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Kotry D, Saillard J, Bonsergent M, Volteau C, Benichou A, Prot-Labarthe S, Huon JF. Observational and prospective study: evaluation of beliefs and representations of chronic treatments of polymedicated patients hospitalised in a vascular medicine and surgery department. BMJ Open 2023; 13:e073250. [PMID: 38097247 PMCID: PMC10729245 DOI: 10.1136/bmjopen-2023-073250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 10/24/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVES Today, the involvement of patients in their care is essential. As the population ages increases, the number of patients with chronic diseases is increasing. In the vascular medicine and surgery departments, patients are polymedicated and mostly suffer from several chronic diseases. Approximately 50% of patients with a chronic disease are not adherent. Among the factors that can influence therapeutic adherence are the beliefs and representations of patients.To evaluate the beliefs and representations of chronic treatments in patients with multiple medications and hospitalised in a vascular medicine and surgery department, and to evaluate the medication adherence, the knowledge and the importance patients attach to their treatments. DESIGN Observational, prospective and a single-centre study. SETTING The study was conducted in a French tertiary hospital centre of around 3000 beds in 9 institutions. PARTICIPANTS Adult polymedicated (ie, minimum of five chronic treatments) patients hospitalised in a vascular medicine and surgery department were included after application of the exclusion criteria. METHODS Patient interviews were carried out in the department and were based on three interviewer-administered questionnaires (a global questionnaire, the Belief Medical Questionnaire and the GIRERD questionnaire). RESULTS Our study showed that patients perceived their treatments as beneficial rather than worrying. A correlation between medication adherence and beliefs was observed. 'Non-adherent'patients had a more negative overall view of medication than 'adherent' patients. The level of compliance and knowledge of our patients was low. Only 11% of the patients were 'good adherent', 16% of the patients could perfectly name their treatment and 36% knew all the indications. CONCLUSION Knowledge of treatment representation and beliefs are central to understanding patient behaviour. Considering patients' representations will allow the identification of levers, and the development of actions and educational tools adapted to improve their adherence, their knowledge and therefore their drug management.
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Affiliation(s)
- Dounia Kotry
- Nantes Université, CHU Nantes, Pharmacie, F-44000, France
| | | | | | - Christelle Volteau
- Nantes Université, CHU Nantes, DRCI, Département Promotion, Nantes, Cedex, France
| | - Antoine Benichou
- Nantes Université, CHU Nantes, Médecine Interne, F-44000, France
| | - Sonia Prot-Labarthe
- Nantes Université, CHU Nantes, Pharmacie, F-44000, France
- Nantes Université, CHU Nantes, F-44000, Pharmacie, France
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Meraz R, McGee J, Caldwell EP, Ke W, Osteen K. The Impact of Resilience, Health Literacy, and Social Support on Medication Adherence and Self-care Among Adults With Heart Failure. J Cardiovasc Nurs 2023; 38:415-424. [PMID: 36103430 DOI: 10.1097/jcn.0000000000000948] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Personal and psychological factors, such as depression, have a considerable influence on nonadherence to medications and self-care in those with heart failure. More evidence is needed about positive personal factors that motivate adherence to medications and self-care in those with heart failure. OBJECTIVE The purpose of this study was to investigate whether there was a relationship between the personal resources of resilience, hope, health literacy, social support, and self-care activation and adherence to HF self-care and medications and whether race impacts adherence. METHODS This study used a cross-sectional, correlational design. Stepwise regression was used to test whether resilience, hope, health literacy, self-care activation, and race significantly predicted medication adherence and self-care. A diverse sample was recruited for this study. RESULTS Of the 174 participants, 51% were female, 51.7% were White, and the mean age was 62 years. After adjustment for differences in age and depressive symptoms, a predictive relationship remained between resilience, health literacy, and medication adherence. Hope, activation, and race were not selected in the final regression model. A high level of perceived social support was the only predictor of better HF self-care. CONCLUSION Persons with heart failure may have better medication adherence and overall self-care if sufficiently resilient, health literate, and supported regardless of their degree of hope or activation. Race and age may be important factors to consider. More research is needed to understand the connection between resilience and medication adherence.
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Bowers MT, Carter T. Heart Failure: Priorities for Transition to Home. Nurs Clin North Am 2023; 58:283-294. [PMID: 37536781 DOI: 10.1016/j.cnur.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Nurses play a key role in promoting successful transitions of patients with heart failure (HF) from the hospital to the ambulatory setting. Engaging patients and caregivers in discharge teaching early in the hospitalization can enhance their understanding of HF as a clinical syndrome and identify precipitants of decompensation. Effective transitional care interventions for patient with HF include a phone call within 48 to 72 hours and a follow-up appointment within 7 days. Early symptom identification and treatment are key aspects of HF care to improve quality of life and minimize risk of hospitalization.
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Affiliation(s)
- Margaret T Bowers
- Department of Medicine, Duke University School of Nursing, 307 Trent Drive, Durham, NC 27710, USA.
| | - Tonya Carter
- University of North Carolina Health, 160 Dental Circle Drive, CB# 7075, Chapel Hill, NC 27599, USA
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Turrise S, Hadley N, Phillips-Kuhn D, Lutz B, Heo S. A snapshot of patient experience of illness control after a hospital readmission in adults with chronic heart failure. BMC Nurs 2023; 22:75. [PMID: 36941635 PMCID: PMC10029248 DOI: 10.1186/s12912-023-01231-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 03/03/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Approximately 6.5 million adults have chronic heart failure (HF), the number one cause of 30-day hospital readmission. Managing HF and its symptoms is critical for patients. Hospitalization may impact patients' perceptions of illness control, which can affect illness management. However, how hospital readmissions are perceived as related to one's ability to control their HF and its symptoms has not been examined. OBJECTIVE The purpose was to explore the experiences of people with HF in managing their illness (i.e., illness control), understand their perceptions of illness control after recent hospital readmission, and clarify the concept of illness control in people with chronic HF. METHODS A qualitative approach, applied thematic analysis was employed. Purposive sampling was used to identify participants. Semi-structured interviews were conducted in 10 participants' homes. Ongoing, concurrent, and comparative data analysis was used with ATLASti© data management software. RESULTS Two themes were identified, strategies to control HF and barriers to controlling HF. Strategies to control HF included four subthemes: managing dietary intake and medications; self- advocacy; monitoring symptoms; and support. Barriers to control also had four subthemes: healthcare systems issues; health care professional relationships and interactions; personal characteristics; and knowledge deficits. CONCLUSION People use many different strategies to control HF. Control comes from both within and outside of the individual. The desire to control HF and its symptoms was evident, but implementing strategies is challenging and takes time, experience, and trial and error. Individuals did not view readmission negatively but as necessary to help them control their symptoms.
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Affiliation(s)
- Stephanie Turrise
- University of North Carolina, Wilmington, 601 S. College Road, Wilmington, NC, 28403, USA.
| | - Nina Hadley
- Novant Health New Hanover Regional Medical Center, Wilmington, NC, USA
| | | | - Barbara Lutz
- University of North Carolina, Wilmington, 601 S. College Road, Wilmington, NC, 28403, USA
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Meraz R, Osteen K, McGee JS, Noblitt P, Viejo H. Applying Stress and Coping Theory to Understand Diuretic Adherence Experiences in Persons with Heart Failure. West J Nurs Res 2023; 45:67-77. [PMID: 35711104 DOI: 10.1177/01939459221106122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Despite the benefits of diuretics for treating the symptoms of heart failure (HF), patients may report side effects and intentionally not adhere to diuretic regimens. Positive internal motivators, such as positive emotions, may benefit individuals in their adaptation to medication-related stress. However, there has been limited study of these potential motivators in those with HF. Using a descriptive qualitative approach, 82 adults taking diuretics for HF were interviewed. This study applied stress and coping theory to understand the diuretic-taking experiences of patients with HF. Data analysis revealed three themes: (a) diuretics are bothersome, (b) staying positive in the mid of hardship, and (c) adapting to endure. Findings suggest that adherent participants stayed positive amid the perceived hardship, maintaining resilient and grateful attitudes. Adherent participants adapted to bothersome diuretic effects and utilized creative strategies. More research is needed to understand the relationships between resilience, adaptive coping, and diuretic adherence.
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Affiliation(s)
- Rebecca Meraz
- Baylor University Louise Herrington School of Nursing, Dallas, TX, USA
| | - Kathryn Osteen
- Baylor University Louise Herrington School of Nursing, Dallas, TX, USA
| | | | - Paul Noblitt
- Baylor Scott & White Medical Center, Irving, TX, USA
| | - Henry Viejo
- Baylor Scott & White Heart and Vascular Hospital, Fort Worth, TX, USA
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The Associations among Gender, Age, eHealth Literacy, Beliefs about Medicines and Medication Adherence among Elementary and Secondary School Teachers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116926. [PMID: 35682509 PMCID: PMC9180475 DOI: 10.3390/ijerph19116926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/21/2022] [Accepted: 06/03/2022] [Indexed: 02/04/2023]
Abstract
Background: A lack of health literacy may negatively impact patient adherence behavior in health care delivery, leading to a major threat to individual health and wellbeing and an increasing financial burden on national healthcare systems. Therefore, how to cultivate citizens’ health literacy, especially electronic health (eHealth) literacy that is closely related to the Internet, may be seen as a way to reduce the financial burden of the national healthcare systems, which is the responsibility of every citizen. However, previous studies on medication adherence have mostly been conducted with chronic disease patient samples rather than normal samples. Teachers are not only the main body of school health efforts, but also role models for students’ healthy behavior. Therefore, understanding differences in eHealth literacy beliefs among schoolteachers would be helpful for improving the existing health promoting programs and merit specific research. Aims: The present study identified the relationships among gender, age, electronic health (eHealth) literacy, beliefs about medicines, and medication adherence among elementary and secondary school teachers. Methods: A total of 485 teachers aged 22−51 years completed a pen-and-paper questionnaire. The instruments included an eHealth literacy scale, a belief about medicines scale and a medication adherence scale. Results: The results showed a significant difference between genders in necessity beliefs about medication (t = 2.00, p < 0.05), and a significant difference between ages in functional eHealth literacy (F = 3.18, p < 0.05) and in necessity beliefs about medication (Welch = 7.63, p < 0.01). Moreover, age (β = 0.09), functional eHealth literacy (β = 0.12), and necessity beliefs about medication (β = 0.11) positively predicted medication adherence, while concerns about medication (β = −0.23) negatively predicted medication adherence. Conclusions: The results showed that male teachers had stronger concerns about medication than female teachers. Teachers aged 42−51 years had lower functional eHealth literacy and stronger necessity beliefs about medication than teachers aged 22−31 years. In addition, teachers who were older, had higher functional eHealth literacy, had stronger necessity beliefs about medication, and had fewer concerns about medication tended to take their medications as prescribed. These findings revealed that helping teachers develop high eHealth literacy and positive beliefs about medicines is an effective strategy for improving medication adherence.
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Medication Nonadherence or Self-care? Understanding the Medication Decision-Making Process and Experiences of Older Adults With Heart Failure. J Cardiovasc Nurs 2021; 35:26-34. [PMID: 31567510 PMCID: PMC6903380 DOI: 10.1097/jcn.0000000000000616] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND More than half of all patients with heart failure (HF) do not take medications as prescribed, resulting in negative health outcomes. Research has shown that medication adherence may be intentional rather than the ability to follow prescribed regimens, yet very little is known about medication-taking decisions in older patients with HF. OBJECTIVE The purpose of this qualitative study was to gain insight into the decision-making processes and experiences of older patients with HF by exploring the different aspects in choosing to take or not take medications as prescribed in the community setting. METHODS Using a narrative inquiry approach, the personal narratives of 11 adults 65 years or older who took at least 2 daily medications for HF were gathered using in-depth, semistructured interviews. The data in this study were organized and analyzed using Riessman's framework for narrative analysis. RESULTS Participants made intentional decisions to take particular medications differently than prescribed. A worrisome symptom prompted a naturalistic decision-making process. When a medication interfered with attaining a personal goal, participants coped by individualizing their medication regimen. Participants did not consider taking a medication differently than prescribed as nonadherence but a necessary aspect of maintaining a personal level of health, which could be seen as self-care. CONCLUSIONS The older patient with HF should be carefully assessed for nonadherence. The development of interventions that are patient specific, target medications with the greatest potential for nonadherence, and use easy-to-access resources may promote decisions for medication adherence. More research is needed to develop interventions that promote decisions for medication adherence.
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Pattinson R, Poole HM, Shorthouse O, Sadiq SA, Bundy C. Exploring beliefs and distress in patients with facial palsies. PSYCHOL HEALTH MED 2021; 27:788-802. [PMID: 33486991 DOI: 10.1080/13548506.2021.1876891] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Evidence suggests that people with facial palsy may experience higher levels of distress, but the reasons for this are yet to be explored. This study aimed to explore people's illness beliefs, emotions, and behaviours in relation to their facial palsy and understand how distress is experienced by this group. Semi-structured individual interviews were conducted in the UK with adults with facial palsy. Interview questions were theoretically informed by the Common-Sense Self-Regulatory Model (CS-SRM). Thematic Analysis was conducted following a combined inductive and deductive approach. Twenty people with facial palsy participated (70% female; aged 29-84). Patient distress was accounted for by illness beliefs (symptoms, cause, control and treatment, timeline and consequences), and four additional themes (coping behaviours, social support, identity and health service provision). Experiences of anxiety, depression, and anger were widespread, and some participants experienced suicidal ideation. The burden of managing a long-term condition, altered self-perception, and social anxiety and isolation were key drivers of distress. There is a need for more integrated psychological support for patients with facial palsy. Within clinical consultations, patient's beliefs about facial palsy should be identified and systematically addressed. Service development should include appropriate referral to specialist psychological support via an established care pathway.
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Affiliation(s)
- R Pattinson
- School of Healthcare Sciences, College of Biomedical Sciences, Cardiff University, Cardiff, UK
| | - H M Poole
- School of Psychology, Liverpool John Moores University, Liverpool John Moores University, Liverpool, UK
| | - O Shorthouse
- Institute of Inflammation and Repair, University of Manchester, Manchester, UK
| | - S A Sadiq
- Manchester Royal Eye Hospital, Manchester, UK
| | - C Bundy
- School of Healthcare Sciences, College of Biomedical Sciences, Cardiff University, Cardiff, UK
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Chang WT, Wang ST, Hsu CH, Tsai LM, Chan SH, Chen HM. Effects of illness representation-focused patient education on illness representations and self-care in patients with heart failure: A randomised clinical trial. J Clin Nurs 2020; 29:3461-3472. [PMID: 32562433 DOI: 10.1111/jocn.15384] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 05/24/2020] [Accepted: 06/05/2020] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To examine the effect of an illness representation-focused patient education intervention on illness representations and self-care behaviours in patients with heart failure 3 months after discharge from the hospital. BACKGROUND Few intervention studies have examined the effect of illness representation-focused interventions on illness representations and self-care in patients with heart failure. DESIGN A randomised clinical trial based on the Consolidated Standard of Reporting Trials-CONSORT 2010-guidelines was employed. The Clinical Trial Registry number is TCTR20190903002. METHODS One hundred and seven participants were randomly assigned to 2 groups, and 62 participants (n = 30 in the intervention group and n = 32 in the usual care group) completed the baseline and one- and three-month postdischarge follow-up assessments. The instruments included the Survey of Illness Beliefs in Heart Failure and the Self-care of Heart Failure Index. The intervention group received illness representation-focused patient education while hospitalised and telephone follow-ups after discharge. Data were analysed with linear mixed-effects model analysis. RESULTS The 107 participants had a mean age of 62.17 years and a mean left ventricular ejection of 53.03%. At baseline, the two groups tended to have accurate illness beliefs but insufficient self-care confidence and self-care maintenance. The analysis showed no significant differences between groups in the illness representation total scores, dimension scores or self-care maintenance scores but did show a significant difference in the self-care confidence scores (F = 3.42, p < .05) over the three months. CONCLUSION The study did not show an effect of the intervention on illness representations or self-care maintenance behaviours. However, the intervention did maintain participants' self-care confidence three months after discharge. RELEVANCE TO CLINICAL PRACTICE It is necessary to conduct long-term follow-ups of patients' illness representations, discuss the implementation of self-care behaviours with patients, enhance patients' self-care confidence, and involve family members or caregivers in self-care practices when needed.
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Affiliation(s)
- Wan-Tzu Chang
- Department of Nursing, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Shan-Tair Wang
- Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi City, Taiwan.,Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chih-Hsin Hsu
- Division of Cardiology, Department of Internal Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Liang-Miin Tsai
- Department of Internal Medicine, Tainan Municipal Hospital, Tainan, Taiwan
| | - Shih-Hung Chan
- Division of Cardiology, Department of Internal Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hsing-Mei Chen
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Riegel B, Lee S, Hill J, Daus M, Baah FO, Wald JW, Knafl GJ. Patterns of adherence to diuretics, dietary sodium and fluid intake recommendations in adults with heart failure. Heart Lung 2019; 48:179-185. [PMID: 30638609 DOI: 10.1016/j.hrtlng.2018.12.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 12/20/2018] [Accepted: 12/21/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Three behaviors advocated to minimize fluid-related hospitalizations in patients with heart failure (HF) are restricted sodium and fluid intake and consistent oral diuretic use. Adherence to behaviors intended to decrease risk of hospitalization is believed to vary over time, but surprisingly little research has addressed patterns of adherence in HF patients. OBJECTIVE To describe patterns over time of 3 recommended self-care behaviors (i.e., diet, fluid intake, and diuretic dosing) in adults with HF and to determine how time and behavior influenced adherence rates. METHODS We enrolled 24 adults hospitalized for a HF exacerbation and discharged on a loop diuretic into a descriptive, longitudinal pilot study. Over 3-months, diuretic use was measured using electronic event monitoring, and participants were telephoned regularly to assess sodium and fluid intake. Data were summarized for each 2-week intervals. RESULTS The overall adherence rates were 42.4% for low sodium diet, 96.4% for fluid restriction, and 84.7% for the diuretic regimen. Early after hospital discharge, medication adherence was the highest, and dietary adherence was the lowest, but adherence to diet and diuretic use decreased significantly over time. CONCLUSION Although participants were just discharged from the hospital after an acute exacerbation of HF, all three behavioral patterns decreased markedly over the 3-month follow-up period.
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Affiliation(s)
- Barbara Riegel
- School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Philadelphia, 19104-4217 PA, USA.
| | - Solim Lee
- School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Philadelphia, 19104-4217 PA, USA
| | - Julia Hill
- Family Nurse Practitioner, North End Waterfront Health, Boston, MA, USA
| | - Marguerite Daus
- School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Philadelphia, 19104-4217 PA, USA
| | - Foster Osei Baah
- School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Philadelphia, 19104-4217 PA, USA
| | - Joyce W Wald
- Advanced heart failure and transplant program, university of Pennsylvania, Philadelphia, PA, USA
| | - George J Knafl
- School of Nursing, University of North Carolina, Chapel Hill, NC, USA
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Riegel B, Dickson VV. A qualitative secondary data analysis of intentional and unintentional medication nonadherence in adults with chronic heart failure. Heart Lung 2016; 45:468-474. [DOI: 10.1016/j.hrtlng.2016.08.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 08/01/2016] [Accepted: 08/02/2016] [Indexed: 02/08/2023]
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