Exploring Iranian β-Thalassemia major patients' perception of barriers and facilitators of adherence to treatment: A qualitative study

Treatment adherence and associated factors in older people with type 2 diabetes: A qualitative study

PATIENT CONTRIBUTION

Older people with T2D participated in this study to achieve the objective of the study.

AIM

Treatment adherence is an important indicator for evaluating successful diabetes control and overall disease management. It is necessary to identify the hidden themes of the concept of treatment adherence and related factors based on the experiences of older people with T2D. Therefore, the present study was conducted to identify the concept of treatment adherence and its associated factors in older people with type 2 diabetes (T2D).

DESIGN

The study was conducted as a qualitative study using a content analysis approach.

METHODS

Semi-structured interviews were conducted with 20 older people with T2D, between May and September 2021. Data were organized using MAXQDA-10 software and analysed using the Elo and Kyngas qualitative content analysis method. We followed the COREQ Checklist to ensure rigour in our study.

RESULTS

Three themes emerged from the analysis of the data, including: 'Health literacy', 'Support umbrella' and 'responsibility'.

Barriers to Treatment Adherence Among Older Adults With Type 2 Diabetes: A Qualitative Study

The current qualitative study aimed to determine the barriers to treatment adherence among older adults with type 2 diabetes (T2D). This study was performed using a content analysis approach. Semi-structured interviews were conducted with 25 older adults with T2D between May and September 2021. Data were organized using MAXQDA-10 software and analyzed using the Elo and Kyngäs qualitative content analysis method. Three themes emerged from the analysis: Patient-Specific Barriers, Health Care Provider- and Heath Care System-Specific Barriers, and Social-Specific Barriers. Results of this study can be used to develop targeted interventions to promote and facilitate treatment adherence among older adults with T2D. [Journal of Gerontological Nursing, 49(1), 42-49.].

The psychosocial challenges of mothers of children with thalassemia: A qualitative study

BACKGROUND

Caring for the children suffering from thalassemia is a stressful experience with various aspects making the mothers face various challenges. Thus, the present study aimed to explain the psychosocial challenges of mothers with thalassemia children based on their lived experience.

MATERIALS AND METHODS

In this qualitative study, which was conducted using the phenomenological method, 14 mothers with thalassemia children were selected from two thalassemia treatment centers in Hamadan and Babol (Iran) in 2020 using the purposive sampling method. Data were collected using in-depth and semi-structured interviews and were analyzed by van Manen's phenomenological methodology.

RESULTS

In the first stage of data analysis, 534 initial codes were extracted, which were reduced to 290 by comparison and integration. The primary themes turned into 24 secondary themes after clustering. By comparing the secondary themes, three main themes (i.e., "psychological distress," "bodily burnout," and "mothers' need to empathy and support") with 7 secondary themes (i.e., "emotional exhaustion," "mental strain," "social stigma," "acute psychosomatic reactions," "long-term psychosomatic consequences," "expectation of family support," and support needs outside the family) were extracted.

CONCLUSION

The results indicated that mothers with thalassemia children experience several challenges in various aspects. Therefore, they require care interventions and psychosocial support.

Experiences of the Patients with Behcet's Syndrom from Adherence to Treatment: A Qualitative Content Analysis

Background

Adherence to treatment plays an important role in the effectiveness of treatment in patients with Behcet's Syndrome (BS). An in-depth understanding of the experiences of patients with BS will help to improve the patients' management. The present qualitative study aimed to explore the experiences of patients with BS from adherence to treatment.

Methods

This qualitative study was conducted during February-September 2019 at Shahid Motahari Behcet's Clinic in Shiraz, Iran. Data were collected through eight unstructured observations and 22 individual in-depth semi-structured interviews with 20 participants (15 patients with BS, three family members, and two rheumatologists). Data analysis was performed simultaneously with data collection, using the conventional content analysis as proposed by Graneheim and Lundman. Data were managed using MAXQDA 10 software.

Results

Data analysis resulted in 21 sub-categories, seven categories, and three themes. The themes included barriers to treatment adherence (inability to cope with treatment and challenges in access to health care), facilitators of treatment adherence (incentives, receiving support, and striving to adapt to illness), and missing aspects of the treatment program (inadequate patient education and the neglect of lifestyle modification).

Conclusion

The barriers to and facilitators of treatment adherence as well as the missing aspects of the treatment program of patients with BS were identified. Adherence to treatment is not only determined by the patients, but also affected by the support system and relies upon the existing context and the nature of the treatment plan. These parameters should be considered during patient management to effectively promote treatment adherence.

Patient Perspective on Iron Chelation Therapy: Barriers and Facilitators of Medication Adherence

Nonadherence to iron chelation therapy (ICT) remains a long-standing and serious issue in thalassemia, especially in resource-constrained developing countries. Barriers and facilitators of adherence to ICT in transfusion-dependent thalassemia (TDT) adult patients in Malaysia are not completely understood. This qualitative study explored factors affecting adherence to ICT among TDT adult patients at a public tertiary hospital in Malaysia. Data were collected through 21 semistructured in-depth interviews conducted among purposively sampled patients using a pretested interview guide. All interviews were audio-recorded and transcribed verbatim. Data were analyzed manually using thematic analysis method and managed using Atlas.Ti software. The most frequently discussed subthemes of barriers to adherence included patient-related factors, medications-related factors, sociocultural-related factors, environmental context and resources, and patient–health care provider relationship factors. The facilitators to adherence included having insights of their illness, prevailing sources of motivation emphasizing on strong self-efficacy, low medication burden, and having enabling environment. This study has identified barriers and facilitators that are unique to Malaysian thalassemic adults related to medication adherence. Options for future multifaceted interventions are suggested.

Experience of Uncertainty in Patients with Thalassemia Major: A Qualitative Study

Background: Uncertainty leads to a stressful situation in patients with thalassemia major that can dramatically affect their psychosocial coping ability, treatment process and disease outcomes, and reduce patients' quality of life. As one of the important factors affecting the health of thalassemia patients, understanding the concept of uncertainty is of major importance to health care providers especially nurses as the first line of exposure to these patients. The present study aimed to explore the experiences of uncertainty in patients with thalassemia major.

Materials and Methods: The present qualitative study was conducted through in-depth face-to-face semi-structured interviews held with 18 patients with major thalassemia selected through purposive sampling. Interviews continued until saturation of data. All interviews were recorded, transcribed and analyzed with conventional content analysis method of Landman and Graneheim using MAXQDA10 software.

Results: Two main themes, including 'living in the shadow of anxiety' and 'coping with uncertainty' emerged from patients’ experiences of illness uncertainty of thalassemia. 'Living in the shadow of anxiety' included four categories of 'fear of complications', 'contradictory views on treatment', 'unknown future' and 'stigma'. 'Coping with uncertainty' included three categories of 'spiritual coping', 'psychosocial coping' and 'knowledge acquisition'.

Conclusion: According to the results of this study, uncertainty is a major psychological stress in patients with thalassemia major. Healthcare providers should therefore consider the challenges and concerns faced by patients and, through utilizing appropriate training and communicational practices, plan interventions and strategies to empower patients for coping with uncertainty.

Which Matters More for Medication Adherence Among Disabled People in Shanghai, China: Family Support or Primary Health Care?

Most disabled people have poor health status. They often have multiple diseases requiring continual medication. This study aimed to explore the factors associated with medication adherence among disabled people, with a particular focus on the factors associated with family and primary health care support. A questionnaire survey was conducted among 226 disabled individuals. The analysis was performed using an ordered logistic regression model, including 4 categories of predictor variables. We found that the community health service center played a positive role in improving medication adherence, whereas the role played by the participant’s family was more complicated. Specifically, those obtaining a brochure were more likely to have higher medication adherence (odds ratio [OR] = 2.732, 95% confidence interval [CI] = 1.349-5.532). Compared with those who were married, widowed participants (OR = 0.207, 95% CI = 0.069-0.620) and divorced participants (OR = 0.330, 95% CI = 0.057-1.914) had lower odds of having greater adherence, whereas the odds of having greater adherence for single participants were 1.679 times the same odds for married participants (OR = 1.679, 95% CI = 0.668-4.224). The odds of having greater medication adherence for participants receiving help with prescriptions from a family member were almost 60% lower than these odds for those who did not receive this kind of help (OR = 0.460, 95% CI = 0.216-0.979). Thus, the role played by participants’ family members was both protective and damaging, whereas the role of the community health service center was clearer. These findings merit further exploration.

Amino acids and fatty acids in patients with beta thalassemia major

BACKGROUND

Oxidative damage and increasing of lipid peroxidation are caused by chronic iron overload in patients with beta thalassemia major. Fatty acids are important structural elements for palmitoylation of membrane proteins which constitute a great part of natural membranes. Oxidative damages caused by reactive oxygen derives in thalassemic erythrocytes can be determined with lipid peroxidation, protein oxidation, and antioxidant system elements. The aim of study was to evaluate the relationship between amino acid and fatty acid levels with iron overload and antioxidant enzymes in beta thalassemia major.

METHODS

A total 40 patients with beta thalassemia major with regular blood transfusion and chelating agents were included in the study. The levels of serum amino acid, fatty acid, ferritin, antioxidant enzymes and malondialdehyde were measured.

RESULTS

Only C16- palmitoyl level was found significantly low in patients, other fatty acids and amino acids were in normal range. There were lower malondialdehyde and ferritin levels in patients with low C-16 palmitoyl level (p<0.05).  Conclusions: The high levels of ferritin and malondialdehyde in the patients with low C16-palmitoyl levels might be caused by this fatty acid's preventative effect on oxidative stress.

Disease Knowledge and Treatment Adherence among Adult Patients with Thalassemia: A Cross-sectional Correlational Study

Aim. To investigate the disease knowledge and treatment adherence among adult patients with thalassemia.

Material and methods. A cross-sectional correlational study was carried out with a convenience sample of 100 adult patients with thalassemia from a university teaching hospital in Jeddah city, Saudi Arabia. The Disease Knowledge about Thalassemia Major, the Treatment Adherence Scale, and sociodemographic survey were completed by participants. The data were analyzed using Statistical Package for the Social Sciences version 22. Descriptive and inferential statistics and Pearson correlations were performed.

Results. The participants had a moderate level of disease knowledge (M = 15.59, SD = 2.30) and a low level of treatment adherence (M = 3.91, SD = 1.83). There was also a weak but significant positive relationship between disease knowledge and treatment adherence (r = 0.297, P = 0.041). A significant difference in treatment adherence mean scores was found among participants with different monthly incomes (P = 0.05).

Conclusions. Knowledge gained from this study may be useful in improving nurses’ understanding of the effects of providing practical knowledge on treatment adherence. Educational strategies/interventions programs may be required to improve knowledge and adherence to treatment among thalassemia patients. Longitudinal studies are also needed to test for moderators and mediators of relationships of disease knowledge and treatment adherence.