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Taiwong A, Uppor W, Vibulchai N. Concordance in the healthcare context: A concept analysis. BELITUNG NURSING JOURNAL 2024; 10:252-260. [PMID: 38947301 PMCID: PMC11211742 DOI: 10.33546/bnj.3343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 04/21/2024] [Accepted: 05/18/2024] [Indexed: 07/02/2024] Open
Abstract
Background The concept of concordance and its usage are indicative of patient-centered healthcare, which encourages an equitable collaboration between patients and clinicians. However, there is a lack of clarity in understanding concordance, and an analysis of this concept is warranted. Objective This paper seeks to explore the essence of the concordance concept in the healthcare context. Methods Walker and Avant's eight-step method of concept analysis was applied. A literature search was conducted using concordance AND concord as keywords on CINAHL, MEDLINE, PubMed, ProQuest, Cochrane database, and ScienceDirect databases, published between 2006 and 2022. Results The attributes of concordance include communication process, therapeutic partnership, and agreement on treatment regimens. Antecedents of concordance comprise provider-patient relationship, patients' beliefs, healthcare providers' characteristics, and complexity of treatment plans. Consequences are improved adherence and compliance, improved clinical outcomes, and better quality of life. Conclusion This paper offers clarification of concordance by presenting its antecedents, attributes, and consequences. The findings serve as a basis for developing assessments and nursing interventions to promote patient concordance. Nurses can use the findings to encourage concordance by establishing a trusty relationship during health encounters that respects patients' beliefs and effectively communicating to improve patients' understanding in dealing with complex treatment plans.
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Affiliation(s)
- Anucha Taiwong
- Srimahasarakham Nursing College, Faculty of Nursing, Praboromarajchanok Institute, Thailand
| | - Wassana Uppor
- Boromarajonani College of Nursing, Suphanburi, Faculty of Nursing, Praboromarajchanok Institute, Thailand
| | - Nisakorn Vibulchai
- Boromarajonani College of Nursing, Nakhon Ratchasima, Faculty of Nursing, Praboromarajchanok Institute, Thailand
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Tahar K, Martin T, Mou Y, Verbuecheln R, Graessner H, Krefting D. Rare Diseases in Hospital Information Systems-An Interoperable Methodology for Distributed Data Quality Assessments. Methods Inf Med 2023; 62:71-89. [PMID: 36596461 PMCID: PMC10462432 DOI: 10.1055/a-2006-1018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/10/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Multisite research networks such as the project "Collaboration on Rare Diseases" connect various hospitals to obtain sufficient data for clinical research. However, data quality (DQ) remains a challenge for the secondary use of data recorded in different health information systems. High levels of DQ as well as appropriate quality assessment methods are needed to support the reuse of such distributed data. OBJECTIVES The aim of this work is the development of an interoperable methodology for assessing the quality of data recorded in heterogeneous sources to improve the quality of rare disease (RD) documentation and support clinical research. METHODS We first developed a conceptual framework for DQ assessment. Using this theoretical guidance, we implemented a software framework that provides appropriate tools for calculating DQ metrics and for generating local as well as cross-institutional reports. We further applied our methodology on synthetic data distributed across multiple hospitals using Personal Health Train. Finally, we used precision and recall as metrics to validate our implementation. RESULTS Four DQ dimensions were defined and represented as disjunct ontological categories. Based on these top dimensions, 9 DQ concepts, 10 DQ indicators, and 25 DQ parameters were developed and applied to different data sets. Randomly introduced DQ issues were all identified and reported automatically. The generated reports show the resulting DQ indicators and detected DQ issues. CONCLUSION We have shown that our approach yields promising results, which can be used for local and cross-institutional DQ assessments. The developed frameworks provide useful methods for interoperable and privacy-preserving assessments of DQ that meet the specified requirements. This study has demonstrated that our methodology is capable of detecting DQ issues such as ambiguity or implausibility of coded diagnoses. It can be used for DQ benchmarking to improve the quality of RD documentation and to support clinical research on distributed data.
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Affiliation(s)
- Kais Tahar
- Department of Medical Informatics, University Medical Center Göttingen, Georg-August-University, Göttingen, Germany
| | - Tamara Martin
- Centre for Rare Diseases, University Hospital Tübingen, Tübingen, Germany
| | - Yongli Mou
- Chair of Computer Science 5, RWTH Aachen University, Aachen, Germany
| | - Raphael Verbuecheln
- Medical Data Integration Center, University Hospital Tübingen, Tübingen, Germany
| | - Holm Graessner
- Centre for Rare Diseases, University Hospital Tübingen, Tübingen, Germany
| | - Dagmar Krefting
- Department of Medical Informatics, University Medical Center Göttingen, Georg-August-University, Göttingen, Germany
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Pacia C, Gunning C, McTiernan A, Holloway J. Developing the Parent-Coaching Assessment, Individualization, and Response to Stressors (PAIRS) Tool for Behavior Analysts. J Autism Dev Disord 2023; 53:3319-3342. [PMID: 35768672 PMCID: PMC10465672 DOI: 10.1007/s10803-022-05637-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2022] [Indexed: 11/25/2022]
Abstract
Parent engagement in early behavioral intervention is essential to achieving meaningful intervention outcomes. However, parents may experience multiple barriers to engagement. The Parent-coaching Assessment, Individualization, and Response to Stressors (PAIRS) was developed to help practitioners assess families' barriers and facilitators, individualize their intervention, and respond to stressors using a contextual, functional approach. An expert panel of Board Certified Behavior Analysts ® (BCBAs) evaluated the content validity of the PAIRS. Average scale values (S-CVI/Ave) were 0.92 for relevance, 0.85 for effectiveness, and 0.91 for appropriateness. The PAIRS was revised, and a follow-up evaluation was conducted to rate the tool's utility. This led to the final version of the PAIRS. Clinical implications and future directions are discussed.
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Affiliation(s)
- Cressida Pacia
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Ciara Gunning
- School of Psychology, National University of Ireland Galway, Galway, Ireland.
| | - Aoife McTiernan
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Jennifer Holloway
- School of Psychology, National University of Ireland Galway, Galway, Ireland
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Valentine KD, Scherer LD. Interpersonal (mis)perceptions and (mis)predictions in patient-clinician interactions. Curr Opin Psychol 2022; 43:244-248. [PMID: 34461604 PMCID: PMC8801540 DOI: 10.1016/j.copsyc.2021.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/15/2021] [Accepted: 07/26/2021] [Indexed: 02/03/2023]
Abstract
Patient-clinician interactions require an interpersonal exchange of information, preferences, expectations, values, and priorities. Given the brief interaction patients and clinicians are allowed, many barriers to effective communication exist, resulting in patients and clinicians leaving an interaction with discordant perceptions of what has occurred and what is to come. We review literature on concordance and lack thereof, between patient and clinician perceptions, reasons why discordance may occur, how to decrease discordance as well as how dischordance impacts patient care and outcomes.
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Affiliation(s)
- KD Valentine
- Massachusetts General Hospital,Harvard Medical School
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Andrews ML, Garcia YA, Catagnus RM, Gould ER. Effects of Acceptance and Commitment Training Plus Behavior Parent Training on Parental Implementation of Autism Treatment. PSYCHOLOGICAL RECORD 2021; 72:601-617. [PMID: 34866659 PMCID: PMC8628834 DOI: 10.1007/s40732-021-00496-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2021] [Indexed: 11/27/2022]
Abstract
The objective of this study was to examine the effects of acceptance and commitment training (ACT) plus behavior parent training (BPT), when delivered via telehealth, on parental implementation of behavioral strategies, experiential avoidance (EA), and stress. The study also examined the subsequent effects on the parents’ autistic children’s behaviors. A multiple baseline design was implemented across four parent-child dyads who participated in the online training. The findings showed that ACT+BPT resulted in parental implementation reaching and maintaining high levels. The training also decreased EA and stress in three parents. Moreover, the parents’ ratings of their children’s challenging behaviors decreased. However, such a trend was not as clearly depicted by direct measures of the children’s behaviors. A social validity interview revealed parents found ACT beneficial in assisting them to learn and use the BPT strategies. Implications and suggestions for future research are discussed.
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Affiliation(s)
- Meredith L. Andrews
- Applied Behavior Analysis Online Program, The Chicago School of Professional Psychology, 325 North Wells Street, Chicago, IL USA
| | | | - Robyn M. Catagnus
- Applied Behavior Analysis Online Program, The Chicago School of Professional Psychology, 325 North Wells Street, Chicago, IL USA
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Takatani S, Honda J, Hohashi N. Development and psychometric testing of a family concordance competency scale for families with children having chronic illnesses. Jpn J Nurs Sci 2021; 18:e12419. [PMID: 33759330 DOI: 10.1111/jjns.12419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 01/25/2021] [Accepted: 02/22/2021] [Indexed: 11/30/2022]
Abstract
AIM This study aimed to develop a Family Concordance Competency Scale for Family System Units (FCCS-Fa) for families with children having chronic disease, and to evaluate its reliability and validity. METHODS FCCS-Fa was developed by taking the following steps: (a) drafting based on the elements comprising concordance between healthcare professionals and families with patients suffering from chronic illness; (b) evaluation of face and content validity by an expert panel; and (c) re-examination of face and content validity by semi-structured interviews with 16 families. Criterion-related validity was evaluated using the existing scale and construct validity was evaluated using exploratory factor analysis. Analysis of each FCCS-Fa evaluation item, internal consistency, and the 2-week test-retest reliability was also conducted. An anonymous self-reported questionnaire survey was conducted, targeting families with chronically ill children who were outpatients at three hospitals. RESULTS A total of 196 subjects were analyzed. As results of FCCS-Fa item analysis and exploratory factor analysis, a scale structure comprised of 17 evaluation items and three factors were adopted. In addition, a significant correlation with several existing scales was identified and the criterion-related validity was also confirmed. The Cronbach's α coefficient for the overall scale was .927, the intraclass correlation coefficient applying the retest method was .905, and internal consistency and test-retest reliability were both confirmed. CONCLUSIONS We developed FCCS-Fa with reliability and validity. Assessing family concordance competency using this scale and supporting families to achieve family concordance can lead to self-management by families.
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Affiliation(s)
| | - Junko Honda
- Child Health Nursing, College of Nursing Art and Science, University of Hyogo, Kobe, Japan
| | - Naohiro Hohashi
- Division of Family Health Care Nursing, Department of Nursing, Graduate School of Health Sciences, Kobe University, Kobe, Japan
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Ng YK, Shah NM, Loong LS, Pee LT, Chong WW. Patient-centred care in the context of pharmacy consultations: A qualitative study with patients and pharmacists in Malaysia. J Eval Clin Pract 2020; 26:1638-1647. [PMID: 31908087 DOI: 10.1111/jep.13346] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 12/15/2019] [Accepted: 12/17/2019] [Indexed: 02/07/2023]
Abstract
RATIONALE, AIMS AND OBJECTIVES Patient-centred care (PCC) has been increasingly recognized as the standard in current health care, especially when it comes to health communication between patients and health care professionals. The evidence suggests that PCC could potentially improve medication-related outcomes such as medication adherence, disease self-management, and patient-provider relationships. Pharmacists are strategically positioned in the health care system to provide medication management to patients. However, there is a paucity of research regarding PCC in pharmacist-patient consultations. This study aimed to explore the views and experiences of pharmacists and patients on the important aspects of a PCC consultation. METHODS A semistructured interview study was conducted among 17 patients and 18 pharmacists in three tertiary hospitals in Malaysia. All interviews were audiotaped and transcribed verbatim. Themes were developed using a constant comparison approach and thematic analysis. RESULTS Five main themes emerged from the data, namely, achieving mutual understanding, recognizing individuality, communication style, information giving, and medication decision making. For both pharmacists and patients, a PCC consultation should promote mutual understanding and non-judgmental discussions. Communication was an important element to bridge the gap between patients' and pharmacists' expectations. Patients emphasized the importance of emotional aspects of the consultation, while pharmacists emphasized the importance of evidence-based information to support patient engagement and information needs. CONCLUSIONS Comparison of pharmacists' and patients' views provided insight towards important aspects of PCC in pharmacist-patient consultations. It was suggested that PCC is not a one-sided approach but rather a patient-provider collaboration to optimize the consultation. Further research can be done to improve the integration of PCC in the local health care context, including pharmacist consultations.
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Affiliation(s)
- Yew Keong Ng
- Centre of Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Noraida Mohamed Shah
- Centre of Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Ly Sia Loong
- Department of Pharmacy, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Lay Ting Pee
- Department of Pharmacy, Hospital Kuala Lumpur, Ministry of Health, Kuala Lumpur, Malaysia
| | - Wei Wen Chong
- Centre of Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Mitchell G, Porter S, Manias E. Enabling sustained communication with patients for safe and effective management of oral chemotherapy: A longitudinal ethnography. J Adv Nurs 2020; 77:899-909. [PMID: 33210337 DOI: 10.1111/jan.14634] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 09/09/2020] [Accepted: 10/26/2020] [Indexed: 01/01/2023]
Abstract
AIMS To examine how patients received, understood, and acted on healthcare professional communication about their oral chemotherapeutic regimen throughout their treatment. DESIGN A longitudinal ethnographic study. METHODS Over 60 hr of observational data were recorded, in the form of field notes and audio-recordings from interactions among nine oncology doctors, six oncology nurses, eight patients, and 11 family members over a period of 6 months in outpatient departments in one hospital in Northern Ireland. Sixteen semi-structured interviews with patients and three focus groups with healthcare professionals were also carried out. This study took place from October 2013-June 2016. Data were thematically analysed. RESULTS Three themes where identified from the data. These were initiating concordance through first communication about oral chemotherapy; which focused on initial communication during oncology consultations about oral chemotherapy, sustained communication of managing chemotherapy side effects; which was about how communication processes supported timely and effective side effect management and un-sustained communication of oral chemotherapy medication-taking practice; when patients and healthcare professionals failed to communicate effectively about chemotherapy medication-taking. CONCLUSION The two most important factors in ensuring the optimal management of oral chemotherapeutic medicines are early recognition and appropriate response to side effects and the maintenance of safe and effective medication administration. This study found that oncology doctors and nurses engaged in sustained communication about the side effects of chemotherapy but did not focus their communication on safe administration after the first consultation. IMPACT Based on this evidence, we recommend that healthcare professionals who provide oral chemotherapy for home administration should review their processes and procedures. Healthcare professionals need to ensure that they embed frequent communication for the duration of treatment between themselves and patients, including open discussion and advice, about side effects and medication administration.
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Affiliation(s)
- Gary Mitchell
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Sam Porter
- Department of Social Sciences & Social Work, Bournemouth University, Poole, UK
| | - Elizabeth Manias
- School of Nursing & Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Burwood, Vic., Australia
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Abstract
The purpose of this essay is to explore the meanings of the widely used terms compliance and adherence and the less widely used term concordance and to raise questions about the appropriateness of these terms when used to describe individuals' or groups' health-related behaviors. Discussion focuses on how recognition of how the meanings of these terms has uncovered the failure to honor nursing's emphasis on person/patient-centered care due to power imbalances between healthcare providers and patents and the subsequent lack of patient autonomy. Consideration of these problems with existing terms could facilitate identification of a potentially more appropriate term based on the language of a nursing conceptual model and/or theory.
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Affiliation(s)
- Jacqueline Fawcett
- Department of Nursing, University of Massachusetts Boston, Boston, MA, USA
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Afriyie D. Effective communication between nurses and patients: an evolutionary concept analysis. Br J Community Nurs 2020; 25:438-445. [PMID: 32881615 DOI: 10.12968/bjcn.2020.25.9.438] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Communication can be considered as the basis of the nurse-patient relationship and is an essential element in building trust and comfort in nursing care. Effective communication is a fundamental but complex concept in nursing practice. This concept analysis aims to clarify effective communication and its impact on patient care using Rodgers's (1989) evolutionary framework of concept analysis. Effective communication between nurses and patients is presented along with surrogate terms, attributes, antecedents, consequences, related concepts and a model case. Effective communication was identified to be a multifactorial concept and defines as a mutual agreement between nurses and patients. This influences the nursing process, clinical reasoning and decision-making. Consequently, promotes high-quality nursing care, positive patient outcome and patient's and nurse's satisfaction of care.
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Wahyuni AS, Soeroso NN, Wahyuni DD. Analysis of Concordance of Medication-Taking Behaviour in Tuberculosis Patients in Medan, Indonesia. Open Access Maced J Med Sci 2018; 6:1699-1701. [PMID: 30337993 PMCID: PMC6182525 DOI: 10.3889/oamjms.2018.380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 09/06/2018] [Accepted: 09/08/2018] [Indexed: 11/23/2022] Open
Abstract
AIM: This study aimed to analyse tuberculosis (TB) medication-taking behaviour based on the concept of concordance between health workers and TB patients in Medan, Indonesia. METHODS: This study was an analytical study with a cross-sectional design. A total of 100 patients undergoing TB treatment at several public health centres in Medan City participated in the study. RESULTS: The results showed that there was a relationship between the concordance behaviour of the health workers with the attitude and medication-taking behaviour of the patients (p < 0.05). However, there was no relationship found between concordance and knowledge of the patients (p > 0.05). CONCLUSION: The results showed that most of the concordance behaviour, knowledge, attitude, and behaviour in the sample were good.
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Affiliation(s)
- Arlinda Sari Wahyuni
- Department of Community Medicine, Faculty of Medicine, Universitas Sumatera Utara, Jl. Dr Mansyur No.5, Medan 20155, Indonesia
| | - Noni Novisari Soeroso
- Department of Pulmonary and Respiratory, Faculty of Medicine, Universitas Sumatera Utara, Jl. Dr Mansyur No.5, Medan 20155, Indonesia
| | - Dian Dwi Wahyuni
- Department of Microbiology, Faculty of Medicine, Universitas Sumatera Utara, Jl. Dr Mansyur No.5, Medan 20155, Indonesia
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Medication Simulation Affects Health Provider Students' Attitudes About Adherence and Concordance. Simul Healthc 2018; 12:308-313. [PMID: 28697054 DOI: 10.1097/sih.0000000000000244] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Assisting polypharmacy patients with complex health regimens is a part of health provider responsibilities. The concepts of adherence and concordance contrast the traditional emphasis on patient compliance. However, health provider students may not be able to empathize with polypharmacy patients. The purpose of this study was to measure the effect of a medication simulation on medical, nursing, and pharmacy students' beliefs about adherence and concordance. METHODS A prospective, quasi-experimental, pretest, and posttest design was used with institutional review board approval. The participants (N = 62) took four simulated medications (varied dosing schedules) for 1 week. Attitudes toward adherence and concordance were assessed before and after the intervention. RESULTS Subjects averaged 24.6 years (SD = 4.32), 72.6% female, and 79% white. Most were medical students (n = 33, 53%), followed by nursing (n = 21, 34%) and pharmacy students (n = 8, 13%). There were significant changes [t(61) = 3.92, P < 0.001] in beliefs about adherence from time 1 (mean = 25.13, SD = 5.77) to time 2 (mean = 22.05, SD = 6.06), and about concordance (mean = 41.85, SD = 5.58 time 1) to (mean = 44.29, SD = 6.32 time 2) [t(61) = 3.31, P < 0.05], for the entire group. Most students (84%) predicted that they would be able to take four medications correctly for 1 week. Fifty-eight students (94%) found that adherence was 'much harder' or 'a little harder' than anticipated. Most (89%) felt that the simulation will impact their patient care. CONCLUSIONS Participation in a medication simulation exercise affected health provider students' attitudes toward adherence and concordant behaviors. These experiences may influence future patient interactions.
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Ng YK, Shah NM, Loong LS, Pee LT, Hidzir SAM, Chong WW. Attitudes toward concordance and self-efficacy in decision making: a cross-sectional study on pharmacist-patient consultations. Patient Prefer Adherence 2018; 12:615-624. [PMID: 29731609 PMCID: PMC5923248 DOI: 10.2147/ppa.s159113] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE This study investigated patients' and pharmacists' attitudes toward concordance in a pharmacist-patient consultation and how patients' attitudes toward concordance relate to their involvement and self-efficacy in decision making associated with medication use. SUBJECTS AND METHODS A cross-sectional study was conducted among patients with chronic diseases and pharmacists from three public hospitals in Malaysia. The Revised United States Leeds Attitudes toward Concordance (RUS-LATCon) was used to measure attitudes toward concordance in both patients and pharmacists. Patients also rated their perceived level of involvement in decision making and completed the Decision Self-Efficacy scale. One-way analysis of variance (ANOVA) and independent t-test were used to determine significant differences between different subgroups on attitudes toward concordance, and multiple linear regression was performed to find the predictors of patients' self-efficacy in decision making. RESULTS A total of 389 patients and 93 pharmacists participated in the study. Pharmacists and patients scored M=3.92 (SD=0.37) and M=3.84 (SD=0.46) on the RUS-LATCon scale, respectively. Seven items were found to be significantly different between pharmacists and patients on the subscale level. Patients who felt fully involved in decision making (M=3.94, SD=0.462) scored significantly higher on attitudes toward concordance than those who felt partially involved (M=3.82, SD=0.478) and not involved at all (M=3.68, SD=0.471; p<0.001). Patients had an average score of 76.7% (SD=14.73%) on the Decision Self-Efficacy scale. In multiple linear regression analysis, ethnicity, number of medications taken by patients, patients' perceived level of involvement, and attitudes toward concordance are significant predictors of patients' self-efficacy in decision making (p<0.05). CONCLUSION Patients who felt involved in their consultations had more positive attitudes toward concordance and higher confidence in making an informed decision. Further study is recommended on interventions involving pharmacists in supporting patients' involvement in medication-related decision making.
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Affiliation(s)
- Yew Keong Ng
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | | | - Ly Sia Loong
- Department of Pharmacy, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Lay Ting Pee
- Department of Pharmacy, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | | | - Wei Wen Chong
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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An ISHLT consensus document for prevention and management strategies for mechanical circulatory support infection. J Heart Lung Transplant 2017; 36:1137-1153. [DOI: 10.1016/j.healun.2017.06.007] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 06/20/2017] [Indexed: 12/18/2022] Open
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Hallett N, Dickens GL. De-escalation of aggressive behaviour in healthcare settings: Concept analysis. Int J Nurs Stud 2017; 75:10-20. [DOI: 10.1016/j.ijnurstu.2017.07.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 06/05/2017] [Accepted: 07/02/2017] [Indexed: 11/15/2022]
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16
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Kangasniemi M, Hirjaba M, Kohonen K, Vellone E, Moilanen T, Pietilä AM. The cardiac patients' perceptions of their responsibilities in adherence to care: a qualitative interview study. J Clin Nurs 2017; 26:2583-2592. [PMID: 27862488 DOI: 10.1111/jocn.13642] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2016] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To describe cardiac patients' perceptions of their responsibilities in adherence to care. BACKGROUND The responsibilities of cardiac patients' adherence to care is a topical issue because of the increasing prevalence of noncommunicable diseases in Western countries, including cardiovascular disease (CVD). Responsibilities for cardiac patients' care have been studied, but little is described about patients' perspectives in this study. DESIGN A qualitative, hermeneutic inquiry. METHODS We used face-to-face individual semistructured interviews with 21 cardiac patients (76% male) aged 58-86 in an urban area of Finland in winter 2013. The data were analysed hermeneutically with inductive content analysis. RESULTS Based on our results, patients with cardiac disease understood that autonomy provided a basis for their responsibility in adherence to care. It included being able to make independent decisions, in collaboration with health professionals, or even to entrust that responsibility to healthcare professionals. Responsibilities were understood to be an expression of adherence, perceived to benefit the patient and included the duty to adopt a healthy lifestyle and care for their own medical condition. The main factors that influenced patients' responsibilities around adherence to care were their individual resources and motivation, relationships with healthcare professionals and the resources of the healthcare system. CONCLUSION Autonomy is an inherent part of cardiac patients' adherence to care, but there has been little focus on their responsibilities in the literature. More attention needs to be paid to the healthcare providers' abilities to support patients' duties and responsibilities in clinical practice and to future research.
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Affiliation(s)
- Mari Kangasniemi
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Marina Hirjaba
- Department of Nursing, The School of Health and Social Studies, JAMK University of Applied Sciences, Jyväskylä, Finland
| | - Katja Kohonen
- Cardiac Surgical Intensive Care Unit M2A, HUS, Meilahti Tower Hospital, Helsinki, Finland
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Tanja Moilanen
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Anna-Maija Pietilä
- Social and Health Care Services, Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
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Randall S, Neubeck L. What's in a name? Concordance is better than adherence for promoting partnership and self-management of chronic disease. Aust J Prim Health 2016; 22:181-184. [PMID: 27150465 DOI: 10.1071/py15140] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 11/25/2015] [Indexed: 11/23/2022]
Abstract
The choice of language health professionals use to discuss self-management of chronic disease is important and influences patients' self-management. The words compliance, adherence and concordance are used to discuss patients' agreement with prescribed treatment plans, but have different tone and meanings. Models of care linked to the words compliance and adherence are underpinned by interactions between patients and healthcare providers that merely reinforce instructions about treatments. The 'patient-professional partnership' is introduced as a model by Bodenheimer et al. (2002, p. 2469) whereby true partnership working should be an opportunity to pool the expertise of both parties to arrive at mutually agreed goals in concordance. The impact these words might have on partnership working is important in defining the patient-health professional relationship, and for the patients' healthcare outcomes and the potential effect on healthcare utilisation.
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Affiliation(s)
- Sue Randall
- Sydney Nursing School, M03 88, Mallett Street, Camperdown, NSW 2050, Australia
| | - Lis Neubeck
- Charles Perkins Centre, Sydney Nursing School, Level 2, Building D17, The University of Sydney, NSW 2006, Australia
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Young J, Snowden A. A systematic review on the factors associated with positive experiences in carers of someone with cancer. Eur J Cancer Care (Engl) 2016; 26. [DOI: 10.1111/ecc.12544] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2016] [Indexed: 01/28/2023]
Affiliation(s)
- J. Young
- Edinburgh Napier University; Edinburgh UK
| | - A. Snowden
- Edinburgh Napier University; Edinburgh UK
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Komatsu H, Yagasaki K, Yamaguchi T. Effects of a nurse-led medication self-management programme in cancer patients: protocol for a mixed-method randomised controlled trial. BMC Nurs 2016; 15:9. [PMID: 26858582 PMCID: PMC4745168 DOI: 10.1186/s12912-016-0130-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 02/02/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND With the widespread use of orally administered anticancer agents, self-management by cancer patients is inevitable, and adherence to medication is becoming the centre of interest in oncology. METHODS/DESIGN This mixed-method study is a two-phased approach with a combined quantitative and qualitative design. In the first phase, we will conduct a prospective randomised controlled study to assess the effects of a nurse-led medication self-management programme for patients receiving oral anticancer treatment. Patients with metastatic breast cancer, who have been newly prescribed an oral chemotherapy or a targeted therapy agent will be enrolled in the study. The participants will be randomly assigned to either the medication self-management support programme group (intervention group) or the conventional care group (control group). This will be an open-label study; therefore, neither the patients nor the nurses will be blinded. Nurses will provide patients in the intervention group with information by using the teach-back method, help patients set a goal based on their preferences, and solve problems through follow-up counselling. The primary outcome measure is adherence to medication, to be measured on the basis of the medication possession ratio (MPR), which is the ratio of the number of days of medication supply to the total days at a specified time interval. We hypothesize that the intervention group will have an MPR of ≥90 % that is significantly higher than that of the control group. Secondary outcome measures include self-efficacy, quality of life, psychological distress, severity and interference of symptoms, patient satisfaction, emergency department visits, and hospital admissions. In the second phase, we will conduct focus-group interviews with intervention nurses, and perform a content analysis to understand their role and challenges these nurses will face in the programme while improving patients' medication adherence. DISCUSSION The present study will be the first Japanese study to evaluate the effects of medication self-management support provided by nurses to patients with metastatic breast cancer who are receiving oral anticancer treatment. The study is characterised by a unique patient-centred approach aiming to help patients manage their medication based on their needs and preferences, with both quantitative and qualitative evaluations. The findings will contribute to the facilitation of medication management in cancer patients. TRIAL REGISTRATION UMIN Clinical Trials Registry (UMIN-CTR), Japan, UMIN000016597. (27 February 2015).
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Affiliation(s)
- Hiroko Komatsu
- Faculty of Nursing and Medical Care, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582 Japan
| | - Kaori Yagasaki
- Faculty of Nursing and Medical Care, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582 Japan
| | - Takuhiro Yamaguchi
- Division of Biostatistics, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574 Japan
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Roettl J, Bidmon S, Terlutter R. What Predicts Patients' Willingness to Undergo Online Treatment and Pay for Online Treatment? Results from a Web-Based Survey to Investigate the Changing Patient-Physician Relationship. J Med Internet Res 2016; 18:e32. [PMID: 26846162 PMCID: PMC4782912 DOI: 10.2196/jmir.5244] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 12/17/2015] [Accepted: 01/03/2016] [Indexed: 12/29/2022] Open
Abstract
Background Substantial research has focused on patients’ health information–seeking behavior on the Internet, but little is known about the variables that may predict patients’ willingness to undergo online treatment and willingness to pay additionally for online treatment. Objective This study analyzed sociodemographic variables, psychosocial variables, and variables of Internet usage to predict willingness to undergo online treatment and willingness to pay additionally for online treatment offered by the general practitioner (GP). Methods An online survey of 1006 randomly selected German patients was conducted. The sample was drawn from an e-panel maintained by GfK HealthCare. Missing values were imputed; 958 usable questionnaires were analyzed. Variables with multi-item measurement were factor analyzed. Willingness to undergo online treatment and willingness to pay additionally for online treatment offered by the GP were predicted using 2 multiple regression models. Results Exploratory factor analyses revealed that the disposition of patients’ personality to engage in information-searching behavior on the Internet was unidimensional. Exploratory factor analysis with the variables measuring the motives for Internet usage led to 2 separate factors: perceived usefulness (PU) of the Internet for health-related information searching and social motives for information searching on the Internet. Sociodemographic variables did not serve as significant predictors for willingness to undergo online treatment offered by the GP, whereas PU (B=.092, P=.08), willingness to communicate with the GP more often in the future (B=.495, P<.001), health-related information–seeking personality (B=.369, P<.001), actual use of online communication with the GP (B=.198, P<.001), and social motive (B=.178, P=.002) were significant predictors. Age, gender, satisfaction with the GP, social motive, and trust in the GP had no significant impact on the willingness to pay additionally for online treatment, but it was predicted by health-related information–seeking personality (B=.127, P=.07), PU (B=–.098, P=.09), willingness to undergo online treatment (B=.391, P<.001), actual use of online communication with the GP (B=.192, P=.001), highest education level (B=.178, P<.001), monthly household net income (B=.115, P=.01), and willingness to communicate with the GP online more often in the future (B=.076, P=.03). Conclusions Age, gender, and trust in the GP were not significant predictors for either willingness to undergo online treatment or to pay additionally for online treatment. Willingness to undergo online treatment was partly determined by the actual use of online communication with the GP, willingness to communicate online with the GP, health information–seeking personality, and social motivation for such behavior. Willingness to pay extra for online treatment was influenced by the monthly household net income category and education level. The results of this study are useful for online health care providers and physicians who are considering offering online treatments as a viable number of patients would appreciate the possibility of undergoing an online treatment offered by their GP.
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Affiliation(s)
- Johanna Roettl
- Alpen-Adria Universitaet Klagenfurt, Department of Marketing and International Management, Klagenfurt, Austria.
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Kähkönen O, Kankkunen P, Saaranen T, Miettinen H, Kyngäs H, Lamidi ML. Motivation is a crucial factor for adherence to a healthy lifestyle among people with coronary heart disease after percutaneous coronary intervention. J Adv Nurs 2015; 71:2364-73. [DOI: 10.1111/jan.12708] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Outi Kähkönen
- Department of Nursing Science; University of Eastern Finland; Kuopio Finland
| | - Päivi Kankkunen
- Department of Nursing Science; University of Eastern Finland; Kuopio Finland
| | - Terhi Saaranen
- Department of Nursing Science; University of Eastern Finland; Kuopio Finland
| | | | - Helvi Kyngäs
- Department of Health Science; University of Oulu; Finland
| | - Marja-Leena Lamidi
- Faculty of Health Sciences; University of Eastern Finland; Kuopio Finland
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Kim CJ, Schlenk EA, Kim DJ, Kim M, Erlen JA, Kim SE. The role of social support on the relationship of depressive symptoms to medication adherence and self-care activities in adults with type 2 diabetes. J Adv Nurs 2015; 71:2164-75. [PMID: 25976591 DOI: 10.1111/jan.12682] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2015] [Indexed: 12/22/2022]
Abstract
AIM To examine the mediating role of social support on the relationship of depressive symptoms to medication adherence and self-care activities in Korean adults. BACKGROUND Recent evidence suggests that higher levels of social support are associated with improved medication adherence and self-care activities; however, the role of social support on the relationship of depressive symptoms to medication adherence and self-care activities is less well understood. DESIGN A cross-sectional survey. METHODS The data were collected from 311 Korean adults with type 2 diabetes who were taking hypoglycaemic agents in the period 2012-2013. Depressive symptoms, social support, medication adherence and self-care activities were assessed using structured questionnaires. Multiple regression analysis with adjustment for covariates and the Sobel test were used to examine the mediating effect of social support on the relationship of depressive symptoms to medication adherence and self-care activities. RESULTS There were statistically significant differences by subgroups with and without depressive symptoms in social support, medication adherence and self-care activities of diet, physical activity and stress management. The Sobel test confirmed that social support mediated the effect of depressive symptoms on medication adherence and self-care activities of diet, physical activity and stress management. CONCLUSION The evidence from this study suggests that social support-enhancing interventions that also manage depressive symptoms may be more timely and effective than interventions that target depressive symptoms alone in promoting adherence to medication adherence and self-care activities in this population.
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Affiliation(s)
- Chun-Ja Kim
- Department of Adult Health Nursing, Ajou University College of Nursing, Suwon, Korea
| | | | - Dae Jung Kim
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea
| | - Moonsun Kim
- Ajou University College of Nursing, Suwon, Korea
| | - Judith A Erlen
- University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA
| | - Se-Eun Kim
- Department of Nursing, Koje College, Geoje, Korea
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Hegedüs A, Kozel B. Does adherence therapy improve medication adherence among patients with schizophrenia? A systematic review. Int J Ment Health Nurs 2014; 23:490-7. [PMID: 25279684 DOI: 10.1111/inm.12089] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Non-adherence to medication is highly prevalent in patients with schizophrenia. Adherence therapy aims to improve medication adherence of these patients by applying techniques of cognitive behavioural therapy, psycho-education, and motivational interviewing. Even though adherence therapy is frequently discussed and researched, its effectiveness is still uncertain. This paper aims to review the effectiveness of adherence therapy on the medication adherence of patients with schizophrenia. To this end, six electronic databases were systematically searched for randomized, controlled trials on adherence therapy from January 2002 to March 2013. Four trials met the inclusion criteria and were incorporated into the review. The findings suggest that adherence therapy does not improve patients' medication adherence in comparison to treatment as usual or a control intervention. However, all the studies reviewed showed high-adherence ratings at baseline. Thus, further well-designed studies that target adherence therapy to patients who are non-adherent to their medication are needed for a more profound understanding of its effectiveness. In addition, if adherence therapy is aimed not only at improving medication adherence, but also to reach an agreement whereby the patient's decision not to take his medication is accepted, the shared decision-making process needs to be assessed as well.
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Affiliation(s)
- Anna Hegedüs
- Nursing & Social Education Research Unit, University of Bern Psychiatric Services, Bern, Switzerland; International Graduate Academy (InGrA), 'Participation as Goal of Nursing and Therapy', Institute of Health and Nursing Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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Grindrod KA, Li M, Gates A. Evaluating user perceptions of mobile medication management applications with older adults: a usability study. JMIR Mhealth Uhealth 2014; 2:e11. [PMID: 25099993 PMCID: PMC4114457 DOI: 10.2196/mhealth.3048] [Citation(s) in RCA: 145] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 01/30/2014] [Accepted: 02/17/2014] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Medication nonadherence has a significant impact on the health and wellbeing of individuals with chronic disease. Several mobile medication management applications are available to help users track, remember, and read about their medication therapy. OBJECTIVE The objective of this study was to explore the usability and usefulness of existing medication management applications for older adults. METHODS We recruited 35 participants aged 50 and over to participate in a 2-hour usability session. The average age ranged from 52-78 years (mean 67 years) and 71% (25/35) of participants were female. Each participant was provided with an iPad loaded with four medication management applications: MyMedRec, DrugHub, Pillboxie, and PocketPharmacist. These applications were evaluated using the 10 item System Usability Scale (SUS) and visual analog scale. An investigator-moderated 30-minute discussion followed, and was recorded. We used a grounded theory (GT) approach to analyze qualitative data. RESULTS When assessing mobile medication management applications, participants struggled to think of a need for the applications in their own lives. Many were satisfied with their current management system and proposed future use only if cognition and health declined. Most participants felt capable of using the applications after a period of time and training, but were frustrated by their initial experiences with the applications. The early experiences of participants highlighted the benefits of linear navigation and clear wording (eg, "undo" vs "cancel") when designing for older users. While there was no order effect, participants attributed their poor performance to the order in which they tried the applications. They also described being a part of a technology generation that did not encounter the computer until adulthood. Of the four applications, PocketPharmacist was found to be the least usable with a score of 42/100 (P<.0001) though it offered a drug interaction feature that was among the favorite features of participants. The usability scores for MyMedRec (56/100), DrugHub (57/100), and Pillboxie (52/100) were not significantly different and participants preferred MyMedRec and DrugHub for their simple, linear interfaces. CONCLUSIONS With training, adults aged 50 and over can be capable and interested in using mHealth applications for their medication management. However, in order to adopt such technology, they must find a need that their current medication management system cannot fill. Interface diversity and multimodal reminder methods should be considered to increase usability for older adults. Lastly, regulation or the involvement of older adults in development may help to alleviate generation bias and mistrust for applications.
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Affiliation(s)
- Kelly Anne Grindrod
- School of Pharmacy, Faculty of Science, University of Waterloo, Waterloo, ON, Canada.
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