Adherence reporting in clinical trials of type 2 Diabetes Metellius in the field of Traditional Chinese Medicine

Factors Affecting Tendency and Adherence to Traditional Persian Medicine: A Qualitative Study

Background: Adherence to medications is crucial for them to be effective. Traditional Persian Medicine (TPM) is an ancient medical discipline originated from old Persia and is currently used along with modern medicine in Iran. Evaluating the factors affecting adherence to TPM can have far-reaching implications for policymakers to make informed decisions. Objectives: This qualitative study investigates the factors affecting tendency and adherence to TPM among Iranians. Methods: We collected data from stakeholders in TPM using a focus group involving 13 participants and by conducting four in-depth interviews. The saturation point was reached at the 4th interview. We recorded all the interviews and then transcribed them verbatim for thematic content analysis. Results: We obtained 297 codes and 29 sub-themes for the factors affecting adherence to TPM, including the factors affecting compliance and tendency. Then we extracted the main themes. People’s beliefs, the inherent characteristics of traditional medicine and its status quo, attempts to bring about positive changes to TPM, and the problems facing the modern health system were the main factors affecting adherence to TPM. Conclusions: Despite many strenuous efforts in Iran to study TPM along with the lines of evidence-based medicine, policymaking, financing, patients’ and healthcare providers’ education, popular beliefs, and administrative transparency are needed to be addressed more adequately to promote adherence to TPM and help build integrative medicine in Iran’s healthcare system.

Refinement and Evaluation of a Chinese and Western Medication Adherence Scale for Patients with Chronic Kidney Disease: Item Response Theory Analyses

PURPOSE

This study aimed to simplify the version-1 Chinese and Western medication adherence scale for patients with chronic kidney disease (CKD) to a version-2 scale using item response theory (IRT) analyses, and to further evaluate the performance of the version-2 scale.

MATERIALS AND METHODS

Firstly, we refined the version-1 scale using IRT analyses to examine the discrimination parameter (a), difficulty parameter (b) and maximum information function peak (Imax). The final scale refinement from version-1 to version-2 scale was also decided upon clinical considerations. Secondly, we analyzed the reliability and validity of version-2 scale using classical test theory (CTT), as well as difficulty, discrimination and Imax of version-1 and version-2 scale using IRT in order to conduct scale evaluation.

RESULTS

For scale refinement, the 26-item version-1 scale was reduced to a 15-item version-2 scale after IRT analyses. For scale evaluation using CTT, internal consistency reliability (total Cronbach α = 0.842) and test-rest reliability (r = 0.909) of version-2 scale were desirable. Content validity indicated 3 components of knowledge, belief and behaviors. We found meritorious construct validity with 3 detected components as the same construct of medication knowledge (items 1-9), medication behavior (items 13-15), and medication belief (items 10-12) based upon exploratory factor analysis. The correlation between the version-2 scale and Morisky, Green and Levine scale (MGL scale) was weak (Pearson coefficient = 0.349). For scale evaluation with IRT, the findings showed enhanced discrimination and decreased difficulty of most retained items (items 1, 2, 3, 4, 5, 6, 7, 9, 10, 11, 12, 13, 14, 15), decreased Imax of items 1, 2, 3, 4, 6, 11, 14, as well as increased Imax of items 5, 7, 8, 9, 10, 12, 13, 14, 15 in the version-2 scale than in the version-1 scale.

CONCLUSION

The original Chinese and Western medication adherence scale was refined to a 15-item version-2 scale after IRT analyses. The scale evaluation using CTT and IRT showed the version-2 scale had the desirable reliability, validity, discrimination, difficulty, and information providedoverall. Therefore, the version-2 scale is clinically feasible to assess the medication adherence of CKD patients.

Understanding the Traditional Chinese Medicine (TCM) consultation: Why do patients adhere to treatment?

BACKGROUND

and purpose: Adherence is an issue that affects Complementary and Alternative Medicine (CAM) and conventional medicine practitioners, whereby approximately half of the patients do not take their medicines or remedies as prescribed. The consultation is an opportune area where practitioners can have an impact on patient adherence to treatment. As such, research was undertaken to explore this in depth within one CAM. The aim of the study was to understand the Traditional Chinese Medicine (TCM) consultation process that occurs in relation to adherence and develop a consultation model health professionals can use.

MATERIALS AND METHODS

A classical grounded theory approach was employed to semi-structured interviews of TCM practitioners and patients along with observations of their consultations. Sampling was theoretical and by snowball in the United Kingdom. NVivo 11 was used to assist with analysis of the transcribed interviews and observations.

RESULTS

Seven TCM practitioners and twenty-eight patients were recruited. TCM practitioners built a therapeutic relationship through the consultation by enabling patients to feel comfortable, valued as individuals which incorporated feeling understood and known, as well as supported in the management of their health. Fundamentally, patients needed to feel cared for and have trust in their TCM practitioner for the therapeutic relationship to be established. This motivated patients to continue with treatment.

CONCLUSION

The TCM Consultation Model for Adherence was developed to conceptualise the consultation process that occurs in relation to adherence. It can be used to encourage patient persistence with treatment by TCM practitioners and potentially other health professionals.