1
|
Arjunan P, D'Souza MS. Efficacy of nurse-led cardiac rehabilitation on health care behaviours in adults with chronic heart failure: An experimental design. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021. [DOI: 10.1016/j.cegh.2021.100859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
|
2
|
Kitsiou S, Gerber BS, Kansal MM, Buchholz SW, Chen J, Ruppar T, Arrington J, Owoyemi A, Leigh J, Pressler SJ. Patient-centered mobile health technology intervention to improve self-care in patients with chronic heart failure: Protocol for a feasibility randomized controlled trial. Contemp Clin Trials 2021; 106:106433. [PMID: 33991686 PMCID: PMC8222185 DOI: 10.1016/j.cct.2021.106433] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/09/2021] [Accepted: 05/08/2021] [Indexed: 12/25/2022]
Abstract
This randomized controlled trial aims to determine the feasibility and preliminary efficacy of a patient-centered, mobile health technology intervention (iCardia4HF) in patients with chronic Heart Failure (HF). Participants (n = 92) are recruited and randomized 1:1 to the intervention or control group. The intervention group receives a commercial HF self-care app (Heart Failure Storylines), three connected health devices that interface with the app (Withings weight scale and blood pressure monitor, and Fitbit activity tracker), and a program of individually tailored text-messages targeting health beliefs, self-care self-efficacy, HF-knowledge, and physical activity. The control group receives the same connected health devices, but without the HF self-care app and text messages. Follow-up assessments occur at 30 days and 12 weeks. The main outcome of interest is adherence to HF self-care assessed objectively through time-stamped data from the electronic devices and also via patient self-reports. Primary measures of HF self-care include medication adherence and adherence to daily weight monitoring. Secondary measures of HF self-care include adherence to daily self-monitoring of HF symptoms and blood pressure, adherence to low-sodium diet, and engagement in physical activity. Self-reported HF self-care and health-related quality of life are assessed with the Self-care Heart Failure Index and the Kansas City Cardiomyopathy Questionnaire, respectively. Hospitalizations and emergency room visits are tracked in both groups over 12 weeks as part of our safety protocol. This study represents an important step in testing a scalable mHealth solution that has the potential to bring about a new paradigm in self-management of HF.
Collapse
Affiliation(s)
- Spyros Kitsiou
- Department of Biomedical & Health Information Sciences, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States of America.
| | - Ben S Gerber
- Division of Academic Internal Medicine and Geriatrics, Department of Medicine, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Mayank M Kansal
- Division of Cardiology, Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Susan W Buchholz
- College of Nursing, Michigan State University, East Lansing, MI, United States of America
| | - Jinsong Chen
- College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Todd Ruppar
- Department of Adult Health and Gerontological Nursing, College of Nursing, Rush University, Chicago, IL, United States of America
| | - Jasmine Arrington
- Department of Biomedical & Health Information Sciences, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Ayomide Owoyemi
- Department of Biomedical & Health Information Sciences, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Jonathan Leigh
- Department of Biomedical & Health Information Sciences, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States of America; Division of Cardiology, Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Susan J Pressler
- School of Nursing, Indiana University, Bloomington, IN, United States of America
| |
Collapse
|
3
|
Tuna S, Pakyüz SÇ. The effectiveness of planned discharge education on health knowledge and beliefs in patients with acute myocardial infarction: a randomized controlled trial. Ir J Med Sci 2021; 191:691-698. [PMID: 33728530 DOI: 10.1007/s11845-021-02601-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 03/11/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND To the best of our knowledge, no other studies investigated acute myocardial infarction patients' beliefs and knowledge level after the discharge education. AIMS The aim of the study was to investigate the effectiveness of planned discharge education on the beliefs and knowledge levels of CVD risk factors, medication compliance, dietary compliance, and individual follow-up in patients with acute myocardial infarction (AMI). METHODS A double-blind randomized controlled study was carried out with 100 AMI patients. All participants were randomly assigned to the intervention (n = 50) and control groups (n = 50). The first evaluation of all participants in both groups was on the day of discharge. Both groups were re-evaluated after 4 weeks. Patients' beliefs on medication, diet, and individual monitoring were assessed by the Beliefs about Medication Compliance Scale (BMCS), the Beliefs about Dietary Compliance Scale (BDCS), and the Beliefs about Individual Follow-up Scale (BIFS), respectively. The knowledge of CVD risk factors was questioned with the Cardiovascular Disease Risk Factors Knowledge Level (CARRF-KL) Scale. RESULTS The mean age of the patients was 59.10 ± 9.38 years in the intervention group and 58.86 ± 9.19 in the control group. After the planned discharge education, beliefs and knowledge levels of CVD risk factors, medication compliance, dietary compliance, and individual follow-up were significantly increased compared with the control group. CONCLUSION Planned discharge education had a positive effect on the knowledge level of cardiovascular diseases risk factors, drug compliance, nutritional compliance, and individual follow-up in patients with acute myocardial infarction.
Collapse
Affiliation(s)
- Serap Tuna
- Department of Elderly Care, Muğla Sıtkı Koçman University, Mugla, Turkey.
| | | |
Collapse
|
4
|
Kwan YH, Weng SD, Loh DHF, Phang JK, Oo LJY, Blalock DV, Chew EH, Yap KZ, Tan CYK, Yoon S, Fong W, Østbye T, Low LL, Bosworth HB, Thumboo J. Measurement Properties of Existing Patient-Reported Outcome Measures on Medication Adherence: Systematic Review. J Med Internet Res 2020; 22:e19179. [PMID: 33034566 PMCID: PMC7584986 DOI: 10.2196/19179] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 07/05/2020] [Accepted: 08/08/2020] [Indexed: 12/11/2022] Open
Abstract
Background Medication adherence is essential for improving the health outcomes of patients. Various patient-reported outcome measures (PROMs) have been developed to measure medication adherence in patients. However, no study has summarized the psychometric properties of these PROMs to guide selection for use in clinical practice or research. Objective This study aims to evaluate the quality of the PROMs used to measure medication adherence. Methods This study was guided by the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines. Relevant articles were retrieved from the EMBASE, PubMed, Cochrane Library, Web of Science, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases. The PROMs were then evaluated based on the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) guidelines. Results A total of 121 unique medication adherence PROMs from 214 studies were identified. Hypotheses testing for construct validity and internal consistency were the most frequently assessed measurement properties. PROMs with at least a moderate level of evidence for ≥5 measurement properties include the Adherence Starts with Knowledge 20, Compliance Questionnaire-Rheumatology, General Medication Adherence Scale, Hill-Bone Scale, Immunosuppressant Therapy Barrier Scale, Medication Adherence Reasons Scale (MAR-Scale) revised, 5-item Medication Adherence Rating Scale (MARS-5), 9-item MARS (MARS-9), 4-item Morisky Medication Adherence Scale (MMAS-4), 8-item MMAS (MMAS-8), Self-efficacy for Appropriate Medication Adherence Scale, Satisfaction with Iron Chelation Therapy, Test of Adherence to Inhalers, and questionnaire by Voils. The MAR-Scale revised, MMAS-4, and MMAS-8 have been administered electronically. Conclusions This study identified 121 PROMs for medication adherence and provided synthesized evidence for the measurement properties of these PROMs. The findings from this study may assist clinicians and researchers in selecting suitable PROMs to assess medication adherence.
Collapse
Affiliation(s)
- Yu Heng Kwan
- Program in Health Services and Systems Research,, Duke-NUS Medical School, Singapore, Singapore.,Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Si Dun Weng
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Dionne Hui Fang Loh
- PULSES Centre Grant, SingHealth Regional Health System, Singapore, Singapore
| | - Jie Kie Phang
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
| | - Livia Jia Yi Oo
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Dan V Blalock
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, United States.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Eng Hui Chew
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Kai Zhen Yap
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Corrinne Yong Koon Tan
- Pharmacy Transformation Office, National Healthcare Group Pharmacy, Singapore, Singapore
| | - Sungwon Yoon
- Program in Health Services and Systems Research,, Duke-NUS Medical School, Singapore, Singapore.,PULSES Centre Grant, SingHealth Regional Health System, Singapore, Singapore
| | - Warren Fong
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore.,NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Truls Østbye
- Program in Health Services and Systems Research,, Duke-NUS Medical School, Singapore, Singapore
| | - Lian Leng Low
- PULSES Centre Grant, SingHealth Regional Health System, Singapore, Singapore.,Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore, Singapore.,Post Acute and Continuing Care, Outram Community Hospital, Singapore, Singapore
| | - Hayden Barry Bosworth
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, United States.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States.,Department of Population Health Sciences, Duke University Medical Center, Durham, NC, United States.,School of Nursing, Duke University Medical Center, Durham, NC, United States
| | - Julian Thumboo
- Program in Health Services and Systems Research,, Duke-NUS Medical School, Singapore, Singapore.,Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore.,NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| |
Collapse
|
5
|
Kwan YH, Oo LJY, Loh DHF, Phang JK, Weng SD, Blalock DV, Chew EH, Yap KZ, Tan CYK, Yoon S, Fong W, Østbye T, Low LL, Bosworth HB, Thumboo J. Development of an Item Bank to Measure Medication Adherence: Systematic Review. J Med Internet Res 2020; 22:e19089. [PMID: 33030441 PMCID: PMC7582150 DOI: 10.2196/19089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/12/2020] [Accepted: 06/14/2020] [Indexed: 02/06/2023] Open
Abstract
Background Medication adherence is important in managing the progression of chronic diseases. A promising approach to reduce cognitive burden when measuring medication adherence lies in the use of computer‐adaptive tests (CATs) or in the development of shorter patient-reported outcome measures (PROMs). However, the lack of an item bank currently hampers this progress. Objective We aim to develop an item bank to measure general medication adherence. Methods Using the preferred reporting items for systematic review and meta-analysis (PRISMA), articles published before October 2019 were retrieved from PubMed, Embase, CINAHL, the Cochrane Library, and Web of Science. Items from existing PROMs were classified and selected (“binned” and “winnowed”) according to standards published by the Patient-Reported Outcomes Measurement Information System (PROMIS) Cooperative Group. Results A total of 126 unique PROMs were identified from 213 studies in 48 countries. Items from the literature review (47 PROMs with 579 items for which permission has been obtained) underwent binning and winnowing. This resulted in 421 candidate items (77 extent of adherence and 344 reasons for adherence). Conclusions We developed an item bank for measuring general medication adherence using items from validated PROMs. This will allow researchers to create new PROMs from selected items and provide the foundation to develop CATs.
Collapse
Affiliation(s)
- Yu Heng Kwan
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.,Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Livia Jia Yi Oo
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Dionne Hui Fang Loh
- PULSES Centre Grant, SingHealth Regional Health System, Singapore, Singapore
| | - Jie Kie Phang
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
| | - Si Dun Weng
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Dan V Blalock
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, United States.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Eng Hui Chew
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Kai Zhen Yap
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Corrinne Yong Koon Tan
- Pharmacy Transformation Office, National Healthcare Group Pharmacy, Singapore, Singapore
| | - Sungwon Yoon
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.,PULSES Centre Grant, SingHealth Regional Health System, Singapore, Singapore
| | - Warren Fong
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore.,NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Truls Østbye
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Lian Leng Low
- PULSES Centre Grant, SingHealth Regional Health System, Singapore, Singapore.,Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore, Singapore.,Post Acute and Continuing Care, Outram Community Hospital, Singapore, Singapore
| | - Hayden Barry Bosworth
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, United States.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States.,School of Nursing, Duke University Medical Center, Durham, NC, United States.,Department of Population Health Sciences, Duke University Medical Center, Durham, NC, United States
| | - Julian Thumboo
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.,Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore.,NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| |
Collapse
|
6
|
Eton DT, Yost KJ, Lai JS, Ridgeway JL, Egginton JS, Rosedahl JK, Linzer M, Boehm DH, Thakur A, Poplau S, Odell L, Montori VM, May CR, Anderson RT. Development and validation of the Patient Experience with Treatment and Self-management (PETS): a patient-reported measure of treatment burden. Qual Life Res 2016; 26:489-503. [PMID: 27566732 DOI: 10.1007/s11136-016-1397-0] [Citation(s) in RCA: 125] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2016] [Indexed: 12/21/2022]
Abstract
PURPOSE The purpose of this study was to develop and validate a new comprehensive patient-reported measure of treatment burden-the Patient Experience with Treatment and Self-management (PETS). METHODS A conceptual framework was used to derive the PETS with items reviewed and cognitively tested with patients. A survey battery, including a pilot version of the PETS, was mailed to 838 multi-morbid patients from two healthcare institutions for validation. RESULTS A total of 332 multi-morbid patients returned completed surveys. Diagnostics supported deletion and consolidation of some items and domains. Confirmatory factor analysis supported a domain model for scaling comprised of 9 factors: medical information, medications, medical appointments, monitoring health, interpersonal challenges, medical/healthcare expenses, difficulty with healthcare services, role/social activity limitations, and physical/mental exhaustion. Scales showed good internal consistency (α range 0.79-0.95). Higher PETS scores, indicative of greater treatment burden, were correlated with more distress, less satisfaction with medications, lower self-efficacy, worse physical and mental health, and lower convenience of healthcare (Ps < 0.001). Patients with lower health literacy, less adherence to medications, and more financial difficulties reported higher PETS scores (Ps < 0.01). CONCLUSION A comprehensive patient-reported measure of treatment burden can help to better characterize the impact of treatment and self-management burden on patient well-being and guide care toward minimally disruptive medicine.
Collapse
Affiliation(s)
- David T Eton
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. .,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Kathleen J Yost
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.,Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Jin-Shei Lai
- Department of Medical Social Sciences, Northwestern University School of Medicine, 633 St. Clair, 19th Floor, Chicago, IL, USA
| | - Jennifer L Ridgeway
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Jason S Egginton
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Jordan K Rosedahl
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.,Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Mark Linzer
- Hennepin County Medical Center, 701 Park Avenue, Minneapolis, MN, USA
| | - Deborah H Boehm
- Minneapolis Medical Research Foundation, 701 Park Avenue, Minneapolis, MN, USA
| | - Azra Thakur
- Amherst H. Wilder Foundation, 451 Lexington Parkway N, Saint Paul, MN, 55104, USA
| | - Sara Poplau
- Minneapolis Medical Research Foundation, 701 Park Avenue, Minneapolis, MN, USA
| | - Laura Odell
- Pharmacy Services, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Victor M Montori
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.,Knowledge Evaluation Research Unit, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Carl R May
- Knowledge Evaluation Research Unit, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.,Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Roger T Anderson
- Department of Public Health Sciences, University of Virginia School of Medicine, 6203E, West Complex, Charlottesville, VA, USA
| |
Collapse
|
7
|
Response by Bennett, Lane, Welch, Perkins, Brater, and Murray. West J Nurs Res 2016. [DOI: 10.1177/0193945905280312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
8
|
Perceived benefits and barriers of heart failure self-care during and after hospitalization. ACTA ACUST UNITED AC 2016; 32:482-8. [PMID: 25171240 DOI: 10.1097/nhh.0000000000000125] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This longitudinal study describes the heart failure (HF) patient's perceived benefits and barriers to self-care during hospitalization, 1 week, and 1 month after hospitalization. Seventy-eight patients with acute HF completed the Health Belief Scales to determine the greatest benefits and barriers to self-care at each time point. Findings suggest that early benefits to performing self-care include reducing symptoms and improving quality of life. Later benefits focus more on promoting health. Barriers to self-care include forgetfulness and knowledge deficits about self-care behaviors. At 1 month, 15.1% to 48.5% patients reported that monitoring increases worry about HF. Home care clinicians can promote self-care through education and skills training.
Collapse
|
9
|
Adherence to a low-sodium diet in patients with heart failure is best when family members also follow the diet: a multicenter observational study. J Cardiovasc Nurs 2015; 30:44-50. [PMID: 24165698 DOI: 10.1097/jcn.0000000000000089] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Adherence to a low-sodium diet (LSD) is difficult without continuous support from spouses or family members. Whether having a family member follow an LSD improves patient adherence has not been tested objectively. OBJECTIVE The aim of this study was to examine the effect of family adherence to an LSD on patient adherence to an LSD and to examine whether this effect differed by relationship status and living arrangement. METHODS In this secondary data analysis, we analyzed data from 379 outpatients with heart failure who had objective evidence of adherence to an LSD (ie, a 24-hour urinary sodium excretion). The t test, analysis of variance, and logistic regressions were used to compare levels of adherence among groups that were categorized by family adherence to an LSD, relationship status, and living arrangement with family member and to predict the likelihood of being adherent to an LSD (24-hour urinary sodium excretion <3000 mg) by the groups. RESULTS Compared with patients whose family did not follow an LSD, patients whose family member followed an LSD had lower average urinary sodium excretion (3651 vs 4280 mg; P = .003) and were 1.6 times more likely to be adherent to an LSD (95% confidence interval, 1.03-2.4; P = .035). Patients whose spouses followed the LSD had lower sodium excretion than did patients whose spouses did not follow the LSD (3730 vs 4534 mg; P = .012). Patients whose nonspousal family member followed an LSD were 4 times more likely to be adherent than were patients whose spousal member did not follow an LSD (odds ratio, 3.94; 95% confidence interval, 1.81-8.58; P = .001). CONCLUSIONS Living with a spouse or other family member improved patient adherence to LSD only when the spouse or family member also followed the LSD. These results suggest that interventions aimed at improving LSD adherence should target patient and family member dyads to encourage family members to follow the LSD with patients.
Collapse
|
10
|
Development and Testing of the Feasibility and Acceptability of a Tailored Dietary Intervention in Patients With Heart Failure. J Cardiovasc Nurs 2015; 30:213-21. [DOI: 10.1097/jcn.0000000000000148] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
11
|
Thompson LE, Bekelman DB, Allen LA, Peterson PN. Patient-Reported Outcomes in Heart Failure: Existing Measures and Future Uses. Curr Heart Fail Rep 2015; 12:236-46. [DOI: 10.1007/s11897-015-0253-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
|
12
|
Alhalaiqa F, Masa’Deh R, Batiha AM, Deane K. Validity of Arabic Version of Beliefs About Medication Questionnaire. Clin Nurs Res 2014; 24:539-55. [PMID: 25106809 DOI: 10.1177/1054773814545383] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
To assess the validity and reliability of the Arabic version of the Beliefs About Medication Questionnaire, a cross-sectional design was used and the data were collected from 605 patients with chronic diseases. The study was conducted between July 2013 and December 2013. The results showed that the Cronbach’s alpha coefficient (.71) was satisfactory. There was a significant strong positive correlation between test–retest for the same group subsample, with a correlation coefficient range of .45 to .78. There were no statistically significant differences between retest subgroups and remaining samples in the questionnaire subscales. The percentage of missing value was around 0.03, which confirmed the feasibility of the Arabic version of the questionnaire. These findings suggested that having a culturally acceptable, valid and reliable instrument to identify patients’ beliefs toward medication in Jordan will play an important role in tailoring appropriate intervention to enhance patient compliance with their prescribed medication.
Collapse
Affiliation(s)
| | - Rami Masa’Deh
- Faculty of Nursing, Applied Science Private University, Amman, Jordan
| | | | - Katherine Deane
- School of Nursing Sceinces, University of East Anglia, Norwich, UK
| |
Collapse
|
13
|
Kara B. Health Beliefs Related to Salt-Restricted Diet in Patients on Hemodialysis: Psychometric Evaluation of the Turkish Version of the Beliefs About Dietary Compliance Scale. J Transcult Nurs 2014; 25:256-64. [PMID: 24381119 DOI: 10.1177/1043659613514114] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate the reliability and validity of the Turkish version of the Beliefs about Dietary Compliance Scale (BDCS-T). METHODS This methodological study enrolled a sample of 140 patients. Data were collected by using a questionnaire form, the BDCS-T, and the Dialysis Diet and Fluid Restrictions Nonadherence Questionnaire. Descriptive statistics, the one-sample Kolmogorov-Smirnov test, Mann-Whitney U test, correlation coefficients, and psychometric tests were used for the analysis of data. RESULTS The factor analysis confirmed that the BDCS-T had a two-factor structure (perceived benefits and perceived barriers) explaining 58.7% of the total variance. The BDCS-T had acceptable internal consistency (Cronbach's alpha coefficients: perceived benefits = .91; perceived barriers = .66), test-retest reliability (intraclass correlation coefficients: perceived benefits = .93; perceived barriers = .79), concurrent validity with the Dialysis Diet and Fluid Restrictions Nonadherence Questionnaire scores, and known group validity with intensity of diet nonadherence. CONCLUSIONS The BDCS-T was found to be a reliable and valid tool for assessing the beliefs related to salt-restricted diet in patients on hemodialysis. IMPLICATIONS FOR PRACTICE Nurses are recommended to make tailored interventions by taking the benefits and barriers that the patients perceive toward low-salt dietary adherence into account.
Collapse
|
14
|
Lehane E, McCarthy G, Collender V, Deasy A, O'Sullivan K. The Reasoning and Regulating Medication Adherence Instrument for patients with coronary artery disease: development and psychometric evaluation. J Nurs Meas 2013; 21:64-79. [PMID: 23786135 DOI: 10.1891/1061-3749.21.1.64] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Many patients experience difficulty taking medications resulting in suboptimal adherence. Ambiguity surrounding adherence issues in chronic illness has been exacerbated by a lack of patient-centered, medication-specific, and theoretically integrative measurement instruments. AIM To develop a reliable and valid instrument to measure the factors that influence adherence in patients prescribed pharmacotherapy for coronary artery disease. METHODS Phase 1 involved the development of instrument structure and content. Constructs to be measured were defined through an analysis of adherence literature and qualitative interviews with patients. Phase 2 established the psychometric properties of the instrument. Exploratory factor analyses, reliability, and validity estimations were undertaken with a sample of patients (n = 404) from 3 tertiary cardiology referral centers. RESULTS Factor analyses resulted in a logically coherent, 16-item, three-factor solution that explained 50.5% variance. The factors were labelled: "Medication Planning Strategies," "Health Risk, and Health Protection." Internal consistency reliability met acceptable standards (alpha = .700 to alpha = .785). Fair to excellent intraclass correlations for temporal stability were demonstrated (.498-.882). Preliminary construct validity was supported by promising findings in relation to content validity results and factor structure stability. CONCLUSIONS A new adherence instrument for patients on pharmacotherapy for coronary artery disease has been developed and initial psychometric properties have been established. Additional instrument validation will be directed at further establishing construct and criterion-related validity. It is intended that this measure will be useful in identifying factors that impede or facilitate adherent behavior and contribute to advancing the science of instrument development within adherence research.
Collapse
Affiliation(s)
- Elaine Lehane
- School of Nursing & Midwifery, University College Cork, Ireland.
| | | | | | | | | |
Collapse
|
15
|
Eton DT, Elraiyah TA, Yost KJ, Ridgeway JL, Johnson A, Egginton JS, Mullan RJ, Murad MH, Erwin PJ, Montori VM. A systematic review of patient-reported measures of burden of treatment in three chronic diseases. PATIENT-RELATED OUTCOME MEASURES 2013; 4:7-20. [PMID: 23833553 PMCID: PMC3699294 DOI: 10.2147/prom.s44694] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background Burden of treatment refers to the workload of health care and its impact on patient functioning and well-being. There are a number of patient-reported measures that assess burden of treatment in single diseases or in specific treatment contexts. A review of such measures could help identify content for a general measure of treatment burden that could be used with patients dealing with multiple chronic conditions. We reviewed the content and psychometric properties of patient-reported measures that assess aspects of treatment burden in three chronic diseases, ie, diabetes, chronic kidney disease, and heart failure. Methods We searched Ovid MEDLINE, Ovid EMBASE, Ovid PsycINFO, and EBSCO CINAHL through November 2011. Abstracts were independently reviewed by two people, with disagreements adjudicated by a third person. Retrieved articles were reviewed to confirm relevance, with patient-reported measures scrutinized to determine consistency with the definition of burden of treatment. Descriptive information and psychometric properties were extracted. Results A total of 5686 abstracts were identified from the database searches. After abstract review, 359 full-text articles were retrieved, of which 76 met our inclusion criteria. An additional 22 articles were identified from the references of included articles. From the 98 studies, 57 patient-reported measures of treatment burden (full measures or components within measures) were identified. Most were multi-item scales (89%) and assessed treatment burden in diabetes (82%). Only 15 measures were developed using direct patient input and had demonstrable evidence of reliability, scale structure, and multiple forms of validity; six of these demonstrated evidence of sensitivity to change. We identified 12 content domains common across measures and disease types. Conclusion Available measures of treatment burden in single diseases can inform derivation of a patient-centered measure of the construct in patients with multiple chronic conditions. Patients should take part in developing the measure to ensure salience and relevance.
Collapse
Affiliation(s)
- David T Eton
- Division of Heath Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Wiggins BS, Rodgers JE, DiDomenico RJ, Cook AM, Page RL. Discharge Counseling for Patients with Heart Failure or Myocardial Infarction: A Best Practices Model Developed by Members of the American College of Clinical Pharmacy's Cardiology Practice and Research Network Based on the Hospital to Home (H2H) Initiati. Pharmacotherapy 2013; 33:558-80. [DOI: 10.1002/phar.1231] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Barbara S. Wiggins
- Department of Pharmacy; Medical University of South Carolina; Charleston; South Carolina
| | - Jo E. Rodgers
- University of North Carolina; Chapel Hill; North Carolina
| | | | | | - Robert L. Page
- School of Pharmacy; University of Colorado; Aurora; Colorado
| |
Collapse
|
17
|
Welch JL, Astroth KS, Perkins SM, Johnson CS, Connelly K, Siek KA, Jones J, Scott LL. Using a mobile application to self-monitor diet and fluid intake among adults receiving hemodialysis. Res Nurs Health 2013; 36:284-98. [PMID: 23512869 DOI: 10.1002/nur.21539] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2013] [Indexed: 11/09/2022]
Abstract
Hemodialysis patients have difficulty self-managing a complex dietary and fluid regimen. The purpose of this feasibility study was to pilot test an electronic self-monitoring intervention based on social cognitive theory. During a 6-week intervention, 24 participants self-monitored diet and fluid intake using the Dietary Intake Monitoring Application (DIMA), and 20 participants served as controls by monitoring their activity using the Daily Activity Monitor Application (DAMA). Results from this pilot study suggest the intervention is feasible and acceptable, although few significant effects on outcomes were found in this small sample. The DIMA has potential to facilitate dietary and fluid self-monitoring but requires additional refinement and further testing.
Collapse
Affiliation(s)
- Janet L Welch
- Indiana University School of Nursing, 1111 Middle Drive, NU E403, Indianapolis, IN, USA.
| | | | | | | | | | | | | | | |
Collapse
|
18
|
Balta S, Kurt O, Cakar M, Demirkol S, Unlu M, Kucuk U. Urinary incontinence in people with chronic heart failure. Heart Lung 2013; 42:154. [PMID: 23287448 DOI: 10.1016/j.hrtlng.2012.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Revised: 12/04/2012] [Accepted: 12/04/2012] [Indexed: 11/17/2022]
|
19
|
Eton DT, Ramalho de Oliveira D, Egginton JS, Ridgeway JL, Odell L, May CR, Montori VM. Building a measurement framework of burden of treatment in complex patients with chronic conditions: a qualitative study. PATIENT-RELATED OUTCOME MEASURES 2012. [PMID: 23185121 PMCID: PMC3506008 DOI: 10.2147/prom.s34681] [Citation(s) in RCA: 221] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: Burden of treatment refers to the workload of health care as well as its
impact on patient functioning and well-being. We set out to build a
conceptual framework of issues descriptive of burden of treatment from the
perspective of the complex patient, as a first step in the development of a
new patient-reported measure. Methods: We conducted semistructured interviews with patients seeking medication
therapy management services at a large, academic medical center. All
patients had a complex regimen of self-care (including polypharmacy), and
were coping with one or more chronic health conditions. We used framework
analysis to identify and code themes and subthemes. A conceptual framework
of burden of treatment was outlined from emergent themes and subthemes. Results: Thirty-two patients (20 female, 12 male, age 26–85 years) were
interviewed. Three broad themes of burden of treatment emerged including:
the work patients must do to care for their health; problem-focused
strategies and tools to facilitate the work of self-care; and factors that
exacerbate the burden felt. The latter theme encompasses six subthemes
including challenges with taking medication, emotional problems with others,
role and activity limitations, financial challenges, confusion about medical
information, and health care delivery obstacles. Conclusion: We identified several key domains and issues of burden of treatment amenable
to future measurement and organized them into a conceptual framework.
Further development work on this conceptual framework will inform the
derivation of a patient-reported measure of burden of treatment.
Collapse
Affiliation(s)
- David T Eton
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | | | | |
Collapse
|
20
|
Granger BB, McBroom K, Bosworth HB, Hernandez A, Ekman I. The meanings associated with medicines in heart failure patients. Eur J Cardiovasc Nurs 2012; 12:276-83. [PMID: 22653088 DOI: 10.1177/1474515112447734] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND The purpose of this study was to explore the theoretical linkages between symptom experiences and meaning associated with medication adherence. The specific objectives were to evaluate the key constructs of Meaning-Response theory for understanding medication adherence in patients with chronic heart failure; to assess the influence of symptom persistence on the meaning associated with prescribed medicines; and to explore the extent to which meaningful associations improve medication adherence. Among patients with heart failure, poor medication adherence occurs in over half of the population, resulting in high rates of symptom exacerbation, avoidable hospitalization, and death. Nurses play a key role in facilitating self-management skills, but patients' perceptions of the relationship between symptoms and medicines is not clear. METHODS Using a prospective mixed methods design, the study assessed patients' (n=10) perception of chronic heart failure symptoms and medication adherence. Patients completed guided interviews related to six concepts of meaning ascribed to medication use and four standardized measures of medication-related beliefs, behaviours, symptoms, and satisfaction. RESULTS This study suggests that patients' perception of meaning associated with medication taking was categorized as positive, negative, or absent. Symptom persistence influenced a majority of patient beliefs in the efficacy medicines, and patients with more positive meaningful associations with their medicines were more likely to remain adherent during the course of this study. CONCLUSIONS Development of meaningful associations with medicines may improve long-term adherence with prescribed medication in heart failure.
Collapse
|
21
|
Tierney S, Elwers H, Sange C, Mamas M, Rutter MK, Gibson M, Neyses L, Deaton C. What influences physical activity in people with heart failure? A qualitative study. Int J Nurs Stud 2011; 48:1234-43. [DOI: 10.1016/j.ijnurstu.2011.03.003] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Revised: 03/02/2011] [Accepted: 03/04/2011] [Indexed: 11/17/2022]
|
22
|
Walsh E, Lehane E. An exploration of the relationship between adherence with dietary sodium restrictions and health beliefs regarding these restrictions in Irish patients receiving haemodialysis for end-stage renal disease. J Clin Nurs 2011; 20:331-40. [PMID: 21219516 DOI: 10.1111/j.1365-2702.2010.03348.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS To measure adherence levels with dietary restrictions in Irish patients with end-stage renal disease receiving haemodialysis and to explore the relationships between adherence with dietary sodium restrictions and health beliefs in relation to following these restrictions in this group. BACKGROUND Non-adherence to medical regimes is an important healthcare issue and an ever-present problem, particularly in patients with a chronic illness. The literature revealed a lack of studies measuring adherence with the sodium component of the renal dietary restrictions and associated factors; despite the fact that adherence with sodium restrictions is essential to the optimal management of end-stage renal disease. Furthermore, despite increased emphasis on 'the patients' view' in healthcare no study to date has contextualised health beliefs and adherence in end-stage renal disease from an Irish perspective. DESIGN A quantitative, descriptive, correlational design was employed using the Health Belief Model as a theoretical framework. METHODS A convenience sample (n = 79) was recruited from the haemodialysis units of a large hospital. Data were collected using self-report questionnaires. Data were analysed using descriptive and correlational statistics. RESULTS Non-adherence with dietary restrictions was a problem among a proportion of the sample. Greater adherence levels with dietary sodium restrictions were associated with greater 'perceived benefits' and fewer 'perceived barriers.' CONCLUSION For the Irish patient, beliefs in relation to following a low sodium diet significantly affected adherence levels with this diet. This is an important finding as delineating key beliefs, particularly key barriers, facilitates an increased understanding of non-adherence for nurses. RELEVANCE FOR CLINICAL PRACTICE These findings have implications for the care of patients with end-stage renal disease in that they can provide guidance in terms of developing interventions designed to improve adherence.
Collapse
Affiliation(s)
- Ella Walsh
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland.
| | | |
Collapse
|
23
|
Section 8: Disease Management, Advance Directives, and End-of-Life Care in Heart Failure Education and Counseling. J Card Fail 2010. [DOI: 10.1016/j.cardfail.2010.05.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
24
|
Agondi RDF, Gallani MCBJ, Rodrigues RCM, Cornélio ME. Relationship between beliefs regarding a low salt diet in chronic renal failure patients on dialysis. J Ren Nutr 2010; 21:160-8. [PMID: 20537916 DOI: 10.1053/j.jrn.2010.03.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2009] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE The aim of this study was to investigate the relationship between beliefs regarding a low salt diet and the nutritional behavior of sodium consumption as well their relation with sociodemographic and clinical variables among chronic renal failure (CRF) patients on dialysis. DESIGN AND METHODS This cross-sectional study enrolled a sample of 117 patients who answered the Brazilian version of the Beliefs about Dietary Compliance Scale (BDCS), the sodium frequency food questionnaire, and the use of discretionary salt/day. RESULTS The average of total salt consumption was 10.6 g/day (±6.3) and it was positively correlated with the interdialytic weight gain (r = 0.20 P = .032) and negatively correlated with the education level (r = -0.19 P = .044). The Benefits beliefs were discriminatory of the higher and lower salt consumers, and proportionally related to monthly income (r = 0.22 P = .017). The Barriers beliefs were positively correlated only to time on dialysis (r = 0.25 P = .008). Subjects with lower schooling and those of older age tended to consume more discretionary salt (r = -0.27, P = .005; r = 0.23, P = .016, respectively); however, they reported a lower consumption of foods with high salt content (r = 0.25 P = .006; r = -0.27 P = .004). CONCLUSIONS Educational interventions aimed at reducing salt consumption for this group must include interventions targeted at different behaviors related to overall salt consumption, the specificities of age, and level of schooling of the patients.
Collapse
Affiliation(s)
- Rúbia de F Agondi
- Department of Nursing, University of Campinas, Campinas, São Paulo, Brazil
| | | | | | | |
Collapse
|
25
|
Wu JR, Lennie TA, De Jong MJ, Frazier SK, Heo S, Chung ML, Moser DK. Medication adherence is a mediator of the relationship between ethnicity and event-free survival in patients with heart failure. J Card Fail 2010; 16:142-9. [PMID: 20142026 PMCID: PMC2819978 DOI: 10.1016/j.cardfail.2009.10.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2008] [Revised: 10/05/2009] [Accepted: 10/06/2009] [Indexed: 11/22/2022]
Abstract
BACKGROUND Rehospitalization rates are higher in African American than Caucasian patients with heart failure (HF). The reasons for the disparity in outcomes between African Americans and Caucasians may relate to differences in medication adherence. To determine whether medication adherence is a mediator of the relationship between ethnicity and event-free survival in patients with HF. METHODS AND RESULTS Medication adherence was monitored longitudinally in 135 HF patients using the Medication Event Monitoring System. Events (emergency department visits for HF exacerbation, HF and cardiac rehospitalization, and all-cause mortality) were obtained by interview and hospital data base review. A series of regression models and survival analyses was conducted to determine whether medication adherence mediated the relationship between ethnicity and event-free survival. Event-free survival was significantly worse in African Americans than Caucasians. Ethnicity was a predictor of medication adherence (P=.011). African Americans were 2.57 times more likely to experience an event than Caucasians (P=.026). Ethnicity was not a predictor of event-free survival after entering medication adherence in the model (P=.06). CONCLUSIONS Medication adherence was a mediator of the relationship between ethnicity and event-free survival in this sample. Interventions designed to reduce barriers to medication adherence may decrease the disparity in outcomes.
Collapse
Affiliation(s)
- Jia-Rong Wu
- University of Kentucky, College of Nursing, Lexington, KY 40536-0232, USA.
| | | | | | | | | | | | | |
Collapse
|
26
|
|
27
|
Wu JR, Chung M, Lennie TA, Hall LA, Moser DK. Testing the psychometric properties of the Medication Adherence Scale in patients with heart failure. Heart Lung 2009; 37:334-43. [PMID: 18790334 DOI: 10.1016/j.hrtlng.2007.10.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Many factors may contribute to medication nonadherence in heart failure (HF), but no standard measure exists to evaluate factors associated with nonadherence. To fill this gap, we developed the Medication Adherence Scale (MAS) and tested its reliability and validity in patients with HF. METHOD Questionnaire data were collected from 100 patients with HF at baseline using the MAS, and objective adherence data were collected for 3 consecutive months using the Medication Event Monitoring System. RESULTS Principal component analysis yielded three factors that explained 63% of the variance in medication adherence: knowledge, attitudes, and barriers to medication adherence. Cronbach's alphas for these subscales ranged from .75 to .94, which supported their internal consistency. The Spearman rho correlation coefficients between the Medication Event Monitoring System and Knowledge, Attitudes, and Barriers scores were .25 to .31 (P < .05), demonstrating support for construct validity. CONCLUSION These results support the reliability and validity of the MAS as a measure of knowledge, attitudes, and barriers of medication adherence.
Collapse
Affiliation(s)
- Jia-Rong Wu
- University of Kentucky, College of Nursing, Lexington, KY 40536-0232, USA
| | | | | | | | | |
Collapse
|
28
|
Wu JR, Moser DK, Chung ML, Lennie TA. Predictors of medication adherence using a multidimensional adherence model in patients with heart failure. J Card Fail 2008; 14:603-14. [PMID: 18722327 DOI: 10.1016/j.cardfail.2008.02.011] [Citation(s) in RCA: 150] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2007] [Revised: 02/12/2008] [Accepted: 02/25/2008] [Indexed: 01/19/2023]
Abstract
BACKGROUND Medication adherence in heart failure (HF) is a crucial but poorly understood phenomenon. The purpose of this study was to explore factors contributing to medication adherence in patients with HF by using the World Health Organization's multidimensional adherence model. METHODS AND RESULTS Patients (N = 134) with HF (70% were male, aged 61 +/- 12 years, 61% with New York Heart Association III/IV) were studied to determine the predictors of medication adherence derived from the multidimensional adherence model. Medication adherence was measured objectively using the medication event monitoring system for 3 months. Three indicators of adherence were assessed by the medication event monitoring system: 1) dose-count, the percentage of prescribed doses taken; 2) dose-days, the percentage of days the correct number of doses were taken; and 3) dose-time, the percentage of doses that were taken on schedule. Barriers to medication adherence, ethnicity, and perceived social support predicted dose-count (P < .001). New York Heart Association functional class, barriers to medication adherence, financial status, and perceived social support predicted dose-day (P < .001). Barriers to medication adherence and financial status predicted dose-time (P = .005). CONCLUSION A number of modifiable factors predicted medication adherence in patients with HF, providing specific targets for intervention.
Collapse
Affiliation(s)
- Jia-Rong Wu
- College of Nursing, University of Kentucky, Lexington, KY 40536-0232, USA
| | | | | | | |
Collapse
|
29
|
van der Wal MHL, Jaarsma T, Moser DK, van Gilst WH, van Veldhuisen DJ. Unraveling the mechanisms for heart failure patients' beliefs about compliance. Heart Lung 2007; 36:253-61. [PMID: 17628194 DOI: 10.1016/j.hrtlng.2006.10.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2006] [Accepted: 10/13/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Compliance with medication, diet, and monitoring symptoms is a problem in heart failure (HF) patients. Noncompliance can lead to worsening symptoms and is associated with personal beliefs about compliance. To intervene effectively, knowledge of factors related to patients' beliefs about compliance is needed. OBJECTIVES The aims of this study are to: (1) gain insight into patients' beliefs about compliance; (2) examine the association of demographic variables and depressive symptoms to beliefs; (3) assess compliance with medication, diet, and daily weighing; and (4) examine the association of compliance to patients' beliefs. METHODS Nine hundred fifty-four HF patients completed questionnaires on beliefs about medication and diet; 297 patients also completed a questionnaire on beliefs about symptom monitoring. Most important barriers and benefits were assessed as well as differences in beliefs between subgroups and the association between compliance and beliefs. RESULTS The most important barriers were diuresis during the night (57%), the taste of food (51%), and limited ability to go out (33%). A barrier related to failure to weigh daily was forgetfulness (26%). Patients with depressive symptoms and patients with a low level of HF knowledge experienced more barriers to compliance with the HF regimen. Self-reported compliance with medication was almost 99%, compliance with diet 77%, and with daily weighing 33%. CONCLUSIONS AND IMPLICATIONS In order to improve compliance, it is important that interventions should be directed to those patients who experience more barriers to compliance, such as patients with depressive symptoms and patients with a low level of knowledge on the HF regimen. Improvement of knowledge, therefore, will remain an important issue in HF management programs.
Collapse
Affiliation(s)
- Martje H L van der Wal
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | | | | | | |
Collapse
|
30
|
Blalock SJ, Patel RA. Drug therapy concerns questionnaire: initial development and refinement. J Am Pharm Assoc (2003) 2006; 45:160-9. [PMID: 15868758 DOI: 10.1331/1544345053623465] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To develop a scale, designed for self-administration, to assess patient perceptions of drug therapy problems (DTPs). DESIGN Cross-sectional survey. SETTING California Central Valley. PARTICIPANTS 200 community-dwelling adults taking at least one prescription medication. MAIN OUTCOME MEASURE 78 items assessing patient perceptions of DTPs. INTERVENTIONS Self-administered questionnaire completed by study participants. RESULTS Based on a Medication Evaluation and Response Model proposed in this article, items were developed to assess patient perceptions about potential or actual DTPs. Scales for five of the seven problem domains specified a priori were reliable based on participant responses: Perceived Efficacy, Overmedication Concerns, Adverse Drug Reaction Concerns, Adherence Issues, and Knowledge. Barriers and Intrusiveness were eliminated from, the questionnaire because of weak factor loadings. After making changes in domain assignment and eliminating redundant and weak items, five items remained in each of the five reliable scales, with Cronbach's alpha values ranging from 0.76 to 0.82. Each of the five scales was significantly associated with patient satisfaction with their medications. Individuals who reported fewer DTPs expressed greater overall satisfaction with their medications. In a forward stepwise regression analysis, four of the five scales exhibited independent associations with medication satisfaction, explaining 58.0% of the total variance in satisfaction [F(4,178) = 61.48, P < .0001]. Only the Knowledge scale failed to exhibit an independent association with satisfaction. CONCLUSION The findings from this initial stage of scale development are encouraging. The association between the scales and medication satisfaction suggests that the scales may be useful in learning more about those factors that influence how patients evaluate their medications.
Collapse
Affiliation(s)
- Susan J Blalock
- School of Pharmacy, CB# 7360, University of North Carolina, Chapel Hill, NC 27599-7360, USA.
| | | |
Collapse
|
31
|
Welch JL, Bennett SJ, Delp RL, Agarwal R. Benefits of and barriers to dietary sodium adherence. West J Nurs Res 2006; 28:162-80; discussion 181-9. [PMID: 16513918 DOI: 10.1177/0193945905282323] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Failure to limit dietary sodium leads to thirst, large fluid weight gain, and poor outcomes in patients receiving hemodialysis. Perceived benefits and barriers may influence adherence; however, tools measuring these relationships are not available. This study's purpose, based on the health belief model, was to evaluate the reliability and validity of the Beliefs about Dietary Compliance Scale (BDCS), describe perceived benefits and barriers over time, and identify individual benefits and barriers that may be amenable to tailored interventions. A convenience sample of 229 completed the BDCS at baseline. One week after baseline, 52 participants completed the BDCS to assess test-retest reliability. Four months after baseline, 187 participants (81%) remained. Cronbach's alphas for the scale ranged from .66 to .81. One-week test-retest reliabilities ranged from .68 to .86. Factor structure was supported by factor analysis. Scores remained stable over time. Barriers to dietary sodium limitations were common and more in need of intervention.
Collapse
Affiliation(s)
- Janet L Welch
- Indiana University School of Nursing, Indianapolis, USA
| | | | | | | |
Collapse
|
32
|
Bennett SJ, Lane KA, Welch J, Perkins SM, Brater DC, Murray MD. Medication and dietary compliance beliefs in heart failure. West J Nurs Res 2006; 27:977-93; discussion 994-9. [PMID: 16275694 DOI: 10.1177/0193945905280253] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patients with heart failure are required to comply with a medication regimen and dietary sodium restrictions. The objectives of this study were to determine the most frequently perceived benefits of and barriers to compliance with medication and dietary sodium restrictions and evaluate the relevancy of these scale items for testing in tailored intervention studies. Data were collected as part of two studies that evaluated the psychometric properties of two questionnaires. The most frequently identified benefit of medication compliance was decreasing the chance of being hospitalized, and the most commonly reported barrier was disruption of sleep. Patients were knowledgeable about the benefits of compliance with dietary sodium restrictions, and the poor taste of food on the low sodium diet was the most common barrier. Heart failure patients perceive benefits of and barriers to compliance with therapeutic regimens that are likely to be amenable to tailored interventions designed to enhance compliance.
Collapse
|
33
|
|
34
|
Bennett SJ, Litzelman DK, Wright A, Perkins SM, Wu J, Meyer L, Vaughn M. The PUMP UP tailored computerized program for heart failure care. Nurs Outlook 2006; 54:39-45. [PMID: 16487779 DOI: 10.1016/j.outlook.2005.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2004] [Revised: 05/02/2005] [Accepted: 05/12/2005] [Indexed: 11/16/2022]
Affiliation(s)
- Susan J Bennett
- Indiana University School of Nursing, Indianapolis, IN 46202, USA.
| | | | | | | | | | | | | |
Collapse
|
35
|
van der Wal MHL, Jaarsma T, Moser DK, Veeger NJGM, van Gilst WH, van Veldhuisen DJ. Compliance in heart failure patients: the importance of knowledge and beliefs. Eur Heart J 2005; 27:434-40. [PMID: 16230302 DOI: 10.1093/eurheartj/ehi603] [Citation(s) in RCA: 334] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS Non-compliance in patients with heart failure (HF) contributes to worsening HF symptoms and may lead to hospitalization. Several smaller studies have examined compliance in HF, but all were limited as they only studied either the individual components of compliance and its related factors or several aspects of compliance without studying the related factors. The aims of this study were to examine all dimensions of compliance and its related factors in one HF population. METHODS AND RESULTS Data were collected in a cohort of 501 HF patients. Clinical and demographic data were assessed and patients completed questionnaires on compliance, beliefs, knowledge, and self-care behaviour. Overall compliance was 72% in this older HF population. Compliance with medication and appointment keeping was high (>90%). In contrast, compliance with diet (83%), fluid restriction (73%), exercise (39%), and weighing (35%) was markedly lower. Compliance was related to knowledge (OR=5.67; CI 2.87-11.19), beliefs (OR=1.78; CI 1.18-2.69), and depressive symptoms (OR=0.53; CI 0.35-0.78). CONCLUSION Although some aspects of compliance had an acceptable level, compliance with weighing and exercise were low. In order to improve compliance, an increase of knowledge and a change of patient's beliefs by education and counselling are recommended. Extra attention should be paid to patients with depressive symptoms.
Collapse
Affiliation(s)
- Martje H L van der Wal
- Department of Cardiology, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands.
| | | | | | | | | | | |
Collapse
|
36
|
Sethares KA, Elliott K. The effect of a tailored message intervention on heart failure readmission rates, quality of life, and benefit and barrier beliefs in persons with heart failure. Heart Lung 2004; 33:249-60. [PMID: 15252415 DOI: 10.1016/j.hrtlng.2004.03.005] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the effect of a tailored message intervention on heart failure readmission rates, quality of life, and health beliefs in persons with heart failure (HF). DESIGN This randomized control trial provided a tailored message intervention during hospitalization and 1 week and 1 month after discharge.Theoretic framework The organizing framework was the Health Belief Model. SUBJECTS Seventy persons with a primary diagnosis of chronic HF were included in the study. RESULTS HF readmission rates and quality of life did not significantly differ between the treatment and control groups. Health beliefs, except for benefits of medications, significantly changed from baseline in the treatment group in directions posited by the Health Belief Model. CONCLUSIONS A tailored message intervention changed the beliefs of the person with HF in regard to the benefits and barriers of taking medications, following a sodium-restricted diet, and self-monitoring for signs of fluid overload. Future research is needed to explore the effect of health belief changes on actual self-care behaviors.
Collapse
Affiliation(s)
- Kristen A Sethares
- College of Nursing, University of Massachusetts Darrtmouth, Darrtmouth, MA 02747, USA
| | | |
Collapse
|
37
|
Akosah KO, Carothers S. Short-Term Aggressive Disease Management Programs for Heart Failure. ACTA ACUST UNITED AC 2004. [DOI: 10.2165/00115677-200412040-00002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
|
38
|
Richardson LG. Psychosocial issues in patients with congestive heart failure. PROGRESS IN CARDIOVASCULAR NURSING 2003; 18:19-27. [PMID: 12624569 DOI: 10.1111/j.0889-7204.2003.00835.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Psychosocial issues are important variables that need to be addressed in patients with congestive heart failure (CHF). Unfortunately, these issues are often overlooked. Depression and lack of social support have been shown to have a negative impact on patients with CHF. Patients with CHF who are depressed or who lack social support have been shown to have increased morbidity and hospital readmission rates, to be less adherent to their medical regimen, and to have an overall increase in cost of care. The variables are often interrelated, as high levels of social support may lessen the impact of depression on mortality. In addition, certain biologic factors may influence the impact of psychosocial factors in patients with CHF. This review addresses the effects of depression, treatment adherence, and social support in patients with CHF and suggests interventions targeted to these problems. Health care professionals must assess these issues in all patients with CHF, address their specific needs, and intervene appropriately when warranted.
Collapse
Affiliation(s)
- Luann G Richardson
- West Penn Allegheny Health System, Allegheny General Hospital, Pittsburgh, PA, USA
| |
Collapse
|
39
|
Diuretic therapy in chronic heart failure: Implications for heart failure nurse specialists. Aust Crit Care 2003. [DOI: 10.1016/s1036-7314(03)80016-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
40
|
Mueller TM, Vuckovic KM, Knox DA, Williams RE. Telemanagement of heart failure: a diuretic treatment algorithm for advanced practice nurses. Heart Lung 2002; 31:340-7. [PMID: 12487012 DOI: 10.1067/mhl.2002.126048] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Thirty-three percent of patients with heart failure (HF) are readmitted to the hospital with worsening disease within 90 days of discharge. Acute decompensation accounts for nearly 50% of these admissions because of nonadherence with diet guidelines, medication regimens, or both. One way to promote adherence is through a disease management approach that can prevent HF decompensation by providing aggressive follow-up care. Within such an approach, advanced practice nurses can use a decision algorithm to implement pharmacologic and nonpharmacologic interventions. This article presents a diuretic treatment algorithm for advanced practice nurses as part of a telemanagement program. Preliminary data from the implementation of such an algorithm within an established HF program shows a decrease in hospitalizations rates and cost of care. In addition, the algorithm helps define the scope of advanced practice nursing and promotes consistency across health care sites.
Collapse
Affiliation(s)
- Teresa M Mueller
- Evanston Northwestern Healthcare, Northwestern University, Chicago, IL, USA
| | | | | | | |
Collapse
|
41
|
Murray MD, Deer MM, Ferguson JA, Dexter PR, Bennett SJ, Perkins SM, Smith FE, Lane KA, Adams LD, Tierney WM, Brater DC. Open-label randomized trial of torsemide compared with furosemide therapy for patients with heart failure. Am J Med 2001; 111:513-20. [PMID: 11705426 DOI: 10.1016/s0002-9343(01)00903-2] [Citation(s) in RCA: 187] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE Because the bioavailability of oral furosemide is erratic and often incomplete, we tested the hypothesis that patients with heart failure who were treated with torsemide, a predictably absorbed diuretic, would have more favorable clinical outcomes than would those treated with furosemide. PATIENTS AND METHODS We conducted an open-label trial of 234 patients with chronic heart failure (mean [+/- SD] age, 64 +/- 11 years) from an urban public health care system. Patients received oral torsemide (n = 113) or furosemide (n = 121) for 1 year. The primary endpoint was readmission to the hospital for heart failure. Secondary endpoints included readmission for all cardiovascular causes and for all causes, numbers of hospital days, and health-related quality of life. RESULTS Compared with furosemide-treated patients, torsemide-treated patients were less likely to need readmission for heart failure (39 [32%] vs. 19 [17%], P <0.01) or for all cardiovascular causes (71 [59%] vs. 50 [44%], P = 0.03). There was no difference in the rate of admissions for all causes (92 [76%] vs. 80 [71%], P = 0.36). Patients treated with torsemide had significantly fewer hospital days for heart failure (106 vs. 296 days, P = 0.02). Improvements in dyspnea and fatigue scores from baseline were greater among patients treated with torsemide, but the differences were statistically significant only for fatigue scores at months 2, 8, and 12. CONCLUSIONS Compared with furosemide-treated patients, torsemide-treated patients were less likely to be readmitted for heart failure and for all cardiovascular causes, and were less fatigued. If our results are confirmed by blinded trials, torsemide may be the preferred loop diuretic for patients with chronic heart failure.
Collapse
Affiliation(s)
- M D Murray
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Bennett SJ, Perkins SM, Lane KA, Forthofer MA, Brater DC, Murray MD. Reliability and validity of the compliance belief scales among patients with heart failure. Heart Lung 2001; 30:177-85. [PMID: 11343003 DOI: 10.1067/mhl.2001.114193] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Lack of medication and dietary compliance leads to troublesome symptoms and hospitalization in patients with heart failure. Compliance behaviors are influenced by beliefs about the behavior. OBJECTIVE The purpose of this study was to evaluate the reliability and validity of the Beliefs about Medication Compliance Scale (BMCS) and the Beliefs about Dietary Compliance Scale (BDCS) among patients with heart failure. THEORETICAL FRAMEWORK This study's theoretical framework is the Health Belief Model. METHODS A convenience sample of 234 patients with heart failure completed the BMCS and the BDCS. Patients completed the scales at baseline by face-to-face interviews and at 8 and 52 weeks after baseline by telephone interview. RESULTS Construct validity of the scales was supported by confirmatory factor analysis. Both the BMCS and the BDCS had benefits and barriers scales with clear factor loadings. The internal consistency reliability estimates of the scales ranged from.63 to.88, with the BMCS having some estimates lower than.70. The test-retest reliability estimates ranged from.07 to.57. The intraclass correlation coefficient estimates were higher between the 8-week and 52-week scores for all scales. Possible reasons for the varying estimates are discussed. CONCLUSIONS The BMCS and the BDCS have documented reliability and validity. Future work should be directed at evaluating the responsiveness of the scales to changing patient conditions and testing interventions to improve medication and dietary compliance through changing beliefs.
Collapse
Affiliation(s)
- S J Bennett
- Indiana University School of Nursing, , Indianapolis, IN 46202, USA
| | | | | | | | | | | |
Collapse
|
43
|
Bennett SJ, Hays LM, Embree JL, Arnould M. Heart Messages: a tailored message intervention for improving heart failure outcomes. J Cardiovasc Nurs 2000; 14:94-105. [PMID: 10902106 DOI: 10.1097/00005082-200007000-00007] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Heart failure is a major health problem in the United States leading to high rates of mortality and morbidity and impaired quality of life. Assisting patients to improve compliance with their self-care regimen, including medications, dietary sodium restrictions, and self-monitoring (daily weights, edema assessment), may improve these poor outcomes. This article describes the development and initial evaluation of Heart Messages, a theory-based, tailored message intervention to improve compliance with the self-care regimen recommended for patients with heart failure. The project involved four phases, each of which is described in this article. The Heart Messages tailored message intervention program is available in both printed and Web-based formats. In a pilot study and clinical evaluation project, the program was found to be useful for patient education and feasible for implementation. Larger randomized trials are now warranted to evaluate the effectiveness of the intervention in improving compliance with the self-care regimen and thereby improving outcomes among patients with heart failure.
Collapse
Affiliation(s)
- S J Bennett
- School of Nursing, Indiana University, Indianapolis, USA
| | | | | | | |
Collapse
|
44
|
Simpson SH, Farris KB, Johnson JA, Tsuyuki RT. Using focus groups to identify barriers to drug use in patients with congestive heart failure. Pharmacotherapy 2000; 20:823-9. [PMID: 10907972 DOI: 10.1592/phco.20.9.823.35205] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVE To explore barriers to adherence to drug therapy identified by patients with congestive heart failure (CHF). SETTING University-associated heart failure clinic and a family practice clinic. PATIENTS Twenty-six patients with CHF. INTERVENTION Four focus group sessions. MEASUREMENTS AND MAIN RESULTS Participants were asked to describe how their lives changed as a result of developing CHF and the challenges they face when taking drugs for the condition. In the second half of each session, participants were asked for their opinions regarding various teaching and memory aids for improving adherence with therapy. They recognized the value of these aids and often created their own when health care professionals did not supply them. Transcripts were reviewed and comments grouped to identify patient-perceived barriers to adherence. The disease placed significant limitations on lifestyle. Furosemide had dramatic effects on daily activities, and some patients altered the dosing schedule to accommodate their plans. Influences on adherence were generalized into five themes: confidence in health care providers; their own knowledge regarding the disease and drugs used to treat it; previous experience with drugs; support from family and friends; and ease of communication with health care professionals. CONCLUSION Focus groups are an effective and efficient method to explore patients opinions of barriers to drug therapy adherence. Such information can have a direct impact on management of patients with CHF. Information gathered in this study will be used to construct a survey to measure barriers to drug adherence and design interventions to improve adherence.
Collapse
Affiliation(s)
- S H Simpson
- Division of Cardiology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | | | | | | |
Collapse
|
45
|
Bennett SJ, Cordes DK, Westmoreland G, Castro R, Donnelly E. Self-care strategies for symptom management in patients with chronic heart failure. Nurs Res 2000; 49:139-45. [PMID: 10882318 DOI: 10.1097/00006199-200005000-00004] [Citation(s) in RCA: 113] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The troublesome symptoms experienced by patients with chronic heart failure are associated with diminished quality of life, frequent hospitalizations, and mortality. OBJECTIVES To describe the symptoms experienced by patients with heart failure, to detail the self-care strategies used by these patients in managing their symptoms, and to categorize the self-care strategies. METHODS Six focus groups were used with 23 patients who had heart failure, along with six focus groups with 18 family members of the patients. Data analysis was performed by transcription of audiotape recordings of the group sessions and review of field notes. RESULTS The patients reported a large number of troublesome symptoms, many consistent with past empirical findings, but some not reported in previous studies. Self-care strategies to manage the symptoms clustered into 11 categories. CONCLUSIONS Results from this study provided direction for future studies to (a) identify the prevalence, severity, and etiologies of the commonly reported symptoms, particularly cognitive impairment, loss of balance, and depression; (b) evaluate the emotions reported by women with heart failure; and (c) test the strategies as part of an intervention program to improve symptom management in patients with heart failure.
Collapse
Affiliation(s)
- S J Bennett
- Adult Health Department, Indiana University School of Nursing, Indianapolis 46202, USA
| | | | | | | | | |
Collapse
|
46
|
Johnson MJ, Williams M, Marshall ES. Adherent and nonadherent medication-taking in elderly hypertensive patients. Clin Nurs Res 1999; 8:318-35. [PMID: 10855101 DOI: 10.1177/10547739922158331] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Nonadherence to medications is a significant reason why patients fail to control their blood pressure. Little work has been attempted to conceptualize medication-taking behaviors from the patient's perspective. This study examined factors that influence elderly hypertensive patients' adherence or nonadherence to prescribed medications. Using a qualitative descriptive research design, 21 hypertensive elderly people were interviewed. Two domains of adherence were identified: purposeful use of the medication for the control of patient's blood pressure and establishing and maintaining patterns of medication-taking. Two similar domains also emerged for nonadherence: purposeful and incidental. Adherence behaviors were dependent on the person's decision to take hypertension medication, access to medications, and ability to initiate treatment and maintain a medication-taking pattern. The timing and location of pills were integral parts of establishing patterns of taking medications. Inadequate access to medications or interruption of a person's pattern were associated with the incidental missing of medications.
Collapse
|
47
|
Poss JE. Developing an instrument to study the tuberculosis screening behaviors of Mexican migrant farmworkers. J Transcult Nurs 1999; 10:306-19. [PMID: 10693422 DOI: 10.1177/104365969901000409] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This article details the use of qualitative data in the construction of a Spanish-language, quantitative research instrument designed for a study of Mexican migrant farmworkers' participation in tuberculosis screening. In the qualitative study, 19 Mexican migrant farmworkers were interviewed in Spanish to elicit their explanatory models (EMs) about tuberculosis. The Tuberculosis Interview Instrument (TII) was developed from the results of the qualitative study and concepts from a theoretical framework consisting of a combination of the Health Belief Model (HBM) and the Theory of Reasoned Action (TRA). After its development, the TII was subjected to translation and back-translation procedures to insure the equivalency of the English and Spanish versions, and it was reviewed for content validity. Internal consistency reliability, based on the responses of 206 subjects, was satisfactory for all subscales. Future testing of the TII is recommended to evaluate its stability among Mexican migrant farmworkers in other parts of the United States.
Collapse
Affiliation(s)
- J E Poss
- University of Texas at El Paso, USA
| |
Collapse
|
48
|
Dunbar SB, Jacobson LH, Deaton C. Heart failure: strategies to enhance patient self-management. AACN CLINICAL ISSUES 1998; 9:244-56. [PMID: 9633275 DOI: 10.1097/00044067-199805000-00007] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Successful management of heart failure requires an active partnership between the patient and health care providers. This can be facilitated through a focused patient education plan that begins in acute care and has continuity into the community. Elements of the education plan involve both teaching content areas and self-management behaviors. Clinical pathways for heart failure incorporate teaching and educational strategies to guide the work of the multidisciplinary team, and the advanced practice nurse has tremendous potential in facilitating improved patient outcomes.
Collapse
Affiliation(s)
- S B Dunbar
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, USA
| | | | | |
Collapse
|