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Bayraktar I, Yalcin N, Nalbant K, Karabulut E, Kultur EC, Demirkan K. Advancing patient care: novel scales for assessing adherence and attitudes toward medication among adolescents with psychiatric disorders and their parents. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02537-0. [PMID: 39066923 DOI: 10.1007/s00787-024-02537-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/13/2024] [Indexed: 07/30/2024]
Abstract
Adolescents with psychiatric disorders may struggle with medication adherence and this can lead to ineffective treatment. Subjective factors, such as attitudes, beliefs, experiences, have a greater impact on adherence in adolescents than objective factors. To better understand these subjective attitudes, self-evaluation rating scales should be developed. The study aimed to develop two scales - Pediatric Medication Adherence Scale (PMAS) and Pediatric Attitudes toward Medication Scale (PAMS) - to assess adherence and attitudes toward medication for pediatric patients and their parents. Total of 288 pediatric patients (67% female) between the ages of 12-18 (mean [standard deviation] age of 15.25 [1.59] years) with psychiatric disorders and 255 parents (83.53% mothers) were administered the scales. The validity of the scales was evaluated through the content validity index and explanatory factor analyses. To evaluate reliability, Cronbach's alpha, and test-retest methods were utilized. The validity and reliability of the PMAS (9 questions for patients, 6 questions for parents) and PAMS (18 questions for patients, 20 questions for parents), Cronbach's alpha values and intraclass correlation coefficients were found above 0.7 for each scale and showed well establishment for this particular population. Analysis revealed that anxiety scores had a greater impact on total attitude scores than necessity scores (p < 0.05). Parent and patient adherence scores were similar, and negative parental attitudes toward medication were associated with lower patient adherence. The present study represents a novel attempt to design a medication adherence and attitude questionnaire for adolescents with psychiatric disorders, along with a parental version.
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Affiliation(s)
- Izgi Bayraktar
- Faculty of Pharmacy, Department of Clinical Pharmacy, Hacettepe University, Ankara, Türkiye.
| | - Nadir Yalcin
- Faculty of Pharmacy, Department of Clinical Pharmacy, Hacettepe University, Ankara, Türkiye
| | - Kevser Nalbant
- Faculty of Medicine, Department of Child and Adolescent Psychiatry, Hacettepe University, Ankara, Türkiye
| | - Erdem Karabulut
- Faculty of Medicine, Department of Biostatistics, Hacettepe University, Ankara, Türkiye
| | - Ebru Cengel Kultur
- Faculty of Medicine, Department of Child and Adolescent Psychiatry, Hacettepe University, Ankara, Türkiye
| | - Kutay Demirkan
- Faculty of Pharmacy, Department of Clinical Pharmacy, Hacettepe University, Ankara, Türkiye
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Exarchos K, Hillas G, Steiropoulos P, Papanastasiou P, Gogali A, Kostikas K. Treatment Adherence and Health Status of Patients With COPD Under Treatment With Salmeterol/Fluticasone via the Elpenhaler® Device: The AHEAD Study. THE CLINICAL RESPIRATORY JOURNAL 2024; 18:e13803. [PMID: 39056534 PMCID: PMC11273290 DOI: 10.1111/crj.13803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 05/06/2024] [Accepted: 06/14/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a heterogeneous progressive lung condition characterized by long-term respiratory symptoms and airflow limitation. Appropriate bronchodilation is the cornerstone of COPD treatment, leading to better health status as well as benefits in prognosis and mortality. METHODS In the current open, noninterventional, observational study, 716 patients diagnosed with COPD of variable severity were administered a fixed-dose combination (FDC) of fluticasone propionate and salmeterol (500 + 50 mcg) through the Elpenhaler® device. The patients' adherence to treatment (based on the MMAS-8 [8-item Morisky Medication Adherence Scale]) and health status (based on the CCQ [Clinical COPD Questionnaire]) were assessed at the beginning of the study and at the end of the 3-month follow-up period. RESULTS The mean ± SD MMAS-8 score at 1 and 3 months was 6.12 ± 1.89 and 6.45 ± 1.80, respectively, indicating medium adherence overall; however, there was a statistically significant increase of 0.33 units in the MMAS-8 score at the end of the follow-up (paired t-test p < 0.0001), suggestive of an improvement in adherence throughout the study. Higher adherence was associated with better health status at baseline, which further improved by the end of the follow-up. Moreover, we observed a statistically significant decrease of 1.07 points (p < 0.0001) in the mean CCQ total score from the baseline (CCQ score = 2.2 ± 1.00) until the end of the study follow-up (CCQ score = 1.13 ± 0.67). Similar conclusions were also drawn in the mean domain scores regarding symptoms (score equal to 1.36 ± 0.72, decrease by 1.18) as well as functional and mental state (scores equal to 0.86 ± 0.73 and 1.20 ± 0.88, decrease by 1.04 and 1.00, respectively, p < 0.0001). Similarly, when patients were stratified into subgroups with and without comorbidities, the former group showed an increase of 7% in the patients with medium to high adherence during the course of the study. In the same patient subgroup, there was a notable decrease in CCQ score by 1.18 points (p < 0.0001) during the study. CONCLUSIONS The administration of FDC of fluticasone propionate and salmeterol, (500 + 50 mcg) via the Elpenhaler® device for COPD, resulted in a well-maintained or slight increase in treatment adherence and a subsequent benefit in health status, which further persisted after 3 months of treatment.
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Affiliation(s)
| | - Georgios Hillas
- 5th Pulmonary Department“Sotiria” Chest Diseases HospitalAthensGreece
| | - Paschalis Steiropoulos
- Department of Respiratory Medicine, Medical SchoolDemocritus University of ThraceAlexandroupolisGreece
| | | | - Athena Gogali
- Respiratory Medicine DepartmentUniversity of Ioannina School of MedicineIoanninaGreece
| | - Konstantinos Kostikas
- Respiratory Medicine DepartmentUniversity of Ioannina School of MedicineIoanninaGreece
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Tirfessa D, Abebe M, Darega J, Aboma M. Dietary practice and associated factors among type 2 diabetic patients attending chronic follow-up in public hospitals, central Ethiopia, 2022. BMC Health Serv Res 2023; 23:1273. [PMID: 37978526 PMCID: PMC10657141 DOI: 10.1186/s12913-023-10293-1] [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: 03/11/2023] [Accepted: 11/07/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Diabetes Mellitus (DM) is affecting numerous Ethiopian populations regardless of environmental and social status. Diabetic people all over the world are commonly urged to acquire a healthy eating habit, which necessitates lifelong changes in food habits, beliefs, and meal patterns. Dietary management is considered one of the cornerstones of diabetes care, as it is an important component of the overall treatment plan. Choosing and following a healthy diet is important for everyone, especially people with diabetes. OBJECTIVE This study aims to assess dietary practices and associated factors among type 2 diabetes patients in the west Shewa Zone, Oromia Regional State, Ethiopia, in 2022. METHODS A hospital-based cross-sectional study design was conducted in West Shewa Zone public hospitals among 421 randomly selected type 2 diabetic patients from February 1 to March 30, 2022. Data were collected using a structured and pre-tested interviewer-administered questionnaire. Descriptive, bivariate, and multivariate binary logistic regression analyses were done using SPSS. RESULTS In this study, about 35.6% (95% CI: 30.9-39.9) of type 2 diabetes patients had good dietary practices. Diabetes knowledge (AOR 9 2; 95% CI 4.4-19.4), food-secured households (AOR 3.3; 95% CI 1.6-6.9), high self-efficacy (AOR 6.6; 95% CI 3.2-13.9), diabetes diet information from healthcare professionals (AOR 2.9; 95% CI 1.3-6.4), complete dietary change (AOR = 2.3; 95% CI 1.1-4.8), and female gender (AOR 3.6; 95% CI 1.6-8.1) were independent predictors of good dietary practice. CONCLUSION The proportion of patients with type 2 diabetes, who attended follow-up at West Shawa Public Hospitals and practiced good dietary habits, was low. Patients' household food insecurity, diabetes knowledge, self-efficacy, source of information on the diabetic diet, complete dietary change after diabetes diagnosis, and gender were all significantly associated with type 2 diabetic patients' dietary practices. Thus, promoting the provision of continuous, modified, and comprehensive education and advice on the importance of diabetes self-management, particularly adherence to dietary recommendations, is fundamental to decreasing the burden of diabetes complications and massive health expenses among diabetic patients.
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Affiliation(s)
- Dureti Tirfessa
- Department of Public Health, Ambo University College of Medicine and Health Sciences, P.O Box 19, Ambo, Ethiopia
| | - Mitsiwat Abebe
- Department of Public Health, Ambo University College of Medicine and Health Sciences, P.O Box 19, Ambo, Ethiopia
| | - Jiregna Darega
- Department of Public Health, Ambo University College of Medicine and Health Sciences, P.O Box 19, Ambo, Ethiopia
| | - Mecha Aboma
- Department of Public Health, Ambo University College of Medicine and Health Sciences, P.O Box 19, Ambo, Ethiopia.
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Dourouka V, Vlastos DD, Theofilou P. Psychotherapy and chronic pain management: a quantitative study evaluating the contribution of psychotherapy to quality of life and treatment compliance in chronic disease patients. HEALTH PSYCHOLOGY REPORT 2023; 12:209-218. [PMID: 39234019 PMCID: PMC11370729 DOI: 10.5114/hpr/171847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 08/02/2023] [Accepted: 09/04/2023] [Indexed: 09/06/2024] Open
Abstract
BACKGROUND The psychology of pain is an important field of study that focuses on understanding the psychological factors associated with pain and developing effective approaches to its management. Pain is a complex sensation that affects a person's physical and mental well-being, and psychological factors can have a significant impact on the perception, response and coping with pain. This research study examines the contribution of psychotherapy in managing chronic pain and improving quality of life and treatment adherence. PARTICIPANTS AND PROCEDURE The sample consisted of 87 participants who completed the McGill Pain Assessment Questionnaire, SF-36 Quality of Life questionnaire, and the Morisky Medication Adherence Scale (MMAS-8) questionnaire. Two groups were created: one group received psychotherapy to manage pain and illness, while the other group either did not receive psychotherapy or had no contact with this therapeutic method. RESULTS The results showed that patients who received psychotherapy had higher scores in the dimensions of mental health, vitality, general health, physical pain, physical functioning, and social functioning compared to patients who did not receive psychotherapy. Statistical analysis confirmed significant differences between the two groups. Additionally, psychotherapy was associated with higher treatment adherence, as indicated by the mean scores of patients receiving psychotherapy compared to those who did not. CONCLUSIONS This suggests that psychotherapy can contribute to increased treatment adherence. The results clearly show that patients who received psychotherapy have significantly higher levels of mental health, vitality, general health and functioning compared to patients who did not receive psychotherapy.
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Affiliation(s)
- Venetia Dourouka
- Department of Psychology, Scientific College of Greece (SCG), Athens, Greece
| | - Dimitris D. Vlastos
- Department of Psychology, Scientific College of Greece (SCG), Athens, Greece
- SCG Lab of Experimental and Applied Psychology, Athens, Greece
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Hlongwana SI, Gray AL. Barriers and facilitators to medicine collection through the CCMDD programme at a Durban Hospital. Health SA 2022; 27:1906. [PMID: 36262925 PMCID: PMC9575334 DOI: 10.4102/hsag.v27i0.1906] [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: 01/07/2022] [Accepted: 06/08/2022] [Indexed: 11/06/2022] Open
Abstract
Background South Africa has rekindled health reform efforts through the implementation of the Centralised Chronic Medicine Dispensing and Distribution (CCMDD) programme, as a precursor towards achieving envisioned National Health Insurance (NHI). The CCMDD programme enables stable patients to collect chronic medicines dispensed centrally from designated pick-up-points (PuPs). Barriers and facilitators of chronic medicine collection exist at different levels. Aim To identify barriers and facilitators associated with patients’ characteristics and noncollection of CCMDD patient medicine parcels (PMPs). Setting The study was conducted at a regional public sector hospital which provides support for 19 primary facilities. Methods An observational cross-sectional comparative study was conducted. Results There was no statistically significant difference in collection status in terms of most of the variables compared. Patients who had been on treatment longer or who were receiving multiple items were more likely to collect medication, as were patients with arthritis, HIV and AIDS, but the association was no longer significant after adjusting for other confounders. Patients using internal PuPs were significantly more likely to collect their PMPs than patients using external PuPs, and this may have implications for achieving CCMDD objectives. Conclusion This study has revealed that recently diagnosed patients are enrolled onto the CCMDD programme whilst the chronic condition stability is not yet attained. Patients were also enrolled onto the programme at the referral facility instead of being down-referred. Contribution This study makes a case for evaluation research to further assess the CCMDD programme implementation, in order to improve uptake and cost-effectiveness.
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Affiliation(s)
- Simangele I. Hlongwana
- Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa,Discipline of Pharmaceutical Sciences, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa,King Edward VIII Hospital, Durban, South Africa
| | - Andrew L. Gray
- Division of Pharmacology, Discipline of Pharmaceutical Sciences, University of KwaZulu-Natal, Durban, South Africa
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Sendekie AK, Netere AK, Kasahun AE, Belachew EA. Medication adherence and its impact on glycemic control in type 2 diabetes mellitus patients with comorbidity: A multicenter cross-sectional study in Northwest Ethiopia. PLoS One 2022; 17:e0274971. [PMID: 36130160 PMCID: PMC9491880 DOI: 10.1371/journal.pone.0274971] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/07/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Medication nonadherence in patients with chronic diseases, particularly in type 2 diabetes mellitus (T2DM) with comorbidity, has continued to be the cause of treatment failure. The current study assessed medication adherence and its impact on glycemic control in T2DM patients with comorbidity. METHODS An institutional-based multicenter cross-sectional study was conducted among T2DM patients with comorbidity at the selected hospitals in Northwest Ethiopia. Medication adherence was measured using a structured questionnaire of the General Medication Adherence Scale (GMAS). A logistic regression model was used to identify predictors of the level of medication adherence and glycemic control. P < 0.05 at 95% confidence interval (CI) was statistically significant. RESULTS A total of 403 samples were included in the final study. This study showed that more than three-fourths (76.9%) of the participants were under a low level of medication adherence. Source of medication cost coverage [AOR = 10.593, 95% CI (2.628-41.835; P = 0.003], monthly income (P < 0.00), self-monitoring of blood glucose (SMBG) practice [AOR = 0.266, 95% CI (0.117-0.604); P = 0.002], number of medications [AOR = 0.068, 95% CI (0.004-0.813); P = 0.014] and medical conditions [AOR = 0.307, 95% CI (0.026-0.437); P = 0.018] were found to be significant predictors of medication adherence. Significantly, majority (74.7%) of participants had poor levels of glycemic control. Patients who had a high level of medication adherence [AOR = 0.003, 95% CI (0.000-0.113); P = 0.002] were found less likely to have poor glycemic control compared with patients who were low adherent to their medications. CONCLUSION The current study concluded that medication adherence was low and significantly associated with poor glycemic control. Number of medical conditions and medications were found to be associated with medication adherence. Management interventions of T2DM patients with comorbidity should focus on the improvement of medication adherence.
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Affiliation(s)
- Ashenafi Kibret Sendekie
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Adeladlew Kassie Netere
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Asmamaw Emagn Kasahun
- Department of Pharmaceutics, School of Pharmacy, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Eyayaw Ashete Belachew
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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Exarchos KP, Rovina N, Krommidas G, Latsios D, Gogali A, Kostikas K. Adherence and quality of life assessment in patients with asthma treatment with budesonide/formoterol via the Elpenhaler device: the COMPLETE study. BMC Pulm Med 2022; 22:254. [PMID: 35761234 PMCID: PMC9238005 DOI: 10.1186/s12890-022-02049-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 06/16/2022] [Indexed: 02/06/2023] Open
Abstract
Background Asthma is a chronic inflammatory disease of the airways that causes recurring episodes of wheezing, breathlessness, chest tightness and coughing. Inhaled drugs on a daily basis are the cornerstone of asthma treatment, therefore, patient adherence is very important. Methods We performed a multicenter, open, non-interventional, observational, prospective study of 716 adult patients diagnosed with asthma receiving FDC (Fixed-dose combination) budesonide/formoterol via the Elpenhaler device. We assessed the adherence to treatment at 3 and 6 months (based on the MMAS-8: 8-item Morisky Medication Adherence Scale), the quality of life and change in forced expiratory volume in 1 s (FEV1) from baseline to follow-up. Results Approximately 80% of the patients showed medium to high adherence throughout the study. The mean (SD) MMAS-8 score at 6 months was 6.85 (1.54) and we observed a statistically significant shift of patients from the low adherence group to the high adherence group at 6 months. Moreover, after 6 months of treatment with FDC budesonide/formoterol, we observed an increase in the patients’ quality of life that as expressed by a change 2.01 (95%CI 1.93–2.10) units in Mini AQLQ (p < 0.0001) that was more pronounced in the high adherence group. The same trend was also observed in terms of spirometry (mean FEV1 2.58 L (0.85) at the end of the study, increased by 220 mL from baseline) with a higher improvement in the medium and high adherence groups. Conclusions Treatment with FDC of budesonide/formoterol via the Elpenhaler device was associated with improvement in asthma-related quality of life and lung function over 6 months that were more prominent in patients with higher adherence. Trial registration: 2017-HAL-EL-74 (ClinicalTrials.gov Identifier: NCT03300076).
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Reliability and validity of the Chinese version of the eight-item Morisky Medication Adherence Scale in Chinese patients with systemic lupus erythematosus. Clin Rheumatol 2022; 41:2713-2720. [PMID: 35536414 DOI: 10.1007/s10067-022-06195-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 04/15/2022] [Accepted: 05/02/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To evaluate the reliability and validity of the Chinese version of the eight-item Morisky Medication Adherence Scale (MMAS-8) in Chinese patients with systemic lupus erythematosus (SLE). METHODS The survey was conducted with a consecutive sampling of 158 Chinese SLE patients attending public hospitals from January to March 2021. We used the translated Chinese version of the MMAS-8 to collect related data. Reliability, item, and factor analyses were used to test the reliability and validity of the MMAS-8 scale in the selected patients. The internal consistency reliability was evaluated using Cronbach's α coefficient. Test-retest reliability was assessed using intraclass correlation coefficients (ICCs) in a subset of 30 participants. Construct validity was evaluated using confirmatory factor analysis and correlations between the Self-efficacy for Appropriate Medication Use Scale (SEAMS) and related measures. RESULTS The internal consistency reliability of the Chinese version of the MMAS-8 was high (Cronbach's α = 0.817), and the test-retest reliability was excellent (intraclass correlation = 0.947; P < 0.001). There were significant differences in the F test and t test between the two extreme groups before and after the ranking of 27% of the questionnaire scores (P < 0.001). The Kaiser-Meyer-Olkin (KMO) value of construct validity was 0.860. The spherical test value of Bartlettgers was 417.8822. Factor analysis yielded three components that accounted for 69.375% of the total variance. Exploratory factor analysis identified three dimensions of the Chinese version of the MMAS-8. In terms of criterion validity, the correlation of the MMAS-8 score in SEAMS indicated that the convergent validity was good (r = 0.926; P < 0.001). CONCLUSIONS This study shows that the Chinese version of the Medication Adherence Scale-8 is a reliable and valid tool for assessing medication adherence in Chinese SLE patients. Key Points • Many factors affect medication adherence in SLE patients. • Many questionnaires measure medication adherence levels. • There is a lack of reliable validation of medication adherence questionnaires specifically for SLE patients.
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Worsa KT, Zinab B, Teshome MS. Dietary Practice among Type 2 Diabetic Ppatients in Southern Ethiopia. Int J Endocrinol 2021; 2021:1359792. [PMID: 34987574 PMCID: PMC8723874 DOI: 10.1155/2021/1359792] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/05/2021] [Accepted: 12/13/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Diabetic patients' dietary practice is critical to improve glycemic, lipid, and blood pressure control. However, a significant number of patients had poor dietary practice. In Ethiopia, more than half of diabetic patients were not practicing a healthy dietary approach. Therefore, this study assessed variables that were hardly addressed in previous studies. The aim of this study was to assess dietary practice and associated factors among patients with type 2 diabetes. METHODS A facility-based cross-sectional study was performed among patients with type 2 diabetes in Arba Minch General Hospital from April 21 to May 20, 2020. A systematic sampling technique was used to select 352 patients. The data were entered into EpiData version 3.1 and exported to SPSS version 21 for cleaning and analysis. Descriptive statistics were performed. All variables in bivariate analysis with p-value <0.25 were entered into a multivariable logistic regression model, and statistical significance was declared at a p-value of less than 0.05. RESULTS The prevalence of poor dietary practice was found to be 40.6% (95%CI (35.7-46.0)). After adjusting for other variables in multivariable analysis, not attending formal education (AOR = 3.0; 95%CI (1.6-5.5)), being at primary education level (AOR = 2.2; 95%CI (1.1-4.4)), being moderately food insecure (AOR = 5.3; 95%CI (2.8-9.9)), having depression (AOR = 5.9; 95%CI (3.0-11.4)), and not having nutrition education (AOR = 2.2; 95% (1.1-4.6)) were factors associated with poor dietary practice. CONCLUSIONS A significant proportion of patients had poor dietary practice. The poor dietary practice was significantly higher among those with no formal education, at the primary education level, from the moderately food-insecure household, having depression, and not having nutrition education. The results imply the need for strengthening health information dissemination concerning healthy dietary practice in the form of a package.
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Affiliation(s)
- Kidus Temesgen Worsa
- School of Public Health, College of Health Science, Arba Minch University, Arba Minch, Ethiopia
| | - Beakal Zinab
- Department of Nutrition and Dietetics, Faculty of Public Health, Health Institute, Jimma University, Jimma, Ethiopia
| | - Melese Sinaga Teshome
- Department of Nutrition and Dietetics, Faculty of Public Health, Health Institute, Jimma University, Jimma, Ethiopia
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Tola Gemeda A, Regassa LD, Weldesenbet AB, Merga BT, Legesse N, Tusa BS. Adherence to antihypertensive medications and associated factors among hypertensive patients in Ethiopia: Systematic review and meta-analysis. SAGE Open Med 2021; 8:2050312120982459. [PMID: 33489230 PMCID: PMC7768850 DOI: 10.1177/2050312120982459] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 12/01/2020] [Indexed: 11/16/2022] Open
Abstract
The foundation of controlling hypertension is adherence to antihypertensive medication adherence. This systematic review and meta-analysis aimed to assess the magnitude and associated factors of adherence to antihypertensive medication among adult hypertensive patients in Ethiopia. A comprehensible bibliographic searching was conducted from PubMed, EMBASE, Scopus, and Web of Science core collection. All published and unpublished studies that had been accessible before 31 May 2020, and written in English were eligible. Joanna Briggs Institute assessment tool was used to evaluate the quality of the findings of the included studies. Stata software 16.0 was used to analyze the data. Study-specific estimates were pooled to determine the overall prevalence estimate across studies using a random-effects meta-analysis model. Publication bias and heterogeneity were checked. Fourteen studies with a total of 4938 hypertensive patients were included in the final systematic review and meta-analysis. The pooled prevalence of medication adherence among hypertensive patients in Ethiopia was 65.41% (95% confidence interval: 58.91-71.91). Sub-group analysis shown that the pooled prevalence of medication adherence was the highest (69.07%, 95% confidence interval: 57.83-80.31, I 2 = 93.51) among studies using questionnaire technique whereas the lowest in Morisky Medication Adherence Scale eight-items (60.66%, 95% confidence interval: 48.92-72.40, I 2 = 97.16). Moreover, medication adherence was associated with the presence of comorbidities (pooled odds ratio = 0.23, 95% confidence interval: 0.07-0.38, p = 0.030, I 2 = 54.9%) and knowledge about the disease and its management (pooled odds ratio = 2.98, 95% confidence interval: 1.72-4.24, p = 0.04, I 2 = 55.55%) but not with place of residence (pooled odds ratio = 1.22, 95% confidence interval: 0.51-1.93, p = 0.00, I 2 = 76.9%). Despite a lack of uniformity among included studies, adherence to antihypertensive medication among the hypertensive population in Ethiopia was moderate. The presence of comorbidities and/or complications reduced the odds of adherence whereas having good knowledge about the disease increased chance of medication adherence among hypertensive patients.
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Affiliation(s)
- Assefa Tola Gemeda
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Lemma Demissie Regassa
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Adisu Birhanu Weldesenbet
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Bedasa Taye Merga
- Department of Public Health and Health Policy, School of Public Health, College of Health and Medical Sciences, Haramaya University, Haramaya, Ethiopia
| | - Nanti Legesse
- School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Biruk Shalmeno Tusa
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Pishkhani MK, Dalvandi A, Ebadi A, Hosseini MA. Adherence to a Rehabilitation Regimen in Stroke Patients: A Concept Analysis. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2020; 25:139-145. [PMID: 32195160 PMCID: PMC7055185 DOI: 10.4103/ijnmr.ijnmr_170_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 12/07/2019] [Accepted: 12/23/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND Adherence to rehabilitation regimens is a major issue in the treatment of stroke. Despite the agreement on the importance of adherence, there is still no clear definition of this concept in rehabilitation. The aim of this study was the concept analysis of the concept of adherence to rehabilitation regimens in stroke patients. MATERIALS AND METHODS This qualitative concept analysis was performed using Walker and Avant's method. English and Persian articles were searched using keywords such as "adherence", "compliance", "rehabilitation", "stroke", and other related keywords among articles published from 1997 to 2018 in PubMed, Scopus, Web of Science, Google Scholar, Iranmedex, Magiran, and Scientific Information Database (SID). Related textbooks were also searched and all articles containing definitions, attributes, antecedents, and consequences of the concept were included in the study. RESULTS The attributes of the concept included complex, multidimensional, and dynamic behavior in the treatment process, personal experience, and adaptive behavior in patients, changeable, situational, voluntary, and collaborative behavior, and active communication between the patient and the healthcare provider. Common antecedents of the concept of adherence to the rehabilitation regimen were classified into patient-related and environmental-related categories and the consequences were classified into the three categories of patient-related, healthcare professional-related, and healthcare system-related. CONCLUSIONS This concept analysis can be useful in eliminating any ambiguity of the concept of adherence to rehabilitation regimens. It helps clarify the vague concepts used in nursing rehabilitation instead of adherence. The results of this study can be helpful for researchers for further studies in this context.
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Affiliation(s)
- Maryam Khoshbakht Pishkhani
- Department of Nursing, School of Rehabilitation, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Asghar Dalvandi
- School of Rehabilitation, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
- School of Nursing and Midwifery, Islamic Azad University of Tehran, Central Branch, Tehran, Iran
| | - Abbas Ebadi
- Behavioral Sciences Research Center, Life Style Institute, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Hosseini
- Department of Rehabilitation Management, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Fanta T, Bekele D, Ayano G. The prevalence and associated factors of depression among patients with schizophrenia in Addis Ababa, Ethiopia, cross-sectional study. BMC Psychiatry 2020; 20:3. [PMID: 31898508 PMCID: PMC6941238 DOI: 10.1186/s12888-019-2419-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 12/23/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Depression is common among people with schizophrenia and associated with severe positive and negative symptoms, higher rates of disability, treatment resistance and mortality related to suicide, physical and drug-related causes. However, to our knowledge, no study has been conducted to report the magnitude of depression among people with schizophrenia in Ethiopia. Therefore, this study aimed to determine the prevalence and associated factors of depression among people with schizophrenia. METHOD A hospital-based cross-sectional study was conducted among 418 patients with schizophrenia selected by systematic sampling technique. Patient Health Questionnaire 9 (PHQ-9) was used to measure depression among the study participants. To identify the potential contributing factors, we performed binary and multivariable logistic regression analysis adjusting the model for the potential confounding factors. Odds ratios (OR) with the corresponding 95% confidence interval (95%CI)) was determined to evaluate the strength of association. RESULT The prevalence estimate of depression among people with schizophrenia was found to be 18.0% [95% confidence interval: 14.50-22.30]. Our multivariable analysis revealed that current substance use (AOR 2.28, 95%CI (1.27, 4.09), suicide attempt (AOR 5.24, 95%CI (2.56, 10.72), duration of illness between 6 and 10 years (AOR 2.09, 95%CI (1.08, 4.04) and poor quality of life (AOR 3.13, 95%CI (1.79, 5.76) were found to be the factors associated with depression among people with schizophrenia. CONCLUSION The current study revealed that comorbid depression was high among people with schizophrenia and associated with current substance use, suicide attempt, and long duration of the illness as well as poor quality of life. Attention needs to be given to address comorbid depression among people with schizophrenia.
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Affiliation(s)
- Tolesa Fanta
- Research and training department, Amanuel mental specialized hospital, Po Box 1971, Addis Ababa, Ethiopia.
| | - Desalegn Bekele
- 0000 0001 1250 5688grid.7123.7Department of psychiatry, Addis Ababa University, Addis Ababa, Ethiopia
| | - Getinet Ayano
- Research and training department, Amanuel mental specialized hospital, Po Box 1971, Addis Ababa, Ethiopia
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Mulgirigama A, Barnes N, Fletcher M, Pedersen S, Pizzichini E, Tsiligianni I. A review of the burden and management of mild asthma in adults - Implications for clinical practice. Respir Med 2019; 152:97-104. [PMID: 31128617 DOI: 10.1016/j.rmed.2019.04.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 04/24/2019] [Accepted: 04/30/2019] [Indexed: 11/28/2022]
Abstract
Mild asthma is present in 50-75% of patients with asthma and is defined by the Global Initiative for Asthma as asthma that can be well controlled with low-intensity treatments (Steps 1 and 2). Despite this definition, 'mild' asthma is often not well controlled in reality, and can have a significant impact on an individual's symptom burden and quality of life. We performed a PubMed literature search to investigate the burden of 'mild' asthma in the lives of patients, including future risk and asthma control, and the current management strategies. While clinical guidelines recommend long-term, daily, low-dose inhaled corticosteroids (ICS) for 'mild' asthma, published data suggest that ICS are often under-prescribed or used intermittently as symptoms arise. Furthermore, patients and physicians tend to overestimate disease control, impacting the accuracy of diagnosing 'mild asthma' and subsequent management. This disconnect may be amplified by miscommunication between patients and physicians, limited objective assessment of control, and differences in guidelines. As with moderate and severe asthma, current evidence supports early initiation of regular ICS in 'mild' asthma to address the underlying inflammation, achieve symptom control and reduce risk of exacerbations. Adherence to ICS treatment is key and can be improved by educating both patients and healthcare professionals. The results of this literature search challenge the term 'mild' asthma and suggest strategies to improve the proactive management of the disease to enable patients to live symptom-free.
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Affiliation(s)
| | - Neil Barnes
- GSK, 980 Great West Rd, Brentford, Middlesex, TW8 9GS, UK; Bart's and the London School of Medicine and Dentistry, 4 Newark St, London, E1 2AT, UK.
| | - Monica Fletcher
- GSK, 980 Great West Rd, Brentford, Middlesex, TW8 9GS, UK; University of Edinburgh, 9 Little France Rd, Edinburgh, EH16 4UX, UK.
| | - Søren Pedersen
- Department of Paediatrics, University of Southern Denmark, Kolding Hospital, Sygehusvej 24, 6000, Kolding, Denmark.
| | - Emilio Pizzichini
- GSK, 980 Great West Rd, Brentford, Middlesex, TW8 9GS, UK; NUPAIVA Asthma Research Centre, Universidade Federal de Santa Catarina (UFSC), Trindade, CEP 88 040 970, Florianópolis, SC, Brazil.
| | - Ioanna Tsiligianni
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Crete, Voutes, GR71003, Greece.
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Demilew YM, Alem AT, Emiru AA. Dietary practice and associated factors among type 2 diabetic patients in Felege Hiwot Regional Referral Hospital, Bahir Dar, Ethiopia. BMC Res Notes 2018; 11:434. [PMID: 29970150 PMCID: PMC6029405 DOI: 10.1186/s13104-018-3531-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 06/23/2018] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Even if patient's dietary practice is a gold standard measure to manage type 2 diabetes, there is a limited study in the area. Therefore, the objective of this study was to assess dietary practice and associated factors among type 2 diabetic patients. RESULT The study revealed that only 35.9% of the patients had good dietary practice. Attending above primary education [AOR = 1.9, 95% CI (1.1, 3.2)], having family support [AOR = 2.6, 95% CI (1.6, 4.2)], and receiving nutrition education [AOR = 2.5, 95% CI (1.5, 4.2)] were independent predictors for good dietary practice. Thus, the findings indicate the need to improve a method of nutrition education both for the patients and their families. Moreover, the government needs to improve literacy rate of citizens.
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Affiliation(s)
- Yeshalem Mulugeta Demilew
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, P.O.Box 79, Bahir Dar, Ethiopia
| | - Abiot Tefera Alem
- School of Medicine, College of Medicine and Health Sciences, Bahir Dar University, P.O.Box 79, Bahir Dar, Ethiopia
| | - Amanu Aragaw Emiru
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, P.O.Box 79, Bahir Dar, Ethiopia
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Therapeutic adherence in patients with systemic lupus erythematosus: a cross-sectional study. ACTA ACUST UNITED AC 2018; 56:109-115. [PMID: 29427555 DOI: 10.2478/rjim-2018-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The aim of the research was the study of the adherence to treatment in patients with systemic lupus erythematosus. METHODS Cross-sectional study including 132 consecutive patients with systemic lupus erythematosus (SLICC, 2012 classification criteria). We collected clinical and socio-demographic data, socio-economic status; we assessed SLEDAI-2k disease activity, and estimated the adherence to treatment by Morisky questionnaire. RESULTS Our results demonstrated that low adherence to treatment in patients with systemic lupus erythematosus was in only 11.36% of patients, while 43.18% and 45.46% of the patients were scored as moderate and high adherence, respectively. A moderate/high adherence to treatment was associated to a high level of education (r = -0.51, p < 0.05, 95% CI = -0.25 to -0.66), low disease activity (r = 0.38, p < 0.05, 95% CI = 0.25 to 0.53) and low indices of physician global assessment (r = -0.31, p<0.05, 95% CI = -0.23 to -0.71). The sub-analysis of the adherence to each drug demonstrated that the highest adherence was to treatment with glucocorticosteroids - 92.85%, followed by hydroxychloroquine and aspirin - 92.15% and 89.79%, respectively. CONCLUSION In our cohort, the adherence to treatment was high in 45.46%, moderate in 43.18% and low in only 11.36% cases. High adherence to treatment was associated to low disease activity. The adherence was positively influenced by the age at the onset of the disease and a high educational level.
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Dalvi V, Mekoth N. Regimen Difficulty and Medication Non-Adherence and the Interaction Effects of Gender and Age. Hosp Top 2017; 96:35-41. [PMID: 29220622 DOI: 10.1080/00185868.2017.1385361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Medication non-adherence is a global health issue. Numerous factors predict it. This study is aimed to identify the association between regimen difficulty and medication non-adherence among patients with chronic conditions and testing the interaction effects of gender and age on the same. It was a cross-sectional study conducted among 479 outpatients from India. Convenience sampling method was used. Multiple regression analyses were performed to find the predictors of non-adherence and to test interaction effects. Regimen difficulty predicted medication non-adherence. The patient's gender and age have interaction effects on the relationship between regimen difficulty and medication non-adherence.
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Affiliation(s)
- Vidya Dalvi
- a Government College of Arts, Science and Commerce , Quepem , Goa , India
| | - Nandakumar Mekoth
- b Department of Management Studies , Goa University , Quepem, Goa , India
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Saputri GZ, Akrom, Dini SM. Validation of behaviour measurement instrument of patients with diabetes mellitus and hypertension. ACTA ACUST UNITED AC 2017. [DOI: 10.1088/1757-899x/259/1/012014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Abstract
INTRODUCTION Most asthma patients have mild disease, although the burden of mild asthma is not well understood nor studied. Some evidence suggests that many patients with mild asthma experience suboptimal symptom control and exacerbations. This study characterizes the burden of illness and treatment patterns among patients with a confirmed diagnosis of mild asthma, defined as GINA Step 1 or Step 2, and residing in China, France, Germany, Italy, Japan, Spain, the United Kingdom, or the United States. METHODS The Respiratory Disease-Specific Programme prospective cross-sectional survey was conducted with primary care and specialty physicians in each of the eight countries. Physician and patient surveys assessed demographic and clinical characteristics, frequency and timing of asthma symptoms, exacerbations, and rescue inhaler usage, the most recent FEV1% predicted, and healthcare utilization. GINA Step was determined by prescribed treatment regimen. GINA Step 1 patients were prescribed as-needed reliever medication and Step 2 required treatment with a low-dose inhaled corticosteroid, leukotriene receptor antagonist, or theophylline. Treatment adherence was assessed with the Morisky Medication Adherence scale, disease control with the Asthma Control Test, and work and activity impairments with the Work Productivity and Activity Impairment scale. RESULTS The sample included 1115 GINA Step 1 and 2 patients, with 53% classified as Step 2. Overall asthma control was suboptimal, with reports of nocturnal symptoms (40.6%), symptom worsening (10.5%), and rescue inhaler usage in the last 4 weeks (33.6%). 25% of patients were uncontrolled. The overall mean number of exacerbations in the last 12 months was 0.4, with a higher frequency of exacerbations in Step 2 patients who also experienced more exacerbations requiring treatment intensification, an emergency department visit, or hospitalization. CONCLUSION Mild asthma imposes a substantial burden on patients, establishing the need for comprehensive management plans and ongoing support for treatment adherence. FUNDING AstraZeneca.
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Affiliation(s)
- Bo Ding
- AstraZeneca Gothenburg, Mölndal, Sweden.
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