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Ernst W, Kneavel M. Barriers to concussion reporting in collegiate athletes: an analysis of a peer-led worksheet activity. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024; 72:1215-1223. [PMID: 35549828 DOI: 10.1080/07448481.2022.2071621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 03/25/2022] [Accepted: 04/25/2022] [Indexed: 06/15/2023]
Abstract
Objective: To determine if a peer-led concussion reporting worksheet activity could elucidate barriers to reporting in collegiate athletes. Participants: Five hundred and three athletes from 7 universities across all three NCAA divisions. Methods: A supplementary qualitative analysis of responses to a concussion reporting worksheet completed during an RCT of a novel peer concussion education program. The first column of the worksheet required participants to list thoughts that prevent reporting and the second column required replacement thoughts that facilitate reporting. Results: A qualitative phenomenological thematic analysis of responses to the first column of the worksheets identified themes that coalesced into three areas: 1) missing out on athletic and social events, 2) losing one's competitive edge, and 3) negative interpersonal interaction/self-perception. Conclusions: Barriers to concussion reporting from several areas central to the collegiate athlete experience were identified. These barriers should be considered during clinical assessment and when developing concussion education programs.
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Affiliation(s)
- William Ernst
- Department of Professional Psychology, Center for Concussion Education and Research, Chestnut Hill College, Philadelphia, Pennsylvania, USA
- Center for Concussion Education and Research, Chestnut Hill College, Philadelphia, Pennsylvania, USA
| | - Meredith Kneavel
- Center for Concussion Education and Research, Chestnut Hill College, Philadelphia, Pennsylvania, USA
- School of Nursing and Health Sciences, La Salle University, Philadelphia, Pennsylvania, USA
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Dores AR, Peixoto M, Carvalho IP, Jesus Â, Moreira F, Marques A. The Pharmacy of the Future: Pharmacy Professionals' Perceptions and Contributions Regarding New Services in Community Pharmacies. Healthcare (Basel) 2023; 11:2580. [PMID: 37761777 PMCID: PMC10531482 DOI: 10.3390/healthcare11182580] [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: 07/27/2023] [Revised: 09/07/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
The use of information and communication technologies (ICTs) has revolutionized the provision of health services, often referred to as eHealth, benefiting community pharmacies that can offer new services in innovative formats, namely through telepharmacy. This study aimed to explore the perceptions of pharmacy professionals (i.e., pharmacists and pharmacy technicians) on the provision of new services. The study consisted of administering an online questionnaire to pharmacy professionals nationwide. The questionnaire was developed by the research team, based on focus group methodology, from which an inductive analysis led to the categories that made up the dimensions of the survey. Participants were 95 pharmacy professionals with a mean age of 33.69 years old (SD = 10.75). Almost 79% were women. The results show overall receptivity to the development of new services in community pharmacies. Suggestions for the development of the new services, conditions necessary for their implementation, potential obstacles, and strategies to promote adherence to the new services, among others, are identified. The knowledge thus acquired will help community pharmacies to develop innovative solutions in counselling, pharmacotherapy monitoring, and pharmacovigilance, for example, of herb/dietary supplement-drug adverse reactions and interactions. Based on this information, new services can become more accessible, namely through the use of ICTs.
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Affiliation(s)
- Artemisa R. Dores
- Laboratório de Reabilitação Psicossocial, Centro de Investigação em Reabilitação (CIR), Escola Superior de Saúde, Instituto Politécnico do Porto (ESS-IPP), 4200-072 Porto, Portugal; (M.P.); (A.M.)
| | - Miguel Peixoto
- Laboratório de Reabilitação Psicossocial, Centro de Investigação em Reabilitação (CIR), Escola Superior de Saúde, Instituto Politécnico do Porto (ESS-IPP), 4200-072 Porto, Portugal; (M.P.); (A.M.)
| | - Irene P. Carvalho
- Clinical Neurosciences and Mental Health Department, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
- CINTESIS@RISE, Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
| | - Ângelo Jesus
- CISA, Escola Superior de Saúde, Instituto Politécnico do Porto (ESS-IPP), 4200-072 Porto, Portugal; (Â.J.); (F.M.)
| | - Fernando Moreira
- CISA, Escola Superior de Saúde, Instituto Politécnico do Porto (ESS-IPP), 4200-072 Porto, Portugal; (Â.J.); (F.M.)
| | - António Marques
- Laboratório de Reabilitação Psicossocial, Centro de Investigação em Reabilitação (CIR), Escola Superior de Saúde, Instituto Politécnico do Porto (ESS-IPP), 4200-072 Porto, Portugal; (M.P.); (A.M.)
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Abbas S, Kermode M, Khan MD, Denholm J, Adetunji H, Kane S. What Makes People With Chronic Illnesses Discontinue Treatment? A Practice Theory Informed Analysis of Adherence to Treatment among Patients With Drug-Resistant Tuberculosis in Pakistan. Int J Health Policy Manag 2023; 12:6576. [PMID: 37579474 PMCID: PMC10125133 DOI: 10.34172/ijhpm.2022.6576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 12/27/2022] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Non-adherence to treatment is a frequently observed phenomenon amongst those on long-term treatment for chronic illnesses. This qualitative study draws upon the tenets of 'practice theory' to reveal what shapes patients' ability to adhere to the demanding treatment for drug-resistant tuberculosis (DR-TB) at three treatment sites in Khyber-Pakhtunkhwa (KP) province of Pakistan. METHODS This qualitative study involved observation of service provision over a period of nine months of stay at, and embedment within the three treatment sites and in-depth interviews with 13 service providers and 22 patients who became non-adherent to their treatment. RESULTS Consistent with the extensive research based on the barriers and facilitator approach, both patients, and providers in our study also talked of patients' doubts about diagnosis and treatment efficacy, side-effects of drugs, economic constraints, unreliable disbursements of monetary incentive, attitude of providers and co-morbidities as reasons for non-adherence to treatment. Applying a practice theory perspective yielded more contextualised insights; inadequate help with patients' physical complaints, unempathetic responses to their queries, and failure to provide essential information, created conditions which hindered the establishment and maintenance of the 'practice' of adhering to treatment. These supply-side gaps created confusion, bred resentment, and exacerbated pre-existing distrust of public health services among patients, and ultimately drove them to disengage with the TB services and stop their treatment. CONCLUSION We argue that the lack of supply-side 'responsiveness' to patient needs beyond the provision of a few material inputs is what is lacking in the existing DR-TB program in Pakistan. We conclude that unless Pakistan's TB program explicitly engages with these supply side, system level gaps, patients will continue to struggle to adhere to their treatments and the TB program will continue to lose patients. Conceptually, we make a case for reimagining the act of adherence (or not) to long-term treatment as a 'Practice.'
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Affiliation(s)
- Shazra Abbas
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Michelle Kermode
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | | | - Justin Denholm
- Department of Infectious Diseases, University of Melbourne, Melbourne, VIC, Australia
| | - Hamed Adetunji
- Faculty of Public Health & Health Informatics, Umm Al Qura University, Makkah Almukarramah, Saudi Arabia
| | - Sumit Kane
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
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Bentley S, Morgan L, Exall E, Arbuckle R, Rossom RC, Roche N, Khunti K, Higgins V, Piercy J. Qualitative Interviews to Support Development and Cognitive Debriefing of the Adelphi Adherence Questionnaire (ADAQ©): A Patient-Reported Measure of Medication Adherence Developed for Use in a Range of Diseases, Treatment Modalities, and Countries. Patient Prefer Adherence 2022; 16:2579-2592. [PMID: 36133076 PMCID: PMC9484566 DOI: 10.2147/ppa.s358046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 07/26/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The Adelphi Adherence Questionnaire (ADAQ©) is a newly developed generic patient-reported outcome (PRO) assessment of medication adherence. The aim was to assess its content validity by conducting cognitive debriefing (CD) interviews with patients prescribed medication(s) of various treatment modalities in a range of therapy areas. MATERIALS AND METHODS Targeted literature/instrument review and concept elicitation interviews informed development of the ADAQ©. CD interviews were conducted with 57 adults from the United States of America (USA; n = 21), Spain (n = 18), and Germany (n = 18) who prescribed medication for hypertension, diabetes, depression, schizophrenia, asthma, multiple myeloma, psoriasis, and/or multiple sclerosis. Interviews were conducted in two rounds to explore the relevance and understanding of the item wording, instructions, recall period and response options. Verbatim transcripts were analysed in ATLAS.Ti using thematic analysis. Three expert clinicians provided guidance throughout the study. RESULTS ADAQ© items/instructions were well understood and relevant to participants. Key modifications following round 1 included revising instructions to refer to current medication(s) for one condition to reduce cognitive burden, removing two items with lower relevance (specifically those assessing running out of medication and social discouragement), and adding a response option for participants to indicate if they had stopped taking a medication. Minor wording modifications were made following round 2. Subgroup differences in item relevance were explored based on clinical characteristics. Cost of medication was more relevant amongst US participants. CONCLUSION Content validity of the ADAQ© was confirmed in demographically and clinically diverse participants. Psychometric properties of the ADAQ© will be explored in future studies.
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Affiliation(s)
- Sarah Bentley
- Patient-Centered Outcomes, Adelphi Values, Bollington, Cheshire, UK
| | - Lucy Morgan
- Patient-Centered Outcomes, Adelphi Values, Bollington, Cheshire, UK
| | - Elizabeth Exall
- Patient-Centered Outcomes, Adelphi Values, Bollington, Cheshire, UK
| | - Rob Arbuckle
- Patient-Centered Outcomes, Adelphi Values, Bollington, Cheshire, UK
- Correspondence: Rob Arbuckle, Patient-Centered Outcomes, Adelphi Values, Bollington, Cheshire, UK, Tel +44 7720 880884, Email
| | - Rebecca C Rossom
- HealthPartners Institute, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Nicholas Roche
- Respiratory Medicine, Cochin Hospital, APHP Centre University Paris Cité, Institut Cochin (UMR1016), Paris, France
| | - Kamlesh Khunti
- Diabetes Research Centre, Leicester University, Leicester, UK
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Kneavel M, Ernst W. Cognitions That Support Concussion Reporting in Collegiate Athletes: An Analysis of a Worksheet Activity. HEALTH EDUCATION & BEHAVIOR 2021; 49:548-559. [PMID: 34636271 DOI: 10.1177/10901981211046535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Sports related concussions continue to be a public health concern and improving reporting behavior a focus of educational programs. While educational programs have addressed changes in knowledge of concussion symptoms, it has been challenging to design educational programs which have lasting effects on reporting behavior. AIMS The current analysis describes an intervention in which thoughts about reporting behavior are actively written down in a worksheet exercise to "pre-arm" athletes with cognitions designed to enhance reporting behavior prior to the injury event. METHOD A total of 503 male and female college athletes participating in collision (football, field hockey, ice hockey, lacrosse, and soccer) and contact sports (baseball, basketball, and softball) from 7 colleges/universities competing across all three NCAA divisions provided data collected during a randomized trial of a peer concussion education program. RESULTS Qualitative analysis revealed 10 themes that would improve reporting including short-term benefits, faster recover, safe and healthy return to play, reporting helps the team, reporting protects the brain, risk aversion, long-term benefits, coach will be supportive, teammates will be supportive and understanding, and academic performance will be affected. DISCUSSION Athletes had awareness of key risks involved in concussions and understood both short- and long-term consequences. CONCLUSION These findings have important implications for understanding how to change athletes' thoughts about reporting concussions.
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Affiliation(s)
- Meredith Kneavel
- Department of Urban Public Health and Nutrtion, La Salle University, Philadelphia, PA, USA.,Center for Concussion Education and Research, Chestnut Hill College, Philadelphia, PA, USA
| | - William Ernst
- Department of Professional Psychology, Chestnut Hill College, Philadelphia, PA, USA.,Center for Concussion Education and Research, Chestnut Hill College, Philadelphia, PA, USA
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Whiteley LB, Olsen EM, Haubrick KK, Odoom E, Tarantino N, Brown LK. A Review of Interventions to Enhance HIV Medication Adherence. Curr HIV/AIDS Rep 2021; 18:443-457. [PMID: 34152554 DOI: 10.1007/s11904-021-00568-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2021] [Indexed: 01/01/2023]
Abstract
PURPOSE OF REVIEW Adherence to antiretroviral treatment (ART) is crucial for the successful treatment of HIV. Unfortunately, it is estimated that 45% of persons living with HIV (PLWH) have poor adherence to ART. To provide health care professionals and PLWH with effective tools for supporting adherence, researchers have investigated the effectiveness of psychosocial interventions to enhance adherence to ART. In this paper, interventional studies, systematic reviews, and meta-analyses that examine ART adherence interventions for PLWH are reviewed. RECENT FINDINGS There is great variability among interventions in terms of quality, sample, measures, and outcome characteristics. Despite a diverse and wide-ranging assortment of ART adherence interventions, consistent lessons have been learned. Interventions that focus on individual and interpersonal factors have been effective for improving ART adherence; however, the improvement in adherence tends to be short-lived. Additionally, interventions are most successful when tailored to those at risk for poor adherence. Finally, theory-based interventions are more likely to be effective than non-theory-based interventions. A variety of individual-level psychological interventions have been shown to be effective in improving ART adherence in the short term. Digital and mobile interventions have the potential to improve dissemination and implementation of these evidence-based interventions and could be used to extend intervention effects. Future interventions that address issues of accessibility, inequality, structural and institutional barriers to ART adherence should also be tested and prioritized. Implementation science frameworks can be used to assess and address issues of accessibility and systematic barriers to care.
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Affiliation(s)
- Laura B Whiteley
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
| | - Elizabeth M Olsen
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Kayla K Haubrick
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
| | - Enyonam Odoom
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
| | | | - Larry K Brown
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
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HIV diagnosis period influences ART initiation: findings from a prospective cohort study in China. AIDS Res Ther 2021; 18:59. [PMID: 34503542 PMCID: PMC8428057 DOI: 10.1186/s12981-021-00379-3] [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: 11/21/2020] [Accepted: 08/11/2021] [Indexed: 11/29/2022] Open
Abstract
Background We estimated the predictive effects of ART-related perceptions on the actual ART uptake behavior among ART naïve PLWH stratified by different time of HIV diagnosis under the new strategy. Methods A prospective cohort study was conducted among ART naïve PLWH in Guangzhou, China from June 2016 to June 2017. Cox regression model was used to evaluate the predictive effects of ART-related perceptions on ART initiation among PLWH stratified by different timepoint of HIV diagnosis (i.e., before or after the update of the new treatment policy). Results Among 411 participants, 150 and 261 were diagnosed before (pre-scaleup group) and after (post-scaleup group) the implementation of the new strategy, respectively. The ART initiation rate in the post-scaleup group (88.9%) was higher than that in the pre-scaleup group (73.3%) (p < 0.001). A significant difference of mean score was detected in each HBM construct between pre- and post-scaleup groups (p < 0.05). After adjusting for significant background variables, among all participants, only the self-efficacy [adjusted HR (HRa) = 1.23, 95% CI 1.06 to 1.43, p = 0.006], has a predictive effect on ART initiation; in pre-scaleup group, all constructs of HBM-related ART perceptions were predictors of ART initiation (HRa = 0.71 to 1.83, p < 0.05), while in post-scaleup group, no significant difference was found in each construct (p > 0.05). Conclusions The ART initiation rate was high particularly among participants who diagnosed after the new treatment strategy. The important role of the time of HIV diagnosis on ART initiation identified in this study suggested that future implementation interventions may consider to modify the ART-related perceptions for HIV patients who diagnosed before the implementation of the new ART strategy, while expand the accessibility of ART service for those who diagnosed after the implementation of the new strategy.
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Mehta P, Moore SL, Bull S, Kwan BM. Building MedVenture - A mobile health application to improve adolescent medication adherence - Using a multidisciplinary approach and academic-industry collaboration. Digit Health 2021; 7:20552076211019877. [PMID: 34104467 PMCID: PMC8145584 DOI: 10.1177/20552076211019877] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 05/01/2021] [Indexed: 02/05/2023] Open
Abstract
Objective Mobile health (mHealth) tools are increasingly used to support medication adherence yet few have been designed specifically for the pediatric population. This paper describes the development of a medication adherence application (MedVenture) using the integration of patient and healthcare provider input, health behavior theory, and user engagement strategies for adolescents with chronic gastrointestinal disease. Methods MedVenture was created by a multidisciplinary research team consisting of a gastroenterologist, a social health psychologist, software developers, and digital health researchers. Healthcare providers and adolescent patients were interviewed to identify barriers to medication adherence, explore ways that technologies could best support medication adherence for both patients and providers, and determine user requirements and core design features for a digital health tool. Intervention mapping was used to match themes from qualitative content analysis to known efficacious adherence strategies, according to a conceptual framework based on self-determination theory. Iterative design with review by the research team and two rounds of user testing informed the final prototype. Results Three themes were identified from content analysis: 1) lack of routine contributes to nonadherence, 2) adolescents sometimes purposefully forgo medications, and 3) healthcare providers would prefer a tool that promotes patient self-management rather than one that involves patient-provider interaction. These findings, combined with evidence-based adherence and user engagement strategies, resulted in the development of MedVenture – a game-based application to improve planning and habit formation. Conclusions Academic-industry collaboration incorporating stakeholders can facilitate the development of mobile health tools designed specifically for adolescents with chronic disease.
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Affiliation(s)
- Pooja Mehta
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Susan L Moore
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Sheana Bull
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Bethany M Kwan
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA
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Blumrosen C, Desta R, Cavanaugh KL, Laferriere HE, Bruce MA, Norris KC, Griffith DM, Umeukeje EM. Interventions Incorporating Therapeutic Alliance to Improve Hemodialysis Treatment Adherence in Black Patients with End-Stage Kidney Disease (ESKD) in the United States: A Systematic Review. Patient Prefer Adherence 2020; 14:1435-1444. [PMID: 32884245 PMCID: PMC7443008 DOI: 10.2147/ppa.s260684] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/10/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In the US, Blacks with end-stage kidney disease (ESKD) have a four-fold higher prevalence rate of hemodialysis treatment and higher subsequent rates of hemodialysis treatment nonadherence and hospitalization compared to their White peers. Nonadherence to prescribed dialysis therapy is an underestimated life-threatening behavior, because of its association with increased morbidity and mortality. Few studies have specified and systematically evaluated targeted methods of increasing hemodialysis treatment adherence among Black hemodialysis patients with added focus on therapeutic alliance, a rewarding patient-centered relationship between patients and providers, based on common goals and objectives. This review seeks to evaluate the state of the science to determine the salience of a therapeutic alliance for the development of effective interventions positively impacting hemodialysis treatment adherence among Black patients. METHODS Medline (via PubMed), Embase (OvidSP), Cumulative Index of Nursing and Allied Health Literature (CINAHL; EBSCOhost), and PsycInfo (ProQuest) databases were used to search for abstracts with the keywords "dialysis", "therapeutic alliance", and "treatment adherence and compliance", including all underlying index terms and alternative variations of terms, in order to cover the entire scope of the field. Only randomized clinical trials and pre/postintervention studies published in the previous 10 years (2009-2019) and including a proportion of Black patients >25% were included for review. RESULTS Only three intervention studies met these criteria, for a total aggregated sample of 130 - mean age 58.1 years and 53% female. None of these studies was composed exclusively of Black patients (range 62%-91.3%), nor did they present data specifically for Blacks. Despite the lack of robust data informing strategies to improve hemodialysis adherence among Blacks with ESRD, a limited number of intervention studies have reported positive effects on hemodialysis attendance. DISCUSSION/CONCLUSION Further research is warranted to fill this significant gap in our understanding of theoretically based, therapeutic alliance-enhanced, and culturally tailored hemodialysis treatment-adherence interventions among Blacks.
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Affiliation(s)
| | | | - Kerri L Cavanaugh
- Vanderbilt Center for Kidney Disease, Nashville, TN, USA
- Division of Nephrology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Heather E Laferriere
- Eskind Biomedical Library, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Marino A Bruce
- Department of Population Health Science, John D Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS, USA
| | - Keith C Norris
- Division of General Internal Medicine and Health Services Research, UCLA, Los Angeles, CA, USA
| | - Derek M Griffith
- Center for Research on Men’s Health, Vanderbilt University, Nashville, TN, USA
| | - Ebele M Umeukeje
- Vanderbilt Center for Kidney Disease, Nashville, TN, USA
- Division of Nephrology, Vanderbilt University Medical Center, Nashville, TN, USA
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Saghayi M, Greenberg J, O’Grady C, Varno F, Hashmi MA, Bracken B, Matwin S, Lazar SW, Hashmi JA. Brain network topology predicts participant adherence to mental training programs. Netw Neurosci 2020; 4:528-555. [PMID: 32885114 PMCID: PMC7462432 DOI: 10.1162/netn_a_00136] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 03/02/2020] [Indexed: 11/04/2022] Open
Abstract
Adherence determines the success and benefits of mental training (e.g., meditation) programs. It is unclear why some participants engage more actively in programs for mental training than others. Understanding neurobiological factors that predict adherence is necessary for understanding elements of learning and to inform better designs for new learning regimens. Clustering patterns in brain networks have been suggested to predict learning performance, but it is unclear whether these patterns contribute to motivational aspects of learning such as adherence. This study tests whether configurations of brain connections in resting-state fMRI scans can be used to predict adherence to two programs: meditation and creative writing. Results indicate that greater system segregation and clustering predict the number of practice sessions and class participation in both programs at a wide range of network thresholds (corrected p value < 0.05). At a local level, regions in subcortical circuitry such as striatum and accumbens predicted adherence in all subjects. Furthermore, there were also some important distinctions between groups: Adherence to meditation was predicted by connectivity within local network of the anterior insula and default mode network; and in the writing program, adherence was predicted by network neighborhood of frontal and temporal regions. Four machine learning methods were applied to test the robustness of the brain metric for classifying individual capacity for adherence and yielded reasonable accuracy. Overall, these findings underscore the fact that adherence and the ability to perform prescribed exercises is associated with organizational patterns of brain connectivity.
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Affiliation(s)
- Marzie Saghayi
- Department of Anesthesia, Pain Management, and Perioperative Medicine, Dalhousie University, NSHA, Halifax, Canada
| | | | - Christopher O’Grady
- Department of Anesthesia, Pain Management, and Perioperative Medicine, Dalhousie University, NSHA, Halifax, Canada
| | - Farshid Varno
- Faculty of Computer Science, Dalhousie University, Halifax, Canada
| | | | | | - Stan Matwin
- Faculty of Computer Science, Dalhousie University, Halifax, Canada
- Institute of Computer Science, Polish Academy of Sciences, Warsaw, Poland
| | - Sara W. Lazar
- Harvard Medical School, Mass General Hospital, Boston, MA, USA
| | - Javeria Ali Hashmi
- Department of Anesthesia, Pain Management, and Perioperative Medicine, Dalhousie University, NSHA, Halifax, Canada
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Owens C, Hubach RD, Lester JN, Williams D, Voorheis E, Reece M, Dodge B. Assessing determinants of pre-exposure prophylaxis (PrEP) adherence among a sample of rural Midwestern men who have sex with men (MSM). AIDS Care 2020; 32:1581-1588. [PMID: 32338061 DOI: 10.1080/09540121.2020.1757021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Pre-exposure prophylaxis (PrEP) efficacy in preventing HIV among gay, bisexual, and other men who have sex with men (MSM) is dependent upon adherence. Little is known about the PrEP adherence experiences among MSM who live in rural areas of the US. This qualitative study was informed by a modified version of Straussian Grounded Theory. Thirty-four 34 rural Midwestern MSM participated in telephone interviews that assessed their PrEP adherence factors. Overall, participants adhered to the PrEP regimen, ranging from missing none to a couple of doses per month. Participants had high self-efficacy (competence) and self-reliance (autonomy) in taking PrEP daily. Participants incorporated PrEP into their already existing routines. Participants were motivated to adhere to prevent HIV acquisition and be financially responsible. All participants mentioned their PrEP provider discussed the importance of adherence with PrEP's effectiveness, but future patient-provider PrEP adherence communication varied among participants. Future PrEP adherence interventions should address counseling strategies that leverage these constructs to support pill taking. Future research should explore patient-provider conversations surrounding PrEP adherence to inform provider- and patient-level interventions.
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Affiliation(s)
- Christopher Owens
- Center for Sexual Health Promotion, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
| | - Randolph D Hubach
- Center for Rural Health, Center for Health Sciences, Oklahoma State University, Tulsa, OK, USA
| | - Jessica Nina Lester
- Deparmtent of Counseling and Educational Psychology, School of Education, Indiana University, Bloomington, IN, USA
| | - Deana Williams
- Center for Sexual Health Promotion, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
| | - Eva Voorheis
- Center for Sexual Health Promotion, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
| | - Michael Reece
- Department of Social and Public Health, College of Health Sciences and Professions, Ohio University, Athens, OH, USA
| | - Brian Dodge
- Center for Sexual Health Promotion, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
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Kneavel ME, Ernst W, McCarthy KS. Randomized Controlled Trial of a Novel Peer Concussion-Education Program for Collegiate Athletes. J Athl Train 2020; 55:456-468. [PMID: 32298143 DOI: 10.4085/1062-6050-0182.19] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT The National Collegiate Athletic Association and US Department of Defense have called for educational programs to change the culture of concussion reporting, increase reporting behavior, and enhance the safety of players and service members. OBJECTIVE To evaluate the effects of a novel peer concussion-education program (PCEP) in changing knowledge, attitudes, and norms about concussion reporting among collegiate student-athletes and assess program implementation. DESIGN Randomized controlled trial and qualitative analysis of interviews. SETTING National Collegiate Athletic Association athletic teams from randomly selected colleges or universities. PATIENTS OR OTHER PARTICIPANTS A total of 1614 male and female student-athletes from 60 teams at 10 colleges and universities and 8 athletic trainers. INTERVENTION(S) The PCEP intervention trains 2 peer concussion educators to provide 2 education modules to their teammates. Knowledge, attitudes (oneself and teammates), and concussion occurrence or reporting were assessed at baseline, postintervention, and 1 month later. Eight athletic trainers were interviewed about program implementation. RESULTS Compared with the control group, the intervention group showed greater increases occurred postintervention and at 1 month in concussion knowledge (F1,2648 = 51.3, P < .0001), intention to report (oneself, F2,2633 = 82.3, P < .0001; teammates, F2,2624 = 53.9, P < .0001), return-to-play protocol knowledge, (F2,2632 = 28.4, P < .0001), direct subjective norms (oneself, F2,2625 = 51.7, P < .0001; teammates, F2,2644 = 40.6, P < .0001), direct perceived behavioral control (oneself, F2,2628 = 53.7, P < .0001; teammates, F2,2615 = 68.2, P < .0001), and indirect attitudes (oneself, F2,2626 = 47.1, P < .001; teammates, F2,2623 = 40.9, P < .0001). Peer concussion-education program participants discussed concussion more often with a teammate (F1,1396 = 13.96, P < .0001) or athletic staff (F1,1396 = 6.62, P < .001). Qualitative program analysis revealed both positive aspects of the PCEP and areas for improvement. CONCLUSIONS The PCEP showed promise in increasing concussion knowledge, intention to report concussion, reporting a teammate's concussion, and facilitating attitudinal changes that support reporting among student-athletes.
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Affiliation(s)
- Meredith E Kneavel
- School of Nursing and Health Sciences, La Salle University, Philadelphia, PA.,Center for Concussion Education and Research, Chestnut Hill College, Philadelphia, PA
| | - William Ernst
- Center for Concussion Education and Research, Chestnut Hill College, Philadelphia, PA.,Department of Professional Psychology, Chestnut Hill College, Philadelphia, PA
| | - Kevin S McCarthy
- Center for Concussion Education and Research, Chestnut Hill College, Philadelphia, PA
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Ernst W, Kneavel ME. Development of a Peer Education Program to Improve Concussion Knowledge and Reporting in Collegiate Athletes. J Athl Train 2020; 55:448-455. [PMID: 32250640 DOI: 10.4085/1062-6050-212-19] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT A novel peer concussion-education program (PCEP) was developed to enhance concussion knowledge and reporting among collegiate student-athletes. OBJECTIVE To describe the PCEP and its development and implementation. DESIGN Program development consisting of a literature review, focus group, and pilot implementation. SETTING Athletics department at a college participating at the National Collegiate Athletic Association Division II-sanctioned competition level. PATIENTS OR OTHER PARTICIPANTS Fifteen student-athletes from the women's soccer and men's lacrosse teams participated in the focus group. Four peer concussion educators (PCEs) were debriefed after the pilot implementation of the PCEP with the women's soccer and men's lacrosse teams. DATA COLLECTION AND ANALYSIS Focus-group data were analyzed qualitatively. The PCEs were debriefed, and responses were organized into recommendation types. RESULTS The literature review contributed information that supported the development of the PCEP's conceptual model. Focus-group results provided information used to train the PCEs and refine the PCEP's education modules. The pilot implementation and PCE debriefing supplied information used to further revise the education modules, PCE training, and PCEP implementation procedure. CONCLUSIONS The PCEP was developed based on the Theory of Reasoned Action and Planned Behavior and uses a peer-mediated, cognitive-behavioral, and interdisciplinary model to enhance concussion knowledge of and reporting by collegiate student-athletes. After a focus-group discussion and pilot implementation, we revised the PCEP and its education modules and developed an online manual to facilitate broad dissemination.
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The use of discrete choice experiments in adherence research: A new solution to an old problem. Res Social Adm Pharm 2020; 16:1487-1492. [PMID: 32111532 DOI: 10.1016/j.sapharm.2020.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 02/18/2020] [Accepted: 02/19/2020] [Indexed: 11/24/2022]
Abstract
Theory can play an important role in providing the framework, and underpinning the design and implementation of interventions to improve medication adherence. Interventions that are grounded in a theory are relatively more effective in improving medication adherence than interventions which do not have a theoretical support. However, a large body of adherence research does not appear to be linked to any theory or model, which therefore may have resulted in interventions that are either ineffective or not sustainable. Interventions that are based on theory have mainly employed socio-behavioural models to explain, and design interventions to address, the complex phenomenon of adherence. Yet, the effectiveness of these interventions is inconclusive, supporting the argument that socio-behavioural models alone have limited applicability in explaining behaviour associated with medication-taking. An important reason for this limitation may be the complex and dynamic nature of adherence. There is a need to include a wide variety of factors in a model and examine adherence in the context of its three phases (initiation, implementation, and discontinuation). One possible way forward is to also examine medication-taking behaviour from an economic perspective, for example, by using a discrete choice experiment (DCE), which provides a different approach to understanding human behaviour about medication-taking and the complexities of decision-making in adhering to medication. DCEs can help in understanding how patients decide to initiate, continue or discontinue taking medication, factors that influence their decision, and the relative importance of those factors, which can assist researchers to prioritise interventions to improve medication adherence. Integration of multiple theories is needed to examine adherence from multiple perspectives and design interventions that are effective and sustainable. This commentary focusses on the pros and cons of some of the commonly used socio-behavioural models in adherence research and suggests a way forward by incorporating DCEs in adherence research.
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Blinder H, Momoli F, Bokhaut J, Bacal V, Goldberg R, Radhakrishnan D, Katz SL. Predictors of adherence to positive airway pressure therapy in children: a systematic review and meta-analysis. Sleep Med 2020; 69:19-33. [PMID: 32045851 DOI: 10.1016/j.sleep.2019.12.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 12/20/2019] [Accepted: 12/21/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND While positive airway pressure (PAP) is effective for treating sleep-disordered breathing (SDB) in children, adherence is poor. Studies evaluating predictors of PAP adherence have inconsistent findings, and no rigorous reviews have been conducted. This systematic review aims to summarize the literature on predictors of PAP therapy adherence in children. METHODS Studies evaluating baseline predictors of PAP therapy adherence in children (≤20 years) with SDB were included. We searched MEDLINE, Embase, CENTRAL, CINAHL, Clinicaltrials.gov, and the last four years of conference abstracts. Results were described narratively, with random-effects meta-analyses performed where feasible. Risk of bias and confidence in the evidence were assessed. RESULTS We identified 50 factors evaluated across 28 studies (21 full text articles, seven abstracts). The highest rates of PAP therapy adherence were most consistently found with female sex, younger age, Caucasian race, higher maternal education, greater baseline apnea-hypopnea index (AHI), and presence of developmental delay. Pooled estimates included odds ratios of 1.48 (95%CI: 0.75-2.93) favoring female sex, 1.26 (95%CI: 0.68-2.36) favoring Caucasian race, and a mean difference in AHI of 4.32 (95%CI: -0.61-9.26) events/hour between adherent and non-adherent groups. There was low quality evidence to suggest that psychosocial factors like health cognitions and family environment may predict adherence. CONCLUSION In this novel systematic review, we identified several factors associated with increased odds of PAP therapy adherence in children. These findings may help guide clinicians to identify and support children less likely to adhere to PAP therapy and should be considered when developing interventions to improve adherence.
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Affiliation(s)
- Henrietta Blinder
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, K1H 5B2, Canada; School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada.
| | - Franco Momoli
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, K1H 5B2, Canada; School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada.
| | - Julia Bokhaut
- Division of Respirology, Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, Ontario, K1H 8L1, Canada.
| | - Vanessa Bacal
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada; Department of Obstetrics and Gynecology, University of Ottawa, 451 Smyth Rd, Ottawa, Ontario, K1H 8L1, Canada.
| | - Reuben Goldberg
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, K1H 5B2, Canada; Department of Family Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, Ontario, K1H 8L1, Canada.
| | - Dhenuka Radhakrishnan
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, K1H 5B2, Canada; Division of Respirology, Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, Ontario, K1H 8L1, Canada; Department of Pediatrics, University of Ottawa, 451 Smyth Rd, Ottawa, Ontario, K1H 8L1, Canada; ICES uOttawa, Ottawa Hospital - Civic Campus, 1053 Carling Ave, Ottawa, Ontario, K1Y 4E9, Canada.
| | - Sherri L Katz
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, K1H 5B2, Canada; Division of Respirology, Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, Ontario, K1H 8L1, Canada; Department of Pediatrics, University of Ottawa, 451 Smyth Rd, Ottawa, Ontario, K1H 8L1, Canada.
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Golaghaie F, Esmaeili-Kalantari S, Sarzaeem M, Rafiei F. Adherence to lifestyle changes after coronary artery bypass graft: Outcome of preoperative peer education. PATIENT EDUCATION AND COUNSELING 2019; 102:2231-2237. [PMID: 31337518 DOI: 10.1016/j.pec.2019.07.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 06/19/2019] [Accepted: 07/15/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE This study was done to investigate the effect of preoperative peer education on patients' adherence to medication and lifestyle changes after Coronary Artery Bypass Graft (CABG). METHODS In this randomized clinical trial, the peers of CABG patients conducted preoperative educational sessions at the ward in groups of 4-5 (n = 36) while the control group (n = 34) received routine education by a nurse. Adherence of both groups to medication and recommendations for lifestyle modification including physical activity, smoking, and diet was measured one and two months after discharge. RESULTS A multivariate analysis of co-variance showed the significant effect of peer education on adherence (F = 32.586, p < 0.001; η2 = 0.671). Univariate ANCOVA revealed a significant difference in adherence to diet between the two groups (F = 62.316, p = 0 0.0001; η2 = 0.482). Based on the repeated measures ANOVA, peer education significantly improved the CABG patients' adherence to diet (F = 55.373, p = 0.0001) and their total adherence (F = 9.911, p = 0.002) compared to the control group. CONCLUSION Preoperative peer education had a significant effect on improving CABG patients' adherence to lifestyle changes after hospital discharge. PRACTICE IMPLICATION Peer education can be used as an effective method to improve the CABG patients ' adherence to lifestyle changes.
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Affiliation(s)
- Farzaneh Golaghaie
- Department of Community Health Nursing, Arak University of Medical Sciences, Arak, Iran.
| | | | - Mahmoodreza Sarzaeem
- Department of Cardiovascular Surgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Rafiei
- Department of Biostatistics & Epidemiology, School of health, Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Ayele BH, Mengesha MM, Tesfa T. Predictors of self-care activities of outpatient diabetic residents in Harar and Dire Dawa: A hospital-based cross-sectional study. SAGE Open Med 2019; 7:2050312119865646. [PMID: 31384462 PMCID: PMC6647214 DOI: 10.1177/2050312119865646] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 07/01/2019] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Diabetes mellitus is a metabolic disorder of major public health importance due to its prevalence and potential health complication. The success of long-term maintenance therapy of diabetes patients depends largely on their ability to adherence to self-care practices. Africa's most populous country, Ethiopia, has the highest burden of diabetes mellitus. However, studies on self-care activities of diabetic patients are limited. Therefore, this study measures the level of self-care activities of diabetic patients in a follow-up clinic of public hospitals in Harar and Dire Dawa, Eastern Ethiopia. METHODS A hospital-based cross-sectional study was conducted on 320 randomly selected diabetic patients in Harar and Dire Dawa. A standard diabetic self-care activity interview tool was used to collect the data. Data were entered into Epi-data v 3.1 and STATA v 14.2 was used for analysis. Our outcome variable, self-care activities, has three ordered categories and a robust Ordinal logistic regression was used to identify predictors. All statistical tests with p-value <0.05 were considered as statistically significant. RESULTS The self-care activities of study participants were rated good for 38.1% (95% confidence interval: 32.94, 43.60). Being rural residents (adjusted odds ratio = 0.38, 95% confidence interval: 0.17, 0.82), attended secondary education (adjusted odds ratio = 2.96, 95% confidence interval: 1.51, 5.78), uncontrolled blood glucose (adjusted odds ratio = 1.68, 95% confidence interval: 1.02, 2.79), and had diabetic complications (one, adjusted odds ratio = 1.91, 95% confidence interval: 1.08, 3.38; two or more, adjusted odds ratio = 4.71, 95% confidence interval: 1.81, 12.25) were significantly associated with the better diabetes mellitus self-care activities. CONCLUSION Significant number of diabetes mellitus patients living in rural areas did not adhere to diabetic self-care activities. This is more evident among participants who have limited or no formal education and patients with controlled blood glucose level. Therefore, individualized diabetic lifestyle education programs in follow-up clinics should target these population groups to improve self-care.
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Affiliation(s)
- Behailu Hawulte Ayele
- Public Health and Policy Unit, School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Melkamu Merid Mengesha
- Epidemiology and Biostatistics Unit, School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tewodros Tesfa
- Department of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Prakash J, Yadav YK, Srivastava K, Madhusudan T. Psychosocial correlates of medication adherence in patients with depressive illness. Ind Psychiatry J 2019; 28:135-140. [PMID: 31879460 PMCID: PMC6929225 DOI: 10.4103/ipj.ipj_78_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 11/04/2019] [Accepted: 11/13/2019] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Nonadherence to medication is common in depressive illness and the same may lead to increased risk of relapse, morbidity, burden of care, and avoidable health cost. Factors which may cause nonadherence are multiple. METHODOLOGY A study was undertaken to appreciate the role of various psychosocial factors in adherence to various antidepressant medication in the patients of depressive disorder. One hundred and fifty patients after due consent were subjected to medico-psychosocial-structured per forma, Beck's Depression Inventory, The Belief About Medicines Questionnaire, and the Morisky Medication Adherence Scale. RESULTS Nonadherence to antidepressant medication in our study was 73.33%. Characteristics of the disease, disease therapies, patient-associated aspects including beliefs, and social and economic support did affect medication adherence. CONCLUSION Nonadherence to medication was common in patients with depressive illness. Finding emphasizes the need to sensitize the patients about the importance of proper adherence.
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Affiliation(s)
- Jyoti Prakash
- Department of Psychiatry, Armed Forces Medical College, Pune, Maharashtra, India
| | - Y K Yadav
- Department of Psychiatry, Command Hospital, Kolkata, West Bengal, India
| | - Kalpana Srivastava
- Department of Psychiatry, Armed Forces Medical College, Pune, Maharashtra, India
| | - T Madhusudan
- Department of Psychiatry, Command Hospital, Lucknow, Uttar Pradesh, India
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Appalasamy JR, Joseph JP, Seeta Ramaiah S, Quek KF, Md Zain AZ, Tha KK. Exploring stroke survivors' self-efficacy in understanding and taking medication and determining associated factors: a cross-sectional study in a neurology clinic in Malaysia. Patient Prefer Adherence 2019; 13:1463-1475. [PMID: 31695338 PMCID: PMC6717850 DOI: 10.2147/ppa.s215271] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 07/20/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND AND AIM Evidence-based prescribing practices for stroke-preventive medication have benefited stroke survivors; however, medication-nonadherence rates remain high. Medication understanding and use self-efficacy (MUSE) has shown great importance in medication-taking behavior, but its relationship with medication nonadherence in stroke-preventive regimens lacks exploration. The aim of this study was to determine the prevalence of MUSE and its association with nonadherence causes and other potential factors among stroke survivors in Malaysia. METHODS This cross-sectional study was conducted among 282 stroke patients who provided informed consent and were in follow-up at the Neurology Outpatient Department of Hospital Kuala Lumpur, Malaysia. The study employed a data-collection form that gathered information on sociodemographics, clinical treatment, outcome measures on MUSE, and medication-nonadherence reasons. RESULTS The prevalence of poor medication understanding and use self-efficacy among stroke patients was 46.5%, of which 29.1% had poor "learning about medication" self-efficacy, while 36.2% lacked self-efficacy in taking medication. Beliefs about medicine (74.02%) was the commonest reason for medication nonadherence, followed by medication-management issues (44.8%). In the multivariate model, independent variables significantly associated with MUSE were health literacy (AOR 0.2, 95% CI 0.069-0.581; P=0.003), medication-management issues (AOR 0.073, 95% CI 0.020-0.266; P<0.001), multiple-medication issues (AOR 0.28, 95% CI 0.085-0.925; P=0.037), beliefs about medicine (AOR 0.131, 95% CI 0.032-0.542; P=0.005), and forgetfulness/convenience issues (AOR 0.173, 95% CI 0.050-0.600; P=0.006). CONCLUSION The relatively poor learning about medication and medication-taking self-efficacy in this study was highly associated with health literacy and modifiable behavioral issues related to nonadherence, such as medication management, beliefs about medicine, and forgetfulness/convenience. Further research ought to explore these underlying reasons using vigorous techniques to enhance medication understanding and use self-efficacy among stroke survivors to determine cause-effect relationships.
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Affiliation(s)
- Jamuna Rani Appalasamy
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
- Correspondence: Jamuna Rani AppalasamyJeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, Selangor47500, MalaysiaTel +60 12 325 3775Email
| | - Joyce Pauline Joseph
- Department of Neurology, Hospital Kuala Lumpur, Ministry of Health, Kuala Lumpur, Malaysia
| | | | - Kia Fatt Quek
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Anuar Zaini Md Zain
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Kyi Kyi Tha
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
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