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Garcia KA, Wippold GM, Goodrum NM, Williams MM, Kloos B. Bridging health self-efficacy and patient engagement with patient-centered culturally sensitive health care for Black American adults. JOURNAL OF COMMUNITY PSYCHOLOGY 2024. [PMID: 39213672 DOI: 10.1002/jcop.23147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 07/03/2024] [Accepted: 08/19/2024] [Indexed: 09/04/2024]
Abstract
This study investigates whether systems-level interventions, specifically patient-centered culturally sensitive health care (PC-CSHC) from healthcare providers, office staff, and the clinic environment, moderate the relationship between health self-efficacy and patient engagement among Black American adults. An online survey was completed by 198 Black American adults. PC-CSHC from healthcare providers, office staff, and the clinic environment did not mitigate the adverse effects of low health self-efficacy on patient engagement. However, PC-CSHC from healthcare providers (b = 0.38) was as significant as health self-efficacy (b = 0.37) in predicting patient engagement, R2 = 0.47, F(9, 177) = 19.61, p < 0.001. Provider-delivered PC-CSHC can enhance patient engagement among Black American adults. This systems-level approach has the potential to reach more patients than intrapersonal interventions alone and alleviates the undue burden placed on Black Americans to leverage intrapersonal strengths in the face of health disparities rooted in structural racism.
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Affiliation(s)
- Kaylyn A Garcia
- Psychology Department, University of South Carolina, Columbia, South Carolina, USA
| | - Guillermo M Wippold
- Psychology Department, University of South Carolina, Columbia, South Carolina, USA
| | - Nada M Goodrum
- Psychology Department, University of South Carolina, Columbia, South Carolina, USA
| | | | - Bret Kloos
- Psychology Department, University of South Carolina, Columbia, South Carolina, USA
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Liddelow C, Mullan B, Boyes M, Ling M. Can temporal self-regulation theory and its constructs predict medication adherence? A systematic review and meta-analysis. Health Psychol Rev 2023; 17:578-613. [PMID: 36154853 DOI: 10.1080/17437199.2022.2127831] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 09/19/2022] [Indexed: 11/04/2022]
Abstract
The relationships between temporal self-regulation theory (TST) constructs (intention, behavioural prepotency and self-regulatory capacity) and medication adherence should be established before further applying the theory to adherence. Searches of PsychINFO, Medline, EMBASE, CINAHL and Web of Science were conducted in 2019 (updated November 2021). Studies had to be original quantitative research, assessed the relationship between one of the constructs and adherence in one illness, and used an adult population. The risk of bias was assessed using the NHLBI Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Three meta-analyses were conducted using R. Moderation analyses were also conducted. A total of 57 articles (60 studies) with 13,995 participants were included, with 7 studies included in more than one analysis. Results identified significant correlations between intention (r = .369, [95% CI: .25, .48]), behavioural prepotency (r = .332, [95% CI: .18, .48]), self-regulatory capacity (r = .213, [95% CI: .10, .32]) and adherence. There was some evidence of publication bias and no significant moderators. No studies explored the interactions in the theory, so whilst the constructs adequately predict adherence, future research should apply the theory to adherence in a specific illness to assess these relationships. Pre-registered on Prospero: CRD42019141395.
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Affiliation(s)
- Caitlin Liddelow
- School of Population Health, Curtin University, Perth, Australia
- Global Alliance for Mental Health and Sport, School of Psychology, University of Wollongong, Wollongong, Australia
| | - Barbara Mullan
- School of Population Health, Curtin University, Perth, Australia
- EnAble Institute, Curtin University, Perth, Australia
| | - Mark Boyes
- School of Population Health, Curtin University, Perth, Australia
- EnAble Institute, Curtin University, Perth, Australia
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Which domains of the theoretical domains framework should be targeted in interventions to increase adherence to antihypertensives? A systematic review. J Hypertens 2022; 40:853-859. [DOI: 10.1097/hjh.0000000000003113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Determinants of Hypertension Self-management Behaviors: An Application of the Intervention Mapping Approach. HEALTH SCOPE 2021. [DOI: 10.5812/jhealthscope.112994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Hypertension is one of the key risk factors for several diseases. Objectives: The aim of this study was to determine the determinants of hypertension self-management behaviors (HSBs) based on intervention mapping approach. Methods: A cross-sectional study was conducted among 800 hypertensive patients in southwestern Iran in 2018. A structured questionnaire was applied for data collection. Data were analyzed using SPSS version 16. Results: The mean age of respondents was 58.25 years (SD: 12.10; age range: 30 - 74 years). The best predictors for HSBs were perceived barriers, outcome expectations, and self-efficacy. Conclusions: Our findings have implications for the evidence-based design of HSBs promotion interventions.
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Villarino RT, Arcay CA, Temblor MC, Villarino ML, Bagsit R, Ocampo L, Bernard P. The Effects of Lifestyle Intervention Using the Modified Beliefs, Attitude, Subjective Norms, Enabling Factors Model in Hypertension Management: Quasi-Experimental Study. JMIR Cardio 2021; 5:e20297. [PMID: 34559063 PMCID: PMC8501407 DOI: 10.2196/20297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/24/2021] [Accepted: 07/27/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Hypertension is a serious health issue and a significant risk factor for cardiovascular disease and stroke. Although various health education models have been used to improve lifestyle in patients with hypertension, the findings have been inconsistent. OBJECTIVE This study aims to assess the effects of a lifestyle intervention program using a modified Beliefs, Attitude, Subjective Norms, Enabling Factors (BASNEF) model among nonadherent participants with hypertension in managing elevated blood pressure (BP) levels. METHODS This study reports a quantitative quasi-experimental research work, particularly using a repeated-measures design of the within-subjects approach on the 50 nonadherent patients who received a diagnosis of essential hypertension in Cebu, Philippines. The research participants received 5 sessions of training based on a modified BASNEF model. An adherence instrument was used as an evaluation platform. The first phase gathers participants' relevant profiles and background, and the final phase gathers participants' systolic BP, diastolic BP, heart rate, and adherence scores. RESULTS The results indicate that the phase 1 mean systolic readings (146.50, SD 19.59) differ significantly from the phase 4 mean systolic readings (134.92, SD 15.24). They also suggest that the lifestyle intervention based on session III or phase IV behavioral intention in the BASNEF model microgroup sessions positively affects BP readings among the research participants. CONCLUSIONS This study has established that the BASNEF model approach can be a good BP management technique.
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Affiliation(s)
- Resti Tito Villarino
- Cebu Technological University, Moalboal Campus, Cebu, Philippines.,National Research Council of the Philippines, Manila, Philippines
| | | | | | | | - Rosita Bagsit
- Cebu Technological University, Moalboal Campus, Cebu, Philippines
| | - Lanndon Ocampo
- Cebu Technological University, Main Campus, Cebu City, Philippines
| | - Paquito Bernard
- Université du Québec à Montréal, Montréal, QC, Canada.,Research Center of the University Institute in Mental Health of Montreal, Montréal, QC, Canada
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Almeida TDCF, Sousa MMD, Gouveia BDLA, Olinda RAD, Freire MEM, Oliveira SHDS. Instrument to evaluate the behavioral intention of hypertensive people when taking anti-hypertensives. Rev Bras Enferm 2021; 74:e20200192. [PMID: 33787791 DOI: 10.1590/0034-7167-2020-0192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 08/04/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to build and analyze the validity of an instrument to assess the behavioral intention of individuals with hypertension to take antihypertensive pills. METHODS methodological study based on the theory of planned behavior, developed in three stages: preparation of the instrument, validation of content and pre-test with the target audience. The content has been validated by six experts. The Content Validity Index was applied. RESULTS five nurses and one psychologist participated, with experiences in systemic arterial hypertension and/or planned behavior theory. The first version of the instrument contained 40 items. After analysis, the second version originated, with 36 items. 100% agreement was obtained for the scope of the constructions. The pre-test showed clarity and understanding of the items by the target audience. CONCLUSIONS the instrument is a reliable and innovative technological product for use in populations with systemic arterial hypertension and beliefs similar to those identified in the surveyed group.
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Shen Z, Shi S, Ding S, Zhong Z. Mediating Effect of Self-Efficacy on the Relationship Between Medication Literacy and Medication Adherence Among Patients With Hypertension. Front Pharmacol 2020; 11:569092. [PMID: 33364943 PMCID: PMC7750474 DOI: 10.3389/fphar.2020.569092] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 10/27/2020] [Indexed: 12/31/2022] Open
Abstract
Background: Studies have reported that medication literacy had a positive effect on medication adherence in patients with hypertension. However, little is known about the mechanism underlying this relationship in patients with hypertension. Objective: The purpose of this study was to investigate the mediating effect of self-efficacy between medication literacy and medication adherence. Methods: A total of 790 patients with hypertension were investigated using the Chinese Medication Literacy Scale for Hypertensive Patients (C-MLSHP), the Morisky Medication Adherence Scale-8 (MMAS-8) and the Medication Adherence Self-efficacy Scale-Revision (MASES-R). Hierarchical regression and the bootstrap approach were used to analyze the mediating effect of self-efficacy on the relationship between medication literacy and medication adherence. Results: A total of 60.9% of hypertensive patients were low adherent to their antihypertensive drug regimens. Self-efficacy had a significant positive correlation with medication literacy (r= 0.408, p < 0.001) and medication adherence (r = 0.591, p < 0.001). Self-efficacy accounts for 28.7% of the total mediating effect on the relationship between medication literacy and adherence to antihypertensive regimens for hypertensive patients. Conclusion: More than half of the hypertensive patients in the study were low adherent to antihypertensive regimens. Self-efficacy had a partial significant mediating effect on the relationship between medication literacy and medication adherence. Therefore, it was suggested that hypertensive patients' medication adherence might be improved and driven by increasing self-efficacy. Targeted interventions to improve patients' self-efficacy should be developed and implemented. In addition, health care providers should also be aware of the importance of medication literacy assessment and promotion in patients with hypertension.
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Affiliation(s)
- Zhiying Shen
- Department of Hematology, Third Xiangya Hospital, Central South University, Changsha, China
- Department of Nursing, Third Xiangya Hospital, Central South University, Changsha, China
- Clinical Nursing Safety Management Reasearch Center of Central South University, Third Xiangya Hospital, Central South University, Changsha, China
| | - Shuangjiao Shi
- Department of Nursing, Third Xiangya Hospital, Central South University, Changsha, China
- Clinical Nursing Safety Management Reasearch Center of Central South University, Third Xiangya Hospital, Central South University, Changsha, China
| | - Siqing Ding
- Department of Nursing, Third Xiangya Hospital, Central South University, Changsha, China
- Clinical Nursing Safety Management Reasearch Center of Central South University, Third Xiangya Hospital, Central South University, Changsha, China
| | - Zhuqing Zhong
- Department of Nursing, Third Xiangya Hospital, Central South University, Changsha, China
- Clinical Nursing Safety Management Reasearch Center of Central South University, Third Xiangya Hospital, Central South University, Changsha, China
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Almeida TDCF, Sousa MMD, Gouveia BDLA, Olinda RAD, Lamas JLT, Oliveira SHDS. Psychosocial Determinants of the Intention to Take Oral Antihypertensive Drugs: A Cross-sectional Study. AQUICHAN 2020. [DOI: 10.5294/aqui.2020.20.4.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective: To identify the psychosocial predictors that influence the behavioral intention to take oral antihypertensive drugs.
Materials and methods: A cross-sectional study, based on the theory of planned behavior. A questionnaire constructed and validated was applied to 220 individuals with systemic arterial hypertension in outpatient follow-up at a public hospital. The chi-square and Fisher’s exact tests, Spearman’s correlation and multiple logistic regression were used for data analysis.
Results: The participants presented a high intention of taking antihypertensive drugs. The behavioral beliefs (ß = 0.0432; p = 0.0364), subjective norm (ß = -1.5708; p < 0.01) and perceived behavioral control (ß = 2.2809; p = 0.0028) explained the behavioral intention in 33 %.
Conclusions: The behavioral beliefs, the subjective norm, and the perceived behavioral control are significant psychosocial predictors of taking antihypertensive drugs and must be valued, individually and jointly, in the health actions targeted at this population.
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Exploring Medication Adherence Amongst Australian Adults Using an Extended Theory of Planned Behaviour. Int J Behav Med 2020; 27:389-399. [DOI: 10.1007/s12529-020-09862-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Jannuzzi FF, Cornélio ME, São-João TM, Gallani MC, Godin G, Rodrigues RCM. Psychosocial determinants of adherence to oral antidiabetic medication among people with type 2 diabetes. J Clin Nurs 2019; 29:909-921. [PMID: 31856319 DOI: 10.1111/jocn.15149] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 06/25/2019] [Accepted: 06/30/2019] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES The aim of this study was to identify the psychosocial determinants of adherence to oral antidiabetic medication, according to the Theory of Planned Behaviour (TPB). BACKGROUND Appropriate adherence to oral antidiabetic medication contributes to long-term glycaemic control. However, glycaemic control is often poor in people with type 2 diabetes, mainly due to the poor adherence to oral antidiabetic agents. DESIGN Prospective study with 2 waves of data collection, based on STROBE checklist was conducted. One hundred and fifty-seven adults with type 2 diabetes, in chronic use of oral antidiabetic agents, composed the sample. At baseline, self-reported measures of medication adherence (proportion and global evaluation of adherence) and of metabolic control (glycated haemoglobin) of diabetes were obtained. METHODS The TPB main constructs (attitude, subjective norm and perceived control) and related beliefs were measured. Adherence and metabolic control measurements were obtained in a two-month follow-up (n = 157). RESULTS Attitude and subjective norm, together, explained 30% of the variability in intention; their underlying belief-based measures (behavioural and normative beliefs) explained 28% of the variability in intention. In addition, intention predicted behaviour at follow-up. However, when added to the prediction model, past behaviour was the only explanatory factor of adherence behaviour. CONCLUSION Adherence behaviour to oral antidiabetic medication was predicted by intention, which, in turn, was determined by attitude and subjective norm. In order to promote adherence to oral antidiabetic agents, health professionals should include motivational strategies as well as strategies targeted to attitude and subjective norm when designing interventions. RELEVANCE TO CLINICAL PRACTICE The nonadherence to antidiabetic medication contributes to lack of control of diabetes and ensuing complications. The comprehension of the factors explaining the variability in medication adherence can inform the design of theory-based interventions aimed at promoting this behaviour.
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Affiliation(s)
| | | | | | | | - Gaston Godin
- Faculté des sciences infirmières, Université Laval, Québec City, Québec, Canada
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Al-Noumani H, Wu JR, Barksdale D, Knafl G, AlKhasawneh E, Sherwood G. Health Beliefs and Medication Adherence in Omanis With Hypertension. J Cardiovasc Nurs 2019; 33:518-526. [PMID: 30130358 PMCID: PMC6179908 DOI: 10.1097/jcn.0000000000000511] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Patients' health beliefs are essential to improve medication adherence among patients with hypertension. OBJECTIVE Our objective was to examine the relationship between (1) patients' beliefs about hypertension, medication, and self-efficacy and medication adherence and (2) medication adherence and blood pressure control in Oman. METHODS This cross-sectional study included 215 participants with hypertension. Participants completed 4 questionnaires (Arabic version) to measure medication adherence, beliefs about hypertension severity, beliefs about medication, and self-efficacy. Bivariate and multivariate logistic regression was used to conduct the analyses. RESULTS Higher self-efficacy (odds ratio [OR], 2.59; 95% confidence interval [CI], 1.54-4.37), stronger beliefs about medication necessity (OR, 1.98; 95% CI, 1.21-3.23), increased age (OR, 1.06; 95% CI, 1.03-1.10), and fewer medication concerns (OR, 0.34; 95% CI, 0.20-0.57) were related to high medication adherence. Moreover, uncontrolled blood pressure was less likely in participants with high medication adherence (OR, 0.47; 95% CI, 0.24-0.93). CONCLUSIONS Patients' beliefs are important consideration to improve medication adherence. Clinically, patients' beliefs should be assessed, and strategies to improve medication adherence should incorporate beliefs as a key component to improve antihypertensive medication adherence. Patient education and counseling regarding hypertension and necessity and side effects of medications are important to maximize positive beliefs and improve medication adherence.
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Affiliation(s)
- Huda Al-Noumani
- Huda Al-Noumani, PhD, RN Assistant Professor, Department of Adult Health and Critical Care, College of Nursing, Sultan Qaboos University, Muscat, Oman. Jia-Rong Wu, PhD, RN Associate Professor, School of Nursing, University of North Carolina at Chapel Hill. Debra Barksdale, PhD, RN, FNP-BC, CNE, FAANP, FAAN Professor, School of Nursing, Virginia Commonwealth University, Richmond. George Knafl, PhD Professor, School of Nursing, University of North Carolina at Chapel Hill. Esra AlKhasawneh, PhD, RN, FAAN Associate Professor, College of Nursing, Sultan Qaboos University, Muscat, Oman. Gwen Sherwood, PhD, RN, FAAN Professor, School of Nursing, University of North Carolina at Chapel Hill
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Al-Noumani H, Wu JR, Barksdale D, Sherwood G, AlKhasawneh E, Knafl G. Health beliefs and medication adherence in patients with hypertension: A systematic review of quantitative studies. PATIENT EDUCATION AND COUNSELING 2019; 102:1045-1056. [PMID: 30846205 DOI: 10.1016/j.pec.2019.02.022] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 02/20/2019] [Accepted: 02/22/2019] [Indexed: 05/23/2023]
Abstract
OBJECTIVE This review synthesizes findings of quantitative studies examining the relationship between health beliefs and medication adherence in hypertension. METHODS This review included published studies in PubMed, CINHAL, EMBASE, and PsycINFO databases. Studies were included if they examined beliefs of patients with hypertension. Quality of the studies was evaluated using the Quality Assessment Tool for Systematic Review of Observational Studies. RESULTS Of the 1558 articles searched, 30 articles were included in the analysis. Most beliefs examined by studies of this review in relation to medication adherence were beliefs related to hypertension severity and susceptibility to its consequences, medication effectiveness or necessity, and barriers to medication adherence. Higher medication adherence was significantly related to fewer perceived barriers to adherence (e.g, side-effects) was fairly consistent across studies. Higher self-efficacy was related to higher medication adherence. Patients' beliefs and their relationship to medication adherence appear to vary unpredictably across and within countries. CONCLUSION Clinicians should assess beliefs for individual patients. When individual beliefs appear likely to undermine adherence, it may be useful to undertake educational interventions to try to modify them. PRACTICAL IMPLICATIONS Clinicians should explore individual patients' beliefs about hypertension and blood pressure medications, discuss their implications for medication adherence, and try to modify counterproductive beliefs.
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Affiliation(s)
| | - Jia-Rong Wu
- School of Nursing, University of North Carolina at Chapel Hill, NC, USA
| | - Debra Barksdale
- School of Nursing, Virginia Commonwealth University, VA, USA
| | - Gwen Sherwood
- School of Nursing, University of North Carolina at Chapel Hill, NC, USA
| | | | - George Knafl
- School of Nursing, University of North Carolina at Chapel Hill, NC, USA
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Al-Ganmi AHA, Perry L, Gholizadeh L, Alotaibi AM. Behaviour change interventions to improve medication adherence in patients with cardiac disease: Protocol for a mixed methods study including a pilot randomised controlled trial. Collegian 2018. [DOI: 10.1016/j.colegn.2017.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Moon Z, Moss-Morris R, Hunter MS, Hughes LD. More than just side-effects: The role of clinical and psychosocial factors in non-adherence to tamoxifen. Br J Health Psychol 2017; 22:998-1018. [DOI: 10.1111/bjhp.12274] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 08/23/2017] [Indexed: 12/13/2022]
Affiliation(s)
- Zoe Moon
- Institute of Psychiatry; Psychology & Neuroscience (IoPPN); Health Psychology Section; King's College London UK
| | - Rona Moss-Morris
- Institute of Psychiatry; Psychology & Neuroscience (IoPPN); Health Psychology Section; King's College London UK
| | - Myra S. Hunter
- Institute of Psychiatry; Psychology & Neuroscience (IoPPN); Health Psychology Section; King's College London UK
| | - Lyndsay D. Hughes
- Institute of Psychiatry; Psychology & Neuroscience (IoPPN); Health Psychology Section; King's College London UK
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Ahn YH, Ham OK. Factors Associated With Medication Adherence Among Medical-Aid Beneficiaries With Hypertension. West J Nurs Res 2016; 38:1298-312. [PMID: 27272159 DOI: 10.1177/0193945916651824] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose was to examine factors associated with medication adherence among medical-aid beneficiaries with hypertension using the Expanded Behavioral Model of Health Services Utilization. A cross-sectional study was conducted with a convenient sample of 289 patients. The instruments included scales to measure medication adherence, health literacy, general self-efficacy, and pros and cons of chronic disease management. Data collection was performed between February and March 2011. A hierarchical regression analysis was performed. The study found that 25.6% to 34.6% had low motivation and low knowledge regarding medication adherence. Those with higher health literacy and higher self-efficacy scores were more likely to have higher medication adherence, whereas widowed and those who perceived more cons of chronic disease management were more likely to have lower medication adherence than their counterparts (p < .05). Interventions incorporating significant factors associated with medication adherence are required to enhance medication adherence and to prevent complications associated with medication non-adherence.
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Affiliation(s)
- Yang Heui Ahn
- Yonse University Wonju College of Medicine, Wonju, Korea
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Understanding if, how and why non-adherent decisions are made in an Australian community sample: A key to sustaining medication adherence in chronic disease? Res Social Adm Pharm 2015; 11:154-62. [DOI: 10.1016/j.sapharm.2014.06.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 06/27/2014] [Accepted: 06/27/2014] [Indexed: 01/09/2023]
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Morrison VL, Holmes EAF, Parveen S, Plumpton CO, Clyne W, De Geest S, Dobbels F, Vrijens B, Kardas P, Hughes DA. Predictors of self-reported adherence to antihypertensive medicines: a multinational, cross-sectional survey. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2015; 18:206-216. [PMID: 25773556 DOI: 10.1016/j.jval.2014.12.013] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 11/27/2014] [Accepted: 12/10/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND Nonadherence to antihypertensive medicines limits their effectiveness, increases the risk of adverse health outcome, and is associated with significant health care costs. The multiple causes of nonadherence differ both within and between patients and are influenced by patients' care settings. OBJECTIVES The objective of this article was to identify determinants of patient nonadherence to antihypertensive medicines, drawing from psychosocial and economic models of behavior. METHODS Outpatients with hypertension from Austria, Belgium, England, Germany, Greece, Hungary, The Netherlands, Poland, and Wales were recruited to a cross-sectional online survey. Nonadherence to medicines was assessed using the Morisky Medication Adherence Scale (primary outcome) and the Medication Adherence Rating Scale. Associations with adherence and nonadherence were tested for demographic, clinical, and psychosocial factors. RESULTS A total of 2595 patients completed the questionnaire. The percentage of patients classed as nonadherent ranged from 24% in The Netherlands to 70% in Hungary. Low age, low self-efficacy, and respondents' perceptions of their illness and cost-related barriers were associated with nonadherence measured on the Morisky Medication Adherence Scale across several countries. In multilevel, multivariate analysis, low self-efficacy (odds ratio = 0.73; 95% confidence interval 0.70-0.77) and a high number of perceived barriers to taking medicines (odds ratio = 1.70; 95% confidence interval 1.38-2.09) were the main significant determinants of nonadherence. Country differences explained 11% of the variance in nonadherence. CONCLUSIONS Among the variables measured, patients' adherence to antihypertensive medicines is influenced primarily by their self-efficacy, illness beliefs, and perceived barriers. These should be targets for interventions for improving adherence, as should an appreciation of differences among the countries in which they are being delivered.
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Affiliation(s)
| | - Emily A F Holmes
- Centre for Health Economics & Medicines Evaluation, Bangor University, Bangor, UK
| | | | - Catrin O Plumpton
- Centre for Health Economics & Medicines Evaluation, Bangor University, Bangor, UK
| | | | | | | | | | | | - Dyfrig A Hughes
- Centre for Health Economics & Medicines Evaluation, Bangor University, Bangor, UK.
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Holmes EAF, Hughes DA, Morrison VL. Predicting adherence to medications using health psychology theories: a systematic review of 20 years of empirical research. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2014; 17:863-876. [PMID: 25498782 DOI: 10.1016/j.jval.2014.08.2671] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 05/27/2014] [Accepted: 08/01/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVES This review sought to identify the empirical evidence for the application of models from sociocognitive theory, self-regulation theory, and social support theory at predicting patient adherence to medications. METHODS A systematic review of the published literature (1990-2010) using MEDLINE, EMBASE, Cochrane Library, CINAHL, and PsychINFO identified studies examining the application of health psychology theory to adherence to medication in adult patients. Two independent reviewers extracted data on medication, indication, study population, adherence measure, theory, model, survey instruments, and results. Heterogeneity in theoretical model specification and empirical investigation precluded a meta-analysis of data. RESULTS Of 1756 unique records, 67 articles were included (sociocognitive = 35, self-regulation = 21, social support = 11). Adherence was most commonly measured by self-report (50 of 67). Synthesis of studies highlighted the significance (P ≤ 0.05) of self-efficacy (17 of 19), perceived barriers (11 of 17), perceived susceptibility (3 of 6), necessity beliefs (8 of 9), and medication concerns (7 of 8). CONCLUSIONS The results of this review provide a foundation for the development of theory-led adherence-enhancing interventions that could promote sustainable behavior change in clinical practice.
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Andrews KL, Jones SC, Mullan J. Asthma self management in adults: a review of current literature. Collegian 2014; 21:33-41. [PMID: 24772988 DOI: 10.1016/j.colegn.2012.12.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Self management programs for chronic conditions, such as asthma, have an important place in healthcare delivery. When properly implemented, they can curb the impact of disease and reduce both the high personal costs for individuals and significant financial costs for health care systems. The purpose of this review was to establish an understanding of current published literature on asthma self management programs in adults and to identify any reported attributes or components which serve to either assist or obstruct the uptake of self management strategies. Electronic data sources including Scopus, Proquest 5000, CINAHL, PubMed and Web of Science were accessed and literature searches were conducted using the key terms: asthma, chronic disease, self management, morbidity, quality of life, health outcomes, patient education and best practice. Inclusion criteria for the search included journal articles relating to adults with asthma published in English in peer reviewed journals from 1995 to 2011. Exclusion criteria included research targeting children, parents of children or families; and articles examining Asthma and COPD (or any other co-morbidity). Sixty four articles were included in this review due to their relevance to the major components of asthma self management, as defined by the Australian Asthma Management Handbook. A major conclusion from this review was that the uptake of asthma self management strategies is poor despite global recommendations for over twenty years; and that a likely reason for this is that generic asthma self management advice does not engage the individual with asthma.
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Gallacher K, Morrison D, Jani B, Macdonald S, May CR, Montori VM, Erwin PJ, Batty GD, Eton DT, Langhorne P, Mair FS. Uncovering treatment burden as a key concept for stroke care: a systematic review of qualitative research. PLoS Med 2013; 10:e1001473. [PMID: 23824703 PMCID: PMC3692487 DOI: 10.1371/journal.pmed.1001473] [Citation(s) in RCA: 126] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 05/09/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Patients with chronic disease may experience complicated management plans requiring significant personal investment. This has been termed 'treatment burden' and has been associated with unfavourable outcomes. The aim of this systematic review is to examine the qualitative literature on treatment burden in stroke from the patient perspective. METHODS AND FINDINGS The search strategy centred on: stroke, treatment burden, patient experience, and qualitative methods. We searched: Scopus, CINAHL, Embase, Medline, and PsycINFO. We tracked references, footnotes, and citations. Restrictions included: English language, date of publication January 2000 until February 2013. Two reviewers independently carried out the following: paper screening, data extraction, and data analysis. Data were analysed using framework synthesis, as informed by Normalization Process Theory. Sixty-nine papers were included. Treatment burden includes: (1) making sense of stroke management and planning care, (2) interacting with others, (3) enacting management strategies, and (4) reflecting on management. Health care is fragmented, with poor communication between patient and health care providers. Patients report inadequate information provision. Inpatient care is unsatisfactory, with a perceived lack of empathy from professionals and a shortage of stimulating activities on the ward. Discharge services are poorly coordinated, and accessing health and social care in the community is difficult. The study has potential limitations because it was restricted to studies published in English only and data from low-income countries were scarce. CONCLUSIONS Stroke management is extremely demanding for patients, and treatment burden is influenced by micro and macro organisation of health services. Knowledge deficits mean patients are ill equipped to organise their care and develop coping strategies, making adherence less likely. There is a need to transform the approach to care provision so that services are configured to prioritise patient needs rather than those of health care systems.
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Affiliation(s)
- Katie Gallacher
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Deborah Morrison
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Bhautesh Jani
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Sara Macdonald
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Carl R. May
- Faculty of Health Sciences, University of Southampton, United Kingdom
| | - Victor M. Montori
- Knowledge and Encounter Research Unit, Mayo Clinic, Rochester, United States of America
| | - Patricia J. Erwin
- Knowledge and Encounter Research Unit, Mayo Clinic, Rochester, United States of America
| | - G. David Batty
- Department of Epidemiology and Public Health, University College London, United Kingdom
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, United Kingdom
| | - David T. Eton
- Knowledge and Encounter Research Unit, Mayo Clinic, Rochester, United States of America
| | - Peter Langhorne
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom
| | - Frances S. Mair
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, United Kingdom
- * E-mail:
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AlGhurair SA, Hughes CA, Simpson SH, Guirguis LM. A systematic review of patient self-reported barriers of adherence to antihypertensive medications using the world health organization multidimensional adherence model. J Clin Hypertens (Greenwich) 2012; 14:877-86. [PMID: 23205755 PMCID: PMC8108877 DOI: 10.1111/j.1751-7176.2012.00699.x] [Citation(s) in RCA: 102] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Revised: 05/23/2012] [Accepted: 07/04/2012] [Indexed: 08/01/2023]
Abstract
Multiple barriers can influence adherence to antihypertensive medications. The aim of this systematic review was to determine what adherence barriers were included in each instrument and to describe the psychometric properties of the identified surveys. Barriers were characterized using the World Health Organization (WHO) Multidimensional Adherence Model with patient, condition, therapy, socioeconomic, and health care system/team-related barriers. Five databases (Medline, Embase, Health and Psychological Instruments, CINHAL, and International Pharmaceutical Abstracts [IPA]) were searched from 1980 to September 2011. Our search identified 1712 citations; 74 articles met inclusion criteria and 51 unique surveys were identified. The Morisky Medication Adherence Scale was the most commonly used survey. Only 20 surveys (39%) have established reliability and validity evidence. According to the WHO Adherence Model domains, patient-related barriers were most commonly addressed, while condition, therapy, and socioeconomic barriers were underrepresented. The complexity of adherence behavior requires robust self-report measurements and the inclusion of barriers relevant to each unique patient population and intervention.
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Affiliation(s)
- Suliman A. AlGhurair
- From the Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada
| | - Christine A. Hughes
- From the Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada
| | - Scot H. Simpson
- From the Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada
| | - Lisa M. Guirguis
- From the Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada
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Kostrzewski AJ, Dhillon S, Goodsman D, Taylor KMG, Weinman JA. The extent and characteristics of United Kingdom hospital pharmacists keeping, or not keeping, a professional development portfolio. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2010. [DOI: 10.1211/ijpp.17.05.0007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Abstract
Objectives
The aim of this study was to examine the use of continuing professional development (CPD) portfolios by hospital pharmacists. The objectives were to assess the extent to which pharmacists use portfolios in CPD and to examine the attitudes/beliefs which differentiate those who do and do not keep a portfolio.
Method
Participants completed two questionnaires: (1) personality traits were examined using the Big-Five questionnaire and (2) a new Pharmacist Portfolio-Engaging Behaviour Questionnaire (PPEBQ) examined the attitudes and beliefs. What constitutes a portfolio was left to the interpretation of the participants, but it was specified that the survey was about participants' views of producing written records of their professional practice for CPD. The setting was hospital pharmacists based in the London area in December 2004.
Key findings
Overall, 134 pharmacists (78%) returned both questionnaires, and 80 stated that they kept a portfolio and 52 stated that they did not (two questionnaires were returned spoilt). There was no significant difference in the age or number of years qualified between those with and without a portfolio. Three personality traits were linked to keeping a portfolio (conscientiousness, agreeableness and emotional stability). Pharmacists with a portfolio scored highly on the perceived behavioural control and behavioural intention scales of the PPEBQ.
Conclusions
The Big-Five personality questionnaire is a useful tool to investigate pharmacists' use of a portfolio. Results of the PPEBQ suggested that hospital pharmacists who had a portfolio were concerned with having control over its production. However, the PPEBQ requires further development to improve its reliability. These findings have implications for the educational support of CPD.
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Affiliation(s)
- Andrzej J Kostrzewski
- Guy's and St. Thomas' NHS Foundation Trust, Pharmacy Department, Guy's Hospital, London, UK
| | - Soraya Dhillon
- School of Pharmacy, University of Hertfordshire, Hatfield, UK
| | - Danë Goodsman
- Institute of Health Sciences Education, Centre for Medical Education, London, UK
| | | | - John A Weinman
- Health Psychology Section, Psychology Department (at Guy's), Institute of Psychiatry, London, UK
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