distress and perception of hyperglycaemia were significantly associated with medication adherence and HbA1c concentration. Mediation analyses showed a significant indirect effect of diabetes-related distress and perception of hyperglycaemia on medication adherence and HbA1c concentration. People with uncontrolled diabetes were found to incur significantly higher total direct medical costs than those with sub-optimally controlled diabetes (P = 0.034), with medication cost as the main cost driver (66.6%). CONCLUSIONS Identifying the influence of the sequential mediating effects of distress and perception was important in understanding the pathway between medication adherence and glycaemic control. This suggests the importance of a team-based approach to address these mediators and thus improve glycaemic control. Poor glycaemic control was also found to be associated with higher direct medical costs.
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Affiliation(s)
- Z K Lum
- Department of Pharmacy, Faculty of Science, National University of Singapore
| | - K Y K Tsou
- National University Polyclinics, Singapore
| | - J Y-C Lee
- Department of Pharmacy, Faculty of Science, National University of Singapore
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Abegaz TM, Sori LM, Toleha HN. Self-Reported Adverse Drug Reactions, Medication Adherence, and Clinical Outcomes among Major Depressive Disorder Patients in Ethiopia: A Prospective Hospital Based Study. PSYCHIATRY JOURNAL 2017; 2017:5812817. [PMID: 29349061 PMCID: PMC5733980 DOI: 10.1155/2017/5812817] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 10/12/2017] [Accepted: 10/19/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is paucity of data on prevalence of Adverse Drug Reactions (ADRs) and adherence and clinical outcomes of antidepressants. The present study determined the magnitude of ADRs of antidepressants and their impact on the level of adherence and clinical outcome. METHODS A prospective cross-sectional study was conducted among depression patients from September 2016 to January 2017 at Gondar University Hospital psychiatry clinic. The Naranjo ADR probability scale was employed to assess the ADRs. The rate of medication adherence was determined using Morisky Medication Adherence Measurement Scale-Eight. RESULTS Two hundred seventeen patients participated in the study, more than half of them being males (122; 56.2%). More than one-half of the subjects had low adherence to their medications (124; 57.1%) and about 186 (85.7%) of the patients encountered ADR. The most common ADR was weight gain (29; 13.2%). More than one-half (125; 57.6%) of the respondents showed improved clinical outcome. Optimal level of medication adherence decreased the likelihood of poor clinical outcome by 56.8%. CONCLUSION ADRs were more prevalent. However, adherence to medications was very poor in the setup. Long duration of depression negatively affects the rate of adherence. In addition, adherence was found to influence the clinical outcome of depression patients.
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Affiliation(s)
- Tadesse Melaku Abegaz
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | | | - Hussien Nurahmed Toleha
- Pharmaceutics Unit, Department of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Ghiasvand F, Riazi H, Hajian S, Kazemi E, Firoozi A. The effect of a self-care program based on the teach back method on the postpartum quality of life. Electron Physician 2017; 9:4180-4189. [PMID: 28607653 PMCID: PMC5459290 DOI: 10.19082/4180] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 11/18/2016] [Indexed: 02/07/2023] Open
Abstract
Background The postpartum period is a critical stage of life with major changes in the quality of life. Therefore, special consideration is needed to this issue. Objective To determine the effect of a self-care program based on the Teach Back method on the postpartum quality of life. Methods This experimental study was conducted on eighty postpartum women who had given birth in health centers across Darreh Shahr County, Ilam Province, Iran in 2016. The control group received only routine postpartum care according to the national guidelines. The trial group received the routine care in addition to two sessions of physical and psychological postpartum self-care based on the Teach Back method. The two groups were assessed in terms of their quality of life before and after the intervention using the Postpartum Quality of Life Questionnaire. The data were analyzed using SPSS version 21. Descriptive statistic tests, Chi squared, independent-samples t-test, paired-samples t-test, Wilcoxon and Mann Whitney’s test was used. Results Before the intervention, the postpartum quality of life score was 106.23±11.866 in the trial group and 107.30±13.197 in the control group; after the intervention, the score was 124.73±10.706 and 115.03±12.687 in the two groups respectively, suggesting a significant inter-group difference after the intervention (p<0.001). Significant differences were also observed between the two groups in terms of the mother’s feelings toward herself, toward her child and toward her spouse and others, and physical health before and after the intervention (p<0.001). Conclusions Using the Teach Back model for a self-care program appears to dramatically improve the postpartum quality of life and is therefore recommended as a useful method for postpartum care. Trial registration The trial was registered at the Iranian Registry of Clinical Trials (http://www.irct.ir) with the Irct ID: IRCT2015012820854N1. Funding The authors received no financial support for the research, authorship, and/or publication of this article.
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Affiliation(s)
- Fatemeh Ghiasvand
- Student Research Committee, School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hedyeh Riazi
- Ph.D., Assistant Professor, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sepideh Hajian
- Ph.D., Assistant Professor, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elahe Kazemi
- Ph.D. Student, Department of Biostatistics, School of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Armin Firoozi
- MS, Clinical Psychologist, Researcher, Department of Psychology, Khwarizmi University, Karaj, Iran
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Abegaz TM, Shehab A, Gebreyohannes EA, Bhagavathula AS, Elnour AA. Nonadherence to antihypertensive drugs: A systematic review and meta-analysis. Medicine (Baltimore) 2017; 96:e5641. [PMID: 28121920 PMCID: PMC5287944 DOI: 10.1097/md.0000000000005641] [Citation(s) in RCA: 276] [Impact Index Per Article: 39.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 11/18/2016] [Accepted: 11/21/2016] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Hypertension drives the global burden of cardiovascular disease and its prevalence is estimated to increase by 30% by the year 2025. Nonadherence to chronic medication regimens is common; approximately 43% to 65.5% of patients who fail to adhere to prescribed regimens are hypertensive patients. Nonadherence to medications is a potential contributing factor to the occurrence of concomitant diseases. OBJECTIVE This systematic review applied a meta-analytic procedure to investigate the medication nonadherence in adult hypertensive patients. METHODS Original research studies, conducted on adult hypertensive patients, using the 8-item Morisky medication adherence scale (MMAS-8) to assess the medication adherence between January 2009 and March 2016 were included. Comprehensive search strategies of 3 databases and MeSH keywords were used to locate eligible literature. Study characteristics, participant demographics, and medication adherence outcomes were recorded. Effect sizes for outcomes were calculated as standardized mean differences using random-effect model to estimate overall mean effects. RESULTS A total of 28 studies from 15 countries were identified, in total comprising of 13,688 hypertensive patients, were reviewed. Of 25 studies included in the meta-analysis involving 12,603 subjects, a significant number (45.2%) of the hypertensive patients and one-third (31.2%) of the hypertensive patients with comorbidities were nonadherent to medications. However, a higher proportion (83.7%) of medication nonadherence was noticed in uncontrolled blood pressure (BP) patients. Although a higher percentage (54%) of nonadherence to antihypertensive medications was noticed in females (P < 0.001), the risk of nonadherence was 1.3 times higher in males, with a relative risk of 0.883. Overall, nearly two-thirds (62.5%) of the medication nonadherence was noticed in Africans and Asians (43.5%). CONCLUSION Nonadherence to antihypertensive medications was noticed in 45% of the subjects studied and a higher proportion of uncontrolled BP (83.7%) was nonadherent to medication. Intervention models aiming to improve adherence should be emphasized.
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Affiliation(s)
- Tadesse Melaku Abegaz
- Department of Clinical Pharmacy, College of Medicine and Health Sciences, School of Pharmacy, University of Gondar, Gondar, Ethiopia
| | - Abdulla Shehab
- Department of Internal Medicine, College of Medicine and Health Sciences, UAE University
| | - Eyob Alemayehu Gebreyohannes
- Department of Clinical Pharmacy, College of Medicine and Health Sciences, School of Pharmacy, University of Gondar, Gondar, Ethiopia
| | - Akshaya Srikanth Bhagavathula
- Department of Clinical Pharmacy, College of Medicine and Health Sciences, School of Pharmacy, University of Gondar, Gondar, Ethiopia
| | - Asim Ahmed Elnour
- Department of Clinical Pharmacy, Faculty of Pharmacy, Fathima College of Health Sciences, Al Ain, UAE
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Yang S, He C, Zhang X, Sun K, Wu S, Sun X, Li Y. Determinants of antihypertensive adherence among patients in Beijing: Application of the health belief model. PATIENT EDUCATION AND COUNSELING 2016; 99:1894-1900. [PMID: 27378081 DOI: 10.1016/j.pec.2016.06.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 05/03/2016] [Accepted: 06/16/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES This study was aimed to determine the factors associated with antihypertensive adherence based on the Health Belief Model (HBM). METHODS A cross-sectional study was conducted in a rural area of China in 2014. The questionnaire included information about demographics, a scale based on the HBM, and the four-item Morisky Medication Adherence Scale. RESULTS 745 hypertensive patients participated in the study (345 men, 400 women). Patients' mean age was 56.4±10.8years. The prevalence of adherence was 43.5%. Structural equation modeling showed that men, older participants, and those with greater knowledge of hypertension showed better medication adherence than did other participants. Based on the HBM, higher levels of self-efficacy and perceived severity and a lower level of perceived barriers were associated with better antihypertensive adherence. Self-efficacy was one of the most important mediating variables affecting antihypertensive adherence. CONCLUSIONS Antihypertensive adherence was not optimal among patients in Beijing. Given that many factors are associated with medication adherence, individualized intervention strategies should be carried out in Beijing, China, especially in community settings. PRACTICE IMPLICATIONS Medication adherence can be improved by enhancing patients' self-efficacy because it was the most important influence and mediating variable.
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Affiliation(s)
- Shuaishuai Yang
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China
| | - Chao He
- Department of Health Education, Shunyi Center for Disease Prevention and Control, Beijing, China
| | - Xuxi Zhang
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China
| | - Kaige Sun
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China
| | - Shiyan Wu
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China
| | - Xinying Sun
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China.
| | - Yindong Li
- Department of Health Education, Shunyi Center for Disease Prevention and Control, Beijing, China.
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The association between health beliefs and medication adherence among patients with type 2 diabetes. Res Social Adm Pharm 2015; 12:914-925. [PMID: 26706405 DOI: 10.1016/j.sapharm.2015.11.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 11/15/2015] [Accepted: 11/16/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND Type 2 diabetes is a major risk factor for cardiovascular disease and microvascular complications. Approximately 20.5% of adults between the ages of 20-79 are diagnosed with type 2 diabetes in Saudi Arabia. Nonadherence with type 2 diabetes medications is an established contributor to higher prevalence in other countries. No published studies have used a theoretical framework to explain or predict medication-taking behavior in Saudi Arabian type 2 diabetes (T2D) patients. OBJECTIVE The purpose of this study was to investigate type 2 diabetes medication adherence using a theoretical framework, the Health Belief Model (HBM). The specific objectives were to 1) assess self-report of medication-taking in a Saudi T2D convenience sample; 2) investigate self-reported HBM constructs for T2D, its complications, and medication-taking in this sample, and 3) test the ability for self-reported health beliefs to predict specific medication-taking behaviors among the sample. METHODS A cross-sectional study was conducted in a convenience sample at an outpatient pharmacy in Saudi Arabia. Adult type 2 diabetes patients on at least one prescribed diabetes medication, who were cognitively capable, and came themselves for prescription pickup, were eligible to participate. Patients completed a questionnaire or were interviewed. Data were collected for demographics, medical history, self-reported medication adherence, and type 2 diabetes medication-taking HBM items. Three measures collected self-report of medication adherence: new multi-dimensional adherence measure (MDAM), previously validated stage of change, and medication-taking recall- 7days (MTR-7). Descriptive statistics were generated and regression analyses were used to explain self-report of adherence. RESULTS Just over half (54%) of the 220 participants were male, mean age was 52 ± 11.2 years, and most (59%) had less than high school education. Approximately 58% were on oral medications only and the rest were on either insulin alone or a combination of oral and insulin; 16.7% reported knowing their hemoglobin A1C (A1C). For adherence, most reported taking the prescribed dose every time taken; however, 60% were not taking it the prescribed number of times per day and 50%, not the prescribed time of day (interval). Over 40% reported low adherence on stage of change and MTR-7. Perceived susceptibility, perceived medication benefits, and self-efficacy were significant HBM predictors for medication adherence (R2 = 0.42). CONCLUSIONS The MDAM has research and practice potential because it evaluates sub-behaviors of medication-taking separately and as a score. Patient perceptions and beliefs should be assessed as part of a patient-centered medication adherence intervention.
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Mo PKH, Lau JTF. Influenza vaccination uptake and associated factors among elderly population in Hong Kong: the application of the Health Belief Model. HEALTH EDUCATION RESEARCH 2015; 30:706-718. [PMID: 26336905 DOI: 10.1093/her/cyv038] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 08/06/2015] [Indexed: 06/05/2023]
Abstract
The impact of influenza on elderly can be severe and fatal. Influenza vaccination (IV) has been shown to be effective in reducing influenza-related complications, but the IV uptake among elderly in Hong Kong remains low. This study investigated the prevalence and factors associated with IV among Chinese elderly in Hong Kong using the Health Belief Model (HBM). A total of 1101 Chinese elderly aged over 65 was randomly selected and completed a phone interview. Background information, experience of and intention to receive IV and IV-related knowledge and perceptions based on the HBM were measured. Results showed that 48.5 and 49.5% of the participants have ever been vaccinated and intended to receive IV, respectively. Female gender, having chronic disease, and participating in community activities were significantly associated with previous IV. Knowledge of the fact that IV is required every year, lower perceived side effect, IV price lower than HK$150, and recommendations from health care providers was associated with both previous IV and intention to be vaccinated in the next year. Interventions promoting IV among elderly should disseminate knowledge regarding the necessity of IV and correct misconceptions about the side effects of IV.
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Affiliation(s)
- P K H Mo
- Centre for Health Behaviours Research, The School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, The Chinese University of Hong Kong Shenzhen Research Institute, Shenzhen, China and
| | - J T F Lau
- Centre for Health Behaviours Research, The School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, The Chinese University of Hong Kong Shenzhen Research Institute, Shenzhen, China and Centre for Medical Anthropology and Behavioral Health, Sun Yat-Sen University, Guangzhou, China
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