Examining whether the information-motivation-behavioral skills model predicts medication adherence for patients with a rare disease

A predictive model for medication adherence in older adults with heart failure

AIMS

Although many studies have examined the predictors of medication adherence (MA), further empirical research is required to clarify the best model for predicting MA for older adults with heart failure (HF). Thus, we hypothesized a model in which information (knowledge), motivation (social support and depressive symptoms), and behavioural skills (barriers to self-efficacy) would be associated with MA in patients with HF.

METHODS AND RESULTS

Using a cross-sectional survey, 153 adults aged ≥ 65 years taking medication for HF were recruited from a university hospital in Korea. Data were collected based on the information-motivation-behavioural skills (IMB) model constructs and MA. In the hypothesized path model, self-efficacy was directly related to MA (β = -0.335, P = 0.006), whereas social support was indirectly related to MA through self-efficacy (β = -0.078, P = 0.027). Depressive symptoms were directly related to MA (β = 0.359, P = 0.004) and indirectly related to MA through self-efficacy (β = 0.141, P = 0.004). The hypothesized MA model showed a good fit for the data. Knowledge, social support, and depressive symptoms accounted for 44.3% of the variance in self-efficacy (P = 0.004). Left ventricular ejection fraction, knowledge, social support, depressive symptoms, and self-efficacy explained 64.4% of the variance in MA (P = 0.004).

CONCLUSION

These results confirmed the IMB model's suitability for predicting MA in older adults with HF. These findings may guide and inform intervention programmes designed to alleviate depressive symptoms in older adults with HF and enhance their HF knowledge, social support, and self-efficacy, with the ultimate goal of improving their MA.

Community behavioral change and management of COVID-19 Pandemic: Evidence from Indonesia

Objectives

This study aims to investigate the effect of information and motivation on behavioral change related to the COVID-19 pandemic management in Indonesia. It also examines the role of behavioral skills in mediating the information-behavioral change relationship and the motivation-behavioral change relationship.

Method

This study employs the partial least squares structural equation modeling (PLS-SEM) to test the research hypotheses. Using the online survey method to collect data, 845 responses were obtained from several main islands of Indonesia.

Results

The results of the study show that information and motivation positively influence people's behavior changes. Behavioral skills mediate the influence of information and motivation on behavioral change. This study contributes to the development of the information-motivation-behavior model (IMB-Model). It also provides additional knowledge on pandemic management in the research setting of Indonesia as a country that has complex characteristics in terms of religion and belief, demography, culture, economy, and politics.

Conclusions

This study concludes that the success of Indonesia in dealing with the pandemic greatly depends on the success of changing the community behavior. Providing reliable and consistent information enhances people's motivation to build their behavioral skills. With increased behavioral skills, people have changed their behavior in fighting against COVID-19 by obeying health protocols, participating in vaccination programs, and practicing a healthier lifestyle.

Improving bleeding disorder treatment log adherence: An application of the information-motivation-behavioral skills model

INTRODUCTION

For people with severe bleeding disorders (PwBD) who are prescribed home treatment, treatment logs are an important part of the management of their care. Treatment logs provide a clinical picture of the home treatment regimen and can serve as a communication tool between the medical team and the person with a bleeding disorder. Most importantly, treatment logs allow for the adjustment of the treatment dose and frequency to prevent bleeding episodes. Yet, a large number of PwBD do not complete treatment logs.

AIMS

We aimed to develop and implement interventions to increase adherence rates of treatment log completion in PwBD on a home treatment regimen by at least 20% over 2 years.

METHODS

We conducted a quality improvement initiative from 2019-2022 involving developing and implementing interventions that were guided by the application of the Information-Motivation-Behavioural Skills Model. Examples of interventions included: the development of educational materials on the different methods of log completion and interactive discussions that involved a patient-driven decision of selecting a treatment log method. Data on the implementation of the theoretically-based interventions as well as outcome data on the success of treatment log completion was reviewed monthly.

RESULTS

Following the application of the Information-Motivation-Behavioural Skills Model on the designed and implemented interventions, there was a 20% increase in individuals' adherence with treatment logs completion (N = 68).

CONCLUSION

Treatment logs are an important piece of a PwBDs' prescribed home treatment regimen. Quality improvement interventions promoted increased treatment log adherence for PwBDs'prescribed prophylactic home treatment.

Mediators and moderators of ART adherence effects of supporting treatment adherence readiness through training (START): evidence that START helps vulnerable clients achieve better adherence

Supporting Treatment Adherence Readiness through Training (START) is an HIV antiretroviral adherence intervention, based on the Information Motivation and Behavioral skills (IMB) model, that significantly improved adherence in our randomized controlled trial. To understand how and for whom START had its effects on adherence, we examined mediators and moderators. Ninety-nine HIV-patients (53 control, 46 intervention) who enrolled in the trial and provided month 6 electronic monitored adherence data. The intervention was associated with increased adherence-related knowledge and lower impulsive/careless problem solving, but had no effects on other IMB-related constructs. Neither of these variables mediated the adherence effects of the intervention (based on linear regression models with bootstraping for unbiased standard errors). Four variables interacted with the intervention to moderate its effects: the intervention group had consistent high adherence across the range of depression and time since HIV diagnosis, compared to lower adherence with higher values in the usual care control; those with unstable housing or frequent drug use had higher adherence if in the intervention group compared to the control group. These findings suggest that START provides support that enables its recipients to cope with and overcome challenges (e.g., depression, unstable housing, drug use) that would typically impede adherence.Trial registration: ClinicalTrials.gov identifier: NCT02329782.

Effectiveness of education intervention to reduce sugar-sweetened beverages and 100% fruit juice in children and adolescents: a scoping review

OBJECTIVE

To determine the impact of educational intervention in reducing the consumption of sugar-sweetened beverages (SSBs) and 100% fruit juice in children and adolescents.

DESIGN

We conducted a comprehensive Ovid Medline and Scopus search. Articles had to be peer-reviewed, full-text and published in English. Studies had to be controlled intervention, published between 1 January 2010 to 7 February 2021, and in children and adolescents. Study quality was measured using the Quality Assessment Tool for Controlled Intervention Studies.

RESULTS

Forty intervention articles were included in this review involving 25,069 children and adolescents. All studies employed a quantitative research method using the Randomized Controlled Trial designs. Twenty-eight out of forty interventions used psychosocial theories. Study quality ranged from 'fair' to 'good.' Results showed that education intervention effectively reduced SSBs, and reduced 100% fruit juice in children.

EXPERT OPINION

Reducing the SSBs consumption in children should be initiated by conducting school-based programs consisting of interactive learning process, psychosocial theories and the involvement of parents or caregivers. Theories that focus on personal, behavior and environment factors improve the effectiveness of the intervention. More research is warranted to investigate the impacts of 100% fruit juice on obesity, dental caries and risk of co-morbidities in children.

Behaviour model integrated by protection motivation theory and information-motivation-behavioural skills model applying in pregnancy weight management (PrInMAMa): a study protocol for a randomised controlled trial in China

INTRODUCTION

Excessive gestational weight gain poses a significant threat to maternal and child health. The healthy behaviour theory has been increasingly applied to weight management during pregnancy, but research is still insufficient. The successful application of the protection motivation theory (PMT) and the information-motivation-behavioural skills (IMB) model in the field of healthy behaviour laid the foundation for this intervention study. The overall aim of this study is to test the effectiveness of interventions based on the behaviour model integrated with the PMT and IMB model (PMT-IMB model) on weight management and provide feasible methods for weight management during pregnancy.

METHODS AND ANALYSIS

This prospective, single-centre, randomised controlled trial involves two steps. First, based on the PMT-IMB model, evaluation tools and intervention materials will be developed. Second, more than 800 women in the first trimester of pregnancy will be randomly assigned to two groups and will be followed until 1 week after delivery. The control group will receive standardised antenatal care (ANC), whereas the experimental group will receive both standardised ANC and interventions based on the PMT-IMB model. After three surveys (at enrolment, at 28 weeks of gestation, and on the day of hospitalisation for delivery), primary outcomes (scores of the subscales of the PMT-IMB model, scores of the pregnancy weight management strategy scale, and gestational weight gain) and secondary outcomes (pregnancy outcomes and pregnancy complications) will be obtained. Differences in outcomes between the two groups will be analysed to evaluate the effectiveness of the intervention.

ETHICS AND DISSEMINATION

The study protocol has been approved by the ethics committee of Nanjing Medical University. All participants will sign an informed consent form prior to enrolment. The findings of the study will be published in peer-reviewed journals and presented at conferences.

TRIAL REGISTRATION NUMBER

ChiCTR2100043231.

Effect of information, motivation, and behavioral skills model on adherence to medication, diet, and physical activity in HIV/ADIS patients: A health promotion strategy

BACKGROUND

Adherence to treatment is one of the major challenges in patients with HIV/ADIS. If the patients do not adhere, they will face recurrent consequences, such as disease progression. The aim of this study was to investigate the effect of information, motivation, and behavioral Skills (IMB) model on medication adherence, diet adherence, and physical activity in HIV/ADIS patients.

MATERIALS AND METHODS

This interventional study was conducted on 122 patients with 20 years of age and over with HIV/AIDS in Kerman City, Iran, in 2018. A total of patients were selected by census method and categorized into the intervention and control groups. Later, a researcher-made questionnaire on IMB was used before and 3 months after the intervention to assess medication adherence, diet adherence, and physical activity .The intervention study consisted of at least 8 training sessions (90 min) over a 12-week period.

RESULTS

In adherence to medication, information (P = 0.034) and personal motivation (P = 0.003) constructs and in adherence to diet, information (P = 0.025), personal motivation (P = 0.001), self-efficacy (P = 0.010), and skills (P = 0.011) were significantly different between the two groups after the intervention (P = 0.011). However, regarding the adherence to physical activity, no significant difference was found between the two groups after the intervention.

CONCLUSIONS

The IMB model can be effective in promoting the diet adherence in HIV/AIDS patients. In this regard, more qualitative and quantitative studies are recommended on the adherence to medication and physical activity.

Knowledge, Attitude, and Practice of Adolescent Girls towards Reducing Malnutrition in Maiduguri Metropolitan Council, Borno State, Nigeria: Cross-Sectional Study

Addressing the gap in knowledge, attitude, and practice among adolescent girls are important as malnutrition has a negative effect on their future generation. This study aimed to determine the knowledge, attitude, and practice of adolescent girls towards reducing malnutrition in Maiduguri Metropolitan Council, Borno State, Nigeria. This was a school-based cross-sectional study conducted among 612 adolescent girls (10 to 19 years old). KoBo collect toolbox was used for the data collection between 3 June and 31 July 2019. Multivariable logistic regression was used to identify predictors of knowledge, attitude, and practice towards reducing malnutrition. The majority of respondents (451, 80.2%; 322, 57.3%) had poor knowledge and attitude towards reducing malnutrition respectively, 278 (49.5%) had poor practice towards reducing malnutrition. Schooling (GGSS; p = 0.022; Shehu Garbai; p = 0.003) was a significant predictor of knowledge. Religion (p = 0.023), information (p < 0.001) and motivation (p < 0.001) were significant predictors of attitude. School (GGSS; p < 0.001; GGC; p < 0.001; Shehu garbai; p < 0.001; Bulabulin; p = 0.030; Zajeri day; p = 0.049), education of father (p = 0.001), information (p = 0.026) and behavioral skill (p = 0.019) were significant predictors of practice. There is a need to focus on both school-based and community-based health education intervention to address the poor knowledge, attitude, and practice among adolescent girls for a healthier future.

Perceptions of patients with rheumatic diseases treated with subcutaneous biologicals on their level of information: RHEU-LIFE Survey

OBJECTIVE

To investigate, in Spanish patients with rheumatic diseases treated with subcutaneous biological drugs, their sources of information, which sources they consider most relevant, and their satisfaction with the information received in the hospital.

METHODS

Rheumatologists from 50 hospitals handed out an anonymous survey to 20 consecutive patients with rheumatoid arthritis, axial spondyloarthritis or psoriatic arthritis treated with subcutaneous biologicals. The survey was developed ad hoc by 4 rheumatologists and 3 patients, and included questions with closed-ended responses on sources of information and satisfaction.

RESULTS

The survey was handed-out to 1,000 patients, 592 of whom completed it (response rate: 59.2%). The rheumatologist was mentioned as the most important source of information (75%), followed by the primary care physician, nurses, and electronic resources; 45.2% received oral and written information about the biological, 46.1% oral only, and 6.0% written only; 8.7% stated that they had not been taught to inject the biological. The percentage of patients satisfied with the information received was high (87.2%), although the satisfaction was lower in relation to safety. If the information came from the rheumatologist, the satisfaction was higher (89.6%) than when coming from other sources (59.6%; P<.001). Satisfaction was also higher if the information was provided orally and written (92.8%) than if provided only orally (86.1%; P=.013); 45.2% reported having sought information from sources outside the hospital.

CONCLUSIONS

The rheumatologist is key in transmitting satisfactory information on biological treatment to patients. He or she must also act as a guide, since a high percentage of patients seeks information in other different sources.

Antiretroviral therapy adherence based on information, motivation, and behavioral skills model and its association with depression among HIV-positive patients: Health promotion strategy towards the 909090 target

BACKGROUND

HIV-infected patients with poor antiretroviral therapy (ART) adherence are prone to depression, and depression can exacerbate the disease condition. This study was conducted to determine ART Adherence based on Information, Motivation, and Behavioral Skills (IMB) Model and its association with depression among HIV-positive patients.

MATERIALS AND METHODS

This descriptive-correlational study was carried out on people over the age of 18 years with HIV/AIDS, who referred to the Behavioral Diseases Counseling Center in Kerman City, Iran, in 2017. In this regard, 119 patients were selected using the table of random numbers. To collect the data, we used the Beck's depressioninventory-II and the IMB researcher made questionnaire to evaluate the ART adherence.

RESULTS

The results of the study reveal that a significant association was observed between the total adherence and all constructs of the IMB model (P < 0.001). Risk perception and self-efficacy had the highest mean scores regarding the ART adherence. The prevalence of depression was 71.5% among patients. Information, personal motivation, and total adherence had a significant association with depression.

CONCLUSIONS

IMB model was an appropriate and practical strategy with regard to the ART adherence among people living with HIV who are prone to depression and drug consumption is crucial for them to achieve the 90-90-90 target. This article created a questionnaire to assist policy-makers and health professionals designing interventions to improve adherence and health outcomes of ART.