Determinants of medication adherence among hypertensive patients using the Pender's health promotion model

Predictors of treatment adherence in patients with type 2 diabetes: a cross-sectional study in Southern Iran based on Pender's Health Promotion Model using structural equation modelling

OBJECTIVES

Treatment adherence in type 2 diabetes (T2D) is an important factor in optimal diabetes control and prevention of mortality. The present study aimed to determine the predictability of Pender's Health Promotion Model (HPM) constructs in T2D treatment adherence behaviour.

DESIGN

The present cross-sectional and analytical study was conducted from November 2022 to January 2023.

SETTING

The present study was conducted in Bandar Abbas, a city in Hormozgan Province, in the south of Iran.

PARTICIPANTS

The participants included 396 patients with T2D with medical records in the Hormoz Diabetes Clinic. Based on their record number, the participants were selected for inclusion in the study through a random systematic sampling.

PRIMARY AND SECONDARY OUTCOME MEASURES

The data collection instruments included a demographic questionnaire and a researcher-made questionnaire based on HPM constructs. The questionnaire was valid and reliable, achieving Cronbach's alpha coefficients ranging from 0.609 to 0.798 across various constructs. The questionnaires were completed face to face. Pearson's correlation test, path analysis and structural equation modelling were conducted using SPSS V.23, and STATA V.15.

STUDY STAGE

This study was conducted before intervention (pre-results).

RESULTS

As the path analysis showed, perceived self-efficacy (β=0.23, p<0.001), treatment adherence experiences (β=0.26, p<0.001), immediate competing demands and preferences (β=-0.15, p<0.001) and commitment to plan of action (β=0.24, p<0.001) could significantly predict the treatment adherence behaviour. The results of indirect path analysis showed that the total effect of perceived benefits (β=0.24, p<0.001), perceived barriers (β=-0.14, p=0.002), perceived self-efficacy (β=0.32, p<0.001) on commitment to plan of action was statistically significant. Through the mediation of commitment to plan of action, they could predict the treatment adherence behaviour.

CONCLUSIONS

In light of the present findings, it can be concluded that the proposed model of T2D treatment adherence behaviour has an acceptable fit. Commitment to plan of action, treatment adherence experiences, perceived self-efficacy and immediate competing demands and preferences are the main predictors of T2D treatment adherence behaviour. It is recommended that educational interventions focus on these constructs.

TRIAL REGISTRATION NUMBER

This study is registered on the Iranian Registry of Clinical Trials (IRCT20211228053558N1).

A health promotion model-based intervention to enhance treatment adherence in patients with type 2 diabetes

BACKGROUND

The present study aimed to determine the effect of an intervention based on Pender's health promotion model (HPM) on treatment adherence in patients with type 2 diabetes (T2D).

METHODS

The present quasi-experimental study with a 3-month follow-up was conducted in Bandar Abbas, a city in the south of Iran in 2023. The intervention group (IG) with a total number of 95 T2D patients was selected from Hormuz diabetes clinic and the control group (CG) with 95 T2D patients was selected from comprehensive health centers through a clustering sampling method. The educational intervention was implemented in 10 sessions to improve patients' treatment adherence. The teaching methods in training sessions were lectures, joint discussions, Q&A, role-play and peer training. The participants were evaluated using a researcher-made questionnaire including the constructs of Pender's HPM about T2D treatment adherence, hemoglobin A1C (HbA1C), and BMI. Independent-samples t-test, paired-samples t-test, covariance analysis and stepwise regression analysis were used. Data analysis was done in SPSS 26.

FINDINGS

Three months after the intervention, in comparison to the CG, the mean and standard deviation of treatment adherence benefits (p = 0.002), treatment adherence self-efficacy (p = 0.010), treatment adherence related affect (p = 0.001), interpersonal influences (p = 0.012), commitment to plan of action (p < 0.001), treatment adherence behavior (p = 0.022), treatment adherence experiences (p = 0.001) was higher in the IG. The mean and standard deviation of situational influences (p < 0.001), immediate competing demands and preferences (p = 0.018) were lower than the CG. The results obtained from the analysis of covariance proved the effectiveness of the intervention in the constructs of Pender's HPM and HbA1C in participants of the IG (p < 0.001). The regression analysis showed, after the intervention, for every 1 unit of change in commitment to behavior planning, action related affect and perceived self-efficacy, compared to before the intervention, there were 0.22 units, 0.16 units and 0.26 units of change in the behavior score in the IG.

CONCLUSION

The findings proved the effectiveness of the educational intervention in improving the constructs in Pender's HPM and the blood sugar level of T2D patients. As the results of the educational intervention showed, the use of a suitable educational approach as well as the development of appropriate educational content for the target population can significantly improve the treatment adherence behavior.

TRIAL REGISTRATION

This study is registered on the Iranian Registry of Clinical Trials (IRCT20211228053558N1: https://www.irct.ir/trial/61741 ) and first release date of 17th March 2022.

Factors associated with medication adherence among older adults with multimorbidity: A culture perspective

Multimorbidity is a healthcare concern. To manage diseases, older adults with multimorbidity are expected to practice health behaviors, particularly medication adherence. Studies have examined adherence issues in older patients with multiple diseases, but it remains unclear which factors affect medication adherence. Therefore, this study aimed to identify the factors affecting medication adherence among older adults with multimorbidity. The participants were recruited from the outpatient departments of two hospitals in the Republic of Korea using convenience sampling. Data were collected using structured questionnaires and analyzed using multiple regression analysis. The results showed that those with a lower education level, no side effects, better health literacy, higher medication self-efficacy, and more social support exhibited better medication adherence. In addition, beliefs about medication were not related to medication adherence. These results suggest that providing individualized education, strengthening social support, and decreasing harmful side effects can improve medication adherence.

Factors related to medication adherence in patients with hypertension in Iran: a systematic review study

OBJECTIVES

This study aimed to review the available studies of the factors in Iranian hypertensive patients' adherence to drug treatment.

METHODS

Four Persian databases and seven English databases were searched. The articles, which were published from 2000 to 2022 in Persian and English and examined the adherence to drug treatment in the Iranian population of adults with high blood pressure, were reviewed. Based on the primary examination, 31 of the initial 1062 articles met the inclusion criteria and were included in the analysis. The evidence, which was provided by the examined articles, was summarized and discussed using the 5-dimensional framework of adherence to long-term treatments, which was developed by WHO.

RESULTS

The factors that significantly correlated with adherence to drug treatment in the examined studies were: (1) factors that were related to the health team or the health system: patients' satisfaction with their doctor-patient relationship; (2) factors that were related to the conditions: the number of concomitant diseases, high quality of life and the implementation of effective interventions; (3) factors which were related to the treatment: long duration of illness, short intervals between the visits, duration of treatment, lower numbers of drugs, and the patient's blood pressure control; and (4) factors that were related to the patient: self-efficacy, health literacy, social support, locus of control, illness perception, beliefs, attitude, knowledge, and cues to action.

CONCLUSION

It is possible to draw definite conclusions about the factors which affect adherence to drug treatment in patients with high blood pressure because most of the relevant studies have been cross-sectional. Therefore, in the future, valuable results can be obtained by conducting more studies that preferably use objective instruments for assessing adherence to drug treatment.

Factors Influencing Medication Adherence in Elderly Patients with Hypertension: A Single Center Study in Western China

Purpose

To develop and empirically test a conceptual model that explains the factors influencing antihypertensive medication adherence behavior in elderly patients in a city in western China.

Patients and Methods

The conceptual model was based on the Theory of Planned Behavior and the Health Belief Model and was empirically tested using cross-sectional survey data from Nanchong City, a city in western China, collected between October and December 2020. Data were analyzed using structural equation modeling.

Results

Behavioral intentions were the main predictor of medication adherence behavior (path coefficient of 0.353). Perceived benefits and perceived barriers directly (path coefficient = 0.201 and -0.150, respectively), and indirectly (path coefficient = 0.118 and -0.060) through behavioral intentions, influenced medication adherence behavior. Perceived susceptibility (path coefficient = 0.390) and perceived severity (path coefficient = 0.408) influenced behavioral attitudes, which influenced behavioral intentions (path coefficient = 0.298).

Conclusion

The conceptual model demonstrates a robust ability to predict and explain medication adherence behavior among elderly patients with hypertension, facilitating the adoption and maintenance of changes in adherence behavior and the potential for preventing disease progression and improving quality of life.

Clinically ill patients' experiences of early mobilisation after liver transplantation: a qualitative study using Pender's health promotion model

The aim of this study is to explore the factors influencing early mobilisation behaviours and patients' needs in critically ill patients after liver transplantation (LT). This interview study used phenomenological research, and Pender's health promotion model (HPM) was used to construct the interview guide. With the use of purposeful sampling, a total of 19 critically ill patients who experienced early mobilisation after LT were recruited at three tertiary hospitals in Beijing from August to November 2022. Data were collected through semi-structured interviews and analysed using Colaizzi's seven-step method. Nine themes were categorised into the three domains of Pender's HPM. The first domain was individual characteristics and experiences: (1) symptoms of end-stage liver disease limiting premobility behaviours and (2) previous treatment experience affecting understanding of early mobilisation after LT. The second domain was behaviour-specific cognition and affect: (3) coexistence of benefits and concerns in early mobilisation after LT, (4) barriers to early mobilisation after LT, (5) high self-efficacy in early mobilisation after LT, (6) individual differences in early mobilisation and (7) support and encouragement from family, wardmates and medical staff. The final domain was behavioural outcomes: (8) the need for sufficient staff, a quiet environment, safety, goals, guidance and family participation and (9) a strong willingness to comply with early mobilisation plans. The three areas and nine themes extracted in this study are helpful for the long-term development of early mobilisation in patients after LT.

Factors related to treatment adherence behaviors among old-age hemodialysis patients in Hamadan, Iran: the application of the extended theory of planned behavior during Covid-19 pandemic

Purpose

This study aimed to identify the factors related to treatment adherence behaviors among old-age hemodialysis patients in Hamadan based on the Extended Theory of Planned Behavior (ETPB) during the covid-19 pandemic.

Methods

This cross-sectional study was conducted from January to March 2021 in Hamadan, Iran. 191 hemodialysis patients were recruited who were referred to hemodialysis centers via the census method. Data were collected by a questionnaire containing items on socio-demographic information, End-Stage Renal Disease Adherence (ESRD-Adherence) Questionnaire, and ETPB constructs scale. Data analysis was performed using descriptive statistics and structural equation modeling.

Results

The mean (SD) age of participants was 62.49 (10.66). Also, the mean (SD) hemodialysis vintage/Month of them was 36.56 (43.34). Moreover, Treatment Adherence Behaviors are associated with education level, sex, and marital status (p < 0.001). Besides, Perceive Behavior Control (β = 0.414, t-value = 3.810) associated with intention. Also, intention (β = 0.158, t-value = 1.976) was associated to adherence behaviors. No significant associations were observed between positive attitudes, subjective norms, a perceived threat with intention, and adherence behaviors. The model explained about 54% of the variance of adherence behaviors. Finally, the goodness of fit index of 0.78, indicating the model good fit.

Conclusion

The present study demonstrates that some of the ETPB constructs such as perceived behavior control and intention are useful to improve adherence among the oldest hemodialysis patients. Also. This framework is revealed alongside the theory of planned behavior (TPB) applicable in the treatment adherence of old-age hemodialysis patients.

Treatment adherence of COVID-19 patients getting medication at home

Introduction: Turkey has adopted outpatient treatment of COVID-19 since the beginning of the pandemic. In the outpatient treatment of COVID-19 in Turkey, only hydroxychloroquine was initially used, favipiravir was added to the treatment, and finally, hydroxychloroquine was removed from the treatment and only favipiravir was used. Our study aims to examine the adherence to the recommended treatment of people diagnosed with COVID-19 who have received outpatient treatment without hospitalization and their attitudes and declared behaviors towards using the medications they were given free of charge. Methods: This follow-up study was conducted between February 15, 2021, and May 15, 2021, by telephone survey method in the Lüleburgaz District of Kırklareli City. The study participants were 4368 people who were diagnosed with COVID-19 with a positive PCR test in Lüleburgaz District between February 15 and May 15, 2021, and were given hydroxychloroquine and/or favipiravir drugs for home use after being deemed suitable for outpatient treatment according to the guidelines of the Republic of Turkey Ministry of Health. Results: 88.1% (n = 3849) of the survey respondents reported using the given medications regularly, while 11.9% (n = 519) did not use them regularly. The most important socio demographic factor affecting the regular use was age, and the patient-centered factor was the sense of trust. Conclusion: In the fight against COVID-19, measures to increase the sense of trust of patients who are expected to adhere to the treatments should be considered a priority.

Causes of nonadherence to treatment in people with myocardial infarction: Content analysis

BACKGROUND

Nonadherence with the medication regimen in patients with heart disease can lead to treatment failure. The purpose of this study was to identify the causes of nonadherence in people with myocardial infarction.

MATERIALS AND METHODS

This study is a qualitative conventional content analysis. Data were collected through semistructured interviews. Thirteen individual interviews and a focus group were conducted with nurses, patients, and doctors. Data were analyzed using conventional content analysis.

RESULTS

Four main themes were identified, which are organizational-managerial causes and factors (drug-related problems, educational system-related problems, weak performance of hospitals, and problems related to insurance companies); sociocultural causes and factors (factors related to cultural problems and factors related to social problems); causes and factors related to care providers (skill problems of care providers and functional problems of care providers); and causes and factors associated with caregivers (factors related to social characteristics of the patient, factors related to patient characteristics, and factors related to the patient's belief).

CONCLUSIONS

Many individual and organizational factors affect nonadherence, which can be reduced by fundamental changes.

Telemedicine Services in Chronic Obstructive Pulmonary Disease: A Systematic Review of Patients' Adherence

BACKGROUND

The current systematic review aimed to determine the effect of telemedicine services on adherence in patients with chronic obstructive pulmonary disease (COPD) and to describe the type of adherence and applied devices and modules.

MATERIALS AND METHODS

We reviewed PubMed, Scopus, Web of Science, and Embase databases to identify relevant studies from the time of inception of these databases to March 10, 2019, using three groups of keywords. The first group comprised words describing COPD, the second group included words describing types of telemedicine interventions, and the third group contained words describing adherence. The reference list of identified articles was also hand-searched to retrieve possibly relevant articles.

RESULTS

In total 21 articles were included, in which 13 reported a positive effect for telemedicine on patients' adherence. Adherence to treatment was classified under six categories. The highest frequency belongs to the adherence to performing exercises and participation in training sessions, using the system, using devices, measuring (like blood pressure, oxygen saturation, heart rate, weight, temperature, sputum volume) and reporting symptoms and the results of measurements, completing tasks, and medication.

CONCLUSION

This study demonstrated the effectiveness of telemedicine services on adherence to treatment plans in patients with COPD. The following factors contribute to the effectiveness of telemedicine services: patient support by healthcare professionals and easy access to them, uninterrupted execution of telemedicine programs, follow-up and supervision of providers, creating and maintaining motivation in patients, and provision of different self-management modules.