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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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Cho J, Song M, Niziol LM, Heisler M, Resnicow K, Musch DC, Lee P, Da rnley-Fisch D, Newman-Casey PA. Patient-Centered Outcomes After a Medication Adherence Intervention: a Pilot Study. J Glaucoma 2023; 32:891-899. [PMID: 37054438 PMCID: PMC10544696 DOI: 10.1097/ijg.0000000000002228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 03/14/2023] [Indexed: 04/15/2023]
Abstract
PRCIS Self-determination theory (SDT) guided behavioral interventions are effective in improving several patient-centered metrics, including glaucoma-related distress. However, whether improvement in patient-centered metrics can drive an improvement in medication-taking behavior remains to be seen. OBJECTIVE The 7-month Support, Educate, Empower (SEE) personalized glaucoma coaching program was previously shown to improve glaucoma medication adherence by 21 percent points. This study's goal was to assess the impact of the SEE program on self-determination theory (SDT) metrics and other patient-centered outcome measures. PARTICIPANTS AND METHODS Glaucoma patients (≥40 y old, taking ≥1 medication) self-reporting poor medication adherence were recruited at the University of Michigan. Eight surveys (with 10 subscales) were completed before and after the 7-month SEE program. Three surveys assessed changes in SDT (Treatment Self-regulation Questionnaire, Healthcare-Climate Questionnaire, Perceived Competence) while the others assessed participants' Glaucoma Knowledge, Glaucoma Medication Self-efficacy, Glaucoma-related distress, Perceived benefits, confidence asking and getting questions answered. RESULTS Thirty-nine participants completed the SEE program. Significant improvements were in 7 subscales, including all three SDT tenets of competence (mean change =0.9, SD =±1.2, adjusted P =0.0002), autonomy (0.5, ±0.9, 0.044), and relatedness ( P =0.002). Glaucoma-related distress (-2.0, ±3.2, 0.004), confidence in asking questions (1.1, ±2.0, 0.008), and confidence in getting questions answered (1.0, ±2.0, 0.009) also improved. Glaucoma-related distress was correlated with perceived competence ( r =-0.56, adjusted P =0.005), and an increase in perceived competence was associated with a decrease in glaucoma-related distress (β=-0.43, 95% CI -0.67 - -0.20, adjusted P =0.007). CONCLUSIONS The SEE program improved participants' autonomous motivation, perceived support, perceived competence, glaucoma-related distress, and competence. These results point to the promising potential of SDT-guided behavioral interventions in improving patient-centered metrics.
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Affiliation(s)
- Juno Cho
- Department of Ophthalmology & Visual Sciences, University of Michigan Medical School, Ann Arbor, MI
| | - Melinda Song
- Department of Ophthalmology & Visual Sciences, University of Michigan Medical School, Ann Arbor, MI
| | - Leslie M. Niziol
- Department of Ophthalmology & Visual Sciences, University of Michigan Medical School, Ann Arbor, MI
| | - Michele Heisler
- Institute for Health Policy and Innovation, University of Mich igan, Ann Arbor, MI
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Ken Resnicow
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI
| | - David C. Musch
- Department of Ophthalmology & Visual Sciences, University of Michigan Medical School, Ann Arbor, MI
- Institute for Health Policy and Innovation, University of Mich igan, Ann Arbor, MI
| | - Paul Lee
- Department of Ophthalmology & Visual Sciences, University of Michigan Medical School, Ann Arbor, MI
- Institute for Health Policy and Innovation, University of Mich igan, Ann Arbor, MI
| | | | - Paula Anne Newman-Casey
- Department of Ophthalmology & Visual Sciences, University of Michigan Medical School, Ann Arbor, MI
- Institute for Health Policy and Innovation, University of Mich igan, Ann Arbor, MI
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Rodriguez SA, Tiro JA, Baldwin AS, Hamilton-Bevil H, Bowen M. Measurement of Perceived Risk of Developing Diabetes Mellitus: A Systematic Literature Review. J Gen Intern Med 2023; 38:1928-1954. [PMID: 37037984 PMCID: PMC10272015 DOI: 10.1007/s11606-023-08164-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 03/10/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND This systematic review describes approaches to measuring perceived risk of developing type 2 diabetes among individuals without diagnoses and describes the use of theories, models, and frameworks in studies assessing perceived risk. While a systematic review has synthesized perceived risk of complications among individuals with diabetes, no reviews have systematically assessed how perceived risk is measured among those without a diagnosis. METHODS Medline, PubMed, PsycINFO, and CINAHAL databases were searched for studies conducted through October 2022 with measures of perceived risk among adults ≥ 18 years without a diabetes diagnosis. Extracted data included study characteristics, measures, and health behavior theories, models, or frameworks used. RESULTS Eighty-six studies met inclusion criteria. Six examined perceived risk scales' psychometric properties. Eighty measured perceived risk using (1) a single item; (2) a composite score from multiple items or subconstructs; and (3) multiple subconstructs but no composite score. Studies used items measuring "comparative risk," "absolute or lifetime risk," and "perceived risk" without defining how each differed. Sixty-four studies used cross-sectional designs. Twenty-eight studies mentioned use of health behavior theories in study design or selection of measures. DISCUSSION There was heterogeneity in how studies operationalized perceived risk; only one third of studies referenced a theory, model, or framework as guiding design or scale and item selection. Use of perceived lifetime risk, absolute risk, or comparative risk limits comparisons across studies. Consideration of context, target population, and how data are utilized is important when selecting measures; we present a series of questions to ask when selecting measures for use in research and clinical settings. This review is the first to categorize how perceived risk is measured in the diabetes prevention domain; most literature focuses on perceived risk among those with diabetes diagnoses. Limitations include exclusion of non-English and gray literature and single reviewer screening and data extraction.
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Affiliation(s)
- Serena A. Rodriguez
- Department of Health Promotion & Behavioral Sciences, The University of Texas Health Science Center Houston (UTHealth Houston) School of Public Health, Trinity Towers, 2777 N Stemmons Fwy, Ste 8400, TX 75207 Dallas, USA
- UTHealth Houston School of Public Health, Center for Health Promotion & Prevention Research, 7000 Fannin Street, Houston, TX 77030 USA
| | - Jasmin A. Tiro
- Department of Public Health Sciences, University of Chicago, 5841 S. Maryland Ave., Chicago, IL 60637 USA
- University of Chicago Medicine Comprehensive Cancer Center, 5841 S. Maryland Avenue, Chicago, IL 60637 USA
| | - Austin S. Baldwin
- Department of Psychology, Southern Methodist University, Expressway Tower, PO Box 750442, Dallas, TX 75275 USA
| | - Hayley Hamilton-Bevil
- University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., San Antonio, TX 75229 USA
| | - Michael Bowen
- Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390 USA
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Duarte-Díaz A, Perestelo-Pérez L, Rivero-Santana A, Peñate W, Álvarez-Pérez Y, Ramos-García V, González-Pacheco H, Goya-Arteaga L, de Bonis-Braun M, González-Martín S, Ramallo-Fariña Y, Carrion C, Serrano-Aguilar P. The relationship between patient empowerment and related constructs, affective symptoms and quality of life in patients with type 2 diabetes: a systematic review and meta-analysis. Front Public Health 2023; 11:1118324. [PMID: 37139389 PMCID: PMC10150112 DOI: 10.3389/fpubh.2023.1118324] [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] [Received: 12/09/2022] [Accepted: 03/27/2023] [Indexed: 05/05/2023] Open
Abstract
Introduction The aim of this systematic review is to assess the relationship between patient empowerment and other empowerment-related constructs, and affective symptoms and quality of life in patients with type 2 diabetes. Methods A systematic review of the literature was conducted, according to the PRISMA guidelines. Studies addressing adult patients with type 2 diabetes and reporting the association between empowerment-related constructs and subjective measures of anxiety, depression and distress, as well as self-reported quality of life were included. The following electronic databases were consulted from inception to July 2022: Medline, Embase, PsycINFO, and Cochrane Library. The methodological quality of the included studies was analyzed using validated tools adapted to each study design. Meta-analyses of correlations were performed using an inverse variance restricted maximum likelihood random-effects. Results The initial search yielded 2463 references and seventy-one studies were finally included. We found a weak-to-moderate inverse association between patient empowerment-related constructs and both anxiety (r = -0.22) and depression (r = -0.29). Moreover, empowerment-related constructs were moderately negatively correlated with distress (r = -0.31) and moderately positively correlated with general quality of life (r = 0.32). Small associations between empowerment-related constructs and both mental (r = 0.23) and physical quality of life (r = 0.13) were also reported. Discussion This evidence is mostly from cross-sectional studies. High-quality prospective studies are needed not only to better understand the role of patient empowerment but to assess causal associations. The results of the study highlight the importance of patient empowerment and other empowerment-related constructs such as self-efficacy or perceived control in diabetes care. Thus, they should be considered in the design, development and implementation of effective interventions and policies aimed at improving psychosocial outcomes in patients with type 2 diabetes. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020192429, identifier CRD42020192429.
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Affiliation(s)
- Andrea Duarte-Díaz
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Department of Clinical Psychology, Psychobiology and Methodology, Universidad de La Laguna, (ULL), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Madrid, Spain
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Madrid, Spain
| | - Lilisbeth Perestelo-Pérez
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Madrid, Spain
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Madrid, Spain
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Tenerife, Spain
- *Correspondence: Lilisbeth Perestelo-Pérez
| | - Amado Rivero-Santana
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Madrid, Spain
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Madrid, Spain
| | - Wenceslao Peñate
- Department of Clinical Psychology, Psychobiology and Methodology, Universidad de La Laguna, (ULL), Tenerife, Spain
| | - Yolanda Álvarez-Pérez
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Madrid, Spain
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Madrid, Spain
| | - Vanesa Ramos-García
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Madrid, Spain
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Madrid, Spain
| | - Himar González-Pacheco
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Madrid, Spain
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Madrid, Spain
| | - Libertad Goya-Arteaga
- Multiprofessional Unit of Family and Community Care of La Laguna-Norte, Tenerife, Spain
| | - Miriam de Bonis-Braun
- Multiprofessional Unit of Family and Community Care of La Laguna-Norte, Tenerife, Spain
| | | | - Yolanda Ramallo-Fariña
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Madrid, Spain
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Madrid, Spain
| | - Carme Carrion
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Madrid, Spain
- eHealth Lab Research Group, School of Health Sciences, Universitat Oberta de Catalunya (UOC), Barcelona, Spain
| | - Pedro Serrano-Aguilar
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Madrid, Spain
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Madrid, Spain
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Tenerife, Spain
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Heise M, Heidemann C, Baumert J, Du Y, Frese T, Avetisyan M, Weise S. Structured diabetes self-management education and its association with perceived diabetes knowledge, information, and disease distress: Results of a nationwide population-based study. Prim Care Diabetes 2022; 16:387-394. [PMID: 35400607 DOI: 10.1016/j.pcd.2022.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/22/2022] [Accepted: 03/31/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate, how participation in structured diabetes self-management education (DSME) programs is associated with perceived level of knowledge about diabetes, information needs, information sources and disease distress. METHODS We included 796 ever- and 277 never-DSME participants of the population-based survey "Disease knowledge and information needs - Diabetes mellitus (2017)" from Germany. Data on perceived level of diabetes knowledge (12 items), information needs (11 items), information sources (13 items) and disease distress (2 indices) were collected. Multiple logistic regression analyses were used to examine the association of DSME-participation with these outcomes. RESULTS DSME-participants showed a higher level of diabetes knowledge compared to never-DSME participants, particularly in aspects concerning diabetes in general (odds ratio 2.53; 95% confidence intervals 1.48-4.33), treatment (2.41; 1.36-4.26), acute complications (1.91; 1.07-3.41) and diabetes in everyday life (1.83; 1.04-3.22). DSME-participants showed higher information needs regarding late complications (1.51; 1.04-2.18) and acute complications (1.71; 1.71-2.48) than DSME never participants. DSME-participants more frequently consulted diabetologists (5.54; 3.56-8.60) and diabetes care specialists (5.62; 3.61-8.75) as information sources. DSME participation was not associated with disease distress. CONCLUSION DSME is a valuable tool for improving individual knowledge about diabetes. However, DSME should focus more on psychosocial aspects to reduce the disease burden.
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Affiliation(s)
- M Heise
- Institute of General Practice and Family Medicine, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Magdeburger Str. 8, 06112 Halle (Saale), Germany.
| | - C Heidemann
- Robert Koch Institute, Department of Epidemiology and Health Monitoring, Unit Physical Health, General-Paper-Str. 62-66, 12101 Berlin, Germany.
| | - J Baumert
- Robert Koch Institute, Department of Epidemiology and Health Monitoring, Unit Physical Health, General-Paper-Str. 62-66, 12101 Berlin, Germany.
| | - Y Du
- Robert Koch Institute, Department of Epidemiology and Health Monitoring, Unit Physical Health, General-Paper-Str. 62-66, 12101 Berlin, Germany.
| | - T Frese
- Institute of General Practice and Family Medicine, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Magdeburger Str. 8, 06112 Halle (Saale), Germany.
| | - M Avetisyan
- Institute of General Practice and Family Medicine, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Magdeburger Str. 8, 06112 Halle (Saale), Germany.
| | - S Weise
- Institute of General Practice and Family Medicine, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Magdeburger Str. 8, 06112 Halle (Saale), Germany.
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Karl JA, Fischer R, Druică E, Musso F, Stan A. Testing the Effectiveness of the Health Belief Model in Predicting Preventive Behavior During the COVID-19 Pandemic: The Case of Romania and Italy. Front Psychol 2022; 12:627575. [PMID: 35095628 PMCID: PMC8789680 DOI: 10.3389/fpsyg.2021.627575] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 12/20/2021] [Indexed: 12/23/2022] Open
Abstract
We use a cultural psychology approach to examine the relevance of the Health Belief Model (HBM) for predicting a variety of behaviors that had been recommended by health officials during the initial stages of the COVID-19 lockdown for containing the spread of the virus and not overburdening the health system in Europe. Our study is grounded in the assumption that health behavior is activated based on locally relevant perceptions of threats, susceptibility and benefits in engaging in protective behavior, which requires careful attention to how these perceptions might be structured and activated. We assess the validity of the HBM in two European countries that have been relatively understudied, using simultaneous measurements during acute periods of infection in Romania and Italy. An online questionnaire provided a total of (N = 1863) valid answers from both countries. First, to understand individual difference patterns within and across populations, we fit a General Linear Model in which endorsement was predicted by behavior, country, their interaction, and a random effect for participants. Second, we assess the effect of demographics and health beliefs on prevention behaviors by fitting a multi-group path model across countries, in which each behavior was predicted by the observed health belief variables and demographics. Health beliefs showed stronger relationships with the recommended behaviors than demographics. Confirming previously reported relationships, self-efficacy, perceived severity, and perceived benefits were consistently related to the greater adoption of individual behaviors, whereas greater perceived barriers were related to lower adoption of health behaviors. However, we also point to important location specific effects that suggest that local norms shape protective behavior in highly contextualized ways.
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Affiliation(s)
- Johannes Alfons Karl
- School of Psychology, Victoria University of Wellington, Wellington, New Zealand
| | - Ronald Fischer
- School of Psychology, Victoria University of Wellington, Wellington, New Zealand.,D'Or Institute for Research and Education, São Paulo, Brazil
| | - Elena Druică
- Centre for Applied Behavioral Economics, Department of Applied Economics and Quantitative Analysis, University of Bucharest, Bucharest, Romania
| | - Fabio Musso
- Department of Economics, Society and Politics, University of Urbino "Carlo Bo", Urbino, Italy
| | - Anastasia Stan
- Centre for Applied Behavioral Economics, Department of Applied Economics and Quantitative Analysis, University of Bucharest, Bucharest, Romania
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Eziefula C, Shah FT, Anie KA. Promoting Adherence to Iron Chelation Treatment in Beta-Thalassemia Patients. Patient Prefer Adherence 2022; 16:1423-1437. [PMID: 35698633 PMCID: PMC9188463 DOI: 10.2147/ppa.s269352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 03/29/2022] [Indexed: 01/19/2023] Open
Abstract
Thalassaemia is one of the commonest inherited genetic disorders world-wide with around 25,000 births of the most severely affected transfusion dependent children annually. Patients with transfusion dependent thalassaemia require regular blood transfusions to maintain life but because of this will develop iron overload. To remove the excess iron, patients are required to take iron chelation therapy (ICT). ICT requires lifelong adherence to treatment to prevent end organ damage from developing. Many of these preventable complications make adherence to therapy more complex for patients. In this review, we focus on two commonly encountered patient scenarios and discuss how different psychological models and a relational theory can be used to understand and support adherence to treatment.
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Affiliation(s)
- Chinea Eziefula
- Camden & Islington NHS Foundation Trust, London, UK
- Psychology Services, Whittington Health NHS Trust, London, UK
| | - Farrukh T Shah
- Department of Haematology, Whittington Health NHS Trust, London, UK
- Medical Director for Transfusion, NHSBT, London, UK
- Correspondence: Farrukh T Shah, Department of Haematology, Whittington Health, Magdala Avenue, London, N19 5NF, Tel +44 0207 288 5144, Email
| | - Kofi A Anie
- London North West University Healthcare NHS Trust, London, UK
- Imperial College London, London, UK
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Oluchina S, Karanja S. Barriers to diabetes self-management in primary care settings – Patient perspectives: Phenomenological design. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2022. [DOI: 10.1016/j.ijans.2022.100465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
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Alzubaidi H, Sulieman H, Mc Namara K, Samorinha C, Browning C. The relationship between diabetes distress, medication taking, glycaemic control and self-management. Int J Clin Pharm 2021; 44:127-137. [PMID: 34586556 DOI: 10.1007/s11096-021-01322-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 08/20/2021] [Indexed: 11/30/2022]
Abstract
Background Diabetes distress (DD) has broad-ranging effects on type 2 diabetes (T2DM) management and outcomes. DD research is scarce among ethnic minority groups, particularly Arabic-speaking immigrant communities. To improve outcomes for these vulnerable groups, healthcare providers, including pharmacists, need to understand modifiable predictors of DD. Aim To assess and compare DD and its association with medication-taking behaviours, glycaemic control, self-management, and psychosocial factors among first-generation Arabic-speaking immigrants and English-speaking patients of Anglo-Celtic background with diabetes, and determine DD predictors. Setting Various healthcare settings in Australia. Method A multicentre cross-sectional study was conducted. Adults with T2DM completed a survey comprised of validated tools. Glycated haemoglobin, blood pressure, and lipid profile were gathered from medical records. Multiple linear regression models were computed to assess the DD predictors. Main outcome measure Diabetes distress level. Results Data was analysed for 696 participants: 56.3% Arabic-speaking immigrants and 43.7% English-speaking patients. Compared with English-speaking patients, Arabic-speaking immigrants had higher DD, lower medication adherence, worse self-management and glycaemic control, and poorer health and clinical profile. The regression analysis demonstrated that higher DD in Arabic-speaking immigrants was associated with cost-related medication underuse and lower adherence to exercise, younger age, lower education level, unemployment, lower self-efficacy, and inadequate glycaemic control. Whereas among English-speaking patients, higher DD was associated with both cost- and non-cost-related underuse of medication and lower dietary adherence. Conclusion Results provided new insights to guide healthcare providers on reducing the apparent excess burden of DD among Arabic-speaking immigrants and potentially improve medication adherence, glycaemic control, and self-management.
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Affiliation(s)
- Hamzah Alzubaidi
- Pharmacy Practice and Pharmacotherapeutics, College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates. .,Sharjah Institute for Medical Research, University of Sharjah, Sharjah, United Arab Emirates.
| | - Hana Sulieman
- Department of Mathematics and Statistics, American University of Sharjah, Sharjah, United Arab Emirates
| | - Kevin Mc Namara
- School of Medicine, Deakin University, Victoria, Australia.,Centre for Population Health Research, Deakin University, Burwood, VIC, Australia
| | - Catarina Samorinha
- Sharjah Institute for Medical Research, University of Sharjah, Sharjah, United Arab Emirates
| | - Colette Browning
- School of Nursing and Healthcare Professions, Federation University, Ballarat, VIC, Australia.,Australian National University, Australian Capital Territory, Canberra, Australia
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Chu HY, Huang HC, Huang CY, Chu CC, Su CT, Tsai IL, Hu HLS, Guo SL. A predictive model for identifying low medication adherence among older adults with hypertension: A classification and regression tree model. Geriatr Nurs 2021; 42:1309-1315. [PMID: 34560525 DOI: 10.1016/j.gerinurse.2021.08.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 08/14/2021] [Accepted: 08/16/2021] [Indexed: 11/28/2022]
Abstract
Various individual characteristics may affect medication adherence; however, few studies have investigated the effect of interrelationships among these various individual characteristics on medication adherence. This cross-sectional study explored the interrelationships among risk factors for medication adherence and established a predictive model of low medication adherence among older adults with hypertension. Convenience sampling was used to recruit 300 older adults with hypertension. The following parameters were recorded: demographic and disease characteristics, health beliefs, self-efficacy, social support, and medication adherence of antihypertensive drugs. Classification and regression tree (CART) analysis was performed to develop a predictive model of low medication adherence. The CART model revealed that health belief, disease duration, self-efficacy, and social support interacted to contribute to various pathways of low medication adherence. The predicted accuracy of the model was validated with a low misclassification rate of 26%. The proposed classification model can help identify risk cases with low medication adherence. Suitable health education programs based on these risk factors to manage and improve medication adherence for older adults with hypertension could be considered.
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Affiliation(s)
- Han-Yu Chu
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan
| | - Hui-Chuan Huang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Chun-Yao Huang
- Division of Cardiology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan; Cardiovascular Research Center, Taipei Medical University Hospital, Taipei, Taiwan; Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan; Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ching-Chi Chu
- Department of Cardiology, En Chu Kong Hospital, New Taipei City, Taiwan
| | - Chien-Tien Su
- Department of Family Medicine, Taipei Medical University Hospital, Taipei Taiwan; School of Public Health, Taipei Medical University, Taipei, Taiwan
| | - I-Lin Tsai
- Department of Biochemistry and Molecular Cell Biology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Huey-Lan Sophia Hu
- School of Nursing, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shu-Liu Guo
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan.
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11
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Azadi NA, Ziapour A, Lebni JY, Irandoost SF, Abbas J, Chaboksavar F. The effect of education based on health belief model on promoting preventive behaviors of hypertensive disease in staff of the Iran University of Medical Sciences. Arch Public Health 2021; 79:69. [PMID: 33952339 PMCID: PMC8097917 DOI: 10.1186/s13690-021-00594-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 04/25/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Hypertension is one of the major causes of many diseases, such as heart attack, strokes, kidney failure, and many internal disorders. This presentresearch study aimed to investigate the impact of educational programs based on the health belief model to promote hypertension prevention behavior of Iran University of Medical Sciences staff. METHODS This study has incorporated pretest-posttest quasi-experimental based on 128 staff members and randomly assigned the recruited and involved participants to an intervention (n = 64) and a control group (n = 64). The data collection tool was based on a questionnaire related to health belief model constructs based on 42 questions. The study interpreted the results using ANCOVA and robust ANCOVA as suitable approaches. RESULTS ANCOVA showed improvement in the cues to participants' action following educational interventional (p = 0.011). the robust ANCOVA specified that the intervention was successful for participants with low to moderate initial levels of knowledge, perceived susceptibility, perceived severity, perceived barriers, and self-efficacy scores. The levels of these components did not change in participants with very high baseline scores. Compared to a control group, regardless of baseline score, the perceived benefits and practice (behavior) of participants at the intervention group were improved significantly (P < 0.05). CONCLUSION This current study specified that the education-based health belief model effectively promotes hypertension preventive behaviors among Iran University of Medical Sciences staff.
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Affiliation(s)
- Nemam Ali Azadi
- Department of Biostatistics, School of Health, Iran University of Medical Sciences, Tehran, Iran
| | - Arash Ziapour
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Javad Yoosefi Lebni
- Health Promotion Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Fahim Irandoost
- Department of Public Health, School of Health, Urmia University of Medical Sciences, Urmia, Iran
| | - Jaffar Abbas
- Antai College of Economics and Management/School of Media and Communication, Shanghai Jiao Tong University, Shanghai, China
| | - Fakhreddin Chaboksavar
- Nursing Care Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, I.R., Iran.
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12
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Pogany L, Lazary J. Health Control Beliefs and Attitude Toward Treatment in Psychiatric and Non-Psychiatric Clinical Samples. Front Psychiatry 2021; 12:537309. [PMID: 34025463 PMCID: PMC8132472 DOI: 10.3389/fpsyt.2021.537309] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 04/01/2021] [Indexed: 11/13/2022] Open
Abstract
Although there is accumulating evidence on the potential influencing factors of medication adherence, the knowledge about patients' attitudes and beliefs toward treatment is only partly utilized in adherence-improving strategies. Several internal and external factors determining adherence have been described regarding many chronic somatic diseases but in recent research, insight on psychiatric patients has been exclusively lacking. As a result, there is a scarcity of effective adherence-improving interventions. Identification of any specific differences or similarities between the attitudes toward treatment of psychiatric and non-psychiatric patients would help to support adherent behavior. We recruited 189 participants from four departments of general psychiatry (GEN PSYCH, n = 106), addictology (ADDICT, n = 42) and somatic diseases (NON PSYCH, n = 41). The Patient's Health Belief Questionnaire on Psychiatric Treatment (PHBQPT) was performed to assess the patients' attitude toward drug treatment, perceived health locus of control, and psychological reactance. The most robust difference of the PHBQT scores occurred between the GEN PSYCH and ADDICT subgroups. ADDICT patients scored significantly higher on the internal and external health locus of control and on the Psychological Reactance subscale as well. While GEN PSYCH subjects provided higher scores on the Positive Aspect of Medication compared to ADDICT persons. Interestingly, the only difference between the GEN PSYCH and NON-PSYCH groups was the more pronounced mistrust in physicians in the case of psychiatric patients. Our data suggest that mistrust toward medication does not differ in psychiatric and non-psychiatric samples, while the acceptance of the doctor's competency may be stronger in the non-psychiatric sample. The analysis of these factors provides information which could help us better understand this important issue and to develop more efficient interventions for improving adherence.
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Affiliation(s)
- Laszlo Pogany
- National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary.,Janos Szentagothai Doctoral School of Neuroscience, Budapest, Hungary
| | - Judit Lazary
- National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary.,Janos Szentagothai Doctoral School of Neuroscience, Budapest, Hungary
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13
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Mrug S, Orihuela C, Rahn E, Mudano A, Foster J, Saag K, Gaffo A. Depressive Symptoms and the Effectiveness of a Urate‐Lowering Therapy in a Clinical Trial. ACR Open Rheumatol 2020; 2:710-714. [PMID: 33216463 PMCID: PMC7738799 DOI: 10.1002/acr2.11192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 09/30/2020] [Indexed: 11/08/2022] Open
Abstract
Objective Methods Results Conclusion
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Affiliation(s)
| | | | | | | | | | | | - Angelo Gaffo
- University of Alabama at Birmingham and Birmingham VA Medical Center Birmingham Alabama
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14
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Casten R, Rovner B, Chang AM, Hollander JE, Kelley M, Leiby B, Nightingale G, Pizzi L, White N, Rising K. A randomized clinical trial of a collaborative home-based diabetes intervention to reduce emergency department visits and hospitalizations in black individuals with diabetes. Contemp Clin Trials 2020; 95:106069. [PMID: 32561466 DOI: 10.1016/j.cct.2020.106069] [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: 01/09/2020] [Revised: 05/29/2020] [Accepted: 06/12/2020] [Indexed: 01/22/2023]
Abstract
The prevalence of diabetes mellitus (DM) in black individuals (blacks) is twice that of white individuals (whites), and blacks are more likely to have worse glycemic control, less optimal medication regimens, and higher levels of mistrust in the medical system. These three factors account for higher rates of acute medical care use in blacks with DM. To address this disparity, we developed DM I-TEAM (Diabetes Interprofessional Team to Enhance Adherence to Medical Care), a home-based multidisciplinary behavioral intervention that integrates care from a community health worker (CHW), the participant's primary care physician (PCP), a DM nurse educator, and a clinical pharmacist. Treatment is delivered during 9 sessions over 1 year, and includes diabetes education and goal setting, telehealth visits with participants' PCP and a DM nurse educator, and comprehensive medication reviews by a pharmacist. We describe the rationale and methods for a randomized controlled trial to test the efficacy of DM I-TEAM to reduce emergency department (ED) visits and hospitalizations. We are enrolling 200 blacks with DM during an ED visit. Participants are randomized to DM I-TEAM or Usual Medical Care (UMC). Follow-up assessments are conducted at 6 and 12 months. The primary outcome is the number of ED visits and hospitalizations over 12 months, and is measured by participant self-report and medical record review. Secondary outcomes include hemoglobin A1c (HbA1c), number of potentially inappropriate medications (PIMs), and trust in health care.
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Affiliation(s)
- Robin Casten
- Department of Psychiatry and Human Behavior, Sidney Kimmel Medical College at Thomas, Jefferson University, United States of America.
| | - Barry Rovner
- Departments of Neurology, Psychiatry, and Ophthalmology, Sidney Kimmel Medical College at Thomas Jefferson University, United States of America
| | - Anna Marie Chang
- Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, United States of America
| | - Judd E Hollander
- Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, United States of America
| | - Megan Kelley
- Department of Neurology, Sidney Kimmel Medical College at Thomas Jefferson University, United States of America
| | - Benjamin Leiby
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Sidney Kimmel Medical College at Thomas Jefferson University, United States of America
| | - Ginah Nightingale
- Jefferson College of Pharmacy at Thomas Jefferson University, United States of America
| | - Laura Pizzi
- Center for Health Outcomes, Policy, and Economics, Ernest Mario School of Pharmacy, Rutgers University, United States of America
| | - Neva White
- Center for Urban Health, Thomas Jefferson University Hospital, United States of America
| | - Kristin Rising
- Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, United States of America
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15
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Qiao X, Tian X, Liu N, Dong L, Jin Y, Si H, Liu X, Wang C. The association between frailty and medication adherence among community-dwelling older adults with chronic diseases: Medication beliefs acting as mediators. PATIENT EDUCATION AND COUNSELING 2020; 103:S0738-3991(20)30279-2. [PMID: 32461040 DOI: 10.1016/j.pec.2020.05.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 05/05/2020] [Accepted: 05/11/2020] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To explore the association between frailty and medication adherence by modeling medication beliefs (i.e., necessity and concerns) as mediators among community-dwelling older patients. METHODS This cross-sectional study was conducted among 780 Chinese older patients. Frailty, medication adherence and medication beliefs were assessed using the Comprehensive Frailty Assessment Instrument (CFAI), the 4-item Morisky Medication Adherence Scale (MMAS-4) and the Beliefs about Medicines Questionnaire-Specific (BMQ-Specific), respectively. The PROCESS SPSS Macro version 2.16.3, model 4 was used to test the significance of the indirect effects. RESULTS Frailty was associated with high medication necessity (β = 0.091, p = 0.011) and high medication concerns (β = 0.297, p < 0.001). Medication adherence was positively associated with medication necessity (β = 0.129, p = 0.001), and negatively associated with medication concerns (β = -0.203, p < 0.001). Medication necessity and medication concerns attenuated the total effect of frailty on medication adherence by -13.6% and 70.3%, respectively CONCLUSION: High medication concerns among frail older patients inhibit their medication adherence, which cannot be offset by the positive effect of their high medication necessity on medication adherence. PRACTICE IMPLICATIONS Interventions should target medication beliefs among frail older patients, particularly medication concerns, to efficiently improve their medication adherence.
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Affiliation(s)
- Xiaoxia Qiao
- School of Nursing, Peking University, 100191, Beijing, China.
| | - Xiaoyu Tian
- School of Nursing, Shandong University, 250012, Jinan, China.
| | - Na Liu
- School of Nursing, Shandong University, 250012, Jinan, China.
| | - Lijuan Dong
- School of Nursing, Shandong University, 250012, Jinan, China.
| | - Yaru Jin
- School of Nursing, Peking University, 100191, Beijing, China.
| | - Huaxin Si
- School of Nursing, Peking University, 100191, Beijing, China.
| | - Xinyi Liu
- School of Nursing, Shandong University, 250012, Jinan, China.
| | - Cuili Wang
- School of Nursing, Peking University, 100191, Beijing, China.
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16
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Ruksakulpiwat S, Liu Z, Yue S, Fan Y. The Association Among Medication Beliefs, Perception of Illness and Medication Adherence in Ischemic Stroke Patients: A Cross-Sectional Study in China. Patient Prefer Adherence 2020; 14:235-247. [PMID: 32103908 PMCID: PMC7026124 DOI: 10.2147/ppa.s235107] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 12/21/2019] [Indexed: 01/12/2023] Open
Abstract
PURPOSE To examine the association and the mediating effect among medication beliefs, perception of illness, and medication adherence in ischemic stroke patients. PATIENTS AND METHODS This is a cross-sectional study, 306 ischemic stroke patients recruited from The Second Affiliated Hospital of Harbin Medical University, China between June 2018 and October 2018. The Beliefs about Medications Questionnaire (BMQ) was used to assess a patient's beliefs about medication. The Brief Illness Perceptions Questionnaire (BIPQ) was used to rapidly determine the cognitive and emotional representation of ischemic stroke. Self-reported adherence was assessed using the Medication Adherence Report Scale (MARS). Logistic regression analysis, Pearson correlations, and mediation analysis were used to evaluate the association and mediating effects among medication beliefs, perception of illness, and medication adherence. RESULTS Overall, 220 (65.48%) participants were non-adherent to their ischemic stroke medications. Non-adherent patients had greater stroke severity (p = 0.031) compared to adherent patients. After adjusting for demographic characteristics, specific concern (odds ratio [OR]: 0.652, 95% confidence interval [CI]: 0.431 to 0.987, p-value [P] = 0.043), and the perception of illness (overall score) (OR: 0.964, 95% CI: 0.944 to 0.985, P = 0.001) were significantly associated with medication adherence in ischemic stroke patients. The mediation analysis showed the significant indirect effects of specific concern, general overuse, and general harm. It suggested that some impacts of medication beliefs have been mediated on medication adherence. CONCLUSION Perceived concern about adverse effects of medicines and perception of illness have an influential impact on self-reported medication adherence in ischemic stroke patients. To enhance adherence, patients' beliefs about medication and perceptions of their disease should be reconsidered. Future work should investigate interventions to influence patient adherence by addressing concerns about their ischemic stroke medications and the perception of the disease.
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Affiliation(s)
- Suebsarn Ruksakulpiwat
- The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, People’s Republic of China
- College of Nursing, Harbin Medical University, Harbin, Heilongjiang Province, People’s Republic of China
| | - Zhaojun Liu
- The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, People’s Republic of China
| | - Shihong Yue
- The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, People’s Republic of China
| | - Yuying Fan
- The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, People’s Republic of China
- College of Nursing, Harbin Medical University, Harbin, Heilongjiang Province, People’s Republic of China
- Correspondence: Yuying Fan The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, People’s Republic of China; College of Nursing, Harbin Medical University, 157 Baojian Road, Nangang Distinct, Harbin150086, Heilongjiang Province, People’s Republic of ChinaTel +86 13603630368 Email
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17
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Vluggen S, Hoving C, Schaper NC, De Vries H. Psychological predictors of adherence to oral hypoglycaemic agents: an application of the ProMAS questionnaire. Psychol Health 2019; 35:387-404. [PMID: 31588778 DOI: 10.1080/08870446.2019.1672873] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: This study aimed to identify psychological predictors of oral hypoglycaemic agent (OHA) adherence and to compare adherence rates between a novel and well-known instrument, i.e. the Probabilistic Medication Adherence Scale (ProMAS) and Medication Adherence Report Scale (MARS-5).Design and main outcome measures: A longitudinal study design was applied with surveys at baseline and 6-month follow-up. At baseline, OHA adherence using the ProMAS and MARS-5, socio-cognitive determinants and demographics were assessed. At follow-up, the ProMAS was applied as outcome measure, on which socio-cognitive determinants and demographics were regressed using linear regression analysis.Results: The baseline and follow-up sample included 304 and 231 participants, respectively. When applying cut-off points of ≥15 for the ProMAS and ≥23 for the MARS-5, 47.4 and 89.5% adhered to their OHAs. Consistent predictors of better adherence comprised a low education, lower severity perceptions, and higher self-efficacy and intention. After correcting for baseline adherence, a low education and higher self-efficacy remained significant adherence predictors.Conclusions: Compared to the MARS-5, ProMAS data was less skewed, similar to objectively collected data, and yielded insights in a broader spectrum of (non)-adherence behaviours. Results stress the need for adherence improving interventions which particularly should target higher educated patients and patients with low self-efficacy, low intention and high severity perceptions.
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Affiliation(s)
- Stan Vluggen
- Department of Health Promotion, School CAPHRI, Maastricht University, Maastricht, the Netherlands
| | - Ciska Hoving
- Department of Health Promotion, School CAPHRI, Maastricht University, Maastricht, the Netherlands
| | - Nicolaas C Schaper
- Department of Endocrinology and Internal Medicine, School CAPHRI, University Medical Centre (MUMC+), Maastricht, the Netherlands
| | - Hein De Vries
- Department of Health Promotion, School CAPHRI, Maastricht University, Maastricht, the Netherlands
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18
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Achouri MY, Mammeri M, Sehanine Y, Selka MA, Ghomari WI, Lahmer A, Hadj Habib M. [Factors associated with medication non-adherence in patients with type 2 diabetes mellitus: The first Algerian survey]. ANNALES PHARMACEUTIQUES FRANÇAISES 2019; 77:506-515. [PMID: 31564421 DOI: 10.1016/j.pharma.2019.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 07/21/2019] [Accepted: 08/08/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Non-adherence in patients with type 2 diabetes is a frequent phenomenon with important impact in terms of management of this disease. The aim of this study was to assess the level of medication adherence and to identify the factors associated with non-adherence in type 2 diabetic patients. METHODS A cross-sectional study was conducted in type 2 diabetic patients at the endocrinology and diabetology department of University Medical Center of Sidi Bel Abbes (Algeria) in 2017. Medication adherence was determined using a morisky 8-Item medication adherence questionnaire. A logistic regression was used to identify factors associated with non-adherence. RESULTS The study enrolled 403 type 2 diabetic patients. The mean age was 60 years and sex-ratio was 0.8. Medication non-adherence rate was 31.3% (95% CI: 26.8-35.8%). The factors significantly associated with non-adherence in multivariate analysis were: health insurance status, self-monitoring of blood glucose, disease duration, education level and need for information on diabetes. CONCLUSION Our study had demonstrated a low adherence in patients with type 2 diabetes. The results suggest that implementation of a therapeutic education program could be important in management of diabetes.
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Affiliation(s)
- M Y Achouri
- Département de pharmacie, faculté de médecine, université Djilali Liabès de Sidi Bel Abbès, boulevard Colonel Othmane, 22000 Sidi Bel Abbès, Algérie.
| | - M Mammeri
- Département de pharmacie, faculté de médecine, université Djilali Liabès de Sidi Bel Abbès, boulevard Colonel Othmane, 22000 Sidi Bel Abbès, Algérie
| | - Y Sehanine
- Département de pharmacie, faculté de médecine, université Djilali Liabès de Sidi Bel Abbès, boulevard Colonel Othmane, 22000 Sidi Bel Abbès, Algérie
| | - M A Selka
- Département de pharmacie, faculté de médecine, université Djilali Liabès de Sidi Bel Abbès, boulevard Colonel Othmane, 22000 Sidi Bel Abbès, Algérie
| | - W I Ghomari
- Département de médecine, faculté de médecine, université Djilali Liabès de Sidi Bel Abbès, 22000, Algérie
| | - A Lahmer
- Département de médecine, faculté de médecine, université Djilali Liabès de Sidi Bel Abbès, 22000, Algérie
| | - M Hadj Habib
- Département de médecine, faculté de médecine, université Djilali Liabès de Sidi Bel Abbès, 22000, Algérie
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MIRZAEI-ALAVIJEH M, JOUYBARI T, JALILIAN F, MOTLAGH M, JALILIAN F. Using intervention mapping approach to finding socio-cognitive determinants of diabetes preventive behaviors. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2019; 60:E237-E242. [PMID: 31650060 PMCID: PMC6797886 DOI: 10.15167/2421-4248/jpmh2019.60.3.1159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 02/26/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Diabetes is one of the most common chronic illnesses with complications. The objective of this study was to determine socio-cognitive determinants of diabetes preventive behaviors among sample of at risk group based on intervention mapping approach (IM) in Kermanshah, the west of Iran. METHODS This cross-sectional study conducted among a total of 200 male and female aged more than 30 years old referred to health centers that randomly selected to participate voluntarily, during 2018. Participants filled out a self-report questionnaire. Data were analyzed by SPSS version 16 using bivariate correlations and linear regression at 95% significant level. RESULTS The mean age of respondents was 38.4 years [95% CI: 37.3, 39.4], ranged from 30 to 56 years. Socio-cognitive determinants were accounted for 40% of the variation in diabetes prevention behaviors F = 35.559, P < 0.001. As well as, perceived self-efficacy, perceived severity, and perceived barrier were the most influential predictors on diabetes preventive behaviors. CONCLUSIONS It seems that planning health promotion programs to reduce barrier to perform diabetes preventive behaviors and increase confidence towards ability to perform preventive behaviors, and seriousness about sides effect of diabetes may be usefulness of the results in order to promotion of diabetes preventive behaviors among at risk group.
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Affiliation(s)
- M. MIRZAEI-ALAVIJEH
- Social Development & Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - T.A. JOUYBARI
- Clinical Research Development Center, Imam Khomeini Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - F. JALILIAN
- Lifestyle Modification Research Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - M.E. MOTLAGH
- Department of Pediatrics, Faculty Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - F. JALILIAN
- Social Development & Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
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20
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Adu MD, Malabu UH, Malau-Aduli AEO, Malau-Aduli BS. Enablers and barriers to effective diabetes self-management: A multi-national investigation. PLoS One 2019; 14:e0217771. [PMID: 31166971 PMCID: PMC6550406 DOI: 10.1371/journal.pone.0217771] [Citation(s) in RCA: 141] [Impact Index Per Article: 28.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 05/19/2019] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE The study aimed to identify the common gaps in skills and self-efficacy for diabetes self-management and explore other factors which serve as enablers of, and barriers to, achieving optimal diabetes self-management. The information gathered could provide health professionals with valuable insights to achieving better health outcomes with self-management education and support for diabetes patients. METHODS International online survey and telephone interviews were conducted on adults who have type 1 or type 2 diabetes. The survey inquired about their skills and self-efficacy in diabetes self-management, while the interviews assessed other enablers of, and barriers to, diabetes self-management. Surveys were analysed using descriptive and inferential statistics. Interviews were analysed using inductive thematic analysis. RESULTS Survey participants (N = 217) had type 1 diabetes (38.2%) or type 2 diabetes (61.8%), with a mean age of 44.56 SD 11.51 and were from 4 continents (Europe, Australia, Asia, America). Identified gaps in diabetes self-management skills included the ability to: recognize and manage the impact of stress on diabetes, exercise planning to avoid hypoglycemia and interpreting blood glucose pattern levels. Self-efficacy for healthy coping with stress and adjusting medications or food intake to reach ideal blood glucose levels were minimal. Sixteen participants were interviewed. Common enablers of diabetes self-management included: (i) the will to prevent the development of diabetes complications and (ii) the use of technological devices. Issues regarding: (i) frustration due to dynamic and chronic nature of diabetes (ii) financial constraints (iii) unrealistic expectations and (iv) work and environment-related factors limited patients' effective self-management of diabetes. CONCLUSIONS Educational reinforcement using technological devices such as mobile application has been highlighted as an enabler of diabetes self-management and it could be employed as an intervention to alleviate identified gaps in diabetes self-management. Furthermore, improved approaches that address financial burden, work and environment-related factors as well as diabetes distress are essential for enhancing diabetes self-management.
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Affiliation(s)
- Mary D. Adu
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
- * E-mail: ,
| | - Usman H. Malabu
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Aduli E. O. Malau-Aduli
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
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21
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Su M, Haldane V, Upshur R, Sullivan F, Légaré F, Greiver M, Wei X. The Impact of Treatment Adherence for Patients With Diabetes and Hypertension on Cardiovascular Disease Risk: Protocol for a Retrospective Cohort Study, 2008-2018. JMIR Res Protoc 2019; 8:e13571. [PMID: 31152529 PMCID: PMC6658229 DOI: 10.2196/13571] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 03/31/2019] [Accepted: 04/02/2019] [Indexed: 01/02/2023] Open
Abstract
Background Cardiovascular disease (CVD) is the leading cause of death globally and in Canada. Diabetes and hypertension are major risk factors for CVD events. Despite the increasing availability of effective treatments, the majority of diabetic and hypertensive patients do not have adequate blood pressure and glycemic control. One of the major contributors is poor treatment adherence. Objective This study aims to evaluate the impact of treatment adherence for patients with both diabetes and hypertension on acute severe CVD events and intermediate clinical outcomes in Canadian primary care settings. Methods We will conduct a population-based retrospective cohort study of patients living with both diabetes and hypertension in Ontario, Canada, between January 1, 2008, and March 31, 2018. The Social Cognitive Theory will be used as a conceptual framework by which to frame the reciprocal relationship between treatment adherence, personal factors, and environmental determinants and how this interplay impacts CVD events and clinical outcomes. Data will be derived from the Diabetes Action Canada National Data Repository. A time-varying Cox proportional hazards model will be used to estimate the impacts of treatment adherence on CVD morbidity and mortality. Multivariable linear regression models and hierarchical regression models will be used to estimate the associations between treatment adherence of different medication categories and intermediate clinical outcomes. Our primary outcome is the association between treatment adherence and the risk of acute severe CVD events, including CVD mortality. The secondary outcome is the association between treatment adherence and intermediate clinical outcomes including diastolic and systolic blood pressures, glycated hemoglobin, low-density lipoprotein cholesterol, and total cholesterol. Owing to data limitation, we use medication prescriptions as a proxy to estimate treatment adherence. We assume that a patient adhered to medications if she or he had any prescription record in the 4 preceding quarters and 1 quarter after each quarter of interest. Acute severe CVD events are defined based on the World Health Organization’s Monitoring Trends and Determinants in Cardiovascular Disease Project, including acute coronary heart disease, stroke, and heart failure. As causes of death are not available, the number of CVD deaths will be computed using the most recent systolic blood pressure distributions and the population attributable risks related to systolic blood pressure level. Results The project was funded by Diabetes Action Canada (reference number: 503854) and approved by the University of Toronto Research Ethics Board (reference number: 36065). The project started in June 2018 and is expected to be finished by September 2019. Conclusions The findings will be helpful in identifying the challenges of treatment adherence for diabetic and hypertensive patients in primary care settings. This will also help to develop intervention strategies to promote treatment adherence for patients with multi-morbidities. International Registered Report Identifier (IRRID) DERR1-10.2196/13571
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Affiliation(s)
- Min Su
- School of Public Administration, Inner Mongolia University, Hohhot, China.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Victoria Haldane
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Ross Upshur
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Lunenfeld Tanenbaum Research Institute, Sinai Health Systems, Toronto, ON, Canada.,Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Frank Sullivan
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,School of Medicine, University of St Andrews, North Haugh, United Kingdom
| | - France Légaré
- Faculty of Medicine, Laval University, Quebec, QC, Canada
| | - Michelle Greiver
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,North York General Hospital, Toronto, ON, Canada
| | - Xiaolin Wei
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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22
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Newman-Casey PA, Niziol LM, Mackenzie CK, Resnicow K, Lee PP, Musch DC, Heisler M. Personalized behavior change program for glaucoma patients with poor adherence: a pilot interventional cohort study with a pre-post design. Pilot Feasibility Stud 2018; 4:128. [PMID: 30062043 PMCID: PMC6055343 DOI: 10.1186/s40814-018-0320-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 07/05/2018] [Indexed: 01/17/2023] Open
Abstract
Background About half of people with glaucoma do not adhere to their recommended medications. Interventions for other chronic conditions have successfully utilized reminder systems and motivational interviewing (MI)-based counseling. This study was designed to pilot a personalized intervention that leverages these strategies to assess their impact on medication adherence in glaucoma patients. Methods Glaucoma patients taking ≥ 1 medication will be pre-screened by telephone survey for adherence to their medication(s). Those who self-report poor adherence will be enrolled in a 3-month monitoring period to measure medication adherence using electronic medication monitors. Participants who are non-adherent (take </=80% of their medication doses) over the 3-month run in phase will be eligible for the study. We plan to enroll 57 participants who are non-adherent to their medications. Participants' adherence will then be continuously measured with electronic medication monitors, by self-report, and via pharmacy refill data over 2 years, during which two successively more resource-intensive components of an intervention aimed to improve medication adherence will be administered. The first component is a 3-month period of reminders (audio and/or visual) and text message or automated phone call if a dose of medication is not taken within a pre-specified time frame. The second component is a 6-month MI-based counseling program with a trained glaucoma counselor. This component uses the eyeGuide, a computer-based personalized behavior change program that enables para-professional staff to provide personalized education and counseling for glaucoma. The primary outcome is change in medication adherence. The secondary outcomes include changes in clinical outcomes (intraocular pressure, IOP, and IOP fluctuation) and psychosocial mediators of adherence (e.g., competence, energy for change and satisfaction). Participants will undergo semi-structured interviews at 12 months to give feedback about the counseling program in order to improve it. Discussion This pilot study will provide insight into ways to deliver more personalized health care to non-adherent glaucoma patients in order to better support them in managing their chronic disease. Trial registration Retrospectively registered with ClinicalTrials.gov (NCT03159247).
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Affiliation(s)
- Paula Anne Newman-Casey
- 1Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, 1000 Wall Street, Ann Arbor, MI 48105 USA
| | - Leslie M Niziol
- 1Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, 1000 Wall Street, Ann Arbor, MI 48105 USA
| | - Chamisa K Mackenzie
- 1Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, 1000 Wall Street, Ann Arbor, MI 48105 USA
| | - Kenneth Resnicow
- 2Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI 48105 USA
| | - Paul P Lee
- 1Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, 1000 Wall Street, Ann Arbor, MI 48105 USA
| | - David C Musch
- 1Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, 1000 Wall Street, Ann Arbor, MI 48105 USA.,3Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI 48105 USA
| | - Michele Heisler
- 4Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI 48109 USA
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Tominaga Y, Aomori T, Hayakawa T, Kijima N, Morisky DE, Takahashi K, Mochizuki M. Possible associations of personality traits representing harm avoidance and self-directedness with medication adherence in Japanese patients with type 2 diabetes. J Pharm Health Care Sci 2018; 4:16. [PMID: 29988655 PMCID: PMC6029079 DOI: 10.1186/s40780-018-0112-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 06/01/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Insufficient medication adherence in diabetes patients, of which numbers continue to increase globally, remains a critical issue. Medication adherence is multifactorial and determined by interactions among factors including socioeconomic status, health care team and system, condition, therapy, and patient-specific factors. On the other hand, personality traits have been studied in adherence other than to medication. Using the instruments of Temperament and Character Inventory (TCI), Harm Avoidance (TCI-HA) and Self-directedness (TCI-SD) showed distinguishing associations with adherence of health-related programs. However, few studies have been performed to elucidate psychometric properties related to medication adherence. We investigated how TCI-HA and TCI-SD of patients with diabetes are related to medication adherence. METHOD A cross-sectional survey was conducted among type 2 diabetes patients recruited at medical institutions or via an online research company. Medication adherence was measured using the 8-item Morisky Medication Adherence Scale (MMAS-8). Personality traits were assessed using the established scales of TCI-HA and TCI-SD. Univariate and multivariate regression analyses of the MMAS-8 scores were performed in addition to assessing demographic and disease characteristics and TCI-HA and TCI-SD. RESULTS A total of 358 responses were analyzed. Multivariate regression analysis of MMAS-8 scores revealed that higher TCI-SD was related to better adherence and experiencing drug-related side effects was related to poor adherence. Aging was significantly associated with better medication adherence in univariate regression analysis but became insignificant in multivariate regression. CONCLUSIONS In diabetes patients, the anxiety reflected in TCI-HA tends to lower and the self-control reflected in TCI-SD tends to promote medication adherence. TCI-SD has a greater effect than TCI-HA.
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Affiliation(s)
- Yoshiko Tominaga
- Division of Hospital Pharmacy Science, Graduate School of Pharmaceutical Sciences, Keio University, 1-5-30 Shibakoen, Minato-ku, Tokyo, 105-8512 Japan
| | - Tohru Aomori
- Division of Hospital Pharmacy Science, Faculty of Pharmacy, Keio University, 1-5-30 Shibakoen, Minato-ku, Tokyo, 105-8512 Japan
| | - Tomohisa Hayakawa
- Division of Hospital Pharmacy Science, Faculty of Pharmacy, Keio University, 1-5-30 Shibakoen, Minato-ku, Tokyo, 105-8512 Japan
| | - Nobuhiko Kijima
- Psychological Laboratory, Keio University, 4-1-1 Hiyoshi, Kohoku-ku, Yokohama, 223-8521 Japan
| | - Donald E. Morisky
- Department of Community Health Sciences, UCLA Fielding School of Public Health, 650 Charles E. Young Drive South, Los Angeles, CA 90095-1772 USA
| | - Kunihiko Takahashi
- Department of Clinical Epidemiology and Biostatistics, Graduate School of Medicine, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 Japan
| | - Mayumi Mochizuki
- Division of Hospital Pharmacy Science, Graduate School of Pharmaceutical Sciences, Keio University, 1-5-30 Shibakoen, Minato-ku, Tokyo, 105-8512 Japan
- Division of Hospital Pharmacy Science, Faculty of Pharmacy, Keio University, 1-5-30 Shibakoen, Minato-ku, Tokyo, 105-8512 Japan
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24
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Gillani SW, Ansari IA, Zaghloul HA, Abdul MIM, Sulaiman SAS, Baig MR, Rathore HA. Women with Type 1 Diabetes Mellitus: Effect of Disease and Psychosocial-Related Correlates on Health-Related Quality of Life. J Diabetes Res 2018; 2018:4079087. [PMID: 29854822 PMCID: PMC5960573 DOI: 10.1155/2018/4079087] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 04/08/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND This study is aimed at investigating the various disease-specific and health-related psychosocial concepts of HRQOL among insulin-dependent diabetes mellitus (IDDM) and understanding the gender differences in HRQOL among IDDM patients. METHODS A cross-sectional observational study was conducted to assess the effect of health-related and psychosocial correlates on HRQOL of IDDM patients in Penang, Malaysia. The participants were recruited from five governmental diabetic clinics. Patients with insulin use only, IDDM diagnosed at least 1 year earlier, were identified from clinical registers. The sample was then age stratified for 20-64 years, and severe complications (e.g., end-stage renal failure, hemodialysis, and liver cirrhosis) were excluded; a total of 1003 participants were enrolled in the study. Multivariate regression analysis was used to predict the response. RESULTS A total of 853 (100%) participants were enrolled and completed the study. Women exhibited significantly higher/better mental health (p < 0.013) and health perception scores (p < 0.001) despite high prevalence of impaired role (49.2%), social (24.2%), and physical (40.5%) functionings as compared to men. Women with longer diabetes exposure and uncontrolled glycemic levels (HbA1c) have poorer HRQOL. Availability of social support showed no significant association with either HRQOL or diabetes distress levels. Diabetes distress levels remained not associated with social support. Women also showed significantly higher association with health perception (15% versus 13% men, p < 0.001) and mental health (13% versus 11% men, p < 0.001) in diabetes-specific psychosocial factors. Thus, among women alone, diabetes-related specific and psychosocial factors explained 15% and 13% of variations in HRQOL extents, respectively. CONCLUSION Women exhibit extensive and significant patterns with health-related factors and diabetes-specific psychosocial factors (self-efficacy, social support, and DLC) to improve HRQOL. Also, women have significantly high reported distress levels and low social functioning compared to men.
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Affiliation(s)
- Syed Wasif Gillani
- College of Pharmacy, Taibah University, Al Madinah Al Munawarah, Saudi Arabia
| | - Irfan Altaf Ansari
- Department of Pathology, College of Medicine, Taibah University, Al Madinah Al Munawarah, Saudi Arabia
| | - Hisham A. Zaghloul
- College of Pharmacy, Taibah University, Al Madinah Al Munawarah, Saudi Arabia
| | | | | | | | - Hassaan Anwar Rathore
- School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM), Penang, Malaysia
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25
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Is patient empowerment the key to promote adherence? A systematic review of the relationship between self-efficacy, health locus of control and medication adherence. PLoS One 2017; 12:e0186458. [PMID: 29040335 PMCID: PMC5645121 DOI: 10.1371/journal.pone.0186458] [Citation(s) in RCA: 279] [Impact Index Per Article: 39.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 10/02/2017] [Indexed: 01/17/2023] Open
Abstract
Background Current health policies emphasize the need for an equitable doctor-patient relationship, and this requires a certain level of patient empowerment. However, a systematic review of the empirical evidence on how empowerment affects medication adherence—the extent to which patients follow the physician’s prescription of medication intake—is still missing. The goal of this systematic review is to sum up current state-of-the-art knowledge concerning the relationship between patient empowerment and medication adherence across medical conditions. As our conceptualization defines health locus of control and self-efficacy as being crucial components of empowerment, we explored the relationship between these two constructs and medication adherence. Methods Relevant studies were retrieved through a comprehensive search of Medline and PsychINFO databases (1967 to 2017). In total, 4903 publications were identified. After applying inclusion and exclusion criteria and quality assessment, 154 articles were deemed relevant. Peer-reviewed articles, written in English, addressing the relationship between empowerment (predictor) and medication adherence (outcome) were included. Findings High levels of self-efficacy and Internal Health Locus of Control are consistently found to promote medication adherence. External control dimensions were found to have mainly negative (Chance and God attributed control beliefs) or ambiguous (Powerful others attributed control beliefs) links to adherence, except for Doctor Health Locus of Control which had a positive association with medication adherence. To fully capture how health locus of control dimensions influence medication adherence, the interaction between the sub-dimensions and the attitudinal symmetry between the doctor and patient, regarding the patient’s control over the disease management, can provide promising new alternatives. Discussion The beneficial effect of patients’ high internal and concurrent physician-attributed control beliefs suggests that a so-called “joint empowerment” approach can be suitable in order to foster medication adherence, enabling us to address the question of control as a versatile component in the doctor-patient relationship.
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Lunghi C, Zongo A, Moisan J, Grégoire JP, Guénette L. The impact of incident depression on medication adherence in patients with type 2 diabetes. DIABETES & METABOLISM 2017; 43:521-528. [PMID: 28822618 DOI: 10.1016/j.diabet.2017.07.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 06/09/2017] [Accepted: 07/14/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Depression has been correlated with suboptimal adherence to antidiabetic drugs (ADs). Most studies on this topic were cross-sectional; thus, the directionality of this relationship could not be established. The objective of this study was to measure the association between incident depression and AD nonadherence among newly treated patients with diabetes. METHODS We performed a population-based cohort study among new AD users using the Quebec public health insurance data. To avoid immortal time bias, we carried out depression diagnosis-time distribution matching by assigning a date of depression diagnosis to individuals without depression. Nonadherence (i.e.,<90% of days covered by≥1 AD) during the year following depression diagnosis (real or assigned date) was the outcome. Multivariate logistic regression analyses that adjusted for baseline adherence and other confounders were used to estimate the adjusted effect of depression on AD nonadherence. RESULTS Between 2000 and 2006, we identified 3,106 new AD users with a subsequent diagnosis of depression and 70,633 without depression, of which 52% and 49% became non-adherent to AD treatment, respectively. Among patients with depression, 52.0% were considered AD non-adherent in the year after depression diagnosis compared with 49.0% of matched patients without depression. Depression was associated with AD nonadherence after accounting for baseline adherence and other confounders with an adjusted odds ratio of 1.24 (95% confidence interval: 1.13-1.37). CONCLUSIONS The results suggest that depression is an independent risk factor for AD nonadherence. Patients with type 2 diabetes and depression might benefit from adherence-enhancing interventions.
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Affiliation(s)
- C Lunghi
- Faculty of Pharmacy, Université Laval, Québec, QC, Canada; Chair on Adherence to Treatments, Université Laval, Québec, QC, Canada; Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Center, Université Laval, Québec, QC, Canada
| | - A Zongo
- Faculty of Pharmacy, Université Laval, Québec, QC, Canada; Chair on Adherence to Treatments, Université Laval, Québec, QC, Canada; Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Center, Université Laval, Québec, QC, Canada
| | - J Moisan
- Faculty of Pharmacy, Université Laval, Québec, QC, Canada; Chair on Adherence to Treatments, Université Laval, Québec, QC, Canada; Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Center, Université Laval, Québec, QC, Canada
| | - J-P Grégoire
- Faculty of Pharmacy, Université Laval, Québec, QC, Canada; Chair on Adherence to Treatments, Université Laval, Québec, QC, Canada; Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Center, Université Laval, Québec, QC, Canada
| | - L Guénette
- Faculty of Pharmacy, Université Laval, Québec, QC, Canada; Chair on Adherence to Treatments, Université Laval, Québec, QC, Canada; Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Center, Université Laval, Québec, QC, Canada.
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Lunghi C, Zongo A, Moisan J, Grégoire JP, Guénette L. Factors associated with antidiabetic medication non-adherence in patients with incident comorbid depression. J Diabetes Complications 2017; 31:1200-1206. [PMID: 28325698 DOI: 10.1016/j.jdiacomp.2017.02.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 02/09/2017] [Accepted: 02/10/2017] [Indexed: 10/20/2022]
Abstract
AIM To identify factors associated with antidiabetic drug (AD) non-adherence among patients with type 2 diabetes and depression. STUDY DESIGN AND SETTINGS We conducted a population-based retrospective cohort study among new AD users with a diagnosis of depression following AD initiation. We used public health insurance data from Quebec. The dependent variable was non-adherence (i.e., <90% of days covered by ≥1AD) in the year after a depression diagnosis. Different sociodemographic, clinical and medication-related variables were assessed as potential factors of non-adherence to AD treatment. We performed univariate and multivariate logistic regressions. RESULTS We identified 3106 new users of ADs with a diagnosis of depression between 2000 and 2006. Of these individuals, 52% were considered non-adherent to their ADs. Baseline non-adherence, younger age, the addition of another AD to the initial treatment, <4 drug claims, visits with several different physicians, high socioeconomic status, and a small number of diabetes complications were associated with AD non-adherence. CONCLUSIONS The factors identified in the present study may help clinicians recognize patients with type 2 diabetes and incident depression at increased risk for non-adherence. In these patients, close follow-up and targeted interventions could help improve adherence to AD treatment, improve glycemic control and reduce complications.
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Affiliation(s)
- Carlotta Lunghi
- Faculty of Pharmacy, Université Laval, Québec, QC, Canada; Chair on Adherence to Treatments, Université Laval, Québec, QC, Canada; Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Centre - Université Laval, Québec, QC, Canada
| | - Arsène Zongo
- Faculty of Pharmacy, Université Laval, Québec, QC, Canada; Chair on Adherence to Treatments, Université Laval, Québec, QC, Canada; Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Centre - Université Laval, Québec, QC, Canada
| | - Jocelyne Moisan
- Faculty of Pharmacy, Université Laval, Québec, QC, Canada; Chair on Adherence to Treatments, Université Laval, Québec, QC, Canada; Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Centre - Université Laval, Québec, QC, Canada
| | - Jean-Pierre Grégoire
- Faculty of Pharmacy, Université Laval, Québec, QC, Canada; Chair on Adherence to Treatments, Université Laval, Québec, QC, Canada; Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Centre - Université Laval, Québec, QC, Canada
| | - Line Guénette
- Faculty of Pharmacy, Université Laval, Québec, QC, Canada; Chair on Adherence to Treatments, Université Laval, Québec, QC, Canada; Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Centre - Université Laval, Québec, QC, Canada.
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28
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Lunghi C, Moisan J, Grégoire JP, Guénette L. The Association between Depression and Medication Nonpersistence in New Users of Antidiabetic Drugs. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2017; 20:728-735. [PMID: 28577689 DOI: 10.1016/j.jval.2016.09.2399] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 07/25/2016] [Accepted: 09/10/2016] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To measure the association between depression and nonpersistence with antidiabetic drugs (ADs) among new users of oral ADs and to estimate factors associated with nonpersistence among these new users with depression. METHODS We used administrative claims data to identify an adult cohort (≥18 years) of new oral AD users who were free of depression. We followed the patients from AD initiation until either discontinuation, ineligibility for the public drug plan, death, or the end of the study. A proportional hazard Cox regression model with depression as a time-dependent variable was used to compute the adjusted hazard ratio of nonpersistence. A proportional hazard Cox regression model was also used to identify factors associated with nonpersistence in the subcohort of patients with depression. RESULTS We identified 114,366 new oral AD users, of whom 4,808 were diagnosed with depression during the follow-up. A greater proportion (55.4%) of patients with depression (vs. 42.5% without depression) discontinued their treatment during the follow-up. The adjusted hazard ratio of nonpersistence with ADs was 1.52 (95% confidence interval 1.41-1.63). Among patients with depression, independent factors associated with nonpersistence included younger age at oral AD initiation (<45 years) and starting treatment with drugs other than metformin (especially polytherapy with insulin). CONCLUSIONS Patients with depression are more likely to discontinue their treatment. Health care professionals should pay attention to patients on AD therapy who also suffer from depression, especially if the patients are young or are using insulin because these patients are at an increased risk of nonpersistence.
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Affiliation(s)
- Carlotta Lunghi
- Faculty of Pharmacy, Laval University, Quebec, Quebec, Canada; Chair on Adherence to Treatments, Laval University, Quebec, Quebec, Canada; Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Center, Laval University, Quebec, Quebec, Canada
| | - Jocelyne Moisan
- Faculty of Pharmacy, Laval University, Quebec, Quebec, Canada; Chair on Adherence to Treatments, Laval University, Quebec, Quebec, Canada; Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Center, Laval University, Quebec, Quebec, Canada
| | - Jean-Pierre Grégoire
- Faculty of Pharmacy, Laval University, Quebec, Quebec, Canada; Chair on Adherence to Treatments, Laval University, Quebec, Quebec, Canada; Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Center, Laval University, Quebec, Quebec, Canada
| | - Line Guénette
- Faculty of Pharmacy, Laval University, Quebec, Quebec, Canada; Chair on Adherence to Treatments, Laval University, Quebec, Quebec, Canada; Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Center, Laval University, Quebec, Quebec, Canada.
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Otieno CFF, Kanu JE, Karari EM, Okech-Helu V, Joshi MD, Mutai K. Glucose-lowering therapies, adequacy of metabolic control, and their relationship with comorbid depression in outpatients with type 2 diabetes in a tertiary hospital in Kenya. Diabetes Metab Syndr Obes 2017; 10:141-149. [PMID: 28496345 PMCID: PMC5417660 DOI: 10.2147/dmso.s124473] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Depression and diabetes mellitus are important comorbid conditions with serious health consequences. When depression and diabetes are comorbid, depression negatively affects self-management activities of diabetes with serious consequences. Relationship between treatment regimens of diabetes, the adequacy of glycemic control, and occurrence of comorbid depression is not known among our patients. PATIENTS AND METHODS This was a cross-sectional descriptive study at the outpatient diabetes clinic of the Kenyatta National Hospital where 220 ambulatory patients with type 2 diabetes on follow-up were systematically sampled. Sociodemographic data and clinical information were documented. The Patient Health Questionnaire-9 (PHQ-9) was used to assess depression. Ethylenediaminetetraacetic acid-anticoagulated blood was used for glycated hemoglobin (HbA1C) assay on automated system, COBAS INTEGRA machine. RESULTS Two hundred twenty patients with type 2 diabetes were enrolled. The prevalence of comorbid depression by PHQ-9 was 32.3% (95% confidence interval: 26.4%-38.6%). The majority, 69.5%, had poor glycemic control, HbA1C >7.0%, mean HbA1C was 8.9%±2.4%. Half, 50.4%, of the study subjects were on insulin-containing regimens. Over 8% (84.5%) of the participants with comorbid depression had poor glycemic control, which worsened with increasing severity of depression. There was significant correlation between comorbid depression and poor glycemic control, which is more consistent in the insulin-treated patients. However, patients on oral agents only, both with and without comorbid depression, were similar in their glycemic control. CONCLUSION Among our type 2 diabetic population with comorbid depression, a large proportion had poor glycemic control, which worsened with increasing severity of depression. The insulin treatment increased the odds of comorbid depression and poor glycemic control in patients. It is justifiable to screen for comorbid depression in patients with type 2 diabetes who are in poor glycemic control, especially the insulin-treated, and then provide specific and appropriate interventions that are necessary to optimize their metabolic outcomes.
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Affiliation(s)
| | - Joseph E Kanu
- Department of Clinical Medicine and Therapeutics, University of Nairobi
| | - Emma M Karari
- Department of Clinical Medicine and Therapeutics, University of Nairobi
| | | | - Mark D Joshi
- Department of Clinical Medicine and Therapeutics, University of Nairobi
| | - Kenn Mutai
- Kenyatta National Hospital, Nairobi, Kenya
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Heisler M, Mase R, Brown B, Wilson S, Reeves PJ. Study protocol: The Technology-Enhanced Coaching (TEC) program to improve diabetes outcomes - A randomized controlled trial. Contemp Clin Trials 2017; 55:24-33. [PMID: 28132876 PMCID: PMC5510884 DOI: 10.1016/j.cct.2017.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 01/19/2017] [Accepted: 01/21/2017] [Indexed: 10/20/2022]
Abstract
Background Racial and ethnic minority adults with diabetes living in under-resourced communities face multiple barriers to sustaining self-management behaviors necessary to improve diabetes outcomes. Peer support and decision support tools each have been associated with improved diabetes outcomes. Methods 290 primarily African American adults with poor glycemic control were recruited from the Detroit Veteran's Administration Hospital and randomized to Technology-Enhanced Coaching (TEC) or Peer Coaching alone. Participants in both arms were assigned a peer coach trained in autonomy-supportive approaches. Coaches are diabetes patients with prior poor glycemic control who now have good control. Participants met face-to-face initially with their coach to review diabetes education materials and develop an action plan. Educational materials in the TEC arm are delivered via a web-based, educational tool tailored with each participant's personalized health data (iDecide). Over six months, coaches call their assigned participants once a week to provide support for weekly action steps. Data are also collected on an Observational Control group with no contact with study staff. Changes in A1c, blood pressure, other patient-centered outcomes and mediators and moderators of intervention effects will be assessed. Results 290 participants were enrolled. Discussion Tailored e-Health tools with educational content may enhance the effectiveness of peer coaching programs to better prepare patients to set self-management goals, identify action plans, and discuss treatment options with their health care providers. The study will provide insights for scalable self-management support programs for diabetes and chronic illnesses that require high levels of sustained patient self-management.
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Affiliation(s)
- Michele Heisler
- Center for Clinical Management Research Ann Arbor VA, HSR&D, Ann Arbor, MI, United States; Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, MI, United States
| | - Rebecca Mase
- Center for Clinical Management Research Ann Arbor VA, HSR&D, Ann Arbor, MI, United States; Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, MI, United States.
| | - Brianne Brown
- Center for Clinical Management Research Ann Arbor VA, HSR&D, Ann Arbor, MI, United States
| | - Shayla Wilson
- Center for Clinical Management Research Ann Arbor VA, HSR&D, Ann Arbor, MI, United States
| | - Pamela J Reeves
- John D. Dingell VA Medical Center, Detroit, MI, United States
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Khorsandi M, Fekrizadeh Z, Roozbahani N. Investigation of the effect of education based on the health belief model on the adoption of hypertension-controlling behaviors in the elderly. Clin Interv Aging 2017; 12:233-240. [PMID: 28184154 PMCID: PMC5291452 DOI: 10.2147/cia.s117142] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Purpose Hypertension is one of the risk factors for cardiovascular diseases and stroke, and has a direct relationship with aging. The aim of this study was to investigate the effect of education based on the health belief model (HBM) on the adoption of hypertension-controlling behaviors in the elderly. Methods The present quasiexperimental study was conducted on 100 hypertensive elderly persons from Qom, Iran. The questionnaire was completed by the participants before, immediately after, and 3 months after the intervention. Results The results of repeated measure analysis of variance showed a significant difference in the scores of the constructs in the intervention and nonintervention groups before, immediately after, and 3 months after the intervention (P<0.001). Conclusion Education based on the HBM increases the performance and enhances the health beliefs regarding hypertension in the elderly population with hypertension. Therefore, it is recommended to consider the HBM to enhance self-care behaviors in the elderly.
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Abstract
Adherence to antihypertensive medication remains a key modifiable factor in the management of hypertension. The multidimensional nature of adherence and blood pressure (BP) control call for multicomponent, patient-centered interventions to improve adherence. Promising strategies to improve antihypertensive medication adherence and BP control include regimen simplification, reduction of out-of-pocket costs, use of allied health professionals for intervention delivery, and self-monitoring of BP. Research to understand the effects of technology-mediated interventions, mechanisms underlying adherence behavior, and sex-race differences in determinants of low adherence and intervention effectiveness may enhance patient-specific approaches to improve adherence and disease control.
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Affiliation(s)
- Erin Peacock
- Department of Medicine, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70112, USA
| | - Marie Krousel-Wood
- Department of Medicine, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70112, USA; Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, New Orleans, LA 70112, USA; Center for Health Research, Ochsner Clinic Foundation, 1514 Jefferson Highway, New Orleans, LA 70121, USA.
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Nelson LA, Mayberry LS, Wallston K, Kripalani S, Bergner EM, Osborn CY. Development and Usability of REACH: A Tailored Theory-Based Text Messaging Intervention for Disadvantaged Adults With Type 2 Diabetes. JMIR Hum Factors 2016; 3:e23. [PMID: 27609738 PMCID: PMC5034151 DOI: 10.2196/humanfactors.6029] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 08/11/2016] [Accepted: 08/21/2016] [Indexed: 12/22/2022] Open
Abstract
Background Among adults with type 2 diabetes mellitus (T2DM), adherence to recommended self-care activities is suboptimal, especially among racial and ethnic minorities with low income. Self-care nonadherence is associated with having worse glycemic control and diabetes complications. Text messaging interventions are improving the self-care of adults with T2DM, but few have been tested with disadvantaged populations. Objective To develop Rapid Education/Encouragement And Communications for Health (REACH), a tailored, text messaging intervention to support the self-care adherence of disadvantaged patients with T2DM, based on the Information-Motivation-Behavioral skills model. We then tested REACH’s usability to make improvements before evaluating its effects. Methods We developed REACH’s content and functionality using an empirical and theory-based approach, findings from a previously pilot-tested intervention, and the expertise of our interdisciplinary research team. We recruited 36 adults with T2DM from Federally Qualified Health Centers to participate in 1 of 3 rounds of usability testing. For 2 weeks, participants received daily text messages assessing and promoting self-care, including tailored messages addressing users’ unique barriers to adherence, and weekly text messages with adherence feedback. We analyzed quantitative and qualitative user feedback and system-collected data to improve REACH. Results Participants were, on average, 52.4 (SD 9.5) years old, 56% (20/36) female, 63% (22/35) were a racial or ethnic minority, and 67% (22/33) had an income less than US $35,000. About half were taking insulin, and average hemoglobin A1c level was 8.2% (SD 2.2%). We identified issues (eg, user concerns with message phrasing, technical restrictions with responding to assessment messages) and made improvements between testing rounds. Overall, participants favorably rated the ease of understanding (mean 9.6, SD 0.7) and helpfulness (mean 9.3, SD 1.4) of self-care promoting text messages on a scale of 1-10, responded to 96% of assessment text messages, and rated the helpfulness of feedback text messages 8.5 (SD 2.7) on a scale of 1-10. User feedback led to refining our study enrollment process so that users understood the flexibility in message timing and that computers, not people, send the messages. Furthermore, research assistants’ feedback on the enrollment process helped improve participants’ engagement with study procedures. Conclusions Testing technology-delivered interventions with disadvantaged adults revealed preferences and concerns unique to this population. Through iterative testing and multiple data sources, we identified and responded to users’ intervention preferences, technical issues, and shortcomings in our research procedures.
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Affiliation(s)
- Lyndsay A Nelson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
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Xu D, Chen L, Wan X, Zhang Y, Liu N, Wang K. Toileting behaviour and related health beliefs among Chinese female nurses. Int J Clin Pract 2016; 70:416-23. [PMID: 27040143 DOI: 10.1111/ijcp.12798] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
AIMS To investigate the toileting behaviours that female nurses used to empty their bladders, health beliefs related to toileting behaviour and the relationships between the health beliefs and toileting behaviour based on the Health Belief Model. METHODS A stratified cluster sampling strategy was used to recruit 636 female nurses from three tertiary hospitals in China. Reliable and valid questionnaires were used to assess female nurses' toileting behaviour and health beliefs related to toileting behaviour. The structural equation model was applied to explore the relationships between health belief constructs and toileting behaviour. RESULTS The most common unhealthy toileting behaviour was that of delayed voiding. More than half of the nurses (53.6%) often or always delayed emptying their bladders when they were busy. Approximately one-third of female nurses often or always crouched over the toilet to empty their bladders when not at home. Nearly two-thirds often or always worried about the cleanliness of public toilets. Of all the participants, 67.5% of female nurses had at least one type of lower urinary tract symptom (LUTS); however, the majority did not believe that they were susceptible to these symptoms. Moreover, they had misconceptions that premature voiding would reduce the risk, relieve the symptoms and prevent the recurrence of LUTS. CONCLUSIONS Many female nurses engaged in unhealthy toileting behaviours and might not know what types of toileting behaviours are healthy. Nurses play an important role in patient education and are a major source of health information for society. It is particularly important to look more closely at toileting behaviour among nurses and implement education and training to promote healthy toileting behaviour and, in turn, optimise bladder health.
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Affiliation(s)
- D Xu
- School of Nursing, Shandong University, Jinan, China
- School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - L Chen
- School of Nursing, Shandong University, Jinan, China
| | - X Wan
- Department of Nursing, School of medicine, Yangzhou University, Yangzhou, China
| | - Y Zhang
- School of Nursing, College of Health Sciences, University of Massachusetts Lowell, Lowell, MA, USA
| | - N Liu
- School of Nursing, Shandong University, Jinan, China
| | - K Wang
- School of Nursing, Shandong University, Jinan, China
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Sen R, Shields AL, Atsuda K. Patient Preference for Once-Weekly Dosing in Type 2 Diabetes Mellitus in Japan. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2016; 4:55-66. [PMID: 37663012 PMCID: PMC10471358 DOI: 10.36469/9826] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
Background: Among several factors that impair adherence to available therapies in type 2 diabetes mellitus (T2DM) is the complexity of the dosing regimen. Moreover, the value of a once-weekly (QW) administration of oral medications for T2DM compared to once, twice, or thrice daily (QD, BID, TID) regimens is unclear. This study aims to identify subgroups and patient characteristics correlated with a preference for QW dosing compared to daily dosing using survey-based methods. Methods: This was a cross-sectional online survey study among patients with T2DM in Japan. Patients with T2DM were categorized into one of the three groups: (1) patients on treatment with oral hypoglycemic agent(s) only, (2) patients on combination treatment with oral hypoglycemic agent(s) and insulin, and (3) patients diagnosed with or suspected to have T2DM with no current or past experience with T2DM drug treatment (treatment naïve). Preliminary logistic regressions and classification and regression tree analysis (QW/QD dosing preferences as the dependent variable) were conducted to identify key predictors of dosing preference, followed by an evaluation of frequencies and trends in dosing preferences by the identified factors (subgroups). Results: Current treatment regimen, age, and work status were identified as the major demographic factors that were most predictive of QW preference. While, overall, 55.5% preferred QD and 33.3% preferred QW, the preference toward QW is higher in a specific cohort of patients that is treatment naïve (i.e., patients diagnosed with T2DM and/on diet/exercise therapy with no current or past experience with T2DM drug treatment) than who are on treatment, younger (age ≤64 years old), working full-time than part-time, and/or currently taking 0 or 1 drugs or more than 6 drugs (68.67% versus 30.12%). The most commonly cited reasons for QW preference were (1) "less burdensome because they didn't have to take it every day" (47.8%), (2) "less psychological burden" (14.6%), and (3) "forget to take it less often"(12.5%). Conclusion: Patients with T2DM vary in terms of preference for dosing regimens. Daily dosing was preferred over QW dosing in the overall population, however, preference for QW was higher in younger, full-time working, treatment naïve subjects, who are/or currently taking 0 or 1 drugs or more than 6 drugs.
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Guénette L, Breton MC, Guillaumie L, Lauzier S, Grégoire JP, Moisan J. Psychosocial factors associated with adherence to non-insulin antidiabetes treatments. J Diabetes Complications 2016; 30:335-42. [PMID: 26615905 DOI: 10.1016/j.jdiacomp.2015.10.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 10/08/2015] [Accepted: 10/21/2015] [Indexed: 11/28/2022]
Abstract
AIMS To discern psychosocial factors of non-insulin antidiabetes drug (NIAD) adherence. METHODS A cross-sectional study based on the theory of planned behavior (TPB). Adults with type 2 diabetes (T2D) who were members of Diabète Québec, a provincial association of persons with diabetes, and were prescribed at least one NIAD were invited to complete a web-based questionnaire. We measured variables ascertaining TPB constructs and other factors potentially associated with NIAD adherence (e.g., habit, social support, and mental health). NIAD adherence was assessed using the 8-item Morisky Medication Adherence Scale. Factors were identified using a multivariate logistic regression model. RESULTS In our study, 901 participants (373 women; 515 retired; mean age: 62.7 years) with T2D for a mean of 10 years, completed the questionnaire. Participants exhibited a high intention to adhere to their NIAD treatment (mean score=5.8/6), positive attitudes toward adherence (mean score=5.5/6), and elevated perceived behavioral control in taking their medication (mean score=5.7/6). Only 405 (45%) participants reported high adherence (score=8/8). Perceived behavioral control, habit, older age, no perceived side effects, a longer period since T2D diagnosis and a lower number of NIAD daily doses were significantly associated with adherence (p<0.05). CONCLUSION We identified several factors that may be modified for NIAD adherence and thereby provided insight into future adherence-enhancing intervention targets.
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Affiliation(s)
- Line Guénette
- Faculty of Pharmacy, Laval University, Quebec City, QC, Canada; Chair on Adherence to Treatments, Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Center, Quebec City, QC, Canada.
| | - Marie-Claude Breton
- Faculty of Pharmacy, Laval University, Quebec City, QC, Canada; Chair on Adherence to Treatments, Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Center, Quebec City, QC, Canada
| | - Laurence Guillaumie
- Chair on Adherence to Treatments, Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Center, Quebec City, QC, Canada; Faculty of Nursing, Laval University, Quebec City, QC, Canada
| | - Sophie Lauzier
- Faculty of Pharmacy, Laval University, Quebec City, QC, Canada; Chair on Adherence to Treatments, Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Center, Quebec City, QC, Canada
| | - Jean-Pierre Grégoire
- Faculty of Pharmacy, Laval University, Quebec City, QC, Canada; Chair on Adherence to Treatments, Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Center, Quebec City, QC, Canada
| | - Jocelyne Moisan
- Faculty of Pharmacy, Laval University, Quebec City, QC, Canada; Chair on Adherence to Treatments, Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Center, Quebec City, QC, Canada
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Fässberg MM, Cheung G, Canetto SS, Erlangsen A, Lapierre S, Lindner R, Draper B, Gallo JJ, Wong C, Wu J, Duberstein P, Wærn M. A systematic review of physical illness, functional disability, and suicidal behaviour among older adults. Aging Ment Health 2016; 20:166-94. [PMID: 26381843 PMCID: PMC4720055 DOI: 10.1080/13607863.2015.1083945] [Citation(s) in RCA: 218] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To conduct a systematic review of studies that examined associations between physical illness/functional disability and suicidal behaviour (including ideation, nonfatal and fatal suicidal behaviour) among individuals aged 65 and older. METHOD Articles published through November 2014 were identified through electronic searches using the ERIC, Google Scholar, PsycINFO, PubMed, and Scopus databases. Search terms used were suicid* or death wishes or deliberate self-harm. Studies about suicidal behaviour in individuals aged 65 and older with physical illness/functional disabilities were included in the review. RESULTS Sixty-five articles (across 61 independent samples) met inclusion criteria. Results from 59 quantitative studies conducted in four continents suggest that suicidal behaviour is associated with functional disability and numerous specific conditions including malignant diseases, neurological disorders, pain, COPD, liver disease, male genital disorders, and arthritis/arthrosis. Six qualitative studies from three continents contextualized these findings, providing insights into the subjective experiences of suicidal individuals. Implications for interventions and future research are discussed. CONCLUSION Functional disability, as well as a number of specific physical illnesses, was shown to be associated with suicidal behaviour in older adults. We need to learn more about what at-risk, physically ill patients want, and need, to inform prevention efforts for older adults.
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Affiliation(s)
| | - Gary Cheung
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
| | | | - Annette Erlangsen
- Research Unit, Mental Health Centre Copenhagen, Denmark,Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Sylvie Lapierre
- Department of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Reinhard Lindner
- Geriatric Psychosomatics and Psychotherapy, Medical Geriatric Clinic Albertinen-Haus, University of Hamburg, Hamburg, Germany
| | - Brian Draper
- School of Psychiatry, University of NSW, Sydney, Australia
| | - Joseph J. Gallo
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | | | - Jing Wu
- Department of Sociology and Work Science, University of Gothenburg, Gothenburg, Sweden
| | - Paul Duberstein
- Department of Psychiatry and Family Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Margda Wærn
- Section of Psychiatry and Neurochemistry, University of Gothenburg/Sahlgrenska University Hospital, Gothenburg, Sweden,Corresponding author.
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von Arx LBW, Gydesen H, Skovlund S. Treatment beliefs, health behaviors and their association with treatment outcome in type 2 diabetes. BMJ Open Diabetes Res Care 2016; 4:e000166. [PMID: 27110367 PMCID: PMC4838662 DOI: 10.1136/bmjdrc-2015-000166] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Revised: 01/19/2016] [Accepted: 01/31/2016] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE While the prevalence of type 2 diabetes is growing, it is increasingly well recognized that treatment outcomes in primary care practice are often suboptimal. The aim of this study is to examine the extent to which treatment beliefs and health behaviors predict diabetes health outcome as measured by glycated hemoglobin (HbA1c) level, blood pressure, and lipid profile. RESEARCH DESIGN AND METHODS This was a large-scale cross-sectional, registry-based study involving a well-defined type 2 diabetes population, in the county of Funen, Denmark. Registry data were combined with a 27-item self-reported survey administered to all insulin-treated people in the registry (n=3160). The survey was constructed to operationalize key concepts of diabetes management, diabetes treatment beliefs, and health behaviors. RESULTS In total, 1033 respondents answered the survey. The majority of treatment beliefs and health behaviors examined were predictors of glycemic control and, to a large extent, lipid profile. Absence from, or a low frequency of, self-measured blood glucose, non-adherence to general medical advice and the prescribed treatment, a low primary care utilization, and perceived low treatment efficacy were factors positively associated with HbA1c levels, s-cholesterol, and low-density lipoprotein. Conversely, infrequent self-measured blood glucose was associated with a significantly higher likelihood of having a blood pressure below 130/80 mm Hg. Perceived low treatment efficacy was the only health belief associated with poorer levels of health outcome other than HbA1c. CONCLUSIONS Health behaviors were stronger predictors for health outcomes than treatment beliefs. Self-reported adherence to either the treatment regimen or general medical advice most consistently predicted both glycemic control and cardiovascular risk factors.
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Affiliation(s)
- Lill-Brith Wium von Arx
- Center for Health Economic Research (COHERE), University of Southern Denmark, Odense, Denmark
- Department of Epidemiology, Novo Nordisk A/S, Søborg, Denmark
| | - Helge Gydesen
- Department of Epidemiology, Novo Nordisk A/S, Søborg, Denmark
| | - Søren Skovlund
- Department of Health Economy and Outcomes Research, Novo Nordisk A/S, Søborg, Denmark
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Yostos M, Wyatt C, Konstantinidis I. Complex comorbidity and adherence to therapy for chronic kidney disease: disease perceptions & adherence in patients with comorbid HIV. BMC Proc 2015. [PMCID: PMC4625102 DOI: 10.1186/1753-6561-9-s7-a20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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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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Alzubaidi H, Mc Narmara K, Kilmartin GM, Kilmartin JF, Marriott J. The relationships between illness and treatment perceptions with adherence to diabetes self-care: A comparison between Arabic-speaking migrants and Caucasian English-speaking patients. Diabetes Res Clin Pract 2015; 110:208-17. [PMID: 26415673 DOI: 10.1016/j.diabres.2015.08.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 08/03/2015] [Accepted: 08/18/2015] [Indexed: 01/22/2023]
Abstract
AIMS To compare illness and treatment perceptions between Arabic-speaking immigrants and Caucasian English-speaking people with type 2 diabetes, and explore the relationships between these beliefs and adherence to self-care activities. METHODS A cross-sectional study was conducted in healthcare settings with large Arabic populations in metropolitan and rural Victoria, Australia. Adherence to self-care activities, illness and treatment perceptions, and clinical data were recorded. Bivariate associations for continuous normally distributed variables were tested with Pearson's correlation. Non-parametric data were tested using Spearman's rank correlation coefficient. RESULTS 701 participants were recruited; 392 Arabic-speaking participants (ASPs) and 309 English-speaking participants (ESPs). There were significant relationships between participants' illness and treatment perceptions and adherence to diabetes self-care activities. ASPs' negative beliefs about diabetes were strongly and significantly correlated with poorer adherence to diet recommendations, exercise, blood glucose testing and foot care. ASPs were significantly less adherent to all aspects of diabetes self-care compared with ESPs: dietary behaviours (P=<0.01; 95% confidence interval (CI)=-1.17, -0.84), exercise and physical activity (P=<0.001, 95% CI -1.14, -0.61), blood glucose testing (P=<0.001) and foot-care (P=<0.001). 52.8% of ASPs were sceptical about prescribed diabetes treatment compared with only 11.2% of the ESPs. 88.3% of ASPs were non-adherent to prescribed medication, compared with 45.1% of ESPs. CONCLUSIONS Arabic-speaking migrants' illness and treatment perceptions were significantly different from the English-speaking group. There is a pressing need to develop new innovative interventions that deliver much-needed improvements in adherence to self-care activities and key health outcomes.
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Affiliation(s)
- Hamzah Alzubaidi
- Centre for Medicine Use and Safety, Monash University, 381 Royal Parade, Parkville, Victoria 3052, Australia.
| | - Kevin Mc Narmara
- Greater Green Triangle University, Department of Rural Health, Flinders University and Deakin University, PO Box 423, Warrnambool, Victoria 3280, Australia; Centre for Medicine Use and Safety, Monash University, 381 Royal Parade, Parkville, Victoria 3052, Australia
| | - Gloria M Kilmartin
- Goulburn Valley Diabetes Centre, Goulburn Valley Health, Graham St., Shepparton, Victoria 3630, Australia; University of Melbourne, Faculty of Medicine, Dentistry and Health Science, Shepparton, Victoria 3630, Australia
| | - John F Kilmartin
- Goulburn Valley Diabetes Centre, Goulburn Valley Health, Graham St., Shepparton, Victoria 3630, Australia; University of Melbourne, Faculty of Medicine, Dentistry and Health Science, Shepparton, Victoria 3630, Australia
| | - Jennifer Marriott
- Centre for Medicine Use and Safety, Monash University, 381 Royal Parade, Parkville, Victoria 3052, Australia
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Krass I, Schieback P, Dhippayom T. Adherence to diabetes medication: a systematic review. Diabet Med 2015; 32:725-37. [PMID: 25440507 DOI: 10.1111/dme.12651] [Citation(s) in RCA: 279] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/25/2014] [Indexed: 11/28/2022]
Abstract
AIMS To investigate the extent of and factors associated with adherence to Type 2 diabetes medication. METHODS The CINAHL, Embase, International Pharmaceutical Abstracts, Medline, PubMed and PsychINFO databases were searched for the period January 2004 to July 2013. Papers were included in the present review if they reported the prevalence of adherence (the percentage of the study population that is classified as adherent) to Type 2 diabetes medication and used validated adherence measures with a defined cut-off point to indicate adherence. Reported factors were classified as potential predictors if the studies that examined that particular variable reported consistent findings. RESULTS Of the 27 studies included in the present review, the prevalence of adherence ranged from 38.5 to 93.1%. Only six out of 27 studies (22.2%) reported prevalence of adherence of ≥ 80% among their study population. Depression and medication cost were found to be consistent and potentially modifiable predictors for diabetes medication-taking behaviour. The associations between adherence and other factors were inconsistent among the reviewed studies. CONCLUSIONS Adherence to diabetes medication remains an ongoing problem. This review has highlighted the urgent need to develop consensus about what constitutes good adherence in diabetes. Further research is needed to clarify modifiable factors, in addition to depression and medication cost, that influence adherence and may provide a focus for targeted interventions to promote adherence, optimize diabetes control and limit the progression of diabetes.
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Affiliation(s)
- I Krass
- Faculty of Pharmacy, University of Sydney, Camperdown, NSW, Australia
| | - P Schieback
- University of Münster, North Rhine-Westphalia, Germany
| | - T Dhippayom
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
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Gonzalez JS, Shreck E, Psaros C, Safren SA. Distress and type 2 diabetes-treatment adherence: A mediating role for perceived control. Health Psychol 2015; 34:505-13. [PMID: 25110840 PMCID: PMC4324372 DOI: 10.1037/hea0000131] [Citation(s) in RCA: 117] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To better understand independent pathways linking emotional distress, medication adherence, and glycemic control in adults with Type 2 diabetes, as well as the potential mediating effects of perceived control over illness and self-efficacy. METHOD Adults with Type 2 diabetes (N = 142) were recruited for an intervention study evaluating cognitive-behavioral therapy for adherence and depression. Depressive symptom severity was assessed via semistructured interview. Validated self-reports assessed diabetes-related distress, perceived control over diabetes (perceived control), self-efficacy for diabetes self-management, and medication adherence. Glycemic control was evaluated by hemoglobin A1C. Only baseline data were included in correlational and linear regression analyses. RESULTS Perceived control was an important mediator of emotional distress for both medication adherence and A1C outcomes. Specifically, regression analyses demonstrated that diabetes distress, but not depression severity, was significantly related to medication adherence and A1C. Self-efficacy and perceived control were also independently associated with medication adherence and A1C. Mediation analyses demonstrated a significant indirect effect for diabetes distress and medication adherence through perceived control and self-efficacy. The relationship between distress and A1C was accounted for by an indirect effect through perceived control. CONCLUSION Results demonstrated that diabetes-related emotional distress is associated with poorer treatment adherence and glycemic control among adults with Type 2 diabetes; these relationships were partially mediated through perceived control over diabetes. Perceptions of one's personal ability to influence the course of diabetes may be important in understanding the pathway between emotional distress and poor diabetes-treatment outcomes.
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Affiliation(s)
- Jeffrey S. Gonzalez
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY
- Diabetes Research Center, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY
| | - Erica Shreck
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY
| | - Christina Psaros
- Behavioral Medicine Service, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Steven A. Safren
- Behavioral Medicine Service, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
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Ferguson MO, Long JA, Zhu J, Small DS, Lawson B, Glick HA, Schapira MM. Low Health Literacy Predicts Misperceptions of Diabetes Control in Patients With Persistently Elevated A1C. DIABETES EDUCATOR 2015; 41:309-19. [DOI: 10.1177/0145721715572446] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose The purpose of this study is to identify factors associated with perceived control of diabetes in a group of poorly controlled patients. Identifying factors associated with perceived control in these patients is an important step in improving actual control as measured by A1C. As health literacy is essential for understanding complex medical information, we hypothesized that low health literacy would be associated with inaccurate perceptions of diabetes control. Methods A cross-sectional analysis was performed on 280 adults with type 2 diabetes whose last 2 A1C measurements were >8.0%. Participants were recruited primarily from 6 University of Pennsylvania primary care practices. Perceived control and factors potentially associated with this outcome, including health literacy, were assessed during an in-person interview. Health literacy was measured using the Rapid Estimate of Adult Literacy. Results Thirty-nine percent of patients responded that they were managing to control their diabetes well or very well. However, 57% of those at the seventh to eighth-grade health literacy level and 61% of those at the level of sixth grade and below reported that they were controlling their diabetes well or very well. Conclusions In this population of patients with poorly controlled diabetes, a majority of those with low health literacy believed that they were controlling their disease well or very well. Patients who believe that they are already controlling their diabetes well may be less likely to make changes to improve control. Health care providers and educators should consider health literacy when discussing control of diabetes and when setting management goals with patients.
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Affiliation(s)
- Monica O. Ferguson
- Division of General Internal Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (Dr Ferguson, Dr Long, Miss Lawson, Dr Glick, Dr Schapira)
- Philadelphia VA Center for Health Equity Research and Promotion, Philadelphia, Pennsylvania (Dr Long, Dr Schapira)
- Leonard Davis Institute of Health Economics, Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, Pennsylvania (Dr Long, Mr Zhu, Dr Small, Dr Schapira)
- Department of Statistics, Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania (Dr Small)
| | - Judith A. Long
- Division of General Internal Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (Dr Ferguson, Dr Long, Miss Lawson, Dr Glick, Dr Schapira)
- Philadelphia VA Center for Health Equity Research and Promotion, Philadelphia, Pennsylvania (Dr Long, Dr Schapira)
- Leonard Davis Institute of Health Economics, Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, Pennsylvania (Dr Long, Mr Zhu, Dr Small, Dr Schapira)
- Department of Statistics, Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania (Dr Small)
| | - Jingsan Zhu
- Division of General Internal Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (Dr Ferguson, Dr Long, Miss Lawson, Dr Glick, Dr Schapira)
- Philadelphia VA Center for Health Equity Research and Promotion, Philadelphia, Pennsylvania (Dr Long, Dr Schapira)
- Leonard Davis Institute of Health Economics, Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, Pennsylvania (Dr Long, Mr Zhu, Dr Small, Dr Schapira)
- Department of Statistics, Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania (Dr Small)
| | - Dylan S. Small
- Division of General Internal Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (Dr Ferguson, Dr Long, Miss Lawson, Dr Glick, Dr Schapira)
- Philadelphia VA Center for Health Equity Research and Promotion, Philadelphia, Pennsylvania (Dr Long, Dr Schapira)
- Leonard Davis Institute of Health Economics, Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, Pennsylvania (Dr Long, Mr Zhu, Dr Small, Dr Schapira)
- Department of Statistics, Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania (Dr Small)
| | - Brittany Lawson
- Division of General Internal Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (Dr Ferguson, Dr Long, Miss Lawson, Dr Glick, Dr Schapira)
- Philadelphia VA Center for Health Equity Research and Promotion, Philadelphia, Pennsylvania (Dr Long, Dr Schapira)
- Leonard Davis Institute of Health Economics, Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, Pennsylvania (Dr Long, Mr Zhu, Dr Small, Dr Schapira)
- Department of Statistics, Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania (Dr Small)
| | - Henry A. Glick
- Division of General Internal Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (Dr Ferguson, Dr Long, Miss Lawson, Dr Glick, Dr Schapira)
- Philadelphia VA Center for Health Equity Research and Promotion, Philadelphia, Pennsylvania (Dr Long, Dr Schapira)
- Leonard Davis Institute of Health Economics, Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, Pennsylvania (Dr Long, Mr Zhu, Dr Small, Dr Schapira)
- Department of Statistics, Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania (Dr Small)
| | - Marilyn M. Schapira
- Division of General Internal Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (Dr Ferguson, Dr Long, Miss Lawson, Dr Glick, Dr Schapira)
- Philadelphia VA Center for Health Equity Research and Promotion, Philadelphia, Pennsylvania (Dr Long, Dr Schapira)
- Leonard Davis Institute of Health Economics, Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, Pennsylvania (Dr Long, Mr Zhu, Dr Small, Dr Schapira)
- Department of Statistics, Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania (Dr Small)
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Holmes EAF, Hughes DA, Morrison VL. Predicting adherence to medications using health psychology theories: a systematic review of 20 years of empirical research. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2014; 17:863-876. [PMID: 25498782 DOI: 10.1016/j.jval.2014.08.2671] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 05/27/2014] [Accepted: 08/01/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVES This review sought to identify the empirical evidence for the application of models from sociocognitive theory, self-regulation theory, and social support theory at predicting patient adherence to medications. METHODS A systematic review of the published literature (1990-2010) using MEDLINE, EMBASE, Cochrane Library, CINAHL, and PsychINFO identified studies examining the application of health psychology theory to adherence to medication in adult patients. Two independent reviewers extracted data on medication, indication, study population, adherence measure, theory, model, survey instruments, and results. Heterogeneity in theoretical model specification and empirical investigation precluded a meta-analysis of data. RESULTS Of 1756 unique records, 67 articles were included (sociocognitive = 35, self-regulation = 21, social support = 11). Adherence was most commonly measured by self-report (50 of 67). Synthesis of studies highlighted the significance (P ≤ 0.05) of self-efficacy (17 of 19), perceived barriers (11 of 17), perceived susceptibility (3 of 6), necessity beliefs (8 of 9), and medication concerns (7 of 8). CONCLUSIONS The results of this review provide a foundation for the development of theory-led adherence-enhancing interventions that could promote sustainable behavior change in clinical practice.
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Hilliard ME, Eakin MN, Borrelli B, Green A, Riekert KA. Medication beliefs mediate between depressive symptoms and medication adherence in cystic fibrosis. Health Psychol 2014; 34:496-504. [PMID: 25110847 DOI: 10.1037/hea0000136] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Depression is a known barrier to regimen adherence for chronic conditions. Despite elevated depression rates and complex regimens for people with cystic fibrosis (CF), little is known about associations between depressive symptoms and CF adherence. One possibility is that depressive symptoms distort beliefs about medications, which may influence adherence. METHOD Adolescents and adults (N = 128; mean age = 29 ± 11 years, range = 16-63, 93% Caucasian) with CF reported on depressive symptoms and medication beliefs (self-efficacy, motivation, perceived importance, and outcome expectancies related to taking medications). Medication adherence was assessed objectively through pharmacy refill data. Cross-sectional structural equation models evaluated medication beliefs as a mediator between depressive symptoms and medication adherence. RESULTS Twenty-three percent of participants exceeded clinical cutoffs for depressive symptoms. Participants took less than half of prescribed pulmonary medications (mean adherence rate = 44.4 ± 26.7%). Depressive symptoms were correlated with adherence (r = -.22, p < .05), and medication beliefs (b = -0.13, 95% CI [-0.24, -0.03]) significantly mediated this relation. Higher depressive symptoms were associated with less positive medication beliefs (b = -0.27, p < .01), which were associated with lower medication adherence (b = 0.49, p < .01). CONCLUSIONS Depressive symptoms are related to beliefs about and adherence to CF medications. Monitoring depressive symptoms and medication beliefs in routine CF care may help identify risks for nonadherence and facilitate interventions to reduce depression, adaptive medication beliefs, and ultimately improve adherence and CF management. (PsycINFO Database Record
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Affiliation(s)
- Marisa E Hilliard
- Johns Hopkins University School of Medicine, Johns Hopkins Adherence Research Center, Division of Pulmonary and Critical Care Medicine
| | - Michelle N Eakin
- Johns Hopkins University School of Medicine, Johns Hopkins Adherence Research Center, Division of Pulmonary and Critical Care Medicine
| | | | - Angela Green
- Johns Hopkins University School of Medicine, Johns Hopkins Adherence Research Center, Division of Pulmonary and Critical Care Medicine
| | - Kristin A Riekert
- Johns Hopkins University School of Medicine, Johns Hopkins Adherence Research Center, Division of Pulmonary and Critical Care Medicine
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Abstract
OBJECTIVES Chronic opioid therapy (COT) for chronic noncancer pain (CNCP) is characterized by both high rates of patient-initiated discontinuation and by perceived helpfulness among those who sustain opioid use. This study examines predictors of the desire to cut down or stop opioid therapy among patients receiving COT who report that opioids are helpful for relieving pain. METHODS We conducted a cross-sectional survey of 1737 selected patients receiving COT for CNCP who perceived opioids to be helpful in relieving their pain. Ambivalence about opioid use was assessed by agreement/disagreement with a statement indicating that they would like to stop or cut down the use of prescribed opioid medications. Depression was measured with the 8-item Patient Health Questionnaire. RESULTS A high percentage (43.3%) of survey respondents who found opioids helpful also reported the desire to stop or cut down opioids. Half of these patients reporting the desire to stop or cut down were clinically depressed, compared with a third of those not wanting to stop or cut down, a highly significant difference after controlling for covariates (P<0.0001). The group wanting to stop or cut down opioid use also reported significantly higher levels of opioid-related psychosocial problems and opioid control concerns. DISCUSSION There are high rates of ambivalence about opioid use among COT recipients who consider opioids helpful for pain relief. Depressed patients are more likely to be ambivalent about use of prescribed opioids. Eliciting patient ambivalence may be helpful in patients who are not benefiting from long-term opioid use as an initial step toward consideration of discontinuation.
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Oh HS, Park JS, Seo WS. Psychosocial influencers and mediators of treatment adherence in haemodialysis patients. J Adv Nurs 2013; 69:2041-53. [PMID: 23294367 DOI: 10.1111/jan.12071] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2012] [Indexed: 11/28/2022]
Abstract
AIM This article is a report of the development and testing of the hypothetical model that illustrates relationships between treatment adherence and its psychosocial influencing factors and to elucidate the direct and indirect (mediating) effects of factors on treatment adherence. BACKGROUND Poor adherence has been consistently reported in haemodialysis patients. Much research has showed various influencing factors of adherence, but these studies have failed to identify consistent influencing factors. DESIGN This study was performed using a non-experimental, cross-sectional design. METHODS The study subjects were 150 end-stage renal failure patients on haemodialysis at a university hospital located in Incheon, South Korea. Data were collected over 10 months (June 2010-April 2011). FINDINGS The hypothetical model provided a good fit with data. Haemodialysis-related knowledge, perceived barrier to adherence, self-efficacy on adherence, and healthcare provider support had significant effects on adherence. Self-efficacy was found to mediate barrier-adherence and family support-adherence relationships. Self-efficacy in combination with barrier, family support, and healthcare provider support was found to mediate the depression-adherence relationship. CONCLUSION Strategies aimed at the development of successful adherence interventions should focus on reducing perceived barriers and enhancing self-efficacy and knowledge. It can be suggested that efforts to improve the healthcare provider-patient relationship would enhance adherence. In depressive patients, strategies that promote self-efficacy and the support of family or healthcare providers could diminish the negative impact of depression on adherence.
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Affiliation(s)
- Hyun Soo Oh
- Department of Nursing, Inha University, Incheon, Korea
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Kjos AL, Worley MM, Schommer JC. The social network paradigm and applications in pharmacy. Res Social Adm Pharm 2012; 9:353-69. [PMID: 23068189 DOI: 10.1016/j.sapharm.2012.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Revised: 05/31/2012] [Accepted: 05/31/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND There have been calls for research to include contextual and macrolevel factors within explanatory models of human health. A network approach focuses on the influence of relationships to predict behavior. OBJECTIVES The first objective was to describe the social network paradigm based in sociology that uses network principles and methods to visualize, quantify, and predict outcomes using the structure and function of relationships. The second objective was to discuss applications of this approach in the context of health to guide future research in pharmacy. METHODS This was a descriptive overview of conceptual models, methods, measures, and analyses that are used in the social network paradigm. RESULTS The social network paradigm contains conceptual models that rely on relational and structural assumptions to make predictions related to human behavior. Although there is not 1 dominate theory of social networks, several models hold across applications and are commonly used by scholars. The methodology emphasized considerations of network boundaries, sampling strategies, and the type of data collected. Specific variables used in social network analysis were defined and dichotomized into constructs of centrality and cohesion. Network analysis was described in terms of available computational programs, data management, and statistical testing. Related research in health care was applied and ideas for pharmacy were proposed using a social network-based theoretical model. CONCLUSIONS There is growing momentum for health behaviorists to gain familiarity for studying the effect of social networks on behavior. Applications in pharmacy using social network models, methods, and analysis can be used as a stand-alone perspective or in conjunction with other theoretical perspectives in an effort to explain human health or organizational behavior in health care settings.
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Affiliation(s)
- Andrea L Kjos
- Department of Pharmaceutical, Biomedical and Administrative Sciences, College of Pharmacy and Health Sciences, Drake University, 2507 University Avenue, Des Moines, IA 50311, USA.
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Sharoni SKA, Wu SFV. Self-efficacy and self-care behavior of Malaysian patients with type 2 diabetes: a cross sectional survey. Nurs Health Sci 2012; 14:38-45. [PMID: 22288688 DOI: 10.1111/j.1442-2018.2011.00658.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study investigated the association between self-efficacy and self-care behavior to determine the degree of self-efficacy and to examine differences in self-efficacy according to patient variables, including state of health, of Malaysian patients with type 2 diabetes. The sample comprised 388 patients (respondents). We collected the data from December 2010 to February 2011. We found a significant positive relationship between self-efficacy and self-care behavior (r(s) = 0.481, P < 0.001). The degree of self-efficacy was moderately high (mean = 7.570). We found significant differences between self-efficacy and education level (Wilk's Lambda = 0.918, F[12, 1008] = 2.779, P < 0.05), duration of diabetes (Wilk's Lambda = 0.954, F[8, 736] = 2.264, P < 0.05), other chronic conditions (Wilk's Lambda = 0.967, F[4, 383] = 3.304, P < 0.05) and diabetic complications (Wilk's Lambda = 0.963, F[4, 383] = 3.653, P < 0.05). Self-efficacy can be used as a model to understand self-care behavior. Individualized nursing interventions based on self-efficacy theory should be utilized in high risk diabetic patients so as to assist and improve self-care behavior.
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Affiliation(s)
- Siti Khuzaimah Ahmad Sharoni
- Nursing Department, Faculty of Health Sciences, Universiti Teknologi MARA, Puncak Alam Campus, Puncak Alam, Selangor, Malaysia.
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