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Huang YM, Yang YM, Wang T, Ho YF, Chan HY. Translation and Validation of the Medication Understanding and Use Self-Efficacy Scale Among Patients With Type 2 Diabetes in Taiwan. Health Expect 2025; 28:e70222. [PMID: 40088009 PMCID: PMC11909503 DOI: 10.1111/hex.70222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2024] [Revised: 02/19/2025] [Accepted: 02/28/2025] [Indexed: 03/17/2025] Open
Abstract
OBJECTIVE The study aimed to translate and assess the validity and reliability of the Traditional Chinese version of the Medication Understanding and Use Self-Efficacy Scale (MUSE-TC) among patients with type 2 diabetes (T2D) in Taiwan. METHODS The original 8-item MUSE was translated into Traditional Chinese using a forward and backward translation method. The translations were reviewed by four experts in pharmacy practice and educational psychology. The validity and reliability of the MUSE-TC were assessed in a cross-sectional study among adults with T2D who were taking diabetes medications. Participants were recruited from five community pharmacies in Taiwan between June 2023 and May 2024. Internal consistency of the MUSE-TC was measured using McDonald's omega (ω), while construct validity was evaluated through confirmatory factor analysis. Criterion validity was established by examining the relationship between self-efficacy and medication adherence. RESULTS A total of 274 patients participated in the study. Confirmatory factor analysis identified a two-factor structure for the 8-item MUSE-TC, consisting of the "taking medication" and "learning about medication" domains. All items loaded onto their intended factors, with factor loadings ranging from 0.433 to 0.511. The scale demonstrated excellent internal consistency, with McDonald's ω values of 0.914 for the "taking medication" domain and 0.906 for the "learning about medication" domain. These robust psychometric properties were further supported by criterion validity, as self-efficacy was shown to be associated with medication adherence. Specifically, the "taking medication" domain was positively correlated with fewer barriers to medication-taking (r = 0.382, p < 0.001), suggesting that individuals with higher self-efficacy tend to adhere to their prescribed medication regimen. CONCLUSIONS This study presents the MUSE-TC with psychometrically sound properties that will enable healthcare professionals to prospectively assess self-efficacy in medication use and evaluate the impact of self-efficacy on a variety of health outcomes across patients with different chronic diseases. PATIENT OR PUBLIC CONTRIBUTION Patients, pharmacists, pharmacy staff, and academic experts worked together on the translation and validation of this self-efficacy scale for medication adherence among individuals with chronic illnesses. Community engagement played a key role in translating the scale, recruiting participants, collecting data, conducting analysis, and interpreting the findings. These collaborative efforts ensure the study relevance and applicability to patient care in routine healthcare settings.
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Affiliation(s)
- Yen-Ming Huang
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei City, Taiwan
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei City, Taiwan
- Department of Pharmacy, National Taiwan University Hospital, Taipei City, Taiwan
| | - Yu-Meng Yang
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei City, Taiwan
| | - Tzu Wang
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei City, Taiwan
| | - Yunn-Fang Ho
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei City, Taiwan
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei City, Taiwan
| | - Hsun-Yu Chan
- Department of Industrial Education, National Taiwan Normal University, Taipei City, Taiwan
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Baby B, McKinnon A, Patterson K, Patel H, Sharma R, Carter C, Griffin R, Burns C, Chang F, Guilcher SJ, Lee L, Fadaleh SA, Patel T. Tools to measure barriers to medication management capacity in older adults: a scoping review. BMC Geriatr 2024; 24:285. [PMID: 38532328 PMCID: PMC10967066 DOI: 10.1186/s12877-024-04893-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 03/13/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Medication management capacity is a crucial component of medication adherence, particularly among older adults. Various factors, including physical abilities, cognitive functions, sensory capabilities, motivational, and environmental factors, influence older adults' ability to manage medications. It is, therefore, crucial to identify appropriate tools that allow clinicians to determine which factors may impact medication management capacity and, consequently, nonadherence to medications. PURPOSE 1)To identify tools that measure physical, cognitive, sensory (vision, hearing, touch), motivational, and environmental barriers to medication self-management in older adults, and 2) to understand the extent to which these tools assess various barriers. METHODS The scoping review was conducted using Arksey and O'Malley's scoping review framework and the PRISMA Extension for Scoping Reviews checklist. In June 2022, the relevant literature was identified by searching PubMed (MEDLINE), Ovid Embase, Ovid IPA, EBSCOhost CINAHL, APA PsycINFO, and Scopus. RESULTS AND DISCUSSION In total, 7235 studies were identified. Following the removal of duplicates, 4607 articles were screened by title and abstract, of which 4253 did not meet the inclusion criteria. Three reviewers reviewed the full texts of the remaining 354 articles; among them, 41 articles, 4 theses and 1 conference abstract met the inclusion criteria. From the included studies, 44 tools were identified that measured a combination of physical, cognitive, sensory, motivational, and environmental barriers (n=19) or only cognition (n=13), vision (n=5), environmental factors (n=3), auditory (n=1), and motivational factors (n=1). The review also examined the psychometric properties of the identified tools and found that most of them had reported validity and reliability data. Several tools have demonstrated promise in assessing a combination of barriers with validity and reliability. These tools include the Self-Medication Assessment Tool (SMAT), ManageMed Screening (MMS), Self-Medication Risk Assessment Tool (RAT), HOME-Rx revised, and Medication Management Ability Assessment (MMAA). CONCLUSION This scoping review identified 44 validated tools to measure various challenges that older adults encounter with medication management. However, no tool measures all five barriers (physical, cognitive, sensory, motivational, and environmental) to medication-taking at home. Therefore, utilizing a combination of tools would be most appropriate to measure these different aspects comprehensively. Further research is needed to develop a new comprehensive tool that simultaneously measures various barriers to medication self-management.
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Affiliation(s)
- Bincy Baby
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
| | | | | | - Hawa Patel
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
| | - Rishabh Sharma
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
| | - Caitlin Carter
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
| | - Ryan Griffin
- National Research Council Canada, Ottawa, ON, Canada
| | - Catherine Burns
- Faculty of Engineering, University of Waterloo, Waterloo, ON, Canada
| | - Feng Chang
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
| | - Sara Jt Guilcher
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Linda Lee
- Department of Family Medicine, McMaster University, Hamilton, Canada
| | - Sara Abu Fadaleh
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
| | - Tejal Patel
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada.
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Lieber SR, Baldelli L, Kim HP, Nash RP, Noriega Ramirez A, Magee G, Barritt AS, Evon DM, Singal AG. Active coping, resilience, post-traumatic growth, and psychiatric symptoms among early and late liver transplant survivors. Liver Transpl 2023; 29:290-306. [PMID: 36811878 PMCID: PMC10197865 DOI: 10.1097/lvt.0000000000000009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 10/10/2022] [Indexed: 02/24/2023]
Abstract
Understanding survivorship experiences at different stages postliver transplantation (poat-LT) is essential to improving care. Patient-reported concepts including coping, resilience, post-traumatic growth (PTG), and anxiety/depression, have been implicated as important predictors of quality of life and health behaviors after LT. We aimed to descriptively characterize these concepts at different post-LT survivorship stages. This cross-sectional study featured self-reported surveys measuring sociodemographic, clinical characteristics, and patient-reported concepts including coping, resilience, PTG, anxiety, and depression. Survivorship periods were categorized as early (1 y or below), mid (1-5 y), late (5-10 y), and advanced (10 y or above). Univariable and multivariable logistic and linear regression modeling examined factors associated with patient-reported concepts. Among 191 adult LT survivors, the median survivorship stage was 7.7 years (interquartile range: 3.1-14.4) and median age was 63 years (range: 28-83); most were male (64.2%) and Caucasian (84.0%). High PTG was more prevalent in the early survivorship period (85.0%) than late survivorship (15.2%). High trait resilience was only reported by 33% of survivors and associated with higher income. Lower resilience was seen among patients with longer LT hospitalization stays and late survivorship stages. About 25% of survivors had clinically significant anxiety and depression, which was more frequent among early survivors and females with pre-LT mental health disorders. In multivariable analysis, factors associated with lower active coping included survivors ≥65 years, non-Caucasian race, lower levels of education, and nonviral liver disease. In a heterogeneous cohort including early and late LT survivors, there was variation in levels of PTG, resilience, anxiety, and depression at different survivorship stages. Factors associated with positive psychological traits were identified. Understanding determinants of LT survivorship has important implications for how we should monitor and support LT survivors.
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Affiliation(s)
- Sarah R Lieber
- Division of Digestive and Liver Diseases, Department of Medicine, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA
| | - Luke Baldelli
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina (UNC), Chapel Hill, North Carolina, USA
| | - Hannah P Kim
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Rebekah P Nash
- Department of Psychiatry, University of North Carolina (UNC), Chapel Hill, North Carolina, USA
| | - Alvaro Noriega Ramirez
- Division of Digestive and Liver Diseases, Department of Medicine, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA
| | - Gabrielle Magee
- Center for Gastrointestinal Biology and Disease, University of North Carolina (UNC), Chapel Hill, North Carolina, USA
| | - Alfred S Barritt
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina (UNC), Chapel Hill, North Carolina, USA
| | - Donna M Evon
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina (UNC), Chapel Hill, North Carolina, USA
| | - Amit G Singal
- Division of Digestive and Liver Diseases, Department of Medicine, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA
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Wu J, Shen J, Tao Z, Song Z, Chen ZL. Self-Efficacy as Moderator and Mediator Between Medication Beliefs and Adherence in Elderly Patients with Type 2 Diabetes. Patient Prefer Adherence 2023; 17:217-226. [PMID: 36713972 PMCID: PMC9875572 DOI: 10.2147/ppa.s382362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/07/2023] [Indexed: 01/21/2023] Open
Abstract
PURPOSE Poor antidiabetic medication adherence remains a great barrier to effective diabetes self-management among aging adults. This study investigates the mediation and moderation effects of self-efficacy on the relationship between medication beliefs and adherence in elderly patients with type 2 diabetes. METHODS This cross-sectional study evaluated a sample of 309 hospitalized elderly patients who completed the assessment of medication beliefs, self-efficacy for medication uses and medication adherence in a tertiary hospital in Shanghai, China. A bootstrapping sampling method and hierarchical moderator regression analysis were used to verify the hypothesis of mediation and moderation effects of self-efficacy on the relationship between medication beliefs and adherence. RESULTS Self-efficacy for medication use acted as a moderator (B=-0.063, t=-2.215, p=0.028) and partial mediator (CItotal effect=4.5-16.63, p=0.001; CIindirect=1.524-5.323, p=0.014; CIdirect=2.151-11.817, p=0.001) on the relationship between general harm medication beliefs and medication adherence. Participants with lower general harm medication beliefs may develop higher self-efficacy, which, in turn, results in a higher level of medication adherence, and higher self-efficacy may attenuate the negative effect of high general harm medication beliefs on medication adherence. CONCLUSION Self-efficacy for medication use not only mediated the relationship between general harm beliefs about medication and medication adherence, but moderated it negatively. The findings of this study indicate an opportunity to improve the prognosis of elderly Chinese patients with type 2 diabetes through improved medication adherence by strengthening factors such as self-efficacy for appropriate medication use and general harm beliefs about medication.
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Affiliation(s)
- Jianbo Wu
- Department of Pharmacy, Huadong Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Jie Shen
- Department of Pharmacy, Huadong Hospital, Fudan University, Shanghai, People’s Republic of China
- Correspondence: Jie Shen; Zhi-Long Chen, Email ;
| | - Zhujun Tao
- Department of Pharmacy, Huadong Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Zhongjuan Song
- Department of Pharmacy, Huadong Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Zhi-Long Chen
- Department of Pharmacy, Huadong Hospital, Fudan University, Shanghai, People’s Republic of China
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Sandbæk A, Møller MCR, Bro F, Høj K, Due Christensen L, Mygind A. Involving patients in medicines optimisation in general practice: a development study of the “PREparing Patients for Active Involvement in medication Review” (PREPAIR) tool. BMC PRIMARY CARE 2022; 23:122. [PMID: 35596147 PMCID: PMC9121082 DOI: 10.1186/s12875-022-01733-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 05/06/2022] [Indexed: 11/10/2022]
Abstract
Abstract
Background
Many patients have multiple health conditions and take multiple medications (polypharmacy). Active patient involvement may improve treatment outcomes and ensure patient-centred care. Yet, patient involvement remains a challenge in clinical practice. We aimed to develop and pilot test a questionnaire-based preparation and dialogue tool, the PREparing Patients for Active Involvement in medication Review (PREPAIR) tool, to encourage the involvement of patients with polypharmacy in medicines optimisation in general practice.
Methods
We conducted a literature review followed by a co-production process to develop the tool: a workshop with six GPs and pilot testing, including observations and interviews, with 22 patients, three GPs and three practice staff. During this process, we made continuous adaptations to the prototype. We analysed the qualitative data thematically, focusing on the development process and mechanisms of impact.
Findings
The final PREPAIR tool included five items concerning the patient’s experience of 1) adverse drug reactions, 2) excess medication, 3) unnecessary medication, 4) medication satisfaction and 5) medication-related topics to discuss with the GP (open-ended question). The applied workflow during testing was as follows; the patient completed the PREPAIR tool at home, to encourage reflection on the medication, and brought it to the GP consultation. During the consultation, the GP and the patient reviewed the patient’s responses and discussed potential medication-related problems. For some patients, the increased reflection led to worries about the medications. Still, the pilot testing showed that, when using the PREPAIR tool, the patients arrived at the clinic well prepared and empowered to speak. From the PREPAIR-supported dialogue, the GPs obtained a better understanding of patients’ perspectives and provided a more patient-centred consultation. For the patients, the PREPAIR-supported dialogue ultimately promoted an increased sense of security, satisfaction and insight into their medication, despite initial worries for some patients.
Conclusions
We developed a brief tool to support active patient involvement in medication review in general practice. The PREPAIR-tool was well received by both patients and GPs and fitted well into the existing clinical practice. Our findings suggest that the PREPAIR-tool can support patient involvement during consultations and facilitate patient-centred care.
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Lieber SR, Kim HP, Baldelli L, Nash R, Teal R, Magee G, Desai CS, Loiselle MM, Lee SC, Singal AG, Marrero JA, Barritt AS, Evon DM. Early Survivorship After Liver Transplantation: A Qualitative Study Identifying Challenges in Recovery From the Patient and Caregiver Perspective. Liver Transpl 2022; 28:422-436. [PMID: 34529886 PMCID: PMC10548343 DOI: 10.1002/lt.26303] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 09/06/2021] [Accepted: 09/11/2021] [Indexed: 02/04/2023]
Abstract
Survivorship after liver transplantation (LT) is a novel concept providing a holistic view of the arduous recovery experienced after transplantation. We explored components of early survivorship including physical, emotional, and psychological challenges to identify intervention targets for improving the recovery process of LT recipients and caregivers. A total of 20 in-person interviews were conducted among adults 3 to 6 months after LT. Trained qualitative research experts conducted interviews, coded, and analyzed transcripts to identify relevant themes and representative quotes. Early survivorship comprises overcoming (1) physical challenges, with the most challenging experiences involving mobility, driving, dietary modifications, and medication adherence, and (2) emotional and psychological challenges, including new health concerns, financial worries, body image/identity struggles, social isolation, dependency issues, and concerns about never returning to normal. Etiology of liver disease informed survivorship experiences including some patients with hepatocellular carcinoma expressing decisional regret or uncertainty in light of their post-LT experiences. Important topics were identified that framed LT recovery including setting expectations about waitlist experiences, hospital recovery, and ongoing medication requirements. Early survivorship after LT within the first 6 months involves a wide array of physical, emotional, and psychological challenges. Patients and caregivers identified what they wish they had known prior to LT and strategies for recovery, which can inform targeted LT survivorship interventions.
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Affiliation(s)
- Sarah R. Lieber
- Division of Digestive and Liver Diseases, Department of Medicine, University of Texas Southwestern, Dallas, TX
| | - Hannah P. Kim
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Luke Baldelli
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Rebekah Nash
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Randall Teal
- Connected Health Applications and Interventions, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Gabrielle Magee
- Center for Gastrointestinal Biology and Disease, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Chirag S. Desai
- Division of Transplantation, Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Marci M. Loiselle
- Division of Behavioral Medicine, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Simon C. Lee
- Department of Population and Data Sciences, University of Texas Southwestern Medical, Dallas, TX
| | - Amit G. Singal
- Division of Digestive and Liver Diseases, Department of Medicine, University of Texas Southwestern, Dallas, TX
| | - Jorge A. Marrero
- Division of Digestive and Liver Diseases, Department of Medicine, University of Texas Southwestern, Dallas, TX
| | - A. Sidney Barritt
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Donna M. Evon
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
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Schnepf J, Christmann U. "It's a war! It's a battle! It's a fight!": Do militaristic metaphors increase people's threat perceptions and support for COVID-19 policies? INTERNATIONAL JOURNAL OF PSYCHOLOGY 2022; 57:107-126. [PMID: 34473349 PMCID: PMC8652818 DOI: 10.1002/ijop.12797] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 07/20/2021] [Indexed: 11/24/2022]
Abstract
At the beginning of the COVID-19 pandemic, governments around the world employed militaristic metaphors to draw attention to the dangers of the virus. But, do militaristic metaphors truly affect individuals' perceived threat of the COVID-19 virus and increase their support for corresponding restrictive policies? This study assessed the effects of fictitious newspaper articles that described COVID-19 policies using similarly negatively valenced metaphors but with differing militaristic connotations (e.g., "war" vs. "struggle"). Overall, data from three framing experiments (N = 1114) in Germany and the United States indicate limited evidence on the effectiveness of the tested militaristic metaphors. In the U.S. context, the non-militaristic concept of struggle was consistently more strongly associated with the desired outcomes than militaristic metaphors were. In Studies 2 and 3, we also tested whether reporting using a narrative or straightforward facts had additional influence on the framing effect. A congruency effect of the use of a narrative and of warfare metaphors was found in the German sample, but not in that of the United States. Results of post-experimental norming studies (N = 437) in both countries revealed that the metaphor of war is associated with people ascribing greater responsibility to their governments, whereas the concept of struggle triggers a sense of individual responsibility. These results are discussed in terms of the usefulness and appropriateness of militaristic metaphors in the context of a pandemic.
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Affiliation(s)
- Julia Schnepf
- Department of Social, Economic, & Environmental PsychologyUniversity of Koblenz‐LandauLandauGermany
| | - Ursula Christmann
- Department of General PsychologyHeidelberg UniversityHeidelbergGermany
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Kwan YH, Weng SD, Loh DHF, Phang JK, Oo LJY, Blalock DV, Chew EH, Yap KZ, Tan CYK, Yoon S, Fong W, Østbye T, Low LL, Bosworth HB, Thumboo J. Measurement Properties of Existing Patient-Reported Outcome Measures on Medication Adherence: Systematic Review. J Med Internet Res 2020; 22:e19179. [PMID: 33034566 PMCID: PMC7584986 DOI: 10.2196/19179] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 07/05/2020] [Accepted: 08/08/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Medication adherence is essential for improving the health outcomes of patients. Various patient-reported outcome measures (PROMs) have been developed to measure medication adherence in patients. However, no study has summarized the psychometric properties of these PROMs to guide selection for use in clinical practice or research. OBJECTIVE This study aims to evaluate the quality of the PROMs used to measure medication adherence. METHODS This study was guided by the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines. Relevant articles were retrieved from the EMBASE, PubMed, Cochrane Library, Web of Science, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases. The PROMs were then evaluated based on the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) guidelines. RESULTS A total of 121 unique medication adherence PROMs from 214 studies were identified. Hypotheses testing for construct validity and internal consistency were the most frequently assessed measurement properties. PROMs with at least a moderate level of evidence for ≥5 measurement properties include the Adherence Starts with Knowledge 20, Compliance Questionnaire-Rheumatology, General Medication Adherence Scale, Hill-Bone Scale, Immunosuppressant Therapy Barrier Scale, Medication Adherence Reasons Scale (MAR-Scale) revised, 5-item Medication Adherence Rating Scale (MARS-5), 9-item MARS (MARS-9), 4-item Morisky Medication Adherence Scale (MMAS-4), 8-item MMAS (MMAS-8), Self-efficacy for Appropriate Medication Adherence Scale, Satisfaction with Iron Chelation Therapy, Test of Adherence to Inhalers, and questionnaire by Voils. The MAR-Scale revised, MMAS-4, and MMAS-8 have been administered electronically. CONCLUSIONS This study identified 121 PROMs for medication adherence and provided synthesized evidence for the measurement properties of these PROMs. The findings from this study may assist clinicians and researchers in selecting suitable PROMs to assess medication adherence.
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Affiliation(s)
- Yu Heng Kwan
- Program in Health Services and Systems Research,, Duke-NUS Medical School, Singapore, Singapore
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Si Dun Weng
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Dionne Hui Fang Loh
- PULSES Centre Grant, SingHealth Regional Health System, Singapore, Singapore
| | - Jie Kie Phang
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
| | - Livia Jia Yi Oo
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Dan V Blalock
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, United States
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Eng Hui Chew
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Kai Zhen Yap
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Corrinne Yong Koon Tan
- Pharmacy Transformation Office, National Healthcare Group Pharmacy, Singapore, Singapore
| | - Sungwon Yoon
- Program in Health Services and Systems Research,, Duke-NUS Medical School, Singapore, Singapore
- PULSES Centre Grant, SingHealth Regional Health System, Singapore, Singapore
| | - Warren Fong
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Truls Østbye
- Program in Health Services and Systems Research,, Duke-NUS Medical School, Singapore, Singapore
| | - Lian Leng Low
- PULSES Centre Grant, SingHealth Regional Health System, Singapore, Singapore
- Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore, Singapore
- Post Acute and Continuing Care, Outram Community Hospital, Singapore, Singapore
| | - Hayden Barry Bosworth
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, United States
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
- Department of Population Health Sciences, Duke University Medical Center, Durham, NC, United States
- School of Nursing, Duke University Medical Center, Durham, NC, United States
| | - Julian Thumboo
- Program in Health Services and Systems Research,, Duke-NUS Medical School, Singapore, Singapore
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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9
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Kwan YH, Oo LJY, Loh DHF, Phang JK, Weng SD, Blalock DV, Chew EH, Yap KZ, Tan CYK, Yoon S, Fong W, Østbye T, Low LL, Bosworth HB, Thumboo J. Development of an Item Bank to Measure Medication Adherence: Systematic Review. J Med Internet Res 2020; 22:e19089. [PMID: 33030441 PMCID: PMC7582150 DOI: 10.2196/19089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/12/2020] [Accepted: 06/14/2020] [Indexed: 02/06/2023] Open
Abstract
Background Medication adherence is important in managing the progression of chronic diseases. A promising approach to reduce cognitive burden when measuring medication adherence lies in the use of computer‐adaptive tests (CATs) or in the development of shorter patient-reported outcome measures (PROMs). However, the lack of an item bank currently hampers this progress. Objective We aim to develop an item bank to measure general medication adherence. Methods Using the preferred reporting items for systematic review and meta-analysis (PRISMA), articles published before October 2019 were retrieved from PubMed, Embase, CINAHL, the Cochrane Library, and Web of Science. Items from existing PROMs were classified and selected (“binned” and “winnowed”) according to standards published by the Patient-Reported Outcomes Measurement Information System (PROMIS) Cooperative Group. Results A total of 126 unique PROMs were identified from 213 studies in 48 countries. Items from the literature review (47 PROMs with 579 items for which permission has been obtained) underwent binning and winnowing. This resulted in 421 candidate items (77 extent of adherence and 344 reasons for adherence). Conclusions We developed an item bank for measuring general medication adherence using items from validated PROMs. This will allow researchers to create new PROMs from selected items and provide the foundation to develop CATs.
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Affiliation(s)
- Yu Heng Kwan
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.,Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Livia Jia Yi Oo
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Dionne Hui Fang Loh
- PULSES Centre Grant, SingHealth Regional Health System, Singapore, Singapore
| | - Jie Kie Phang
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
| | - Si Dun Weng
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Dan V Blalock
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, United States.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Eng Hui Chew
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Kai Zhen Yap
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Corrinne Yong Koon Tan
- Pharmacy Transformation Office, National Healthcare Group Pharmacy, Singapore, Singapore
| | - Sungwon Yoon
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.,PULSES Centre Grant, SingHealth Regional Health System, Singapore, Singapore
| | - Warren Fong
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore.,NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Truls Østbye
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Lian Leng Low
- PULSES Centre Grant, SingHealth Regional Health System, Singapore, Singapore.,Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore, Singapore.,Post Acute and Continuing Care, Outram Community Hospital, Singapore, Singapore
| | - Hayden Barry Bosworth
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, United States.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States.,School of Nursing, Duke University Medical Center, Durham, NC, United States.,Department of Population Health Sciences, Duke University Medical Center, Durham, NC, United States
| | - Julian Thumboo
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.,Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore.,NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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10
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Kobayashi S, Tsutsui J, Okabe S, Hideki I, Akaho R, Nishimura K. Medication nonadherence after kidney transplantation: an internet-based survey in Japan. PSYCHOL HEALTH MED 2019; 25:91-101. [PMID: 31144516 DOI: 10.1080/13548506.2019.1622745] [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] [Indexed: 10/26/2022]
Abstract
Nonadherence to immunosuppressive medications after kidney transplantation is a major risk factor for allograft rejection and graft loss. Transplant recipients tend to conceal nonadherence in clinical settings. We conducted an internet-based cross-sectional survey aimed to clarify the prevalence and risk factors of patient nonadherence after kidney transplantation in Japan. The Basel Assessment of Adherence to Immunosuppressive Medication Scale (BAASIS©) was used to detect nonadherence. In this survey, patients were asked about their relationship with medical staff and their self-efficacy for taking medication, along with other questions. A total of 219 kidney transplant recipients were included in the analysis. Ninety-four demonstrated nonadherence (42.7%). The following factors were associated with nonadherence: short dialysis period prior to transplantation; undergoing transplantation at least twice; male sex; lack of satisfaction with the explanation of immunosuppressive medication; and absence of medical staff to consult upon forgetting to take drugs. The nonadherence group reported low self-efficacy for medication in many settings. This anonymous survey provides valuable insight into the actual nonadherence rate, factors associated with nonadherence, and life situations that may complicate medication-taking.
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Affiliation(s)
- Sayaka Kobayashi
- Department of Psychiatry, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan.,Department of Psychiatry, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Junko Tsutsui
- Department of Psychiatry, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Sachi Okabe
- Department of Nursing, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Ishida Hideki
- Department of Urology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Rie Akaho
- Department of Psychiatry, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Katsuji Nishimura
- Department of Psychiatry, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
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11
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Du C, Wu S, Liu H, Hu Y, Li J. Correlation of long-term medication behaviour self-efficacy with social support and medication knowledge of kidney transplant recipients. Int J Nurs Sci 2018; 5:352-356. [PMID: 31406847 PMCID: PMC6626269 DOI: 10.1016/j.ijnss.2018.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 06/15/2018] [Accepted: 09/18/2018] [Indexed: 11/05/2022] Open
Abstract
Aim This study aimed to explore the correlation of long-term medication behaviour self-efficacy with social support and medication knowledge of kidney transplant recipients. Methods A convenient sample of kidney transplant recipients in a general hospital in Guangzhou was recruited from November 2016 to January 2017. Self-reported survey data were provided by the kidney transplant recipients using long-term medication behaviour self-efficacy scale (LTMBSES), perceived social support scale (PSSS) and scale for patient-perceived medication knowledge in medication usage. Descriptive statistics and Spearman's correlation analysis were used for data analysis. Results A total of 195 kidney transplant recipients (132 men and 63 women) were recruited for this study. The mean scores of all LTMBSES dimensions, namely personal attitudes, environmental and task-related and behavioural factors, were 32.49 ± 4.34, 60.90 ± 7.56 and 32.32 ± 4.40, respectively. The mean scores of three PSSS dimensions, namely, family, friends and significant others, were 24.91 ± 3.42, 22.71 ± 4.66 and 22.15 ± 4.26, correspondingly. The mean scores of two five-item knowledge subscale dimensions, namely, general and interaction knowledge, were 9.56 ± 1.07 and 13.02 ± 2.67, respectively. Spearman's correlation analysis showed that social support (rs = 0.232, P < 0.01) and medication knowledge (rs = 0.352, P < 0.01) were positively associated with long-term medication self-efficacy in the kidney transplant recipients. Conclusion The levels of long-term medication self-efficacy, perceived social support and medication knowledge of the kidney transplant recipients were high. Social support and medication knowledge were correlated with self-efficacy.
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Affiliation(s)
- Chunyan Du
- School of Nursing, Beijing University of Chinese Medicine (BUCM), Beijing, China
| | - Sisi Wu
- School of Nursing, Beijing University of Chinese Medicine (BUCM), Beijing, China
| | - Hongxia Liu
- School of Nursing, Beijing University of Chinese Medicine (BUCM), Beijing, China
| | - Yue Hu
- School of Nursing, Beijing University of Chinese Medicine (BUCM), Beijing, China
| | - Jiaqi Li
- School of Nursing, Beijing University of Chinese Medicine (BUCM), Beijing, China
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12
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Côté J, Fortin MC, Auger P, Rouleau G, Dubois S, Boudreau N, Vaillant I, Gélinas-Lemay É. Web-Based Tailored Intervention to Support Optimal Medication Adherence Among Kidney Transplant Recipients: Pilot Parallel-Group Randomized Controlled Trial. JMIR Form Res 2018; 2:e14. [PMID: 30684400 PMCID: PMC6334708 DOI: 10.2196/formative.9707] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 04/16/2018] [Accepted: 06/18/2018] [Indexed: 12/05/2022] Open
Abstract
Background Optimal immunosuppressive medication adherence is essential to graft survival. Transplant-TAVIE is a Web-based tailored intervention developed to promote this adherence. Objective The objective of our study was to evaluate the Transplant-TAVIE intervention’s acceptability, feasibility, and preliminary efficacy. Methods In a pilot, parallel-group, randomized controlled trial, we randomly assigned a convenience sample of 70 kidney transplant patients on immunosuppressive medication either to an experimental group (Transplant-TAVIE) or to a control group (existing websites). Kidney transplant recipients had to be older than 18 years, be taking immunosuppressant medication, and have access to the internet to participate in this study. Transplant-TAVIE was composed of three interactive Web-based sessions hosted by a virtual nurse. We documented user appreciation of and exposure to the intervention. Furthermore, we assessed medication adherence, medication self-efficacy, intake-related skills, and medication side effects at baseline and 3 and 6 months later. Analyses of variance were used to assess intergroup differences over time. Results After baseline questionnaire completion, participants were randomly assigned either to Transplant-TAVIE (n=35) or to the websites (n=35) group. All participants had received their kidney graft <1 year to 32 years earlier (mean 6.8 years). Of the experimental group, 54% (19/35) completed the sessions of Transplant-TAVIE. Users found the intervention to be acceptable—33% were extremely satisfied (6/18), 39% were very satisfied (7/18), and 28% were satisfied (5/18). At baseline and over time, both experimental and control groups reported high medication adherence, high medication self-efficacy, and frequent use of skills related to medication intake. No intergroup differences emerged over time. Conclusions The results of this study support the feasibility and acceptability of Transplant-TAVIE. It could constitute an accessible adjunct in support of existing specialized services.
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Affiliation(s)
- José Côté
- Research Chair in Innovative Nursing Practices, Montreal, QC, Canada.,Faculty of Nursing, Université de Montréal, Montreal, QC, Canada.,Research Centre of the Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Marie-Chantal Fortin
- Research Centre of the Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.,Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Patricia Auger
- Research Chair in Innovative Nursing Practices, Montreal, QC, Canada.,Research Centre of the Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Geneviève Rouleau
- Research Chair in Innovative Nursing Practices, Montreal, QC, Canada.,Research Centre of the Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Sylvie Dubois
- Faculty of Nursing, Université de Montréal, Montreal, QC, Canada
| | - Nathalie Boudreau
- Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Isabelle Vaillant
- Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
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13
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Lamarche L, Tejpal A, Mangin D. Self-efficacy for medication management: a systematic review of instruments. Patient Prefer Adherence 2018; 12:1279-1287. [PMID: 30050290 PMCID: PMC6056165 DOI: 10.2147/ppa.s165749] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Medication self-efficacy is a potentially important construct in research around optimal use of prescription medications. A number of medication self-efficacy measures are available; however, there is no systematic review of existing instruments and cataloguing of their theoretical underpinnings or psychometric properties, strengths, and weaknesses. The aim of the study was to identify instruments that measure self-efficacy for medication management. The study also aimed to examine the quality, theoretical grounding, and psychometric evaluation of existing measures of self-efficacy for medication management. The study was a systematic review. METHODS Data were extracted from PubMed, OVID, and MEDLINE using a predefined search strategy. Citations were included if they reported the development and/or psychometric evaluation of an instrument to measure self-efficacy for medication management and were in English. Abstracts were screened for studies potentially meeting eligibility criteria. Full articles of these studies were then reviewed in depth. The review was carried out independently by two members of the research team. RESULTS The search identified 158 citations of which 12 were included after screening. Full review identified 3 articles fitting inclusion criteria for the review. Generally, development was theoretically grounded and included patients and experts in the field. Psychometric testing showed evidence of internal consistency (2/3 instruments) and test-retest reliability (1/3 instruments). All instruments showed some validity; however, assessment of all forms of validity for each instrument was lacking. CONCLUSION Although our analysis would recommend the use of the Self-Efficacy for Appropriate Medication Use Scale because of the current evidence of validity and reliability, more psychometric evaluation is required, particularly in terms of responsiveness to change as self-efficacy is a malleable patient-level factor. Three measures of self-efficacy for medication management were identified. Overall, some evidence of reliability and/or validity was demonstrated for all instruments; however, other forms of validity were not tested (ie, responsiveness to change). Use of a well-validated measure of self-efficacy medication management is essential in order to understand relationships between medication self-efficacy and other patient-reported outcomes such as patient-centeredness, patient enablement, and burden of treatment, an important area of research that is currently lacking.
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Affiliation(s)
- Larkin Lamarche
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada,
| | - Ambika Tejpal
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada,
| | - Dee Mangin
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada,
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14
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Shen Y, Peng X, Wang M, Zheng X, Xu G, Lü L, Xu K, Burstrom B, Burstrom K, Wang J. Family member-based supervision of patients with hypertension: a cluster randomized trial in rural China. J Hum Hypertens 2017; 31:29-36. [PMID: 26911532 PMCID: PMC5144121 DOI: 10.1038/jhh.2016.8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 01/17/2016] [Accepted: 01/21/2016] [Indexed: 02/02/2023]
Abstract
Empirical evidence has suggested that social support from family can help patients take their medicines correctly. This study aims to evaluate the role of a family member-based supervision package in the management of hypertension using a cluster randomized trial in rural China. We recruited patients with hypertension from four villages in Yangzhong and randomly allocated them to the control group (n=288) and the intervention group (n=266). A family member-based supervision package was applied to the intervention group, while the usual service was applied to the controls. Patients were followed for 12 months and completed face-to-face interviews at the end of 6 and 12 months. The primary outcomes were patients' medication adherence and frequency of blood pressure measurement. Secondary outcomes included changes in blood pressure, altered risk behaviours and occurrence of hypertension-related complications. To control for the effects of cluster randomization, multilevel mixed-effects regression models were used to compare group changes. We observed that the intervention improved patients' blood pressure measurement frequency (OR: 9.00, 95% CI: 4.52-17.91) and adherence to antihypertensive treatment (OR: 1.74, 95% CI: 0.91-3.32). Its effect on the blood pressure control rate was significant at the mid-term investigation (OR: 0.67, 95% CI: 0.40-0.93), but the long-term effect was not significant (OR: 0.89, 95% CI: 0.64-1.26). After 6 months of intervention, either systolic or diastolic blood pressure was significantly decreased in the intervention group. However, this difference was not significant at the final investigation. Findings from this study revealed that the family member-based supervised therapy may have positive effects on patients' adherence to blood monitoring and hypertensive medications.
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Affiliation(s)
- Y Shen
- Department of Gastrointestinal Surgery, Aoyoung Hospital, Zhangjiagang, China
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
| | - X Peng
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
| | - M Wang
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
| | - X Zheng
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
| | - G Xu
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
| | - L Lü
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
| | - K Xu
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, China
| | - B Burstrom
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - K Burstrom
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Health Care Services, Stockholm County Council, Stockholm, Sweden
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - J Wang
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, China
- The Innovation Center for Social Risk Governance in Health, School of Public Health, Nanjing Medical University, Nanjing, China
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15
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Rathbone AP, Todd A, Jamie K, Bonam M, Banks L, Husband AK. A systematic review and thematic synthesis of patients' experience of medicines adherence. Res Social Adm Pharm 2016; 13:403-439. [PMID: 27432023 DOI: 10.1016/j.sapharm.2016.06.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 06/06/2016] [Accepted: 06/06/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Medicines non-adherence continues to be problematic in health care practice. After decades of research, few interventions have a robust evidence-based demonstrating their applicability to improve adherence. Phenomenology has a place within the health care research environment. OBJECTIVE To explore patients' lived experiences of medicines adherence reported in the phenomenonologic literature. METHODS A systematic literature search was conducted to identify peer-reviewed and published phenomenological investigations in adults that aimed to investigate patients' lived experiences of medicines adherence. Studies were appraised using the Critical Appraisal Skills Programme (CASP) Qualitative Research Tool. Thematic synthesis was conducted using a combination of manual coding and NVivo10 [QSR International, Melbourne] coding to aid data management. RESULTS Descriptive themes identified included i) dislike for medicines, ii) survival, iii) perceived need, including a) symptoms and side-effects and b) cost, and iv) routine. Analytic themes identified were i) identity and ii) interaction. CONCLUSIONS This work describes adherence as a social interaction between the identity of patients and medicines, mediated by interaction with family, friends, health care professionals, the media and the medicine, itself. Health care professionals and policy makers should seek to re-locate adherence as a social phenomenon, directing the development of interventions to exploit patient interaction with wider society, such that patients 'get to know' their medicines, and how they can be taken, throughout the life of the patient and the prescription.
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Affiliation(s)
- A P Rathbone
- School of Medicine, Pharmacy and Health, Durham University, University Boulevard, Queen's Campus, Stockton-on-Tees TS17 6BH, United Kingdom
| | - A Todd
- School of Medicine, Pharmacy and Health, Durham University, University Boulevard, Queen's Campus, Stockton-on-Tees TS17 6BH, United Kingdom
| | - K Jamie
- School of Applied Social Sciences, Durham University, 32 Old Elvet, Durham DH1 3HN, United Kingdom
| | - M Bonam
- AstraZeneca PLC, Charter Way, Macclesfield SK10 2NA, United Kingdom
| | - L Banks
- AstraZeneca PLC, Charter Way, Macclesfield SK10 2NA, United Kingdom
| | - A K Husband
- School of Medicine, Pharmacy and Health, Durham University, University Boulevard, Queen's Campus, Stockton-on-Tees TS17 6BH, United Kingdom.
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16
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Lua AYH, Hong L, Bong SHS, Yeo JLS, Tsang MLP, Ong KZ, Wong SSW, Tan NC. A narrative review of the evaluation and selection of instruments which assess self-efficacy amongst patients with essential hypertension. PROCEEDINGS OF SINGAPORE HEALTHCARE 2015. [DOI: 10.1177/2010105815621327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Hypertension is a chronic disease that is mostly managed by the patients themselves inbetween consultation with their physicians. Self-efficacy, which is an individual’s belief in their capabilities to produce given attainments, is a desirable quality to enable the person to take charge of their health and any long-term illness. Assessment of self-efficacy is thus pivotal in developing a holistic patient-centric care plan to optimize their disease control. For hypertension, self-efficacy is associated with better self-care and outcomes of the disease. This literature review aims to identify self-efficacy assessment instruments, evaluate their origin, quality and development, compare their strengths and limitations, and applicability in specific target population. Searches performed using PubMed, Scopus and The Cochrane Library eventually yielded 34 relevant articles and 12 instruments. All instruments were validated in specific populations. Two instruments were specific to hypertension, two instruments measured multiple domains of self-management, while medication adherence was the most common single domain assessed. To select an appropriate instrument, one should take into consideration the clinical context and study design. An algorithm is proposed to facilitate the selection of instrument that is best suited for the specific purpose.
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Affiliation(s)
- Adela Yi Hui Lua
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Liyue Hong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | | | | | - Kai Zhi Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Ngiap Chuan Tan
- SingHealth Polyclinics, Singapore
- Duke NUS Graduate Medical School, Singapore
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17
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Dolz-Marco R, Gallego-Pinazo R, Díaz-Llopis M, Cunningham ET, Arévalo JF. Noninfectious uveitis: strategies to optimize treatment compliance and adherence. Clin Ophthalmol 2015; 9:1477-81. [PMID: 26316689 PMCID: PMC4547652 DOI: 10.2147/opth.s36650] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Noninfectious uveitis includes a heterogenous group of sight-threatening ocular and systemic disorders. Significant progress has been made in the treatment of noninfectious uveitis in recent years, particularly with regard to the effective use of corticosteroids and non-corticosteroid immunosuppressive drugs, including biologic agents. All of these therapeutic approaches are limited, however, by any given patient’s ability to comply with and adhere to their prescribed treatment. In fact, compliance and adherence are among the most important patient-related determinants of treatment success. We discuss strategies to optimize compliance and adherence.
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Affiliation(s)
- Rosa Dolz-Marco
- Unit of Macula, Department of Ophthalmology, University and Polytechnic Hospital La Fe, Spain
| | - Roberto Gallego-Pinazo
- Unit of Macula, Department of Ophthalmology, University and Polytechnic Hospital La Fe, Spain
| | | | - Emmett T Cunningham
- Department of Ophthalmology, California Pacific Medical Center, San Francisco, CA, USA ; Department of Ophthalmology, Stanford University School of Medicine, Stanford, CA, USA ; The Francis I Proctor Foundation, University of California San Francisco Medical Center, San Francisco, CA, USA ; West Coast Retina Medical Group, San Francisco, CA, USA
| | - J Fernando Arévalo
- Vitreoretina Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia ; Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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18
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Ortega F, Díaz-Corte C, Valdés C. Adherence to immunosuppressor medication in renal transplanted patients. World J Clin Urol 2015; 4:27-37. [DOI: 10.5410/wjcu.v4.i1.27] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 05/27/2014] [Accepted: 12/17/2014] [Indexed: 02/06/2023] Open
Abstract
Non-adherence is a priority public health concern. Non-adherence means not taking medications, missing medications, taking too much, not taking enough, wrong timing, wrong dose and/or wrong pill, but may also refer to missing appointments, not booking appointments, not doing blood work, not returning calls and/or refusal to follow the treatment regimen. In renal transplantation, adherence to immunosuppressive medication is a fundamental requisite in order to preserve graft function, since non-adherence is one of the main causes for late acute rejection, incomplete recovery after rejection treatment, chronic graft dysfunction, graft loss, and death. Transplantation failure due to treatment non-adherence is economically, socially, ethically and morally unjustifiable. This is a very prevalent issue: in some studies, its incidence is as high as 70% of patients. The self-reported nonadherence levels found in certain studies, including those performed immediately after transplantation show the need for early and continued intervention after kidney transplantation in order to maximise adherence and consequently clinical outcomes. There is not a single method to assess non adherence, thus combining several measures increases diagnostic accuracy. Electronic monitoring with a microdevice that records each time a pill bottle is opened is considered the “gold standard” for measuring adherence, but self-report at a confidential interview was the best measure of adherence. Thus non-adherence risk can be effectively assessed using clinically available assessment tools. Medication Adherence Scale, Brief Medical Questionnaire, Immunosuppressant Therapy Adherence Scale, Immunosuppressant Therapy Barrier Scale, Long-Term Medication Behavior Self-Efficacy Scale and Simplified Medication Adherence Questionnaire are some of the self-reported questionnaires. There are multiple factors associated with non-adherence in immunosuppressant therapy: Younger patients (adolescent, especially), poor health coverage, poor social support, unmarried, no family, non-Caucasian, immigrant, lower income, lower socioeconomic class, greater parental distress and lower family cohesion; complex medical regimens, higher number of drugs, longer time after transplant, toxicity, side effects, poor tolerance to medication, higher number of physicians involved, poor provider-patient rapport; psychological (dependency, high levels of anxiety and hostility, poorer behavioral functioning and greater distress in children) and psychiatric (depression) illnesses, low self-efficacy with medicine intake, perception of immunosuppressive therapy as not been necessary to preserve kidney function, forgetfulness, rebelliousness, poor perception of health, poor satisfaction, low Health-related Quality of life, addictions, lack of coping strategies and avoidance behavior; patient morbidity: comorbidity, receiving a transplant from a live donor, retransplantation, and non-insulin-dependent diabetes. The most frequent strategies to promote medication-taking must focus on modifiable risk factors. Reasons for non-adherence are complex and diverse and any successful intervention aimed at improving adherence must be multidimensional. Although effective intervention strategies are needed to improve immunosuppressant therapy adherence, few intervention studies have been conducted in the adult renal transplant population. In this study, we perform an exhaustive review of the different strategies reported in the literature. A number of key reasons for non-adherence are also provided.
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19
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Kjeldsen LJ, Bjerrum L, Dam P, Larsen BO, Rossing C, Søndergaard B, Herborg H. Safe and effective use of medicines for patients with type 2 diabetes – A randomized controlled trial of two interventions delivered by local pharmacies. Res Social Adm Pharm 2015; 11:47-62. [DOI: 10.1016/j.sapharm.2014.03.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 03/26/2014] [Accepted: 03/27/2014] [Indexed: 12/01/2022]
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20
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Farris KB, Carter BL, Xu Y, Dawson JD, Shelsky C, Weetman DB, Kaboli PJ, James PA, Christensen AJ, Brooks JM. Effect of a care transition intervention by pharmacists: an RCT. BMC Health Serv Res 2014; 14:406. [PMID: 25234932 PMCID: PMC4262237 DOI: 10.1186/1472-6963-14-406] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 09/10/2014] [Indexed: 11/10/2022] Open
Abstract
Background Pharmacists may improve medication-related outcomes during transitions of care. The aim of the Iowa Continuity of Care Study was to determine if a pharmacist case manager (PCM) providing a faxed discharge medication care plan from a tertiary care institution to primary care could improve medication appropriateness and reduce adverse events, rehospitalization and emergency department visits. Methods Design. Randomized, controlled trial of 945 participants assigned to enhanced, minimal and usual care groups conducted 2007 to 2012. Subjects. Participants with cardiovascular-related conditions and/or asthma or chronic obstructive pulmonary disease were recruited from the University of Iowa Hospital and Clinics following admission to general medicine, family medicine, cardiology or orthopedics. Intervention. The minimal group received admission history, medication reconciliation, patient education, discharge medication list and medication recommendations to inpatient team. The enhanced group also received a faxed medication care plan to their community physician and pharmacy and telephone call 3–5 days post-discharge. Participants were followed for 90 days post-discharge. Main Outcomes and Measures. Medication appropriateness index (MAI), adverse events, adverse drug events and post-discharge healthcare utilization were compared by study group using linear and logistic regression, as models accommodating random effects due to pharmacists indicated little clustering. Results Study groups were similar at baseline and the intervention fidelity was high. There were no statistically significant differences by study group in medication appropriateness, adverse events or adverse drug events at discharge, 30-day and 90-day post-discharge. The average MAI per medication as 0.53 at discharge and increased to 0.75 at 90 days, and this was true across all study groups. Post-discharge, about 16% of all participants experienced an adverse event, and this did not differ by study group (p > 0.05). Almost one-third of all participants had any type of healthcare utilization within 30 days post-discharge, where 15% of all participants had a 30-day readmission. Healthcare utilization post-discharge was not statistically significant different at 30 or 90 days by study group. Conclusion The pharmacist case manager did not affect medication use outcomes post-discharge perhaps because quality of care measures were high in all study groups. Trial registration Clinicaltrials.gov registration: NCT00513903, August 7, 2007.
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Affiliation(s)
- Karen B Farris
- College of Pharmacy, University of Michigan, 428 Church St, Ann Arbor MI 48109-1065, USA.
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Russell CL, Ashbaugh C, Peace L, Cetingok M, Hamburger KQ, Owens S, Coffey D, Webb AW, Hathaway D, Winsett RP, Madsen R, Wakefield MR. Time-in-a-bottle (TIAB): a longitudinal, correlational study of patterns, potential predictors, and outcomes of immunosuppressive medication adherence in adult kidney transplant recipients. Clin Transplant 2014; 27:E580-90. [PMID: 24093614 DOI: 10.1111/ctr.12203] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2013] [Indexed: 10/23/2022]
Abstract
This study examined patterns, potential predictors, and outcomes of immunosuppressive medication adherence in a convenience sample of 121 kidney transplant recipients aged 21 yr or older from three kidney transplant centers using a theory-based, descriptive, correlational, longitudinal design. Electronic monitoring was conducted for 12 months using electronic monitoring. Participants were persistent in taking their immunosuppressive medications, but execution, which includes both taking and timing, was poor. Older age was the only demographic variable associated with medication adherence (r = 0.25; p = 0.005). Of the potential predictors examined, only medication self-efficacy was associated with medication non-adherence, explaining about 9% of the variance (r = 0.31, p = 0.0006). The few poor outcomes that occurred were not significantly associated with medication non-adherence, although the small number of poor outcomes may have limited our ability to detect a link. Future research should test fully powered, theory-based, experimental interventions that include a medication self-efficacy component.
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Affiliation(s)
- Cynthia L Russell
- School of Nursing and Health Studies, University of Missouri-Kansas City, Kansas City, MO, USA; Research Service, Harry S. Truman Memorial Veterans Hospital, Columbia, MO, USA
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Daouphars M, Ouvry M, Lenain P, Rouvet J, Jardin F, Bubenheim M, Varin R. Preliminary validation of self-assessment tool to measure imatinib adherence in patients with chronic myeloid leukemia. Pharmacotherapy 2013; 33:152-6. [PMID: 23359430 DOI: 10.1002/phar.1174] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
STUDY OBJECTIVES To develop and validate a self-assessment adherence tool for imatinib in patients with chronic myeloid leukemia (CML), and to correlate the use of this tool with response to treatment and adverse effects. DESIGN Retrospective cohort study. SETTING Regional cancer center in France. PATIENTS Forty-six patients with chronic phase CML treated with imatinib for 6 months or longer as of July 1, 2009. MEASUREMENTS AND MAIN RESULTS We developed a self-assessment questionnaire consisting of 10 questions to identify patients who were nonadherent to their cancer treatment. Each answer was worth 1 point, resulting in a possible maximum score of 10. The questionnaire was validated in patients receiving imatinib, using an objective adherence evaluation: a patient's score on the self-assessment questionnaire was correlated with prescription refills, expressed as a medication possession ratio. A score of less than 8 was associated with a positive predictive value of 0.83 to have a medication possession ratio below 90%. With use of this questionnaire, half of the patients receiving imatinib would be identified as being nonadherent (sensitivity 0.5). Few adherent patients would be falsely identified as nonadherent, as the questionnaire's specificity was 0.97. CONCLUSION This self-assessment questionnaire was validated for the first time in patients receiving imatinib for CML treatment. It provides a simple practical tool for health care professionals to assess patient adherence during their routine clinical practice and to propose targeted interventions for those identified as possibly nonadherent.
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Affiliation(s)
- Mikael Daouphars
- Department of Pharmacy, Cancer Centre Henri Becquerel, Rouen, France.
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Wierdsma J, van Zuilen A, van der Bijl J. SELF-EFFICACY AND LONG-TERM MEDICATION USE IN PATIENTS WITH CHRONIC KIDNEY DISEASE. J Ren Care 2011; 37:158-66. [DOI: 10.1111/j.1755-6686.2011.00227.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Constantiner M, Cukor D. Barriers to immunosuppressive medication adherence in high-risk adult renal transplant recipients. ACTA ACUST UNITED AC 2011. [DOI: 10.1002/dat.20536] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Psychometrics of the Computer-Based Relationships With Health Care Provider Scale in Older Adults. J Nurs Meas 2011; 19:3-16. [DOI: 10.1891/1061-3749.19.1.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The type and quality of the provider–patient health care relationship impacts patient adherence. The study purpose was to convert the 5-item paper and pencil Relationships With Health Care Provider Scale (RHCPS) to a reliable and valid computer-based scale for use with older adults. Outpatient adults (N = 121) older than 59 years were recruited. The RHCPS underwent several iterations documenting internal consistency reliability, content and factorial validity, and scale usability in a computer tablet format. A total of 5 expert judges rated all 5 items as valid, which resulted in a scale content validity index of 1. Cronbach’s standardized alpha was .81. Principal components analysis extracted 1 factor (eigenvalue > 1; confirmed by scree plot) as anticipated. Computer-based RHCPS has the potential to reveal valuable clinical and scientific data on patient–provider relationships among older adults.
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Krummenacher I, Cavassini M, Bugnon O, Spirig R, Schneider MP. Antiretroviral adherence program in HIV patients: a feasibility study in the Swiss HIV Cohort Study. ACTA ACUST UNITED AC 2010; 32:776-86. [DOI: 10.1007/s11096-010-9437-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Accepted: 08/30/2010] [Indexed: 11/24/2022]
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Russell CL, Cetingok M, Hamburger KQ, Owens S, Thompson D, Hathaway D, Winsett RP, Conn VS, Madsen R, Sitler L, Wakefield MR. Medication adherence in older renal transplant recipients. Clin Nurs Res 2010; 19:95-112. [PMID: 20185804 DOI: 10.1177/1054773810362039] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This project examined patterns, predictors, and outcomes of medication adherence in a convenience sample of 37 renal transplant recipients aged 55 years or older in a Mid-Southern U.S. facility using an exploratory, descriptive, longitudinal design. Electronic monitoring was conducted for 12 months using the Medication Event Monitoring System. An alarming 86% of the participants were nonadherent with medications. Four clusters of medication taking and timing patterns were identified with evening doses presenting particular challenges. Depression, self-efficacy, social support, and medication side effects did not predict medication adherence. There was no significant difference in medication adherence scores between those with and without infections. Medication adherence pattern data from electronic monitoring provides an opportunity for health care professionals to move away from blaming the patient by attempting to identify predictors for medication nonadherence. Medication dose taking and timing patterns could be explored with patients so that medication adherence interventions could target specific patient patterns.
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Affiliation(s)
- Cynthia L Russell
- Sinclair School of Nursing, University of Missouri, Columbia, MO 65203, USA.
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Criswell TJ, Weber CA, Xu Y, Carter BL. Effect of self-efficacy and social support on adherence to antihypertensive drugs. Pharmacotherapy 2010; 30:432-41. [PMID: 20411995 PMCID: PMC4073236 DOI: 10.1592/phco.30.5.432] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
STUDY OBJECTIVE To determine the relationship between poor adherence and self-efficacy or social support after a pharmacist intervention. DESIGN Post-hoc analysis of data from two randomized controlled trials of physician-pharmacist collaborative interventions (6 and 9 mo, respectively) to improve blood pressure control. SETTING Eleven university-affiliated primary care clinics. PATIENTS Five hundred eighty-four patients (aged 21-85 yrs) with uncontrolled primary hypertension; 296 were in the intervention group and 288 were in the control group. INTERVENTION Pharmacists provided intensified hypertension management and drug adherence counseling to patients in the intervention group. MEASUREMENTS AND MAIN RESULTS Social support and self-efficacy questionnaires were administered at baseline and end-of-study visits. Patient adherence was monitored by using the Morisky self-reported adherence questionnaire. Self-reported adherence scores improved significantly in the control group (p=0.0053) but not in the intervention group; however, adherence at baseline in both groups was high. There were small, but significant, improvements in self-efficacy (p<0.04) and social support (p<0.05) scores in the intervention group but not the control group at the end of the study. Social support and, to a lesser extent, self-efficacy improved as a function of duration of study participation (9-mo vs 6-mo intervention), regardless of whether the patient received the intervention. Blood pressure control in both groups improved significantly at the end of the study; however, mean blood pressure was significantly lower in the intervention group (129.7/76.6 mm Hg) compared with the control group (140.8/78.9 mm Hg; p<0.0001 for systolic, p=0.032 for diastolic). CONCLUSION Social support and self-efficacy improved significantly in the intervention group at the end of the pharmacist intervention. Drug adherence was correlated with self-efficacy even though drug adherence did not improve significantly in the intervention group. The fact that social support and self-efficacy improved as a function of duration of study participation suggests that participation in a research study may have had a positive influence on these measures. Even though the changes in social support, self-efficacy, and drug adherence were modest, there was significantly better blood pressure control in the intervention group compared with the control group. These findings indicate that changes in drug adherence, self-efficacy, or social support probably played a minor role in the blood pressure outcomes in these studies.
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Affiliation(s)
- Thomas J Criswell
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, Iowa 52242, USA
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Johnson VR, Jacobson KL, Gazmararian JA, Blake SC. Does social support help limited-literacy patients with medication adherence? A mixed methods study of patients in the Pharmacy Intervention for Limited Literacy (PILL) study. PATIENT EDUCATION AND COUNSELING 2010; 79:14-24. [PMID: 19647967 DOI: 10.1016/j.pec.2009.07.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2008] [Revised: 06/25/2009] [Accepted: 07/02/2009] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To explore whether social support helps patients with limited health literacy adhere to their medication regimens. METHODS We interviewed 275 pharmacy patients and assessed social support's influence on medication adherence for those with limited vs. adequate health literacy. We talked with patients (n=26) and pharmacists (n=7) to explore possible explanations for the quantitative findings. RESULTS Social support was associated with better medication adherence for patients with adequate health literacy but not those with limited health literacy (p<0.05). When individual subscales for social support were analyzed, having a trusted confidant was the only type of social support associated with better medication adherence for limited-literacy patients (p<0.05). Comments from patients and pharmacists suggest that limited-literacy patients were less likely to ask the pharmacists questions and infrequently brought relatives with them to the pharmacy. CONCLUSION Unless they have a trusted confidant, limited-literacy patients might be reluctant to ask others for the kind of help needed to take their medicines correctly. PRACTICE IMPLICATIONS Pharmacists need training to increase their awareness of limited health literacy and to communicate effectively with all patients, regardless of their literacy skills. To succeed, pharmacists also need the support of the health care systems where they work.
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Affiliation(s)
- Valerie R Johnson
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
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Swanlund SL. Successful cardiovascular medication management processes as perceived by community-dwelling adults over age 74. Appl Nurs Res 2010; 23:22-9. [DOI: 10.1016/j.apnr.2008.03.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2007] [Revised: 03/17/2008] [Accepted: 03/22/2008] [Indexed: 11/30/2022]
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Neafsey PJ, Anderson E, Coleman C, Lin CA, M’lan CE, Walsh S. Reducing adverse self-medication behaviors in older adults with the Next Generation Personal Education Program (PEP-NG): Design and methodology. Patient Prefer Adherence 2009; 3:323-34. [PMID: 20016796 PMCID: PMC2792870 DOI: 10.2147/ppa.s7906] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A randomized controlled efficacy trial targeting older adults with hypertension is providing a tailored education intervention with a Next Generation Personal Education Program (PEP-NG) in primary care practices in New England. Ten participating advanced practice registered nurses (APRNs) completed online knowledge and self-efficacy measures pre-onsite training and twice more after completing a continuing education program. Patient participants self-refer in response to study recruitment brochures and posters. Twenty-four participants from each APRN practice (total N = 240) are randomly assigned by the PEP-NG software to either control (data collection and four routine APRN visits) or tailored intervention (PEP-NG interface and four focused APRN visits) conditions. Patients access the PEP-NG interface via wireless tablet and use a stylus to answer demographic, knowledge, and self-efficacy questions as well as prescription and over-the-counter self-medication practice questions. The PEP-NG analyzes patient-reported information and delivers tailored educational content. Patients' outcome measures are self-reported antihypertensive medication adherence, blood pressure, knowledge and self-efficacy concerning potential adverse self-medication practices, adverse self-medication behavior "risk" score and satisfaction with the PEP-NG and APRN provider relationship. APRN outcome measures are knowledge and self-efficacy concerning adverse self-medication practices, self-efficacy for communicating with older adults and satisfaction with the PEP-NG. Time-motion and cost-benefit analyses will be conducted.
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Affiliation(s)
| | | | | | - Carolyn A Lin
- Center for Health Intervention and Prevention (CHIP)
- Department of Communication Sciences
| | | | - Stephen Walsh
- Center for Nursing Research, School of Nursing, University of Connecticut, Storrs, CT, USA
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Prevalence, determinants, and outcomes of nonadherence to imatinib therapy in patients with chronic myeloid leukemia: the ADAGIO study. Blood 2009; 113:5401-11. [PMID: 19349618 DOI: 10.1182/blood-2008-12-196543] [Citation(s) in RCA: 450] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Imatinib mesylate (imatinib) has been shown to be highly efficacious in the treatment of chronic myeloid leukemia (CML). Continuous and adequate dosing is essential for optimal outcomes and with imatinib treatment possibly being lifelong, patient adherence is critical. The ADAGIO (Adherence Assessment with Glivec: Indicators and Outcomes) study aimed to assess prospectively over a 90-day period the prevalence of imatinib nonadherence in patients with CML; to develop a multivariate canonical correlation model of how various determinants may be associated with various measures of nonadherence; and to examine whether treatment response is associated with adherence levels. A total of 202 patients were recruited from 34 centers in Belgium, of whom 169 were evaluable. One-third of patients were considered to be nonadherent. Only 14.2% of patients were perfectly adherent with 100% of prescribed imatinib taken. On average, patients with suboptimal response had significantly higher mean percentages of imatinib not taken (23.2%, standard deviation [SD] = 23.8) than did those with optimal response (7.3%, SD = 19.3, P = .005; percentages calculated as proportions x 100). Nonadherence is more prevalent than patients, physicians, and family members believe it is, and therefore should be assessed routinely. It is associated with poorer response to imatinib. Several determinants may serve as alert signals, many of which are clinically modifiable.
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Gordon EJ, Gallant M, Sehgal AR, Conti D, Siminoff LA. Medication-taking among adult renal transplant recipients: barriers and strategies. Transpl Int 2009; 22:534-45. [PMID: 19175560 DOI: 10.1111/j.1432-2277.2008.00827.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Medication adherence is essential for the survival of kidney grafts, however, the complexity of the medication-taking regimen makes adherence difficult. Little is known about barriers to medication-taking and strategies to foster medication-taking. This cross-sectional study involved semi-structured interviews with 82 kidney transplant recipients approximately 2 months post-transplant on medication-related adherence, barriers to medication-taking, and strategies to foster medication-taking. Although self-reported adherence was high (88%), qualitative analysis revealed that half of the patients (49%) reported experiencing at least one barrier to medication-taking. The most common barriers were: not remembering to refill prescriptions (13%), changes to medication prescriptions or dosages (13%), being busy (10%), forgetting to bring medicines with them (10%), and being away from home (10%). The most common strategies to foster medication-taking were: maintaining a schedule of medication-taking (60%), organizing pills using pillboxes, baggies, cups (42%), bringing medicines with them (34%), organizing pills according to routine times (32%), and relying on other people to remind them (26%). Understanding the range of barriers to adherence and strategies kidney recipients devised to promote medication-taking may help transplant clinicians to better educate transplant recipients about appropriate medication-taking, mitigate the risk of medication nonadherence-related rejection, and may help inform patient-centered interventions to improve medication adherence.
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Affiliation(s)
- Elisa J Gordon
- Institute for Healthcare Studies, Department of Surgery, Division of Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
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Weber CA, Leloux MR, Carter BL, Farris KB, Xu Y. Reduction in adverse symptoms as blood pressure becomes controlled. Pharmacotherapy 2009; 28:1104-14. [PMID: 18752381 DOI: 10.1592/phco.28.9.1104] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
STUDY OBJECTIVES To evaluate trends in adverse symptoms as blood pressure becomes controlled, and to determine if these symptoms are influenced by social support and self-efficacy. DESIGN Secondary analysis from a randomized controlled study of physician-pharmacist collaboration to improve blood pressure control. SETTING Five university-affiliated primary care clinics. PATIENTS A total of 179 patients (aged 21-85 yrs) with uncontrolled primary hypertension who were taking no antihypertensive drugs or up to three antihypertensive drugs at baseline were randomized to the intervention group, in which pharmacists were involved in their care, or to the control group, who received usual care from their physicians. Of these patients, 160 completed the study: 92 were in the intervention group, and 68 were in the control group. INTERVENTION In both groups, patient-reported symptoms suggestive of adverse drug reactions (ADRs) were recorded at each study visit with use of a structured ADR questionnaire. Social support and self-efficacy questionnaires were also administered at each study visit. MEASUREMENTS AND MAIN RESULTS Patients' ADR scores decreased significantly from baseline to the end of the study in both the control (from a mean of 26.5 to 18.4) and intervention (from 29.9 to 22.7) groups (p<0.0001 for both comparisons), although no significant difference was noted between groups. The mean +/- SD number of antihypertensive drugs/patient increased in both the intervention (from 1.5 +/- 1.0 to 2.4 +/- 0.9 drugs) and control (from 1.4 +/- 1.0 to 1.9 +/- 1.0 drugs) groups; however, the difference between groups was significant only at the end of the study. Additional analyses were performed on self-efficacy and social support to determine a potential reason for the reduction in ADR scores despite an increase in drug use. Improvements in self-efficacy and social support scores were significantly and independently associated with improvement in ADR score (p<0.05). CONCLUSIONS In both groups, ADR scores improved despite an increase in antihypertensive drug use. Improvements in social support and, to a lesser extent, self-efficacy were associated with improvements in ADR scores. Patients should not expect an increase in distressful symptoms as their blood pressure becomes controlled with antihypertensive drugs, especially when adequate social support is available.
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Affiliation(s)
- Cynthia A Weber
- Division of Clinical and Administrative Pharmacy, College of Pharmacy, University of Iowa, Iowa City, Iowa 52242, USA
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Abstract
BACKGROUND After an acute cardiac event, adhering to recommendations for pharmacologic therapy is important in achieving optimal health outcomes. Considering the impressive evidence base for cardiovascular pharmacotherapy, strategies for promoting adherence are less well developed. Furthermore, accessing reliable, valid, and cost-effective mechanisms of monitoring adherence in the research and clinical settings is challenging. AIM The aim of this article was to review published self-report measures assessing and monitoring medication adherence in cardiovascular disease and provide recommendations for research into medication adherence. METHODS The electronic databases CINAHL, Medline, and Science Direct were searched using the key search terms medication adherence and/or compliance, cardiovascular, self-report measures, and questionnaires. The World Wide Web was searched using the Google and Google Scholar search engines, and reference lists of retrieved documents were reviewed. The search strategy was verified by a health librarian. Instruments were included if they specifically addressed medication adherence as a discrete construct rather than a disease-specific or a generic health status measurement. FINDINGS Despite of the problems with medication adherence identified in the literature, only 7 instruments met the search criteria. There was limited use of instruments across studies and settings to enable comparison across populations and extensive psychometric evaluation. CONCLUSIONS Medication adherence is a complex, multifaceted construct dependent on a range of physical, social, economic, and psychological considerations. In spite of the importance of adherence in ensuring optimal cardiovascular outcomes, conceptual underpinnings and methods of assessing medication adherence require further discussion and debate.
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Neafsey PJ, Anderson E, Peabody S, Lin CA, Strickler Z, Vaughn K. Beta testing of a network-based health literacy program tailored for older adults with hypertension. Comput Inform Nurs 2008; 26:311-9. [PMID: 19047879 PMCID: PMC3655693 DOI: 10.1097/01.ncn.0000336466.17811.e7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A touch screen-enabled "Personal Education Program" was modified to the "next generation" to capture self-medication behaviors of older adults with hypertension and assess related knowledge and self-efficacy. The program analyzes patient-entered information and delivers interactive educational content tailored to the reported behaviors. Summaries of self-reported symptoms, medication use (including frequency/time), drug interactions, and corrective strategies with an illustration of the drug interaction are printed to inform the provider before the primary care visit and for the patient to take home for self-study. After formative research during development and formal diagnostic and verification usability studies with advanced practice nurses and older adults, a beta test was conducted with older adults with hypertension over a 3-month period. Findings from the beta test suggest that older adult user satisfaction was high. Blood pressure declined over the four visits for 82% of the participants. The next generation of the Personal Education Program had a large effect size in increasing knowledge and self-efficacy for avoiding adverse self-medication behaviors. Behavior risk score did not change significantly but was significantly correlated with systolic blood pressure on the fourth visit. The positive results found in this small sample suggest that the next generation of the Personal Education Program could play a central role in facilitating patient-provider communication and medication adherence.
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Affiliation(s)
- Patricia J Neafsey
- School of Nursing, University of Connecticut, Storrs, Connecticut 06269, USA.
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Swanlund SL, Scherck KA, Metcalfe SA, Jesek-Hale SR. Keys to Successful Self-Management of Medications. Nurs Sci Q 2008; 21:238-46. [DOI: 10.1177/0894318408319276] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Medication use by community-dwelling elderly accounts for a significant portion of all U.S. drug use. Many elderly manage over three prescriptions a day. Recent evidence indicates that non-adherence to prescribed drug regimens can lead to symptoms that result in hospitalizations. The study's purpose was to explore self-management of medications as perceived by community-dwelling elderly. Guided by Orem's Self-Care Deficit Nursing Theory, 19 older adults were interviewed about their medication self-management practices. Inductive data analysis revealed three major themes: successful self-management of medications, living orderly, and aging well. Success in establishing individual management systems may be the result of developing and maintaining orderly lifestyles.
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Gamble J, Fitzsimons D, Lynes D, Heaney LG. Difficult asthma: people's perspectives on taking corticosteroid therapy. J Clin Nurs 2008; 16:59-67. [PMID: 17518870 DOI: 10.1111/j.1365-2702.2006.01750.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES This study aimed to explore the experiences of patients with difficult asthma, who take corticosteroid therapy, and provide insight into why some patients comply with therapy, whilst others do not. BACKGROUND Asthma is growing in prevalence and affects more than 100 million people worldwide. Corticosteroids are the mainstay treatment but, despite considerable risk to the individual in terms of morbidity and mortality, compliance is low. Previous research has been mainly quantitative and analysed variables associated with compliance, doing little to increase professional understanding of the patient's perspective on taking corticosteroid treatment. METHODS A hermeneutic phenomenological approach was selected as most appropriate for this study. Unstructured interviews were undertaken with a purposive sample of 10 participants. Interviews were taped, transcribed and the data were analysed using a multi-step technique described by Holloway. FINDINGS Fear of side effects was the strongest theme to emerge; illustrated by the negative images participants described such as weight gain, anxiety, irritability and depression. Participants related control and power over their condition to knowledge and information. They wanted more information, but believed that health professionals assumed they were already well informed. Costs and benefits of treatment were weighed up before decisions were made. Participants described feelings of 'not being themselves' and personality changes resulting in the loss of their role within relationships. Routine, time and opinions of significant others, also impacted on taking steroids. CONCLUSION Decision-making was a complex process, involving evaluation of the personal costs and benefits of treatment; fear of side effects was the dominant concern. Compliance with treatment saves lives in this population. RELEVANCE TO CLINICAL PRACTICE This study uncovers issues participants consider when making decisions regarding adherence and highlights the importance of the nurse's role in eliciting patients' concerns and the providing appropriate information to allay fears and misconceptions.
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Affiliation(s)
- Jacqueline Gamble
- Regional Respiratory Centre, Belfast City Hospital, Belfast, Ireland, UK.
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Lerut E, Kuypers DR, Verbeken E, Cleutjens J, Vlaminck H, Vanrenterghem Y, Van Damme B. Acute rejection in non-compliant renal allograft recipients: a distinct morphology. Clin Transplant 2007; 21:344-51. [PMID: 17488383 DOI: 10.1111/j.1399-0012.2007.00647.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Non-compliance for immunosuppressive medication is frequent in renal transplant recipients, and associated with late acute rejection and graft loss. Although numerous studies were published on risk factors and outcome, no data are available on the histopathology of the 'non-compliant' allograft. As non-compliant patients swing between subtherapeutic and toxic doses of immunosuppression, trough levels show large variation. We questioned whether the histology of acute rejection in non-compliers (i) differs from the 'classical' acute rejection; (ii) shows more concomitant calcineurin-inhibitor toxicity; (iii) is associated with C4d and plasma cell (PC)-rich infiltrates. Based on validated interview methods/self reporting, 145 adult renal allograft recipients, transplanted for greater than one yr, on cyclosporine A and corticosteroids, were categorized as either compliant or non-compliant. Non-compliance was defined in 32 patients (22.1%). All late (greater than one yr) allograft biopsies were reviewed (Banff) and immuno-stained for C4d. Computerized morphometry was performed on late biopsies with features of acute cellular rejection. Sixty-two patients had > or =1 late biopsy [41 (36.2%) compliant/21 (65.6%) non-compliant; p = 0.0043], comprising a pool of 90 biopsies (61 compliant/29 non-compliant; p = 0.0303). 'Non-compliant' biopsies had higher scores of C4d (p = 0.0092), acute tubular damage (p = 0.0058), and peritubular capillaritis (p = 0.0070). 'Non-compliant' biopsies with acute cellular rejection showed less interstitial edema (p = 0.0165), more interstitial infiltrate (p = 0.0100), more interstitial fibrosis (p = 0.0277), and more tubular atrophy (p = 0.0197). PC-rich infiltrates correlated with C4d (p = 0.0080). Detection of non-compliance is mandatory as it represents an important cause of graft loss. This study describes histologic features of renal allograft biopsies in non-compliant patients that could help identifying this patient profile.
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Affiliation(s)
- Evelyne Lerut
- Departments of Morphology and Molecular Pathology, University Hospitals Leuven, Leuven, Belgium.
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Denhaerynck K, Steiger J, Bock A, Schäfer-Keller P, Köfer S, Thannberger N, De Geest S. Prevalence and risk factors of non-adherence with immunosuppressive medication in kidney transplant patients. Am J Transplant 2007; 7:108-16. [PMID: 17109727 DOI: 10.1111/j.1600-6143.2006.01611.x] [Citation(s) in RCA: 138] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Non-adherence with immunosuppressive regimen is a major risk factor for poor outcome after kidney transplantation. Identifying patients at risk for non-adherence requires understanding the risk factors for non-adherence. This prospective study included a convenience sample of 249 adult kidney transplant patients >1 year post-transplant. Non-adherence was monitored electronically using MEMS(R). Selected socio-economic, therapy-, patient-, condition- and healthcare team-related risk factors for non-adherence were assessed. Period prevalences were expressed as the percent of prescribed doses taken (taking adherence), the percent of correctly dosed days (dosing adherence), the percentage of inter-dose intervals not exceeding 25% of the prescribed interval (timing adherence), and the number of drug holidays per 100 days (no intake for > 48 h if once daily or for > 24 h if twice daily intake). Testing occurred by simple mixed logistic regression analysis. Factors significant after correction for multiple testing were entered into a multiple logistic regression model. Mean taking, dosing, timing adherence, and drug holidays were 98%, 96%, 93%, and 1.1 days, respectively. Non-adherence was associated with lower self-efficacy, higher self-reported non-adherence, no pillbox usage, and male gender. Adherence declined between Monday and Sunday. This study provides a framework for identifying patients at risk for non-adherence and for developing adherence-enhancing interventions.
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Affiliation(s)
- K Denhaerynck
- Institute of Nursing Science, University of Basel & Clinical Nursing Science, University Hospital Basel, Switzerland
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De Geest S, Schäfer-Keller P, Denhaerynck K, Thannberger N, Köfer S, Bock A, Surber C, Steiger J. Supporting medication adherence in renal transplantation (SMART): a pilot RCT to improve adherence to immunosuppressive regimens. Clin Transplant 2006; 20:359-68. [PMID: 16824155 DOI: 10.1111/j.1399-0012.2006.00493.x] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although non-adherence to an immunosuppressive regimen (NAH) is a major risk factor for poor outcome after renal transplantation (RTx), very few studies have examined non-adherence intervention in this context. This pilot randomized controlled trial (RCT) tested the efficacy of an educational-behavioural intervention to increase adherence in non-adherent RTx patients. We also assessed how NAH evolves over time. METHODS Eighteen RTx non-adherent patients (age: 45.6 +/- 1.2 yr; 78.6% male) were randomly assigned to either an intervention group (IG) (n = 6) or an enhanced usual care group (EUCG) (n = 12), the latter receiving the usual clinical care. The IG received one home visit and three telephone interviews. We assessed NAH through electronic monitoring (EM) of medication intake during a nine-month period (three months intervention, six months follow-up). RESULTS Five of 18 patients withdrew. Inclusion in the study resulted in a remarkable decrease in NAH in both groups over the first three months (IG chi(2) = 3.97, df = 1, p = 0.04; EUCG chi(2) = 3.40, df = 1, p = 0.06). The IG showed the greatest decrease in NAH after three months, although this did not reach statistical significance (at 90 d, chi(2) = 1.05, df = 1, p = 0.31). Thereafter, NAH increased gradually in both groups, reaching comparable levels at the end of the six-month follow-up (i.e. at nine months). CONCLUSION Our findings suggest an inclusion effect. Although the intervention in this pilot RCT appeared to add further benefit in medication compliance, a lack of statistical power prevented us from making a strong statistical statement.
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Affiliation(s)
- Sabina De Geest
- Institute of Nursing Science, University of Basel, Switzerland.
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Berg J, Nyamathi A, Christiani A, Morisky D, Leake B. Predictors of screening results for depressive symptoms among homeless adults in Los Angeles with latent tuberculosis. Res Nurs Health 2005; 28:220-9. [PMID: 15884031 PMCID: PMC3109748 DOI: 10.1002/nur.20074] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The purpose of this study was to examine predictors of screening results for depressive symptoms in a Los Angeles homeless population with latent tuberculosis (TB). Four hundred and fifteen homeless adults participating in a nurse case managed intervention were included in this analysis. Logistic regression results indicated that those who reported a physical health limitation, multiple sex partners, daily drug use, alcohol dependence, or not having completed high school, were more likely to screen positive. Social support from non-drug users was protective. Given the importance of adherence to TB treatment regimens, the high prevalence of a positive screening for depressive symptoms in the homeless and the potential for depression to reduce adherence rates, routine screening and treatment for depression in high risk homeless adults being treated for TB may be warranted.
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Affiliation(s)
- Jill Berg
- School of Nursing, University of California, Los Angeles, CA
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Deschamps AE, Graeve VDE, van Wijngaerden E, De Saar V, Vandamme AM, van Vaerenbergh K, Ceunen H, Bobbaers H, Peetermans WE, de Vleeschouwer PJ, de Geest S. Prevalence and correlates of nonadherence to antiretroviral therapy in a population of HIV patients using Medication Event Monitoring System. AIDS Patient Care STDS 2004; 18:644-57. [PMID: 15633262 DOI: 10.1089/apc.2004.18.644] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Nonadherence to antiretroviral therapy (ART) jeopardizes good clinical outcome in people living with HIV. In a single-center prospective study, prevalence and correlates of nonadherence were investigated in 43 patients on ART. Nonadherence was assessed using Medication Event Monitoring System (MEMS), self-report and collateral report of treating physicians. Based on MEMS data, median taking adherence, dosing adherence, and timing adherence was 98% (interquartile range [IQR] = 5.3), 91.5% (IQR = 18), and 86% (IQR = 31.5), respectively. The median number of drug holidays per 100 days was 0.8 (IQR = 4.8). The prevalence of nonadherence measured by MEMS was 40%. Self-reported nonadherence and collateral report of nonadherence by physicians varied from 5% to 41% and 24% to 28%, respectively. Patients were categorized as adherent or nonadherent based on a clinically validated algorithm derived from MEMS parameters. Nonadherent patients used significantly more escaping coping strategies (p = 0.003) and planned problem solving strategies (p = 0.049), were prescribed significantly more antiretroviral medications (p = 0.02) and were significantly longer on ART (p = 0.04) than adherent patients. Identified correlates of nonadherence may help clinicians in detecting patients with HIV at risk for nonadherence and can support the development of adherence enhancing interventions.
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Affiliation(s)
- Ann E Deschamps
- University Hospitals KU-Leuven, Department of Internal Medicine, Leuven, Belgium
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Iihara N, Tsukamoto T, Morita S, Miyoshi C, Takabatake K, Kurosaki Y. Beliefs of chronically ill Japanese patients that lead to intentional non-adherence to medication. J Clin Pharm Ther 2004; 29:417-24. [PMID: 15482384 DOI: 10.1111/j.1365-2710.2004.00580.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To identify factors, associated with personal beliefs, involved in intentional non-adherence to prescribed medication of Japanese patients with chronic diseases. METHODS A cross-sectional study of Japanese subjects with chronic, primarily liver, gastrointestinal, or nervous system diseases who had been prescribed oral medicines for regular use, was performed. The subjects were admitted to a university hospital and were interviewed face-to-face on admission. Intentional non-adherence was defined as experience of deliberate adjustment of self-managed prescription medicines during the few months prior to hospital admission. Patients' beliefs about taking medicines were assessed from the perspective of what the patient valued in order to take medicines without anxiety; whether the patient valued information about the medication such as its function and side-effects and/or mutual reliance on doctors. Using logistic multivariate regression analyses, factors associated with intentional non-adherence were identified. RESULTS Among 154 subjects, 51 showed intentional non-adherence. Intentional non-adherence was associated with the following three factors: (a) the patients' beliefs with respect to taking medicines without anxiety, especially putting no value on mutual reliance on the patient-doctor relationship (P < 0.001) and putting great value on knowing the drug's side-effects (P < 0.001), (b) poor comprehension of general aspects of medication (P for trend < 0.001), and (c) being in the prime of life (40-59 years) (P = 0.011). Comprehension of the function of each medicine, experience of side-effects, anxiety about taking medicines, and the number of types of medicines taken, were not associated with non-adherence. CONCLUSIONS Beliefs on which individual Japanese patients with chronic diseases attach value in order to take medicines without anxiety were potential factors for intentional non-adherence. This emphasizes the necessity of a patient-oriented approach to take account of patients' personal beliefs about medicines to increase adherence rate in Japan.
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Affiliation(s)
- N Iihara
- Department of Pharmacy, Kagawa University Hospital, Ikenobe Miki-cho, Kita-gun, Japan.
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Robbins B, Rausch KJ, Garcia RI, Prestwood KM. Multicultural medication adherence: a comparative study. J Gerontol Nurs 2004; 30:25-32. [PMID: 15287324 DOI: 10.3928/0098-9134-20040701-07] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The purpose of this study was to evaluate the effect of several interventions on improving medication adherence among White, Black, and Hispanic older women. A total of 109 women older than age 65 who were participating in a clinical osteoporosis trial were recruited for this 12-month study examining medication adherence. After baseline medication adherence was assessed, participants underwent standardized teaching. Participants were contacted monthly by telephone and were seen in a clinic setting every 3 months. All participants used a pillbox for 6 months, and the minority women used an electronic monitoring bottle for 6 months. Adherence was highest in White women. Black women showed significant improvement in adherence at 9 and 12 months, and Hispanic women demonstrated a significant increase in adherence at 12 months. The use of electronic monitors had a positive effect on adherence for the minority women.
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Affiliation(s)
- Bertha Robbins
- Clinical Trials Unit, Connecticut Children's Medical Center, Hartford 06106, USA
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Denhaerynck K, Abraham I, Gourley G, Drent G, De Vleeschouwer P, Papajcik D, Lince E, De Geest S. Validity Testing of the Long-Term Medication Behavior Self-Efficacy Scale. J Nurs Meas 2003; 11:267-82. [PMID: 15633781 DOI: 10.1891/jnum.11.3.267.61271] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Self-efficacy is an important determinant of health behavior that can be targeted for intervention. Little effort has been given to the development of valid measures for self-efficacy with medication taking for adherence research. The purpose of this study was to determine the criterion validity of the Long-Term Medication Behavior Self-Efficacy Scale (LTMBSES). Individual patient data from 6 existing adherence studies in transplant, hyperlipidemia, and AIDS/HIV patients (n = 1021) were pooled. Validity was determined by assessing the relation between the LTMBSES score and medication adherence—both self-reported and electronically monitored. A weak relationship was found between the LTMBSES score and adherence, which can possibly be attributed to a ceiling effect, caused by a too homogeneous population and/or a failure of the scale to challenge patients. Generalized Estimating Equations revealed that the total average self-efficacy score predicted reported medication adherence (p < .0001). The Receiver Operating Characteristic curve revealed the area under the curve was 0.67, indicating a significant (p < .0001), but poor predictive capability. Evidence for criterion validity of the Long-Term Medication Behavior Self-Efficacy Scale is not yet convincing. Future research should focus on: (1) validation in a population with a more heterogenous level of adherence, and (2) making the scale more challenging by referring to “always taking the medication without exception.”
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Ramírez García P, Côté JK. Factors affecting adherence to antiretroviral therapy in people living with HIV/AIDS. J Assoc Nurses AIDS Care 2003; 14:37-45. [PMID: 12953611 DOI: 10.1177/1055329003252424] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Antiretroviral treatments have given hope to people living with HIV/AIDS and play a role in improving their quality of life. However, the effectiveness of these treatments is directly related to the level of adherence and commitment to them. Researchers have demonstrated that there are many factors that play an important role in adopting and maintaining adherence behavior. In this article, the authors present an indepth review of the literature and from this, enumerate the factors that link adherence behavior to the individual, the treatment, the illness, and the relationship with the health professional. An understanding of these factors is essential to develop interventions that will improve adherence to therapeutic regimens among people with HIV/AIDS.
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Smith SR, Rublein JC, Marcus C, Brock TP, Chesney MA. A medication self-management program to improve adherence to HIV therapy regimens. PATIENT EDUCATION AND COUNSELING 2003; 50:187-199. [PMID: 12781934 DOI: 10.1016/s0738-3991(02)00127-1] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
This study examined whether a self-management intervention based on feedback of adherence performance and principles of social cognitive theory improves adherence to antiretroviral dosing schedules. Forty-three individuals with HIV/AIDS who were starting or switching to a new protease inhibitor regimen were randomly assigned to be in a medication self-management program or usual care control group. The self-management program included skills development exercises, three monthly visits for medication consultations, and monthly feedback of adherence performance using electronic monitors on medication bottles. Participants also completed a 40-item questionnaire that measured self-efficacy to take medications, on schedule, in a variety of situations. Logistic regression analysis indicated that individuals in the self-management group were significantly more likely to take 80% or more of their doses each week than individuals in the control group (n=29, OR=7.8, 95% CI=2.2-28.1). Self-management training with feedback of adherence performance is a potentially useful model for improving adherence to complex regimens in HIV/AIDS care.
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Affiliation(s)
- Scott R Smith
- School of Pharmacy, Center for AIDS Research, University of North Carolina at Chapel Hill, Beard Hall, Campus Box #7360, Chapel Hill, NC 27599-7360, USA.
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St-Louis L, Robichaud-Ekstrand S. Knowledge level and coping strategies according to coagulation levels in older persons with atrial fibrillation. Nurs Health Sci 2003; 5:67-75. [PMID: 12603723 DOI: 10.1046/j.1442-2018.2003.00136.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The present study examined the knowledge level and the coping strategies of older persons with atrial fibrillation, who were on oral anticoagulant therapy. The relationship among knowledge level, problem and affective-oriented coping strategies, and the level of anticoagulant effectiveness were examined. We also compared differences between subjects who were within a therapeutic range for International Normalized Ratio levels with those who were not. The research design was descriptive and correlational. One hundred older persons completed the Jaloweic Coping Scale (a knowledge questionnaire) and socio-demographic, contextual and clinical characteristic questions. The findings suggested that the knowledge levels were low (53%), and problem-oriented coping strategies were most often used (32.62%) compared to affective-oriented coping strategies (18.96%). Other than praying and putting one's trust in God (P = 0.05), it appeared that no other significant coping strategies differentiated the subjects regarding their level of anticoagulant effectiveness. It is recommended that further examination of the reasons for older persons' low knowledge level, in regard to their oral anticoagulant therapy, occurs and that use of problem-oriented coping strategies, to improve self-care measures, be encouraged.
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Affiliation(s)
- Lyne St-Louis
- Sir Mortimer B. Davis Jewish General Hospital of Montreal, Quebec, Canada.
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Resnick B, Wehren L, Orwig D. Reliability and validity of the self-efficacy and outcome expectations for osteoporosis medication adherence scales. Orthop Nurs 2003; 22:139-47. [PMID: 12703398 DOI: 10.1097/00006416-200303000-00012] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The purpose of this study was to test the reliability and validity of the self-efficacy and outcome expectations for osteoporosis medication adherence measures (SEOMA and OEOMA). DESIGN This was a descriptive study involving a single face-to-face interview. SAMPLE The study included 152 older adults with a mean age of 85.7 (+) 5.5 years, the majority of whom were Caucasian (99%), female (74%), and unmarried (75%). METHODS In addition to the SEOMA and OEOMA measures, demographic information (age, gender, and marital status) and other health behaviors (exercise and osteoporosis medication use) were explored. RESULTS There was evidence of reliability of the SEOMA and OEOMA based on internal consistency and R values. Evidence of the validity of the SEOMA and OEOMA measures was based on confirmatory factor analysis and hypothesis testing. CONCLUSION This study is an important first step to developing reliable and valid measures of self-efficacy and outcome expectations for adherence to osteoporosis medications. IMPLICATIONS FOR NURSING PRACTICE The SEOMA and OEOMA can be used to evaluate self-efficacy and outcome expectancy beliefs related to osteoporosis medication use in older adults and interventions developed to strengthen those beliefs and improve medication adherence.
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