Factors affecting medication adherence in community-managed patients with hypertension based on the principal component analysis: evidence from Xinjiang, China

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Zhang YJ

2018-05-01

Full Text Available Yuji Zhang,* Xiaoju Li,* Lu Mao, Mei Zhang, Ke Li, Yinxia Zheng, Wangfei Cui, Hongpo Yin, Yanli He, Mingxia Jing Department of Public Health, Shihezi University School of Medicine, Shihezi, Xinjiang, China *These authors contributed equally to this work Purpose: The analysis of factors affecting the nonadherence to antihypertensive medications is important in the control of blood pressure among patients with hypertension. The purpose of this study was to assess the relationship between factors and medication adherence in Xinjiang community-managed patients with hypertension based on the principal component analysis.Patients and methods: A total of 1,916 community-managed patients with hypertension, selected randomly through a multi-stage sampling, participated in the survey. Self-designed questionnaires were used to classify the participants as either adherent or nonadherent to their medication regimen. A principal component analysis was used in order to eliminate the correlation between factors. Factors related to nonadherence were analyzed by using a χ2-test and a binary logistic regression model.Results: This study extracted nine common factors, with a cumulative variance contribution rate of 63.6%. Further analysis revealed that the following variables were significantly related to nonadherence: severity of disease, community management, diabetes, and taking traditional medications.Conclusion: Community management plays an important role in improving the patients’ medication-taking behavior. Regular medication regimen instruction and better community management services through community-level have the potential to reduce nonadherence. Mild hypertensive patients should be monitored by community health care providers. Keywords: hypertension, medication adherence, factors, principal component analysis, community management, China

Factors relevant to medication non-adherence in kidney transplant: a systematic review.

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Belaiche, Stephanie; Décaudin, Bertrand; Dharancy, Sébastien; Noel, Christian; Odou, Pascal; Hazzan, Marc

2017-06-01

Background Medication non-adherence is a major issue after transplant that can lead to misdiagnosis, rejection, poor health affecting quality of life, graft loss or death. Several estimations of adherence and related factors have previously been described but conclusions leave doubt as to the most accurate assessment method. Aim of the review To identify the factors most relevant to medication non-adherence in kidney transplant in current clinical practice. Method This systematic review is registered in the PROSPERO data base and follows the Prisma checklist. Articles in English in three databases from January 2009 to December 2014 were analysed. A synthesis was made to target adherence assessment methods, their prevalence and significance. Results Thirty-seven studies were analysed rates of non-adherence fluctuating from 1.6 to 96%. Assessment methods varied from one study to another, although self-reports were mainly used. It appears that youth (≤50 years old), male, low social support, unemployment, low education, ≥3 months post graft, living donor, ≥6 comorbidities, ≥5 drugs/d, ≥2 intakes/d, negative beliefs, negative behavior, depression and anxiety were the factors significantly related to non-adherence. Conclusion As there are no established guidelines, consideration should be given to more than one approach to identify medication non-adherence although self-reports should remain the cornerstone of adherence assessment.

Factors affecting medication adherence in community-managed patients with hypertension based on the principal component analysis: evidence from Xinjiang, China.

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Zhang, Yuji; Li, Xiaoju; Mao, Lu; Zhang, Mei; Li, Ke; Zheng, Yinxia; Cui, Wangfei; Yin, Hongpo; He, Yanli; Jing, Mingxia

2018-01-01

The analysis of factors affecting the nonadherence to antihypertensive medications is important in the control of blood pressure among patients with hypertension. The purpose of this study was to assess the relationship between factors and medication adherence in Xinjiang community-managed patients with hypertension based on the principal component analysis. A total of 1,916 community-managed patients with hypertension, selected randomly through a multi-stage sampling, participated in the survey. Self-designed questionnaires were used to classify the participants as either adherent or nonadherent to their medication regimen. A principal component analysis was used in order to eliminate the correlation between factors. Factors related to nonadherence were analyzed by using a χ 2 -test and a binary logistic regression model. This study extracted nine common factors, with a cumulative variance contribution rate of 63.6%. Further analysis revealed that the following variables were significantly related to nonadherence: severity of disease, community management, diabetes, and taking traditional medications. Community management plays an important role in improving the patients' medication-taking behavior. Regular medication regimen instruction and better community management services through community-level have the potential to reduce nonadherence. Mild hypertensive patients should be monitored by community health care providers.

Factors influencing adherence to antiretroviral treatment in Nepal: a mixed-methods study.

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Wasti, Sharada P; Simkhada, Padam; Randall, Julian; Freeman, Jennifer V; van Teijlingen, Edwin

2012-01-01

Antiretroviral therapy (ART) is a lifesaver for individual patients treated for Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS). Maintaining optimal adherence to antiretroviral drugs is essential for HIV infection management. This study aimed to understand the factors influencing adherence amongst ART-prescribed patients and care providers in Nepal. A cross-sectional mixed-methods study surveying 330 ART-prescribed patients and 34 in-depth interviews with three different types of stakeholders: patients, care providers, and key people at policy level. Adherence was assessed through survey self-reporting and during the interviews. A multivariate logistic regression model was used to identify factors associated with adherence, supplemented with a thematic analysis of the interview transcripts. A total of 282 (85.5%) respondents reported complete adherence, i.e. no missed doses in the four-weeks prior to interview. Major factors influencing adherence were: non-disclosure of HIV status (OR = 17.99, p = 0.014); alcohol use (OR = 12.89, p = 1 hour (OR = 2.84, p = 0.035). Similarly, lack of knowledge and negative perception towards ART medications also significantly affected non-adherence. Transport costs (for repeat prescription), followed by pills running out, not wanting others to notice, side-effects, and being busy were the most common reasons for non-adherence. The interviews also revealed religious or ritual obstacles, stigma and discrimination, ART-associated costs, transport problems, lack of support, and side-effects as contributing to non-adherence. Improving adherence requires a supportive environment; accessible treatment; clear instructions about regimens; and regimens tailored to individual patients' lifestyles. Healthcare workers should address some of the practical and cultural issues around ART medicine whilst policy-makers should develop appropriate social policy to promote adherence among ART

Factors influencing adherence to antiretroviral treatment in Nepal: a mixed-methods study.

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Sharada P Wasti

Full Text Available BACKGROUND: Antiretroviral therapy (ART is a lifesaver for individual patients treated for Human Immunodeficiency Virus (HIV and Acquired Immune Deficiency Syndrome (AIDS. Maintaining optimal adherence to antiretroviral drugs is essential for HIV infection management. This study aimed to understand the factors influencing adherence amongst ART-prescribed patients and care providers in Nepal. METHODS: A cross-sectional mixed-methods study surveying 330 ART-prescribed patients and 34 in-depth interviews with three different types of stakeholders: patients, care providers, and key people at policy level. Adherence was assessed through survey self-reporting and during the interviews. A multivariate logistic regression model was used to identify factors associated with adherence, supplemented with a thematic analysis of the interview transcripts. RESULTS: A total of 282 (85.5% respondents reported complete adherence, i.e. no missed doses in the four-weeks prior to interview. Major factors influencing adherence were: non-disclosure of HIV status (OR = 17.99, p = 0.014; alcohol use (OR = 12.89, p = 1 hour (OR = 2.84, p = 0.035. Similarly, lack of knowledge and negative perception towards ART medications also significantly affected non-adherence. Transport costs (for repeat prescription, followed by pills running out, not wanting others to notice, side-effects, and being busy were the most common reasons for non-adherence. The interviews also revealed religious or ritual obstacles, stigma and discrimination, ART-associated costs, transport problems, lack of support, and side-effects as contributing to non-adherence. CONCLUSION: Improving adherence requires a supportive environment; accessible treatment; clear instructions about regimens; and regimens tailored to individual patients' lifestyles. Healthcare workers should address some of the practical and cultural issues around ART medicine whilst policy-makers should develop

Factors Influencing Adherence to Antiretroviral Treatment in Nepal: A Mixed-Methods Study

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Wasti, Sharada P.; Simkhada, Padam; Randall, Julian; Freeman, Jennifer V.; van Teijlingen, Edwin

2012-01-01

Background Antiretroviral therapy (ART) is a lifesaver for individual patients treated for Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS). Maintaining optimal adherence to antiretroviral drugs is essential for HIV infection management. This study aimed to understand the factors influencing adherence amongst ART-prescribed patients and care providers in Nepal. Methods A cross-sectional mixed-methods study surveying 330 ART-prescribed patients and 34 in-depth interviews with three different types of stakeholders: patients, care providers, and key people at policy level. Adherence was assessed through survey self-reporting and during the interviews. A multivariate logistic regression model was used to identify factors associated with adherence, supplemented with a thematic analysis of the interview transcripts. Results A total of 282 (85.5%) respondents reported complete adherence, i.e. no missed doses in the four-weeks prior to interview. Major factors influencing adherence were: non-disclosure of HIV status (OR = 17.99, p =  0.014); alcohol use (OR = 12.89, p = 1 hour (OR = 2.84, p = 0.035). Similarly, lack of knowledge and negative perception towards ART medications also significantly affected non-adherence. Transport costs (for repeat prescription), followed by pills running out, not wanting others to notice, side-effects, and being busy were the most common reasons for non-adherence. The interviews also revealed religious or ritual obstacles, stigma and discrimination, ART-associated costs, transport problems, lack of support, and side-effects as contributing to non-adherence. Conclusion Improving adherence requires a supportive environment; accessible treatment; clear instructions about regimens; and regimens tailored to individual patients’ lifestyles. Healthcare workers should address some of the practical and cultural issues around ART medicine whilst policy-makers should develop appropriate social

Review on Factors Influencing Physician Guideline Adherence in Cardiology.

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Hoorn, C J G M; Crijns, H J G M; Dierick-van Daele, A T M; Dekker, L R C

2018-04-09

Cardiovascular disease is the most common cause of death in Western countries. Physician adherence to guidelines is often suboptimal, resulting in impaired patient outcome and prognosis. Multiple studies have been conducted to evaluate patterns and the influencing factors of patient adherence, but little is known about factors influencing physician guideline adherence. This review aims to identify factors influencing physician guideline adherence relevant to cardiology and to provide insights and suggestions for future improvement. Physician adherence was measured as adherence to standard local medical practice and applicable guidelines. Female gender and older age had a negative effect on physician guideline adherence. In addition, independent of the type of heart disease, physicians without cardiologic specialization were linked to physician noncompliance. Also, guideline adherence in primary care centers was at a lower level compared to secondary or tertiary care centers. The importance of guideline adherence increases as patients age, and complex diseases and comorbidity arise. Appropriate resources and interventions, taking important factors for nonadherence in account, are necessary to improve guideline adoption and adherence in every level of the chain. This in turn should improve patient outcome.

Knowledge of HIV-AIDS a dominant factor of antiretroviral therapeutic adherence in women with HIV-AIDS

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Surilena

2015-08-01

Full Text Available Background Antiretroviral therapy adherence (ART adherence is a factor significantly extending life expectancy of people living with HIV/AIDS. The objective of this study was determine several factors on ART adherence in women infected with HIV/AIDS. Methods A cross-sectional study involving 99 women with HIV/AIDS who were infected through their sexual partner or spouse was conducted in Dharmais Hospital between March and August 2014. The instruments used were demographic and self-esteem questionnaires, Hamilton rating scale for depression, Hamilton rating scale for anxiety, knowledge, perception of ART benefits and limitations, family support, peer support as well as assessment of ART adherence. The knowledge questionnaire has been validated with Cronbach’s alpha = 0.823. Data were analyzed using Chi-Square test and multivariate logistic regression. Results A total of 99 women with HIV/AIDS participated in the study, with an age range of 30- 60 years and mean age of 36 ± 3.72 years. A total of 57.58% of participants showed poor ART adherence. Multivariate logistic regression analysis showed that knowledge, ART side effects, depression, peer support and ARV availability significantly affected ART adherence (p<0.05. The most dominant factor affecting ART adherence was knowledge, with OR = 64.02 (95% CI 4.99-670.12. Conclusion With good knowledge about HIV/AIDS infection, ART benefits, and possible ARV side effects, women living with HIV/AIDS are expected to carry out ART adherence according to the recommended rules.

The role of Patient Health Engagement Model (PHE-model in affecting patient activation and medication adherence: A structural equation model.

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Guendalina Graffigna

Full Text Available Increasing bodies of scientific research today examines the factors and interventions affecting patients' ability to self-manage and adhere to treatment. Patient activation is considered the most reliable indicator of patients' ability to manage health autonomously. Only a few studies have tried to assess the role of psychosocial factors in promoting patient activation. A more systematic modeling of the psychosocial factors explaining the variance of patient activation is needed.To test the hypothesized effect of patient activation on medication adherence; to test the the hypothesized effects of positive emotions and of the quality of the patient/doctor relationship on patient activation; and to test the hypothesized mediating effect of Patient Health Engagement (PHE-model in this pathway.This cross-sectional study involved 352 Italian-speaking adult chronic patients. The survey included measures of i patient activation (Patient Activation Measure 13 -short form; ii Patient Health Engagement model (Patient Health Engagement Scale; iii patient adherence (4 item-Morinsky Medication Adherence Scale; iv the quality of the patients' emotional feelings (Manikin Self Assessment Scale; v the quality of the patient/doctor relationship (Health Care Climate Questionnaire. Structural equation modeling was used to test the hypotheses proposed.According to the theoretical model we hypothesized, research results confirmed that patients' activation significantly affects their reported medication adherence. Moreover, psychosocial factors, such as the patients' quality of the emotional feelings and the quality of the patient/doctor relationship were demonstrated to be factors affecting the level of patient activation. Finally, the mediation effect of the Patient Health Engagement model was confirmed by the analysis.Consistently with the results of previous studies, these findings demonstrate that the Patient Health Engagement Model is a critical factor in

The role of Patient Health Engagement Model (PHE-model) in affecting patient activation and medication adherence: A structural equation model.

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Graffigna, Guendalina; Barello, Serena; Bonanomi, Andrea

2017-01-01

Increasing bodies of scientific research today examines the factors and interventions affecting patients' ability to self-manage and adhere to treatment. Patient activation is considered the most reliable indicator of patients' ability to manage health autonomously. Only a few studies have tried to assess the role of psychosocial factors in promoting patient activation. A more systematic modeling of the psychosocial factors explaining the variance of patient activation is needed. To test the hypothesized effect of patient activation on medication adherence; to test the the hypothesized effects of positive emotions and of the quality of the patient/doctor relationship on patient activation; and to test the hypothesized mediating effect of Patient Health Engagement (PHE-model) in this pathway. This cross-sectional study involved 352 Italian-speaking adult chronic patients. The survey included measures of i) patient activation (Patient Activation Measure 13 -short form); ii) Patient Health Engagement model (Patient Health Engagement Scale); iii) patient adherence (4 item-Morinsky Medication Adherence Scale); iv) the quality of the patients' emotional feelings (Manikin Self Assessment Scale); v) the quality of the patient/doctor relationship (Health Care Climate Questionnaire). Structural equation modeling was used to test the hypotheses proposed. According to the theoretical model we hypothesized, research results confirmed that patients' activation significantly affects their reported medication adherence. Moreover, psychosocial factors, such as the patients' quality of the emotional feelings and the quality of the patient/doctor relationship were demonstrated to be factors affecting the level of patient activation. Finally, the mediation effect of the Patient Health Engagement model was confirmed by the analysis. Consistently with the results of previous studies, these findings demonstrate that the Patient Health Engagement Model is a critical factor in enhancing

Barriers affecting adherence to radiation treatment and strategies to overcome those barriers.

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Rangarajan, R; Jayaraman, K

2017-01-01

The WHO defines adherence as the extent to which a patient's behavior coincides with recommendations from a health-care provider. Nonadherence to cancer treatment has a major impact on the therapeutic outcome. To assess the prevalence of nonadherence to radiation regimen and to analyze the factors that affect adherence to cancer treatment. Patients receiving radiation treatment in our hospital were screened for adherence to appointment keeping and to the prescribed radiation regimen and patients who had unplanned treatment breaks during treatment were interviewed. Between January and July 2013, we identified 61 patients who had unplanned breaks during treatment. We analyzed the social, emotional, educational, economic, and therapeutic barriers that led to nonadherence. Of the 61 patients who had unplanned breaks during treatment, 54% were males and 46% were females. Fifty-seven percent of patients had head and neck cancers and 25% had gynecological cancers. Seventy-one percent of patients were planned for concurrent chemoradiation. The number of days of unplanned treatment breaks ranged from 3 to 27 days. Social and therapeutic barriers were found to be the most common factor that led to nonadherence in these patients. Identification of barriers that lead to nonadherence, designing strategies to overcome such barriers and effective communication becomes imperative to ensure uninterrupted treatment. Based on the above analysis, we have designed several strategies to improve adherence to treatment among our patients.

Adherence treatment factors in hypertensive African American women

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Marie N Fongwa

2008-02-01

Full Text Available Marie N Fongwa1, Lorraines S Evangelista1, Ron D Hays2, David S Martins3, David Elashoff4, Marie J Cowan1, Donald E Morisky51University of California Los Angeles School of Nursing, Los Angeles, CA, USA; 2University of California Los Angeles School of Medicine, Division of General Internal Medicine and Health Services Research, Los Angeles, CA, USA; 3To Help Everyone Clinic Inc. Los Angeles, CA, USA; 4University of California Los Angeles Public Health, Los Angeles, CA, USA; 5University of California Los Angeles School of Public Health, CA, USABackground: Hypertension among African American women is of epidemic proportions. Nonadherence to treatment contributes to uncontrolled blood pressure in this population. Factors associated with adherence to treatment in African American women are unknown. The purpose of this study was to identify factors associated with adherence to hypertension treatment in African American women.Methods: Five audio-taped focus groups were conducted with hypertensive African American women, 35 years and older receiving treatment for hypertension from an inner-city free clinic. All transcripts from the tapes were analyzed for content describing adherence to treatment factors.Findings: Factors associated with adherence to treatment in hypertensive African American women were in three main categories including: beliefs about hypertension, facilitators of adherence to treatment, and barriers to adherence to treatment.Implications: The study supports the need for education on managing hypertension and medication side effects, early screening for depression in hypertensive African Americans, development of culturally sensitive hypertension educational material, and formation of support groups for promoting adherence to treatment among African American women with hypertension.Keywords: adherence, African American, hypertension treatment factors

Factors influencing long-term adherence to pelvic floor exercises in women with urinary incontinence.

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Venegas, Mónica; Carrasco, Bernardita; Casas-Cordero, Romina

2018-03-01

To ensure the effectiveness of Physical Therapy for urinary incontinence (UI), it is crucial that patients adhere to treatment in both the long and the short term. Treatment adherence may prevent symptom progression and the need for surgery, which is associated with higher costs and potential complications. Adherence is defined as carrying out a recommended behavioral modification or change. The World Health Organization (WHO) has established that adherence is a multifactorial phenomenon determined by the interaction of five dimensions, which include diverse factors that affect long-term adherence on many levels. To identify the factors that influence long-term adherence to pelvic floor exercises in women with UI. Observational, descriptive, cross-sectional study. The sample was recruited from the "Centro Integral de Reeducación de Piso Pélvico" (CIREP), and included 61 women treated for UI at the center in 2014 and 2015. Participants completed a self-administered, 28-item questionnaire developed for this study based on the WHO five dimensions. Data analysis was performed using STATA 13.0 software. Having performed pelvic floor home exercises after discharge from Physical Therapy was significantly associated with self-rated treatment adherence (P pelvic floor exercise program (P pelvic floor exercises in women with UI; forgetting to do the exercises and boredom with the exercises were the factors most strongly related to low treatment adherence, while motivation and commitment were associated with high adherence in this population. © 2017 Wiley Periodicals, Inc.

Culicoides antigen extract stimulates equine blood mononuclear (BMN) cell proliferation and the release of eosinophil adherence-inducing factor(s).

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Mckelvie, J; Foster, A P; Hamblin, A S; Cunningham, F M

2001-04-01

Intradermal injection of a Culicoides antigen extract (CAgX) induces T lymphocyte and eosinophil accumulation in the skin of horses with sweet itch. Blood mononuclear (BMN) cells from normal ponies proliferate when stimulated by mitogen (phytohaemagglutinin, PHA) or antigen (tetanus toxoid, TT) and, as shown here, release soluble factor(s) that induce eosinophil adherence. CAgX also caused concentration dependent proliferation of BMN cells from sweet itch and normal ponies [stimulation index: 29 (13) and 17 (7) for BMN cells from sweet itch and normal ponies, respectively during the active phase of disease; 4 microg protein ml(-1)CAgX; 168 h]. A heat labile factor(s) which caused eosinophil adherence was also released [sweet itch ponies: 6.0 (1.6) per cent adherence versus 1.3 (0.4) per cent; normal ponies: 6.6 (0.5) per cent adherence versus 0.9 (0.1) per cent for supernatants from CAgX (4 microg protein ml(-1); 48 hours) stimulated versus unstimulated BMN cells, respectively]. These results suggest that soluble proteins released from T lymphocytes could affect eosinophil function in the lesional skin of sweet itch horses. Copyright 2001 Harcourt Publishers Ltd.

Patients' views toward knee osteoarthritis exercise therapy and factors influencing adherence - a survey in China.

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Zhou, Zhiwei; Hou, Yunfei; Lin, Jianhao; Wang, Kai; Liu, Qiang

2018-05-01

To understand the views toward exercise therapy for knee osteoarthritis (KOA) in China and to analyze factors affecting treatment adherence. A survey-based study, which included multiple choice and open-ended questions on knee OA exercise therapy was conducted in a Chinese population. The content included the respondents' attitudes and beliefs, willingness to receive treatment, and reasons why they could or could not adhere to the treatment. We used Chi-squared tests to compare cognitive differences between the patients and non-patient groups. A total of 1,069 people responded to the questionnaire, and the response rate was 81.8%. A total of 93.6% of the patients thought that they could adhere to the exercise treatment if they received professional advice and prescriptions. The following questionnaire items achieved consensus: 'Increasing the strength of the muscles around the knee stops the knee pain from getting worse,' 'It is the person's own responsibility to continue doing their exercise program,' 'How helpful the exercise program will be determines how well a person sticks to it,' 'Health professionals should educate patients with knee pain about how to change their lifestyle for the better,' and 'Exercise for knee pain is most helpful when it is designed for each person, to suit their own particular needs.' Patient adherence was affected by multiple factors, and some negative factors included 'forgetfulness,' 'getting joint symptoms improved after therapy,' 'professional guidance, subsequent monitoring and supervision,' 'willing to enhance overall health and quality of life,' 'having no time,' 'occupational factors,' 'considering that the pain would worsen while/after exercise,' and 'family factors.' A general Chinese population accepted exercise therapy for treating KOA in our survey. Education is necessary because patients were uncertain and had misunderstandings regarding the potential benefits of exercise therapy. Some factors related to treatment

A Study on Adherence to Follow-up, Quality of Life, and Associated Factors Among Renal Transplant Recipients in China.

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Zhao, L; Yan, J; Yang, G-L; Liu, Y

Adherence to follow-up is vital for the medical surveillance of the postoperative blood concentration, but relatively little research has examined it, and there is less study on relationships between adherence to follow-up and quality of life (QoL). We investigated the status of adherence to follow-up and QoL and associated factors among kidney transplantation recipients in China. A cross-sectional study with the use of a Kidney Transplantation Recipient's Adherence to Follow-Up Questionnaire and a Quality of Life of Kidney Transplantation Recipients Questionnaire was conducted among 250 kidney transplantation recipients in Changsha, China, from January to March in 2015. The mean score for adherence to follow-up was 54.71 ± 6.46. Time after transplantation was the only factor affecting adherence to follow-up scores (β = -0.210; P adherence to follow-up, economic level, job status, donor source, and original disease affected with QoL. Adherence to follow-up decreases with time after transplantation, and better compliance is associated with better QoL in all areas. Improvements in adherence to follow-up, income and reimbursement, psychologic guidance, and social support may increase QoL of kidney transplantat recipients. Copyright © 2017 Elsevier Inc. All rights reserved.

Factors influencing adherence to routine iron supplementation ...

African Journals Online (AJOL)

Anemia in pregnancy is a common problem especially in developing countries. and has been linked with feotal and maternal complications. Taking iron supplements could reduce anaemia in pregnancy but some pregnant women do not adhere to this. The study identified some factors associated with non adherence ...

The guardians' perspective on paediatric cancer treatment in Malawi and factors affecting adherence.

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Israëls, Trijn; Chirambo, Chawanangwa; Caron, Huib; de Kraker, Jan; Molyneux, Elizabeth; Reis, Ria

2008-11-01

Abandonment of paediatric cancer treatment is a common problem in developing countries. Little is known about the guardians' perspective on cancer treatment in these countries, especially the factors that affect adherence. Following a pilot study enquiring into the possible causes of abandonment, a problem analysis diagram was drawn which helped to develop the questionnaires. Semi-structured interviews (n = 83) and focus group discussions (n = 8) were held with the guardians of 25 Burkitt lymphoma patients and 7 Wilms tumour patients at different phases of therapy in Malawi. Parents in Malawi are very motivated to continue treatment if they think that it will cure their child. Financial costs are important concerns. Not all tasks at home are assumed by other household members. The diagnosis of cancer was unknown before being told about it in hospital and caused fear of recurrence and death. Guardians are reluctant to ask the health personnel questions. They worry that taking frequent blood samples will weaken their child. The side effects of the chemotherapy are seen as a proof of efficacy. It is important to appreciate the guardians' concerns when offering treatment that requires their sustained commitment. It is necessary to provide not only medical treatment, but also travel allowances and adequate nutritional support during long hospital stays to impoverished families. Information should be given proactively. (c) 2008 Wiley-Liss, Inc.

A cohort study of possible risk factors for over-reporting of antihypertensive adherence

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Lee Mei-Ling Ting

2001-12-01

Full Text Available Abstract Background The identification of poor medicinal adherence is difficult because direct observation of medication use is usually impractical. Up to 50% of individuals on chronic therapies may not be taking their medication as prescribed. This study is one of the first to explore possible risk factors for over-reporting of antihypertensive adherence using electronic medication monitoring. Methods The adherence of 286 individuals on single-drug antihypertensive therapy in a large managed care organization was electronically monitored for approximately three months. Questionnaires on socioeconomic background, adherence to therapy, health beliefs, and social support before and after adherence monitoring were completed. Over-reporting of antihypertensive adherence was assessed by comparing the self-reported frequency of noncompliance with that determined from electronic dosing records. Risk factors for over-reporting were identified by contingency table analysis and step-wise logistic regression. Results Although only 21% of participants acknowledged missing doses on one or more days per week, electronic monitoring documented nonadherence at this or a higher level in 42% of participants. The following variables were associated with over-reporting: >1 versus 1 daily dose (OR = 2.58; 95% CI = 1.50–4.41; p = .0006, lower perceived health risk from nonadherence (OR = 1.35; 95% CI = 1.10–1.64; p = .0035, and annual household income of $30,000 (OR = 2.64; 95% CI = 1.13–6.18; p = .025. Conclusions Over-reporting of adherence may be affected by factors related to dosing frequency, health beliefs and socioeconomic status. This topic deserves further investigation in other patient populations to elucidate possible underlying behavioral explanations.

Factors associated with medication adherence in school-aged children with asthma

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Amy H.Y. Chan

2016-03-01

Full Text Available Adherence to preventive asthma treatment is poor, particularly in children, yet the factors associated with adherence in this age group are not well understood. Adherence was monitored electronically over 6 months in school-aged children who attended a regional emergency department in New Zealand for an asthma exacerbation and were prescribed twice-daily inhaled corticosteroids. Participants completed questionnaires including assessment of family demographics, asthma responsibility and learning style. Multivariable analysis of factors associated with adherence was conducted. 101 children (mean (range age 8.9 (6–15 years, 51% male participated. Median (interquartile range preventer adherence was 30% (17–48% of prescribed. Four explanatory factors were identified: female sex (+12% adherence, Asian ethnicity (+19% adherence, living in a smaller household (−3.0% adherence per person in the household, and younger age at diagnosis (+2.7% for every younger year of diagnosis (all p<0.02. In school-aged children attending the emergency department for asthma, males and non-Asian ethnic groups were at high risk for poor inhaled corticosteroid adherence and may benefit most from intervention. Four factors explained a small proportion of adherence behaviour indicating the difficulty in identifying adherence barriers. Further research is recommended in other similar populations.

Analysis of the factors that prevent adherence to treatment in patients with diabetes mellitus and the strategies that contribute to the improvement in adherence

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Natalia V. Likhodey

2018-03-01

Full Text Available This review examined the current problem of low adherence to treatment in patients with chronic diseases, particularly type 2 diabetes mellitus. According to the definition of the World Health Organization, ‘adherence to treatment’ is the degree to which a patient’s behaviour corresponds to the doctor’s recommendations with respect to medications and implementation of dietary advice and/or lifestyle changes. The current medical literature includes a large number of scientific publications devoted to the study of various factors that lead to low adherence to treatment. The term ‘barriers’ is most often used to designate these factors. The first part of this work contains an analysis of the main factors that impede compliance to the doctor’s recommendations, such as socioeconomic and psychological (personal barriers related to the disease itself, the peculiarities of its treatment and the organisation of medical care (the health care system. The second part of this review examines the different theoretical models of patient behaviour and strategies that improve adherence to treatment. Most researchers believe that there is an unsatisfactory (low adherence to treatment and that none of the existing intervention strategies can improve adherence to treatment among all patients. The cornerstone of the entire diabetes management system is the training of patients within the framework of developed structured programmes. Conversely,, success depends on the individual approach, the course of the disease and the mandatory consideration of the individual psychological characteristics of each person. Establishment of a partnership built on trust between a doctor and a patient contributes to greater patient satisfaction with treatment and improved adherence, and this relationship ultimately affects the treatment efficacy and clinical outcomes.

Cognitive-behavioral therapy for persistent pain: does adherence after treatment affect outcome?

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Curran, Charlotte; Williams, Amanda C de C; Potts, Henry W W

2009-02-01

It is a tenet of cognitive behavioral treatment of persistent pain problems that ex-patients should adhere to treatment methods over the longer term, in order to maintain and to extend treatment gains. However, no research has quantified the causal influence of adherence on short-term outcome in this field. The aims of this study are to assess determinants of adherence to treatment recommendations in several domains, and to examine the extent to which cognitive and behavioral adherence predicts better outcome of cognitive behavioral treatment for persistent pain. Longitudinal data from a sample of 2345 persistent pain patients who attended a multicomponent treatment programme were subjected to structural equation modeling. Adherence emerged as a mediating factor linking post-treatment and follow-up treatment outcome, but contributed only 3% unique variance to follow-up outcomes. Combined end-of-treatment outcomes and adherence factors accounted for 72% of the variance in outcome at one-month follow-up. Notwithstanding shortcomings in the measurement of adherence, these findings question the emphasis normally given to adherence in the maintenance of behavioral and cognitive change, and clinical implications are discussed.

Factors associated with false-positive self-reported adherence to antihypertensive drugs.

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Tedla, Y G; Bautista, L E

2017-05-01

Self-reported medication adherence is known to overestimate true adherence. However, little is known about patient factors that may contribute to the upward bias in self-reported medication adherence. The objective of this study is to examine whether demographic, behavioral, medication and mood factors are associated with being a false-positive self-reported adherer (FPA) to antihypertensive drug treatment. We studied 175 patients (mean age: 50 years; 57% men) from primary-care clinics starting antihypertensive drug treatment. Self-reported adherence (SRA) was measured with the Medication Adherence Report Scale (MARS) and by the number of drug doses missed in the previous week/month, and compared with pill count adherence ratio (PCAR) as gold standard. Data on adherence, demographic, behavioral, medication and mood factors were collected at baseline and every 3 months up to 1 year. FPA was defined as being a non-adherer by PCAR and an adherer by self-report. Mixed effect logistic regression was used for the analysis. Twenty percent of participants were FPA. Anxiety increased (odds ratio (OR): 3.00; P=0.01), whereas smoking (OR: 0.40; P=0.03) and drug side effects (OR: 0.46, P=0.03) decreased the probability for FPA by MARS. Education below high-school completion increased the probability of being an FPA as measured by missing doses in the last month (OR: 1.66; P=0.04) and last week (OR: 1.88; P=0.02). The validity of SRA varies significantly according to drug side effects, behavioral factors and patient's mood. Careful consideration should be given to the use of self-reported measures of adherence among patients likely to be false-positive adherers.

Behavioral and Pharmacological Adherence in Pediatric Sickle Cell Disease: Parent-Child Agreement and Family Factors Associated With Adherence.

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Klitzman, Page H; Carmody, Julia K; Belkin, Mary H; Janicke, David M

2018-01-01

This study aimed to evaluate agreement between children and parents on a measure of behavioral and pharmacological adherence in children with sickle cell disease (SCD), and the associations among family factors (i.e., problem-solving skills, routines, communication) and adherence behaviors. In all, 85 children (aged 8-18 years) with SCD and their parents completed questionnaires assessing individual and family factors. Overall parent-child agreement on an adherence measure was poor, particularly for boys and older children. Greater use of child routines was associated with better overall child-reported adherence. Open family communication was associated with higher overall parent-reported adherence. While further research is needed before definitive conclusions can be drawn, results suggest the need to assess child adherence behaviors via both child and parent reports. Findings also suggest that more daily family routines and open family communication may be protective factors for better disease management. © The Author 2017. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

[Factors that influence treatment adherence in chronic disease patients undergoing hemodialysis].

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Maldaner, Cláudia Regina; Beuter, Margrid; Brondani, Cecília Maria; Budó, Maria de Lourdes Denardin; Pauletto, Macilene Regina

2008-12-01

The following bibliographical research wanted to identify the main factors that influence adherence to treatment in chronic disease. The study focused on patients undergoing hemodialysis, as well as on the support nurses require for the promotion of health education among individuals with low treatment adherence. The identification of bibliographical sources was conducted at Health Virtual Library and Scientific Electronic Library Online (SciELO) data bases. Some printed magazines were also used. The results indicated nine factors influencing treatment adherence or non-adherence: team trust, support nets, educational level; accepting disease, treatment side effects, lack of access to medicines, long-term treatment, complex therapeutic approach, and lack of symptoms. It is advisable that nurses take into account these factors when dealing with chronic-disease patients that present low treatment adherence, getting family and multidisciplinary team support seeking treatment adherence.

A systematic review of individual and contextual factors affecting ART initiation, adherence, and retention for HIV-infected pregnant and postpartum women.

Directory of Open Access Journals (Sweden)

Ian Hodgson

Full Text Available Despite progress reducing maternal mortality, HIV-related maternal deaths remain high, accounting, for example, for up to 24 percent of all pregnancy-related deaths in sub-Saharan Africa. Antiretroviral therapy (ART is effective in improving outcomes among HIV-infected pregnant and postpartum women, yet rates of initiation, adherence, and retention remain low. This systematic literature review synthesized evidence about individual and contextual factors affecting ART use among HIV-infected pregnant and postpartum women.Searches were conducted for studies addressing the population (HIV-infected pregnant and postpartum women, intervention (ART, and outcomes of interest (initiation, adherence, and retention. Quantitative and qualitative studies published in English since January 2008 were included. Individual and contextual enablers and barriers to ART use were extracted and organized thematically within a framework of individual, interpersonal, community, and structural categories.Thirty-four studies were included in the review. Individual-level factors included both those within and outside a woman's awareness and control (e.g., commitment to child's health or age. Individual-level barriers included poor understanding of HIV, ART, and prevention of mother-to-child transmission, and difficulty managing practical demands of ART. At an interpersonal level, disclosure to a spouse and spousal involvement in treatment were associated with improved initiation, adherence, and retention. Fear of negative consequences was a barrier to disclosure. At a community level, stigma was a major barrier. Key structural barriers and enablers were related to health system use and engagement, including access to services and health worker attitudes.To be successful, programs seeking to expand access to and continued use of ART by integrating maternal health and HIV services must identify and address the relevant barriers and enablers in their own context that are

Factors influencing long-term adherence to two previously implemented hospital guidelines

NARCIS (Netherlands)

Knops, A. M.; Storm-Versloot, M. N.; Mank, A. P. M.; Ubbink, D. T.; Vermeulen, H.; Bossuyt, P. M. M.; Goossens, A.

2010-01-01

After successful implementation, adherence to hospital guidelines should be sustained. Long-term adherence to two hospital guidelines was audited. The overall aim was to explore factors accounting for their long-term adherence or non-adherence. A fluid balance guideline (FBG) and body temperature

Assessment of the prevalence and factors influencing adherence to ...

African Journals Online (AJOL)

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adherence to exclusive breast feeding among HIV positive ... Despite its benefits, the practice of EBF among HIV positive mothers is low in Ethiopia. Objective: This study is intended to assess factors influencing adherence to exclusively breast ...

Exercise, Affect, and Adherence: An Evolutionary Perspective

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Harold Lee

2016-08-01

Full Text Available The low rates of regular exercise and overall physical activity (PA in the general population represent a significant public health challenge. Previous research suggests that, for many people, exercise leads to a negative affective response and, in turn, reduced likelihood of future exercise. The purpose of this paper is to examine this exercise-affect-adherence relationship from an evolutionary perspective. Specifically, we argue that low rates of physical exercise in the general population are a function of the evolved human tendency to avoid unnecessary physical exertion. This innate tendency evolved because it allowed our evolutionary ancestors to conserve energy for physical activities that had immediate adaptive utility such as pursuing prey, escaping predators, and engaging in social and reproductive behaviors. The commonly observed negative affective response to exercise is an evolved proximate psychological mechanism through which humans avoid unnecessary energy expenditure. The fact that the human tendencies toward negative affective response to and avoidance of unnecessary physical activities are innate does not mean that they are unchangeable. Indeed, it is only because of human-engineered changes in our environmental conditions (i.e., it is no longer necessary for us to work for our food that our predisposition to avoid unnecessary physical exertion has become a liability. Thus, it is well within our capabilities to reengineer our environments to once again make PA necessary or, at least, to serve an immediate functional purpose. We propose a two-pronged approach to PA promotion based on this evolutionary functional perspective: First, to promote exercise and other physical activities that are perceived to have an immediate purpose, and second, to instill greater perceived purpose for a wider range of physical activities. We posit that these strategies are more likely to result in more positive (or at least less negative affective

Factors influencing medication knowledge and beliefs on warfarin adherence among patients with atrial fibrillation in China

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Zhao, Shujuan; Zhao, Hongwei; Wang, Xianpei; Gao, Chuanyu; Qin, Yuhua; Cai, Haixia; Chen, Boya; Cao, Jingjing

2017-01-01

Objectives Warfarin is often used for ischemic stroke prevention in patients with atrial fibrillation (AF), but the factors affecting patient adherence to warfarin therapy have not been fully understood. Methods A cross-sectional survey was conducted in AF patients undergoing warfarin therapy at least 6 months prior to the study. The clinical data collected using questionnaires by phone interviews included the following: 1) self-reported adherence measured by the Morisky Medication Adherence Scale-8©; 2) beliefs about medicines surveyed by Beliefs about Medicines Questionnaire (BMQ); and 3) drug knowledge as measured by the Warfarin Related Knowledge Test (WRKT). Demographic and clinical factors associated with warfarin adherence were identified using a logistic regression model. Results Two hundred eighty-eight patients completed the survey and 93 (32.3%) of them were classified as nonadherent (Morisky Medication Adherence Scale-8 score <6). Major factors predicting warfarin adherence included age, cardiovascular disorders, WRKT, and BMQ; WRKT and BMQ were independently correlated with adherence to warfarin therapy by multivariate logistic regression analysis. Adherents were more likely to have greater knowledge scores and stronger beliefs in the necessity of their specific medications ([odds ratio {OR} =1.81, 95% confidence interval {CI} =1.51–2.15] and [OR =1.17, 95% CI =1.06–1.29], respectively). Patients with greater concerns about adverse reactions and more negative views of general harm were more likely to be nonadherent ([OR =0.76, 95% CI =0.69–0.84] and [OR =0.82, 95% CI =0.73–0.92], respectively). Conclusion BMK and WRKT are related with patient behavior toward warfarin adherence. BMQ can be applied to identify patients at increased risk of nonadherence. PMID:28223782

Treating depression in HIV-positive patients affects adherence

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M Y H Moosa

2012-08-01

of treatment and sociodemographic factors. It is necessary to identify HIV-positive patients at risk of depression, to initiate antidepressant treatment which may prevent ART non-adherence, and subsequent disease progression and increased morbidity.

Contributing factors for therapeutic diet adherence in patients receiving haemodialysis treatment: an integrative review.

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Oquendo, Lissete González; Asencio, José Miguel Morales; de Las Nieves, Candela Bonill

2017-12-01

The objective of this integrative review is to identify the factors that contribute to diet adherence in people suffering from kidney disease who are receiving haemodialysis treatment. Adherence to the therapeutic regimen determines therapeutic success, quality of life and survival in patients on haemodialysis. Lack of diet adherence ranges from 25%-86% in patients receiving haemodialysis treatment and affects patient morbidity and mortality. An integrative literature review was conducted based on the criteria of Whittemore & Knafl. A literature review was performed by two members of the team using twelve databases including PubMed, CUIDEN, CINAHL, The Cochrane Library and ScienceDirect. The main issues identified after analysing the results were as follows: the intrinsic barriers (age, dialysis time, motivation, perceived benefit, distorted perception of adherence) and facilitators (self-efficacy, perception of disease, perception of control), extrinsic barriers (family dysfunction, lack of social support, cultural patterns of consumption of food) and facilitators (social support, relationship with healthcare providers), and interventions to encourage diet adherence, such as the use of motivational interviewing in educational interventions, and the training and education of relevant professionals in communication skills. Diet nonadherence remains a serious health problem and suffers from a lack of solid criteria to identify this condition. The onset of depression signs and the level of social support available to the patient should be assessed, because these are important factors that determine adherence to treatment. Professionals should be trained in health education and communication techniques to contribute to the patient's self-management and motivation for diet adherence. Controlled and randomised clinical studies involving predialysis stages should be performed to investigate the impact of the assessment and control of barriers to diet adherence. © 2017

Which psychosocial factors are related to chelation adherence in thalassemia? A systematic review.

Science.gov (United States)

Evangeli, Michael; Mughal, Kulsoom; Porter, John B

2010-06-01

Good adherence to iron chelation therapy in thalassemia is crucial. Although there is evidence that adherence is related to regimen factors, there has been less emphasis on the relationship between psychosocial (psychological, demographic and social) factors and adherence. We present a systematic review of psychosocial correlates of chelation adherence in thalassemia. Nine studies met the inclusion criteria. Information was extracted regarding the study characteristics and the relationship between psychosocial factors and chelation adherence. Methodological quality was rated. The studies took place in a range of countries, were mostly cross sectional in design, and examined adherence to deferoxamine (DFO) only. Sample sizes ranged from 15 to 1573. A variety of psychosocial variables were examined. Definitions of adherence varied between studies and non adherence rates were also variable (9 to 66%). Older age was consistently associated with lower levels of chelation adherence. There were few other consistent findings. The methodological quality of studies was variable. There is a need for more methodologically sophisticated and theoretically informed studies on psychosocial correlates of chelation adherence. We offer specific suggestions.

Genetic factors in exercise adoption, adherence and obesity.

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Herring, M P; Sailors, M H; Bray, M S

2014-01-01

Physical activity and exercise play critical roles in energy balance. While many interventions targeted at increasing physical activity have demonstrated efficacy in promoting weight loss or maintenance in the short term, long term adherence to such programmes is not frequently observed. Numerous factors have been examined for their ability to predict and/or influence physical activity and exercise adherence. Although physical activity has been demonstrated to have a strong genetic component in both animals and humans, few studies have examined the association between genetic variation and exercise adherence. In this review, we provide a detailed overview of the non-genetic and genetic predictors of physical activity and adherence to exercise. In addition, we report the results of analysis of 26 single nucleotide polymorphisms in six candidate genes examined for association to exercise adherence, duration, intensity and total exercise dose in young adults from the Training Interventions and Genetics of Exercise Response (TIGER) Study. Based on both animal and human research, neural signalling and pleasure/reward systems in the brain may drive in large part the propensity to be physically active and to adhere to an exercise programme. Adherence/compliance research in other fields may inform future investigation of the genetics of exercise adherence. © 2013 The Authors. obesity reviews © 2013 International Association for the Study of Obesity.

Adherence to immunosuppression in adult lung transplant recipients : Prevalence and risk factors

NARCIS (Netherlands)

Bosma, Otto H.; Vermeulen, Karin M.; Verschuuren, Erik A.; Erasmus, Michiel E.; van der Bij, Wim

2011-01-01

BACKGROUND: Adherence to medication is a favourable with regard to survival after kidney, heart and liver transplantation. Little is known about adherence to medication in lung transplant recipients. To determine the prevalence of adherence and identify risk factors of non-adherence (NA) we

Factors influencing medication knowledge and beliefs on warfarin adherence among patients with atrial fibrillation in China.

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Zhao, Shujuan; Zhao, Hongwei; Wang, Xianpei; Gao, Chuanyu; Qin, Yuhua; Cai, Haixia; Chen, Boya; Cao, Jingjing

2017-01-01

Warfarin is often used for ischemic stroke prevention in patients with atrial fibrillation (AF), but the factors affecting patient adherence to warfarin therapy have not been fully understood. A cross-sectional survey was conducted in AF patients undergoing warfarin therapy at least 6 months prior to the study. The clinical data collected using questionnaires by phone interviews included the following: 1) self-reported adherence measured by the Morisky Medication Adherence Scale-8 © ; 2) beliefs about medicines surveyed by Beliefs about Medicines Questionnaire (BMQ); and 3) drug knowledge as measured by the Warfarin Related Knowledge Test (WRKT). Demographic and clinical factors associated with warfarin adherence were identified using a logistic regression model. Two hundred eighty-eight patients completed the survey and 93 (32.3%) of them were classified as nonadherent (Morisky Medication Adherence Scale-8 score beliefs in the necessity of their specific medications ([odds ratio {OR} =1.81, 95% confidence interval {CI} =1.51-2.15] and [OR =1.17, 95% CI =1.06-1.29], respectively). Patients with greater concerns about adverse reactions and more negative views of general harm were more likely to be nonadherent ([OR =0.76, 95% CI =0.69-0.84] and [OR =0.82, 95% CI =0.73-0.92], respectively). BMK and WRKT are related with patient behavior toward warfarin adherence. BMQ can be applied to identify patients at increased risk of nonadherence.

Factors influencing medication knowledge and beliefs on warfarin adherence among patients with atrial fibrillation in China

Directory of Open Access Journals (Sweden)

Zhao S

2017-02-01

Full Text Available Shujuan Zhao,1 Hongwei Zhao,1 Xianpei Wang,2 Chuanyu Gao,2 Yuhua Qin,1 Haixia Cai,1 Boya Chen,1 Jingjing Cao1 1Department of Pharmacy, 2Department of Cardiovascular Medicine, People’s Hospital of Henan Province, Zhengzhou, Henan, People’s Republic of China Objectives: Warfarin is often used for ischemic stroke prevention in patients with atrial fibrillation (AF, but the factors affecting patient adherence to warfarin therapy have not been fully understood. Methods: A cross-sectional survey was conducted in AF patients undergoing warfarin therapy at least 6 months prior to the study. The clinical data collected using questionnaires by phone interviews included the following: 1 self-reported adherence measured by the Morisky Medication Adherence Scale-8©; 2 beliefs about medicines surveyed by Beliefs about Medicines Questionnaire (BMQ; and 3 drug knowledge as measured by the Warfarin Related Knowledge Test (WRKT. Demographic and clinical factors associated with warfarin adherence were identified using a logistic regression model. Results: Two hundred eighty-eight patients completed the survey and 93 (32.3% of them were classified as nonadherent (Morisky Medication Adherence Scale-8 score <6. Major factors predicting warfarin adherence included age, cardiovascular disorders, WRKT, and BMQ; WRKT and BMQ were independently correlated with adherence to warfarin therapy by multivariate logistic regression analysis. Adherents were more likely to have greater knowledge scores and stronger beliefs in the necessity of their specific medications ([odds ratio {OR} =1.81, 95% confidence interval {CI} =1.51–2.15] and [OR =1.17, 95% CI =1.06–1.29], respectively. Patients with greater concerns about adverse reactions and more negative views of general harm were more likely to be nonadherent ([OR =0.76, 95% CI =0.69–0.84] and [OR =0.82, 95% CI =0.73–0.92], respectively. Conclusion: BMK and WRKT are related with patient behavior toward warfarin

Medication Adherence and its Related Factors in Patients with Type II Diabetes

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Behzad Gholamaliei

2016-03-01

Full Text Available Background and Objectives: Low levels of medication adherence in patients with type 2 diabetes is one of the greatest challenges in the treatment and control of diabetes. This study was designed to determine medication adherence and its related factors in patients with type II diabetes. Materials and Methods: In this cross-sectional study, a total of 300patients with type 2diabetes records in the health centers of Tuyserkan city were randomly selected in 2015. Data collection instrument was a self-made questionnaire, which consisted of factors related to the medication adherence. Questionnaires were completed after confirmation of validity and reliability, by interviews. To analyze the data, descriptive and inferential statistics (T-test, AnOVA, Simple and multiple linear regression were applied, using SPSS software, version 19. Results: Overall, %26.3 of patients were male and %73.7 were female. Also, %65 of patients were illiterate, %24 had some degree of symptoms, and %59.4 had poor medication adherence. There was a significant relationship between age, education, patient care and treatment expenditure, health care team and health system, therapy-related factors and condition-related factors, beliefs about illness, efficacy, and concerns about drugs and medication adherence (P < 0.05. Conclusions: This study showed that medication adherence in patients with diabetes was not suitable and individual, economical and social factors were influential.Therefore, the role of these factors must be considered when designing intervention programs.

Does the Number of Pharmacies a Patient Frequents Affect Adherence to Statins?

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Christie, Russell; Sketris, Ingrid; Andreou, Pantalis; Holbrook, Anne; Levy, Adrian; Tamim, Hala

2017-05-06

We hypothesized that medication adherence is affected by the number of pharmacies a patient frequents. The objective was to estimate the strength of association between the number of pharmacies a patient frequents and adherence to statins. Using administrative data from the Nova Scotia Seniors' Pharmacare program, a retrospective cohort study was conducted among subjects aged 65 years and older first dispensed statin between 1998 and 2008. The Usual Provider of Care (UPC), was defined as the number of dispensation days from the most frequented pharmacy divided by the total number of dispensation days. Estimated adherence of over 80% of the Medication Possession Ratio was defined as adherent. Data were analyzed using hierarchical linear regression. The cohort of 25,641 subjects was 59% female with a mean age of 74 years. During follow-up, subjects filled prescriptions in a median of 2 (mean = 2; standard deviation = 0.88) pharmacies and visited pharmacies a median of 28 (mean = 30) times. During that time, 61% of patients used one pharmacy exclusively. Among subjects using 1 pharmacy, 59% were adherent while 58% using more than one pharmacy were adherent. However, upon adjustment for differences in distributions of age, sex, and other confounders, subjects who used more than one pharmacy had 10% decreased odds of statin adherence (odds ratio: 0.90, 95% confidence interval: 0.86-0.96). These results were robust in sensitivity analyses. Among seniors newly starting statin therapy, using a single community pharmacy was modestly associated with adherence.

Factors influencing adherence to standard precautions among nursing professionals in psychiatric hospitals

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Thaís Helena Piai-Morais

2015-06-01

Full Text Available OBJECTIVE Evaluate and correlate individual, work-related and organizational factors that influence adherence to standard precautions among nursing professionals of psychiatric hospitals in São Paulo. METHOD An exploratory cross-sectional study conducted with 35 nursing professionals, using the assessment tool for adherence to standard precautions through the Likert scale, ranging from 1 to 5. RESULTS Knowledge of the precautions received a high score (4.69; adherence received (3.86 and obstacles (3.78, while intermediaries and the scales of organizational factors received low scores (2.61. There was a strong correlation between the magnitude adherence scale and the personal protective equipment availability (r = 0.643; p = 0.000. The training scale for prevention of HIV exposure (p = 0.007 was statistically different between the nurses and nursing assistants. CONCLUSION The organizational factors negatively contributed to adherence to standard precautions, indicating that psychiatric institutions lack safe working conditions, ongoing training and management actions to control infections.

Factors associated with suboptimal adherence to antiretroviral therapy in Asia

Science.gov (United States)

Jiamsakul, Awachana; Kumarasamy, Nagalingeswaran; Ditangco, Rossana; Li, Patrick CK; Phanuphak, Praphan; Sirisanthana, Thira; Sungkanuparph, Somnuek; Kantipong, Pacharee; Lee, Christopher KC; Mustafa, Mahiran; Merati, Tuti; Kamarulzaman, Adeeba; Singtoroj, Thida; Law, Matthew

2014-01-01

Introduction Adherence to antiretroviral therapy (ART) plays an important role in treatment outcomes. It is crucial to identify factors influencing adherence in order to optimize treatment responses. The aim of this study was to assess the rates of, and factors associated with, suboptimal adherence (SubAdh) in the first 24 months of ART in an Asian HIV cohort. Methods As part of a prospective resistance monitoring study, the TREAT Asia Studies to Evaluate Resistance Monitoring Study (TASER-M) collected patients’ adherence based on the World Health Organization-validated Adherence Visual Analogue Scale. SubAdh was defined in two ways: (i) 14 days. Time was divided into four intervals: 0–6, 6–12, 12–18 and 18–24 months. Factors associated with SubAdh were analysed using generalized estimating equations. Results Out of 1316 patients, 32% ever reported 2 assessments per patient per year had an odds ratio (OR)=0.7 (95% confidence interval (CI) (0.55 to 0.90), p=0.006), compared to sites with ≤2 assessments per patient per year. Compared to heterosexual exposure, SubAdh was higher in injecting drug users (IDUs) (OR=1.92, 95% CI (1.23 to 3.00), p=0.004) and lower in homosexual exposure (OR=0.52, 95% CI (0.38 to 0.71), p<0.001). Patients taking a nucleoside transcriptase inhibitor and protease inhibitor (NRTI+PI) combination were less likely to report adherence <100% (OR=0.36, 95% CI (0.20 to 0.67), p=0.001) compared to patients taking an NRTI and non-nucleoside transcriptase inhibitor (NRTI+NNRTI) combination. SubAdh decreased with increasing time on ART (all p<0.001). Similar associations were found with adherence <95% as the outcome. Conclusions We found that SubAdh, defined as either <100% and <95%, was associated with mode of HIV exposure, ART regimen, time on ART and frequency of adherence measurement. The more frequently sites assessed patients, the lower the SubAdh, possibly reflecting site resourcing for patient counselling. Although social

Factors that determine self-reported immunosuppressant adherence in kidney transplant recipients: a correlational study.

Science.gov (United States)

Weng, Li-Chueh; Yang, Ya-Chen; Huang, Hsiu-Li; Chiang, Yang-Jen; Tsai, Yu-Hsia

2017-01-01

To determine the factors related to immunosuppressant therapy adherence in kidney transplant recipients in Taiwan. Adherence to immunosuppressant treatment is critical after kidney transplantation. Thus, the factors associated with self-reported medication adherence in kidney transplant recipients warrant investigation. The study used a cross-sectional and correlation design. A convenience sample of 145 kidney transplant recipients was included. Structured questionnaires were used to collect data during 2012-2013. Multivariate linear regression was used to examine the factors related to immunosuppressant therapy adherence. Over half of the participants were female (54·5%), mean age was 45·5 years, and mean year after transplant was 7·4. The mean score for medication adherence was 29·73 (possible score range 7-35). The results of the multivariate linear regression analysis showed that gender (male), low income with a high school or college education, years after transplantation and concerns about medication taking were negatively associated with adherence. Medication self-efficacy was positively associated with adherence. Therapy-related factors, partnerships with healthcare professionals and having private healthcare insurance did not significantly relate to immunosuppressant therapy adherence. Kidney transplant recipients demonstrated a high level of adherence. Strategies to enhance patients' self-efficacy and alleviate concerns about medication may promote medication adherence. Male patients, those with a lower income and those with a higher education level, should be a focus of efforts to maintain adherence to the medication regimen. © 2016 John Wiley & Sons Ltd.

Use of protection motivation theory, affect, and barriers to understand and predict adherence to outpatient rehabilitation.

Science.gov (United States)

Grindley, Emma J; Zizzi, Samuel J; Nasypany, Alan M

2008-12-01

Protection motivation theory (PMT) has been used in more than 20 different health-related fields to study intentions and behavior, albeit primarily outside the area of injury rehabilitation. In order to examine and predict patient adherence behavior, this study was carried out to explore the use of PMT as a screening tool in a general sample of people with orthopedic conditions. New patients who were more than 18 years old and who were prescribed 4 to 8 weeks of physical therapy treatment (n=229) were administered a screening tool (Sports Injury Rehabilitation Beliefs Scale, Positive and Negative Affect Schedule, and a barriers checklist) prior to treatment. Participants' adherence was assessed with several attendance measures and an in-clinic assessment of behavior. Statistical analyses included correlation, chi-square, multiple regression, and discriminant function analyses. A variety of relationships among affect, barriers, and PMT components were evident. In-clinic behavior and attendance were influenced by affect, whereas dropout status was predicted by affect, severity, self-efficacy, and age. The screening tool used in this study may assist in identifying patients who are at risk for poor adherence and provide valuable information to enhance provider-patient relationships and foster patient adherence. However, it is recommended that more research be conducted to further understand the impact of variables on patient adherence and that the screening tool be enhanced to increase its predictive ability.

Associations between patients' adherence and GPs' attitudes towards risk, statin therapy and management of non-adherence

DEFF Research Database (Denmark)

Barfoed, Benedicte L; Paulsen, Maja S; Christensen, Palle M

2016-01-01

BACKGROUND: Previous studies suggest that doctors' personal lifestyle, risk taking personality and beliefs about risk reducing therapies may affect their clinical decision-making. Whether such factors are further associated with patients' adherence with medication is largely unknown. OBJECTIVE...... statin treatment as important, how they managed non-adherence and whether non-adherence annoyed them. The Jackson Personality Inventory-revised was used to measure risk attitude. The GPs' responses were linked to register data on their patients' redeemed statin prescriptions. Mixed effect logistic...

A holistic approach to factors affecting depression in haemodialysis patients.

Science.gov (United States)

Gerogianni, Georgia; Kouzoupis, Anastasios; Grapsa, Eirini

2018-05-19

Depression in dialysis populations is affected by co-morbid diseases, such as cardiovascular disease, diabetes, and immune dysfunction, and it also includes high suicide risk and frequent hospitalizations. Depressive disorders have a close association with malnutrition and chronic inflammation, as well as with cognitive impairment. Impaired cognitive function may be manifested as low adherence to dialysis treatment, leading to malnutrition. Additionally, chronic pain and low quality of sleep lead to high rates of depressive symptoms in haemodialysis patients, while an untreated depression can cause sleep disturbances and increased mortality risk. Depression can also lead to sexual dysfunction and non-adherence, while unemployment can cause depressive disorders, due to patients' feelings of being a financial burden on their family. The present review provides a holistic approach to the factors affecting depression in haemodialysis, offering significant knowledge to renal professionals.

Factors related to medication non-adherence for patients with hypertension in Taiwan.

Science.gov (United States)

Li, Wen-Wen; Kuo, Chi-Tai; Hwang, Shiow-Li; Hsu, Hsin-Tien

2012-07-01

To characterise a Taiwanese population and to examine the prevalence of antihypertensive medication non-adherence and how the cultural/clinical factors were associated with non-adherence in Taiwan. Antihypertensive medication non-adherence is a significant clinical issue in the United States. However, little is known about hypertension (HTN) control and cultural/clinical factors related to non-adherence in Taiwan. A convenience sample survey design was used. Data were gathered from a convenience sample of 200 subjects recruited from a large teaching hospital. Medication non-adherence and cultural/clinical factors were recorded using various self-administered questionnaires, and blood pressure was taken twice for each participant. The mean age of the participants was 60.4 (SD 11.5 years) including 62% men. Two-thirds had less than a high school education (64.5%), and the majority of them were married (86·0%) and lived with family or close friends (93.5%). The average length of HTN diagnosis was 8.6 years (SD 9.0 years). Medication non-adherence rate was 47·5%, and uncontrolled HTN rate was 49.0%. Some participants (17.0%) used Chinese herbs for treating their disease (e.g. cough) and promoting health in addition to their regular antihypertensive medications. Two factors were found to be statistically significant for predicting medication non-adherence: Lower Perceived Susceptibility to Specific Diseases [OR = 1.15 (95%CI, 1.01-1.31)] and Longer Length of HTN Diagnosis [OR = 1.06 (95%CI, 1.01-1.12)]. Taiwanese at risk of non-adherence included those who perceived lower susceptibility to specific diseases and had been diagnosed with HTN for a longer time. Those using herbs need to be studied for an impact of herbs on their adherence behaviour. These findings can help guide the development of culturally sensitive and clinically appropriate nursing interventions for HTN management in Taiwan. © 2012 Blackwell Publishing Ltd.

Factors affecting adherence to short-course ARV prophylaxis for preventing mother-to-child transmission of HIV in sub-Saharan Africa: a review and lessons for future elimination.

Science.gov (United States)

Colombini, Manuela; Stöckl, Heidi; Watts, Charlotte; Zimmerman, Cathy; Agamasu, Enyonam; Mayhew, Susannah H

2014-01-01

Despite the biomedical potential to eliminate vertical HIV transmission, drug adherence to short regimens is often sub-optimal. To inform future programmes, we reviewed evidence on the factors influencing maternal and infant drug adherence to preventing MTCT drug regimens at delivery in sub-Saharan Africa. A literature review yielding 14 studies on adherence to drug regimes among HIV-positive pregnant women and mothers in sub-Saharan Africa was conducted. Rates of maternal adherence to preventive drug regimens at time of delivery varied widely across sites between 35 and 93.5%. Factors most commonly associated with low adherence to antiretroviral therapy (ARV) prophylaxis for preventing MTCT at the health system level include giving birth at home, quality and timing of HIV testing and counselling, and late distribution of nevirapine (NVP). Socio-demographic and demand-side factors include fear of stigma, lack of male involvement, fear of partner's reaction to disclosure, few antenatal (ANC) visits, young age and lack of education. With the implementation of the newly published WHO guidelines recommending triple-drug ARV regimen during pregnancy and breastfeeding for all women with HIV, it is important that women are able to adhere to recommended drug regimens. Service improvements should include clear and timely communication with women about the benefits of combined regimens and greater emphasis on patient confidentiality. Efforts must be made to help women overcome barriers that reduce adherence, such as financial logistical challenges, social stigma and women's fear of violence.

Factors influencing adherence to antiretroviral treatment in\\ud Asian developing countries: a systematic review

OpenAIRE

Wasti, Sharada Prasad; Van Teijlingen, Edwin; Simkhada, Padam; Randall, Julian; Baxter, Susan; Kirkpatrick, P.; Vijay Singh, G.C.

2011-01-01

Objective To systematically review the literature of factors affecting adherence to Antiretroviral treatment (ART) in Asian developing countries.\\ud Methods Database searches in Medline ⁄ Ovid, Cochrane library, CINAHL, Scopus and PsychINFO for studies published between 1996 and December 2010. The reference lists of included papers were also checked, with citation searching on key papers.\\ud Results A total of 437 studies were identified, and 18 articles met the inclusion criteria and were ex...

Factors associated to acceptable treatment adherence among children with chronic kidney disease in Guatemala.

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Brooke M Ramay

Full Text Available Pediatric patients with Chronic Kidney Disease face several barriers to medication adherence that, if addressed, may improve clinical care outcomes. A cross sectional questionnaire was administered in the Foundation for Children with Kidney Disease (FUNDANIER, Guatemala City from September of 2015 to April of 2016 to identify the predisposing factors, enabling factors and need factors related to medication adherence. Sample size was calculated using simple random sampling with a confidence level of 95%, confidence interval of 0.05 and a proportion of 87%. A total of 103 participants responded to the questionnaire (calculated sample size was 96. Independent variables were defined and described, and the bivariate relationship to dependent variables was determined using Odds Ratio. Multivariate analysis was carried out using logistic regression. The mean adherence of study population was 78% (SD 0.08, max = 96%, min = 55%. The mean adherence in transplant patients was 82% (SD 7.8, max 96%, min 63%, and the mean adherence in dialysis patients was 76% (SD 7.8 max 90%, min 55%. Adherence was positively associated to the mother's educational level and to higher monthly household income. Together predisposing, enabling and need factors illustrate the complexities surrounding adherence in this pediatric CKD population. Public policy strategies aimed at improving access to comprehensive treatment regimens may facilitate treatment access, alleviating economic strain on caregivers and may improve adherence outcomes.

Hypertension: adherence to treatment in rural Bangladesh – findings from a population-based study

OpenAIRE

Khanam, Masuma Akter; Lindeboom, Wietze; Koehlmoos, Tracey Lynn Perez; Alam, Dewan Shamsul; Niessen, Louis; Milton, Abul Hasnat

2014-01-01

Background: Poor adherence has been identified as the main cause of failure to control hypertension. Poor adherence to antihypertensive treatment is a significant cardiovascular risk factor, which often remains unrecognized. There are no previous studies that examined adherence with antihypertensive medication or the characteristics of the non-adherent patients in Bangladesh.Objective: This paper aims to describe hypertension and factors affecting adherence to treatment among hypertensive per...

Associations between alcohol use, other psychosocial factors, structural factors and antiretroviral therapy (ART) adherence among South African ART recipients.

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Morojele, Neo K; Kekwaletswe, Connie T; Nkosi, Sebenzile

2014-03-01

We examined whether alcohol use is associated with antiretroviral therapy (ART) adherence independently of structural and psychosocial factors among 304 male and female ART recipients in ART sites in Tshwane, South Africa. ART adherence was assessed by the CASE Adherence Index. Independent variables were demographic, structural, psycho-social, and alcohol use (AUDIT score) factors. In hierarchical multiple regression, demographic variables (Step 1) explained 4 % of variance in ART adherence (p ≤ 0.01). Variance explained increased to 16 % (p ≤ 0.001) after entering structural variables (Step 2); 19 % (p ≤ 0.001) after entering psychosocial variables (Step 3); and 24 % (p ≤ 0.001) after entering AUDIT score (Step 4). Alcohol use is independently associated with ART adherence.

Factors influencing adherence to dietary guidelines: a qualitative ...

African Journals Online (AJOL)

2014-01-17

Jan 17, 2014 ... Original Research: Factors influencing adherence to dietary guidelines. 76. 2014 Volume ..... eat, because they dik (tired) of giving you special food. Then they go .... patients in this study were satisfied with the advice received ...

Generic substitution of antidiabetic drugs in the elderly does not affect adherence

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Francesco Trotta

2014-12-01

Full Text Available INTRODUCTION: The possibility that variation in packaging and pill appearance may reduce adherence is a reason for concern, especially for chronic diseases. The objectives of the study were to quantify the extent of switches between generic antidiabetics and to verify whether switching between different products of the same substance affects adherence. MATERIALS AND METHODS: All elderly residents of the Umbria Region who received at least 2 prescriptions of antidiabetics in 2010 and 2011 were included in the study. Switching was defined as the dispensing of two different products of the same substance in a series of two prescriptions. Single and multiple switchers were identified according to the number of switches during 2011. Switching relevant to the three off-patent substances with generic use ≥ 5% (metformin, gliclazide and repaglinide was quantified. The effect of switching on adherence, defined as the proportion of days in 2011 covered by prescriptions (Medication Possession Ratio, MPR, was estimated. RESULTS: Among the 15 964 patients receiving antidiabetics (14.4% of the elderly population 9211 were prescribed at least one of the generic substances. Of these patients, 23.3% experienced a single switch and 15.7% were multiple switchers (61.0% never switched. The proportion of multiple switchers increased with the number of prescriptions, reaching 26% among patients with ≥ 11 prescriptions. MPR was 62%, 62% and 72%, respectively among non-switchers, single and multiple switchers. CONCLUSIONS: In elderly patients treated with antidiabetics, the substitution between branded and unbranded products (as well as between generics of the same substance, did not negatively affect adherence.

The Effect of Psychosocial Factors and Patients' Perception of Tuberculosis Treatment Non-Adherence in Addis Ababa, Ethiopia.

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Tola, Habteyes Hailu; Garmaroudi, Gholamreza; Shojaeizadeh, Davoud; Tol, Azar; Yekaninejad, Mir Saeed; Ejeta, Luche Tadesse; Kebede, Abebaw; Kassa, Desta

2017-09-01

Although there are several studies reported on factors affecting tuberculosis (TB) treatment non-adherence, there is information gap on psychosocial and patients' perceptions aspects. Therefore, this study was aimed to investigate the effect of psychosocial factors and patients' perceptions on TB treatment non-adherence in Ethiopia. A cross sectional study was conducted in Addis Ababa from May to December, 2014. Thirty one health facilities were randomly selected and 698 TB patients, who had been on treatment, were enrolled consecutively using patient registration number. Structured questionnaire was used to collect data on demographics, knowledge, psychological distress, alcohol use, tobacco smoking and six HBM domains. Treatment adherence level was the main outcome variable, and it measured using visual analog scale. Statistical Package for Social Sciences version 20 was used for data analysis. Non-adherence level within last one month prior to the study was 19.5%. After controlling for all potential confounding variables, Antiretroviral Therapy (ART) status (Adjusted Odds Ratio (AOR) = 1.79, 95% Confidence interval (CI) (1.09 -2.95)), alcohol use (AOR = 2.11, 95% CI (1.33-3.37)), economic status (AOR = 0.53, 95% CI (0.33-0.82)), perceived barriers (AOR = 1.21, 95% CI (1.10-1.47)) and psychological distress (AOR = 1.83, 95% CI (1.47-2.29)) were independently associated with TB treatment non-adherence. ART status, economic status, alcohol use, perceived barrier and psychological distress are the major areas that need to be targeted with health promotion intervention to enhance TB treatment adherence.

Predicting and influencing voice therapy adherence using social-cognitive factors and mobile video.

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van Leer, Eva; Connor, Nadine P

2015-05-01

Patient adherence to voice therapy is an established challenge. The purpose of this study was (a) to examine whether adherence to treatment could be predicted from three social-cognitive factors measured at treatment onset: self-efficacy, goal commitment, and the therapeutic alliance, and (b) to test whether the provision of clinician, self-, and peer model mobile treatment videos on MP4 players would influence the same triad of social cognitive factors and the adherence behavior of patients. Forty adults with adducted hyperfunction with and without benign lesions were prospectively randomized to either 4 sessions of voice therapy enhanced by MP4 support or without MP4 support. Adherence between sessions was assessed through self-report. Social cognitive factors and voice outcomes were assessed at the beginning and end of therapy. Utility of MP4 support was assessed via interviews. Self-efficacy and the therapeutic alliance predicted a significant amount of adherence variance. MP4 support significantly increased generalization, self-efficacy for generalization, and the therapeutic alliance. An interaction effect demonstrated that MP4 support was particularly effective for patients who started therapy with poor self-efficacy for generalization. Adherence may be predicted and influenced via social-cognitive means. Mobile technology can extend therapy to extraclinical settings.

Antiretroviral treatment adherence as a mediating factor between psychosocial variables and HIV viral load.

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Attonito, Jennifer; Dévieux, Jessy G; Lerner, Brenda D G; Hospital, Michelle M; Rosenberg, Rhonda

2014-01-01

Psychosocial factors may directly impact HIV health measures such as viral load (VL) whether or not patients are taking antiretroviral treatment (ART) consistently. Structural equation modeling plus Baron and Kenny's (1986) four-step approach were used to test a mediated model predicting VL among 246 HIV-infected adults who were on ART. Exogenous variables were social support, barriers to adherence, and stress. Moderators were alcohol use, marijuana use, and neurocognitive impairment. A small positive association between marijuana use and ART adherence approached significance. Only barriers to adherence predicted a decrease in adherence rates and an increase in VL. No other factors were significantly associated with either VL or adherence, and no interaction effects between exogenous variables and moderators were identified. The association between barriers to adherence and VL was partially mediated by ART adherence. Findings provide modest support for a direct link between psychosocial variables and a virologic response to ART. Copyright © 2014 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.

Transient improvement of urticaria induces poor adherence as assessed by Morisky Medication Adherence Scale-8.

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Kaneko, Sakae; Masuda, Koji; Hiragun, Takaaki; Inomata, Naoko; Furue, Masutaka; Onozuka, Daisuke; Takeuchi, Satoshi; Murota, Hiroyuki; Sugaya, Makoto; Saeki, Hidehisa; Shintani, Yoichi; Tsunemi, Yuichiro; Abe, Shinya; Kobayashi, Miwa; Kitami, Yuki; Tanioka, Miki; Imafuku, Shinichi; Abe, Masatoshi; Hagihara, Akihito; Morisky, Donald E; Katoh, Norito

2015-11-01

Poor adherence to medication is a major public health challenge. Here, we aimed to determine the adherence to oral and topical medications and to analyze underlying associated factors using the translated Japanese version of Morisky Medication Adherence Scale-8 regarding urticaria treatment. Web-based questionnaires were performed for 3096 registered dermatological patients, along with a subanalysis of 751 registered urticaria patients in this study. The adherence to oral medication was significantly associated with the frequency of hospital visits. Variables that affected the adherence to topical medication included age and experience of drug effectiveness. The rate of responses that "It felt like the symptoms had improved" varied significantly among the dermatological diseases treated with oral medications. Dermatologists should be aware that adherence to the treatment of urticaria is quite low. Regular visits and active education for patients with urticaria are mandatory in order to achieve a good therapeutic outcome by increasing the adherence. © 2015 The Authors. The Journal of Dermatology published by Wiley Publishing Asia Pty Ltd on behalf of Japanese Dermatological Association.

Patient adherence to antihypertensive therapy and its individual psychological factors

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Lidia Trachuk

2016-09-01

Full Text Available Background. In the treatment of chronic, especially asymptomatic pathology one of the main problem is the adherence to therapy. Patients with arterial hypertension need long-term, often lifelong medication, and how strictly they adhere to prescriptions often determines the course of the disease and the medical measures effectiveness. According to statistics, more than half of patients with hypertension are characterized by low compliance, which leads to complications of this disease. The objective of the research is to identify and analize the individual psychological factors that determine patient adherence to antihypertensive therapy. Methods and materials. This study was conducted during 2011-2013 at the cardiology departments of the Kyiv Alexander Hospital, polyclinics number 2 Shevchenko district in Kyiv, Desnyanskiy clinic №3 district in Kyiv, medical center "Adonis plus". We examined 203 patients with arterial hypertension (average age 53,5 ± 4,5 years. Methods: socio-demographic, clinical, clinical and psychological, psychodiagnostical, mathematical and statistical methods. Psychodiagnostical method included: 8-item Morisky medical adherence scale (Morisky D. E., 2008; self-assessment anxiety scale Charles D. Spielberger – Y.L Hanin (A.V. Batarshev, 2005; the Minnesota Multiphasic Personality Inventory questionnaire (MMRI (F.B. Berezin, 1994; "The level of subjective control" (A.A. Rean, 2001; "Index of attitudes to health" (S.D. Deryabo, VA Yasvin, 2000. Results. According to the results of 8-item Morisky medical adherence scale patients were divided into 3 groups according to the level of compliance - with high (26.11%, average (24.14% and low (49.75% levels of adherence to antihypertensive therapy. The individual-psychological predictors of poor adherence to antihypertensive therapy include the following personal characteristics of patients: a low level of intensity of attitude to health, internal type of subjective control, a

Factors influencing non-adherence to tuberculosis treatment in Jepara, central Java, Indonesia.

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Rondags, Angelique; Himawan, Ari Budi; Metsemakers, Job Fm; Kristina, Tri Nur

2014-07-01

One of the most serious problems for tuberculosis (TB) control is non-adherence to TB treatment. We studied the factors influencing non-adherence to TB treatment in Indonesia to inform TB treatment adherence strategies. We con- ducted semi-structured interviews with non-adherent patients and key informants in Jepara, Central Java, Indonesia. Three major themes were found in reasons for non-adherence to TB treatment: 1) knowledge about TB, 2) knowledge about TB treatment and 3) choosing and changing a health care treatment facility. Respondents had an inadequate knowledge about TB and its treatment. Feeling healthy and having financial problems were the most common reasons for TB treatment non-adherence. Respondents sought treatment from many different health care providers, and often changed the treatment facility location. TB treatment adherence might improve by providing better education about the disease and its treatment to those undergoing treatment. Providing information about where to receive treatment and that treatment is free could also improve compliance.

Factors associated with adherence to medication among depressed patients from Saudi Arabia: a cross-sectional study

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Al Jumah K

2014-10-01

Full Text Available Khalaf Al Jumah,1 Mohamed Azmi Hassali,2 Dalal Al Qhatani,1 Kamal El Tahir3 1Department of Pharmacy, Al Amal Psychiatric Hospital, Riyadh, Saudi Arabia; 2School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia; 3College of Pharmacy, King Saud University, Riyadh, Saudi Arabia Background: Several studies have investigated the factors associated with adherence to antidepressants, with inconsistent conclusions. However, no similar study has investigated this issue among patients diagnosed with major depressive disorder in Saudi Arabia. The aim of this study is to explore patients’ adherence to antidepressant medications, and the factors associated with adherence.Methods: A non-experimental cross-sectional design was used to measure adherence to antidepressants among major depressive disorder patients, and the factors associated with adherence. The patients were recruited from the outpatient clinic at the Al-Amal Complex for Mental Health in Riyadh, Saudi Arabia, between August 2013 and January 2014. Eligible participants met with one of the research coordinators for assessment of their adherence. Adherence was investigated indirectly by use of the Morisky Medication Adherence Scale, and patients’ beliefs were assessed through the Beliefs about Medicine Questionnaire. Information about the severity of their depression, demographics, and other study variables were collected.Results: A total of 403 patients met the inclusion criteria and participated in the study. Of those, 203 (50.37% were females, while the remaining 200 (49.6% were males. There was an average age of 39 years (standard deviation, ±11 years. Half of the patients (52.9% reported low adherence to their antidepressant medication, with statistically significant differences between the low adherence and high adherence scores relating to sex, age, and duration of illness. Conclusion: Low medication adherence is a common problem among major depressive disorder

Variations in infant and childhood vitamin D supplementation programmes across Europe and factors influencing adherence

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Suma Uday

2017-10-01

Full Text Available Background: Nutritional rickets is a growing global public health concern despite existing prevention programmes and health policies. We aimed to compare infant and childhood vitamin D supplementation policies, implementation strategies and practices across Europe and explore factors influencing adherence. Methods: European Society for Paediatric Endocrinology Bone and Growth Plate Working Group members and other specialists completed a questionnaire on country-specific vitamin D supplementation policy and child health care programmes, socioeconomic factors, policy implementation strategies and adherence. Factors influencing adherence were assessed using Kendall’s tau-b correlation coefficient. Results: Responses were received from 29 of 30 European countries (97%. Ninety-six per cent had national policies for infant vitamin D supplementation. Supplements are commenced on day 1–5 in 48% (14/29 of countries, day 6–21 in 48% (14/29; only the UK (1/29 starts supplements at 6 months. Duration of supplementation varied widely (6 months to lifelong in at-risk populations. Good (≥80% of infants, moderate (50–79% and low adherence (<50% to supplements was reported by 59% (17/29, 31% (9/29 and 10% (3/29 of countries, respectively. UK reported lowest adherence (5–20%. Factors significantly associated with good adherence were universal supplementation independent of feeding mode (P = 0.007, providing information at neonatal unit (NNU discharge (P = 0.02, financial family support (P = 0.005; monitoring adherence at surveillance visits (P = 0.001 and the total number of factors adopted (P < 0.001. Conclusions: Good adherence to supplementation is a multi-task operation that works best when parents are informed at birth, all babies are supplemented, and adherence monitoring is incorporated into child health surveillance visits. Implementation strategies matter for delivering efficient prevention policies.

Factors Associated with Adherence to Follow-up Colposcopy

Science.gov (United States)

Fish, Laura J.; Moorman, Patricia G.; Wordlaw-Stintson, Lashawn; Vidal, Adriana; Smith, Jennifer S.; Hoyo, Cathrine

2013-01-01

Background: Understanding the gaps in knowledge about human papilloma virus (HPV) infection, transmission, and health consequences and factors associated with the knowledge gap is an essential first step for the development of interventions to improve adherence to follow-up among women with abnormal Pap smears. Purpose: To examine the relationship…

Determinants of Adherence to Living on Dialysis for Mexican Americans

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Shirley A. Wells

2015-03-01

Full Text Available This study explores perceptions that affect adherence behaviors among Mexican Americans living with dialysis. In-depth narrative interviews were conducted with 15 Mexican Americans with end-stage renal disease (ESRD living on dialysis, 15 family members, and 6 health care personnel who provided care to them. Four themes emerged: (a positive influences to adherence, (b obstacles to adherence, (c daily activity losses, and (d fears about living with dialysis. From the findings, the perceptions given for non-adherence with the dialysis regimen ranged from denial of the condition, lack of pre-education, to cultural factors. Those given for adherence included prolonged life, family, and hope of getting a transplant. Health care providers were the reminder to adhere. Several cultural factors influenced their adherence perceptions. Strategies to enhance adherence behaviors should focus on knowledge about dialysis, use of the collective efficacy of the family, and the inclusion of cultural values.

Factors influencing ambulance nurses' adherence to a national protocol ambulance care: an implementation study in the Netherlands

NARCIS (Netherlands)

Ebben, R.H.; Vloet, L.C.M.; Grunsven, P.M. van; Breeman, W.; Goosselink, B.; Lichtveld, R.A.; Groot, J. de; Achterberg, T. van

2015-01-01

OBJECTIVES: Adherence to prehospital guidelines and protocols is suboptimal. Insight into influencing factors is necessary to improve adherence. The aim of this study was to identify factors that influence ambulance nurses' adherence to a National Protocol Ambulance Care (NPAC). METHODS: A

Oral anticancer agent medication adherence by outpatients.

Science.gov (United States)

Kimura, Michio; Usami, Eiseki; Iwai, Mina; Nakao, Toshiya; Yoshimura, Tomoaki; Mori, Hiromi; Sugiyama, Tadashi; Teramachi, Hitomi

2014-11-01

In the present study, medication adherence and factors affecting adherence were examined in patients taking oral anticancer agents. In June 2013, 172 outpatients who had been prescribed oral anticancer agents by Ogaki Municipal Hospital (Ogaki, Gifu, Japan) completed a questionnaire survey, with answers rated on a five-point Likert scale. The factors that affect medication adherence were evaluated using a customer satisfaction (CS) analysis. For patients with good and insufficient adherence to medication, the median ages were 66 years (range, 21-85 years) and 73 years (range, 30-90 years), respectively (P=0.0004), while the median dosing time was 131 days (range, 3-3,585 days) and 219 days (24-3,465 days), respectively (P=0.0447). In 36.0% (62 out of 172) of the cases, there was insufficient medication adherence; 64.5% of those cases (40 out of 62) showed good medication compliance (4-5 point rating score). However, these patients did not fully understand the effects or side-effects of the drugs, giving a score of three points or less. The percentage of patients with good medication compliance was 87.2% (150 out of 172). Through the CS analysis, three items, the interest in the drug, the desire to consult about the drug and the condition of the patient, were extracted as items for improvement. Overall, the medication compliance of the patients taking the oral anticancer agents was good, but the medication adherence was insufficient. To improve medication adherence, a better understanding of the effectiveness and necessity of drugs and their side-effects is required. In addition, the interest of patients in their medication should be encouraged and intervention should be tailored to the condition of the patient. These steps should lead to improved medication adherence.

COPD patients' self-reported adherence, psychosocial factors and mild cognitive impairment in pulmonary rehabilitation.

Science.gov (United States)

Pierobon, Antonia; Sini Bottelli, Elisa; Ranzini, Laura; Bruschi, Claudio; Maestri, Roberto; Bertolotti, Giorgio; Sommaruga, Marinella; Torlaschi, Valeria; Callegari, Simona; Giardini, Anna

2017-01-01

In addition to clinical comorbidities, psychological and neuropsychological problems are frequent in COPD and may affect pulmonary rehabilitation delivery and outcome. The aims of the study were to describe a COPD population in a rehabilitative setting as regards the patients depressive symptoms, anxiety, mild cognitive impairment (MCI) and self-reported adherence and to analyze their relationships; to compare the COPD sample MCI scores with normative data; and to investigate which factors might predict adherence to prescribed physical exercise. This was a multicenter observational cross-sectional study. Of the 117 eligible stable COPD inpatients, 84 were enrolled according to Global initiative for chronic Obstructive Lung Disease (GOLD) criteria (mainly in Stage III-IV). The assessment included Mini Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), anxiety, depression and self-reported pharmacological and nonpharmacological adherence. From the MMSE, 3.6% of patients were found to be impaired, whereas from the MoCA 9.5% had a likely MCI. Patients referred had mild-severe depression (46.7%), anxiety (40.5%), good pharmacological adherence (80.3%) and difficulties in following prescribed diet (24.1%) and exercise (51.8%); they struggled with disease acceptance (30.9%) and disease limitations acceptance (28.6%). Most of them received good family (89%) or social (53%) support. Nonpharmacological adherence, depression, anxiety and MCI showed significant relations with 6-minute walking test, body mass index (BMI) and GOLD. Depression was related to autonomous long-term oxygen therapy modifications, disease perception, family support and MCI. In the multivariate logistic regression analysis, higher BMI, higher depression and lower anxiety predicted lower adherence to exercise prescriptions ( P =0.0004, odds ratio =0.796, 95% CI =0.701, 0.903; P =0.009, odds ratio =0.356, 95% CI =0.165, 0.770; and P =0.05, odds ratio =2.361, 95% CI =0.995, 5

The rate and factors associated with non-adherence to surgery, chemotherapy, radiotherapy and hormonal therapy among breast cancer patients attending public hospitals in Malaysia

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Nur Aishah Taib

2017-12-01

Full Text Available Background: The role of breast cancer treatments in reducing recurrence and death has been established. However, the treatments side effects greatly impact on quality of life and little is known about the non-adherence rates. The purpose of this study was to determine the non-adherence rates to surgery, chemotherapy, radiotherapy and hormonal therapy, and factors that affect it in public hospitals in Malaysia. Methods: A multicentre cross-sectional study was conducted in six public hospitals involving all newly diagnosed breast cancer patients in 2012. Data were collected through medical record reviews and interview by using structured questionnaire. Non-adherence was categorized as any breast cancer patients refusing or discontinuing any treatment due to non-medical reasons. Univariable logistic regression and multiple logistic regressions were used for analysis. Results: A total of 340 breast cancer patients were included in the study. The proportion for non-adherence to surgery, chemotherapy, radiotherapy and hormonal therapy were 14%, 30.1%, 33.3% and 36.3% respectively. Factors associated with non-adherence to surgery were localities involving Kuala Lumpur (2 (OR: 3.41, Johor (OR: 8.38 and Kelantan (OR: 6.32, and those required mastectomy (OR: 5.66. No factors were found to be associated with non-adherence to chemotherapy, radiotherapy and hormonal therapy. These three treatment modalities were then combined as oncology therapy and the only independent factor associated with non-adherence to oncology therapy was Perak locality (OR: 1.42. Conclusion: Non-adherence to breast cancer treatments was high among breast cancer patients at public hospitals in Malaysia. Factors influencing non-adherence were locations and mastectomy implicating of socio-culture, body image issues, psychological disturbance and treatment navigation. Community educational programs focusing on correcting misconceptions, treatment outcomes and treatments’ side effects

Development and Application of the Lincoln Adherence Instrument Record for Assessing Client Adherence to Advice in Dog Behavior Consultations and Success

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Lisanna Lamb

2018-03-01

Full Text Available Adherence to the advice of medical practitioners is critical to successful treatment outcomes and has been much researched in human health, but is less well studied in the veterinary and clinical animal behavior fields. Given that the management of behavior problems often requires substantial change in established client behavior, it is likely that adherence is a substantive issue affecting success. However, little is known about the relationships between relevant factors, and there is no established way of assessing these. Therefore, the aim of this study was to develop an instrument for coding factors likely to impinge on pet owner adherence to behavior advice and validate its utility through the identification of the factors appearing to relate most closely to a successful treatment outcome in a sample population from our clinic. Potential factors affecting adherence were identified from human health and animal behavior studies, and a survey instrument developed with items matched to these factors. Forty-two dog owners who had attended the University of Lincoln Animal Behavior Clinic over a 2-year period provided data used in the analysis. The assessment of treatment outcome success by clients and clinicians was correlated, but clinicians tended to overestimate success by half a point on a 5-point scale. Eleven items relating to adherence were found to correlate with client ratings of treatment success in a univariate analysis, with three of these remaining in an ordinal logistic regression model. These three related to trust in the advice given by the clinician, concern over distress caused to the pet in the longer term and the perceived recommendation of treatment measures that had failed. By further examining the relationship between all of these factors in a hierarchical cluster analysis, we were able to postulate ways in which we might be able to improve client adherence and thus treatment success. This provides a model for the

Development and Application of the Lincoln Adherence Instrument Record for Assessing Client Adherence to Advice in Dog Behavior Consultations and Success.

Science.gov (United States)

Lamb, Lisanna; Affenzeller, Nadja; Hewison, Lynn; McPeake, Kevin James; Zulch, Helen; Mills, Daniel S

2018-01-01

Adherence to the advice of medical practitioners is critical to successful treatment outcomes and has been much researched in human health, but is less well studied in the veterinary and clinical animal behavior fields. Given that the management of behavior problems often requires substantial change in established client behavior, it is likely that adherence is a substantive issue affecting success. However, little is known about the relationships between relevant factors, and there is no established way of assessing these. Therefore, the aim of this study was to develop an instrument for coding factors likely to impinge on pet owner adherence to behavior advice and validate its utility through the identification of the factors appearing to relate most closely to a successful treatment outcome in a sample population from our clinic. Potential factors affecting adherence were identified from human health and animal behavior studies, and a survey instrument developed with items matched to these factors. Forty-two dog owners who had attended the University of Lincoln Animal Behavior Clinic over a 2-year period provided data used in the analysis. The assessment of treatment outcome success by clients and clinicians was correlated, but clinicians tended to overestimate success by half a point on a 5-point scale. Eleven items relating to adherence were found to correlate with client ratings of treatment success in a univariate analysis, with three of these remaining in an ordinal logistic regression model. These three related to trust in the advice given by the clinician, concern over distress caused to the pet in the longer term and the perceived recommendation of treatment measures that had failed. By further examining the relationship between all of these factors in a hierarchical cluster analysis, we were able to postulate ways in which we might be able to improve client adherence and thus treatment success. This provides a model for the application of the instrument

Psychosocial factors and adherence to drug treatment in patients on chronic haemodialysis.

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Huertas-Vieco, María P; Pérez-García, Rafael; Albalate, Marta; de Sequera, Patricia; Ortega, Mayra; Puerta, Marta; Corchete, Elena; Alcázar, Roberto

2014-11-17

The daily pill burden in hemodialysis patients is one of the highest reported to date in any chronic disease. The adherence to prescribed treatment has implications on the quality of life, the survival of patients, and the economic cost of their treatment, this being a priority public health issue. To evaluate the adherence to pharmacological treatment examining, among the possible causes of non-adherence, psychosocial factors such as depression, anxiety, cognitive impairment and social support. Transversal-observational study of thirty five patients that suffer from chronic renal disease and who are on manteinance hemodialysis, evaluated by self-reported measures. Non-adherent patients have significant higher depression index than adherent patients. Anxiety, cognitive impairment and social support do not show a significant relation with the degree of adherence or compliance with farmacological treatment. These results suggest that psychological intervention in chronic haemodialysis patients with a severe depression index could increase the degree of fulfillment and general well-being of renal patients.

Risk factors for non-adherence to antidepressant treatment in patients with mood disorders.

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De las Cuevas, Carlos; Peñate, Wenceslao; Sanz, Emilio J

2014-01-01

Adherence to antidepressant therapy by patients with depressive disorders is essential not only to achieve a positive patient outcome but also to prevent a relapse. The aim of this study was to identify potential modelling factors influencing adherence to antidepressant treatment by patients with mood disorders in the community mental health care setting A total of 160 consecutive psychiatric outpatients attending two Community Mental Health Centres on Tenerife Island between September 2011 and May 2012 were asked to participate in the study; of these, 145 accepted. The Morisky self-report scale was used to assess adherence. The potential predictors examined included socio-demographic, clinical and therapeutic variables. The Clinical Global Impression-Severity and -Improvement scales and the Beck Depression Inventory were used for clinical assessment. Drug treatment side-effects were assessed using the "Self-report Antidepressant Side-Effect Checklist." All participants were also asked to complete the "Drug Attitude Inventory" (DAI), "Beliefs about Medicine Questionnaire" (BMQ), and "Leeds Attitude towards concordance Scale". Discriminant analyses were performed to predict non-adherence. There was no clear correlation between adherence and the socio-demographic variables examined, but adherence was related to a positive attitude of the patients towards his/her treatment (DAI) and low scores in the BMQ-Harm and -Concern subscales. Non-adherence was also related to an increasing severity of depression and to the presence and severity of side-effects. Among our study cohort, the profiles of adherent patients to antidepressant treatment were more closely associated with each patient's attitudes and beliefs than to objective socio-demographic variables. The severity of depression played a relevant role in adherence, but whether this role is direct or an interaction with several concurrent factors is not yet clear. Side-effects were also closely related to adherence, as

Factors related to high and low levels of drug adherence according to patients with type 2 diabetes

NARCIS (Netherlands)

Borgsteede, S.D.; Westerman, M.J.; Kok, I.L.; Meeuse, J.C.; de Vries, T.P.G.M.; Hugtenburg, J.G.

2011-01-01

Objective Adherence to medication in patients with type 2 diabetes varies widely, yet the factors that influence adherence according to patients are not fully known. The aim of this study is to explore both factors related to high and lower levels of adherence that patients with type 2 diabetes

Factors governing long-term adherence to a gluten-free diet in adult patients with coeliac disease.

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Villafuerte-Galvez, J; Vanga, R R; Dennis, M; Hansen, J; Leffler, D A; Kelly, C P; Mukherjee, R

2015-09-01

A strict gluten-free diet is the cornerstone of treatment for coeliac disease. Studies of gluten-free diet adherence have rarely used validated instruments. There is a paucity of data on long-term adherence to the gluten-free diet in the adult population. To determine the long-term adherence to the gluten-free diet and potential associated factors in a large coeliac disease referral centre population. We performed a mailed survey of adults with clinically, serologically and histologically confirmed coeliac disease diagnosed ≥5 years prior to survey. The previously validated Celiac Disease Adherence Test was used to determine adherence. Demographic, socio-economic and potentially associated factors were analysed with adherence as the outcome. The response rate was 50.1% of 709 surveyed, the mean time on a gluten-free diet 9.9 ± 6.4 years. Adequate adherence (celiac disease adherence test score 75% of respondents. Perceived cost remains a barrier to adherence. Perceptions of effectiveness of gluten-free diet as well as its knowledge, are potential areas for intervention. © 2015 John Wiley & Sons Ltd.

Factors Influencing Antiretroviral Adherence and Virological Outcomes in People Living with HIV in the Highlands of Papua New Guinea.

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Janet Gare

Full Text Available Adherence to antiretroviral therapy (ART is paramount for virological suppression and positive treatment outcomes. ART has been rapidly scaled up in Papua New Guinea (PNG in recent years, however clinical monitoring of HIV+ individuals on ART is limited. A cross-sectional study was conducted at two major sexual health clinics in high HIV prevalence provinces in the Highlands Region of PNG to assess ART adherence, factors affecting adherence and the relationship between ART adherence and virological outcomes. Ninety-five HIV+ individuals were recruited and administered a questionnaire to gather demographic and ART adherence information whilst clinical data and pill counts were extracted from patient charts and blood was collected for viral load testing. Bivariate analysis was performed to identify independent predictors of ART adherence. Fourteen percent (n = 12 of participants showed evidence of virological failure. Although the majority of participants self-reported excellent ART adherence in the last seven days (78.9%, 75/91, pill count measurements indicated only 40% (34/84 with >95% adherence in the last month. Taking other medications while on ART (p = 0.01 and taking ART for ≥1 year (p = 0.037 were positively associated with adherence by self-report and pill count, respectively. Participants who had never heard of drug resistance were more likely to show virological failure (p = 0.033. Misconception on routes of HIV transmission still persists in the studied population. These findings indicate that non-adherence to ART is high in this region of PNG and continued education and strategies to improve adherence are required to ensure the efficacy of ART and prevent HIV drug resistance.

Perspectives Regarding Adherence to Prescribed Treatment in Highly Adherent HIV-Infected Gay Men.

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Brion, John M; Menke, Edna M

2008-01-01

Focus group methodology was used to describe the medication adherence experience of 24 HIV-infected gay men who reported being adherent to their medication regimens. A conceptualization of medication adherence as an evolving process consisted of challenges to adherence (learning the diagnosis, starting the medications, struggling with the medications, dealing with side effects, coping with stigma) as well as those factors supportive of adherence (believing in medications, finding motivating factors, using reminders, depending on others, owning the disease). Themes associated with challenges to adherence focused on diagnosis and the physical and emotional adjustments individuals made to incorporate antiretroviral medications into their daily lives and move toward medication adherence. The factors supportive of adherence were related to the ongoing behaviors identified with establishing and maintaining adherence behaviors. What can be taken from the study is that adherence is a complex and dynamic process rather than a static behavior.

A nationwide survey of factors influencing adherence to ocular hypotensive eyedrops in Japan.

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Tsumura, Toyoaki; Kashiwagi, Kenji; Suzuki, Yasuyuki; Yoshikawa, Keiji; Suzumura, Hirotaka; Maeda, Toshine; Takeda, Ryuji; Saito, Hitomi; Araie, Makoto

2018-01-12

Few reports have investigated the status of adherence in Japan on a large scale. We aimed to investigate the status of adherence to topical glaucoma treatment and its associated factors. A nationwide survey was conducted as a prospective fashion. Participants in this survey were subjects with primary open-angle glaucoma, normal-tension glaucoma, or ocular hypertension or pseudoexfoliation glaucoma who had been prescribed anti-glaucoma ophthalmic eyedrops and whose ophthalmologist considered prescribing any fixed combination of ocular hypotensive eyedrops for the first time between 2011 and 2012. Subjects and their attending ophthalmologists independently completed a questionnaire by utilizing a fixed combination of ocular hypotensive eyedrops. A total of 1358 ophthalmologists from 1071 medical institutions participated in this survey. We registered 4430 subjects (2049 males and 2381 females). In total, data from 3853 subjects (87.6%) were analyzed after inclusion of subjects based on inclusion and exclusion criteria. Good adherence was defined as not forgetting instillation during the past week. Rates of good adherence reported by subjects and ophthalmologists were 72.4 and 78.5%, respectively (P < 0.0001). The consistency of adherence evaluation between subjects and ophthalmologists was moderate [kappa score 0.5025 (95% confidence interval 0.4740-0.5309)]. Significant factors associated with adherence were size of clinic, age, gender, number of types of ocular hypotensive eyedrops, ease of instillation, preferred number of eyedrops, preferred frequency of instillation of eyedrops, and knowledge of glaucoma. Adherence to ocular hypotensive eyedrops among Japanese subjects was relatively good. Concordance of adherence between subjects' reports and ophthalmologists' responses was moderate. Size of clinic, number of types of ocular hypotensive eyedrops, ease of instillation, preferred number of eyedrops, preferred frequency of instillation of eyedrops, and knowledge

Adherence to the Mediterranean Diet and Factors Affecting Obesity in High School Students

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Aysun Yüksel

2017-12-01

Full Text Available The prevalence overweight and obese among children and adolescents increases gradually in the world and became an epidemic in both developing and developed countries. Overweight and obesity in the adolescent period are the main risk factors contributing to the development of cardiovascular diseases in the adulthood period. This study was planned to reveal the prevalence of obesity and association of healthy lifestyle behaviors with obesity in adolescents. Methods: This research was carried out 859 students studying at Istanbul Hezarfen High School between the dates 1 February to 31 March 2017. The general dietary habits and night eating statuses were determined using the Mediterranean Diet Quality Index (KIDMED and Night Eating Questionnaire (NEQ and anthropometric parameters such as height and body weight were measured. Results: The mean age of the students was 15.9 ± 1.3 years. Of the students, 19.2% had overweight, 13.7% had obese BMI values. In this study, 32.4% of all students had low and 13% of them had optimal nutritional quality. The difference between two genders was statistically significant (p<0.05. The Night Eating Syndrome was not present in 78.9% of all students whereas it was detected in 21.1% of them. Conclusions: In our study, there was no statistically significant relationship between obesity, adherence to Mediterranean Diet and Night Eating Syndrome.

Factors Associated With Adherence to Methylphenidate Treatment in Adult Patients With Attention-Deficit/Hyperactivity Disorder and Substance Use Disorders.

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Skoglund, Charlotte; Brandt, Lena; Almqvist, Catarina; DʼOnofrio, Brian M; Konstenius, Maija; Franck, Johan; Larsson, Henrik

2016-06-01

Adherence to treatment is one of the most consistent factors associated with a favorable addiction treatment outcome. Little is known about factors associated with treatment adherence in individuals affected with comorbid attention-deficit/hyperactivity disorder and substance use disorders (SUD). This study aimed to explore whether treatment-associated factors, such as the prescribing physician's (sub)specialty and methylphenidate (MPH) dose, or patient-related factors, such as sex, age, SUD subtype, and psychiatric comorbidity, were associated with adherence to MPH treatment. Swedish national registers were used to identify adult individuals with prescriptions of MPH and medications specifically used in the treatment of SUD or a diagnosis of SUD and/or coexisting psychiatric diagnoses. Primary outcome measure was days in active MPH treatment in stratified dose groups (≤36 mg, ≥37 mg to ≤54 mg, ≥55 mg to ≤72 mg, ≥73 mg to ≤90 mg, ≥91 mg to ≤108 mg, and ≥109 mg). Lower MPH doses (ie, ≤36 mg day 100) were associated with treatment discontinuation between days 101 and 830 (HR≤36 mg, 1.67; HR37-54mg, 1.37; HR55-72mg, 1.36; HR73-90mg, 1.19; HR≥108mg, 1.09). The results showed a linear trend (P attention-deficit/hyperactivity disorder and SUD.

Factors associated with intentions to adhere to colorectal cancer screening follow-up exams

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Ishibashi Teruo

2006-11-01

Full Text Available Abstract Background To increase adherence rate to recommendations for follow-up after abnormal colorectal cancer (CRC screening results, factors that inhibit and facilitate follow-up must be identified. The purpose of this study was to identify the factors associated with intention to adhere to CRC screening follow-up exams. Methods During a 4-week period in October 2003, this survey was conducted with 426 subjects participating in a community-based CRC screening program in Nagano, Japan. Study measures included intention to adhere to recommendation for clinical follow-up in the event of an abnormal fecal occult blood test (FOBT result, perceived susceptibility and severity of CRC, perceived benefits and barriers related to undergoing follow-up examination, social support, knowledge of CRC risk factors, health status, previous CRC screening, personality and social demographic characteristics. Univariate and multivariate logistic regression analyses on intention to adhere to recommendations for follow-up were performed. Results Among the 288 individuals analyzed, approximately 74.7% indicated that they would definitely adhere to recommendations for follow-up. After controlling for age, gender, marital status, education, economic status, trait anxiety, bowel symptoms, family history of CRC, and previous screening FOBT, analyses revealed that lower levels of perceived barriers, higher levers of perceived benefits and knowledge of CRC risk factors were significantly associated with high intention respectively. Conclusion The results of this study suggest that future interventions should focus on reducing modifiable barriers by clarifying misperceptions about follow-up, promoting the acceptance of complete diagnostic evaluations, addressing psychological distress, and making follow-up testing more convenient and accessible. Moreover, educating the public regarding the risk factors of CRC and increasing understanding of the benefits of follow-up is

Approaches to improve adherence to pharmacotherapy in patients with schizophrenia.

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Shuler, Kimberly M

2014-01-01

In patients with schizophrenia, nonadherence to prescribed medications increases the risk of patient relapse and hospitalization, key contributors to the costs associated with treatment. The objectives of this review were to evaluate the impact of nonadherence to pharmacotherapy in patients with schizophrenia as it relates to health care professionals, particularly social workers, and to identify effective team approaches to supporting patients based on studies assessing implementation of assertive community treatment teams. A systematic review of the medical literature was conducted by searching the Scopus database to identify articles associated with treatment adherence in patients with schizophrenia. Articles included were published from January 1, 2003, through July 15, 2013, were written in English, and reported findings concerning any and all aspects of nonadherence to prescribed treatment in patients with schizophrenia. Of 92 unique articles identified and formally screened, 47 met the inclusion criteria for the systematic review. The burden of nonadherence in schizophrenia is significant. Factors with the potential to affect adherence include antipsychotic drug class and formulation, patient-specific factors, and family/social support system. There is inconclusive evidence suggesting superior adherence with an atypical versus typical antipsychotic or with a long-acting injectable versus an oral formulation. Patient-specific factors that contribute to adherence include awareness/denial of illness, cognitive issues, stigma associated with taking medication, substance abuse, access to health care, employment/poverty, and insurance status. Lack of social or family support may adversely affect adherence, necessitating the assistance of health care professionals, such as social workers. Evidence supports the concept that an enhanced team-oriented approach to managing patients with schizophrenia improves adherence and supports corresponding reductions in relapse

Eating habits and factors affecting food choice of adolescents living in rural areas.

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Bargiota, Alexandra; Pelekanou, Maria; Tsitouras, Andreas; Koukoulis, Georgios N

2013-01-01

To establish factors that affect food choices among adolescents living in rural areas and to identify their food choices. A random sample of adolescents living in a Greek rural area (n=382) aged 12-18 years were individually interviewed. Food consumption was assessed by a semi-quantitative food-frequency questionnaire and adherence to the Mediterranean diet was evaluated using the KIDMED questionnaire. Information was collected regarding self-perceived body size, dieting, dietary knowledge, parental control, meal and snack frequency, eating out of home, eating takeaways and precooked meals, eating from the school canteen. Body image concerns, dieting, education about food, parental control, maternal education level and eating with family and peers are factors that were found to affect food choices in this group of Greek adolescents. The adherence to the Mediterranean diet was low (KIDMED index was 4.5±2.7). Regular family meals at home were frequent in this group and 99% of the adolescents ate lunch daily at home. Eating out with peers and eating from the school canteen was related with higher consumption of 'junk type of food'. Girls and younger adolescents and those whose mothers had a higher education level seem to make healthier choices. Factors such as personal issues, family and peer pressure significantly affect food choices among adolescents living in a Greek rural area and highlight the importance of implementing multilevel strategies to promote healthy eating among adolescents.

Factors associated with non-adherence to highly active antiretroviral therapy in Nairobi, Kenya

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Wakibi Samwel N

2011-12-01

Full Text Available Abstract Background Antiretroviral therapy (ART requires high-level (> 95% adherence. Kenya is rolling out ART access programmes and, issue of adherence to therapy is therefore imperative. However, published data on adherence to ART in Kenya is limited. This study assessed adherence to ART and identified factors responsible for non adherence in Nairobi. Methods This is a multiple facility-based cross-sectional study, where 416 patients aged over 18 years were systematically selected and interviewed using a structured questionnaire about their experience taking ART. Additional data was extracted from hospital records. Patients were grouped into adherent and non-adherent based on a composite score derived from a three questions adherence tool developed by Center for Adherence Support Evaluation (CASE. Multivariate regression model was used to determine predictors of non-adherence. Results Overall, 403 patients responded; 35% males and 65% females, 18% were non-adherent, and main (38% reason for missing therapy were being busy and forgetting. Accessing ART in a clinic within walking distance from home (OR = 2.387, CI.95 = 1.155-4.931; p = 0.019 and difficulty with dosing schedule (OR = 2.310, CI.95 = 1.211-4.408, p = 0.011 predicted non-adherence. Conclusions The study found better adherence to HAART in Nairobi compared to previous studies in Kenya. However, this can be improved further by employing fitting strategies to improve patients' ability to fit therapy in own lifestyle and cue-dose training to impact forgetfulness. Further work to determine why patients accessing therapy from ARV clinics within walking distance from their residence did not adhere is recommended.

Facilitating and inhibiting factors related to treatment adherence in women with polycystic ovary syndrome: A qualitative study

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Fatemeh Bazarganipour

2017-09-01

Full Text Available Background: Adherence issues in polycystic ovary syndrome (PCOS patients have not been examined thoroughly. Patients report prolonged periods of treatment and side effects of the drug as the most common reason for withdrawal from treatment. To improve the effective management of PCOS patients, it is fundamental to understand facilitating and inhibiting factors to treatment adherence. Objective: To explore facilitating/inhibiting factors related to treatment adherence among PCOS patients. Materials and Methods: This was a qualitative study with a purposive sample of women with confirmed diagnosis of PCOS. The data were collected via 20 in-depth semi-structured interviews with women aged between 21-34 yr. A qualitative content analysis was used to analyze the data. Results: Five themes were identified which described different types of facilitating/ inhibiting factors to treatment adherence. Inhibiting factors included financial issues, patient-related, disease-related, and health care provider-related factors; while social factors were found to be both facilitating and inhibiting. Conclusion: The findings suggest that successful adherence to PCOS treatment is highly dependent on patients recognizing and adapting to financial, social, and health care related inhibiting factors. It is also crucial for clinicians and policy makers to recognize these key inhibiting factors in order to improve treatment outcomes.

Approaches to improve adherence to pharmacotherapy in patients with schizophrenia

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Shuler KM

2014-05-01

Full Text Available Kimberly M Shuler Shuler Counseling and Consulting, Fayetteville, AR, USA Purpose: In patients with schizophrenia, nonadherence to prescribed medications increases the risk of patient relapse and hospitalization, key contributors to the costs associated with treatment. The objectives of this review were to evaluate the impact of nonadherence to pharmacotherapy in patients with schizophrenia as it relates to health care professionals, particularly social workers, and to identify effective team approaches to supporting patients based on studies assessing implementation of assertive community treatment teams. Materials and methods: A systematic review of the medical literature was conducted by searching the Scopus database to identify articles associated with treatment adherence in patients with schizophrenia. Articles included were published from January 1, 2003, through July 15, 2013, were written in English, and reported findings concerning any and all aspects of nonadherence to prescribed treatment in patients with schizophrenia. Results: Of 92 unique articles identified and formally screened, 47 met the inclusion criteria for the systematic review. The burden of nonadherence in schizophrenia is significant. Factors with the potential to affect adherence include antipsychotic drug class and formulation, patient-specific factors, and family/social support system. There is inconclusive evidence suggesting superior adherence with an atypical versus typical antipsychotic or with a long-acting injectable versus an oral formulation. Patient-specific factors that contribute to adherence include awareness/denial of illness, cognitive issues, stigma associated with taking medication, substance abuse, access to health care, employment/poverty, and insurance status. Lack of social or family support may adversely affect adherence, necessitating the assistance of health care professionals, such as social workers. Evidence supports the concept that an

Risk Factors for Non-Adherence to cART in Immigrants with HIV Living in the Netherlands: Results from the ROtterdam ADherence (ROAD Project.

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Sabrina K Been

Full Text Available In the Netherlands, immigrant people living with HIV (PLWH have poorer psychological and treatment outcomes than Dutch PLWH. This cross-sectional field study examined risk factors for non-adherence to combination Antiretroviral Therapy (cART among immigrant PLWH. First and second generation immigrant PLWH attending outpatient clinics at two HIV-treatment centers in Rotterdam were selected for this study. Socio-demographic and clinical characteristics for all eligible participants were collected from an existing database. Trained interviewers subsequently completed questionnaires together with consenting participants (n = 352 to gather additional data on socio-demographic characteristics, psychosocial variables, and self-reported adherence to cART. Univariable and multivariable logistic regression analyses were conducted among 301 participants who had used cART ≥6 months prior to inclusion. Independent risk factors for self-reported non-adherence were (I not having attended formal education or only primary school (OR = 3.25; 95% CI: 1.28-8.26, versus University, (II experiencing low levels of social support (OR = 2.56; 95% CI: 1.37-4.82, and (III reporting low treatment adherence self-efficacy (OR = 2.99; 95% CI: 1.59-5.64. Additionally, HIV-RNA >50 copies/ml and internalized HIV-related stigma were marginally associated (P<0.10 with non-adherence (OR = 2.53; 95% CI: 0.91-7.06 and OR = 1.82; 95% CI: 0.97-3.43. The findings that low educational attainment, lack of social support, and low treatment adherence self-efficacy are associated with non-adherence point to the need for tailored supportive interventions. Establishing contact with peer immigrant PLWH who serve as role models might be a successful intervention for this specific population.

Perspectives of patients on factors relating to adherence to post-acute coronary syndrome medical regimens

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Lambert-Kerzner A

2015-07-01

Full Text Available Anne Lambert-Kerzner,1,2 Edward P Havranek,2,3 Mary E Plomondon,1,2 Katherine M Fagan,1 Marina S McCreight,1 Kelty B Fehling,1 David J Williams,2 Alison B Hamilton,4 Karen Albright,2 Patrick J Blatchford,2 Renee Mihalko-Corbitt,5 Chris L Bryson,6 Hayden B Bosworth,7 Miriam A Kirshner,7 Eric J Del Giacco,5 P Michael Ho1,2 1Department of Cardiology, Veterans Health Administration (VA Eastern Colorado Health Care System, Denver, CO, 2School of Public Health or School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, 3Cardiology, Denver Health Medical Center, Denver, CO, 4Health Services Research, Veterans Health Administration (VA Greater Los Angeles Healthcare System, Los Angeles, CA, 5Internal Medicine, John L. McClellan Memorial Veterans Hospital, Little Rock, AR, 6Health Services Research, Veterans Health Administration (VA Puget Sound Health Care System, Seattle, WA, 7Health Services Research, Durham Veterans Affairs Medical Center, Durham, NC, USA Purpose: Poor adherence to cardioprotective medications after acute coronary syndrome (ACS hospitalization is associated with increased risk of rehospitalization and mortality. Clinical trials of multifaceted interventions have improved medication adherence with varying results. Patients’ perspectives on interventions could help researchers interpret inconsistent outcomes. Identifying factors that patients believe would improve adherence might inform the design of future interventions and make them more parsimonious and sustainable. The objective of this study was to obtain patients’ perspectives on adherence to medical regimens after experiencing an ACS event and their participation in a medication adherence randomized control trial following their hospitalization. Patients and methods: Sixty-four in-depth interviews were conducted with ACS patients who participated in an efficacious, multifaceted, medication adherence randomized control trial. Interview transcripts were

[Factors associated with treatment adherence for tuberculosis infection].

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Gallardo, Carmen R; Gea Velázquez de Castro, María Teresa; Requena Puche, Juana; Miralles Bueno, Juan José; Rigo Medrano, María Vicenta; Aranaz Andrés, Jesús M

2014-01-01

To analyze adherence to treatment of tuberculosis infection and to identify risk factors for its compliance. An observational historical cohort study. Hospital Universitari Sant Joan d'Alacant (Alicante). All patients with a tuberculin skin test (TST) done during tuberculosis contact tracing during 6 years. We included 764 tuberculosis contacts in the analysis. 59.7% of the 566 patients who completed the contact tracing, had tuberculosis infection (TI). Of the patients with TI, 45.6% had not started treatment for tuberculosis infection (TTBI). Factors associated with not starting TTBI were: age (36-65 years, RR: 5.8; 95% CI: 1.2-27.5, and > 65 years, RR: 11.3; 95% CI: 2.0-64.0), the social relationship with TB case (RR: 2.2; 95% CI 1.2-3.8), and the TST reaction (≥ 15mm; RR: 0.5; 95% CI: 0.3-0.9). The completion rate for TTBI was 80.4% among people who started therapy. The treatment regimen was associated with greater compliance to TTBT (7-9H, RR: 12.7; 95% CI: 1.5-107.3). The treatment compliance rate of Tuberculosis infection was high among people who started therapy. Almost a half of the contacts with TI did not start treatment, and associated factors were: age, social relationship, and the TST reaction. The treatment regimen was associated with greater compliance. It is important to know the factors associated with adherence to treatment of TI in each health area, and focus efforts on risk groups; thereby approaching the global control of tuberculosis. Copyright © 2013 Elsevier España, S.L. All rights reserved.

Risk factors for antipsychotic medication non-adherence behaviors and attitudes in adult-onset psychosis.

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Hui, Christy Lai Ming; Poon, Venessa Wing Yan; Ko, Wai Tung; Miao, Ho Yee; Chang, Wing Chung; Lee, Edwin Ho Ming; Chan, Sherry Kit Wa; Lin, Jingxia; Chen, Eric Yu Hai

2016-07-01

Research on antipsychotic medication non-adherence in first-episode psychosis patients tends to examine non-adherence behaviors and attitudes together. Nonetheless, attitudes do not always directly translate into behaviors. We examined the baseline predictors for antipsychotics non-adherence behaviors and attitudes separately in a first-episode psychosis cohort. We also included cognitive impairments as one of the predictor variables as this domain is rarely explored in adherence studies. Participants were 313 adult-onset psychosis patients recruited from the Jockey Club Early Psychosis project in Hong Kong. Demographic, premorbid, clinical, and cognitive characteristics were first assessed at baseline. Six months later, participants completed a 14-item Medication Compliance Questionnaire, which was a modified and Cantonese-translated version of the Medication Adherence Rating Scale that includes items pertaining to both adherence behaviors and attitudes. Rates of poor adherence behaviors and negative adherence attitudes were 17.6% and 27.8%, respectively. Determinants of poor adherence behavior included more severe positive symptoms, hospitalization at onset of illness, and poorer engagement in extended social network. As for negative adherence attitude, determinants included more severe general psychopathology, poorer insight, more psychic medication side-effects, and poorer performance on backward digit span test and WAIS-R information test. The risk factors for non-adherence behaviors and attitudes are different and they should all be taken into careful consideration while formulating appropriate intervention programs to tackle the adherence problem in adult onset psychosis. Copyright © 2016 Elsevier B.V. All rights reserved.

Factors affecting adherence to national malaria treatment guidelines in management of malaria among public healthcare workers in Kamuli District, Uganda.

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Bawate, Charles; Callender-Carter, Sylvia T; Nsajju, Ben; Bwayo, Denis

2016-02-24

Malaria remains a major public health threat accounting for 30.4 % of disease morbidity in outpatient clinic visits across all age groups in Uganda. Consequently, malaria control remains a major public health priority in endemic countries such as Uganda. Experiences from other countries in Africa that revised their malaria case management suggest that health workers adherence may be problematic. A descriptive, cross-sectional design was used and collected information on health system, health workers and patients. Using log-binomial regression model, adjusted prevalence risk ratios (PRRs) and their associated 95 % confidence intervals were determined in line with adherence to new treatment guidelines of parasitological diagnosis and prompt treatment with artemisinin combination therapy (ACT). Nine health centres, 24 health workers and 240 patient consultations were evaluated. Overall adherence to national malaria treatment guidelines (NMTG) was 50.6 % (122/241). It was significantly high at HC III [115 (53 %)] than at HC IV (29 %) [PRR = 0.28 (95 % CI 0.148 0.52), p = 0.000]. Compared to the nursing aide, the adherence level was 1.57 times higher among enrolled nurses (p = 0.004) and 1.68 times higher among nursing officers, p = 0.238, with statistical significance among the former. No attendance of facility malaria-specific continuing medical education (CME) sessions [PRR = 1.9 (95 % CI 1.29 2.78), p = 0.001] and no display of malaria treatment job aides in consultation rooms [PRR = 0.64 (95 % CI 0.4 1.03), p = 0.07] was associated with increased adherence to guidelines with the former showing a statistical significance and the association of the latter borderline statistical significance. The adherence was higher when the laboratory was functional [PRR = 0.47 (95 % CI 0.35 0.63)] when the laboratory was functional in previous 6 months. Age of health worker, duration of employment, supervision, educational level, and age of patient were found not associated with

Perceived adherence barriers among patients failing second-line ...

African Journals Online (AJOL)

1 School of Public Health and Family Medicine, University of Cape Town, South Africa ... To examine factors affecting adherence to second-line ART from the perspective of clinic staff and .... because she did not realise her VL would go up.

Adherence to antidepressants

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Abimbola Farinde

2013-01-01

Full Text Available While major depression is considered a frequent mental illness there are ongoing reports of high non-adherence to antidepressant medications which places suffers at high risk for relapse, recurrence, or greater impairment,. The World Health Organization (WHO defines adherence as the extent to which a person′s behavior (e.g. taking medications can align with the agreed recommendations of a health care provider. Unfortunately while patient may recognize the importance of adherence to antidepressant medications the majority of patients do not adhere to their prescribed antidepressants. Some of the factors that may contribute to or lead to non-adherence include knowingly or unknowingly missing doses, taking extra doses, delaying administration times, or taking drug holidays. Pharmacists have the unique ability to deter non-adherence through the performance of continuous assessment and monitoring of adherence in this population given these accessibility. Additionally, pharmacists are able to develop therapeutic alliances with patients that can help to increase the likelihood of achieving positive patient outcomes. Antidepressant non-adherence can be viewed as a significant public health concern so it is important for patients to be educated about the importance of adherence, and health care professionals should be aware of factors or patient characteristics that can serve as barriers to non-adherence.

Improving adherence to antiretroviral therapy

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Nischal K

2005-01-01

Full Text Available Antiretroviral therapy (ART has transformed HIV infection into a treatable, chronic condition. However, the need to continue treatment for decades rather than years, calls for a long-term perspective of ART. Adherence to the regimen is essential for successful treatment and sustained viral control. Studies have indicated that at least 95% adherence to ART regimens is optimal. It has been demonstrated that a 10% higher level of adherence results in a 21% reduction in disease progression. The various factors affecting success of ART are social aspects like motivation to begin therapy, ability to adhere to therapy, lifestyle pattern, financial support, family support, pros and cons of starting therapy and pharmacological aspects like tolerability of the regimen, availability of the drugs. Also, the regimen′s pill burden, dosing frequency, food requirements, convenience, toxicity and drug interaction profile compared with other regimens are to be considered before starting ART. The lack of trust between clinician and patient, active drug and alcohol use, active mental illness (e.g. depression, lack of patient education and inability of patients to identify their medications, lack of reliable access to primary medical care or medication are considered to be predictors of inadequate adherence. Interventions at various levels, viz. patient level, medication level, healthcare level and community level, boost adherence and overall outcome of ART.

Asthma medication adherence: the role of God and other health locus of control factors.

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Ahmedani, Brian K; Peterson, Edward L; Wells, Karen E; Rand, Cynthia S; Williams, L Keoki

2013-02-01

Medication adherence is an important determinant of disease outcomes, yet medication use on average tends to be low among patients with chronic conditions, including asthma. Although several predictors of non-adherence have been assessed, more research is needed on patients' beliefs about God and how these relate to medication use. To examine the relationship between perceptions about "God's" role in health and other locus of control factors with inhaled corticosteroid (ICS) adherence among asthma patients. Participants were from a clinical trial to improve ICS adherence and were 5-56 years old, had a diagnosis of asthma, and were receiving ICS medication. Baseline adherence was estimated from electronic prescription and pharmacy fill records. Patients were considered to be adherent if ICS use was ≥80% of prescribed. A baseline survey with the Multidimensional Health Locus of Control scale was used to assess five sources (God, doctors, other people, chance, and internal). Medication adherence was low (36%). Patients' who had a stronger belief that God determined asthma control were less likely to be adherent (odds ratio [OR] 0.82, 95% confidence interval [CI] 0.70-0.96). This relationship was stronger among African American (OR 0.68, 95% CI0.47-0.99) compared to white patients (OR 0.89, 95% CI 0.75-1.04), and among adults (OR 0.81, 95% CI 0.69-0.96) compared to children (OR 0.84, 95% CI 0.58-1.22). Patients' belief in God's control of health appears to be a factor in asthma controller use, and therefore should be considered in physician-patient discussions concerning course of treatment. ClinicalTrials.gov: NCT00459368. Copyright © 2013 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Antidiabetic medication adherence and associated factors among ...

African Journals Online (AJOL)

Godfrey Mutashambara Rwegerera

2017-03-06

Mar 6, 2017 ... tive of the study was to determine current antidiabetic medication adherence in ...... A systematic review of adherence with medications for diabetes. .... Pascal IGU, Ofoedu JN, Uchenna NP, Nkwa AA, Uchamma GUE.

COPD patients’ self-reported adherence, psychosocial factors and mild cognitive impairment in pulmonary rehabilitation

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Pierobon A

2017-07-01

Full Text Available Antonia Pierobon,1 Elisa Sini Bottelli,1 Laura Ranzini,1 Claudio Bruschi,2 Roberto Maestri,3 Giorgio Bertolotti,4 Marinella Sommaruga,5 Valeria Torlaschi,1 Simona Callegari,1 Anna Giardini1 1Psychology Unit, 2Department of Pulmonary Rehabilitation, 3Department of Biomedical Engineering, Istituti Clinici Scientifici Maugeri, IRCCS, Montescano, 4Psychology Unit, Istituti Clinici Scientifici Maugeri, IRCCS, Tratate, 5Clinical Psychology and Social Support Unit, Istituti Clinici Scientifici Maugeri, IRCCS, Camaldoli, Italy Abstract: In addition to clinical comorbidities, psychological and neuropsychological problems are frequent in COPD and may affect pulmonary rehabilitation delivery and outcome. The aims of the study were to describe a COPD population in a rehabilitative setting as regards the patients depressive symptoms, anxiety, mild cognitive impairment (MCI and self-reported adherence and to analyze their relationships; to compare the COPD sample MCI scores with normative data; and to investigate which factors might predict adherence to prescribed physical exercise. This was a multicenter observational cross-sectional study. Of the 117 eligible stable COPD inpatients, 84 were enrolled according to Global initiative for chronic Obstructive Lung Disease (GOLD criteria (mainly in Stage III–IV. The assessment included Mini Mental State Examination (MMSE, Montreal Cognitive Assessment (MoCA, anxiety, depression and self-reported pharmacological and nonpharmacological adherence. From the MMSE, 3.6% of patients were found to be impaired, whereas from the MoCA 9.5% had a likely MCI. Patients referred had mild-severe depression (46.7%, anxiety (40.5%, good pharmacological adherence (80.3% and difficulties in following prescribed diet (24.1% and exercise (51.8%; they struggled with disease acceptance (30.9% and disease limitations acceptance (28.6%. Most of them received good family (89% or social (53% support. Nonpharmacological adherence

Personality and medication non-adherence among older adults enrolled in a six-year trial

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Jerant, Anthony; Chapman, Benjamin; Duberstein, Paul; Robbins, John; Franks, Peter

2011-01-01

Objectives Personality factors parsimoniously capture the variation in dispositional characteristics that affect behaviours, but their value in predicting medication non-adherence is unclear. We investigated the relationship between five-factor model personality factors (Conscientiousness, Neuroticism, Agreeableness, Extraversion, and Openness) and medication non-adherence among older participants during a six-year randomized placebo-controlled trial (RCT). Design Observational cohort data from 771 subjects aged ≥72 years enrolled in the Ginkgo Evaluation of Memory study, a RCT of Ginkgo biloba for prevention of dementia. Methods Random effects logistic regression analyses examined effects of NEO Five-Factor Inventory scores on medication non-adherence, determined via pill counts every 6 months (median follow-up 6.1 years) and defined as taking personality factor associated with non-adherence: a 1 SD increase was associated with a 3.8% increase in the probability of non-adherence (95% CI [0.4, 7.2]). Lower cognitive function was also associated with non-adherence: a 1 SD decrease in mental status exam score was associated with a 3.0% increase in the probability of non-adherence (95% CI [0.2, 5.9]). Conclusions Neuroticism was associated with medication non-adherence over 6 years of follow-up in a large sample of older RCT participants. Personality measurement in clinical and research settings might help to identify and guide interventions for older adults at risk for medication non-adherence. PMID:21226789

FACTORS AFFECTING THE COMPLIANCE OF MYANMAR NURSES IN PERFORMING STANDARD PRECAUTION

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Sa Sa Aung

2017-06-01

Full Text Available Introduction: Exposure to pathogens is a serious issue for nurses. The literature explains that standard precaution have not consistently done in nursing. The purpose of this study was to analyze the factors affecting the compliance of nurses in Myanmar in performing standard precautions. Methods: This study used a cross-sectional design. Samples included 34 nurses in Waibagi Specialist Hospital (SHW, Myanmar. The independent variables were the characteristics of nurses, knowledge of standard precaution, and exposure to blood / body fluids and needle puncture wounds. The dependent variable was the performance of standard prevention. Data analyzed using descriptive analysis and logistic regression. Results: The result showed that almost respondents (91.18% had a good knowledge about prevention standards and 73.5% of respondents had good adherence in performing standard precaution. However, in practice nurses have not been consistent in closing the needles that have been used correctly. The results showed that nurse characteristics did not significantly affect adherence to standard precaution with statistical test results as follows: age (p = 0.97, gender (p = 1.00, religion (p = 0.72, education (p = 0.85, work experience at SHW (p = 0, 84, education training program (p = 0.71, knowledge (p = 0.76, and needle stick injury (p = 0,17. But, there was a significant influence between adherence to standard precaution on the incidence of injury due to puncture needle with p value = 0.01. Discussion: The barriers to applying standard precautions by Myanmar nurses can be reduced by providing basic training, supervision and improvement of operational standard procedures.

Pharmacoepidemiological assessment of adherence and influencing co-factors among primary open-angle glaucoma patients-An observational cohort study.

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Stefanie Frech

Full Text Available The goal of this study was to assess the adherence of primary open-angle glaucoma (POAG patients to medication, and to determine co-factors influencing adherence, using a representative sample of members of the largest German public health insurer. The observational cohort study was based on a longitudinal data set from 2010-2013 and included 250,000 insured persons aged 50 and older with 10,120 diagnosed POAG patients. Uni- and multivariate analysis was performed to investigate several aspects of glaucoma, such as prevalence, adherence, and co-factors influencing adherence. The main outcome measured adherence with prescriptions filled within a year. Multivariate panel regression analysis was used to determine the co-factors influencing this adherence. Prevalence of POAG was 3.36% [CI: 3.28-3.43%], with 2.91% [CI: 2.81-3.01%] for males and 3.71% [CI: 3.61-3.81%] for females, increasing with age. The mean level of adherence in terms of prescriptions filled was 66.5% [CI: 65.50-67.60%]. The results of this analysis revealed a significant influence of age, duration of the disease, care need, distance to death, and multimorbidity as co-factors of non-adherence, whereas gender had no influence. The analysis provided detailed information about POAG health care aspects concerning prevalence and adherence. The most endangered risk groups for non-adherence were patients aged 50-59, patients older than 80 years, patients with a longer duration of POAG, patients with care needs, and patients with three or more severe diseases in addition to glaucoma. To know the predictors responsible for an increased risk to develop POAG is of importance for all persons involved in health care management. Therefore effective strategies to increase awareness of patients and medical care personnel about non-adherence and the importance of a regular and continuous medication to avoid further nerve fiber damage and possible blindness have to be developed.

Adherence with Preventive Medication in Childhood Asthma

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Scott Burgess

2011-01-01

Full Text Available Suboptimal adherence with preventive medication is common and often unrecognised as a cause of poor asthma control. A number of risk factors for nonadherence have emerged from well-conducted studies. Unfortunately, patient report a physician's estimation of adherence and knowledge of these risk factors may not assist in determining whether non-adherence is a significant factor. Electronic monitoring devices are likely to be more frequently used to remind patients to take medication, as a strategy to motivate patients to maintain adherence, and a tool to evaluate adherence in subjects with poor disease control. The aim of this paper is to review non-adherence with preventive medication in childhood asthma, its impact on asthma control, methods of evaluating non-adherence, risk factors for suboptimal adherence, and strategies to enhance adherence.

Subjective reasons for adherence to psychotropic medication and associated factors among older adults with schizophrenia.

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Sapra, Mamta; Vahia, Ipsit V; Reyes, Pia N; Ramirez, Paul; Cohen, Carl I

2008-12-01

There are limited data examining subjective influences on medication adherence among older persons with schizophrenia. The subjective reasons for adherence to antipsychotic medication and associated clinical and psychosocial factors in this population are examined. The sample consisted of 198 community dwelling persons aged >or=55 who developed schizophrenia before age 45. Using the Rating of Medication Influences Scale (ROMI), a principal component factor analysis with varimax rotation yielded three subscales: Medication Affinity and Prevention, Influence of Others, and Impact of Authority. These subscales were dichotomized into high and low based on a median split. We also created an ordinal High Adherence measure based on the summed scores of each person's three dichotomized ROMI subscales. A modified Health Belief Model was used to examine the association between 18 predictor variables and the ROMI subscales and the adherence scale. The mean subscale rankings were Medication Affinity and Prevention > Impact of Authority > Influence of Others. In logistic regression, lower education, more side effects, higher depression scores, and more mental health services were associated with higher scores on Influence of Others subscale. More side effects and more entitlements were associated with higher scores on the Medication Affinity and Prevention subscale. The Impact of Authority subscale had no significant associations. More side effects and higher depression scores were associated with higher scores on High Adherence measure. We identified a three-dimensional model for explaining the subjective reasons for medication adherence in older persons with schizophrenia. Our findings suggest that cognitive approaches and use of authority figures may be useful for promoting adherence in older adults. Independent variables associated with these subscales may provide guidance for improving adherence in this population.

Adherence to a Mediterranean diet in a rural Appalachian food desert.

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Hardin-Fanning, F

2013-01-01

Rural Appalachian food deserts have disproportionately high cardiovascular disease (CVD) rates. The Mediterranean diet, consisting of plant-based dishes prepared with unsaturated fatty acids, contributes to decreased risk of CVD. Several factors can affect dietary choices in rural food deserts. The purpose of this exploratory study was to identify predisposing, reinforcing and enabling factors that affect eating a Mediterranean diet in a rural Appalachian food desert with disproportionately high rates of cardiovascular disease. The PRECEDE-PROCEED model was used as an assessment framework in this study. Volunteers (n=43) were recruited from four churches in a rural Appalachian county to participate in this mixed methods convergent parallel design study. During each of four sessions with 8-12 participants each, a Mediterranean-style meal was prepared by a local caterer and included plant-based dishes prepared with unsaturated fatty acids. The nature of a Mediterranean diet was explained to participants using an illustrated pamphlet. Nominal group process was used to determine predisposing, reinforcing and enabling factors that would affect adherence to a Mediterranean diet. Multivariate ANOVA and t-tests, using SPSS 18, were performed to determine factors associated with potential future adoption and adherence to a Mediterranean diet among a sample of rural residents and assess whether the factors varied based on age, gender and socioeconomic status. All p values of ≤0.05 were considered significant. Factors affecting future adherence to a Mediterranean diet included difficulty changing personal habits, limited access to healthy foods, cost, difficulty of preparation, limited knowledge of the health benefits of foods, family attitudes toward food and difficulty determining how to incorporate healthy foods into meals. Younger participants and those with lower incomes were more likely to identify food cost as a barrier to adherence compared to those who were older

Allopurinol Medication Adherence as a Mediator of Optimal Outcomes in Gout Management.

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Coburn, Brian W; Bendlin, Kayli A; Sayles, Harlan; Meza, Jane; Russell, Cynthia L; Mikuls, Ted R

2017-09-01

Patient and provider factors, including allopurinol medication adherence, affect gout treatment outcomes. The aim of this study was to examine associations of patient and provider factors with optimal gout management. Linking longitudinal health and pharmacy dispensing records to questionnaire data, we assessed patient and provider factors among 612 patients with gout receiving allopurinol during a recent 1-year period. Associations of patient (medication adherence and patient activation) and provider factors (dose escalation, low-dose initiation, and anti-inflammatory prophylaxis) with serum urate (SU) goal achievement of less than 6.0 mg/dL were examined using multivariable logistic regression. Medication adherence was assessed as a mediator of these factors with goal achievement. A majority of patients (63%) were adherent, whereas a minority received dose escalation (31%). Medication adherence was associated with initiation of daily allopurinol doses of 100 mg/d or less (odds ratio [OR], 1.82; 95% confidence interval [CI], 1.20-2.76). In adjusted models, adherence (OR, 2.35; 95% CI, 1.50-3.68) and dose escalation (OR, 2.48; 95% CI, 2.48-4.25) were strongly associated with SU goal attainment. Low starting allopurinol dose was positively associated with SU goal attainment (OR, 1.11; 95% CI, 1.02-1.20) indirectly through early adherence, but also had a negative direct association with SU goal attainment (OR, 0.21; 95% CI, 0.12-0.37). Medication adherence and low starting dose combined with dose escalation represent promising targets for future gout quality improvement efforts. Low starting dose is associated with better SU goal attainment through increased medication adherence, but may be beneficial only in settings where appropriate dose escalation is implemented.

Stroke and TIA survivors’ cognitive beliefs and affective responses regarding treatment and future stroke risk differentially predict medication adherence and categorised stroke risk

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Phillips, L. Alison; Diefenbach, Michael A.; Abrams, Jessica; Horowitz, Carol R.

2014-01-01

Cognitive beliefs and affective responses to illness and treatment are known to independently predict health behaviours. The purpose of the current study is to assess the relative importance of four psychological domains – specifically, affective illness, cognitive illness, affective treatment and cognitive treatment – for predicting stroke and transient ischemic attack (TIA) survivors’ adherence to stroke prevention medications as well as their objective, categorised stroke risk. We assessed these domains among stroke/TIA survivors (n = 600), and conducted correlation and regression analyses with concurrent and prospective outcomes to determine the relative importance of each cognitive and affective domain for adherence and stroke risk. As hypothesised, patients’ affective treatment responses explained the greatest unique variance in baseline and six-month adherence reports (8 and 5%, respectively, of the variance in adherence, compared to 1–3% explained by other domains). Counter to hypotheses, patients’ cognitive illness beliefs explained the greatest unique variance in baseline and six-month objective categorised stroke risk (3 and 2%, respectively, compared to 0–1% explained by other domains). Results indicate that domain type (i.e. cognitive and affective) and domain referent (illness and treatment) may be differentially important for providers to assess when treating patients for stroke/TIA. More research is required to further distinguish between these domains and their relative importance for stroke prevention. PMID:25220292

Stroke and TIA survivors' cognitive beliefs and affective responses regarding treatment and future stroke risk differentially predict medication adherence and categorised stroke risk.

Science.gov (United States)

Phillips, L Alison; Diefenbach, Michael A; Abrams, Jessica; Horowitz, Carol R

2015-01-01

Cognitive beliefs and affective responses to illness and treatment are known to independently predict health behaviours. The purpose of the current study is to assess the relative importance of four psychological domains - specifically, affective illness, cognitive illness, affective treatment and cognitive treatment - for predicting stroke and transient ischemic attack (TIA) survivors' adherence to stroke prevention medications as well as their objective, categorised stroke risk. We assessed these domains among stroke/TIA survivors (n = 600), and conducted correlation and regression analyses with concurrent and prospective outcomes to determine the relative importance of each cognitive and affective domain for adherence and stroke risk. As hypothesised, patients' affective treatment responses explained the greatest unique variance in baseline and six-month adherence reports (8 and 5%, respectively, of the variance in adherence, compared to 1-3% explained by other domains). Counter to hypotheses, patients' cognitive illness beliefs explained the greatest unique variance in baseline and six-month objective categorised stroke risk (3 and 2%, respectively, compared to 0-1% explained by other domains). Results indicate that domain type (i.e. cognitive and affective) and domain referent (illness and treatment) may be differentially important for providers to assess when treating patients for stroke/TIA. More research is required to further distinguish between these domains and their relative importance for stroke prevention.

Treatment adherence in South African primary health care

African Journals Online (AJOL)

system. In the context of meagre financial resources, inadequate public funds di- rected at ... issues that are highlighted as affecting adherence include health locus of control, self-efficacy, ... mined to have little or no effect, a medical .... health as controlled by internal factors .... about information technology in the treatment.

Women's experiences of factors affecting treatment engagement and adherence in internet delivered Behavioural Activation for Postnatal Depression

Directory of Open Access Journals (Sweden)

Heather A. O'Mahen

2015-03-01

Discussion: Open access, self-help internet interventions are acceptable to women with postnatal depression, but it is critical to provide tailoring and support to help overcome barriers and improve treatment adherence.

Trends and determining factors associated with adherence to antiretroviral therapy (ART in Cameroon: a systematic review and analysis of the CAMPS trial

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Mbuagbaw Lawrence

2012-12-01

Full Text Available Abstract Background The benefits of antiretroviral therapy (ART cannot be experienced if they are not taken as prescribed. Yet, not all causes of non-adherence are dependent on the patient. Having to pay for medication reduces adherence rates. Non- adherence has severe public health implications which must be addressed locally and globally. This paper seeks to describe the trends in adherence rates reported in Cameroon and to investigate the determinants of adherence to ART in the Cameroon Mobile Phone SMS (CAMPS trial. Methods We conducted a systematic review of electronic databases (PubMed, Google Scholar, Web of Science, CINAHL, EMBASE and PSYCINFO for publications on adherence to ART in Cameroon (from January 1999 to May 2012 and described the trend in reported adherence rates and the factors associated with adherence. Data were extracted in duplicate. We used multivariable analyses on the baseline data for 200 participants in the CAMPS trial to determine the factors associated with adherence in four models using different measures of adherence (more than 90% or 95% on the visual analogue scale, no missed doses and a composite measure: 100% on the visual analogue scale, no missed doses and all pills taken on time. Results We identified nine studies meeting our inclusion criteria. Adherence to ART in Cameroon has risen steadily between 2000 and 2010, corresponding to reductions in the cost of medication. The factors associated with adherence to ART in Cameroon are grouped into patient, medication and disease related factors. We also identified factors related to the health system and the patient-provider relationship. In the CAMPS trial, education, side effects experienced and number of reminder methods were found to improve adherence, but only using multiple reminder methods was associated with better adherence in all the regression models (Adjusted Odds Ratio [AOR] 4.11, 95% Confidence Interval [CI] 1.89, 8.93; p Conclusions Reducing the

Factors contributing to antiretroviral drug adherence among adults living with HIV or AIDS in a Kenyan rural community.

Science.gov (United States)

Kioko, Mary T; Pertet, Anne M

2017-07-31

Antiretroviral (ARV) adherence of ≥ 95% is recommended for suppressing HIV. However, studies have shown that the ≥ 95% recommended level is rarely achieved. This cross-sectional community-based study sought to assess factors contributing to ARV drug adherence among adults living with HIV or AIDS. The study was conducted in a rural community in Machakos County, Kenya. The questions used for the study were adapted from the Patient Medicine Adherence Questionnaire (PMAQ), a tool grounded in the Health Belief Model. Adherence to ARV was measured using self-reports and pill counts. The perception social support was measured with a 5-point Likert scale, whereas the type and the number of side effects experienced were recorded using 'yes' and 'no' questions. We used the chi-square test to test associations and binary logistic regression to assess factors explaining dose adherence to ARV. The levels of adherence of 86% using self-reports were significantly higher (p < 0.001) than the pill count of 58.6%. The immediate family was rated high in providing social support (3.7 ± 0.6) followed by social support groups (3.1 ± 0.8). A binary logistic regression analysis was conducted to predict ARV adherence (adherent, non-adherent) using social support, side effects and marital status as explanatory variables. The Wald criterion demonstrated that marital status (p = 0.019) and burden of side effects (p ≤ 0.001) made a significant contribution to the prediction of ARV adherence. The burden of side effects and being a divorcee are primary predictors of ARV adherence.

Importance of family/social support and impact on adherence to diabetic therapy

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Miller TA

2013-11-01

Full Text Available Tricia A Miller, M Robin DiMatteoDepartment of Psychology, University of California, Riverside, Riverside, CA, USAAbstract: Diabetes mellitus affects 24 million individuals in the US. In order to manage their diabetes successfully, patients must adhere to treatment regimens that include dietary restrictions, physical activity goals, and self-monitoring of glucose levels. Numerous factors affect patients' ability to adhere properly, eg, self-efficacy, treatment expectations, health beliefs, and lack of social support. Consequently, diabetes management can be quite complex, requiring lifelong commitment and drastic changes to the patient's lifestyle. Empirical studies have shown positive and significant relationships between social support and treatment adherence among patients with diabetes. Social support from family provides patients with practical help and can buffer the stresses of living with illness. However, the exact mechanism by which social support affects patient adherence is not yet completely understood. Further research is needed to address how the differences in types of support, such as functional or emotional support, are linked to outcomes for patients. The purpose of this review is to summarize what is known of the impact of social and family support on treatment adherence in patients with diabetes and to explore the current methods and interventions used to facilitate family support for diabetic patients.Keywords: patient adherence, patient compliance, diabetes management, support, family, social

Patient non-adherence: an interpretative phenomenological analysis.

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Dalvi, Vidya; Mekoth, Nandakumar

2017-04-18

Purpose While interpretative phenomenological analysis (IPA) has been used in health psychology research, it has so far not been applied to seek deeper insights into the patients' experiences about treatment. The purpose of this paper is to address this gap by using IPA to understand patient non-adherence. Design/methodology/approach In total, 18 patients with chronic conditions seeking healthcare services in Goa and Karnataka, India, were selected by using the snowball sampling method. In-depth interviews were conducted face to face. A semi-structured questionnaire developed by the researchers was used to collect the data. IPA was used to explore the themes to predict patient non-adherence. Findings The study results indicate that economic factors, health system related factors, social factors and psychological factors impact patient non-adherence. Patient non-adherence includes medication non-adherence and lifestyle modification non-adherence. Research limitations/implications Being cross sectional in design, the results may not be as appropriate as the results derived from a longitudinal study given that non-adherence occurs over time. Practical implications Patient non-adherence is a global health issue. Multidisciplinary approach to enhance patient adherence to treatment should form part of public healthcare policy. Social implications Exploring the factors influencing patient non-adherence will help the health-care industry stakeholders to reduce healthcare cost and improve patient's quality of life. Originality/value Although there is extensive quantitative research on the prevalence of non-adherence, qualitative research is limited. This paper addresses this gap by using IPA to understand patient non-adherence and its factors and dimensions.

Factors associated with a low adherence to a Mediterranean diet pattern in healthy Spanish women before pregnancy.

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Olmedo-Requena, Rocío; Fernández, Julia Gómez; Prieto, Carmen Amezcua; Moreno, Juan Mozas; Bueno-Cavanillas, Aurora; Jiménez-Moleón, José J

2014-03-01

To analyse the factors associated with the level of adherence to a Mediterranean dietary pattern in healthy Spanish women before pregnancy. A prospective series of 1175 women. An FFQ validated in Spanish populations served to collect dietary data. The Mediterranean Diet Adherence Index was used to assess the level of adherence to a Mediterranean diet pattern. Polytomic regression was performed to identify the associated factors. Catchment area of Virgen de las Nieves University Hospital, Andalusia, Spain. The women were invited to participate in the study at the 20th-22nd gestational week. The selection criteria were: Spanish nationality, 18 years of age or older, singleton pregnancy and absence of health problems that required modifying the diet or physical activity. An inverse relationship was found between women's age and level of adherence to a Mediterranean diet pattern, with a clear dose-response association: a younger age entailed worse adherence (P smoking and sedentary lifestyle had a positive relationship with low adherence, giving OR = 5·36 (95 % 1·91, 15·07) for women who smoked >20 cigarettes/d and OR = 2·07 (95 % CI 1·34, 3·17) for sedentary women. Higher age, higher educational level, and higher social class of the women were associated with a higher level of adherence to the Mediterranean diet (P smoking and lack of exercise were associated with low adherence to a Mediterranean diet.

Factors influencing adherence with therapeutic sunlight exposure in older people in intermediate care facilities.

Science.gov (United States)

Durvasula, Seeta; Sambrook, Philip N; Cameron, Ian D

2012-01-01

The purpose of this study was to investigate the factors influencing low adherence with therapeutic sunlight exposure in a randomized controlled trial conducted with older people living in intermediate care facilities. The study involved participants in the FREEDOM (Falls Risk Epidemiology: Effect of vitamin D on skeletal Outcomes and other Measures) study, a randomized controlled trial of therapeutic sun exposure to reduce falls in older people in intermediate care facilities. Semi-structured interviews were conducted with thirty participants in the FREEDOM trial, and with ten sunlight officers who were employed to facilitate the sun exposure. Two focus groups involving 10 participants in the FREEDOM trial were also held at the end of the intervention period. Common themes were derived from the interview and focus group transcripts. The study showed that the perceived health benefits did not influence adherence with the sun exposure. Factors such as socializing with others and being outdoors were more important in encouraging attendance. The main barriers to adherence included the perceived inflexibility and regimentation of daily attendance, clash with other activities, unsuitable timing and heat discomfort. This study showed that providing greater flexibility and autonomy to older people in how and when they receive sun exposure is likely to improve adherence. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Factors influencing adherence to psychopharmacological medications in psychiatric patients: a structural equation modeling approach.

Science.gov (United States)

De Las Cuevas, Carlos; de Leon, Jose; Peñate, Wenceslao; Betancort, Moisés

2017-01-01

To evaluate pathways through which sociodemographic, clinical, attitudinal, and perceived health control variables impact psychiatric patients' adherence to psychopharmacological medications. A sample of 966 consecutive psychiatric outpatients was studied. The variables were sociodemographic (age, gender, and education), clinical (diagnoses, drug treatment, and treatment duration), attitudinal (attitudes toward psychopharmacological medication and preferences regarding participation in decision-making), perception of control over health (health locus of control, self-efficacy, and psychological reactance), and level of adherence to psychopharmacological medications. Structural equation modeling was applied to examine the nonstraightforward relationships and the interactive effects among the analyzed variables. Structural equation modeling demonstrated that psychiatric patients' treatment adherence was associated: 1) negatively with cognitive psychological reactance (adherence decreased as cognitive psychological reactance increased), 2) positively with patients' trust in their psychiatrists (doctors' subscale), 3) negatively with patients' belief that they are in control of their mental health and that their mental health depends on their own actions (internal subscale), and 4) positively (although weakly) with age. Self-efficacy indirectly influenced treatment adherence through internal health locus of control. This study provides support for the hypothesis that perceived health control variables play a relevant role in psychiatric patients' adherence to psychopharmacological medications. The findings highlight the importance of considering prospective studies of patients' psychological reactance and health locus of control as they may be clinically relevant factors contributing to adherence to psychopharmacological medications.

Democratic Constraints and Adherence to the Classical Gold Standard

NARCIS (Netherlands)

Kramer, Bert S.; Milionis, Petros

We study how domestic politics affected the decisions of countries to adhere to the classical gold standard. Using a variety of econometric techniques and controlling for a wide range of economic factors, we demonstrate that political constraints were important in the decision of countries to adopt

Dissociative Identity Disorder CPAP Adherence: An Uncommon Factor in Obstructive Sleep Apnea.

Science.gov (United States)

Gandotra, Kamal; Golish, Joseph; Rosenberg, Carl; Strohl, Kingman

2018-04-15

We present a case of a patient with dissociative identity disorder and symptomatic sleep apnea who was treated with continuous positive airway pressure (CPAP). CPAP use depended upon which personality the patient exhibited but apnea reduction did not. This case illustrates in one individual how personality can positively or negatively affect CPAP adherence. © 2018 American Academy of Sleep Medicine.

Non-adherence to life-style modification and its factors among type 2 diabetic patients.

Science.gov (United States)

Mumu, Shirin Jahan; Saleh, Farzana; Ara, Ferdous; Afnan, Fadia; Ali, Liaquat

2014-01-01

Non-adherence to preventive and therapeutic life-style recommendations among patients with diabetes is special challenge in the management of these patients. This study aimed to measure the proportion of non-adherence to life-style modification and factors associated with these among a group of Bangladeshi type 2 diabetic patients. Under an analytical cross-sectional design 374 type 2 diabetic patients (age >20 years), diagnosed for at least 1 year, were selected from different health care centers operated by the Diabetic Association of Bangladesh. Non-adherence rate were assessed for: Diet (88%), exercise (25%), routine blood glucose testing (32%), foot care (70%), smoking (6%) and betel quid chewing habit (25%). Binary logistic regression suggests that higher education group (P = 0.013), rural area (P = 0.013) and attendance to diabetes education classes (P = 0.043) showed good adherence to diet and non-attendance to diabetes education class (P = 0.014), older age (P = 0.037) are associated to non-adherence to exercise. Unemployed patients showed more non-adherence to blood glucose testing (P = 0.045) than others. Non-attendance to diabetes education class (P = 0.037) and business occupation group (P = 0.039) showed significant association to smoking and betel quid intake habit respectively.

A Systematic Review of CPAP Adherence Across Age Groups: Clinical and Empiric Insights for Developing CPAP Adherence Interventions

Science.gov (United States)

Sawyer, A.M.; Gooneratne, N.; Marcus, C.L.; Ofer, D.; Richards, K.C.; Weaver, T.E.

2011-01-01

Continuous positive airway pressure (CPAP) is a highly efficacious treatment for obstructive sleep apnea (OSA) but adherence to the treatment limits its overall effectiveness across all age groups of patients. Factors that influence adherence to CPAP include disease and patient characteristics, treatment titration procedures, technological device factors and side effects, and psychological and social factors. These influential factors have guided the development of interventions to promote CPAP adherence. Various intervention strategies have been described and include educational, technological, psychosocial, pharmacological, and multi-dimensional approaches. Though evidence to date has led to innovative strategies that address adherence in CPAP-treated children, adults, and older adults, significant opportunities exist to develop and test interventions that are clinically applicable, specific to subgroups of patients likely to demonstrate poor adherence, and address the multifactorial nature of CPAP adherence. The translation of CPAP adherence promotion interventions to clinical practice is imperative to improve health and functional outcomes in all persons with CPAP-treated OSA. PMID:21652236

Individual and contextual factors of influence on adherence to antiretrovirals among people attending public clinics in Rio de Janeiro, Brazil

Science.gov (United States)

2013-01-01

Background There are inconsistencies in the determinants of adherence to antiretrovirals (ARVs) across settings as well as a lack of studies that take into consideration factors beyond the individual level. This makes it necessary to examine factors holistically in multiple settings and populations while taking into consideration the particularities of each context, in order to understand the patterns of ARV adherence. This research explored ARV adherence and individual, relational and environmental-structural factors. Methods A cross-sectional survey was conducted from August 2008 through July 2009 among participants currently on ARVs recruited from 6 public health clinics, selected to maximize diversity in terms of caseload and location, representing the range of clinics within Rio de Janeiro city, Brazil. Multivariate logistic regression analysis was used to assess the association between our multilevel factors with ARV adherence among participants with complete cases (n = 632). Results Eighty-four percent of respondents reported adherence to all of their ARV doses in the last 4 days. Of the socio-demographic variables, those who had one child were positively associated with adherence (AOR 2.29 CI [1.33-3.94]). On the relational level, those with high social support (AOR 2.85 CI [1.50-5.41]) were positively associated with adherence to ARVs. On the environmental-structural level, we found gender was significant with women negatively associated with adherence to ARVs (AOR 0.58 CI [0.38-0.88]) while those with a high asset index (AOR 2.47 CI [1.79-3.40]) were positively associated with adherence to ARVs. Conclusions This research highlights the importance of examining the multiple levels of influence on ARV adherence. Intervention research in lower and middle-income settings should address and evaluate the impact of attending to both gender and economic inequalities to improve ARV adherence, as well as relational areas such as the provision of social support. PMID

Non-adherence to life-style modification and its factors among type 2 diabetic patients

OpenAIRE

Shirin Jahan Mumu; Farzana Saleh; Ferdous Ara; Fadia Afnan; Liaquat Ali

2014-01-01

Non-adherence to preventive and therapeutic life-style recommendations among patients with diabetes is special challenge in the management of these patients. This study aimed to measure the proportion of non-adherence to life-style modification and factors associated with these among a group of Bangladeshi type 2 diabetic patients. Under an analytical cross-sectional design 374 type 2 diabetic patients (age >20 years), diagnosed for at least 1 year, were selected from different health care ce...

Patient adherence to tuberculosis treatment: a systematic review of qualitative research.

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Munro, Salla A; Lewin, Simon A; Smith, Helen J; Engel, Mark E; Fretheim, Atle; Volmink, Jimmy

2007-07-24

-of-argument synthesis describing how four major factors interact to affect adherence to TB treatment: structural factors, including poverty and gender discrimination; the social context; health service factors; and personal factors. The findings of this study are limited by the quality and foci of the included studies. Adherence to the long course of TB treatment is a complex, dynamic phenomenon with a wide range of factors impacting on treatment-taking behaviour. Patients' adherence to their medication regimens was influenced by the interaction of a number of these factors. The findings of our review could help inform the development of patient-centred interventions and of interventions to address structural barriers to treatment adherence.

Patient adherence to tuberculosis treatment: a systematic review of qualitative research.

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Salla A Munro

2007-07-01

themes across all studies produced a line-of-argument synthesis describing how four major factors interact to affect adherence to TB treatment: structural factors, including poverty and gender discrimination; the social context; health service factors; and personal factors. The findings of this study are limited by the quality and foci of the included studies. CONCLUSIONS: Adherence to the long course of TB treatment is a complex, dynamic phenomenon with a wide range of factors impacting on treatment-taking behaviour. Patients' adherence to their medication regimens was influenced by the interaction of a number of these factors. The findings of our review could help inform the development of patient-centred interventions and of interventions to address structural barriers to treatment adherence.

Coeliac disease in adolescence: Coping strategies and personality factors affecting compliance with gluten-free diet.

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Wagner, Gudrun; Zeiler, Michael; Grylli, Vasileia; Berger, Gabriele; Huber, Wolf-Dietrich; Woeber, Christian; Rhind, Charlotte; Karwautz, Andreas

2016-06-01

Patients suffering from a chronic condition such as coeliac disease (CD) need to develop coping strategies in order to preserve emotional balance and psychosocial functioning while adhering to their obligatory life-long gluten free diet (GFD). However, this can be particularly challenging for adolescents and may lead to dietary transgressions. Little is currently known about the influence of coping strategies and personality factors on dietary compliance. This study aims to explore these factors for the first time in adolescents with biopsy-proven CD. We included 281 adolescents with CD and 95 healthy controls. We classified patients according to their GFD adherence status (adherent vs. non-adherent) and assessed coping strategies using the KIDCOPE and personality traits using the Junior-Temperament and Character Inventory (J-TCI). Adolescents with CD adherent to GFD used less emotional regulation and distraction as coping strategies than non-adherent patients. In terms of personality traits, adherent patients differed from non-adherent patients with respect to temperament, but not with respect to character, showing lower scores in novelty seeking, impulsivity and rule transgressions and higher scores in eagerness with work and perfectionism compared to non-adherent patients. No differences were found between healthy controls and adherent CD patients across these personality traits. Coping strategies and personality traits differ in adolescent patients with CD adherent to GFD from those not adherent, and may therefore relate to risk or protective factors in adherence. Targeting coping and temperament using psychological interventions may therefore be beneficial to support adolescents with CD and optimise their adherence to GFD. Copyright © 2016 Elsevier Ltd. All rights reserved.

Factors affecting HIV-infected mothers' ability to adhere to ...

African Journals Online (AJOL)

The postnatal feeding practices of 222 HIV-infected mothers were compared with their prenatal intentions and ... categorical data and Student's t-test for continuous data. Factors ... give an excuse, such as ill health (including breast cancer,.

ADHERENCE TO ANTIRETROVIRAL THERAPY IN A TERTIARY CARE HOSPITAL

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Muralidhara Panigrahi

2017-03-01

Full Text Available BACKGROUND The Million Death Study Collaborators in the British Medical Journal have estimated that the people living with HIV/AIDS population to be between 1.4-1.6 million. Development of Antiretroviral Therapy (ART has been one of the dramatic advances in the history of medicine. Among several factors that can affect the ART outcome, adherence to the ART has been cited as a major factor associated with poor outcomes. For ART to have maximum effect greater than 95%, adherence has been suggested. Additionally, non adherence to ART is a major cause of HIV drug resistance. Especially, in the Indian context, adherence to ART is very important due to the sheer number of HIV/AIDS cases, the socioeconomic status, diversity of the population and regions. That is, the socioeconomic challenges faced by patients contribute to nonadherence to ART in India. With this background, this study was done with the primary objective of assessing the level of adherence to the given regimen of ART as per the NACO guidelines and factors influencing adherence. MATERIALS AND METHODS This is a prospective patient record-based study conducted in the Antiretroviral Therapy Centre at MKCG Medical College, Berhampur, from January 2016 to June 2016. Simple random sampling technique was used to select 150 patients’ records from the ART Centre of the medical college. The data was collected in a predesigned case record form from the patient card available at antiretroviral therapy centre. The patients were followed up through the patient card for six months from their recruitment. The adherence to treatment was evaluated using the adherence score adopted by NACO where a score of 1, 2 and 3 implied that 95%, 80-95% and 95% medication taken. Persons with primary education, married individuals and persons without employment had better improvement in adherence score than other groups. Anaemia was the predominant adverse drug reaction encountered. CONCLUSION The findings of this

Adherence to phosphate binders in hemodialysis patients: prevalence and determinants.

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Van Camp, Yoleen P M; Vrijens, Bernard; Abraham, Ivo; Van Rompaey, Bart; Elseviers, Monique M

2014-12-01

Phosphate control is a crucial treatment goal in end-stage renal disease, but poor patient adherence to phosphate binder therapy remains a challenge. This study aimed to estimate the extent of phosphate binder adherence in hemodialysis patients and to identify potential determinants. Phosphate binder adherence was measured blindly in 135 hemodialysis patients for 2 months using the medication event monitoring system. Patient data, gathered at inclusion through medical records, ad hoc questionnaires and the short form (SF)-36 health survey, included: (1) demographics, (2) perceived side-effects, belief in benefit, self-reported adherence to the therapy, (3) knowledge about phosphate binder therapy, (4) social support, and (5) quality of life (SF-36). Phosphatemia data was collected from charts. 'Being adherent' was defined as missing adherent' as missing adherent. Over the entire 8-week period, 22 % of patients were totally adherent. Mean phosphatemia levels were 0.55 mg/dl lower in adherent than nonadherent patients (4.76 vs. 5.31 mg/dl). Determinants for being totally adherent were living with a partner, higher social support (both were interrelated) and higher physical quality of life. Experiencing intake-related inconvenience negatively affected adherence. The social support and quality of life physical score explained 26 % of the variance in adherence. Phosphate binder nonadherence remains a major problem. Interventions should aim, at least, to improve social support. With few associated factors found and yet low adherence, an individualized approach seems indicated.

Multiple interacting factors influence adherence, and outcomes associated with surgical safety checklists: a qualitative study.

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Anna R Gagliardi

Full Text Available The surgical safety checklist (SSC is meant to enhance patient safety but studies of its impact conflict. This study explored factors that influenced SSC adherence to suggest how its impact could be optimized.Participants were recruited purposively by profession, region, hospital type and time using the SSC. They were asked to describe how the SSC was adopted, associated challenges, perceived impact, and suggestions for improving its use. Grounded theory and thematic analysis were used to collect and analyse data. Findings were interpreted using an implementation fidelity conceptual framework.Fifty-one participants were interviewed (29 nurses, 13 surgeons, 9 anaesthetists; 18 small, 14 large and 19 teaching hospitals; 8 regions; 31 had used the SC for ≤12 months, 20 for 13+ months. The SSC was inconsistently reviewed, and often inaccurately documented as complete. Adherence was influenced by multiple issues. Extensive modification to accommodate existing practice patterns eliminated essential interaction at key time points to discuss patient management. Staff were often absent or not paying attention. They did not feel it was relevant to their work given limited evidence of its effectiveness, and because they were not engaged in its implementation. Organizations provided little support for implementation, training, monitoring and feedback, which are needed to overcome these, and other individual and team factors that challenged SSC adherence. Responses were similar across participants with different characteristics.Multiple processes and factors influenced SSC adherence. This may explain why, in studies evaluating SSC impact, outcomes were variable. Recommendations included continuing education, time for pilot-testing, and engaging all staff in SSC review. Others may use the implementation fidelity framework to plan SSC implementation or evaluate SSC adherence. Further research is needed to establish which SSC components can be modified

[Factors associated with adherence to school meals by adolescents in State public schools in Colombo, Paraná State, Brazil].

Science.gov (United States)

Valentim, Emanuele de Araujo; Almeida, Claudia Choma Bettega de; Taconeli, César Augusto; Osório, Mônica Maria; Schmidt, Suely Teresinha

2017-10-26

This study aimed to estimate the prevalence of adherence to school meals and associated factors among adolescent schoolchildren (N = 1,569). The adolescents completed an on-line questionnaire on adherence to school meals, and their parents answered another questionnaire on socioeconomic data. The chi-square test was used to assess the association between adherence to school meals and gender, nutritional status, per capita family income, maternal schooling, adolescents' opinions on the dining hall layout, whether they considered school meals healthy, and consumption of other foods. Variables with statistical significance for adherence to school meals were included in the multilevel proportional odds logistic regression model. The covariates for comprising the final model were defined by backward selection methods. The results of the adjusted model were presented as odds ratios with respective 95% confidence intervals (95%CI). Prevalence of adherence to school meals was low, especially effective adherence (19.8%). Adherence was associated with per capita family income less than one minimum wage, lower consumption of foods outside of school meals, the fact that adolescents considered the dining hall space adequate, and believing that school meals are healthy. Adherence to school meals in this study falls short of universal coverage for the program. Different factors contribute to incomplete program implementation, which may hinder achieving the food and nutritional security policy under the Brazilian National School Feeding Program (PNAE).

Predictive factors of adherence to frequency and duration components in home exercise programs for neck and low back pain: an observational study

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Jimeno-Serrano Francisco J

2009-12-01

Full Text Available Abstract Background Evidence suggests that to facilitate physical activity sedentary people may adhere to one component of exercise prescriptions (intensity, duration or frequency without adhering to other components. Some experts have provided evidence for determinants of adherence to different components among healthy people. However, our understanding remains scarce in this area for patients with neck or low back pain. The aims of this study are to determine whether patients with neck or low back pain have different rates of adherence to exercise components of frequency per week and duration per session when prescribed with a home exercise program, and to identify if adherence to both exercise components have distinct predictive factors. Methods A cohort of one hundred eighty-four patients with chronic neck or low back pain who attended physiotherapy in eight primary care centers were studied prospectively one month after intervention. The study had three measurement periods: at baseline (measuring characteristics of patients and pain, at the end of physiotherapy intervention (measuring characteristics of the home exercise program and a month later (measuring professional behaviors during clinical encounters, environmental factors and self-efficacy, and adherence behavior. Results Adherence to duration per session (70.9% ± 7.1 was more probable than adherence to frequency per week (60.7% ± 7.0. Self-efficacy was a relevant factor for both exercise components (p Conclusion We have shown in a clinic-based study that adherence to exercise prescription frequency and duration components have distinct levels and predictive factors. We recommend additional study, and advise that differential attention be given in clinical practice to each exercise component for improving adherence.

Medication adherence and its associated factors among diabetic patients at Zewditu Memorial Hospital, Addis Ababa, Ethiopia.

Science.gov (United States)

Ali, Muhammed; Alemu, Tigestu; Sada, Oumer

2017-12-04

Diabetes is a global problem with devastating human, social and economic impact. Anti-diabetic medications play a major role in the glycemic control of patients with diabetes. However, inadequate adherence compromises safety and treatment effectiveness, leading to increased mortality and morbidity. The aim of this study was to assess adherence to anti-diabetic medications and associated factors among patient with diabetes mellitus receiving care at Zewditu Memorial Hospital. Among the total of 146 diabetic patients (mean age 46.5 ± 14.7), the level of adherence to anti diabetic medication was 54.8% (80) whilst 45.2% (66) of the participants were non adherent. Multiple logistic regression showed that knowledge of medication (AOR = 4.905, 95% CI 1.64-14.62, medication availability (AOR = 0.175, 95% CI 0.031-0.987) and education level (AOR = 13.65, 95% CI 1.45-128.456) were reasons for non-adherence.

Interpersonal Factors Are Associated with Lower Therapist Adherence in Cognitive-Behavioural Therapy for Panic Disorder.

Science.gov (United States)

Zickgraf, Hana F; Chambless, Dianne L; McCarthy, Kevin S; Gallop, Robert; Sharpless, Brian A; Milrod, Barbara L; Barber, Jacques P

2016-05-01

, although whether this is true varies across therapists. Therapists' adherence to a structured protocol and borrowing from outside of the CBT model do not appear to be affected by disorder severity or Axis I comorbidity. Copyright © 2015 John Wiley & Sons, Ltd.

Self-management of chronic illness: the role of 'habit' versus reflective factors in exercise and medication adherence.

Science.gov (United States)

Phillips, L Alison; Cohen, Joshua; Burns, Edith; Abrams, Jessica; Renninger, Steffi

2016-12-01

Non-adherence to health behaviors required for chronic illness self-management is pervasive. Advancing health-behavior theory to include behavioral initiation and maintenance factors, including reflective (e.g., belief- and feedback-based) and automatic (e.g., habit-based) mechanisms of adherence to different treatment-related behaviors could improve non-adherence prediction and intervention efforts. To test behavioral initiation and maintenance factors from an extended common sense self-regulation theoretical framework for predicting medication adherence and physical activity among patients with Type 2 diabetes. Patients (n = 133) in an in-person (n = 80) or online (n = 53) version of the study reported treatment-related (1) barriers, (2) beliefs and experiential feedback (reflective mechanisms of treatment-initiation and short-term repetition), and (3) habit strength (automatic mechanism of treatment-maintenance) for taking medication and engaging in regular physical activity at baseline. Behaviors were assessed via self-reports (n = 133) and objectively (electronic monitoring pill bottles, accelerometers; n = 80) in the subsequent month. Treatment-specific barriers and habit strength predicted self-reported and objective adherence for both behaviors. Beliefs were inconsistently related to behavior, even when habits were "weak". Experiential feedback from behavior was not related to adherence. Among patients with Type 2 diabetes diagnosis, medication and physical activity adherence were better predicted by their degree of automatic behavioral repetition than their beliefs/experiences with the treatment-actions. Habit strength should be an intervention target for chronic illness self-management; assessing it in practice settings may effectively detect non-adherence to existing treatment-regimens. However, future research and further refining of CS-SRM theory regarding the processes required for such habit development are needed.

Adherence to low-carbohydrate and low-fat diets in relation to weight loss and cardiovascular risk factors.

Science.gov (United States)

Hu, Tian; Yao, Lu; Reynolds, Kristi; Niu, Tianhua; Li, Shengxu; Whelton, Paul K; He, Jiang; Steffen, Lyn M; Bazzano, Lydia A

2016-03-01

A low-carbohydrate diet can reduce body weight and some cardiovascular disease (CVD) risk factors more than a low-fat diet, but differential adherence may play a role in these effects. Data were used from 148 adults who participated in a 12-month clinical trial examining the effect of a low-carbohydrate diet (fat diet (fat, fat) on weight and CVD risk factors. We compared attendance at counseling sessions, deviation from nutrient goals, urinary ketone presence, and composite scores representing the overall adherence based on the distribution of these individual indicators between two interventions. Composite scores were similar between the two groups. A one-interquartile-range increase in composite score representing better adherence to a low-carbohydrate diet was associated with 2.2 kg or 2.3 % greater weight loss, 1.1 greater reduction in percent fat mass, and 1.3 greater increase in proportion of lean mass. Indicators of adherence to a low-fat diet was not associated with changes in weight, fat mass or lean mass. Despite comparable adherence between groups, a low-carbohydrate diet was associated with greater reductions in body weight and improvement in body composition, while a low-fat diet was not associated with weight loss.

Adherence to anti-retroviral therapy & factors associated with it: A community based cross-sectional study from West Bengal, India

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Sobha Pahari

2015-01-01

Full Text Available Background & objectives: Failure to adhere to anti-retroviral therapy (ART can lead to a range of unfavourable consequences impacting upon people living with HIV (PLH and society. It is, therefore, paramount that ART adherence is measured in a reliable manner and factors associated with adherence are identified. Lack of such data from West Bengal necessitated undertaking the current study. Methods: Participants were included during August-October, 2011 from three Drop-In-Centres (DICs from the three districts of West Bengal, India. ART-adherence was calculated by using formula based on pill-count and records collected from ART-card in possession of each of the 128 consenting adult PLH. Information on self-reported adherence, socio-demography, and adherence influencing issues was also collected through interviewer-administered questionnaire. Results: Of the 128 PLH, 99 (77% and 93 (73% PLH had ≥90 per cent and ≥95 per cent adherence, respectively to ART. Conversely, subjective reporting captured much higher proportion of PLH as ′well adherent′; a finding having implications for ongoing ART programme. Factors, independently associated with poor adherence (<90%, were ′7 th to 12 th month period of ART intake′ (adjusted OR=9.5; 90% CI 1.9 - 47.3; p0 =0.02 and ′non-disclosure of HIV status to family members′ (adjusted OR=4; 90% CI 1.3 - 13; P=0.05. Results at 95 per cent adherence cut-off were similar. Interpretation & conclusions: Enabling environment, which would encourage people to disclose their HIV status and in turn seek adherence partners from families and beyond and ongoing adherence-counselling appear to be important issues in the programme. Relevance of these study findings in wider context is conceivable.

Episodic medication adherence in adolescents and young adults with perinatally acquired HIV: a within-participants approach.

Science.gov (United States)

Hawkins, Amy; Evangeli, Michael; Sturgeon, Kate; Le Prevost, Marthe; Judd, Ali

2016-01-01

Due to the success of antiretroviral (ART) medications, young people living with perinatally acquired HIV (PHIV+) are now surviving into adolescence and young adulthood. Understanding factors influencing ART non-adherence in this group is important in developing effective adherence interventions. Most studies of ART adherence in HIV-positive populations assess differences in adherence levels and adherence predictors between participants, over a period of time (global adherence). Many individuals living with HIV, however, including PHIV+ young people, take medication inconsistently. To investigate this pattern of adherence, a within-participants design, focussing on specific episodes of adherence and non-adherence, is suitable (episodic adherence). A within-participants design was used with 29 PHIV+ young people (17 female, median age 17 years, range 14-22 years), enrolled in the UK Adolescents and Adults Living with Perinatal HIV cohort study. Participants were eligible if they could identify one dose of medication taken and one dose they had missed in the previous two months. For each of the two episodes (one adherent, one non-adherent), behavioural factors (whom they were with, location, routine, day, reminders) and psychological factors at the time of the episode (information about medication, adherence motivation, perceived behavioural skills to adhere to medication - derived from the Information-Motivation-Behavioural Skills (IMB) Model - and affect) were assessed in a questionnaire. Non-adherence was significantly associated with weekend days (Friday to Sunday versus Monday to Thursday, p = .001), lack of routine (p = .004), and being out of the home (p = .003), but not with whom the young person was with or whether they were reminded to take medication. Non-adherence was associated with lower levels of behavioural skills (p ART, or ART motivation. The use of situationally specific strategies to enhance adherence in young people who take their

Risk factors for non-adherence to cART in immigrants with HIV living in the Netherlands: Results from the Rotterdam ADherence (ROAD) project

NARCIS (Netherlands)

S.K. Been; D.A.M.C. van de Vijver (David); P.T. Nieuwkerk (Pythia); Brito, I. (Inês); J. Stutterheim (Janine); A.E.R. Bos (Arjan); M.E.G. Wolfers (Mireille); K. Pogány (Katalin); A. Verbon (Annelies)

2016-01-01

textabstractIn the Netherlands, immigrant people living with HIV (PLWH) have poorer psychological and treatment outcomes than Dutch PLWH. This cross-sectional field study examined risk factors for non-adherence to combination Antiretroviral Therapy (cART) among immigrant PLWH. First and second

Risk Factors for Non-Adherence to cART in Immigrants with HIV Living in the Netherlands: Results from the ROtterdam ADherence (ROAD) Project

NARCIS (Netherlands)

Been, Sabrina K.; van de Vijver, David A. M. C.; Nieuwkerk, Pythia T.; Brito, Inês; Stutterheim, Sarah E.; Bos, Arjan E. R.; Wolfers, Mireille E. G.; Pogány, Katalin; Verbon, Annelies

2016-01-01

In the Netherlands, immigrant people living with HIV (PLWH) have poorer psychological and treatment outcomes than Dutch PLWH. This cross-sectional field study examined risk factors for non-adherence to combination Antiretroviral Therapy (cART) among immigrant PLWH. First and second generation

Understanding Factors Associated with Early Therapeutic Alliance in PTSD Treatment: Adherence, Childhood Sexual Abuse History, and Social Support

Science.gov (United States)

Keller, Stephanie M.; Zoellner, Lori A.; Feeny, Norah C.

2010-01-01

Objective: Therapeutic alliance has been associated with better treatment engagement, better adherence, and less dropout across various treatments and disorders. In treatment of posttraumatic stress disorder (PTSD), it may be particularly important to establish a strong early alliance to facilitate treatment adherence. However, factors such as…

Children and Adolescents with Perinatal HIV-1 Infection: Factors Associated with Adherence to Treatment in the Brazilian Context

Science.gov (United States)

Cruz, Maria Letícia Santos; Cardoso, Claudete A. Araújo; Darmont, Mariana Q.; Dickstein, Paulo; Bastos, Francisco I.; Souza, Edvaldo; Andrade, Solange D.; Fabbro, Marcia D’All; Fonseca, Rosana; Monteiro, Simone

2016-01-01

Challenges to the adherence to combination antiretroviral therapy among the pediatric population should be understood in the context of the trajectories of families, their interaction with healthcare services, and their access to material and symbolic goods. The present study analyzed individual, institutional and social factors that might be associated with the caregivers’ role in the treatment adherence of children and adolescents living with HIV (CALHIV). Based on semi-structured interviews and questionnaires applied to 69 caregivers seen at pediatric AIDS services of five Brazilian macro-regions, we observed that adherent caregivers had better acceptance of diagnosis and treatment, were less likely to face discrimination and social isolation secondary to AIDS-related stigma and tended to believe in the efficacy of treatment, and to be more optimistic about life perspectives of CALHIV. Interventions aiming to improve adherence and to promote the health of CALHIV should take in consideration the interplay of such different factors. PMID:27338431

Children and Adolescents with Perinatal HIV-1 Infection: Factors Associated with Adherence to Treatment in the Brazilian Context

Directory of Open Access Journals (Sweden)

Maria Letícia Santos Cruz

2016-06-01

Full Text Available Challenges to the adherence to combination antiretroviral therapy among the pediatric population should be understood in the context of the trajectories of families, their interaction with healthcare services, and their access to material and symbolic goods. The present study analyzed individual, institutional and social factors that might be associated with the caregivers’ role in the treatment adherence of children and adolescents living with HIV (CALHIV. Based on semi-structured interviews and questionnaires applied to 69 caregivers seen at pediatric AIDS services of five Brazilian macro-regions, we observed that adherent caregivers had better acceptance of diagnosis and treatment, were less likely to face discrimination and social isolation secondary to AIDS-related stigma and tended to believe in the efficacy of treatment, and to be more optimistic about life perspectives of CALHIV. Interventions aiming to improve adherence and to promote the health of CALHIV should take in consideration the interplay of such different factors.

Children and Adolescents with Perinatal HIV-1 Infection: Factors Associated with Adherence to Treatment in the Brazilian Context.

Science.gov (United States)

Cruz, Maria Letícia Santos; Cardoso, Claudete A Araújo; Darmont, Mariana Q; Dickstein, Paulo; Bastos, Francisco I; Souza, Edvaldo; Andrade, Solange D; Fabbro, Marcia D'All; Fonseca, Rosana; Monteiro, Simone

2016-06-21

Challenges to the adherence to combination antiretroviral therapy among the pediatric population should be understood in the context of the trajectories of families, their interaction with healthcare services, and their access to material and symbolic goods. The present study analyzed individual, institutional and social factors that might be associated with the caregivers' role in the treatment adherence of children and adolescents living with HIV (CALHIV). Based on semi-structured interviews and questionnaires applied to 69 caregivers seen at pediatric AIDS services of five Brazilian macro-regions, we observed that adherent caregivers had better acceptance of diagnosis and treatment, were less likely to face discrimination and social isolation secondary to AIDS-related stigma and tended to believe in the efficacy of treatment, and to be more optimistic about life perspectives of CALHIV. Interventions aiming to improve adherence and to promote the health of CALHIV should take in consideration the interplay of such different factors.

Adherence to tuberculosis care in Canadian Aboriginal populations, Part 1: definition, measurement, responsibility, barriers.

Science.gov (United States)

Orr, Pamela

2011-04-01

In a 2-part series, the current literature with respect to adherence to tuberculosis care among Canadian Aboriginal populations is reviewed. In the current paper, which comprises part 1 of this review, adherence is defined, and methods of measurement, issues of responsibility and potential barriers to adherence are explored. Study design. Literature review. A systematic search and analytic review of relevant studies was undertaken, including an online search of electronic databases (PubMed, PsychINFO, MEDLINE, Native Health Database, Scopus, Social Science Citation Index) and publications by governmental and non-governmental agencies. Poor adherence to therapy for TB disease is the most common cause of initial treatment failure and of disease relapse worldwide. Adherence to care for TB disease is necessary for the health of both the affected individual and society as a whole. Adherence is a task-specific behaviour that is not inherent to ethnic identity. The term applies only when common agreement over a care plan has been reached between patient and provider. The International Standards for Tuberculosis Care and the Patients Charter outline the responsibilities for adherence on the part of both patients and providers. For Canadian Aboriginals, barriers to adherence may derive from a complex interaction between the health system, personal factors and social factors, which may include dysfunctional acute and public health systems, dissonant (between health care provider and patient) belief systems, concurrent co-morbidities and life stressors, poverty and social stigma. Adherence is a task-specific behaviour, not a personality trait. It is influenced by the interaction of systemic, personal and societal factors. These factors must be understood within the historical experience of TB and the cultural meaning of health and illness among Indigenous Canadians.

Medication adherence among Nigerians with schizophrenia: correlation between clinico-demographic factors and quality of life

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Oluseun P. Ogunnubi

2017-03-01

Full Text Available Medication adherence contributes significantly to symptom remission, recovery and wellbeing in mental illnesses. We evaluated how medication adherence correlates with clinico-demographic factors and quality of life (QoL in a sample of Nigerians with schizophrenia. This descriptive crosssectional study involved 160 randomly selected participants with confirmed diagnosis of schizophrenia based on MINI International Neuropsychiatric Interview. Data on socio-demographic and clinical characteristics of participants were collected with a questionnaire. Medication adherence was assessed with Morisky Medication Adherence Questionnaire, and participants completed the World Health Organization Quality of Life Scale-BREF. The mean age of participants was 38.54 (±11.30 years, and all the participants were on antipsychotics, but only 45% were adherent to their medication. Out of all the participants, 45 (28.2% considered their overall QoL to be good, 97 (60.6% considered theirs to be fair, while 18 (11.2% reported poor QoL. Medication non-adherence correlated negatively with good QoL across multiple dimensions including overall QoL (r=- 0.175, health satisfaction (r=-0.161, physical (r=-0.186 and psychological domain (r=-0.175. Again, participant’s age (r=- 0.190 and age of onset of illness (r=-0.172 correlated negatively with medication nonadherence, and a trend towards relapse delay with medication adherence was also observed (r=-0.155. The effect size of these correlations were however small. Our findings suggest a link between medication adherence and QoL in schizophrenia, such that strategy that addresses medication nonadherence and its determinants may have potential benefits on wellbeing. Further hypotheses-driven studies are desirable.

Type D Personality Predicts Poor Medication Adherence in Patients with Heart Failure in the USA

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Wu, Jia-Rong; Moser, Debra K.

2015-01-01

Background Type D (distressed) personality and medication nonadherence have been associated with poor health outcomes. Type D personality is associated with poor medication adherence in patients with coronary artery disease. However, the relationship between type D personality and medication adherence in patients with heart failure (HF) remains unknown. Purpose Therefore, the goal of this study was to examine the association between type D personality and medication adherence in patients with HF. Method This was a sub-analysis of baseline data from a randomized controlled trial with 84 patients with HF in the USA. Demographic, clinical, and psychological data were collected at baseline by interview, questionnaires, and medical record review. Type D personality was assessed using the Type D Personality Scale (DS14). Medication adherence was measured using both objective (Medication Event Monitoring System, MEMS) and self-reported (Morisky Medication Adherence Scale, MMAS-4) measures. Patients started medication adherence monitoring with the MEMS bottle at baseline and is used continuously for a month. Multiple regressions were used to explore the relationships between type D personality and medication adherence while adjusting for demographic, clinical, and psychological factors. Results Patients with type D personality were more likely to have poor medication adherence. Type D personality was associated with medication adherence before and after adjusting for covariates when it was analyzed as a categorical variable. However, type D personality was not associated with medication adherence when analyzed as a dimensional construct. Negative affectivity, a component of type D personality, was associated with medication adherence. Conclusion As a dimensional construct, type D personality may not reflect the components of the personality associated with poor outcomes. Negative affectivity was associated with medication adherence in patients with HF. Interventions aiming

Treating depression in HIV-positive patients affects adherence

African Journals Online (AJOL)

2012-09-02

Sep 2, 2012 ... reported that the number of people newly infected with HIV and the number .... and immunity. Subjects were ... of change in adherence as a response ..... retroviral drugs: Theorising contextual relationships. ... Drug-resistant HIV-1: The virus strikes back. ... persons with human immunodeficiency virus (HIV).

Understanding factors associated with early therapeutic alliance in PTSD treatment: adherence, childhood sexual abuse history, and social support.

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Keller, Stephanie M; Zoellner, Lori A; Feeny, Norah C

2010-12-01

Therapeutic alliance has been associated with better treatment engagement, better adherence, and less dropout across various treatments and disorders. In treatment of posttraumatic stress disorder (PTSD), it may be particularly important to establish a strong early alliance to facilitate treatment adherence. However, factors such as childhood sexual abuse (CSA) history and poor social support may impede the development of early alliance in those receiving PTSD treatment. We sought to examine treatment adherence, CSA history, and social support as factors associated with early alliance in individuals with chronic PTSD who were receiving either prolonged exposure therapy (PE) or sertraline. At pretreatment, participants (76.6% female; 64.9% Caucasian; mean age = 37.1 years, SD = 11.3) completed measures of trauma history, general support (Inventory of Socially Supportive Behaviors), and trauma-related social support (Social Reactions Questionnaire). Over the course of 10 weeks of PE or sertraline, they completed early therapeutic alliance (Working Alliance Inventory) and treatment adherence measures. Early alliance was associated with PE adherence (r = .32, p history was not predictive of a lower early alliance. Given the associations with adherence, clinicians may find it useful to routinely assess alliance early in treatment. Positive trauma support, not CSA history, may be particularly important in the development of a strong early therapeutic alliance. (c) 2010 APA, all rights reserved.

One of the Major Problems in Tuberculosis Control: Adherence to Therapy

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Belguzar Kara

2009-02-01

Full Text Available Abstract: Although tuberculosis (TB is a preventable and curable disease, approximately one third of the world’s population is infected with the TB bacillus. Tuberculosis is a major public health problem in especially developing countries. Nonadherence to TB therapy regimes is common, as treatment is difficult and requires long courses of multiple antibiotics. It is estimated that the rate of nonadherence to TB treatment ranges from 20 to 80%. Nonadherence to TB treatment is the most serious barrier in disease control because incomplete treatment may result in prolonged infectiousness, drug resistance, relapse and death. However, handling the factors affecting adherence to treatment for the patients may increase the efficiency of the treatment and help to reach better health outcomes. This article reviews evidence regarding adherence to TB treatment in patients and affecting factors and makes recommendations for health care professionals. [TAF Prev Med Bull 2009; 8(1.000: 75-82

Optimizing adherence in HIV prevention product trials: Development and psychometric evaluation of simple tools for screening and adherence counseling.

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Tolley, Elizabeth E; Guthrie, Kate Morrow; Zissette, Seth; Fava, Joseph L; Gill, Katherine; Louw, Cheryl E; Kotze, Philip; Reddy, Krishnaveni; MacQueen, Kathleen

2018-01-01

Low adherence in recent HIV prevention clinical trials highlights the need to better understand, measure, and support product use within clinical trials. Conventional self-reported adherence instruments within HIV prevention trials, often relying on single-item questions, have proven ineffective. While objective adherence measures are desirable, none currently exist that apply to both active and placebo arms. Scales are composed of multiple items in the form of questions or statements that, when combined, measure a more complex construct that may not be directly observable. When psychometrically validated, such measures may better assess the multiple factors contributing to adherence/non-adherence. This study aimed to develop and psychometrically evaluate tools to screen and monitor trial participants' adherence to HIV prevention products within the context of clinical trial research. Based on an extensive literature review and conceptual framework, we identified and refined 86 items assessing potential predictors of adherence and 48 items assessing adherence experience. A structured survey, including adherence items and other variables, was administered to former ASPIRE and Ring Study participants and similar non-trial participants (n = 709). We conducted exploratory factor analyses (EFA) to identify a reduced set of constructs and items that could be used at screening to predict potential adherence, and at follow-up to monitor and intervene on adherence. We examined associations with other variables to assess content and construct validity. The EFA of screener items resulted in a 6-factor solution with acceptable to very good internal reliability (α: .62-.84). Similar to our conceptual framework, factors represent trial-related commitment (Distrust of Research and Commitment to Research); alignment with trial requirements (Visit Adherence and Trial Incompatibility); Belief in Trial Benefits and Partner Disclosure. The EFA on monitoring items resulted in 4

Illness perception, coping and adherence to treatment among patients with chronic kidney disease.

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Vélez-Vélez, Esperanza; Bosch, Ricardo J

2016-04-01

To analyse the predictive value of illness representations on treatment adherence and coping strategies in a group of patients on haemodialysis. Understanding the cognitive and emotional factors that influence adherence behaviour and coping strategies and determining their relationship to sociodemographic factors remain a challenge; meeting this challenge would encourage comprehensive patient care, thereby improving their quality of life Cross-sectional study with predictive means in a sample of 135 patients on haemodialysis. Data collection occurred from September 2010-January 2012 and tools included the following: sociodemographic data, Illness Perception Questionnaire-Revised, the Cuestionario de Afrontamiento del Estrés and the Morisky-Green test to study adherence to treatment. Being a woman, having a greater knowledge of the disease and having a poorer sense of personal control affected adherence to treatment on controlling for each factor. 'Identity', 'personal control' and 'adherence' were associated with a proactive coping strategy, whereas 'evolution' and 'gender' were related independently to avoidance coping strategies; those who believed that their illness had a chronic course were more likely to cope by avoiding the problem and this tendency was stronger among women. This study provides evidence supporting the role of gender, knowledge about the disease and sense of personal control in adherence to therapeutic regimens of patients in chronic haemodialysis. The identification and characterization of patients' perception of chronic illness may represent a useful framework to influence disease outcomes such as adherence. © 2015 John Wiley & Sons Ltd.

Determinants of Adherence to Antiretroviral Treatment among HIV ...

African Journals Online (AJOL)

This study investigated factors of adherence to Antiretroviral Treatment (ART), factors or variables that can discriminate between adherent and non-adherent patients on ART were selected. Simple structured questionnaire was employed. The study sample consisted of 145 HIV patients who received ART in the Shashemene ...

Factors Associated with Adherence to and Treatment Duration of Erlotinib Among Patients with Non-Small Cell Lung Cancer.

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Hess, Lisa M; Louder, Anthony; Winfree, Katherine; Zhu, Yajun E; Oton, Ana B; Nair, Radhika

2017-06-01

In lung cancer, there is an increasing number of oral agents available for patients; however, little is known about the factors associated with adherence to and treatment duration on oral medications in non-small cell lung cancer (NSCLC). To evaluate the clinical and demographic factors associated with adherence and treatment discontinuation, respectively, to oral oncolytics among patients with NSCLC. A retrospective, claims-based analysis of the Humana Research Database supplemented with medical chart review was conducted among patients with NSCLC who started an oral oncolytic between January 1, 2008, and June 30, 2013. Patients were required to be enrolled at least 1 year before the start of oral oncolytics and have no evidence of any oral oncolytic use during this period. Logistic regression models and Cox proportional hazard models were used to identify predictors associated with medication adherence and treatment duration, respectively. Among all oral oncolytics, only the cohort starting on erlotinib had sufficient sample size (n = 1,452). A wide variety of factors were found to be associated with adherence. Low-income subsidy status, previous use of intravenous chemotherapy, and lower total baseline health care costs were significantly related to decreasing adherence (each P cost was associated with decreasing adherence to erlotinib (P costs (P Company to Comprehensive Health Insights, a Humana company, as a collaborative research project involving employees of both companies. Hess, Winfree, Zhu, and Oton are employees of Eli Lilly and Company. Louder and Nair are employees of Comprehensive Health Insights, which received funding to complete this research. Study concept and design were contributed by Hess, Zhu, Winfree, and Oton. Nair and Louder collected the data, and data interpretation was performed by all the authors. The manuscript was written primarily by Hess, along with Nair, and revised by Hess, Nair, Louder, and Winfree, with assistance from Zhu and

Improving Adherence to Treatment and Reducing Economic Costs of Hypertension: The Role of Olmesartan-Based Treatment.

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Costa, Francesco Vittorio

2017-09-01

Poor adherence to antihypertensive treatment is the single most important factor of unsatisfactory blood pressure (BP) control. This review focuses on therapy-related factors affecting adherence and suggests how to improve it with a wise choice of treatment schedule. Complex drug treatment schemes, poor tolerability and drug substitutions are frequent causes of poor adherence which, in turn, causes insufficient BP control, greater incidence of cardiovascular events and, finally, higher global health costs. The effects of prescribing generic drugs and of drug substitutions on adherence is also discussed. In terms of adherence, generic drugs do not seem to be better than branded drugs, unless patients have to bear very high "out of pocket" expenses to buy original drugs, suggesting no advantages in switching drug with the mere goal of reducing the cost of therapy. An important role in improving adherence (and thus cardiovascular events and health expenditure) is also played by the availability of fixed-dose combinations; among antihypertensive drugs, angiotensin receptor blockers (ARBs) are those associated with higher levels of adherence and persistence. Among ARBs, olmesartan stands out for a wide choice of effective fixed-dose combinations.

Factors affecting pain relief in response to physical exercise interventions among healthcare workers.

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Jakobsen, M D; Sundstrup, E; Brandt, M; Andersen, L L

2017-12-01

The aim of this study is to identify factors associated with musculo-skeletal pain reduction during workplace-based or home-based physical exercise interventions among healthcare workers. Two hundred female healthcare workers (age: 42.0, BMI: 24.1, average pain intensity: 3.1 on a scale of 0-10) from three hospitals participated. Participants were randomly allocated at the cluster level (18 departments) to 10 weeks of (i) workplace physical exercise (WORK) performed in groups during working hours for 5 × 10 minutes per week and up to five group-based coaching sessions on motivation for regular physical exercise, or (ii) home-based physical exercise (HOME) performed alone during leisure-time for 5 × 10 minutes per week. Linear mixed models accounting for cluster identified factors affecting pain reduction. On average 2.2 (SD: 1.1) and 1.0 (SD: 1.2) training sessions were performed per week in WORK and HOME, respectively. The multi-adjusted analysis showed a significant effect on pain reduction of both training adherence (P=.04) and intervention group (P=.04) with participants in WORK experiencing greater reductions compared with HOME. Obesity at baseline was associated with better outcome. Leisure-time exercise, daily patient transfer, age, and chronic pain did not affect the changes in pain. In conclusion, even when adjusted for training adherence, performing physical exercise at the workplace is more effective than home-based exercise in reducing musculo-skeletal pain in healthcare workers. Noteworthy, obese individuals may especially benefit from physical exercise interventions targeting musculo-skeletal pain. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Organizational culture affecting quality of care: guideline adherence in perioperative antibiotic use.

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Ukawa, Naoto; Tanaka, Masayuki; Morishima, Toshitaka; Imanaka, Yuichi

2015-02-01

The objective of this work was to elucidate aspects of organizational culture associated with hospital performance in perioperative antibiotic prophylaxis using quantitative data in a multicenter and multidimensional study. Cross-sectional retrospective study using a survey data and administrative data. Eighty-three acute hospitals in Japan. A total of 4856 respondents in the organizational culture study, and 23 172 patients for the quality indicator analysis. Multilevel models of various cultural dimensions were used to analyze the association between hospital organizational culture and guideline adherence. The dependent variable was adherence or non-adherence to Japanese and CDC guidelines at the patient level and main independent variable was hospital groups categorized according to organizational culture score. Other control variables included hospital characteristics such as ownership, bed capacity, region and urbanization level of location. The multilevel analysis showed that hospitals with a high score in organizational culture were more likely to adhere to the Japanese and CDC guidelines when compared with lower scoring hospitals. In particular, the hospital group with high scores in the 'collaboration' and 'professional growth' dimensions had three times the odds for Japanese guideline adherence in comparison with low-scoring hospitals. Our study revealed that various aspects of organizational culture were associated with adherence to guidelines for perioperative antibiotic use. Hospital managers aiming to improve quality of care may benefit from improving hospital organizational culture. © The Author 2014. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

Factors associated with low adherence to a Mediterranean diet in healthy children in northern Spain.

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Arriscado, Daniel; Muros, José J; Zabala, Mikel; Dalmau, José M

2014-09-01

There is a tendency in Mediterranean countries to abandon the characteristic Mediterranean diet. This is especially apparent within younger populations. This could have negative consequences for health such as, cardiovascular diseases, obesity or metabolic syndrome. The aim of this study was to describe adherence to the Mediterranean diet within a population of school children and to examine the influence of different socio-demographic factors and lifestyle habits. The study was conducted on a representative sample of 321 school children aged 11-12 years from 31 schools in the city of Logroño (La Rioja). Socio-demographic variables, anthropometric variables, blood pressure, level of development, aerobic fitness, lifestyle, physical activity habits and adherence to the Mediterranean diet were recorded. High adherence to the Mediterranean diet was reported by 46.7% of school children, with low adherence being reported by 4.7% of them. Children attending state schools, immigrants and families from low-to-medium socio-economic strata reported significantly lower adherence to the Mediterranean diet (p = .039), but the results did not reveal any significant differences in terms of body composition. Correlations were found between adherence to the Mediterranean diet and other lifestyle habits, especially level of physical activity (r = .38) and screen time (r = -.18). Adherence to a Mediterranean diet differs according to the type of school attended by children, and the child's nationality and socio-economic status. Children who attended state schools, immigrants and those from families with a medium-to-low socio-economic status were less likely to follow healthy diets. Copyright © 2014 Elsevier Ltd. All rights reserved.

Medication adherence among transgender women living with HIV

OpenAIRE

Baguso, Glenda N.; Gay, Caryl L.; Lee, Kathryn A.

2016-01-01

Medication adherence is linked to health outcomes among adults with HIV infection. Transgender women living with HIV (TWLWH) in the U.S. report suboptimal adherence to medications and are found to have difficulty integrating HIV medication into their daily routine, but few studies explore factors associated with medication adherence among transgender women. Thus, the purpose of this paper is to examine demographic and clinical factors related to self-reported medication adherence among transg...

A model of parental distress and factors that mediate its link with parental monitoring of youth diabetes care, adherence, and glycemic control.

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Robinson, Elizabeth M; Weaver, Patrick; Chen, Rusan; Streisand, Randi; Holmes, Clarissa S

2016-12-01

Parental monitoring of adolescents' diabetes self-care is associated with better adherence and glycemic control (A1c). A number of parent-level factors are associated with higher levels of parental monitoring, including lower levels of parental distress (depressive symptoms, stress, anxiety), as well as higher levels of parental self-efficacy for diabetes management and authoritative parenting. Often studied in isolation, these factors may be best considered simultaneously as they are interrelated and are associated with parental monitoring and youth adherence. Structural equation modeling with a cross-sectional sample of 257 parent/youth (aged 11-14) dyads: (a) examined a broad model of parental factors (i.e., parental distress, parental diabetes self-efficacy, authoritative parenting), and (b) assessed their relation to parental monitoring, youth adherence, and A1c. Post hoc analyses of variance (ANOVAs) evaluated clinical implications of daily parental monitoring. Parental distress was not related directly to parental monitoring. Instead less distress related indirectly to more monitoring via higher parental self-efficacy and more authoritative parenting which, in turn, related to better adherence and A1c. Higher parental self-efficacy also related directly to better youth adherence and then to better A1c. Clinically, more parental monitoring related to more daily blood glucose checks and to better A1c (8.48% vs. 9.17%). A broad model of parent-level factors revealed more parental distress was linked only indirectly to less monitoring via lower parental self-efficacy and less authoritative parenting. Behaviorally, more parental monitoring related to better adherence and to clinically better A1c in adolescents. Further study of parent-level factors that relate to parental distress and monitoring of adherence appears warranted. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Psychological aspects of caregivers associated with family support in the therapeutic adherence of diabetic patients

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Miriam Teresa Domínguez - Guedea

2010-03-01

Full Text Available Objective: To analyze the relationship of psychological aspects of family caregivers with the support that they offer to the diabetic patient’s adherence to treatment. The psychological aspects were: subjective well-being, attachment styles, coping strategies to problems and perceived social support. Methods: Joined in the study 29 family caregivers in a noneprobabilistic sample. Participants were contacted from three Mutual Aid Groups for diabetic and hypertensive patients in the city of Hermosillo, México. Questionnaires designed for the purposes of research were applied, as well as psychometric instruments previously validated in the cultural reference group. Results: The data showed that the psychological aspects that are statistically significant and negatively related to adherence therapy are avoidant attachment and negative affection, both associated to each other in a positive way, indicating that they occur in parallel. Avoidant attachment was positively associated with avoidant coping strategies and emotional disturbance, but negatively with secure attachment and material satisfaction. Negative affection were positively associated with emotional coping, but negatively with secure attachment and material satisfaction. Negative affect were positively associated with emotional confrontation, but negatively with positive affection, material satisfaction, emotional support and guidance support. Conclusions: More applied research in needed on the influence of family factors in achieving adherence to treatment, because so far, most work focuses more on the individual patient, disregarding the family factor.

Factors influencing adherence to psychopharmacological medications in psychiatric patients: a structural equation modeling approach

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De las Cuevas C

2017-03-01

positively (although weakly with age. Self-efficacy indirectly influenced treatment adherence through internal health locus of control.Conclusion: This study provides support for the hypothesis that perceived health control variables play a relevant role in psychiatric patients’ adherence to psychopharmacological medications. The findings highlight the importance of considering prospective studies of patients’ psychological reactance and health locus of control as they may be clinically relevant factors contributing to adherence to psychopharmacological medications. Keywords: attitude to health, medication adherence, health behavior, internal-external control, model, statistical, psychiatry

Predictors of medication non-adherence for vasculitis patients

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Hogan, Susan L.; DeVellis, Robert F.

2013-01-01

The primary purpose of this article is to document whether demographic, clinical, regimen-related, intrapersonal, and interpersonal factors predict medication non-adherence for vasculitis patients. A secondary purpose is to explore whether adherence varies by medication type and whether patients experienced drug-related side effects. Vasculitis patients (n=228) completed online baseline and 3-month follow-up surveys. Demographic (age, gender, education, race, marital status, and insurance status), clinical (perceived vasculitis severity, disease duration, vasculitis type, and relapse/remission status), regimen-related (experience of side effects), intrapersonal (depressive symptoms), and interpersonal (adherence-related support from family and friends) factors were measured at baseline. Medication non-adherence was assessed at follow-up using the Vasculitis Self-Management Survey medication adherence sub-scale (α=0.89). Variables that significantly correlated (pvasculitis medication types, patients who experienced side effects were less adherent than patients who did not experience side effects. Multiple factors are associated with medication non-adherence for vasculitis patients. Providers should discuss medication adherence and drug-related side effects with vasculitis patients. Providers may want to particularly target younger patients and patients with clinical signs of depression. PMID:23314654

Interplay between Oral Hypoglycemic Medication Adherence and Quality of Life among Elderly Type 2 Diabetes Mellitus Patients.

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Manan, Mohamed Mansor; Husin, Akhma Radzuanna; Alkhoshaiban, Ali Saleh; Al-Worafi, Yaser Mohammed Ali; Ming, Long Chiau

2014-12-01

Adherence to medications is an important factor that contributes to therapeutic success. With the current increase in the elderly population, information relating to adherence to treatment and quality of life (QoL) of diabetic elderly patients will help the healthcare provider to improve their treatment. Thus, this study aims to determine the factors affecting adherence to medications and the consequence of non adherence to QoL. This was a cross-sectional study using validated Morisky Medication Adherence Scale (MMAS) Questionnaire. This study was conducted to assess the level of adherence on oral hypoglycemic medications (OHM) and quality of life of the Type 2 diabetes mellitus (T2DM) elderly patients in an urban health centre in Malaysia. A retrospective medication record review was also conducted to collect and confirm data on patients' demographics, diagnosis, treatments, and outcomes. One hundred and seventy nine patients were recruited in this study. Median adherence score was 7.75 (IQR 6.50- 8.00). Good adherer was observed in 48.00% of the participants. A Chi-square test indicated significant correlation between adherence and HbA1c (p= 0.010). The mean elderly diabetes mellitus Problem Areas in Diabetes (PAID) score was 6.30 ±SD 8.50. A significant inversed association was observed between PAID score and the level of adherence (r = - 0.175, pwestern countries.

[The challenge of improving evidence-based therapy adherence in the secondary prevention of coronary artery disease: the next frontier of cardiac rehabilitation].

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Scardi, Sabino; Mazzone, Carmine; Umari, Paolo

2009-06-01

Non-adherence to prescribed drug regimens is an increasing medical problem affecting physicians and patients and contribute to negative outcomes, such as the increased risk of subsequent cardiovascular events. Analysis of various patient populations shows that the choice of drug, its tolerability and the duration of treatment influence the non-adherence. Intervention is required toward patients and health-care providers to improve medication adherence. This review deals about the prevalence of non-adherence to therapy after medical and surgical cardiac event, the risk factors affecting non-adherence and the strategies to implement it. Interventions that may successfully improve adherence should include improved physician compliance with guidelines, patient education and patient reminders, frequent visits or telephone calls from staff, simplification of the patient's drug regimen by reducing the number of pills and daily doses. Since single interventions do not appear efficaceous, it is necessary to establish multiple interventions simultaneously addressing a number of barriers to adherence.

Influencing factors on CPAP adherence and anatomic characteristics of upper airway in OSA subjects.

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Park, Pona; Kim, Jinil; Song, Yoon Jae; Lim, Jae Hyun; Cho, Sung Woo; Won, Tae-Bin; Han, Doo Hee; Kim, Dong-Young; Rhee, Chae Seo; Kim, Hyun Jik

2017-12-01

Although continuous positive airway pressure (CPAP) is the most effective treatment modality, poor adherence still remains a problem for obstructive sleep apnea (OSA) treatment and there is little evidence regarding how this might be improved. This study aims to analyze the anatomic and clinical factors of OSA subjects who failed to comply with CPAP therapy.The medical records of 47 OSA subjects who received CPAP therapy as a first-line treatment modality were retrospectively reviewed. The medical records were reviewed for demographic and polysomnographic data and anatomic findings of the nasal cavity and oropharynx.24 patients who adhered to CPAP therapy and 23 patients who were nonadherent were enrolled in the study. There were no statistically significant differences in sleep parameters between CPAP-adherent patients and CPAP nonadherent subjects. Mean body mass index of CPAP nonadherent group was significantly higher than CPAP adherent group. Higher grades of septal deviation and hypertrophic change of the inferior turbinate were observed more in the CPAP nonadherent group. In addition, CPAP nonadherent subjects showed considerably bigger tonsils and higher grade palatal position comparing with the CPAP adherent subjects. Subjective discomfort including inconvenience, mouth dryness, and chest discomfort were the main problems for OSA subjects who did not comply with CPAP therapy.Excessive upper airway blockage in the nasal cavity and oropharynx was predominant in CPAP nonadherent subjects, which might cause the reported subjective discomfort that reduces CPAP compliance. Therefore, resolution of these issues is needed to enhance CPAP compliance for control of OSA. Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.

MAC-1 Glycoprotein Family mediates adherence of neutrophils to endothelial cells stimulated by leukotriene B/sub 4/ and platelet activating factor

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Tonnesen, M.G.; Anderson, D.C.; Springer, T.A.; Knedler, A.; Avdi, N.; Henson, P.M.

1986-03-01

The process of neutrophil (N) adhesion to and migration through endothelium (EC), an early event in the induction of the acute inflammatory response, has been attributed to the generation of extravascular chemoattractant peptides and lipids. Although both leukotriene B/sub 4/ (LTB/sub 4/) and platelet activating factor (PAF) enhance N adherence to EC, the mechanisms involved in this interaction are still not completely understood. Since the MAC-1 Glycoprotein (GP) Family has recently been shown to be required for a variety of adherence-dependent functions of stimulated N, the authors questioned whether these adherence-associated GP might be involved in N adherence to EC stimulated by LTB/sub 4/ or PAF. Using a microtiter adherence assay with /sup 111/In labeled N, they assessed the ability of N from patients with MAC-1, LFA-1 Deficiency to adhere to monolayers of human omental microvascular or umbilical vein EC as well as to serum-coated plastic. Patient N exhibited markedly diminished adherence in response to LTB/sub 4/ or PAF compared to normal controls. LTB/sub 4/ and PAF enhanced expression of the MAC-1 GP Family on the surface of normal N as determined by flow cytofluorimetry using a monoclonal antibody (TS1/18) to the GP common beta subunit. In addition TS1/18 (20 ..mu..g/ml) completely inhibited N adherence stimulated by either LTB/sub 4/ (10/sup -8/M) or PAF(10/sup -11/M). Thus, the MAC-1 GP Family appears to be important in chemotactic factor regulation of N adherence to EC.

Patient adherence with COPD therapy

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C. S. Rand

2005-12-01

Full Text Available Although there are very few published studies on adherence to treatment regimens in chronic obstructive pulmonary disease (COPD, the evidence that exists suggests that, as with asthma therapy, adherence is poor. Patient beliefs about COPD, as well as their motivation and expectations about the likelihood of success of medical interventions, can influence adherence rates. Other critical factors include the patient's understanding of their illness and therapy, and the complexity of the prescribed treatment regimen. Incorrect inhaler technique is also a common failing. When prescribing in primary or specialist care, healthcare professionals should address adherence as a vital part of the patient consultation. Improved patient education may also increase adherence rates.

Psychosocial influencers and mediators of treatment adherence in haemodialysis patients.

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Oh, Hyun Soo; Park, Ji Suk; Seo, Wha Sook

2013-09-01

This article is a report of the development and testing of the hypothetical model that illustrates relationships between treatment adherence and its psychosocial influencing factors and to elucidate the direct and indirect (mediating) effects of factors on treatment adherence. Poor adherence has been consistently reported in haemodialysis patients. Much research has showed various influencing factors of adherence, but these studies have failed to identify consistent influencing factors. This study was performed using a non-experimental, cross-sectional design. The study subjects were 150 end-stage renal failure patients on haemodialysis at a university hospital located in Incheon, South Korea. Data were collected over 10 months (June 2010-April 2011). The hypothetical model provided a good fit with data. Haemodialysis-related knowledge, perceived barrier to adherence, self-efficacy on adherence, and healthcare provider support had significant effects on adherence. Self-efficacy was found to mediate barrier-adherence and family support-adherence relationships. Self-efficacy in combination with barrier, family support, and healthcare provider support was found to mediate the depression-adherence relationship. Strategies aimed at the development of successful adherence interventions should focus on reducing perceived barriers and enhancing self-efficacy and knowledge. It can be suggested that efforts to improve the healthcare provider-patient relationship would enhance adherence. In depressive patients, strategies that promote self-efficacy and the support of family or healthcare providers could diminish the negative impact of depression on adherence. © 2013 Blackwell Publishing Ltd.

Factors Influencing Adherence to Routine Iron Supplementation

African Journals Online (AJOL)

Fineprint

2016-06-01

Jun 1, 2016 ... adherence among pregnant women in three selected health centers in Akinyele. Local Government Area, Ibadan ... socioeconomic status, and illiteracy. [12]. .... 80.74% in India [24 ] Although the reason for this disparity is not ...

Factors associated with beliefs about adherence to non-pharmacological treatment of patients with heart failure

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Izabel Cristina Ribeiro da Silva Saccomann

2014-02-01

Full Text Available This study aimed at assessing beliefs about the benefits and barriers to adherence to daily self-monitoring of weight/edema in patients with heart failure, and the influence of demographic and clinical variables on those beliefs. 105 patients were interviewed. The mean of the subscales Benefits and Barriers were 20.2 (± 5.7 and 30.1 (±7.1, respectively. Patients perceived that adherence to daily self-monitoring of weight/edema could keep them healthy, improve their quality of life and decrease the chances of readmission. Approximately half of patients (46.7% reported forgetting this measure. Those who controlled weight once a month were more likely to have barriers to adherence (OR= 6.6; IC 95% 1.9-13.8; p=0.01, showing this measure to be the main factor related to perceived barriers. Education in health can contribute with the development of strategies aimed at lowering barriers and increasing benefits of this control.

Adherence to Cancer Screening Guidelines and Predictors of Improvement Among Participants in the Kansas State Employee Wellness Program

OpenAIRE

Hui, Siu-kuen Azor; Engelman, Kimberly K.; Shireman, Theresa I.; Ellerbeck, Edward F.

2013-01-01

Introduction Employee wellness programs (EWPs) have been used to implement worksite-based cancer prevention and control interventions. However, little is known about whether these programs result in improved adherence to cancer screening guidelines or how participants’ characteristics affect subsequent screening. This study was conducted to describe cancer screening behaviors among participants in a state EWP and identify factors associated with screening adherence among those who were initia...

Post-ART Symptoms Were Not the Problem: A Qualitative Study on Adherence to ART in HIV-Infected Patients in a Mozambican Rural Hospital

NARCIS (Netherlands)

Maixenchs, M.; Boene, H.; Anselmo, R.; Mindu, C.; Alonso, P.; Menéndez, C.; Macete, E.; Pool, R.; Letang, E.; Naniche, D.; Munguambe, K.

2015-01-01

Objective The objective of this qualitative study was to explore how clinical symptoms may affect adherence to antiretroviral therapy (ART) in HIV patients, and to explore factors, perceptions and attitudes related to adherence to therapy. Design A qualitative study was carried out in the context of

Understanding how adherence goals promote adherence behaviours: a repeated measure observational study with HIV seropositive patients

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Jones Gareth

2012-08-01

Full Text Available Abstract Background The extent to which patients follow treatments as prescribed is pivotal to treatment success. An exceptionally high level (> 95% of HIV medication adherence is required to suppress viral replication and protect the immune system and a similarly high level (> 80% of adherence has also been suggested in order to benefit from prescribed exercise programmes. However, in clinical practice, adherence to both often falls below the desirable level. This project aims to investigate a wide range of psychological and personality factors that may lead to adherence/non-adherence to medical treatment and exercise programmes. Methods HIV positive patients who are referred to the physiotherapist-led 10-week exercise programme as part of the standard care are continuously recruited. Data on social cognitive variables (attitude, intention, subjective norms, self-efficacy, and outcome beliefs about the goal and specific behaviours, selected personality factors, perceived quality of life, physical activity, self-reported adherence and physical assessment are collected at baseline, at the end of the exercise programme and again 3 months later. The project incorporates objective measures of both exercise (attendance log and improvement in physical measures such as improved fitness level, weight loss, improved circumferential anthropometric measures and medication adherence (verified by non-invasive hair analysis. Discussion The novelty of this project comes from two key aspects, complemented with objective information on exercise and medication adherence. The project assesses beliefs about both the underlying goal such as following prescribed treatment; and about the specific behaviours such as undertaking the exercise or taking the medication, using both implicit and explicit assessments of patients’ beliefs and attitudes. We predict that i the way people think about the underlying goal of their treatments explains medication and exercise

Factors associated to adherence to blood glucose self-monitoring in patients with diabetes treated with insulin. The dapa study.

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Vidal Florc, Mercè; Jansà Morató, Margarita; Galindo Rubio, Mercedes; Penalba Martínez, Maite

2018-02-01

To assess adherence to self-monitoring of blood glucose and the main factors associated with it, particularly those related to self-perception of glycemia, in patients with diabetes on insulin therapy. An epidemiological, observational, prospective, multicenter study conducted in standard clinical practice in primary care, outpatient centers, and hospitals from different Spanish regions. Sociodemographic, clinical and treatment data were collected. Patients were considered adherent to self-monitoring if they performed the minimum number of controls recommended by the Spanish Society of Diabetes (SED). Adherence was shown in 61.6% of patients. Factors associated to adherence included treatment with less than three insulin injections daily (OR 2.678; 95% CI 2.048- 3.5029; p <0.001), presence of peripheral vascular disease (OR 1.529; 95% CI 1.077 - 2.171; p=0.018), alcohol abstinence (OR 1.442; 95% CI 1.118 - 1.858; p=0.005), and collection of the glucose test strips from the pharmacy (OR 1.275; 95% CI 1.026 - 1.584; p=0.028). Adequate self-perception of glycemia was found in 21.4% of patients. Our results show a suboptimal adherence to the recommended protocol for blood glucose self-monitoring in patients with diabetes on insulin therapy. Independent variables associated to good adherence were treatment with less than three insulin injections dailyu, presence of peripheral vascular disease, alcohol abstinence, and collection of glucose test strips from the pharmacy. Copyright © 2017 SEEN y SED. Publicado por Elsevier España, S.L.U. All rights reserved.

Executive function and self-regulated exergaming adherence

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Cay eAnderson-Hanley

2014-12-01

Full Text Available The rise in dementia and the evidence of cognitive benefits of exercise for the older adult population together make salient the research into variables affecting cognitive benefit and exercise behavior. One promising avenue for increasing exercise participation has been the introduction of exergaming, a type of exercise that works in combination with virtual reality to enhance both the exercise experience and health outcomes. Past research has revealed that executive function (EF was related to greater use of self-regulatory strategies, which in turn was related to greater adherence to exercise following an intervention (McAuley et al., 2011. Best et al. (2014 found improvement in EF related to adherence to exercise post- intervention. Anderson-Hanley et al. (2012 found that for older adults aerobic exergaming yielded greater cognitive benefit than traditional exercise alone; however, questions remain as to the possible impact of greater cognitive benefit and other factors on participants’ involvement in exercise following the end of an intervention. The current study presents follow-up data exploring the relationship between change in EF, self-regulation, and exercise adherence in the post-intervention (naturalistic period. Herein, it was predicted that improvement in EF during an exercise intervention, would predict subsequent exercise with an exergame during the naturalistic window. Contrary to expectations, results suggest that those with EF decline during the intervention used the exergame more frequently. The results of this study contradict previous literature, but suggest an interesting relationship between change in executive function, self-regulation, and exercise behaviors when exergaming is employed, particularly with older adults with some cognitive decline. We hypothesize that other factors may be at work; perhaps expectation of cognitive benefit might act as a unique motivator or caregivers may be instrumental in adherence.

Satisfaction and adherence of patients with amputations to physiotherapy service at public hospitals in KwaZulu-Natal, South Africa.

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Verusia, Chetty; Tanuja, Dunpath; Simira, Meghnath; Sarisha, Mothalal; Varuna, Sewmungal; Ursula, Kunene; Thalente, Ntshakala

2015-06-01

Individuals who have undergone a lower limb amputation require comprehensive rehabilitation from the multidisciplinary team to ensure optimal treatment outcomes and social integration. Physiotherapists play a pivotal role within the multidisciplinary team and offer patients physical and psychosocial rehabilitative care. Determining patients' satisfaction levels and exploring factors affecting adherence to physiotherapy interventions can inform practice and improve service delivery of rehabilitation within resource poor settings such as South Africa. To determine the level of satisfaction with physiotherapy services rendered to acute and sub-acute in-patients with lower limb amputations and to explore factors affecting adherence to physiotherapy intervention. A prospective survey of 35 patients with lower limb amputations from four public hospitals in South Africa was undertaken. A modified version of the Hampstead rehabilitation centre patient satisfaction questionnaire was utilised. Majority of participants were satisfied with the physiotherapy services whilst a few reported dissatisfaction. Three themes emerged whilst exploring the patients' experience relating to adherence to physiotherapy programmes. Themes included service delivery, patient-therapist interaction and participation barriers and facilitators. Recommendations aimed to improve quality of care and healthcare outcomes thereby enhancing the participants' adherence to the physiotherapy programme.

Measures and predictors of varenicline adherence in the treatment of nicotine dependence.

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Peng, Annie R; Morales, Mark; Wileyto, E Paul; Hawk, Larry W; Cinciripini, Paul; George, Tony P; Benowitz, Neal L; Nollen, Nicole L; Lerman, Caryn; Tyndale, Rachel F; Schnoll, Robert

2017-12-01

While adherence to medication in smoking cessation clinical trials is strongly associated with clinical outcome, very few studies have evaluated the validity of pill count as a measure of adherence relative to a biological assay, and evaluated a broad range of correlates of adherence. In a smoking cessation clinical trial of varenicline, we compared pill counts collected over 4 different time periods to varenicline salivary levels taken after 2weeks of treatment, as well as evaluated predictors of adherence to varenicline. Using a binary measure of adherence based on salivary varenicline levels, adherence was higher among older, white, and more educated participants. Relative to 3, 7, and 14-day pill count, 12-week pill count was the only significant measure able to discriminate adherence as defined by salivary varenicline levels (assessed by area under the receiver operating characteristic curve; AUC=0.59, p=0.004). Seventy-two percent of participants who indicated adherence on 12-week pill count were classified as adherent based on varenicline saliva levels (sensitivity=0.80; specificity=0.40). There was modest variability in the relationship between 12-week pill count and varenicline levels across race and rate of nicotine metabolism. Lastly, General Estimating Equation models demonstrated that longitudinal changes in withdrawal, craving, negative and positive affect, and side effect count and severity were not related to adherence based on salivary varenicline levels. These results indicate that 12-week pill count was the best, albeit a relatively weak, measure of varenicline adherence; additional factors associated with treatment adherence need to be identified. Copyright © 2017 Elsevier Ltd. All rights reserved.

Adherence to antiretroviral treatment and associated factors in people living with HIV/AIDS in Quindío, Colombia

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Deisy Viviana Cardona-Duque; Oscar Adolfo Medina-Pérez; Sandra Milena Herrera-Castaño; Paula Andrea Orozco-Gómez

2017-01-01

Introduction: HIV/AIDS is a chronic disease; therefore, recognizing which factors favor adherence to antiretroviral treatment is necessary. Objective: To determine the association between adherence to antiretroviral treatment and depression, anxiety, perception of social support and sociodemographic variables in people living with HIV/AIDS in Quindío, Colombia. Materials and methods: An observational, cross-sectional study was performed in an intentional sample of 70 adults, who were ap...

The rate of adherence to urate-lowering therapy and associated factors in Chinese gout patients: a cross-sectional study.

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Yin, Rulan; Cao, Haixia; Fu, Ting; Zhang, Qiuxiang; Zhang, Lijuan; Li, Liren; Gu, Zhifeng

2017-07-01

The aim of this study was to assess adherence rate and predictors of non-adherence with urate-lowering therapy (ULT) in Chinese gout patients. A cross-sectional study was administered to 125 gout patients using the Compliance Questionnaire on Rheumatology (CQR) for adherence to ULT. Patients were asked to complete the Treatment Satisfaction Questionnaire for Medication version II, Health Assessment Questionnaire, Confidence in Gout Treatment Questionnaire, Gout Knowledge Questionnaire, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and 36-Item Short Form Health Survey. Data were analyzed by independent sample t test, rank sum test, Chi-square analysis as well as binary stepwise logistic regression modeling. The data showed that the rate of adherence (CQR ≥80%) to ULT was 9.6% in our investigated gout patients. Adherence was associated with functional capacity, gout-related knowledge, satisfaction with medication, confidence in gout treatment and mental components summary. Multivariable analysis of binary stepwise logistic regression identified gout-related knowledge and satisfaction of effectiveness with medication was the independent risk factors of medication non-adherence. Patients unaware of gout-related knowledge, or with low satisfaction of effectiveness with medication, were more likely not to adhere to ULT. Non-adherence to ULT among gout patients is exceedingly common, particularly in patients unaware of gout-related knowledge, or with low satisfaction of effectiveness with medication. These findings could help medical personnel develop useful interventions to improve gout patients' medication adherence.

Brazilian study on substance misuse in adolescents: associated factors and adherence to treatment

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Silva Vilma A da

2003-01-01

Full Text Available OBJECTIVES: To investigate developmental and environmental factors associated to substance misuse in adolescents seen at a university day-hospital in Brazil and to verify the correlations between those factors and adherence to treatment. To compare factors associated to substance misuse in adolescents with the available scientific literature and to suggest specific preventive interventions for a national policy in Brazil. METHODS: Eighty-six adolescent's guardians were evaluated at admission to the service by using a semistructured interview including sociodemographic data, family relationship, perinatal and pregnancy histories, psychomotor and educational development, social relations, history of previous illnesses and family diseases, including drug abuse. RESULTS: The sample was predominantly male (90%. Adolescents referred from the criminal justice were older than those originating from other sources (16.4 x 15.4 years old p=.00. Forty-four percent of adolescents reported school failure, a level which is two times higher than Brazilian statistics. Forty percent of the sample had criminal involvement, mainly drug dealing. Cannabis was the most prevalent reported drug. Living with both parents was protective, delaying the age of initiation by one year. Domestic violence was more frequent among parents with illicit drugs abuse (38.1% x 12.5%, p<.05. Alcoholism and drug addiction in parents and relatives were about four times higher than those reported for the Brazilian population. No correlation was found between the investigated factors and adherence to treatment. CONCLUSION: Our results indicate that the programs must include treatment of adults and education of parents and parents to be. Withdrawal of treatment occurs in the first month, and seems to be related to factors extrinsic to the adolescent.

Psychosocial and demographic predictors of adherence and non-adherence to health advice accompanying air quality warning systems: a systematic review.

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D'Antoni, Donatella; Smith, Louise; Auyeung, Vivian; Weinman, John

2017-09-22

Although evidence shows that poor air quality can harm human health, we have a limited understanding about the behavioural impact of air quality forecasts. Our aim was to understand to what extent air quality warning systems influence protective behaviours in the general public, and to identify the demographic and psychosocial factors associated with adherence and non-adherence to the health advice accompanying these warnings. In August 2016 literature was systematically reviewed to find studies assessing intended or actual adherence to health advice accompanying air quality warning systems, and encouraging people to reduce exposure to air pollution. Predictors of adherence to the health advice and/or self-reported reasons for adherence or non-adherence were also systematically reviewed. Studies were included only if they involved participants who were using or were aware of these warning systems. Studies investigating only protective behaviours due to subjective perception of bad air quality alone were excluded. The results were narratively synthesised and discussed within the COM-B theoretical framework. Twenty-one studies were included in the review: seventeen investigated actual adherence; three investigated intended adherence; one assessed both. Actual adherence to the advice to reduce or reschedule outdoor activities during poor air quality episodes ranged from 9.7% to 57% (Median = 31%), whereas adherence to a wider range of protective behaviours (e.g. avoiding busy roads, taking preventative medication) ranged from 17.7% to 98.1% (Median = 46%). Demographic factors did not consistently predict adherence. However, several psychosocial facilitators of adherence were identified. These include knowledge on where to check air quality indices, beliefs that one's symptoms were due to air pollution, perceived severity of air pollution, and receiving advice from health care professionals. Barriers to adherence included: lack of understanding of the indices

Adherence to oral and topical medication in 445 patients with tinea pedis as assessed by the Morisky Medication Adherence Scale-8.

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Tsunemi, Yuichiro; Abe, Shinya; Kobayashi, Miwa; Kitami, Yuki; Onozuka, Daisuke; Hagihara, Akihito; Takeuchi, Satoshi; Murota, Hiroyuki; Sugaya, Makoto; Masuda, Koji; Hiragun, Takaaki; Kaneko, Sakae; Saeki, Hidehisa; Shintani, Yoichi; Tanioka, Miki; Imafuku, Shinichi; Abe, Masatoshi; Inomata, Naoko; Morisky, Donald E; Furue, Masutaka; Katoh, Norito

2015-01-01

Adherence is defined as the extent to which a person's behavior corresponds with recommendations from health care providers. Adherence to treatment is an important factor for a good therapeutic outcome. This study aimed to examine the adherence of patients with tinea pedis and to clarify the factors related to it. We assessed medication adherence for oral and topical drugs using a translated version of the Morisky Medication Adherence Scale-8 (MMAS-8) together with other background factors in 445 Japanese patients with tinea pedis, using a questionnaire in a web-based monitoring system. Overall, high, medium and low adherence rates as assessed by MMAS-8 were 8.7%, 31.7% and 59.6% for oral medication, and 8.6%, 17.4% and 74.0% for topical medication, respectively. The adherence level was significantly higher for oral medication than for topical medication. Subgroup analyses showed that the adherence level for topical medication was significantly higher when topical and oral medications were used in combination than when topical medication was used alone. A low adherence level was shown in employed patients, those for whom their oral medication had not been effective and those with topical medication who had visited their hospital less often than once every six months. Patient adherence to therapy can be effectively improved by selecting highly effective medication while considering the prescription of topical and oral antifungal medications concomitantly, by carefully selecting a therapy plan for employed patients and by encouraging patients to visit their doctor regularly.

Airway delivery of soluble factors from plastic-adherent bone marrow cells prevents murine asthma.

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Ionescu, Lavinia I; Alphonse, Rajesh S; Arizmendi, Narcy; Morgan, Beverly; Abel, Melanie; Eaton, Farah; Duszyk, Marek; Vliagoftis, Harissios; Aprahamian, Tamar R; Walsh, Kenneth; Thébaud, Bernard

2012-02-01

Asthma affects an estimated 300 million people worldwide and accounts for 1 of 250 deaths and 15 million disability-adjusted life years lost annually. Plastic-adherent bone marrow-derived cell (BMC) administration holds therapeutic promise in regenerative medicine. However, given the low cell engraftment in target organs, including the lung, cell replacement cannot solely account for the reported therapeutic benefits. This suggests that BMCs may act by secreting soluble factors. BMCs also possess antiinflammatory and immunomodulatory properties and may therefore be beneficial for asthma. Our objective was to investigate the therapeutic potential of BMC-secreted factors in murine asthma. In a model of acute and chronic asthma, intranasal instillation of BMC conditioned medium (CdM) prevented airway hyperresponsiveness (AHR) and inflammation. In the chronic asthma model, CdM prevented airway smooth muscle thickening and peribronchial inflammation while restoring blunted salbutamol-induced bronchodilation. CdM reduced lung levels of the T(H)2 inflammatory cytokines IL-4 and IL-13 and increased levels of IL-10. CdM up-regulated an IL-10-induced and IL-10-secreting subset of T regulatory lymphocytes and promoted IL-10 expression by lung macrophages. Adiponectin (APN), an antiinflammatory adipokine found in CdM, prevented AHR, airway smooth muscle thickening, and peribronchial inflammation, whereas the effect of CdM in which APN was neutralized or from APN knock-out mice was attenuated compared with wild-type CdM. Our study provides evidence that BMC-derived soluble factors prevent murine asthma and suggests APN as one of the protective factors. Further identification of BMC-derived factors may hold promise for novel approaches in the treatment of asthma.

Medication adherence in inflammatory bowel disease

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Webber Chan

2017-10-01

Full Text Available Inflammatory bowel disease (IBD is a chronic idiopathic inflammatory condition with intestinal and extraintestinal manifestations. Medications are the cornerstone of treatment of IBD. However, patients often adhere to medication poorly. Adherence to medications is defined as the process by which patients take their medications as prescribed. Treatment non-adherence is a common problem among chronic diseases, averaging 50% in developed countries and is even poorer in developing countries. In this review, we will examine the adherence data in IBD which vary greatly depending on the study population, route of administration, and methods of adherence measurement used. We will also discuss the adverse clinical outcomes related to non-adherence to medical treatment including increased disease activity, flares, loss of response to anti-tumor necrosis factor therapy, and so forth. There are many methods to measure medication adherence namely direct and indirect methods, each with their advantages and drawbacks. Finally, we will explore different intervention strategies to improve adherence to medications.

Stroke and TIA survivors’ cognitive beliefs and affective responses regarding treatment and future stroke risk differentially predict medication adherence and categorised stroke risk

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Phillips, L. Alison; Diefenbach, Michael A.; Abrams, Jessica; Horowitz, Carol R.

2014-01-01

Cognitive beliefs and affective responses to illness and treatment are known to independently predict health behaviours. The purpose of the current study is to assess the relative importance of four psychological domains – specifically, affective illness, cognitive illness, affective treatment and cognitive treatment – for predicting stroke and transient ischemic attack (TIA) survivors’ adherence to stroke prevention medications as well as their objective, categorised stroke risk. We assessed...

Factors associated to adherence to different treatment schemes with meglumine antimoniate in a clinical trial for cutaneous leishmaniasis.

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Ribeiro, Madelon Novato; Pimentel, Maria Inês Fernandes; Schubach, Armando de Oliveira; Oliveira, Raquel de Vasconcellos Carvalhães de; Teixeira, José Liporage; Leite, Madson Pedro da Silva; Fonseca, Monique; Santos, Ginelza Peres Lima dos; Salgueiro, Mariza Matos; Ferreira e Vasconcellos, Erica de Camargo; Lyra, Marcelo Rosandiski; Saheki, Mauricio Naoto; Valete-Rosalino, Claudia Maria

2014-01-01

The favorable outcome of the treatment of a disease is influenced by the adherence to therapy. Our objective was to assess factors associated with adherence to treatment of patients included in a clinical trial of equivalence between the standard and alternative treatment schemes with meglumine antimoniate (MA) in the treatment of cutaneous leishmaniasis (CL), in the state of Rio de Janeiro. Between 2008 and 2011, 57 patients with CL were interviewed using a questionnaire to collect socioeconomic data. The following methods were used for adherence monitoring: counting of vial surplus, monitoring card, Morisky test and modified Morisky test (without the question regarding the schedule); we observed 82.1% (vial return), 86.0% (monitoring card), 66.7% (Morisky test) and 86.0% (modified Morisky test) adherence. There was a strong correlation between the method of vial counting and the monitoring card and modified Morisky test. A significant association was observed between greater adherence to treatment and low dose of MA, as well as with a lower number of people sleeping in the same room. We recommend the use of the modified Morisky test to assess adherence to treatment of CL with MA, because it is a simple method and with a good performance, when compared to other methods.

FACTORS ASSOCIATED TO ADHERENCE TO DIFFERENT TREATMENT SCHEMES WITH MEGLUMINE ANTIMONIATE IN A CLINICAL TRIAL FOR CUTANEOUS LEISHMANIASIS

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Madelon Novato Ribeiro

2014-07-01

Full Text Available The favorable outcome of the treatment of a disease is influenced by the adherence to therapy. Our objective was to assess factors associated with adherence to treatment of patients included in a clinical trial of equivalence between the standard and alternative treatment schemes with meglumine antimoniate (MA in the treatment of cutaneous leishmaniasis (CL, in the state of Rio de Janeiro. Between 2008 and 2011, 57 patients with CL were interviewed using a questionnaire to collect socioeconomic data. The following methods were used for adherence monitoring: counting of vial surplus, monitoring card, Morisky test and modified Morisky test (without the question regarding the schedule; we observed 82.1% (vial return, 86.0% (monitoring card, 66.7% (Morisky test and 86.0% (modified Morisky test adherence. There was a strong correlation between the method of vial counting and the monitoring card and modified Morisky test. A significant association was observed between greater adherence to treatment and low dose of MA, as well as with a lower number of people sleeping in the same room. We recommend the use of the modified Morisky test to assess adherence to treatment of CL with MA, because it is a simple method and with a good performance, when compared to other methods.

Effect of medication-related factors on adherence in people with schizophrenia: a European multi-centre study

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Meier, Johanna; Becker, Thomas; Patel, Anita; Robson, Debbie; Schene, Aart; Kikkert, Martijn; Barbui, Corrado; Burti, Lorenzo; Puschner, Bernd

2010-01-01

To investigate the relation between medication-related factors and adherence in people with schizophrenia in outpatient treatment. The sample comprised 409 outpatients (ICD-10 diagnosis of schizophrenia) with clinician-rated instability in four European cities (Amsterdam, The Netherlands; Verona,

Predictors and outcomes of non-adherence in patients receiving maintenance hemodialysis.

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Tohme, Fadi; Mor, Maria K; Pena-Polanco, Julio; Green, Jamie A; Fine, Michael J; Palevsky, Paul M; Weisbord, Steven D

2017-08-01

Predictors of and outcomes associated with non-adherent behavior among patients on chronic hemodialysis (HD) have been incompletely elucidated. We conducted a post hoc analysis of data from the SMILE trial to identify patient factors associated with non-adherence to dialysis-related treatments and the associations of non-adherence with clinical outcomes. We defined non-adherence as missed HD and abbreviated HD. We used negative binomial regression to model the associations of demographic and clinical factors with measures of non-adherence, and negative binomial and Cox regression to analyze the associations of non-adherence with hospitalizations and mortality, respectively. We followed 286 patients for up to 24 months. Factors independently associated with missing HD included Tuesday/Thursday/Saturday HD schedule [incident rate ratio (IRR) 1.85, p adherence to HD-related treatments, and independent associations of non-adherence with hospitalization and mortality. These findings should inform the development and implementation of interventions to improve adherence and reduce health resource utilization.

Influence of intention to adhere, beliefs and satisfaction about medicines on adherence in solid organ transplant recipients.

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Hugon, Amélie; Roustit, Matthieu; Lehmann, Audrey; Saint-Raymond, Christel; Borrel, Elisabeth; Hilleret, Marie-Noëlle; Malvezzi, Paolo; Bedouch, Pierrick; Pansu, Pascal; Allenet, Benoît

2014-07-27

Nonadherence to immunosuppressive (IS) therapy is associated with poor outcomes. Identifying factors predicting poor adherence is therefore essential. The primary objective of this study was to test whether parameters of a model adapted from the theory of planned behavior, and more specifically attitudes that are influenced by beliefs and satisfaction with medication, could predict adherence in solid organ transplant patients. Adherence was assessed with a self-reported medication adherence scale and IS blood trough concentrations over 6 months, in four transplant units. Satisfaction and beliefs were assessed using the Treatment Satisfaction with Medicines Questionnaire (SATMED-Q) and Beliefs about Medicines Questionnaire (BMQ), respectively. Theory of planned behavior was assessed with a specific questionnaire exploring intentions, subjective norms, attitudes and perceived behavioral control. Treatment characteristics and socioeconomic data were also collected. One hundred and fifty-three solid organ transplant patients were enrolled, including lung (n=33), heart (n=43), liver (n=42), and kidney (n=44) patients. Satisfaction and positive beliefs about medication were higher in adherent than those in nonadherent patients. Factors independently associated with an increased risk of nonadherence were negative general beliefs about medications (odds ratio [OR]=0.89 [0.83-0.97]), living alone (OR=2.78 [1.09-7.09]), heart transplantation (OR=3.49 [1.34-9.09]), and being on everolimus (OR=5.02 [1.21-20.8]). Negative beliefs toward medications were shown to be an independent risk factor of poor adherence. Therefore, the BMQ could be an effective, easy to implement tool, for use in everyday practice, to identify patients needing interventions to improve adherence to IS.

Interrelation and independence of positive and negative psychological constructs in predicting general treatment adherence in coronary artery patients - Results from the THORESCI study.

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van Montfort, Eveline; Denollet, Johan; Widdershoven, Jos; Kupper, Nina

2016-09-01

In cardiac patients, positive psychological factors have been associated with improved medical and psychological outcomes. The current study examined the interrelation between and independence of multiple positive and negative psychological constructs. Furthermore, the potential added predictive value of positive psychological functioning regarding the prediction of patients' treatment adherence and participation in cardiac rehabilitation (CR) was investigated. 409 percutaneous coronary intervention (PCI) patients were included (mean age = 65.6 ± 9.5; 78% male). Self-report questionnaires were administered one month post-PCI. Positive psychological constructs included positive affect (GMS) and optimism (LOT-R); negative constructs were depression (PHQ-9, BDI), anxiety (GAD-7) and negative affect (GMS). Six months post-PCI self-reported general adherence (MOS) and CR participation were determined. Factor Analysis (Oblimin rotation) revealed two components (r = − 0.56), reflecting positive and negative psychological constructs. Linear regression analyses showed that in unadjusted analyses both optimism and positive affect were associated with better general treatment adherence at six months (p psychological constructs (i.e. optimism) may be of incremental value to negative psychological constructs in predicting patients' treatment adherence. A more complete view of a patients' psychological functioning will open new avenues for treatment. Additional research is needed to investigate the relationship between positive psychological factors and other cardiac outcomes, such as cardiac events and mortality.

Bio-social factors and perceptions of life with quality: a challenge to the adherence of h i v patients to the antirretroviral treatment

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John Harold Estrada M

2008-06-01

Full Text Available In spite that antirretroviral therapy has contributed to improve life quality among people living with h i v, adherence to the treatment still persists as a major obstacle for therapeutic success. In order to assess the biosocial factors that contributes to adherence to this therapy by people with h i v. In order to evaluate the bio-social aspects that facilitate or obstruct the adherence to the treatment, a qualitative study combining ethnographic research, a hermeneutic approach to narratives, and a situational analysis of life experiences of people living with h i v in Colombia. Two theoretical categories were applied throughout the study: Victoria Camps’ life with quality and Saussure’s auto- and hetero-perception. All of the ten people who took part in the study were male patients who were attending an integral oral health program. The main factors that obstruct the adherence to the therapy were the following: 1 the discourse of the medical team loaded with biomedical jargon; 2 the dosages and side effects of the medications used in Colombia; 3 negative attitudes linked to a poor selfimage, a low social capital, and a low self-esteem; 4 low expectations in regards to a life with quality accompanied by the therapy. Among the factors that promote adherence the following were identified: 1 intra- and inter-personal negotiation processes based on the h i v serum status and the treatment; 2 knowledge about those negotiations by family members, friends, coworkers, and sentimental partners; 3 a positive perception of improvement in life quality while in treatment; 4 expectations of a life with quality depending on the adherence. Nevertheless, it was also found that those factors that contribute or impede adherence change rapidly and produce swinging in the person’s mood. This mood is here understood as a complex feeling concerning life with quality in constant change, both merging individual and social aspects implied in the experience of

Risk factors for suboptimal antiretroviral therapy adherence in HIV-infected adolescents in Gaborone, Botswana: a pilot cross-sectional study

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Ndiaye M

2013-09-01

Full Text Available Maimouna Ndiaye,1,2 Peter Nyasulu,1 Hoang Nguyen,6,7 Elizabeth D Lowenthal,8,9 Robert Gross,10 Edward J Mills,3 Jean B Nachega4–6 1School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; 2Central Medical Stores, Ministry of Health, Gaborone, Botswana; 3Faculty of Health Sciences, University of Ottawa, Ottawa, Canada; 4Department of Medicine and Centre for Infectious Diseases, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; 5Department of Epidemiology, Infectious Disease Epidemiology Research Program, Pittsburgh University Graduate School of Public Health, Pittsburgh, PA, USA; 6Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; 7Tay Ho Clinics, Department of Medicine, Hanoi Health Services, Hanoi, Vietnam; 8Departments of Pediatrics and Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; 9Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA, USA; 10Departments of Medicine and Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA Objective: Little is known about factors associated with suboptimal antiretroviral treatment (ART adherence among adolescents in Sub-Saharan Africa. Our objective was to determine the level of ART adherence and predictors of non-adherence among human immunodeficiency virus (HIV-infected adolescents at the Botswana-Baylor Children's Clinical Centre of Excellence in Gaborone, Botswana. Methods: In a cross-sectional study, 82 HIV-infected adolescents receiving ART and their caregivers were administered a structured questionnaire. The patient's clinical information was retrieved from medical records. Outcome measures included excellent pill count ART adherence (>95% and virologic suppression

The Role of Theory in Increasing Adherence to Prescribed Practice

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Richardson, Julie; Wishart, Laurie; Hanna, Steven

2009-01-01

ABSTRACT Purpose: The purpose of this article is to apply theoretical frameworks to adherence behaviour and to guide the development of an intervention to increase adherence to prescribed home programmes. Summary of Key Points: Delivering an effective intervention requires establishing one that is evidence based and of adequate dosage. Two-thirds of patients who receive home exercise prescriptions do not adhere to their home programme, which may contribute to their physiotherapy's being ineffective. The mediating concepts of self-efficacy (SE) and outcome expectations (OE) are common to the five relevant theories used to explain adherence to exercise: the health belief model, protection motivation theory, theory of reasoned action, theory of planned behaviour, and social cognitive theory. Conclusion/Recommendations: Few intervention studies with any theoretical underpinning have examined adherence to exercise. Even fewer have been designed to affect and measure change in the theoretical mediators of SE and OE in patient populations. Physiotherapists must consider increasing adherence as a component of effective physiotherapy. Ongoing research is needed to increase our understanding of adherence to prescribed home programmes and to design interventions to affect theoretical mediators for increasing adherence. PMID:20190989

Socioeconomic factors explain suboptimal adherence to antiretroviral therapy among HIV-infected Australian adults with viral suppression.

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Krista J Siefried

Full Text Available Missing more than one tablet of contemporary antiretroviral therapy (ART per month increases the risk of virological failure. Recent studies evaluating a comprehensive range of potential risk factors for suboptimal adherence are not available for high-income settings.Adults on ART with undetectable viral load (UDVL were recruited into a national, multi-centre cohort, completing a comprehensive survey assessing demographics, socio-economic indicators, physical health, well-being, life stressors, social supports, HIV disclosure, HIV-related stigma and discrimination, healthcare access, ART regimen, adherence, side effects, costs and treatment beliefs. Baseline data were assessed, and suboptimal adherence was defined as self-reported missing ≥1 ART dose/month over the previous 3-months; associated factors were identified using bivariate and multivariate binary logistic regression.We assessed 522 participants (494 [94.5%] men, mean age = 50.8 years, median duration UDVL = 3.3 years [IQR = 1.2-6.8] at 17 sexual health, hospital, and general practice clinics across Australia. Seventy-eight participants (14.9% reported missing ≥1 dose/month over the previous three months, which was independently associated with: being Australian-born (AOR [adjusted odds ratio] = 2.4 [95%CI = 1.2-4.9], p = 0.014, not being in a relationship (AOR = 3.3 [95%CI = 1.5-7.3], p = 0.004, reaching the "Medicare safety net" (capping annual medical/pharmaceutical costs (AOR = 2.2 [95%CI = 1.1-4.5], p = 0.024, living in subsidised housing (AOR = 2.5 [95%CI = 1.0-6.2], p = 0.045, receiving home-care services (AOR = 4.4 [95%CI = 1.0-18.8], p = 0.046, HIV community/outreach services linkage (AOR = 2.4 [95%CI = 1.1-5.4], p = 0.033, and starting ART following self-request (AOR = 3.0 [95%CI = 1.3-7.0], p = 0.012.In this population, 15% reported recent suboptimal ART adherence at levels associated in prospective studies with subsequent virological failure, despite all having an

Adjuvant endocrine therapy after breast cancer: a qualitative study of factors associated with adherence

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Brett J

2018-02-01

Full Text Available Jo Brett,1 Mary Boulton,1 Debbie Fenlon,2 Nick J Hulbert-Williams,3 Fiona M Walter,4 Peter Donnelly,5 Bernadette A Lavery,6 Adrienne Morgan,7 Carolyn Morris,7 Eila K Watson1 1Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, 2College of Human and Health Sciences, Swansea University, Swansea, Wales, 3Department of Psychology, Chester Research Unit for the Psychology of Health, University of Chester, Chester, 4Department of Public Health and Primary Care, University of Cambridge, Cambridge, 5South Devon Healthcare NHS Foundation Trust, Torbay Hospital, Torquay, 6Cancer Services, Oxford University Hospitals Foundation NHS Trust, Oxford, 7Independent Cancer Patients’ Voice, London, UK Introduction: Despite evidence of the efficacy of adjuvant endocrine therapy (AET in reducing the risk of recurrence and mortality after treatment for primary breast cancer, adherence to AET is suboptimal. This study aimed to explore factors that influence adherence and nonadherence to AET following breast cancer to inform the development of supportive interventions.Methods: Interviews were conducted with 32 women who had been prescribed AET, 2–4 years following their diagnosis of breast cancer. Both adherers (n=19 and nonadherers (n=13 were recruited. The analysis was conducted using the Framework approach.Results: Factors associated with adherence were as follows: managing side effects including information and advice on side effects and taking control of side effects, supportive relationships, and personal influences. Factors associated with nonadherence were as follows: burden of side effects, feeling unsupported, concerns about long-term AET use, regaining normality, including valuing the quality of life over length of life, and risk perception.Conclusion: Provision of timely information to prepare women for the potential side effects of AET and education on medication management strategies are needed, including provision of timely and

Medication Adherence After Renal Transplantation-a Review of the Literature.

Science.gov (United States)

Rebafka, Anne

2016-12-01

Whether or not patients follow the advice given by their healthcare professional is commonly referred to as adherence. In the case of kidney transplantation, transplant recipients need to take immunosuppressive drugs on a regular basis to prevent rejection of their transplant. However, medication adherence can be problematic for many patients. This critical appraisal of evidence aimed to gain insights into factors contributing to adherence and non-adherence in recipients of kidney transplants, and to explore patients' perceptions regarding adherence to immunosuppression. A comprehensive literature search was performed using Medline, PsycInfo, the Joanna Briggs Institute, CINAHL and the Cochrane Library. Included were primary research studies or reviews of primary research, independent of their research paradigms, on adult kidney or kidney/pancreas transplant recipients published in English or German. Children or adolescents were not considered. No time-frame was applied RESULTS: Fifty-two papers were included in the review. All extracted findings of included papers were organised according to the five factors influencing medication-taking behaviour as defined by the World Health Organisation: social and economic factors; therapy-related factors; patient-related factors; condition-related factors; healthcare team and system-related factors. Reasons for non-adherence after kidney transplantations are diverse. Attention is attracted by the fact that potentially modifiable factors such as social support, experiences on dialysis, side effects, features of the treatment regimen, intentions and beliefs, forgetfulness and mental health issues play a greater role than other factors in the development of medication non-adherence. Factors not related to patient characteristics seem to be under researched. © 2016 European Dialysis and Transplant Nurses Association/European Renal Care Association.

The combined impact of adherence to five lifestyle factors on all-cause, cancer and cardiovascular mortality

DEFF Research Database (Denmark)

Petersen, Kristina E N; Johnsen, Nina F; Olsen, Anja

2015-01-01

guidelines into account. The objective of the present prospective cohort study was to investigate the combined impact of adherence to five lifestyle factors (smoking, alcohol intake, physical activity, waist circumference and diet) on all-cause, cancer and cardiovascular mortality based on international...

Socioeconomic factors explain suboptimal adherence to antiretroviral therapy among HIV-infected Australian adults with viral suppression

NARCIS (Netherlands)

Siefried, Krista J; Mao, Limin; Kerr, Stephen; Cysique, Lucette A; Gates, Thomas M; McAllister, John; Maynard, Anthony; de Wit, John; Carr, Andrew

2017-01-01

BACKGROUND: Missing more than one tablet of contemporary antiretroviral therapy (ART) per month increases the risk of virological failure. Recent studies evaluating a comprehensive range of potential risk factors for suboptimal adherence are not available for high-income settings. METHODS: Adults on

Predictors of Vitamin Adherence After Bariatric Surgery.

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Sunil, Supreet; Santiago, Vincent A; Gougeon, Lorraine; Warwick, Katie; Okrainec, Allan; Hawa, Raed; Sockalingam, Sanjeev

2017-02-01

Vitamin supplementation in bariatric aftercare is essential to prevent nutrient deficiencies; however, rates of vitamin adherence have been as low as 30 % 6 months post-surgery. Preliminary literature suggests non-adherence to prescribed treatments can be linked to demographic and psychological factors. We aimed to determine the relationship between these factors to vitamin adherence in post-bariatric surgery patients. A total of 92 bariatric patients were assessed 6 months post-surgery. Patients were administered a questionnaire collecting demographic information, psychological scores, and self-reported adherence. Nutrient deficiencies were analyzed through serum vitamin levels measured 3 and 6 months after surgery. Wilcoxon rank-sum and chi-square tests were used for analysis. Non-adherence was associated with male sex and full-time employment (p = 0.027, p = 0.015). There were no differences with respect to living situation, education level, or relationship type. Non-adherent patients did not have significantly higher scores for generalized anxiety, depressive symptoms, or avoidant behaviors. However, non-adherent patients displayed greater attachment anxiety than their adherent counterparts (p = 0.0186). Non-adherence was also associated with lower vitamin B12 levels 6 months post-surgery (p = 0.001). Male gender and full-time work have previously been shown to be associated with non-adherence. This is the first study to demonstrate that attachment anxiety is associated with poor multivitamin adherence in the post-surgical bariatric population. This result is concordant with recent literature that has demonstrated attachment anxiety is associated with poor adherence to dietary recommendations in bariatric patients 6 months postoperatively. Presurgical screening for attachment anxiety could facilitate early interventions to promote better bariatric aftercare in this group.

Factors associated with adherence to antiretroviral therapy in HIV/AIDS patients: a cross-sectional study in Southern Brazil

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C.A.T. Pinheiro

2002-10-01

Full Text Available A cross-sectional study was conducted on HIV-infected adults being treated with antiretroviral drugs at a reference service in Southern Brazil. Participants answered a sociodemographic questionnaire and were tested by scales assessing sociocognitive variables. Adherence to treatment was assessed by a self-report inventory developed for the study. Clinical information was obtained from the patients' records. Significance tests were conducted using univariate logistic regressions followed by multivariate logistic regression analysis. A total of 195 patients participated in the study and 56.9% of them reported > or = 95% adherence on the previous two days. In univariate analysis, the odds of adherence increased with self-efficacy (a person's conviction that he/she can successfully execute the behavior required to produce a certain desired outcome in taking medications as prescribed (OR = 3.50, 95% CI 1.90-6.55, and decreased with perception of negative affect and physical concerns (OR = 0.71, 95% CI 0.53-0.95. The odds were lower for taking antiretroviral medications >4 times a day (OR = 0.44, 95% CI 0.20-0.94 and higher for patients with 8 years of schooling (OR = 2.28, 95% CI 1.12-4.66. In the multivariate analysis, self-efficacy (OR = 3.33, 95% CI 1.69-6.56 and taking medication >4 times a day (OR = 0.34, 95% CI 0.14-0.80 were independently associated with adherence. Self-efficacy was the most important predictor of adherence, followed by number of times antiretroviral medication was taken per day. Among sociodemographic and clinical variables, only the number of years of schooling was associated with adherence. Motivational interventions based on self-efficacy may be useful for increasing treatment adherence.

Factors Affecting University Library Website Design

OpenAIRE

Kim, Yongi-Mi; University of Oklahoma

2011-01-01

Existing studies have extensively explored factors that affect users’ intentions to use university library website resources (ULWR); yet little attention has been given to factors affecting university library website design. This paper investigates factors that affect university library website design and assesses the success of the university library website from both designers’ and users’ perspectives. The findings show that when planning a website, university web designers consider univers...

Conceptualisations of masculinity and self-reported medication adherence among HIV-positive Latino men in Los Angeles, California, USA.

Science.gov (United States)

Galvan, Frank H; Bogart, Laura M; Wagner, Glenn J; Klein, David J; Chen, Ying-Tung

2014-06-01

HIV-positive Latino men have been found to have poorer medication adherence compared to Whites. This study sought to identify how cultural conceptualisations of masculinity are associated with self-reported medication adherence among Latino men. A total of 208 HIV-positive men reported the number of doses of antiretroviral medication missed in the previous seven days (dichotomised at 100% adherence versus less). Conceptualisations of masculinity consisted of traditional machismo (e.g., power and aggressive attitudes, which are normally associated with negative stereotypes of machismo) and caballerismo (e.g., fairness, respect for elders and the importance of family). Multivariate logistic regression was used to identify factors associated with adherence. The mean adherence was 97% (SD = 6.5%; range = 57-100%). In all, 77% of the participants reported 100% adherence in the previous seven days. Caballerismo was associated with a greater likelihood (OR = 1.77; 95% CI: 1.08-2.92; p = 0.03) and machismo with a lower likelihood (OR = 0.60; 95% CI: 0.38-0.95; p = 0.03) of medication adherence. In addition, higher medication side-effects were found to be associated with a lower likelihood (OR = 0.59; 95% CI: 0.43-0.81; p = 0.001) of medication adherence. These findings reinforce the importance of identifying cultural factors that may affect medication adherence among HIV-positive Latino men resident in the USA.

Factors predicting adherence with psychiatric follow-up appointments for patients assessed by the liaison psychiatric team in the emergency department.

LENUS (Irish Health Repository)

Agyapong, Vincent I O

2010-01-01

Several factors may predict adherence with psychiatric follow-up appointment for patients seen in the emergency department (ED) by liaison psychiatric teams. Awareness of these factors would allow for interventions targeted at vulnerable groups.

Medication adherence to oral iron therapy in patients with iron deficiency anemia.

Science.gov (United States)

Gereklioglu, Cigdem; Asma, Suheyl; Korur, Asli; Erdogan, Ferit; Kut, Altug

2016-01-01

This study aimed at investigating the factors affecting medication adherence in patients who use oral iron therapy due to iron deficiency anemia. A total of 96 female patients in fertile age with mean age of 30±10.1 years (range 18-53) who were admitted to Family Medicine Clinic between 01 January and 31 March 2015 and who had received iron therapy within the recent three years were enrolled in the study. Data were collected through a questionnaire form. Of the patients, 39 (40,6%) were detected not to use the medication regularly or during the recommended period. A statistically significant relationship was found between non-adherence to therapy and gastrointestinal side effects and weight gain (p<0.05). Medication adherence is deficient in patients with iron deficiency anemia. The most important reason for this seems gastrointestinal side effects, in addition to weight gain under treatment.

Barriers and facilitators to paediatric adherence to antiretroviral therapy in rural South Africa: a multi-stakeholder perspective.

Science.gov (United States)

Coetzee, Bronwyne; Kagee, Ashraf; Bland, Ruth

2015-01-01

Poor adherence to antiretroviral therapy (ART) contributes to the development of drug resistance. HIV-infected children, especially those 5 years and under, are dependent on a caregiver to adhere to ART. However, characteristics of the caregiver, child, regimen, clinic and social context affect clinic attendance and medication-taking, both of which constitute adherent behaviour. We conducted nine interviews and three focus groups to determine how doctors, nurses, counsellors, traditional healers and caregivers understood the barriers and facilitators to ART adherence among children residing in rural South Africa. The data were transcribed, translated into English from isiZulu where necessary, and coded using Atlas.ti version 7. Results were interpreted through the lens of Bronfenbrenner's Ecological Systems Theory. We found that at the micro-level, palatability of medication and large volumes of medication were problematic for young children. Characteristics of the caregiver including absent mothers, grandmothers as caregivers and denial of HIV amongst fathers were themes related to the micro-system. Language barriers and inconsistent attendance of caregivers to monthly clinic visits were factors affecting adherence in the meso-system. Adherence counselling and training were the most problematic features in the exo-system. In the macro-system, the effects of food insecurity and the controversy surrounding the use of traditional medicines were most salient. Increased supervision and regular training amongst lay adherence counsellors are needed, as well as regular monitoring of the persons attending the clinic on the child's behalf.

Optimizing Patient Management and Adherence for Children Receiving Growth Hormone.

Science.gov (United States)

Acerini, Carlo L; Wac, Katarzyna; Bang, Peter; Lehwalder, Dagmar

2017-01-01

Poor adherence with growth hormone (GH) therapy has been associated with worse clinical outcomes, which in children relates specifically to their linear growth and loss of quality of life. The "360° GH in Europe" meeting, held in Lisbon, Portugal, in June 2016 and funded by Merck KGaA (Germany), examined many aspects of GH diseases. The three sessions, entitled " Short Stature Diagnosis and Referral ," " Optimizing Patient Management ," and " Managing Transition ," each benefited from three guest speaker presentations, followed by an open discussion and are reported as a manuscript, authored by the speakers. Reported here is a summary of the proceedings of the second session, which reviewed the determinants of GH therapy response, factors affecting GH therapy adherence and the development of innovative technologies to improve GH treatment in children. Response to GH therapy varies widely, particularly in regard to the underlying diagnosis, although there is little consensus on the definition of a poor response. If the growth response is seen to be less than expected, the possible reasons should be discussed with patients and their parents, including compliance with the therapy regimen. Understanding and addressing the multiple factors that influence adherence, in order to optimize GH therapy, requires a multi-disciplinary approach. Because therapy continues over many years, various healthcare professionals will be involved at different periods of the patient's journey. The role of the injection device for GH therapy, frequent monitoring of response, and patient support are all important for maintaining adherence. New injection devices are incorporating electronic technologies for automated monitoring and recording of clinically relevant information on injections. Study results are indicating that such devices can at least maintain GH adherence; however, acceptance of novel devices needs to be assessed and there remains an on-going need for innovations.

Optimizing Patient Management and Adherence for Children Receiving Growth Hormone

Directory of Open Access Journals (Sweden)

Carlo L. Acerini

2017-11-01

Full Text Available Poor adherence with growth hormone (GH therapy has been associated with worse clinical outcomes, which in children relates specifically to their linear growth and loss of quality of life. The “360° GH in Europe” meeting, held in Lisbon, Portugal, in June 2016 and funded by Merck KGaA (Germany, examined many aspects of GH diseases. The three sessions, entitled “Short Stature Diagnosis and Referral,” “Optimizing Patient Management,” and “Managing Transition,” each benefited from three guest speaker presentations, followed by an open discussion and are reported as a manuscript, authored by the speakers. Reported here is a summary of the proceedings of the second session, which reviewed the determinants of GH therapy response, factors affecting GH therapy adherence and the development of innovative technologies to improve GH treatment in children. Response to GH therapy varies widely, particularly in regard to the underlying diagnosis, although there is little consensus on the definition of a poor response. If the growth response is seen to be less than expected, the possible reasons should be discussed with patients and their parents, including compliance with the therapy regimen. Understanding and addressing the multiple factors that influence adherence, in order to optimize GH therapy, requires a multi-disciplinary approach. Because therapy continues over many years, various healthcare professionals will be involved at different periods of the patient’s journey. The role of the injection device for GH therapy, frequent monitoring of response, and patient support are all important for maintaining adherence. New injection devices are incorporating electronic technologies for automated monitoring and recording of clinically relevant information on injections. Study results are indicating that such devices can at least maintain GH adherence; however, acceptance of novel devices needs to be assessed and there remains an on

Social networks and treatment adherence among Latino offenders with mental illness.

Science.gov (United States)

Eno Louden, Jennifer; Manchak, Sarah M

2018-02-01

Mental health treatment adherence is often required for offenders with mental illness supervised on probation and parole. However, research on offenders with mental illness has largely overlooked cultural and ethnic responsivity factors that may affect adherence to treatment. Latinos are a quickly growing subgroup of offenders whose social networks differ in meaningful ways from European Americans' (e.g., size, composition, centrality of family). Social networks are known to relate to both clinical and criminal justice outcomes for offenders with mental illness, and there are features of nonoffender Latinos' social networks that suggest that findings distilled from work with non-Latino offenders may not apply to them. The present study examined the social networks of 86 Latino probationers with serious mental illness to (a) describe the size and composition of these networks and (b) to determine which factors of social networks are related to treatment adherence. The authors found that Latino offenders' social networks are small (∼6 individuals), consisting primarily of family and professionals such as treatment providers and probation officers. Supportive relationships with nonprofessionals and treatment providers was related to lower likelihood of missing treatment appointments, whereas social control and pressure from family and friends to attend treatment was not related to treatment adherence. Findings are discussed within the context of improved practices for community corrections and mental health agencies in working with Latino offenders with mental illness. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Adherence to antiretroviral therapy and treatment outcomes among conflict-affected and forcibly displaced populations: a systematic review

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Mendelsohn Joshua B

2012-10-01

Full Text Available Abstract Background Optimal adherence to highly active antiretroviral therapy (HAART is required to promote viral suppression and to prevent disease progression and mortality. Forcibly displaced and conflict-affected populations may face challenges succeeding on HAART. We performed a systematic review of the literature on adherence to HAART and treatment outcomes in these groups, including refugees and internally-displaced persons (IDPs, assessed the quality of the evidence and suggest a future research program. Methods Medline, Embase, and Global Health databases for 1995–2011 were searched using the Ovid platform. A backward citation review of subsequent work that had cited the Ovid results was performed using the Web of Science database. ReliefWeb and Médecins Sans Frontières (MSF websites were searched for additional grey literature. Results and conclusion We screened 297 records and identified 17 reports covering 15 quantitative and two qualitative studies from 13 countries. Three-quarters (11/15 of the quantitative studies were retrospective studies based on chart review; five studies included

Improving medication adherence of patients with chronic heart failure: challenges and solutions

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Shah D

2015-07-01

Full Text Available Deval Shah,1 Kim Simms,2 Debra J Barksdale,3 Jia-Rong Wu3 1Internal Medicine, Wake Forest Baptist Hospital, Winston-Salem, 2Duke University Hospital, Durham, 3School of Nursing, University of North Carolina, Chapel Hill, NC, USA Abstract: Heart failure is a chronic debilitating illness that affects 5.7 million Americans. The financial burden of heart failure in the US toppled $31 billion in 2012, which is one of the highest among all chronic medical conditions. Medication adherence is a major component of heart failure self-care behaviors. Therefore, medication non-adherence is associated with more emergency department visits, frequent rehospitalizations, and higher medical cost. Medication adherence rates have varied from 10% to 98% depending on the definition and measurement used to assess and analyze adherence. Many factors contribute to medication non-adherence such as lack of support, finances, absent of symptoms, cognitive decline, adverse reactions, depression, poor attention span, poor knowledge about medication, multiple medications, difficulty swallowing large pills, and inconveniences of urinary frequency with diuretics. Researchers have explored various strategies such as the use of pharmacists, nurses, telemedicine, and interdisciplinary teams to provide interventions to improve medication adherence in heart failure. Health care providers should continue to provide education, constantly reinforce the importance of taking medication as prescribed, and when feasible, utilize one of the successful evidence-based strategies to increase adherence. Keywords: pharmacy, tele-health, interdisciplinary, registered nurse, interventions

Non-adherence to topical treatments for actinic keratosis

Directory of Open Access Journals (Sweden)

Shergill B

2013-12-01

Full Text Available Bav Shergill,1 Simon Zokaie,2 Alison J Carr3 1Department of Dermatology, Brighton and Sussex University Hospitals, Elm Grove, Brighton, UK; 2Leo Pharma, Princes Risborough, 3Hamell, London, UK Background: There is limited information on the patterns of use, adherence rates, and factors that impact adherence with topical treatments for actinic keratosis (AK. Objectives: To establish patterns of use and adherence with topical treatments for AK and to identify treatment-related factors that impact on adherence. Methods: A community-based, cross-sectional study was performed using a standardized questionnaire completed online or via telephone interview. Patients were stratified according to the presence of AK lesions on the scalp and/or other extremities; and presence of scarring resulting from treatment. Results: This study included 305 patients with AK who were currently using a patient-applied topical therapy for AK or had used one within the previous 12 months. In total, 88% (n = 268/305 of patients were either non-adherent, non-persistent or both non-adherent and non-persistent to topical therapy. Duration of treatment was associated with increasing rates of non-adherence (adjusted odds ratio [OR]; for treatment durations greater than 4 weeks, 2.2, P < 0.01: 52% of patients were non-adherent with 3–4 week treatment duration; 69% of patients with 4–8 week treatment duration; and 71% of patients with 6–12 week treatment duration. There were similar increases in non-persistence with increasing treatment duration (adjusted OR; for treatment durations greater than 4 weeks, 2.1, P < 0.05. Conclusion: This study found high rates of non-adherence and non-persistence in patients with AK. Duration of treatment was a significant factor contributing to non-adherence and non-persistence to topical treatments. Patient-applied topical therapies that require less frequent application and have shorter treatment duration may be associated with improved

The effects of psychological factors in sports medicine rehabilitation adherence.

Science.gov (United States)

Lampton, C C; Lambert, M E; Yost, R

1993-09-01

This study investigated the influence of achievement motivation and self-esteem on injury treatment adherence in a general sample of injured patients receiving treatment in a sports medicine clinic. Subjects consisted of both injured athletes and workers who had incurred an on-the-job injury. Based on scales of self-esteem and achievement motivation, patients were categorized as either high or low in self-esteem certainty, self-esteem level, tendency to be task-involved, and tendency to ego-involved in tasks. Treatment adherence was measured by number of missed appointments and by physical therapist ratings of effort and progress. It was found that patients low in self-esteem certainty and high in ego-involvement tended to miss the most treatment appointments. Contrary to previous findings, task-involvement was not found to be related to treatment adherence.

Self-monitoring of blood glucose among patients with diabetes in Jordan: Perception, adherence, and influential factors.

Science.gov (United States)

Al-Keilani, Maha S; Almomani, Basima A; Al-Sawalha, Nour A; Shhabat, Batool A

2017-04-01

To investigate the self-monitoring of blood glucose (SMBG) adherence among Jordanian patients with diabetes and to identify the predictive factors. A cross-sectional survey was carried out in 18 hospitals and healthcare centers covering south, north, and middle of Jordan. All patients with diabetes attending endocrinology clinics from May to December, 2015 were approached. The questionnaires were distributed by trained pharmacists and were self-administered. A total of 1079 participants completed the survey. Only 59% of participants were SMBG adherent. Predictors of SMBG adherence were treatment regimen; insulin with oral hypoglycemic agents (p=0.044, CI 1.023-5.274, OR=2.323) or insulin only (p=0.005, CI 1.225-3.115, OR=1.953), and health education on how to use the SMBG meter (p<0.001, CI 10.538-32.497, OR=18.506). The frequency of SMBG was significantly associated with the treatment regimen, with patients who were taking oral hypoglycemic agents (p<0.001) or insulin therapy (p=0.004) tested more frequently as compared to others. Additionally, the frequency of testing was significantly associated with the reason of performing SMBG (p<0.001). Frequency of daily testing was the highest among patients who performed SMBG to know if they were hypoglycemic (48.9%) or hyperglycemic (48.0%), or to inform their doctors (28.4%). SMBG adherence was suboptimal. Predictors of SMBG adherence were treatment regimen and health education about the SMBG meter. Copyright © 2017 Elsevier B.V. All rights reserved.

Validating the Modified Drug Adherence Work-Up (M-DRAW) Tool to Identify and Address Barriers to Medication Adherence.

Science.gov (United States)

Lee, Sun; Bae, Yuna H; Worley, Marcia; Law, Anandi

2017-09-08

Barriers to medication adherence stem from multiple factors. An effective and convenient tool is needed to identify these barriers so that clinicians can provide a tailored, patient-centered consultation with patients. The Modified Drug Adherence Work-up Tool (M-DRAW) was developed as a 13-item checklist questionnaire to identify barriers to medication adherence. The response scale was a 4-point Likert scale of frequency of occurrence (1 = never to 4 = often). The checklist was accompanied by a GUIDE that provided corresponding motivational interview-based intervention strategies for each identified barrier. The current pilot study examined the psychometric properties of the M-DRAW checklist (reliability, responsiveness and discriminant validity) in patients taking one or more prescription medication(s) for chronic conditions. A cross-sectional sample of 26 patients was recruited between December 2015 and March 2016 at an academic medical center pharmacy in Southern California. A priming question that assessed self-reported adherence was used to separate participants into the control group of 17 "adherers" (65.4%), and into the intervention group of nine "unintentional and intentional non-adherers" (34.6%). Comparable baseline characteristics were observed between the two groups. The M-DRAW checklist showed acceptable reliability (13 item; alpha = 0.74) for identifying factors and barriers leading to medication non-adherence. Discriminant validity of the tool and the priming question was established by the four-fold number of barriers to adherence identified within the self-selected intervention group compared to the control group (4.4 versus 1.2 barriers, p tool will include construct validation.

The function of medication beliefs as mediators between personality traits and adherence behavior in people with asthma

Directory of Open Access Journals (Sweden)

Axelsson M

2013-10-01

Full Text Available Malin Axelsson,1,2 Christina Cliffordson,2 Bo Lundbäck,1 Jan Lötvall11Krefting Research Centre, Institute of Medicine, Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; 2Department of Nursing, Health and Culture, University West, Trollhättan, SwedenBackground: There is evidence that both personality traits and personal beliefs about medications affect adherence behavior. However, limited research exists on how personality and beliefs about asthma medication interact in influencing adherence behavior in people with asthma. To extend our knowledge in this area of adherence research, we aimed to determine the mediating effects of beliefs about asthma medication between personality traits and adherence behavior.Methods: Asthmatics (n=516 selected from a population-based study called West Sweden Asthma Study completed the Neuroticism, Extraversion and Openness to Experience Five-Factor Inventory, the Medication Adherence Report Scale, and the Beliefs about Medicines Questionnaire. Data were analyzed using confirmatory factor analysis and structural equation modeling.Results: Three of the five investigated personality traits – agreeableness, conscientiousness, and neuroticism – were associated with both concerns about asthma medication and adherence behavior. Concerns functioned as a partial mediator for the influencing effects of agreeableness, conscientiousness, and neuroticism on adherence behavior.Conclusion: The findings suggest that personality traits could be used to identify individuals with asthma who need support with their adherence behavior. Additionally, targeting concerns about asthma medication in asthmatics with low levels of agreeableness or conscientiousness or high levels of neuroticism could have a favorable effect on their adherence behavior.Keywords: adherence, individual differences, medication concerns, health behavior

Emotional distress as a predictor of statin non-adherence among Swedish first-time myocardial infarction patients, 2006-2013.

Science.gov (United States)

Lissåker, C T; Wallert, J; Held, C; Olsson, E

2017-06-01

Emotional distress (depression and anxiety) has been known to affect mortality after a myocardial infarction (MI). One possible mechanism is through medication non-adherence. Few studies have investigated the link between statin adherence and emotional distress, and results are not consistent. We aimed to explore whether emotional distress affects adherence among first-time MI patients younger than 75years old receiving a prescription for the first time. We identified first-MI individuals younger than 75years from the SWEDEHEART national quality registers discharged with a statin prescription. The main exposure was the anxiety/depression portion of the EQ-5D from Interview 1 (6-10weeks post-MI) and Interview 2 (12-14months post-MI). We calculated adherence from the Swedish Prescribed Drugs Register during three observation periods (OP): [1] Interview 1 to Interview 2, [2] one year post Interview 2, and [3] two years post Interview 1. Emotional distress at Interview 1 was not associated with statin adherence for OP1 (RR: 0.99, 95% CI: 0.98, 1.01). Emotional distress at Interview 2 was associated with lower adherence one year later (RR: 0.95, 95% CI: 0.93, 0.98). Emotional distress at Interview 1 was associated with a small decrease in adherence in the complete OP for adherence (RR: 0.98, 95% CI: 0.96, 0.99). Emotional distress was marginally, but independently, associated with lower adherence to statin two years after the MI. Our study suggests that emotional distress may be an important factor for long-term statin adherence, and, thus, may play a clinically important role in long-term outcome. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Adherence to anti-Parkinson drug therapy in the "REASON" sample of Italian patients with Parkinson's disease: the linguistic validation of the Italian version of the "Morisky Medical Adherence Scale-8 items".

Science.gov (United States)

Fabbrini, G; Abbruzzese, G; Barone, P; Antonini, A; Tinazzi, M; Castegnaro, G; Rizzoli, S; Morisky, D E; Lessi, P; Ceravolo, R

2013-11-01

Information about patients' adherence to therapy represents a primary issue in Parkinson's disease (PD) management. To perform the linguistic validation of the Italian version of the self-rated 8-Item Morisky Medical Adherence Scale (MMAS-8) and to describe in a sample of Italian patients affected by PD the adherence to anti-Parkinson drug therapy and the association between adherence and some socio-demographic and clinical features. MMAS-8 was translated into Italian language by two independent Italian mother-tongue translators. The consensus version was then back-translated by an English mother-tongue translator. This translation process was followed by a consensus meeting between the authors of translation and investigators and then by two comprehension tests. The translated version of the MMAS-8 scale was then administered at the baseline visit of the "REASON" study (Italian Study on the Therapy Management in Parkinson's disease: Motor, Non-Motor, Adherence and Quality Of Life Factors) in a large sample of PD patients. The final version of the MMAS-8 was easily understood. Mean ± SD MMAS-8 score was 6.1 ± 1.2. There were no differences in adherence to therapy in relationship to disease severity, gender, educational level or decision to change therapy. The Italian version of MMAS-8, the key tool of the REASON study to assess the adherence to therapy, has shown to be understandable to patients with PD. Patients enrolled in the REASON study showed medium therapy adherence.

Facilitators and Barriers to Noninvasive Ventilation Adherence in Youth with Nocturnal Hypoventilation Secondary to Obesity or Neuromuscular Disease.

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Ennis, Jonathan; Rohde, Kristina; Chaput, Jean-Philippe; Buchholz, Annick; Katz, Sherri Lynne

2015-12-15

Many youth struggle with adherence to bilevel noninvasive ventilation (NIV), often shortly after initiation of treatment. Anecdotal evidence suggests youths with comorbid obesity struggle with adherence while youths with comorbid neuromuscular disease demonstrate better adherence rates. The objective of this study was to explore factors relating to bilevel NIV adherence, and to compare these between youths with underlying obesity or neuromuscular disease. An exploratory qualitative approach was used to examine youth and caregivers' experiences with and perceptions of bilevel NIV. Semi-structured interviews (n = 16) of caregivers and youths were conducted. Youths 12 years and older with nocturnal hypoventilation diagnosed on polysomnography and managed with bilevel NIV, with either concurrent obesity or neuromuscular disease were included. Thematic analysis of interview data was conducted using qualitative analysis software. Factors associated with positive bilevel NIV adherence included previous encouraging experiences with therapy; subjective symptom improvement; familiarity with medical treatments; understanding of nocturnal hypoventilation and its consequences; family and health-care team support; and early adaptation to treatments. Factors associated with poor bilevel NIV adherence included previous negative experiences with therapy, negative attitude towards therapy; difficulty adapting; perceived lack of support from family or health-care team; fear/embarrassment regarding treatment; caregivers not being health-minded; technical issues; side effects; and a lack of subjective symptom improvement. The dimensions which most affect adherence to bilevel NIV are those which contribute to youths' conception of feeling "well" or "unwell." Adherence to treatment may hinge largely on the way in which NIV is initially experienced and framed. A commentary on this article appears in this issue on page 1355. © 2015 American Academy of Sleep Medicine.

Non-adherence in patients on peritoneal dialysis: a systematic review.

Science.gov (United States)

Griva, Konstadina; Lai, Alden Yuanhong; Lim, Haikel Asyraf; Yu, Zhenli; Foo, Marjorie Wai Yin; Newman, Stanton P

2014-01-01

It has been increasingly recognized that non-adherence is an important factor that determines the outcome of peritoneal dialysis (PD) therapy. There is therefore a need to establish the levels of non-adherence to different aspects of the PD regimen (dialysis procedures, medications, and dietary/fluid restrictions). A systematic review of peer-reviewed literature was performed in PubMed, PsycINFO and CINAHL databases using PRISMA guidelines in May 2013. Publications on non-adherence in PD were selected by two reviewers independently according to predefined inclusion and exclusion criteria. Relevant data on patient characteristics, measures, rates and factors associated with non-adherence were extracted. The quality of studies was also evaluated independently by two reviewers according to a revised version of the Effective Public Health Practice Project assessment tool. The search retrieved 204 studies, of which a total of 25 studies met inclusion criteria. Reported rates of non-adherence varied across studies: 2.6-53% for dialysis exchanges, 3.9-85% for medication, and 14.4-67% for diet/fluid restrictions. Methodological differences in measurement and definition of non-adherence underlie the observed variation. Factors associated with non-adherence that showed a degree of consistency were mostly socio-demographical, such as age, employment status, ethnicity, sex, and time period on PD treatment. Non-adherence to different dimensions of the dialysis regimen appears to be prevalent in PD patients. There is a need for further, high-quality research to explore these factors in more detail, with the aim of informing intervention designs to facilitate adherence in this patient population.

Investigation of factors affecting adhesion of 99Tcm labelled colloids to glass vials

International Nuclear Information System (INIS)

Elliott, A.T.; Murray, T.; Hilditch, T.E.; Whateley, T.L.

1990-01-01

Factors which may possibly influence the adhesion of 99 Tc m labelled colloid to glass vials were investigated. Of five colloids studied, two protein-free tin colloids were affected most by the problem, some 12-18% being lost by adhesion to the glass vial when the colloid was left resting on the bench, or 60-87% when it was rotated for a period of 4 h. The proportion of activity which adhered to the vial was dependent on the time the product had been contained within it, whether on the bench or rotated. Two of the colloids, both of which contained protein, were affected only slightly by the problem, one being a tin colloid and the other a sulphur colloid. An antimony sulphide colloid, which contained no added protein, was virtually unaffected by the problem. The degree of adhesion was not related to the pH of the product, or to the temperature at which the product was stored, nor to the tendency of the colloidal particles to grow in size upon vigorous agitation. (author)

Protocol adherence and the ability to achieve target haemoglobin levels in haemodialysis patients.

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Chan, Kevin; Moran, John; Hlatky, Mark; Lafayette, Richard

2009-06-01

Anemia management remains complicated in patients with endstage renal disease on hemodialysis. We wished to evaluate the effect of protocol adherence to EPO and intravenous iron dosing on achieving the desired range of hemoglobin levels. A cohort of hemodialysis patients was studied to evaluate the rate of adherence to EPO and iron dosing protocols over a 5 month period. A database was completed to evaluate all known comorbidities, demographic factors, and facility issues that might affect hemoglobin levels. A logistic regression model was employed to evaluate the effect of adherence to the anemia protocols on the probability of achieving a hemoglobin level below, within or above the targeted range of 11-12.5 g/dl. Among 2114 patients, we found that adherence to both the EPO and iron dosing protocol resulted in the greatest probability of achieving the target hemoglobin range (56 +/- 5% in anemia protocol adherent patients versus 42 +/- 7% in non adherent patients). This was predominantly due to a lowered risk of having above target hemoglobin levels rather than below. The use of the anemia protocols was associated with lower rates of hospitalization (9 +/- 0.7 visits/100 months in adherent group vs 15 +/- 2 in non adherent group) and lower utilization of both EPO and intravenous iron. Furthermore, patients in the adherent groups had less variability of their hemoglobin levels month by month, at least as judged by standard deviation. Adherence to anemia protocols, as practiced in the dialysis units included in this cohort, may improve hemodialysis patients' ability to achieve target hemoglobin levels, and by avoiding above target hemoglobin values, lower drug utilization and reduce variability of hemoglobin levels.

Adherence therapy improves medication adherence and quality of life in people with Parkinson's disease: a randomised controlled trial.

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Daley, D J; Deane, K H O; Gray, R J; Clark, A B; Pfeil, M; Sabanathan, K; Worth, P F; Myint, P K

2014-08-01

Many factors are associated with medication non-adherence in Parkinson's disease (PD), including complex treatment regimens, mood disorders and impaired cognition. However, interventions to improve adherence which acknowledge such factors are lacking. A phase II randomised controlled trial was conducted investigating whether Adherence Therapy (AT) improves medication adherence and quality of life (QoL) compared with routine care (RC) in PD. Eligible PD patients and their spouse/carers were randomised to intervention (RC plus AT) or control (RC alone). Primary outcomes were change in adherence (Morisky Medication Adherence Scale) and QoL (Parkinson's Disease Questionnaire-39) from baseline to week-12 follow up. Secondary outcomes were MDS-UPDRS (part I, II, IV), Beliefs about Medication Questionnaire (BMQ), EuroQol (EQ-5D) and the Caregiving Distress Scale. Blinded data were analysed using logistic and linear regression models based on the intention-to-treat principle. Seventy-six patients and 46 spouse/carers completed the study (intervention: n = 38 patients, n = 24 spouse/carers). At week-12 AT significantly improved adherence compared with RC (OR 8.2; 95% CI: 2.8, 24.3). Numbers needed to treat (NNT) were 2.2 (CI: 1.6, 3.9). Compared with RC, AT significantly improved PDQ-39 (-9.0 CI: -12.2, -5.8), BMQ general harm (-1.0 CI: -1.9, -0.2) and MDS-UPDRS part II (-4.8 CI: -8.1, -1.4). No significant interaction was observed between the presence of a spouse/carer and the effect of AT. Adherence Therapy improved self-reported adherence and QoL in a PD sample. The small NNT suggests AT may be cost-effective. A larger pragmatic trial to test the efficacy and cost-effectiveness of AT by multiple therapists is required. © 2014 John Wiley & Sons Ltd.

[Adherence to pharmacological treatment in adult patients undergoing hemodialysis].

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Sgnaolin, Vanessa; Figueiredo, Ana Elizabeth Prado Lima

2012-06-01

Adherence to treatment in patients on hemodialysis is not a simple process. Strategies to promote adherence will meet the need for improvements in the process of orientation concerning the disease and its pharmacological treatment. To identify compliance with pharmacological treatment of patients on hemodialysis and the main factors related to it we used the Adherence Scale. Observational, descriptive and cross-sectional study. Interviews were conducted to collect socioeconomic, pharmacological data, as well as those regarding self-reported adherence to drug. Out of the 65 participants, 55.4% showed non-compliance. The mean number of drugs used was 4.1 ± 2.5 (self-report) and 6.2 ± 3.0 (prescription). Statistical analysis showed significant differences concerning compliance at different ages (> 60 years are more adherent). A significant proportion of patients have difficulty to comply with treatment and the main factor was forgetfulness. Regarding age, elderly patients are more adherent to treatment. The low level of knowledge about the used drugs may be one of the reasons for the lack of adherence, and the patient's orientation process by a team of multiprofessionals involved in assisting is a strategy to promote adherence.

Factors affecting nuclear development

International Nuclear Information System (INIS)

Stevens, G.H.; Girouard, P.

1995-01-01

Among the factors affecting nuclear development, some depend more or less on public authorities, but many are out of public authorities control (foreign policies, market and deregulation, socials and environmental impacts, public opinion). As far as possible, the following study tries to identify those factors. (D.L.). 2 photos

An information-motivation-behavioral skills model of adherence to antiretroviral therapy.

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Fisher, Jeffrey D; Fisher, William A; Amico, K Rivet; Harman, Jennifer J

2006-07-01

HIV-positive persons who do not maintain consistently high levels of adherence to often complex and toxic highly active antiretroviral therapy (HAART) regimens may experience therapeutic failure and deterioration of health status and may develop multidrug-resistant HIV that can be transmitted to uninfected others. The current analysis conceptualizes social and psychological determinants of adherence to HAART among HIV-positive individuals. The authors propose an information-motivation-behavioral skills (IMB) model of HAART adherence that assumes that adherence-related information, motivation, and behavioral skills are fundamental determinants of adherence to HAART. According to the model, adherence-related information and motivation work through adherence-related behavioral skills to affect adherence to HAART. Empirical support for the IMB model of adherence is presented, and its application in adherence-promotion intervention efforts is discussed.

Factors affecting construction performance: exploratory factor analysis

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Soewin, E.; Chinda, T.

2018-04-01

The present work attempts to develop a multidimensional performance evaluation framework for a construction company by considering all relevant measures of performance. Based on the previous studies, this study hypothesizes nine key factors, with a total of 57 associated items. The hypothesized factors, with their associated items, are then used to develop questionnaire survey to gather data. The exploratory factor analysis (EFA) was applied to the collected data which gave rise 10 factors with 57 items affecting construction performance. The findings further reveal that the items constituting ten key performance factors (KPIs) namely; 1) Time, 2) Cost, 3) Quality, 4) Safety & Health, 5) Internal Stakeholder, 6) External Stakeholder, 7) Client Satisfaction, 8) Financial Performance, 9) Environment, and 10) Information, Technology & Innovation. The analysis helps to develop multi-dimensional performance evaluation framework for an effective measurement of the construction performance. The 10 key performance factors can be broadly categorized into economic aspect, social aspect, environmental aspect, and technology aspects. It is important to understand a multi-dimension performance evaluation framework by including all key factors affecting the construction performance of a company, so that the management level can effectively plan to implement an effective performance development plan to match with the mission and vision of the company.

Medication adherence to oral iron therapy in patients with iron deficiency anemia

Science.gov (United States)

Gereklioglu, Cigdem; Asma, Suheyl; Korur, Asli; Erdogan, Ferit; Kut, Altug

2016-01-01

Objective: This study aimed at investigating the factors affecting medication adherence in patients who use oral iron therapy due to iron deficiency anemia. Methods: A total of 96 female patients in fertile age with mean age of 30±10.1 years (range 18-53) who were admitted to Family Medicine Clinic between 01 January and 31 March 2015 and who had received iron therapy within the recent three years were enrolled in the study. Data were collected through a questionnaire form. Results: Of the patients, 39 (40,6%) were detected not to use the medication regularly or during the recommended period. A statistically significant relationship was found between non-adherence to therapy and gastrointestinal side effects and weight gain (p<0.05). Conclusion: Medication adherence is deficient in patients with iron deficiency anemia. The most important reason for this seems gastrointestinal side effects, in addition to weight gain under treatment. PMID:27375698

Factors influencing adherence to guidelines in general practice

NARCIS (Netherlands)

Stewart, RE; Vroegop, S; van der Werf, GT; Meyboom-de Jong, B; Kamps, G.

2003-01-01

Objectives: To identify and assess the effects of general practitioner and patient characteristics on global adherence to pharmacotherapeutic guidelines. Methods: In a cross-sectional study in the northern Netherlands, a two-level multilevel model was applied to patients (n = 269,067) in 190

Non-adherence in patients on peritoneal dialysis: a systematic review.

Directory of Open Access Journals (Sweden)

Konstadina Griva

Full Text Available BACKGROUND: It has been increasingly recognized that non-adherence is an important factor that determines the outcome of peritoneal dialysis (PD therapy. There is therefore a need to establish the levels of non-adherence to different aspects of the PD regimen (dialysis procedures, medications, and dietary/fluid restrictions. METHODS: A systematic review of peer-reviewed literature was performed in PubMed, PsycINFO and CINAHL databases using PRISMA guidelines in May 2013. Publications on non-adherence in PD were selected by two reviewers independently according to predefined inclusion and exclusion criteria. Relevant data on patient characteristics, measures, rates and factors associated with non-adherence were extracted. The quality of studies was also evaluated independently by two reviewers according to a revised version of the Effective Public Health Practice Project assessment tool. RESULTS: The search retrieved 204 studies, of which a total of 25 studies met inclusion criteria. Reported rates of non-adherence varied across studies: 2.6-53% for dialysis exchanges, 3.9-85% for medication, and 14.4-67% for diet/fluid restrictions. Methodological differences in measurement and definition of non-adherence underlie the observed variation. Factors associated with non-adherence that showed a degree of consistency were mostly socio-demographical, such as age, employment status, ethnicity, sex, and time period on PD treatment. CONCLUSION: Non-adherence to different dimensions of the dialysis regimen appears to be prevalent in PD patients. There is a need for further, high-quality research to explore these factors in more detail, with the aim of informing intervention designs to facilitate adherence in this patient population.

Non-Adherence in Patients on Peritoneal Dialysis: A Systematic Review

Science.gov (United States)

Griva, Konstadina; Lai, Alden Yuanhong; Lim, Haikel Asyraf; Yu, Zhenli; Foo, Marjorie Wai Yin; Newman, Stanton P.

2014-01-01

Background It has been increasingly recognized that non-adherence is an important factor that determines the outcome of peritoneal dialysis (PD) therapy. There is therefore a need to establish the levels of non-adherence to different aspects of the PD regimen (dialysis procedures, medications, and dietary/fluid restrictions). Methods A systematic review of peer-reviewed literature was performed in PubMed, PsycINFO and CINAHL databases using PRISMA guidelines in May 2013. Publications on non-adherence in PD were selected by two reviewers independently according to predefined inclusion and exclusion criteria. Relevant data on patient characteristics, measures, rates and factors associated with non-adherence were extracted. The quality of studies was also evaluated independently by two reviewers according to a revised version of the Effective Public Health Practice Project assessment tool. Results The search retrieved 204 studies, of which a total of 25 studies met inclusion criteria. Reported rates of non-adherence varied across studies: 2.6–53% for dialysis exchanges, 3.9–85% for medication, and 14.4–67% for diet/fluid restrictions. Methodological differences in measurement and definition of non-adherence underlie the observed variation. Factors associated with non-adherence that showed a degree of consistency were mostly socio-demographical, such as age, employment status, ethnicity, sex, and time period on PD treatment. Conclusion Non-adherence to different dimensions of the dialysis regimen appears to be prevalent in PD patients. There is a need for further, high-quality research to explore these factors in more detail, with the aim of informing intervention designs to facilitate adherence in this patient population. PMID:24586478

Household factors, family behavior patterns, and adherence to dietary and physical activity guidelines among children at risk for obesity.

Science.gov (United States)

Kunin-Batson, Alicia S; Seburg, Elisabeth M; Crain, A Lauren; Jaka, Meghan M; Langer, Shelby L; Levy, Rona L; Sherwood, Nancy E

2015-01-01

To describe the proportion of children adhering to recommended physical activity and dietary guidelines, and examine demographic and household correlates of guideline adherence. Cross-sectional (pre-randomization) data from a behavioral intervention trial designed to prevent unhealthy weight gain in children. A total of 421 children (aged 5-10 years) at risk for obesity (body mass index percentile, 70-95). Physical activity (accelerometry), screen time (parent survey), and fruit and vegetable and sugar-sweetened beverage intake (24-hour dietary recall). Proportions meeting guidelines were calculated. Logistic regression examined associations between demographic and household factors and whether children met recommended guidelines for (1) physical activity (≥ 60 min/d), (2) screen time (≤ 2 h/d), (3) fruit and vegetable intake (≥ 5 servings/d), and (4) sugar-sweetened beverage avoidance. Few children met more than 1 guideline. Only 2% met all 4 recommended guidelines and 19% met none. Each guideline had unique sociodemographic and domain-specific household predictors (ie, availability of certain foods and beverages, media, and active play and exercise equipment). Families equipped to promote healthy child behavior patterns in 1 activity or dietary domain may not be in others. Results have implications for the development of interventions to affect children's weight-related behaviors and growth trajectories. Copyright © 2015 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

Negative psychological responses of injury and rehabilitation adherence effects on return to play in competitive athletes: a systematic review and meta-analysis

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Ivarsson A

2017-03-01

Full Text Available Andreas Ivarsson,1 Ulrika Tranaeus,2,3 Urban Johnson,1 Andreas Stenling 4 1Center of Research on Welfare, Health and Sport, School of Health and Welfare, Halmstad University, Halmstad, 2Performance and Training Unit, The Swedish School of Sport and Health Sciences (GIH, 3Musculoskeletal & Sports Injury Epidemiology Center, IMM, Karolinska Institutet, Stockholm, 4Department of Psychology, Umeå University, Umeå, Sweden Abstract: Previous research offers evidence that psychological factors influence an injured athlete during the rehabilitation process. Our first objective was to conduct a systematic review and meta-analysis of the results from all published studies that examined the relationships among negative affective responses after sport injuries, rehabilitation adherence, and return to play (RTP. The second objective was to use a meta-analytic path analysis to investigate whether an indirect effect existed between negative affective responses and RTP through rehabilitation adherence. This literature review resulted in seven studies providing 14 effect sizes. The results from the meta-analysis showed that negative affective responses had a negative effect on successful RTP, whereas rehabilitation adherence had a positive effect on RTP. The results from the meta-analytic path analysis showed a weak and nonsignificant indirect effect of negative affective responses on RTP via rehabilitation adherence. These results underline the importance of providing supportive environments for injured athletes to increase the chances of successful RTP via a decrease in negative affective responses and increase in rehabilitation adherence. Keywords: affective responses, rehabilitation behaviors, return to play, sport injuries

What puts heart failure patients at risk for poor medication adherence?

Directory of Open Access Journals (Sweden)

Knafl GJ

2014-07-01

Full Text Available George J Knafl,1 Barbara Riegel2,31School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; 2School of Nursing, University of Pennsylvania, Philadelphia, PA, USA; 3Leonard Davis Institute, University of Pennsylvania, Philadelphia, PA, USABackground: Medication nonadherence is a major cause of hospitalization in patients with heart failure (HF, which contributes enormously to health care costs. We previously found, using the World Health Organization adherence dimensions, that condition and patient level factors predicted nonadherence in HF. In this study, we assessed a wider variety of condition and patient factors and interactions to improve our ability to identify those at risk for hospitalization. Materials and methods: Medication adherence was measured electronically over the course of 6 months, using the Medication Event Monitoring System (MEMS. A total of 242 HF patients completed the study, and usable MEMS data were available for 218 (90.1%. Participants were primarily white (68.3%, male (64.2%, and retired (44.5%. Education ranged from 8–29 years (mean, 14.0 years; standard deviation, 2.9 years. Ages ranged from 30–89 years (mean, 62.8 years; standard deviation, 11.6 years. Analyses used adaptive methods based on heuristic searches controlled by cross-validation scores. First, individual patient adherence patterns over time were used to categorize patients in poor versus better adherence types. Then, risk factors for poor adherence were identified. Finally, an effective model for predicting poor adherence was identified based on identified risk factors and possible pairwise interactions between them. Results: A total of 63 (28.9% patients had poor adherence. Three interaction risk factors for poor adherence were identified: a higher number of comorbid conditions with a higher total number of daily medicines, older age with poorer global sleep quality, and fewer months since diagnosis of HF with poorer

Can human error theory explain non-adherence?

Science.gov (United States)

Barber, Nick; Safdar, A; Franklin, Bryoney D

2005-08-01

To apply human error theory to explain non-adherence and examine how well it fits. Patients who were taking chronic medication were telephoned and asked whether they had been adhering to their medicine, and if not the reasons were explored and analysed according to a human error theory. Of 105 patients, 87 were contacted by telephone and they took part in the study. Forty-two recalled being non-adherent, 17 of them in the last 7 days; 11 of the 42 were intentionally non-adherent. The errors could be described by human error theory, and it explained unintentional non-adherence well, however, the application of 'rules' was difficult when considering mistakes. The consideration of error producing conditions and latent failures also revealed useful contributing factors. Human error theory offers a new and valuable way of understanding non-adherence, and could inform interventions. However, the theory needs further development to explain intentional non-adherence.

Determinants of Adherence to Antiretroviral Therapy among HIV-Infected Patients in Africa

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Ayalu A. Reda

2012-01-01

Full Text Available Background. There are only a few comprehensive studies of adherence to ART and its challenges in Africa. This paper aims to assess the evidence on the challenges and prospects of ART adherence in sub-Saharan Africa. Methods. The authors reviewed original and review articles involving HIV-positive individuals that measured adherence to ART and its predictors in the past decade. Findings. Against expectations, sub-Saharan Africa patients have similar or higher adherence levels compared to those of developed countries. The challenges to ART adherence include factors related to patients and their families, socioeconomic factors, medication, and healthcare systems. Conclusion. Despite good adherence and program-related findings, antiretroviral treatment is challenged by a range of hierarchical and interrelated factors. There is substantial room for improvement of ART programs in sub-Sahara African countries.

A New Lebanese Medication Adherence Scale: Validation in Lebanese Hypertensive Adults.

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Bou Serhal, R; Salameh, P; Wakim, N; Issa, C; Kassem, B; Abou Jaoude, L; Saleh, N

2018-01-01

A new Lebanese scale measuring medication adherence considered socioeconomic and cultural factors not taken into account by the eight-item Morisky Medication Adherence Scale (MMAS-8). Objectives were to validate the new adherence scale and its prediction of hypertension control, compared to MMAS-8, and to assess adherence rates and factors. A cross-sectional study, including 405 patients, was performed in outpatient cardiology clinics of three hospitals in Beirut. Blood pressure was measured, a questionnaire filled, and sodium intake estimated by a urine test. Logistic regression defined predictors of hypertension control and adherence. 54.9% had controlled hypertension. 82.4% were adherent by the new scale, which showed good internal consistency, adequate questions (KMO coefficient = 0.743), and four factors. It predicted hypertension control (OR = 1.217; p value = 0.003), unlike MMAS-8, but the scores were correlated (ICC average measure = 0.651; p value < 0.001). Stress and smoking predicted nonadherence. This study elaborated a validated, practical, and useful tool measuring adherence to medications in Lebanese hypertensive patients.

A New Lebanese Medication Adherence Scale: Validation in Lebanese Hypertensive Adults

Directory of Open Access Journals (Sweden)

R. Bou Serhal

2018-01-01

Full Text Available Background. A new Lebanese scale measuring medication adherence considered socioeconomic and cultural factors not taken into account by the eight-item Morisky Medication Adherence Scale (MMAS-8. Objectives were to validate the new adherence scale and its prediction of hypertension control, compared to MMAS-8, and to assess adherence rates and factors. Methodology. A cross-sectional study, including 405 patients, was performed in outpatient cardiology clinics of three hospitals in Beirut. Blood pressure was measured, a questionnaire filled, and sodium intake estimated by a urine test. Logistic regression defined predictors of hypertension control and adherence. Results. 54.9% had controlled hypertension. 82.4% were adherent by the new scale, which showed good internal consistency, adequate questions (KMO coefficient = 0.743, and four factors. It predicted hypertension control (OR = 1.217; p value = 0.003, unlike MMAS-8, but the scores were correlated (ICC average measure = 0.651; p value < 0.001. Stress and smoking predicted nonadherence. Conclusion. This study elaborated a validated, practical, and useful tool measuring adherence to medications in Lebanese hypertensive patients.

The effects of Risk Factor-Targeted Lifestyle Counselling Intervention on working-age stroke patients' adherence to lifestyle change.

Science.gov (United States)

Oikarinen, Anne; Engblom, Janne; Kääriäinen, Maria; Kyngäs, Helvi

2017-09-01

Since a history of stroke or transient ischaemic attack is a major risk factor for a recurrent event, lifestyle counselling during the hospital phase is an essential component of treatment and may increase the probability of lifestyle change. To study the effect of risk factor-targeted lifestyle counselling intervention on working-age stroke patients' adherence to lifestyle changes. A quasi-experimental, nonequivalent control group pretest-post-test design. Stroke patients in an acute neurological unit were divided into a control group (n = 75) receiving standard counselling and an experimental group (n = 75) receiving risk factor-targeted counselling. Lifestyle data and clinical outcomes were collected at hospital between January 2010 and October 2011, while data on adherence to lifestyle changes 3, 6, and 12 months after discharge. The baseline lifestyle habits did not differ significantly other than in alcohol behaviour. Both groups increased their intake, but the intervention group to a lesser degree. However, the experimental group significantly lost their weight for the first 3 and 6 months; at 3 months reduction in cigarette consumption and at 6 months significant increases in smoking cessation were also achieved. All improved some of their lifestyle habits. Intervention was associated with support from nurses as well as from family and friends. Adherence scores were higher in the experimental group. Some short-term advantages in lifestyle habits due to the intervention were noted. Participants in both groups improved some of their lifestyle habits. © 2016 Nordic College of Caring Science.

Hypertension: adherence to treatment in rural Bangladesh – findings from a population-based study

Science.gov (United States)

Khanam, Masuma Akter; Lindeboom, Wietze; Koehlmoos, Tracey Lynn Perez; Alam, Dewan Shamsul; Niessen, Louis; Milton, Abul Hasnat

2014-01-01

Background Poor adherence has been identified as the main cause of failure to control hypertension. Poor adherence to antihypertensive treatment is a significant cardiovascular risk factor, which often remains unrecognized. There are no previous studies that examined adherence with antihypertensive medication or the characteristics of the non-adherent patients in Bangladesh. Objective This paper aims to describe hypertension and factors affecting adherence to treatment among hypertensive persons in rural Bangladesh. Design The study population included 29,960 men and women aged 25 years and older from three rural demographic surveillance sites of the International Center for Diarrheal Disease Research, Bangladesh (icddr,b): Matlab, Abhoynagar, and Mirsarai. Data was collected by a cross-sectional design on diagnostic provider, initial, and current treatment. Discontinuation of medication at the time of interview was defined as non-adherence to treatment. Results The prevalence of hypertension was 13.67%. Qualified providers diagnosed only 53.5% of the hypertension (MBBS doctors 46.1 and specialized doctors 7.4%). Among the unqualified providers, village doctors diagnosed 40.7%, and others (nurse, health worker, paramedic, homeopath, spiritual healer, and pharmacy man) each diagnosed less than 5%. Of those who started treatment upon being diagnosed with hypertension, 26% discontinued the use of medication. Age, sex, education, wealth, and type of provider were independently associated with non-adherence to medication. More men discontinued the treatment than women (odds ratio [OR] 1.74, confidence interval [CI] 1.48–2.04). Non-adherence was greater when hypertension was diagnosed by unqualified providers (OR 1.52, CI 1.31–1.77). Hypertensive patients of older age, least poor quintile, and higher education were less likely to be non-adherent. Patients with cardiovascular comorbidity were also less likely to be non-adherent to antihypertensive medication (OR 0

Factors Affecting Medical Service Quality.

Science.gov (United States)

Mosadeghrad, Ali Mohammad

2014-02-01

A better understanding of factors influencing quality of medical service can pinpoint better strategies for quality assurance in medical services. This study aimed to identify factors affecting the quality of medical services provided by Iranian physicians. Exploratory in-depth individual interviews were conducted with sixty-four physicians working in various medical institutions in Iran. Individual, organizational and environmental factors enhance or inhibit the quality of medical services. Quality of medical services depends on the personal factors of the physician and patient, and factors pertaining to the healthcare setting and the broader environment. Differences in internal and external factors such as availability of resources, patient cooperation and collaboration among providers affect the quality of medical services and patient outcomes. Supportive leadership, proper planning, education and training and effective management of resources and processes improve the quality of medical services. This article contributes to healthcare theory and practice by developing a conceptual framework for understanding factors that influence medical services quality.

Model of socio-cultural dimensions involved in adherence to antiretroviral therapy for HIV/AIDS in public health care centers in Chile.

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Stuardo Ávila, Valeria; Manriquez Urbina, Jose Manuel; Fajreldin Chuaqui, Valentina; Belmar Prieto, Julieta; Valenzuela Santibáñez, Victoria

2016-11-01

In Chile, over 14,000 adults are living with HIV receive antiretroviral therapy (HAART). Adequate adherence to HAART has a major impact on survival. There is little consensus on the causes of poor adherence, due to the unique and diverse sociocultural parameters involved in the issue. The objective of this study was to identify sociocultural dimensions that serve as barriers or facilitators to HAART adherence among persons living with HIV/AIDS (PLHIV) in Chile. A qualitative study design, with an exploratory followed by a descriptive phase was conducted. The study population consisted of adults living with HIV/AIDS, with and without HAART. A theoretical sample was designed and three gender profiles defined: women, men, and transwomen. Data collection methods included in-depth interviews by anthropologists in seven public health care centers for PLHIV. The model of sociocultural dimensions indicated that factors associated with family, expectations, gender/sexuality, affect, relationship with HIV, HAART, work, social support and networks, and stigma and discrimination influenced adherence, with different patterns among profiles. This study found that adherence is a dynamic category. It is crucial to consider sociocultural factors in developing strategies to improve HAART adherence.

Examining the Factors Affecting Student Dropout

Directory of Open Access Journals (Sweden)

Fethi Ahmet INAN

2006-07-01

Full Text Available This study examined the factors affecting student dropouts in an online certificate program. In this research, a combination of quantitative and qualitative methods was used. Online Course Dropout Survey was developed and used to determine which factors affect student attrition from the program. The dropout survey was sent by e-mail to 98 students who had dropped the program. Twenty-six students returned the survey. The findings show that the most important factor affecting student retention is finding sufficient time to study. Having personal problems and affordability of the program took second and third place.

Social factors and barriers to self-care adherence in Hispanic men and women with diabetes.

Science.gov (United States)

Mansyur, Carol L; Rustveld, Luis O; Nash, Susan G; Jibaja-Weiss, Maria L

2015-06-01

To explore quantitatively the extent to which social support, social norms and barriers are associated with self-efficacy and self-care adherence in Hispanic patients with diabetes and the extent to which these differ for men and women. Baseline survey data were collected from 248 low-SES, Hispanic men and women who were participants in a randomized controlled trial of a culturally targeted intervention for diabetes management. Student's t, Pearson correlations and multiple regression were used to analyze the data. Compared to men, women were less likely to receive support, faced more barriers, reported less self-efficacy and had lower levels of self-care adherence. Perceived support was consistently correlated with better self-efficacy in women but not men, even though men reported higher levels of support. The lack of adequate support seems to be a fundamental barrier for Hispanic women with diabetes. Health care providers should be sensitive to sociocultural influences in Hispanic groups that may facilitate men's self-care adherence, but could potentially hamper women's efforts. Interventions designed for Hispanics should augment women's support needs and address culture and social factors that may differentially impact the ability of men and women to manage their diabetes. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Appointment length, psychiatrists' communication behaviors, and medication management appointment adherence.

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Cruz, Mario; Roter, Debra L; Cruz, Robyn F; Wieland, Melissa; Larson, Susan; Cooper, Lisa A; Pincus, Harold Alan

2013-09-01

The authors explored the relationship between critical elements of medication management appointments (appointment length, patient-centered talk, and positive nonverbal affect among providers) and patient appointment adherence. The authors used an exploratory, cross-sectional design employing quantitative analysis of 83 unique audio recordings of split treatment medication management appointments for 46 African-American and 37 white patients with 24 psychiatrists at four ambulatory mental health clinics. All patients had a diagnosis of depression. Data collected included demographic information; Patient Health Questionnaire-9 scores for depression severity; psychiatrist verbal and nonverbal communication behaviors during medication management appointments, identified by the Roter Interaction Analysis System during analysis of audio recordings; and appointment adherence. Bivariate analyses were employed to identify covariates that might influence appointment adherence. Generalized estimating equations (GEEs) were employed to assess the relationship between appointment length, psychiatrist patient-centered talk, and positive voice tone ratings and patient appointment adherence, while adjusting for covariates and the clustering of observations within psychiatrists. Wald chi square analyses were used to test whether all or some variables significantly influenced appointment adherence. GEE revealed a significant relationship between positive voice tone ratings and appointment adherence (p=.03). Chi square analyses confirmed the hypothesis of a positive and significant relationship between appointment adherence and positive voice tone ratings (p=.03) but not longer visit length and more patient-centered communication. The nonverbal conveyance of positive affect was associated with greater adherence to medication management appointments by depressed patients. These findings potentially have important implications for communication skills training and adherence research.

[ANALYSIS OF BACKGROUNDS AND LEVEL OF UNDERSTANDING OF TREATMENT OF POOR ADHERENCE AND DROPOUT CASES ON SUBLINGUAL IMMUNOTHERAPY FOR JAPANESE CEDAR POLLINOSIS IN THE FIRST FOLLOW-UP YEAR].

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Kikkawa, Sayaka; Kamijo, Atsushi; Nakagome, Kazuyuki; Soma, Tomoyuki; Kobayashi, Takehito; Uchida, Yoshitaka; Morita, Eiji; Nagata, Makoto; Inoue, Tomoe; Kase, Yasuhiro

We considered the factors of poor adherence to and dropout from sublingual immunotherapy (SLIT) by verifying patient backgrounds 1 year after start of treatment. We recruited 38 patients who began SLIT between November 2014 and September 2015. We analyzed their attributes and level of understanding of the treatment, and conducted a self-reported survey on factors behind dropout cases and poor adherence cases. Four patients dropped out 1 year after start of treatment. Three left for reasons related to anxiety about side effects. There were five cases of poor adherence. There was no significant difference between good adherence, poor adherence, and dropout regarding level of understanding of the treatment (p=0.59). In the comparison between good and poor adherence groups, except four dropout patients, the adherence tended to be poor in patients with short duration of disease, smoking patients, and young patients. Continuous rate of SLIT achieved about 90%, suggesting relatively high level of adherence. It appears possible that anxiety related to side effects could be a factor affecting dropout from SLIT. There was no significant difference regarding level of understanding of the treatment. The adherence tended to be poor in patients with short duration of disease, smoking patients, and young patients.

Risk factors for non-adherence and loss to follow-up in a three-year clinical trial in Botswana.

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Deborah A Gust

Full Text Available BACKGROUND: Participant non-adherence and loss to follow-up can compromise the validity of clinical trial results. An assessment of these issues was made in a 3-year tuberculosis prevention trial among HIV-infected adults in Botswana. METHODS AND FINDINGS: Between 11/2004-07/2006, 1995 participants were enrolled at eight public health clinics. They returned monthly to receive bottles of medication and were expected to take daily tablets of isoniazid or placebo for three years. Non-adherence was defined as refusing tablet ingestion but agreeing to quarterly physical examinations. Loss to follow-up was defined as not having returned for appointments in ≥60 days. Between 10/2008-04/2009, survey interviews were conducted with 83 participants identified as lost to follow-up and 127 identified as non-adherent. As a comparison, 252 randomly selected adherent participants were also surveyed. Multivariate logistic regression analysis was used to identify associations with selected risk factors. Men had higher odds of being non-adherent (adjusted odds ratio (AOR, 2.24; 95% confidence interval [95%CI] 1.24-4.04 and lost to follow-up (AOR 3.08; 95%CI 1.50-6.33. Non-adherent participants had higher odds of reporting difficulties taking the regimen or not knowing if they had difficulties (AOR 3.40; 95%CI 1.75-6.60 and lower odds associated with each year of age (AOR 0.95; 95%CI 0.91-0.98, but other variables such as employment, distance from clinic, alcohol use, and understanding study requirements were not significantly different than controls. Among participants who were non-adherent or lost to follow-up, 40/210 (19.0% reported that they stopped the medication because of work commitments and 33/210 (15.7% said they thought they had completed the study. CONCLUSIONS: Men had higher odds of non-adherence and loss to follow-up than women. Potential interventions that might improve adherence in trial participants may include:targeting health education for men

Risk factors for non-adherence and loss to follow-up in a three-year clinical trial in Botswana.

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Gust, Deborah A; Mosimaneotsile, Barudi; Mathebula, Unami; Chingapane, Balladiah; Gaul, Zaneta; Pals, Sherri L; Samandari, Taraz

2011-04-25

Participant non-adherence and loss to follow-up can compromise the validity of clinical trial results. An assessment of these issues was made in a 3-year tuberculosis prevention trial among HIV-infected adults in Botswana. Between 11/2004-07/2006, 1995 participants were enrolled at eight public health clinics. They returned monthly to receive bottles of medication and were expected to take daily tablets of isoniazid or placebo for three years. Non-adherence was defined as refusing tablet ingestion but agreeing to quarterly physical examinations. Loss to follow-up was defined as not having returned for appointments in ≥60 days. Between 10/2008-04/2009, survey interviews were conducted with 83 participants identified as lost to follow-up and 127 identified as non-adherent. As a comparison, 252 randomly selected adherent participants were also surveyed. Multivariate logistic regression analysis was used to identify associations with selected risk factors. Men had higher odds of being non-adherent (adjusted odds ratio (AOR), 2.24; 95% confidence interval [95%CI] 1.24-4.04) and lost to follow-up (AOR 3.08; 95%CI 1.50-6.33). Non-adherent participants had higher odds of reporting difficulties taking the regimen or not knowing if they had difficulties (AOR 3.40; 95%CI 1.75-6.60) and lower odds associated with each year of age (AOR 0.95; 95%CI 0.91-0.98), but other variables such as employment, distance from clinic, alcohol use, and understanding study requirements were not significantly different than controls. Among participants who were non-adherent or lost to follow-up, 40/210 (19.0%) reported that they stopped the medication because of work commitments and 33/210 (15.7%) said they thought they had completed the study. Men had higher odds of non-adherence and loss to follow-up than women. Potential interventions that might improve adherence in trial participants may include:targeting health education for men, reducing barriers, clarifying study expectations, educating

Up-regulation of intestinal vascular endothelial growth factor by Afa/Dr diffusely adhering Escherichia coli.

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Gaëlle Cane

Full Text Available BACKGROUND: Angiogenesis has been recently described as a novel component of inflammatory bowel disease pathogenesis. The level of vascular endothelial growth factor (VEGF has been found increased in Crohn's disease and ulcerative colitis mucosa. To question whether a pro-inflammatory Escherichia coli could regulate the expression of VEGF in human intestinal epithelial cells, we examine the response of cultured human colonic T84 cells to infection by E. coli strain C1845 that belongs to the typical Afa/Dr diffusely adhering E. coli family (Afa/Dr DAEC. METHODOLOGY: VEGF mRNA expression was examined by Northern blotting and q-PCR. VEGF protein levels were assayed by ELISA and its bioactivity was analysed in endothelial cells. The bacterial factor involved in VEGF induction was identified using recombinant E. coli expressing Dr adhesin, purified Dr adhesin and lipopolysaccharide. The signaling pathway activated for the up-regulation of VEGF was identified using a blocking monoclonal anti-DAF antibody, Western blot analysis and specific pharmacological inhibitors. PRINCIPAL FINDINGS: C1845 bacteria induce the production of VEGF protein which is bioactive. VEGF is induced by adhering C1845 in both a time- and bacteria concentration-dependent manner. This phenomenon is not cell line dependent since we reproduced this observation in intestinal LS174, Caco2/TC7 and INT407 cells. Up-regulation of VEGF production requires: (1 the interaction of the bacterial F1845 adhesin with the brush border-associated decay accelerating factor (DAF, CD55 acting as a bacterial receptor, and (2 the activation of a Src protein kinase upstream of the activation of the Erk and Akt signaling pathways. CONCLUSIONS: Results demonstrate that a Afa/Dr DAEC strain induces an adhesin-dependent activation of DAF signaling that leads to the up-regulation of bioactive VEGF in cultured human intestinal cells. Thus, these results suggest a link between an entero-adherent, pro

Adherence to cancer screening guidelines and predictors of improvement among participants in the Kansas State Employee Wellness Program.

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Hui, Siu-kuen Azor; Engelman, Kimberly K; Shireman, Theresa I; Ellerbeck, Edward F

2013-07-11

Employee wellness programs (EWPs) have been used to implement worksite-based cancer prevention and control interventions. However, little is known about whether these programs result in improved adherence to cancer screening guidelines or how participants' characteristics affect subsequent screening. This study was conducted to describe cancer screening behaviors among participants in a state EWP and identify factors associated with screening adherence among those who were initially nonadherent. We identified employees and their dependents who completed health risk assessments (HRAs) as part of the Kansas state EWP in both 2008 and 2009. We examined baseline rates of adherence to cancer screening guidelines in 2008 and factors associated with adherence in 2009 among participants who were initially nonadherent. Of 53,095 eligible participants, 13,222 (25%) participated in the EWP in 2008 and 6,205 (12%) participated in both years. Among the multiyear participants, adherence was high at baseline to screening for breast (92.5%), cervical (91.8%), and colorectal cancer (72.7%). Of participants who were initially nonadherent in 2008, 52.4%, 41.3%, and 33.5%, respectively, became adherent in the following year to breast, cervical, and colorectal cancer screening. Suburban/urban residence and more frequent doctor visits predicted adherence to breast and colorectal cancer screening guidelines. The effectiveness of EWPs for increasing cancer screening is limited by low HRA participation rates, high rates of adherence to screening at baseline, and failure of nonadherent participants to get screening. Improving overall adherence to cancer screening guidelines among employees will require efforts to increase HRA participation, stronger interventions for nonadherent participants, and better access to screening for rural employees.

Adherence to blood pressure and glucose recommendations in chronic kidney disease hospital inpatients: Clinical inertia and patient adherence.

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Gardiner, Fergus William; Nwose, Ezekiel Uba; Bwititi, Phillip Taderera; Crockett, Judith; Wang, Lexin

2018-05-01

To determine the extent to which targets for blood pressure (BP) (inertia affects BP and glucose control in CKD and diabetes mellitus (DM). Data was collected from the 1st January 2015 until 31st December 2015 on key patient pathology, admission reason, final discharge diagnosis, and information concerning clinical guideline adherence. Eighty-seven (n = 87) CKD patients were included. The average hospital BP for all CKD patients was 134.3/73.4 mmHg, adhering to recommendations of 7.0% >53 mmol/mol). There were 21 cases of clinical inertia, affecting 18 out of 87 patients (20.7%), with significant adverse hospital discharge differences (p = inertia and non- clinical inertia patient systolic BP (144.2 vs. 132.8 mmHg), deranged BGL (66.7% vs. 35.3%), and reduction in kidney function (83.3% vs. 30.9%). Adherence appears to be related to inpatient clinical inertia and outpatient patient health literacy and empowerment. Copyright © 2017 Diabetes India. Published by Elsevier Ltd. All rights reserved.

Medicine non-adherence in kidney transplantation.

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Williams, Allison Fiona; Manias, Elizabeth; Gaskin, Cadeyrn J; Crawford, Kimberley

2014-06-01

The increasing prevalence of chronic kidney disease, the relative shortage of kidney donors and the economic- and health-related costs of kidney transplant rejection make the prevention of adverse outcomes following transplantation a healthcare imperative. Although strict adherence to immunosuppressant medicine regimens is key to preventing kidney rejection, evidence suggests that adherence is sub-optimal. Strategies need to be developed to help recipients of kidney transplants adhere to their prescribed medicines. This review has found that a number of factors contribute to poor adherence, for example, attitudes towards medicine taking and forgetfulness. Few investigations have been conducted, however, on strategies to enhance medicine adherence in kidney transplant recipients. Strategies that may improve adherence include pharmacist-led interventions (incorporating counselling, medicine reviews and nephrologist liaison) and nurse-led interventions (involving collaboratively working with recipients to understand their routines and offering solutions to improve adherence). Strategies that have shown to have limited effectiveness include supplying medicines free of charge and providing feedback on a participant's medicine adherence without any educational or behavioural interventions. Transplantation is the preferred treatment option for people with end-stage kidney disease. Medicine non-adherence in kidney transplantation increases the risk of rejection, kidney loss and costly treatments. Interventions are needed to help the transplant recipient take all their medicines as prescribed to improve general well-being, medicine safety and reduce healthcare costs. © 2014 European Dialysis and Transplant Nurses Association/European Renal Care Association.

Mediterranean diet adherence by patients with primary open angle glaucoma.

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Abreu-Reyes, J A; Álvarez-Luis, D; Arteaga-Hernández, V; Sánchez-Mendez, M; Abreu-González, R

2017-08-01

To study the adherence to the Mediterranean diet in patients affected by primary open angle glaucoma (POAG). An observational study was conducted to assess the adherence to the Mediterranean diet in patients affected by POAG, and who attended the Ophthalmology Department of the Canary Islands University Hospital. The study included completing a 14-item questionnaire validated by the PREDIMED Study, in person or by telephone. A total of 100 questionnaires were completed successfully by 50 males and 50 females. The mean age was 69.58 years for the males and 67.42 years for women. The men had more comorbidities than women (tobacco 14 vs. 3%), arterial hypertension, and diabetes (30 vs. 28%, and 16 vs. 6%, respectively). Adherence to the Mediterranean diet in males, was low in 9 patients (18%), moderate in 37 (74%), and high in 4 (8%) cases. In women adherence was low in 14 patients (28%), moderate in 34 (68%), and high in 2 (6%) cases. The overall adhesion to the Mediterranean diet is low in 23%, moderate in 71% and high in 6% of the cases. Patients who are affected by POAG have moderate adherence to the Mediterranean diet. Copyright © 2017 Sociedad Española de Oftalmología. Publicado por Elsevier España, S.L.U. All rights reserved.

Guidelines Adherence and Hypertension Control in an Outpatient ...

African Journals Online (AJOL)

Purpose: To evaluate doctors' adherence to Malaysian Clinical Practice Guideline (CPG) 2008 in established hypertensive patients with cardiovascular diseases and factors associated with guideline adherence and hypertension control in Pulau Pinang Hospital, Malaysia. Methods: Prescriptions written by 13 doctors for ...

Level of insulin adherence among diabetes mellitus patients in Felege Hiwot Referral Hospital, Bahir Dar, Northwest Ethiopia, 2017: a cross-sectional study.

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Tewabe, Tilahun; Kindie, Selamsew

2018-05-11

The objective of this study was to know the level of insulin adherence and to identify factors affecting insulin adherence among diabetes mellitus patients in Felege Hiwot Referral Hospital, Bahir Dar, Northwest Ethiopia. Prevalence of insulin adherence was 59.2%. Patients who are married [AOR = 0.3 (0.14-0.7)], have regular health care visit [AOR = 3.3 (1.5-7.5)] and accessing insulin with low cost [AOR = 2.9 (1.3-6.3)] were more likely to adhere insulin therapy than their counterparts. Recommendations to increase insulin adherence were: government and non-governmental organizations, volunteers and concerned bodies should support syringe and needles for diabetes patients, health care providers and responsible bodies should give intensive health education about the effect of stopping insulin medication.

Adherence to Combined Lifestyle Factors and Their Contribution to Obesity in the IDEFICS Study

DEFF Research Database (Denmark)

Kovács, Eva; Hunsberger, Monica; Reisch, Lucia

2015-01-01

to childhood obesity, namely water/sweetened drink, fruit/vegetable consumption, daily TV time, physical activity, family time and adequate sleep duration, was measured at baseline. Adherence to international recommendations was converted into a composite score ranging from 0 (none) to 6 (adhering to all......). Data on adherence were available for 7,444 to 15,084 children aged 2-9.9 years, depending on the behaviour. By means of multi-level logistic regression models adjusted for age, sex and country, we calculated odds ratios (OR) and 95% confidence intervals (CI) to estimate the relationship between.......65-1.01) compared with non-adherence (score = 0), while adhering to more than half of the key behaviours (score ≥ 4) halved the chance for overweight/obesity (OR = 0.54, CI: 0.37-0.80). Adherence to physical activity, TV and sleep recommendations was the main driver reducing the chance of being overweight...

Adherence to cognitive behavioral therapy for insomnia: a systematic review.

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Matthews, Ellyn E; Arnedt, J Todd; McCarthy, Michaela S; Cuddihy, Leisha J; Aloia, Mark S

2013-12-01

Chronic insomnia is a significant public health problem worldwide, and insomnia has considerable personal and social costs associated with serious health conditions, greater healthcare utilization, work absenteeism, and motor-vehicle accidents. Cognitive behavioral therapy for insomnia (CBTI) is an efficacious treatment, yet attrition and suboptimal adherence may diminish its impact. Despite the increasing use of CBTI, surprisingly little attention has been devoted to understanding the role of adherence. This review describes a comprehensive literature search of adherence to CBTI. The search revealed 15 studies that evaluated adherence to CBTI in adults using valid and reliable measures of sleep, and measure of adherence other than study withdrawals. The primary purposes of this review were to 1) synthesize current study characteristics, methodology, adherence rates, contributing factors, and impact on outcomes, 2) discuss measurement issues, and 3) identify future practice and research directions that may lead to improved outcomes. Strong patterns and inconsistencies were identified among the studies, which complicate an evaluation of the role of adherence as a factor and outcome of CBTI success. The importance of standardized adherence and outcome measures is discussed. In light of the importance of adherence to behavior change, this systematic review may better inform future intervention efforts. Copyright © 2013 Elsevier Ltd. All rights reserved.

Understanding Adherence to Daily and Intermittent Regimens of Oral HIV Pre-exposure Prophylaxis Among Men Who Have Sex with Men in Kenya.

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Mugo, Peter Mwangi; Sanders, Eduard J; Mutua, Gaudensia; van der Elst, Elisabeth; Anzala, Omu; Barin, Burc; Bangsberg, David R; Priddy, Frances H; Haberer, Jessica E

2015-05-01

A qualitative assessment of Kenyan men who have sex with men taking daily and intermittent oral HIV pre-exposure prophylaxis (PrEP) found stigma, sex work, mobility, and alcohol impacted adherence. We analyzed quantitative data from the same cohort to explore different definitions of intermittent adherence. Volunteers were randomized to daily emtricitabine/tenofovir or placebo, or intermittent (prescription: Mondays/Fridays/after sex, maximum 1 dose/day) emtricitabine/tenofovir or placebo (2:1:2:1), and followed for 4 months. By electronic monitoring, median adherence for daily dosing was 80 %. Median adherence for intermittent dosing was 71 % per a "relaxed" definition (accounting for off-prescription dosing) and 40 % per a "strict" definition (limited to the prescription). Factors associated with lower adherence included travel, transactional sex, and longer follow-up; higher adherence was associated with daily dosing and an income. The definition of intermittent dosing strongly affects interpretation of adherence. These findings suggest interventions should address challenges of mobility, sex work, and long-term PrEP.

Adherence to nutritional therapy in obese adolescents; a review.

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França, Silvana Lima Guimarães; Sahade, Viviane; Nunes, Mônica; Adan, Luis F

2013-01-01

Considering the controversies existent on the subject, the aim of this review is to discuss adherence to diet in obese adolescents. The selection of articles was made in the SCOPUS, COCHRANE, APA Psyc Net, SciELO, LILACS, CAPES Journals, PUBMED/MEDLINE and GOOGLE ACADEMIC databases. Studies published between 2002 and 2012 were selected. There was lack of evidence of conceptual discussion about adherence to diet in obesity in the child-youth context, in addition to scarcity of data on adherence to diet itself in obese adolescents and the methods of evaluating this. Lastly, multiple interdependent factors were found which both facilitated and made the process of adherence to diet difficult for obese youngsters. The majority of these (factors) belong to the socioeconomic and cultural dimension, in addition to pointing out cognitive and psychological factors and those associated with health services and professionals. Copyright © AULA MEDICA EDICIONES 2013. Published by AULA MEDICA. All rights reserved.

Health behavior change: can genomics improve behavioral adherence?

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McBride, Colleen M; Bryan, Angela D; Bray, Molly S; Swan, Gary E; Green, Eric D

2012-03-01

The National Human Genome Research Institute recommends pursuing "genomic information to improve behavior change interventions" as part of its strategic vision for genomics. The limited effectiveness of current behavior change strategies may be explained, in part, by their insensitivity to individual variation in adherence responses. The first step in evaluating whether genomics can inform customization of behavioral recommendations is evidence reviews to identify adherence macrophenotypes common across behaviors and individuals that have genetic underpinnings. Conceptual models of how biological, psychological, and environmental factors influence adherence also are needed. Researchers could routinely collect biospecimens and standardized adherence measurements of intervention participants to enable understanding of genetic and environmental influences on adherence, to guide intervention customization and prospective comparative effectiveness studies.

Optimizing patient management and adherence for children receiving growth hormone

DEFF Research Database (Denmark)

Acerini, Carlo L.; Wac, Katarzyna; Bang, Peter

2017-01-01

© 2017 Acerini, Wac, Bang and Lehwalder. Poor adherence with growth hormone (GH) therapy has been associated with worse clinical outcomes, which in children relates specifically to their linear growth and loss of quality of life. The "360° GH in Europe" meeting, held in Lisbon, Portugal, in June...... and are reported as a manuscript, authored by the speakers. Reported here is a summary of the proceedings of the second session, which reviewed the determinants of GH therapy response, factors affecting GH therapy adherence and the development of innovative technologies to improve GH treatment in children....... Response to GH therapy varies widely, particularly in regard to the underlying diagnosis, although there is little consensus on the definition of a poor response. If the growth response is seen to be less than expected, the possible reasons should be discussed with patients and their parents, including...

A risk stratification model for antihypertensive medication non-adherence among Chinese immigrants

Directory of Open Access Journals (Sweden)

Wen-Wen Li

2016-12-01

Full Text Available The purpose of this study was to establish a risk stratification model for identifying Chinese immigrants at risk for non-adherence to antihypertensive medications. Questionnaires were self-administered to 200 Chinese immigrants in San Francisco, USA. Questionnaires included demographics, culture factors (e.g., Perceived Susceptibility in General, Perceived Benefits of Western Medication, Perceived Benefits of Chinese Herbs, and Health-Related Social Support, and medications adherence. Participants' mean age was 70.6 (±10.3 years. Three stratification factors were identified for non-adherence: Lower Perceived Susceptibility in General, lower Perceived Benefit of Western Medications, and longer Length of Stay in the United States. The probability of non-adherence was 77%, 62%, and 57% for lower perceived susceptibility, longer stay in the United States, and lower perceived benefits of Western medications, respectively. A combination of lower perceived susceptibility and lower perceived benefits of medication predicted 81% non-adherence and lower perceived susceptibility with longer stay in the United States predicted at 84%. All three factors combined predicted nearly 90%. Patients with all three factors had the highest risk for non-adherence. The second priority groups are patients with lower perceived susceptibility and those with lower perceived susceptibility combined with any of the other two factors. In the clinical setting, these three groups are a high priority for education on the importance of medication adherence.

Microbial adherence to cosmetic contact lenses.

Science.gov (United States)

Chan, Ka Yin; Cho, Pauline; Boost, Maureen

2014-08-01

To investigate whether cosmetic contact lenses (CCL) with surface pigments affect microbial adherence. Fifteen brands of CCL were purchased from optical, non-optical retail outlets, and via the Internet. A standardized rub-off test was performed on each CCL (five lenses per brand) to confirm the location of the pigments. The rub-off test comprised gentle rubbing on the surfaces of each CCL with wetted cotton buds for a maximum of 20 rubs per surface. A new set of CCL (five lenses per brand) were incubated in Pseudomonas aeruginosa overnight. Viable counts of adhered bacteria were determined by the number of colony-forming units (CFU) on agar media on each lens. The adherence of P. aeruginosa as well as Staphylococcus aureus and Serratia marcescens to three brands of CCL (A-C) (five lenses per brand) were also compared to their adherences on their clear counterparts. Only two of the 15 brands of CCL tested (brands B and C) had pigments that did not detach with the rub-off test. The remaining 13 brands of CCL all failed the rub-off test and these lenses showed higher P. aeruginosa adherence (8.7 × 10(5)-1.9 × 10(6) CFU/lens). Brands B and C lenses showed at least six times less bacterial adhesion than the other 13 brands. Compared to their clear counterparts, bacterial adherence to brands B and C lenses did not differ significantly, whereas brand A lenses showed significantly higher adherence. Surface pigments on CCL resulted in significantly higher bacterial adherence. Copyright © 2013 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.

Dietary Adherence, Glycemic Control, and Psychological Factors Associated with Binge Eating Among Indigenous and Non-Indigenous Chileans with Type 2 Diabetes.

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Herbozo, Sylvia; Flynn, Patricia M; Stevens, Serena D; Betancourt, Hector

2015-12-01

Despite the strong association between obesity and binge eating, limited research has examined the implications of binge eating on dietary adherence and psychological factors in ethnically diverse type 2 diabetes patients. This study investigated the prevalence of binge eating and its association with dietary adherence, glycemic control, and psychological factors among indigenous and non-indigenous type 2 diabetes patients in Chile. Participants were 387 indigenous (Mapuche) and non-indigenous (non-Mapuche) adults with type 2 diabetes. Self-report measures of binge eating, dietary adherence, diet self-efficacy, body image dissatisfaction, and psychological well-being were administered. Participants' weight, height, and glycemic control (HbA(1c)) were also obtained. Approximately 8 % of the type 2 diabetes patients reported binge eating. The prevalence among Mapuche patients was 4.9 %, and among non-Mapuche patients, it was 9.9 %. Compared to non-binge eaters, binge eating diabetes patients had greater body mass index values, consumed more high-fat foods, were less likely to adhere to their eating plan, and reported poorer body image and emotional well-being. Results of this study extend previous research by examining the co-occurrence of binge eating and type 2 diabetes as well as the associated dietary behaviors, glycemic control, and psychological factors among indigenous and non-indigenous patients in Chile. These findings may increase our understanding of the health challenges faced by indigenous populations from other countries and highlight the need for additional research that may inform interventions addressing binge eating in diverse patients with type 2 diabetes.

Addressing drug adherence using an operations management model.

Science.gov (United States)

Nunlee, Martin; Bones, Michelle

2014-01-01

OBJECTIVE To provide a model that enables health systems and pharmacy benefit managers to provide medications reliably and test for reliability and validity in the analysis of adherence to drug therapy of chronic disease. SUMMARY The quantifiable model described here can be used in conjunction with behavioral designs of drug adherence assessments. The model identifies variables that can be reproduced and expanded across the management of chronic diseases with drug therapy. By creating a reorder point system for reordering medications, the model uses a methodology commonly seen in operations research. The design includes a safety stock of medication and current supply of medication, which increases the likelihood that patients will have a continuous supply of medications, thereby positively affecting adherence by removing barriers. CONCLUSION This method identifies an adherence model that quantifies variables related to recommendations from health care providers; it can assist health care and service delivery systems in making decisions that influence adherence based on the expected order cycle days and the expected daily quantity of medication administered. This model addresses the possession of medication as a barrier to adherence.

Adherence to hydroxyurea medication by children with sickle cell disease (SCD) using an electronic device: a feasibility study.

Science.gov (United States)

Inoue, Susumu; Kodjebacheva, Gergana; Scherrer, Tammy; Rice, Gary; Grigorian, Matthew; Blankenship, Jeremy; Onwuzurike, Nkechi

2016-08-01

Adherence to hydroxyurea (HU) is a significant modifying factor in sickle cell vaso-occlusive pain. We conducted a study using an electronic medication container-monitor-reminder device (GlowCap™) to track adherence and determine whether use of this device affected rates of HU adherence. Subjects were regular attendees to our clinic. They were given a 37-item questionnaire and were asked to use a GlowCap containing HU. When the device cap is opened, it makes a remote "medication taken" record. The device also provides usage reminder in the form of lights and alarm sounds if the cap opening is delayed. Nineteen subjects participated in the survey, and 17 in the intervention phase. Of the 17, 12 had reliable adherence data. Seventeen caregivers of patients and two patients completed the survey. Two most common barriers to adherence identified were lack of reminders and absence of medicine home delivery. The intervention component of this study, which used both the electronic (GlowCap) method and medication possession ratio showed that the median adherence rate for the 12 patients evaluated was 85 %. The GlowCap device accurately kept a record of adherence rates. This device may be an effective tool for increasing HU medication adherence.

Psychosocial Variables Associated with Immunosuppressive Medication Non-Adherence after Renal Transplantation

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Jennifer Felicia Scheel

2018-02-01

Full Text Available IntroductionNon-adherence to immunosuppressive medication is regarded as an important factor for graft rejection and loss after successful renal transplantation. Yet, results on prevalence and relationship with psychosocial parameters are heterogeneous. The main aim of this study was to investigate the association of immunosuppressive medication non-adherence and psychosocial factors.MethodsIn 330 adult renal transplant recipients (≥12 months posttransplantation, health-related quality of life, depression, anxiety, social support, and subjective medication experiences were assessed, and their associations with patient-reported non-adherence was evaluated.Results33.6% of the patients admitted to be partially non-adherent. Non-adherence was associated with younger age, poorer social support, lower mental, but higher physical health-related quality of life. There was no association with depression and anxiety. However, high proportions of clinically relevant depression and anxiety symptoms were apparent in both adherent and non-adherent patients.ConclusionIn the posttransplant follow-up, kidney recipients with lower perceived social support, lower mental and higher physical health-related quality of life, and younger age can be regarded as a risk group for immunosuppressive medication non-adherence. In follow-up contacts with kidney transplant patients, physicians may pay attention to these factors. Furthermore, psychosocial interventions to optimize immunosuppressive medication adherence can be designed on the basis of this information, especially including subjectively perceived physical health-related quality of life and fostering social support seems to be of importance.

Low Calorie Diet Affects Aging-Related Factors

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... Current Issue Past Issues Research News From NIH Low Calorie Diet Affects Aging-Related Factors Past Issues / ... to learn more about the effects of sustained low-calorie diets in humans on factors affecting aging. ...

Pattern and Determinants of Antiretroviral Drug Adherence among Nigerian Pregnant Women

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S. O. Ekama

2012-01-01

Full Text Available Background. The need for a high level of adherence to antiretroviral drugs has remained a major hurdle to achieving maximal benefit from its use in pregnancy. This study was designed to determine the level of adherence and identify factors that influence adherence during pregnancy. Method. This is a cross-sectional study utilizing a semistructured questionnaire. Bivariate and multiple logistic regression models were used to determine factors independently associated with good drug adherence during pregnancy. Result. 137 (80.6% of the interviewed 170 women achieved adherence level of ≥95% using 3 day recall. The desire to protect the unborn child was the greatest motivation (51.8% for good adherence. Fear of being identified as HIV positive (63.6% was the most common reason for nonadherence. Marital status, disclosure of HIV status, good knowledge of ART, and having a treatment supporter were found to be significantly associated with good adherence at bivariate analysis. However, after controlling for confounders, only HIV status disclosure and having a treatment partner retained their association with good adherence. Conclusion. Disclosure of HIV status and having treatment support are associated with good adherence. Maternal desire to protect the child was the greatest motivator for adherence.

Non-adherence to pharmacological treatment in schizophrenia and schizophrenia spectrum disorders

DEFF Research Database (Denmark)

Ljungdalh, P. M.

2017-01-01

Background and objectives The primary treatment for schizophrenia and schizophrenia-spectrum disorders is antipsychotic medication. One of the many public health challenges in mental illness, is to identify contributing factors to non-adherence to pharmacological treatment. The objective...... of this study was to perform an updated systematic review of risk factors for non-adherence to pharmacological treatment in schizophrenia in a European and American context. Methods The study was a systematic literature review of studies that included at least two measurements of pharmacological adherence...... of illness, alcohol or drug abuse and unspecified younger age. Conclusions The findings in this systematic literature review are consistent with previous reviews on non-adherence and schizophrenia. It stresses the methodological challenges in psychiatric adherence research and establishes the need for more...

Adherence in pediatric kidney transplant recipients: solutions for the system.

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Steinberg, Elizabeth A; Moss, Mary; Buchanan, Cindy L; Goebel, Jens

2018-03-01

Non-adherence remains a significant problem among pediatric (and adult) renal transplant recipients. Non-adherence among solid organ transplant recipients results in US$15-100 million annual costs. Estimates of non-adherence range from 30 to 70% among pediatric patients. Research demonstrates that a 10% decrement in adherence is associated with 8% higher hazard of graft failure and mortality. Focus has begun to shift from patient factors that impact adherence to the contributing healthcare and systems factors. The purpose of this review is to describe problems within the systems implicated in non-adherence and potential solutions that may be related to positive adherence outcomes. Systems issues include insurance and legal regulations, provider and care team barriers to optimal care, and difficulties with transitioning to adult care. Potential solutions include recognition of how systems can work together to improve patient outcomes through improvements in insurance programs, a multi-disciplinary care team approach, evidence-based medical management, pharmacy-based applications and interventions to simplify medication regimens, improved transition protocols, and telehealth/technology-based multi-component interventions. However, there remains a significant lack of reliability in the application of these potential solutions to systems issues that impact patient adherence. Future efforts should accordingly focus on these efforts, likely by leveraging quality improvement and related principles, and on the investigation of the efficacy of these interventions to improve adherence and graft outcomes.

A systematic review of medication non-adherence in persons with dementia or cognitive impairment.

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Daisy Smith

Full Text Available Adherence to medication is vital for disease management while simultaneously reducing healthcare expenditure. Older persons with cognitive impairment (CI are at risk for non-adherence as cognitive processes are needed to manage medications. This systematic review focuses on the relationship between medication non-adherence and specific cognitive domains in persons with CI, and explores determinants of medication non-adherence. When available, relationships and factors are compared with cognitively intact populations.A seven database systematic search of studies published between 1 January 1949-31 December 2015 examining medication non-adherence in community dwelling persons with CI or dementia was conducted. Articles reporting medication non-adherence in people with CI or dementia in the community, with or without caregiver supports were eligible for inclusion. Papers reporting adherence to treatments in cognitively intact populations, populations from hospital or institutional settings, for non-prescribed medication or those describing dementia as a factor predicting medication non-adherence were excluded. Data on study and population characteristics, research design, data sources and analysis, specific cognitive domains, non-adherence prevalence, measurement of adherence, salient findings, factors associated with adherence and strategies to improve medication adherence were extracted. Study limitations included inconsistencies between data sources and definitions, resulting in a loss of fidelity in the value and comprehensiveness of data, as well as exclusion of non-pharmacological treatments and regimens.Fifteen studies met inclusion criteria. Adherence among CI subjects ranged from 10.7%-38% with better rates of adherence in non-CI individuals. Medication non-adherence definitions varied considerably. New-learning, memory and executive functioning were associated with improved adherence and formed the focus of most studies. Multiple factors

Association of adherence to therapy and complementary and alternative medicine use with demographic factors and disease phenotype in patients with inflammatory bowel disease.

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Lakatos, Peter Laszlo; Czegledi, Zsofia; David, Gyula; Kispal, Zsofia; Kiss, Lajos S; Palatka, Karoly; Kristof, Tunde; Nagy, Ferenc; Salamon, Agnes; Demeter, Pal; Miheller, Pal; Szamosi, Tamas; Banai, Janos; Papp, Maria; Bene, Laszlo; Kovacs, Agota; Racz, Istvan; Lakatos, Laszlo

2010-09-01

Previous studies have suggested an increasing use of complementary and alternative medicine (CAM) in patients with inflammatory bowel disease (IBD). Furthermore, a significant number of IBD patients fail to comply with treatment. The aim of our study was to evaluate the prevalence of non-adherence and the use of CAM in Hungarian patients with IBD. A total of 655 consecutive IBD patients (CD: 344, age: 38.2 [SD 12.9]years; UC: 311, age: 44.9 [15.3]years) were interviewed during the specialist visit by self-administered questionnaire including demographic and disease-related data as well as items analyzing the extent of non-adherence and CAM use. Patients taking more than 80% of each prescribed medication were classified as adherent. The overall rate of self-reported non-adherence (CD: 20.9%, UC: 20.6%) and CAM (CD: 31.7%, UC: 30.9%) use did not differ between Crohn's disease (CD) and ulcerative colitis (UC). The most common causes of non-adherence were: forgetfulness (47.8%), too many/unnecessary pills (39.7%), being afraid of side effects (27.9%) and too frequent dosing. Most common forms of CAM were herbal tea (47.3%), homeopathy (14.6%), special diet (12.2%), and acupuncture (5.8%). In CD, disease duration, date of last follow-up visit, educational level and previous surgeries were predicting factors for non-adherence. Alternative medicine use was associated in both diseases with younger age, higher educational level, and immunosuppressant use. In addition, CAM use in UC was more common in females and in patients with supportive psychiatric/psychological therapy. Non-adherence and CAM use is common in patients with IBD. Special attention should be paid to explore the identified predictive factors during follow-up visits to improve adherence to therapy and improving patient-doctor relationship. Copyright © 2009 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.

Self-perception of knowledge and adherence reflecting the effectiveness of antiretroviral therapy.

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Dagli-Hernandez, Carolina; Lucchetta, Rosa Camila; de Nadai, Tales Rubens; Galduróz, José Carlos Fernandez; Mastroianni, Patricia de Carvalho

2016-01-01

To evaluate which indirect method for assessing adherence best reflects highly active antiretroviral therapy (HAART) effectiveness and the factors related to adherence. This descriptive, cross-sectional study was performed in 2012 at a reference center of the state of São Paulo. Self-report (simplified medication adherence questionnaire [SMAQ]) and drug refill parameters were compared to the viral load (clinical parameter of the effectiveness of pharmacotherapy [EP]) to evaluate the EP. The "Cuestionario para la Evaluación de la Adhesión al Tratamiento Antiretroviral" (CEAT-VIH) was used to evaluate factors related to adherence and the EP and, complementarily, patient self-perception of adherence was compared to the clinical parameter of the EP. Seventy-five patients were interviewed, 60 of whom were considered as adherent from the clinical parameter of the EP and ten were considered as adherent from all parameters. Patient self-perception about adherence was the instrument that best reflected the EP when compared to the standardized self-report questionnaire (SMAQ) and drug refill parameter. The level of education and the level of knowledge on HAART were positively correlated to the EP. Forgetfulness, alcohol use, and lack of knowledge about the medications were the factors most frequently reported as a cause of nonadherence. A new parameter of patient self-perception of adherence, which is a noninvasive, inexpensive instrument, could be applied and assessed as easily as self-report (SMAQ) during monthly drug refill, since it allows monitoring adherence through pharmaceutical assistance. Therefore, patient adherence to HAART could be evaluated using self-perception (CEAT-VIH) and the viral load test.

Self-reported Medication Adherence and CKD Progression

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Esteban A. Cedillo-Couvert

2018-05-01

Full Text Available Introduction: In the general population, medication nonadherence contributes to poorer outcomes. However, little is known about medication adherence among adults with chronic kidney disease (CKD. We evaluated the association of self-reported medication adherence with CKD progression and all-cause death in patients with CKD. Methods: In this prospective observational study of 3305 adults with mild-to-moderate CKD enrolled in the Chronic Renal Insufficiency Cohort (CRIC Study, the baseline self-reported medication adherence was assessed by responses to 3 questions and categorized as high, medium, and low. CKD progression (50% decline in eGFR or incident end-stage renal disease and all-cause death were measured using multivariable Cox proportional hazards. Results: Of the patients, 68% were categorized as high adherence, 17% medium adherence, and 15% low adherence. Over a median follow-up of 6 years, there were 969 CKD progression events and 675 deaths. Compared with the high-adherence group, the low-adherence group experienced increased risk for CKD progression (hazard ratio = 1.27, 95% confidence interval = 1.05, 1.54 after adjustment for sociodemographic and clinical factors, cardiovascular medications, number of medication types, and depressive symptoms. A similar association existed between low adherence and all-cause death, but did not reach standard statistical significance (hazard ratio = 1.14 95% confidence interval = 0.88, 1.47. Conclusion: Baseline self-reported low medication adherence was associated with an increased risk for CKD progression. Future work is needed to better understand the mechanisms underlying this association and to develop interventions to improve adherence. Keywords: CKD, death, medication adherence, progression

An observational study of health literacy and medication adherence in adult kidney transplant recipients.

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Demian, Maryam N; Shapiro, R Jean; Thornton, Wendy Loken

2016-12-01

There is a high prevalence of non-adherence to immunosuppressants in kidney transplant recipients. Although limited health literacy is common in kidney recipients and is linked to adverse outcomes in other medical populations, its effect on medication adherence in kidney transplant recipients remains poorly understood. The objective was to investigate the effect of lower health literacy on immunosuppressant adherence. Kidney recipients who were at least 6 months post-transplant and outpatients of Vancouver General Hospital in B.C., Canada were recruited through invitation letters. A total of 96 recipients completed the Health Literacy Questionnaire, which provides a multifactorial profile of self-reported health literacy and the Transplant Effects Questionnaire-Adherence subscale measuring self-reported immunosuppressant adherence. Hierarchical linear regression was used to analyze the association between health literacy and adherence after controlling for identified risk factors of non-adherence. Our sample was on average 53 years old, 56% male and 9 years post-transplant. Kidney recipients reported low levels of health literacy on scales measuring active health management and critical appraisal of information and 75% reported non-perfect adherence. Worse adherence was associated with poorer overall health literacy (Δ R 2 = 0.08, P = 0.004) and lower scores on six of nine of the health literacy factors. Poorer health literacy is associated with lower immunosuppressant adherence in adult kidney transplant recipients suggesting the importance of considering a recipient's level of health literacy in research and clinical contexts. Medication adherence interventions can target the six factors of health literacy identified as being risk factors for lower medication adherence.

Factors Affecting University Library Website Design

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Yongi-Mi Kim

2011-09-01

Full Text Available Existing studies have extensively explored factors that affect users’ intentions to use university library website resources (ULWR; yet little attention has been given to factors affecting university library website design. This paper investigates factors that affect university library website design and assesses the success of the university library website from both designers’ and users’ perspectives. The findings show that when planning a website, university web designers consider university guidelines, review other websites, and consult with experts and other divisions within the library; however, resources and training for the design process are lacking. While website designers assess their websites as highly successful, user evaluations are somewhat lower. Accordingly, use is low, and users rely heavily on commercial websites. Suggestions for enhancing the usage of ULWR are provided.

Factors associated with low adherence to medicine treatment for chronic diseases in Brazil.

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Tavares, Noemia Urruth Leão; Bertoldi, Andréa Dâmaso; Mengue, Sotero Serrate; Arrais, Paulo Sergio Dourado; Luiza, Vera Lucia; Oliveira, Maria Auxiliadora; Ramos, Luiz Roberto; Farias, Mareni Rocha; Pizzol, Tatiane da Silva Dal

2016-12-01

To analyze factors associated with low adherence to drug treatment for chronic diseases in Brazil. Analysis of data from Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM - Brazilian Survey on Access, Use and Promotion of Rational Use of Medicines), a population-based cross-sectional household survey, based on a probabilistic sample of the Brazilian population. We analyzed the association between low adherence to drug treatment measured by the Brief Medication Questionnaire and demographic, socioeconomic, health, care and prescription factors. We used Poisson regression model to estimate crude and adjusted prevalence ratios, their respective 95% confidence interval (95%CI) and p-value (Wald test). The prevalence of low adherence to drug treatment for chronic diseases was 30.8% (95%CI 28.8-33.0). The highest prevalence of low adherence was associated with individuals: young adults; no education; resident in the Northeast and Midwest Regions of Brazil; paying part of the treatment; poor self-perceived health; three or more diseases; reported limitations caused by a chronic disease; using five drugs or more. Low adherence to drug treatment for chronic diseases in Brazil is relevant, and regional and demographic differences and those related to patients' health care and therapy regime require coordinated action between health professionals, researchers, managers and policy makers. Analisar fatores associados à baixa adesão ao tratamento farmacológico de doenças crônicas no Brasil. Análise de dados oriundos da Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM), inquérito domiciliar de base populacional, de delineamento transversal, baseado em amostra probabilística da população brasileira. Analisou-se a associação entre baixa adesão ao tratamento medicamentoso mensurado pelo Brief Medication Questionnaire e fatores demográficos, socioeconômicos, de saúde, assist

Predicting exercise adherence in cancer patients and survivors: a systematic review and meta-analysis of motivational and behavioural factors.

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Husebø, Anne M Lunde; Dyrstad, Sindre M; Søreide, Jon A; Bru, Edvin

2013-01-01

To examine research findings regarding predictors of adherence to exercise programmes in cancer populations. Cancer patients are advised to participate in daily exercise. Whether they comply with the recommendations for physical activity or not remains unclear. A systematic review and meta-analysis. Empirical articles published in English between 1995 and 2011 were searched in electronic databases and in reference lists, using the search terms 'adherence', 'predictors', 'exercise', and 'cancer' in varying combinations. Twelve of 541 screened abstracts met the inclusion criteria. The included studies' eligibility considering predictors of exercise adherence were reviewed. A quality assessment process evaluating the studies methodological quality was performed. Eight of the reviewed studies were considered eligible for a meta-analysis involving Pearson's r correlations. Exercise stage of change, derived from the transtheoretical model of behaviour change (TTM) was found to be statistically significant and a strong predictor of exercise adherence. In addition, the theory of planned behaviour (TPB) construct; intention to engage in a health-changing behaviour and perceived behavioural control, demonstrated significant correlations with exercise adherence. The review identified that both the TPB and the TTM frameworks include aspects that predicts exercise adherence in cancer patients, and thus contributes to the understanding of motivational factors of change in exercise behaviour in cancer populations. However, the strengths of predictions were relatively weak. More research is needed to identify predictors of greater importance. Surveying the patients' readiness and intention to initiate and maintain exercise levels, as well as tailoring exercise programmes to individual needs may be important for nurses in order to help patients meet exercise guidelines and stay active. © 2012 Blackwell Publishing Ltd.

[Medication adherence of 65 patients in hemodialysis in Togo].

Science.gov (United States)

Sabi, K A; Noto-Kadou-Kaza, B; Amekoudi, Y E; Tsevi, M C; Sylla, F; Kossidze, K; Gnionsahe, D A

2014-01-01

The aim of this study was to assess adherence in people on hemodialysis and determine the factors of poor adherence. This cross-sectional study took place throughout the month of September, 2012, in the hemodialysis center of the Sylvanus Olympio University Hospital, the only such center in Togo. The study included 65 patients, with a mean age of 49.5 years (range: 22 to 77 years), more often men (sex ratio: 1.82) and married (74 %). More than half (58%) had completed secondary education, while 73% belonged to the least advantaged socioeconomic class; 61 (94%) had health insurance, and 57% had been on dialysis for 1 to 4 years. The compliance rate was 11%. The main factors associated with good adherence were marital status (p = 0.0339) and the patient's general health status (p = 0.001). Treatment fatigue (p = 0.0347), forgetfulness (p = 0.0001), dosage forms and drug characteristics (p = 0.0198) were all factors of noncompliance. Therapeutic non-compliance was proportional to the number of drugs prescribed (p = 0.4263). Adherence in hemodialysis patients in Togo is very poor.

Glia maturation factor gamma regulates the migration and adherence of human T lymphocytes

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Lippert Dustin ND

2012-04-01

Full Text Available Abstract Background Lymphocyte migration and chemotaxis are essential for effective immune surveillance. A critical aspect of migration is cell polarization and the extension of pseudopodia in the direction of movement. However, our knowledge of the underlying molecular mechanisms responsible for these events is incomplete. Proteomic analysis of the isolated leading edges of CXCL12 stimulated human T cell lines was used to identify glia maturation factor gamma (GMFG as a component of the pseudopodia. This protein is predominantly expressed in hematopoietic cells and it has been shown to regulate cytoskeletal branching. The present studies were undertaken to examine the role of GMFG in lymphocyte migration. Results Microscopic analysis of migrating T-cells demonstrated that GMFG was distributed along the axis of movement with enrichment in the leading edge and behind the nucleus of these cells. Inhibition of GMFG expression in T cell lines and IL-2 dependent human peripheral blood T cells with shRNAmir reduced cellular basal and chemokine induced migration responses. The failure of the cells with reduced GMFG to migrate was associated with an apparent inability to detach from the substrates that they were moving on. It was also noted that these cells had an increased adherence to extracellular matrix proteins such as fibronectin. These changes in adherence were associated with altered patterns of β1 integrin expression and increased levels of activated integrins as detected with the activation specific antibody HUTS4. GMFG loss was also shown to increase the expression of the β2 integrin LFA-1 and to increase the adhesion of these cells to ICAM-1. Conclusions The present studies demonstrate that GMFG is a component of human T cell pseudopodia required for migration. The reduction in migration and increased adherence properties associated with inhibition of GMFG expression suggest that GMFG activity influences the regulation of integrin mediated

Factors Affecting Tocopherol Concentrations in Soybean Seeds.

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Carrera, Constanza S; Seguin, Philippe

2016-12-21

Soybean seeds contain several health-beneficial compounds, including tocopherols, which are used by the nutraceutical and functional food industries. Soybean tocopherol concentrations are, however, highly variable. Large differences observed in tocopherol concentrations among soybean genotypes together with the relatively simple biosynthetic pathway involving few genes support the feasibility of selecting for high-tocopherol soybean. Tocopherol concentrations are also highly influenced by environmental factors and field management. Temperature during seed filling and soil moisture appear to be the main factors affecting tocopherol concentrations; other factors such as soil fertility and solar radiation also affect concentrations and composition. Field management decisions including seeding date, row spacing, irrigation, and fertilization also affect tocopherols. Knowledge of factors affecting soybean tocopherols is essential to develop management strategies that will lead to the production of seeds with consistent target concentrations that will meet the needs of the nutraceutical and functional food industries.

Factors Affecting Wound Healing

OpenAIRE

Guo, S.; DiPietro, L.A.

2010-01-01

Wound healing, as a normal biological process in the human body, is achieved through four precisely and highly programmed phases: hemostasis, inflammation, proliferation, and remodeling. For a wound to heal successfully, all four phases must occur in the proper sequence and time frame. Many factors can interfere with one or more phases of this process, thus causing improper or impaired wound healing. This article reviews the recent literature on the most significant factors that affect cutane...

Experiences of non-adherence to Internet-delivered cognitive behavior therapy: A qualitative study

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Olof Johansson

2015-05-01

Full Text Available Many trials on Internet-delivered psychological treatments have had problems with nonadherence, but not much is known about the subjective reasons for non-adhering. The aim of this study was to explore participants' experiences of non-adherence to Internet-delivered psychological treatment. Grounded theory was used to analyze data from seven in-depth interviews with persons who had non-adhered to a study on Internet-delivered cognitive behavioral therapy for generalized anxiety disorder. The process of non-adherence is described as an interaction between patient factors and treatment factors. A working model theory was generated to illustrate the experience of nonadherence. The model describes a process where treatment features such as workload, text-content complexity and treatment process don't match personal prerequisites regarding daily routines, perceived language skills and treatment expectations respectively, resulting in the decision to nonadhere. Negative effects were also stated as a reason for non-adherence. Several common strategies used for increasing adherence to Internet-delivered therapy in general are by these non-completers regarded as factors directly related to their reason for non-adherence.

Relationship of adherence determinants and parental spirituality in cystic fibrosis.

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Grossoehme, Daniel H; Opipari-Arrigan, Lisa; VanDyke, Rhonda; Thurmond, Sophia; Seid, Michael

2012-06-01

The course of cystic fibrosis (CF) progression in children is affected by parent adherence to treatment plans. The Theory of Reasoned Action (TRA) posits that intentions are the best behavioral predictors and that intentions reasonably follow from beliefs ("determinants"). Determinants are affected by multiple "background factors," including spirituality. This study's purpose was to understand whether two parental adherence determinants (attitude towards treatment and self-efficacy) were associated with spirituality (religious coping and sanctification of the body). We hypothesized that parents' attitudes toward treatment adherence are associated with these spiritual constructs. A convenience sample of parents of children with CF aged 3-12 years (n = 28) participated by completing surveys of adherence and spirituality during a regular outpatient clinic visit. Type and degree of religious coping was examined using principal component analysis. Adherence measures were compared based on religious coping styles and sanctification of the body using unpaired t-tests. Collaborative religious coping was associated with higher self-efficacy for completing airway clearance (M = 1070.8; SD = 35.8; P = 0.012), for completing aerosolized medication administration (M = 1077.1; SD = 37.4; P = 0.018), and for attitude towards treatment utility (M = 38.8; SD = 2.36; P = 0.038). Parents who attributed sacred qualities to their child's body (e.g., "blessed" or "miraculous") had higher mean scores for self-efficacy (airway clearance, M = 1058.6; SD = 37.7; P = 0.023; aerosols M = 1070.8; SD = 41.6; P = 0.020). Parents for whom God was manifested in their child's body (e.g., "My child's body is created in God's image") had higher mean scores for self-efficacy for airway clearance (M = 1056.4; SD = 59.0; P = 0.039), aerosolized medications (M = 1068.8; SD = 42.6; P = 0.033) and treatment utility (M�

Adherence to inhaled corticosteroids in children with asthma and their parents

NARCIS (Netherlands)

Dellen, Q.M. van; Stronks, K.; Bindels, P.J.E.; Öry, F.G.; Aalderen, W.M.C. van

2006-01-01

Poor adherence to inhaled corticosteroids (ICSs) may contribute to the recent rise in asthma morbidity. In general, appropriate adherence to ICSs is a complex process that is influenced by various determinants. The purpose of this study was to identify factors that were associated with adherence to

Web-based Factors Affecting Online Purchasing Behaviour

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Ariff, Mohd Shoki Md; Sze Yan, Ng; Zakuan, Norhayati; Zaidi Bahari, Ahamad; Jusoh, Ahmad

2013-06-01

The growing use of internet and online purchasing among young consumers in Malaysia provides a huge prospect in e-commerce market, specifically for B2C segment. In this market, if E-marketers know the web-based factors affecting online buyers' behaviour, and the effect of these factors on behaviour of online consumers, then they can develop their marketing strategies to convert potential customers into active one, while retaining existing online customers. Review of previous studies related to the online purchasing behaviour in B2C market has point out that the conceptualization and empirical validation of the online purchasing behaviour of Information and Communication Technology (ICT) literate users, or ICT professional, in Malaysia has not been clearly addressed. This paper focuses on (i) web-based factors which online buyers (ICT professional) keep in mind while shopping online; and (ii) the effect of web-based factors on online purchasing behaviour. Based on the extensive literature review, a conceptual framework of 24 items of five factors was constructed to determine web-based factors affecting online purchasing behaviour of ICT professional. Analysis of data was performed based on the 310 questionnaires, which were collected using a stratified random sampling method, from ICT undergraduate students in a public university in Malaysia. The Exploratory factor analysis performed showed that five factors affecting online purchase behaviour are Information Quality, Fulfilment/Reliability/Customer Service, Website Design, Quick and Details, and Privacy/Security. The result of Multiple Regression Analysis indicated that Information Quality, Quick and Details, and Privacy/Security affect positively online purchase behaviour. The results provide a usable model for measuring web-based factors affecting buyers' online purchase behaviour in B2C market, as well as for online shopping companies to focus on the factors that will increase customers' online purchase.

Web-based Factors Affecting Online Purchasing Behaviour

International Nuclear Information System (INIS)

Ariff, Mohd Shoki Md; Yan, Ng Sze; Zakuan, Norhayati; Bahari, Ahamad Zaidi; Jusoh, Ahmad

2013-01-01

The growing use of internet and online purchasing among young consumers in Malaysia provides a huge prospect in e-commerce market, specifically for B2C segment. In this market, if E-marketers know the web-based factors affecting online buyers' behaviour, and the effect of these factors on behaviour of online consumers, then they can develop their marketing strategies to convert potential customers into active one, while retaining existing online customers. Review of previous studies related to the online purchasing behaviour in B2C market has point out that the conceptualization and empirical validation of the online purchasing behaviour of Information and Communication Technology (ICT) literate users, or ICT professional, in Malaysia has not been clearly addressed. This paper focuses on (i) web-based factors which online buyers (ICT professional) keep in mind while shopping online; and (ii) the effect of web-based factors on online purchasing behaviour. Based on the extensive literature review, a conceptual framework of 24 items of five factors was constructed to determine web-based factors affecting online purchasing behaviour of ICT professional. Analysis of data was performed based on the 310 questionnaires, which were collected using a stratified random sampling method, from ICT undergraduate students in a public university in Malaysia. The Exploratory factor analysis performed showed that five factors affecting online purchase behaviour are Information Quality, Fulfilment/Reliability/Customer Service, Website Design, Quick and Details, and Privacy/Security. The result of Multiple Regression Analysis indicated that Information Quality, Quick and Details, and Privacy/Security affect positively online purchase behaviour. The results provide a usable model for measuring web-based factors affecting buyers' online purchase behaviour in B2C market, as well as for online shopping companies to focus on the factors that will increase customers' online purchase.

Determining the Factors Affecting Labor Productivity of Nurses

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Yurdanur Dikmen

2016-12-01

Results: It was found that the 45.5% of nurses participated in the study were in the 23-53 age group, 79.5% were women, 76.9% married, 41.1% associate degree graduates. 42.3% of nurses' durations of professional experience were 0-5 years, 22.4% of nurses were clinical chief, 69.2% were working as shifts. Participants believe that the factors affecting the labor productivity were respectively organizational factors, ergonomic factors and personal factors. When organizational factors was examined; nurses stated that the lack of working personnel in the section, the low wages and unequal wages for the same work, the long working hours and the system which based on personal relations instead of merit were affecting productivity. The factors affecting labor productivity of nurses were not different according to age, gender, education level and marital status (p>0.05, but different according to mode of operation and years of experience (p<0.05. Conclusion: According to this study, it was found that there are many factors that affect the efficiency of the nurses. The most important factors affecting nurses' efficiency were determined as wage and working conditions. [J Contemp Med 2016; 6(4.000: 334-342

Adherence to multiple micronutrient powders and associated factors in children aged 6 to 35 months treated in sentinel health facilities, Ministry of Health of Peru.

Science.gov (United States)

Munares-García, Oscar; Gómez-Guizado, Guillermo

2016-01-01

Anemia in children is a public health issue, and the current strategies include treatment and iron supplementation, but their level of adherence or compliance is unknown. To consider the adherence to multiple micronutrient powders and the associated factors. Epidemiological study of active surveillance through sentinel facilities in 2,024 children aged 6 to 35 months treated in health facilities of the Ministry of Health of Peru, from October to December 2014. Household visits were conducted in which counting of multiple micronutrient powders was applied and determined an adherence of consumption ≥ 90% envelopes, besides a form on the associated factors (anemia knowledge, iron-rich food, side effects, dosage regimen, drugs used, and motivation) was applied. Descriptive statistics, χ² test, Odds Ratio with a 95% confidence interval (CI), and binary logistic regression or adjusted Odds Ratio (aOR) were used. Of all, 79.1% participants were aged 6 to 23 months; 75.9% received multiple micronutrient powders; and the adherence was equivalent to 24.4% (95%CI 22.3 - 26.6). The factors: continue supplementation (OR = 3.5; 95%CI 1.7 - 7.5); no nausea (OR = 3.0; 95%CI 2.0 - 4.3); no use of antibiotics (OR = 2.5; 95%CI 1.7 - 3.6); and intention to continue treatment (OR = 2.3; 95%CI 1.3 - 4.1) were associated with adherence. The variables: thought of continuing treatment (aOR = 2.6; 95%CI 1.1 - 6.1); presence of side effects, but no discontinuation of the treatment (aOR = 2.5; 95%CI 1.4 - 4.3); no use of antibiotics (aOR = 2.0; 95%CI 1.1 - 3.4); and belief that not only drugs cure anemia (aOR = 1.6; 95%CI 1.0 - 2.6) were associated in the multivariate analysis. There was a low prevalence of adherence to a demanding cut-off point (≥ 90% of envelopes of multiple micronutrient powders), and the associated factors are associated with absence of infections, side effects, and mother's beliefs.

Chesapeake Bay recovery and factors affecting trends: Long-termmonitoring, indicators, and insights

Science.gov (United States)

Tango, Peter J.; Batiuk, Richard A.

2016-01-01

Monitoring the outcome of restoration efforts is the only way to identify the status of a recovery and the most effective management strategies. In this paper, we discuss Chesapeake Bay and watershed recovery and factors influencing water quality trends. For over 30 years, the Chesapeake Bay Program Partnership’s long-term tidal and watershed water quality monitoring networks have measured physical, chemical and biological parameters throughout the bay and its surrounding watershed underpinning an adaptive management process to drive ecosystem recovery. There are many natural and anthropogenic factors operating and interacting to affect the watershed and bay water quality recovery responses to management actions. Across habitats and indicators, the bay and its watershed continue to express a diverse spatial and temporal fabric of multiscale conditions, stressors and trends that show a range of health conditions and impairments, as well as evidence of progress and degradation. Recurrent independent reviews of the monitoring program have driven a culture of continued adaptation of the monitoring networks to reflect ever evolving management information needs. The adherence to bay and watershed-wide consistent monitoring protocols provides monitoring data supporting analyses and development of scientific syntheses that underpin indicator and model development, regulatory assessments, targeting of management actions, evaluation of management effectiveness, and directing of priorities and policies.

Determinants of Adherence with Malaria Chemoprophylactic Drugs Used in a Traveler's Health Clinic

Science.gov (United States)

Shady, Ibrahim

2015-01-01

Background. The WHO recommends mefloquine, atovaquone/proguanil, and doxycycline for malaria chemoprophylaxis. Adherence to a drug is determined by many factors. Objective. To detect the determinants of travelers' adherence to malaria chemoprophylaxis. Methods. A prospective comparative study was conducted from January 2012 to July 2013 that included travelers (928 travelers) to malaria endemic countries who visited the THC. They were classified into 3 groups: the 1st is the mefloquine group (396 travelers), the 2nd is the doxycycline group (370 travelers), and finally those who did not receive any drugs (162 travelers). The participants from the 1st and 2nd groups enrolled in the study. Results. Univariate and multivariate analyses were performed. The predictors for adherence in the mefloquine group were travel to an African destination [OR = 51 (6.8–2385)], higher than a secondary school education [OR = 21 (4.1–144.2)], organized travel [OR = 4 (2.1–6.5)], traveling for leisure [OR = 2.1 (1.1–0.4)], and nationality [OR = 2 (1.11–4.00)]. In the doxycycline group, the predictors included higher than a secondary education [OR = 20.1 (4.5–125.1)], organized travel [OR = 11.4 (5.5–20.9)], travel for leisure [OR = 7 (2.3–22.9)], travel to an African destination [OR = 6.1 (0.41–417)], and nationality [OR = 4.5 (2.3–9.5)]. Conclusion. Adherence with malaria chemoprophylaxis could be affected by many factors such as nationality, education, and organized travel. PMID:26379712

Associations between adherence to the Danish Food-Based Dietary Guidelines and cardiometabolic risk factors in a Danish adult population: the DIPI study

DEFF Research Database (Denmark)

Arentoft, Johanne Louise; Hoppe, Camilla; Andersen, Elisabeth Wreford

2018-01-01

Diet is recognised as one modifiable lifestyle factor for ischaemic heart disease (IHD). We aimed at investigating the associations between adherence to the Danish Food-Based Dietary Guidelines (FBDG) indicated by a Dietary Quality Index (DQI) and selected cardiometabolic risk factors in a cross-...

Ethno-Cultural Considerations in Cardiac Patients' Medication Adherence.

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King-Shier, K M; Singh, S; Khan, N A; LeBlanc, P; Lowe, J C; Mather, C M; Chong, E; Quan, H

2017-10-01

We aimed to develop an in-depth understanding about factors that influence cardiac medication adherence among South Asian, Chinese, and European White cardiac patients. Sixty-four patients were purposively sampled from an ongoing study cohort. Interviews were audio-recorded and transcribed for analyses. Physicians' culturally sensitive communication and patients' motivation to live a symptom-free and longer life enhanced adherence. European Whites were motivated to enhance personal well-being and enjoy family life. South Asians' medication adherence was influenced by the desire to fulfill the will of God and family responsibilities. The Chinese were motivated to avoid pain, illness, and death, and to obey a health care provider. The South Asians and Chinese wanted to ultimately reduce medication use. Previous positive experiences, family support, and establishing a routine also influenced medication adherence. Deterrents to adherence were essentially the reverse of the motivators/facilitators. This analysis represents an essential first step forward in developing ethno-culturally tailored interventions to optimize adherence.

Medication Adherence in Patients with Rheumatoid Arthritis: The Effect of Patient Education, Health Literacy, and Musculoskeletal Ultrasound

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Samantha Joplin

2015-01-01

Full Text Available Background. Rheumatoid arthritis (RA is a chronic systemic inflammatory disease affecting <1% of the population. Incompletely controlled RA results in fatigue, joint and soft tissue pain, progressive joint damage, reduced quality of life, and increased cardiovascular mortality. Despite an increasing range of disease modifying agents which halt disease progression, poor patient adherence with medication is a significant barrier to management. Objective. The goal of this review was to examine the effectiveness of measures to improve patient medication adherence. Methods. Studies addressing treatment adherence in patients with RA were identified by trawling PsycINFO, Medline, Cochrane, Pubmed, and ProQuest for studies published between January 2000 and October 2014. Articles were independently reviewed to identify relevant studies. Results. Current strategies were of limited efficacy in improving patient adherence with medications used to treat RA. Conclusion. Poor medication adherence is a complex issue. Low educational levels and limited health literacy are contributory factors. Psychological models may assist in explaining medication nonadherence. Increasing patient knowledge of their disease seems sensible. Existing educational interventions appear ineffective at improving medication adherence, probably due to an overemphasis on provision of biomedical information. A novel approach to patient education using musculoskeletal ultrasound is proposed.

Ambulatory blood pressure and adherence monitoring: diagnosing pseudoresistant hypertension.

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Burnier, Michel; Wuerzner, Gregoire

2014-01-01

A small proportion of the treated hypertensive population consistently has a blood pressure greater than 140/90 mm Hg despite a triple therapy including a diuretic, a calcium channel blocker, and a blocker of the renin-angiotensin system. According to guidelines, these patients have so-called resistant hypertension. The prevalence of this clinical condition is higher in tertiary than primary care centers and often is associated with chronic kidney disease, diabetes, obesity, and sleep apnea syndrome. Exclusion of pseudoresistant hypertension using ambulatory or home blood pressure monitoring is a crucial step in the investigation of patients with resistant hypertension. Thus, among the multiple factors to consider when investigating patients with resistant hypertension, ambulatory blood pressure monitoring should be performed very early. Among other factors to consider, physicians should investigate patient adherence to therapy, assess the adequacy of treatment, exclude interfering factors, and, finally, look for secondary forms of hypertension. Poor adherence to therapy accounts for 30% to 50% of cases of resistance to therapy depending on the methodology used to diagnose adherence problems. This review discusses the clinical factors implicated in the pathogenesis of resistant hypertension with a particular emphasis on pseudoresistance, drug adherence, and the use of ambulatory blood pressure monitoring for the diagnosis and management of resistant hypertension.

Factors affecting endoglucanase production by Trichoderma reesei ...

African Journals Online (AJOL)

Jane

2011-08-22

Aug 22, 2011 ... from the ANOVA analysis have a significant value of Pmodel>F= 0.0008 and R2 .... there are various environmental and nutritional factors ... reported to affect cellulase production from wheat straw ... many factors affecting simultaneously the fermentation ..... and control its stability (Kalra and Sandhu, 1986).

Influence of route of administration/drug formulation and other factors on adherence to treatment in rheumatoid arthritis (pain related) and dyslipidemia (non-pain related).

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Fautrel, Bruno; Balsa, Alejandro; Van Riel, Piet; Casillas, Marta; Capron, Jean-Philippe; Cueille, Carine; de la Torre, Inmaculada

2017-07-01

A comprehensive review was performed to investigate the effect of route of administration on medication adherence and persistence in rheumatoid arthritis (RA) and to compare adherence/persistence with oral medications between RA and a non-painful disease (dyslipidemia). Comprehensive database searches were performed to identify studies investigating medication adherence and/or persistence in adults with RA receiving conventional synthetic or biologic agents. Similar searches were performed for studies of patients with dyslipidemia receiving statins. Studies had to be published after 1998 in English and involve ≥6 months' follow up. Adherence and persistence were compared between the different routes of drug administration in RA, and between the two diseases for oral medications. A total of 35 and 28 papers underwent data extraction for RA and dyslipidemia, respectively. Within the constraints of the analysis, adherence and persistence rates appeared broadly similar for the different routes of drug administration in RA. Adherence to oral medications was also broadly similar across the two diseases, but persistence was lower in dyslipidemia. Poor adherence has clinical consequences in both diseases: greater disease activity and risk of flare in RA, and increased serum cholesterol levels and risk of heart and cerebrovascular disease in dyslipidemia. Over 1-3 years, poor adherence to biologic RA medications led to increased resource use and medical costs but lower total direct costs due to reduced biologic drug costs. Conversely, poor adherence to dyslipidemia medications resulted in increased total direct costs. In both diseases, adherence improved with patient education/support. The route of drug administration and the symptomatic (pain) nature of the disease do not appear to be dominant factors for drug adherence or persistence in RA. The wide range of adherence and persistence values and definitions across studies made comparisons between drug formulations and

Constraint - Induced Movement Therapy: Determinants and Correlates of Duration of Adherence to Restraint use Among Stroke Survivors with Hemiparesis

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Arinola Olasumbo Sanya

2012-02-01

Full Text Available Background: Constraint-Induced Movement Therapy (CIMT was developed to improve purposeful movement of the stroke-affected extremity by restrictingthe use of the unaffected extremity. The two main components of CIMT are the training of the more-impaired arm to perform functional tasks, and the restraint of the less-impaired arm. One challenge that the application of CIMT faces is in ensuring adherence to the use of restraint.Purpose: There is a need to determine the factors that may influence adherence, as this would allow CIMT to be delivered more effectively, and prevent situations where unrealistic expectations are placed on stroke–affected individuals.Methods: Thirty stroke survivors with hemiparesis who met the inclusion criteria were consecutively recruited from the physiotherapy out-patient clinics, using a purposive sampling technique. A structured questionnaire was used to obtain information on clinical and socio-demographic parameters. The participants were given a restraint and an adherence time log-book, to make a daily record during the period they wore the restraint. The adherence time logbook was collected at the end of every week of the 3-week study. Motor function and functional use of the upper limb were measured using Motricity Index and Motor Activity Log respectively. Data was analysed using mean and standard deviations, independent t-test and Spearman rho; p was significant at 0.05.Results: Gender (p=0.73 and side affected/handedness (p=0.79 had no significant influence on the percentage duration of adherence to restraint use (DARU. The influence of socio-economic status was seen, with the participants of middle socio-economic status adhering for longer duration (p=0.02. Age had weak and no significant correlation with percentage DARU (p=0.55. There was significantly fair correlation between motor function/functional use at any stage (p=0.55 and the corresponding percentage duration of adherence to restraint use, except

Barriers and facilitators of antiretroviral therapy adherence in rural ...

African Journals Online (AJOL)

Multivariable logistic regression was conducted to examine the associations between household economic factors and adherence. Our findings suggest that the role of economic status on adherence appears to be a function of the economic component. Debt and non-farming-related occupation were consistently associated ...

Effects of Psychosocial Parameters on Adherence of Adult Nigerians ...

African Journals Online (AJOL)

Aim: To determine the rate of adherence of adult HIV seropositive adult Nigerian to antiretroviral therapy and the effects of psychosocial factors including psychiatric morbidity, patients' perception of their illness, availability of social support, preference for alternative medicine on adherence to antiretroviral therapy. Methods: ...

Factors influencing bacterial adhesion to contact lenses.

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Dutta, Debarun; Cole, Nerida; Willcox, Mark

2012-01-01

The process of any contact lens related keratitis generally starts with the adhesion of opportunistic pathogens to contact lens surface. This article focuses on identifying the factors which have been reported to affect bacterial adhesion to contact lenses. Adhesion to lenses differs between various genera/species/strains of bacteria. Pseudomonas aeruginosa, which is the predominant causative organism, adheres in the highest numbers to both hydrogel and silicone hydrogel lenses in vitro. The adhesion of this strain reaches maximum numbers within 1h in most in vitro studies and a biofilm has generally formed within 24 h of cells adhering to the lens surface. Physical and chemical properties of contact lens material affect bacterial adhesion. The water content of hydroxyethylmethacrylate (HEMA)-based lenses and their iconicity affect the ability of bacteria to adhere. The higher hydrophobicity of silicone hydrogel lenses compared to HEMA-based lenses has been implicated in the higher numbers of bacteria that can adhere to their surfaces. Lens wear has different effects on bacterial adhesion, partly due to differences between wearers, responses of bacterial strains and the ability of certain tear film proteins when bound to a lens surface to kill certain types of bacteria.

Identification of documented medication non-adherence in physician notes.

Science.gov (United States)

Turchin, Alexander; Wheeler, Holly I; Labreche, Matthew; Chu, Julia T; Pendergrass, Merri L; Einbinder, Jonathan S; Einbinder, Jonathan Seth

2008-11-06

Medication non-adherence is common and the physicians awareness of it may be an important factor in clinical decision making. Few sources of data on physician awareness of medication non-adherence are available. We have designed an algorithm to identify documentation of medication non-adherence in the text of physician notes. The algorithm recognizes eight semantic classes of documentation of medication non-adherence. We evaluated the algorithm against manual ratings of 200 randomly selected notes of hypertensive patients. The algorithm detected 89% of the notes with documented medication non-adherence with specificity of 84.7% and positive predictive value of 80.2%. In a larger dataset of 1,000 documents, notes that documented medication non-adherence were more likely to report significantly elevated systolic (15.3% vs. 9.0%; p = 0.002) and diastolic (4.1% vs. 1.9%; p = 0.03) blood pressure. This novel clinically validated tool expands the range of information on medication non-adherence available to researchers.

The social determinants of tuberculosis treatment adherence in a remote region of Papua New Guinea

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Tanya Diefenbach-Elstob

2017-01-01

Full Text Available Abstract Background Papua New Guinea (PNG is a diverse and culturally-rich country with severe infrastructural and health problems. Tuberculosis (TB is widespread, and the number of cases with drug resistance is rising. Treatment adherence is known to be important for both effective treatment and limiting the emergence of drug resistance. The aim of this study was to construct a matrix of the factors that act as facilitators or barriers to TB treatment adherence in a remote region of PNG. Methods The study was based in the Balimo region of the Western Province. People known to have undergone TB treatment, as well as staff involved in managing people with TB, were asked to participate in an in-depth interview about their experiences. Purposive sampling was used to identify a diverse range of participants, from different geographic locations, social backgrounds, and with successful and unsuccessful treatment outcomes. The interview data was analysed based on grounded theory methodology. Results The study identified a range of factors that influence TB treatment adherence, with these being classified as personal, systems, and sociocultural. These factors are presented along with suggested recommendations for adaptations to DOTS-based treatment in this region. Barriers included the challenges associated with travel to treatment sites, and the difficulties of undertaking treatment alongside the daily need to maintain subsistence food production. However, facilitators were also identified, including the positive influence of religious beliefs, and high confidence in the ability of DOTS-based treatment to cure TB. Conclusions Documenting the wide range of factors that influence treatment adherence in a severely affected remote population will assist in improving TB control. These results provide impetus for further community-based efforts aimed at improving access to TB diagnosis and treatment, and maintaining successful treatment outcomes in the face

Risk-factors for non-adherence to antiretroviral therapy Fatores preditivos de não-adesão à terapia antiretroviral

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Márcia Cristina Fraga Silva

2009-06-01

Full Text Available Cross-sectional study analyzed as case-control to identify risk factors for non-adherence to antiretroviral therapy. We studied 412 out-clinics HIV infected subjects of three public hospitals of Recife, Pernambuco. The objective was to examine the association between non-adherence to the antiretroviral therapy and biological, social-behavior and demographics and economic factors, factors related to the disease and/or treatment, factors related to life habits and depression symptoms. Variables significantly associated with non-adherence to antiretroviral therapy were: time elapsed since HIV diagnosis (p = 0.002, daily dose (p = 0.046, use of alcohol (p = 0.030 and past drug use (p = 0.048, and borderline p-values were found for educational level (p = 0.093 and family monthly income (p = 0.08. In the multivariable analysis, the factors that remained in the final model were family monthly income, time period with HIV infection and use of alcohol. No association was observed between non-adherence to antiretroviral therapy and gender, age, sexual orientation, marital status, educational level and place of residence. Based on our results and the local situation we suggest: assessment of social needs; training of partners and/or families on supporting adherence, creation of "adherence groups" to motivate and to reassure patients on the benefits of treatment; counseling and/or psychotherapy for alcohol drinkers.Estudo transversal com análise tipo caso-controle, que avaliou 412 pacientes de hospitais públicos do Recife - PE, com o objetivo de identificar fatores preditivos de não adesão à terapia antiretroviral. Verificou-se associação entre não adesão à terapia antiretroviral e aspectos biológicos, sócio-comportamentais e demográficos, econômicos, relacionados à doença e ao tratamento, aos hábitos de vida e aos distúrbios do humor. Variáveis com associação estatisticamente significante com não adesão na análise univariada foram

"Weariness" and "unpleasantness" reduce adherence to branched-chain amino acid granules among Japanese patients with liver cirrhosis: results of a single-center cross-sectional survey.

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Eguchi, Yuichiro; Furukawa, Naoko; Furukawa, Takeshi; Egashira, Yoshimitsu; Hotokezaka, Hiroshi; Oeda, Satoshi; Iwane, Shinji; Anzai, Keizo

2017-03-01

Branched-chain amino acids (BCAA) are valuable in the treatment of liver cirrhosis because they increase serum albumin levels. Poor adherence to BCAA may adversely affect prognosis, but little is known about factors predicting adherence. We undertook a survey of patients prescribed BCAA for the treatment of cirrhosis. Pharmacists carried out face-to-face interviews with patients (or their representatives) prescribed any of nine BCAA formulations. Question categories included patient characteristics, prescription of BCAA granules, and perceptions of BCAA administration, including adherence and possible factors that might impact adherence. "Poor adherence" was defined as "not taking the medication appropriately" or "forgetting to take the medication". Overall, 253 patients (or representatives) completed the survey, of whom 135 were men, 114 were women, and 148 were ≥70 years old. Most patients (163) were prescribed BCAA for ≥2 years and were using three packs per day. Thirty-two patients did not take their medication appropriately and 69 sometimes forgot to administer it. Weariness of taking the medication (P BCAA in clinical practice. Poor adherence was associated with weariness with taking medication, and the unpleasantness of the medication itself. Patient education from general practitioners and hepatologists combined with adherence counseling from pharmacists may help improve adherence. © 2016 The Authors. Hepatology Research published by John Wiley & Sons Australia, Ltd on behalf of Japan Society of Hepatology.

Contextual investigation of factors affecting sludge accumulation ...

African Journals Online (AJOL)

Pit latrines in slums areas of Uganda fill up faster than might be expected from some estimates owing to inappropriate use and failure to consider critical factors affecting sludge accumulation rates at the planning, design and construction stages. This study sought to investigate factors affecting filling rates of lined pit latrines ...

Factors Affecting Wound Healing

Science.gov (United States)

Guo, S.; DiPietro, L.A.

2010-01-01

Wound healing, as a normal biological process in the human body, is achieved through four precisely and highly programmed phases: hemostasis, inflammation, proliferation, and remodeling. For a wound to heal successfully, all four phases must occur in the proper sequence and time frame. Many factors can interfere with one or more phases of this process, thus causing improper or impaired wound healing. This article reviews the recent literature on the most significant factors that affect cutaneous wound healing and the potential cellular and/or molecular mechanisms involved. The factors discussed include oxygenation, infection, age and sex hormones, stress, diabetes, obesity, medications, alcoholism, smoking, and nutrition. A better understanding of the influence of these factors on repair may lead to therapeutics that improve wound healing and resolve impaired wounds. PMID:20139336

CHILDREN'S ADHERENCE TO HAART ADHERENCE

African Journals Online (AJOL)

han or equal IQ 2 log" and in 64% of children wirh smaller man 2 log,o decrease in viral load. Secondly, i caregivers are not well prepared for adherence issues before starting HAART, or if regimens are too onerous to follow, treatment is likely to fail. Every effort should be made to see the burden of adherence from the.

Validating the Modified Drug Adherence Work-Up (M-DRAW Tool to Identify and Address Barriers to Medication Adherence

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Sun Lee

2017-09-01

Full Text Available Barriers to medication adherence stem from multiple factors. An effective and convenient tool is needed to identify these barriers so that clinicians can provide a tailored, patient-centered consultation with patients. The Modified Drug Adherence Work-up Tool (M-DRAW was developed as a 13-item checklist questionnaire to identify barriers to medication adherence. The response scale was a 4-point Likert scale of frequency of occurrence (1 = never to 4 = often. The checklist was accompanied by a GUIDE that provided corresponding motivational interview-based intervention strategies for each identified barrier. The current pilot study examined the psychometric properties of the M-DRAW checklist (reliability, responsiveness and discriminant validity in patients taking one or more prescription medication(s for chronic conditions. A cross-sectional sample of 26 patients was recruited between December 2015 and March 2016 at an academic medical center pharmacy in Southern California. A priming question that assessed self-reported adherence was used to separate participants into the control group of 17 “adherers” (65.4%, and into the intervention group of nine “unintentional and intentional non-adherers” (34.6%. Comparable baseline characteristics were observed between the two groups. The M-DRAW checklist showed acceptable reliability (13 item; alpha = 0.74 for identifying factors and barriers leading to medication non-adherence. Discriminant validity of the tool and the priming question was established by the four-fold number of barriers to adherence identified within the self-selected intervention group compared to the control group (4.4 versus 1.2 barriers, p < 0.05. The current study did not investigate construct validity due to small sample size and challenges on follow-up with patients. Future testing of the tool will include construct validation.

The influence of frailty syndrome on medication adherence among elderly patients with hypertension

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Jankowska-Polańska B

2016-12-01

Full Text Available Beata Jankowska-Polańska,1 Krzysztof Dudek,2 Anna Szymanska-Chabowska,3 Izabella Uchmanowicz1 1Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, 2Department of Logistic and Transport Systems, Faculty of Mechanical Engineering, Wroclaw University of Technology, 3Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Wroclaw, Poland Background: Hypertension affects about 80% of people older than 80 years; however, diagnosis and treatment are difficult because about 55% of them do not adhere to treatment recommendations due to low socioeconomic status, comorbidities, age, physical limitations, and frailty syndrome.Aims: The purposes of this study were to evaluate the influence of frailty on medication adherence among elderly hypertensive patients and to assess whether other factors influence adherence in this group of patients.Methods and results: The study included 296 patients (mean age 68.8±8.0 divided into frail (n=198 and non-frail (n=98 groups. The Polish versions of the Tilburg Frailty Indicator (TFI for frailty assessment and 8-item Morisky Medication Adherence Scale for adherence assessment were used. The frail patients had lower medication adherence in comparison to the non-frail subjects (6.60±1.89 vs 7.11±1.42; P=0.028. Spearman’s rank correlation coefficients showed that significant determinants with negative influence on the level of adherence were physical (rho =-0.117, psychological (rho =-0.183, and social domain (rho =-0.163 of TFI as well as the total score of the questionnaire (rho =-0.183. However, multiple regression analysis revealed that only knowledge about complications of untreated hypertension (β=0.395 and satisfaction with the home environment (β=0.897 were found to be independent stimulants of adherence level.Conclusion: Frailty is highly prevalent among elderly hypertensive patients. Higher level of frailty

Adherence to Technology-Mediated Insomnia Treatment: A Meta-Analysis, Interviews, and Focus Groups

OpenAIRE

Horsch, Corine; Lancee, Jaap; Beun, Robbert Jan; Neerincx, Mark A; Brinkman, Willem-Paul

2015-01-01

Background: Several technologies have been proposed to support the reduction of insomnia complaints. A user-centered assessment of these technologies could provide insight into underlying factors related to treatment adherence. Objective: Gaining insight into adherence to technology-mediated insomnia treatment as a solid base for improving those adherence rates by applying adherence-enhancing strategies. Methods: Adherence to technology-mediated sleep products was studied in three ways. First...

Understanding the factors associated with initiation and adherence of osteoporosis medication in Japan: An analysis of patient perceptions

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Hajime Orimo

2017-12-01

Conclusions: Different factors were found to be associated with initiation and adherence of osteoporosis medication. Patient knowledge of their disease and the perception of barriers were found to be the most influential. Empowering patients with the knowledge to better understand their disease and decreasing the perception of barriers through education initiatives may be effective in improving patient outcomes.

Psychological and behavioral barriers to ART adherence among PLWH in China: role of self-efficacy.

Science.gov (United States)

Zhou, Guangyu; Li, Xiaoming; Qiao, Shan; Zhou, Yuejiao; Shen, Zhiyong

2017-12-01

Globally, optimal adherence to antiretroviral therapy (ART) is insufficient despite it is critical for maximum clinical benefits and treatment success among people living with HIV (PLWH). Many factors have been evidenced to influence medication adherence, including perceived barriers and self-efficacy. However, limited data are available regarding to psychological and behavioral barriers to ART adherence in China. Moreover, few studies have examined the mechanism of these two factors underlying HIV medication adherence. The aim of the current study is to examine the mediating role of adherence self-efficacy between perceived barriers and ART adherence among PLWH. Cross-sectional data were obtained from 2095 PLWH in Guangxi China who provided data on ART adherence. Participants reported their medication adherence, self-efficacy, barriers to ART adherence, as well as background characteristics. Results indicated a significant indirect effect from perceived barriers to medication adherence through adherence self-efficacy. Higher perceived psychological and behavioral barriers to ART adherence were related to lower adherence self-efficacy, which in turn was related to lower ART adherence. Self-efficacy could buffer the negative effects of perceived barriers on ART adherence. Future interventions to promote HIV medication adherence are recommended to focus on eliminating psychological and behavioral barriers, as well as increasing adherence self-efficacy.

Women’s Beliefs on Early Adherence to Adjuvant Endocrine Therapy for Breast Cancer: A Theory-Based Qualitative Study to Guide the Development of Community Pharmacist Interventions

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Brittany Humphries

2018-06-01

Full Text Available Adjuvant endocrine therapy (AET taken for a minimum of five years reduces the recurrence and mortality risks among women with hormone-sensitive breast cancer. However, adherence to AET is suboptimal. To guide the development of theory-based interventions to enhance AET adherence, we conducted a study to explore beliefs regarding early adherence to AET. This qualitative study was guided by the Theory of Planned Behavior (TPB. We conducted focus groups and individual interviews among women prescribed AET in the last two years (n = 43. The topic guide explored attitudinal (perceived advantages and disadvantages, normative (perception of approval or disapproval, and control beliefs (barriers and facilitating factors towards adhering to AET. Thematic analysis was conducted. Most women had a positive attitude towards AET regardless of their medication-taking behavior. The principal perceived advantage was protection against a recurrence while the principal inconvenience was side effects. Almost everyone approved of the woman taking her medication. The women mentioned facilitating factors to encourage medication-taking behaviors and cope with side effects. For adherent women, having trouble establishing a routine was their main barrier to taking medication. For non-adherent women, it was side effects affecting their quality of life. These findings could inform the development of community pharmacy-based adherence interventions.

Understanding rational non-adherence to medications. A discrete choice experiment in a community sample in Australia

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Laba Tracey-Lea

2012-06-01

Full Text Available Abstract Background In spite of the potential impact upon population health and expenditure, interventions promoting medication adherence have been found to be of moderate effectiveness and cost effectiveness. Understanding the relative influence of factors affecting patient medication adherence decisions and the characteristics of individuals associated with variation in adherence will lead to a better understanding of how future interventions should be designed and targeted. This study aims to explore medication-taking decisions that may underpin intentional medication non-adherence behaviour amongst a community sample and the relative importance of medication specific factors and patient background characteristics contributing to those decisions. Methods A discrete choice experiment conducted through a web-enabled online survey was used to estimate the relative importance of eight medication factors (immediate and long-term medication harms and benefits, cost, regimen, symptom severity, alcohol restrictions on the preference to continue taking a medication. To reflect more closely what usually occurs in practice, non-disease specific medication and health terms were used to mimic decisions across multiple medications and conditions.161 general community participants, matching the national Australian census data (age, gender were recruited through an online panel provider (participation rate: 10% in 2010. Results Six of the eight factors (i.e. immediate and long-term medication harms and benefits, cost, and regimen had a significant influence on medication choice. Patient background characteristics did not improve the model. Respondents with private health insurance appeared less sensitive to cost then those without private health insurance. In general, health outcomes, framed as a side-effect, were found to have a greater influence over adherence than outcomes framed as therapeutic benefits. Conclusions Medication-taking decisions are the

Understanding rational non-adherence to medications. A discrete choice experiment in a community sample in Australia.

Science.gov (United States)

Laba, Tracey-Lea; Brien, Jo-Anne; Jan, Stephen

2012-06-20

In spite of the potential impact upon population health and expenditure, interventions promoting medication adherence have been found to be of moderate effectiveness and cost effectiveness. Understanding the relative influence of factors affecting patient medication adherence decisions and the characteristics of individuals associated with variation in adherence will lead to a better understanding of how future interventions should be designed and targeted. This study aims to explore medication-taking decisions that may underpin intentional medication non-adherence behaviour amongst a community sample and the relative importance of medication specific factors and patient background characteristics contributing to those decisions. A discrete choice experiment conducted through a web-enabled online survey was used to estimate the relative importance of eight medication factors (immediate and long-term medication harms and benefits, cost, regimen, symptom severity, alcohol restrictions) on the preference to continue taking a medication. To reflect more closely what usually occurs in practice, non-disease specific medication and health terms were used to mimic decisions across multiple medications and conditions.161 general community participants, matching the national Australian census data (age, gender) were recruited through an online panel provider (participation rate: 10%) in 2010. Six of the eight factors (i.e. immediate and long-term medication harms and benefits, cost, and regimen) had a significant influence on medication choice. Patient background characteristics did not improve the model. Respondents with private health insurance appeared less sensitive to cost then those without private health insurance. In general, health outcomes, framed as a side-effect, were found to have a greater influence over adherence than outcomes framed as therapeutic benefits. Medication-taking decisions are the subject of rational choices, influenced by the attributes of

Does good medication adherence really save payers money?

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Stuart, Bruce C; Dai, Mingliang; Xu, Jing; Loh, Feng-Hua E; S Dougherty, Julia

2015-06-01

Despite a growing consensus that better adherence with evidence-based medications can save payers money, assertions of cost offsets may be incomplete if they fail to consider additional drug costs and/or are biased by healthy adherer behaviors unobserved in typical medical claims-based analyses. The objective of this study was to determine whether controlling for healthy adherer bias (HAB) materially affected estimated medical cost offsets and additional drug spending associated with higher adherence. A total of 1273 Medicare beneficiaries with diabetes enrolled in Part D plans between 2006 and 2009. Using survey and claims data from the Medicare Current Beneficiary Survey, we measured medical and drug costs associated with good and poor adherence (proportion of days covered ≥ 80% and <80%, respectively) to oral antidiabetic drugs, ACE inhibitors/ARBs, and statins over 2 years. To test for HAB, we estimated pairs of regression models, one set containing variables typically controlled for in conventional claims analysis and a second set with survey-based variables selected to capture HAB effects. We found consistent evidence that controlling for HAB reduces estimated savings in medical costs from better adherence, and likewise, reduces estimates of additional adherence-related drug spending. For ACE inhibitors/ARBs we estimate that controlling for HAB reduced adherence-related medical cost offsets from $6389 to $4920 per person (P<0.05). Estimates of additional adherence-related drug costs were 26% and 14% lower in HAB-controlled models (P < 0.05). These results buttress the economic case for action by health care payers to improve medication adherence among insured persons with chronic disease. However, given the limitations of our research design, further research on larger samples with other disease states is clearly warranted.

Predicting the effect of interactive video bikes on exercise adherence: An efficacy trial.

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Rhodes, Ryan E; Warburton, Darren E R; Bredin, Shannon S D

2009-12-01

Exercise games that employ video game technology are increasing in the marketplace but have received scant research attention despite their popularity. The purpose of this study was to evaluate the effect of videobike gaming on the constructs of the theory of planned behavior (TPB) and adherence in comparison to a cycling condition where participants listen to self-selected music. Participants were 29 inactive young men assigned randomly to experimental (n = 16) or comparison (n = 13) conditions. The recommended training regime consisted of moderate intensity activity (60-75% heart rate reserve), 3 days/week for 30 min/day for 6 weeks. At the end of the first session, participants were asked to complete TPB measures and these were subsequently measured 6 weeks later. Attendance was used as the measure of adherence. Results showed that affective attitude and adherence across the 6 weeks significantly favored the videobike condition over the comparison condition. Regression analyses suggested partial mediation of the effect of the videobike condition on adherence via affective attitude. This is the first study to provide evidence that interactive videobikes may improve adherence over traditional cycling because the activity produces higher affective attitudes. The results are promising for expanding to community-based evaluation.

Higher adherence to Mediterranean diet prior to pregnancy is associated with decreased risk for deviation from the maternal recommended gestational weight gain.

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Koutelidakis, Antonios E; Alexatou, Olga; Kousaiti, Savvina; Gkretsi, Elisavet; Vasios, George; Sampani, Anastasia; Tolia, Maria; Kiortsis, Dimitrios N; Giaginis, Constantinos

2018-02-01

The present retrospective study was conducted on 1482 women in order to evaluate whether their pre-pregnancy adherence to the Mediterranean diet may affect maternal gestational weight gain (GWG). For this purpose, the study population was classified according to the Institute of Medicine (IOM) recommendations concerning GWG. Pre-pregnancy adherence to the Mediterranean diet was assessed with 11 food patterns groups based on their contribution in the Mediterranean diet pyramid. Women with high adherence to the Mediterranean diet were more frequently characterised by GWG inside the IOM recommendations. In multivariate analysis, women with low Mediterranean diet adherence were almost twice at risk in presenting deflection from recommended GWG regardless of various confounding factors. These findings suggested that high pre-pregnancy adherence to the Mediterranean diet may be associated with reduced risk for GWG outside the IOM recommendations. However, larger prospective studies are strongly recommended in order for more precise conclusions to be drawn.

The role of irrational thought in medicine adherence: people with diabetic kidney disease.

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Williams, Allison F; Manias, Elizabeth; Walker, Rowan

2009-10-01

This paper is a report of a study conducted to examine how irrational thinking affects people's adherence to multiple medicines prescribed to manage their diabetic kidney disease. Approximately 50% of people are non-adherent to their prescribed medicines and the risk of non-adherence escalates as the number of prescribed medicines increases. Adherence to prescribed medicines can slow disease progression in diabetic kidney disease. A descriptive exploratory design was used. In-depth interviews were conducted with 23 participants recruited from a nephrology outpatient clinic in Australia in 2007. Data were analysed using a 'framework' method. Participants' mean age was 59 years, they had approximately six chronic conditions in addition to their diabetic kidney disease and were prescribed a median of ten medicines daily. Two major themes of irrational thinking--heuristics and denial--and subthemes were identified. Heuristics contributed to inaccurate risk assessment and biases affecting rational judgement concerning medicines, whereas denial was used to enhance coping necessary to manage this complex health condition. Participants underestimated their health risks because they had been taking medicines for many years and preferred not to dwell on their ill health. A large amount of irrational thinking was related to maintaining the emotional strength necessary to manage their comorbid conditions as best they could. Regular assessment and support of medicine adherence throughout the disease course is necessary to avert the development of counterproductive heuristics and denial affecting medicine adherence.

Determinants of Adherence with Malaria Chemoprophylactic Drugs Used in a Traveler’s Health Clinic

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Ibrahim Shady

2015-01-01

Full Text Available Background. The WHO recommends mefloquine, atovaquone/proguanil, and doxycycline for malaria chemoprophylaxis. Adherence to a drug is determined by many factors. Objective. To detect the determinants of travelers’ adherence to malaria chemoprophylaxis. Methods. A prospective comparative study was conducted from January 2012 to July 2013 that included travelers (928 travelers to malaria endemic countries who visited the THC. They were classified into 3 groups: the 1st is the mefloquine group (396 travelers, the 2nd is the doxycycline group (370 travelers, and finally those who did not receive any drugs (162 travelers. The participants from the 1st and 2nd groups enrolled in the study. Results. Univariate and multivariate analyses were performed. The predictors for adherence in the mefloquine group were travel to an African destination [OR = 51 (6.8–2385], higher than a secondary school education [OR = 21 (4.1–144.2], organized travel [OR = 4 (2.1–6.5], traveling for leisure [OR = 2.1 (1.1–0.4], and nationality [OR = 2 (1.11–4.00]. In the doxycycline group, the predictors included higher than a secondary education [OR = 20.1 (4.5–125.1], organized travel [OR = 11.4 (5.5–20.9], travel for leisure [OR = 7 (2.3–22.9], travel to an African destination [OR = 6.1 (0.41–417], and nationality [OR = 4.5 (2.3–9.5]. Conclusion. Adherence with malaria chemoprophylaxis could be affected by many factors such as nationality, education, and organized travel.

Improving adherence to acne treatment: the emerging role of application software

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Park C

2014-02-01

Full Text Available Chanhyun Park,1 Gilwan Kim,1 Isha Patel,2 Jongwha Chang,3 Xi Tan2 1College of Pharmacy, University of Texas at Austin, Austin, TX, USA; 2College of Pharmacy, University of Michigan, Ann Arbor, MI, USA; 3McWhorter School of Pharmacy, Samford University, Birmingham, AL, USA Objective: To examine recent studies on the effect of mobile and electronic (ME-health technology on adherence to acne treatment. Background: With emerging use of ME-health technology, there is a growing interest in evaluating the effectiveness of the tools on medication adherence. Examples of ME-health technology-based tools include text message-based pill reminders and Web-based patient education. Methods: MEDLINE, Cochrane Library, and Web of Science were searched for articles on adherence to acne treatment published through November 2013. A combination of search terms such as "acne" and "adherence" or "compliance" were used. Results: Adherence to oral acne medication was higher than for topical acne medication. The frequency of office visits was also an influencing factor for acne treatment adherence. The telephone-based reminders on a daily basis did not improve acne patients' medication adherence, whereas the Web-based educational tools on a weekly basis had a positive effect on medication adherence in acne treatment. Conclusion: In using ME-health interventions, factors such as medication dosage forms, frequency of intervention, and patients' preferences should be taken into consideration. Developing disease-specific text message reminders may be helpful to increase adherence rates. In addition, a combination of text message reminders with another type of intervention may improve medication adherence. Keywords: acne vulgaris, medication adherence, compliance, mobile and electronic health technology, application software, telemedicine

[Improving treatment adherence in kidney transplantation: a major challenge].

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Kessler, Michèle

2014-06-01

The kidney transplant recipient is faced not only with the perspective of taking immunosuppressive drugs lifelong, but also the possibility of other long-term treatments prescribed for preexisting conditions, complications, or side effects. Proper management, and most importantly patient adherence, can become a complex challenge. Here we recall current definitions and describe methods for measuring treatment adherence, followed by a discussion on the prevalence of non-adherence in kidney transplant recipients, its effect on graft survival, and factors predictive of non-adherence. Ways of improving adherence are examined, leading to the conviction that helping patients take their medications regularly would probably have a greater impact on graft survival than marketing a new immunosuppressive agent. Copyright © 2014 Association Société de néphrologie. Published by Elsevier SAS. All rights reserved.

Identification of factors affecting individual industries

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Maryam Sadat Mirzadeh

2017-10-01

Full Text Available High knowledge and technology are rapidly becoming a competitive advantage in today’s world. Individual industries are considered one of the key sectors in the country’s industry. Ranking the factors that affect these industries makes us more familiar with their effectiveness and helps us take actions to improve such factors in knowledge-based companies. Consequently, based on previous research studies on Individual Industries, field observations, and a questionnaire prepared by the researchers, the current study explores and classifies the factors affecting the establishment of these industries. Regarding its purpose, this is an applied research, and regarding data collection, it is a descriptive survey. Using purposive sampling, 60 questionnaires were collected and effective factors were classified applying the SPSS software and the TOPSIS technique. This study suggests that content factors are ranked first place, while contextual and structural factors are ranked second and third, respectively. Therefore, executives and managers in single industries are recommended to strengthen joint enterprise norms and dominant values and beliefs in knowledge-based companies in order to help the growth and development of single industries.

[Family adherence in serious mental disorder].

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Martín Padilla, Ernesto; Obando Posada, Diana; Sarmiento Medina, Pedro

2017-10-09

Identify attitudes and behaviors that evidence and characterize family adherence to treatment in patients with severe mental disorder. Qualitative descriptive, from an interpretative social approach. Chia, Colombia, with professionals in the psychiatric and geriatric settings. Twelve professionals in psychiatry, nursing and psychology, with experience in care of patients with serious mental disorder and their families. Intentional sampling. Twelve semi-structured interviews were carried out. The analysis strategy was made from the procedures of constant comparison and open coding of the grounded theory. As validation strategies, triangulation was done between researchers and methods, as interviews and results survey. Two categories of family adherence were defined: family and treatment (treatment cooperation, knowledge about the disease and attention to the disease evolution), and family attitudes towards the patient (patient's care, patient's promotion of autonomy, and affective attachment with the patient). A third category showed aspects that diminished family adherence, such as lack or distortion of information regarding mental disorder, or family and patient endurance attitudes. Participants agree about the relevance of the construct named «family adherence», which describes the behaviors and attitudes of the family regarding the treatment of patients with severe mental disorder. Family adherence can be seen as active participation behavior, but also as a process of strengthening relationships, which can reduce the burden and suffering on family members, caregivers and patients. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

Adherence to physical activity in adults with chronic diseases: ELSA-Brasil.

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Forechi, Ludimila; Mill, José Geraldo; Griep, Rosane Härter; Santos, Itamar; Pitanga, Francisco; Molina, Maria Del Carmen Bisi

2018-04-09

The objective of this study is to investigate the adherence and the factors that influence adherence to physical activity in adults with dyslipidemia, hypertension, or diabetes. The analyses were based on data collected at the baseline of the 14,521 participants from the study ELSA-Brasil aged between 35 and 74 years. The level of leisure time physical activity was determined using the International Physical Activity Questionnaire. Logistic regression analyses were performed to examine the influence of the demographic data, socioeconomic conditions, perceived health status, and access to exercise facilities in the neighborhood on adherence to physical activity. Men with hypertension and dyslipidemia were more active than women. The results show that 17.8%, 15.1%, and 13.9% of the subjects who reported dyslipidemia, hypertension, and diabetes, respectively, adhere to the physical activity recommendations. The factors positively associated with adherence were higher education and income. Older individuals who reported poor perceived health, were overweight and obese, regularly smoked, and had fewer opportunities to exercise in the neighborhood presented lower adherence. The number of adults with dyslipidemia, hypertension, and diabetes who adhere to the physical activity recommendations is very low. Higher education and income are positively associated with adherence, while age, excess body weight, negative perceived health, regular smoking, and lack of opportunity to exercise in the neighborhood were considered barriers to physical activity.

Factors associated with non-adherence to antiretroviral therapy in adults with AIDS in the first six months of treatment in Salvador, Bahia State, Brazil.

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Silva, José Adriano Góes; Dourado, Inês; Brito, Ana Maria de; Silva, Carlos Alberto Lima da

2015-06-01

The control of viral replication is essential in the highly active antiretroviral therapy (HAART), and adherence to therapy is instrumental for such control. Individual and external factors influence adhesion to the use of antiretroviral (ARV) drugs. This is a cross-sectional study to investigate factors associated with non-adherence to HAART in AIDS patients in Salvador, Bahia State, Brazil, with age ≥ 13 years and first prescription in 2009. Data was collected from patient charts and pharmacy records. From a total of 216 patients, 65.3% were males; mean age 37.8 ± 9.5 years; single, 67.9%; heterosexual, 64%; more than 8 years of school education, 65.3%; alcohol users, 61.5%; non-smokers, 75,1% or non-illicit drug users, 93.7%. A proportion of 94% started ARV therapy with TCD4+ drug reaction. The prevalence of non-adherence was 25%. The variables associated were: longer time between HIV infection and AIDS (aOR = 3.9), adverse drug reaction (aOR = 2.4), under 34 years of age (aOR = 2.2), less than 8 years of school education (aOR = 2.2) and illicit drugs use (aOR = 2.6). A high-non-adherence rate is an important problem within the first six months of HAART.

Living situation affects adherence to combination antiretroviral therapy in HIV-infected adolescents in Rwanda: a qualitative study

NARCIS (Netherlands)

Mutwa, P.R.; Ilo van Nuil, J.; Asiimwe-Kateera, B.; Kestelyn, E.; Vyankandondera, J.; Pool, R.; Ruhirimbura, J.; Kanakuze, C.; Reiss, P.; Geleen, S.; van de Wijgert, J.; Boer, K.R.

2013-01-01

Introduction Adherence to combination antiretroviral therapy (cART) is vital for HIV-infected adolescents for survival and quality of life. However, this age group faces many challenges to remain adherent. We used multiple data sources (role-play, focus group discussions (FGD), and in-depth

Adherence and competence in two manual-guided therapies for co-occurring substance use and posttraumatic stress disorders: clinician factors and patient outcomes.

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Meier, Andrea; McGovern, Mark P; Lambert-Harris, Chantal; McLeman, Bethany; Franklin, Anna; Saunders, Elizabeth C; Xie, Haiyi

2015-01-01

The challenges of implementing and sustaining evidence-based therapies into routine practice have been well-documented. This study examines the relationship among clinician factors, quality of therapy delivery, and patient outcomes. Within a randomized controlled trial, 121 patients with current co-occurring substance use and posttraumatic stress disorders were allocated to receive either manualized Integrated Cognitive Behavioral Therapy (ICBT) or Individual Addiction Counseling (IAC). Twenty-two clinicians from seven addiction treatment programs were trained and supervised to deliver both therapies. Clinician characteristics were assessed at baseline; clinician adherence and competence were assessed over the course of delivering both therapies; and patient outcomes were measured at baseline and 6-month follow-up. Although ICBT was delivered at acceptable levels, clinicians were significantly more adherent to IAC (p drug problem severity. The differential impact of adherence and competence for both therapy types is consistent with their purported primary target: ICBT for PTSD and IAC for substance use. These findings also suggest the benefits of considering clinician factors when implementing manual-guided therapies. Future research should focus on diverse clinician samples, randomization of clinicians to therapy type, and prospective designs to evaluate models of supervision and quality monitoring.

Feeding in full-time public schools: Do students adhere and accept?

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Nágila Araújo de CARVALHO

Full Text Available ABSTRACT Objective Identifying adherence to, and acceptance of school feeding, and analyzing the factors associated with non-adherence/non-acceptance in full-time public schools in Goiânia, Goiás, Brazil. Methods Cross-sectional study with students of both sexes aged 6-14 years. Issues regarding the consumption of meals, food distribution, food eaten outside the school and socioeconomic data, including nutritional assessment of students, were investigated. Adherence to meals was defined as the consumption of school meals four to five times/week, and acceptance was defined as meal approval, using the facial hedonic scale. Results A total of 359 students participated in this study and it was observed that adherence was high for lunch (95% and afternoon snacks (78%, and low for morning snacks (44%. Acceptance did not reach the required minimum percentage of 85% for any of the meals. Factors associated with non-adherence were the presence of >4 people in a household, having meals in a refectory, the meal location being considered uncomfortable and a negative evaluation of utensils used in eating meals. Factors associated with non-acceptance were age >10 years, female sex, the negative evaluation of utensils used in eating meals and inadequate food temperature. Conclusion Lunch and afternoon snacks showed the highest adherence, but the stipulated acceptance was not reached. Non-adherence and non-acceptance were mainly associated with aspects related to school feeding. This study allowed the evaluation of feeding in full-time public schools, in order to influence its improvement.

Epigenetic effects of the pregnancy Mediterranean diet adherence on the offspring metabolic syndrome markers.

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Lorite Mingot, David; Gesteiro, Eva; Bastida, Sara; Sánchez-Muniz, Francisco J

2017-11-01

Metabolic syndrome (MS) has a multifactorial and not yet fully clarified origin. Insulin resistance is a key element that connects all the accepted components of MS (obesity, dyslipemia, high blood pressure, and hyperglycemia). There is strong evidence that epigenetic changes during fetal development are key factors in the development of MS. These changes are induced by maternal nutrition, among different factors, affecting the intrauterine environment. The Mediterranean diet has been shown to be a healthy eating pattern that protects against the development of MS in adults. Similarly, the Mediterranean diet could have a similar action during pregnancy, protecting the fetus against the development of MS throughout life. This review assembles studies carried out, both in animals and humans, on the epigenetic modifications associated with the consumption, during pregnancy, of Mediterranean diet main components. The relationship between these modifications and the occurrence of factors involved in development of MS is also explained. In addition, the results of our group relating adherence to the Mediterranean diet with MS markers are discussed. The paper ends suggesting future actuation lines in order to increase knowledge on Mediterranean diet adherence as a prevention tool of MS development.

Factors affecting farm diversification in rice-wheat

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Ashfaq, M.; Hassan, S.; Naseer, M.Z.; Baig, I.A.; Asma, J.

2008-01-01

The risk in agriculture sector is due to various factors like weather and market conditions, particularly the demand of the commodities. This uncertainty can result in variable returns (farm income) to the decisions that farmers make in a particular season. Diversification is a frequently used risk management strategy that involves participation in more than one activity. It has the added advantage of mitigating price risk as well as fluctuations in outputs. The main purpose of this paper was to determine the factors affecting crop diversification. For determining the effect of different factors on diversification a multiple regression model was used. The values of Entropy index computed for measuring horizontal diversification were taken as dependent variable and different factors affecting diversification were taken as independent variables. The results showed that the main factors affecting diversification were size of land holding, age of respondent, education level of respondent, farming experience of respondent, off farm income of respondent, distance of farm from main road, distance of farm from main market and farm machinery. (author)

Living situation affects adherence to combination antiretroviral therapy in HIV-infected adolescents in Rwanda: a qualitative study

NARCIS (Netherlands)

Mutwa, Philippe R.; van Nuil, Jennifer Ilo; Asiimwe-Kateera, Brenda; Kestelyn, Evelyne; Vyankandondera, Joseph; Pool, Robert; Ruhirimbura, John; Kanakuze, Chantal; Reiss, Peter; Geelen, Sibyl; van de Wijgert, Janneke; Boer, Kimberly R.

2013-01-01

Adherence to combination antiretroviral therapy (cART) is vital for HIV-infected adolescents for survival and quality of life. However, this age group faces many challenges to remain adherent. We used multiple data sources (role-play, focus group discussions (FGD), and in-depth interviews (IDI)) to

Psychosocial factors associated with adherence to treatment and quality of life in people living with HIV/AIDS in Brazil

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Prisla Ücker Calvetti

2014-03-01

Full Text Available Objective: The objective of this article was to investigate the biopsychosocial factors that influence adherence to treatment and the quality of life of individuals who have been successfully following the HIV/AIDS treatment. Methods: It is a cross-sectional study carried out with 120 HIV positive participants in the south of Brazil. Among the variables studied, of note are: perceived stress, social support, symptoms of anxiety and depression and quality of life. Results: The results show that a moderate to high adherence to the treatment paired with a strong sense of social support indicate a higher quality of life. Conclusion: The combination of social support and antiretroviral treatment have an impact on physical conditions, improving immune response and quality of life.

Adherence to internet-based mobile-supported stress management

DEFF Research Database (Denmark)

Zarski, A C; Lehr, D.; Berking, M.

2016-01-01

of this study was to investigate the influence of different guidance formats (content-focused guidance, adherence-focused guidance, and administrative guidance) on adherence and to identify predictors of nonadherence in an Internet-based mobile-supported stress management intervention (ie, GET.ON Stress......) for employees. Methods: The data from the groups who received the intervention were pooled from three randomized controlled trials (RCTs) that evaluated the efficacy of the same Internet-based mobile-supported stress management intervention (N=395). The RCTs only differed in terms of the guidance format...... of the predictors significantly predicted nonadherence. Conclusions: Guidance has been shown to be an influential factor in promoting adherence to an Internet-based mobile-supported stress management intervention. Adherence-focused guidance, which included email reminders and feedback on demand, was equivalent...

Adherence to the Mediterranean Diet and Inflammatory Markers

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Antoni Sureda

2018-01-01

Full Text Available The aim was to assess inflammatory markers among adults and adolescents in relation to the adherence to the Mediterranean diet. A random sample (219 males and 379 females of the Balearic Islands population (12–65 years was anthropometrically measured and provided a blood sample to determine biomarkers of inflammation. Dietary habits were assessed and the adherence to the Mediterranean dietary pattern calculated. The prevalence of metabolic syndrome increased with age in both sexes. The adherence to the Mediterranean diet in adolescent males was 51.3% and 45.7% in adults, whereas in females 53.1% and 44.3%, respectively. In males, higher adherence to the Mediterranean diet was associated with higher levels of adiponectin and lower levels of leptin, tumor necrosis factor alpha (TNF-α, plasminogen activator inhibitor 1 (PAI-1 and high-sensitivity C-reactive protein (hs-CRP in adults, but not in young subjects. In females, higher adherence was associated with lower levels of leptin in the young group, PAI-1 in adults and hs-CRP in both groups. With increasing age in both sexes, metabolic syndrome increases, but the adherence to the Mediterranean diet decreases. Low adherence to the Mediterranean dietary pattern (MDP is directly associated with a worse profile of plasmatic inflammation markers.

Acceptance-based behavior therapy to promote HIV medication adherence.

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Moitra, Ethan; Herbert, James D; Forman, Evan M

2011-12-01

A significant number of adults with HIV in the USA do not maintain adherence to highly active antiretroviral therapy (HAART) at adequate levels. Although traditional cognitive behavioral interventions have shown promise in promoting HAART adherence, acceptance-based behavior therapy (ABBT) may be particularly useful in this population. ABBT has the potential to overcome common avoidance-based barriers associated with poor adherence, including denial of various illness-related factors and avoidance of stigmatization. We describe the rationale for promoting psychological and behavioral acceptance in HIV-positive populations; outline an ABBT to promote HAART adherence targeting primary care patients from urban, minority, low socioeconomic backgrounds; and report preliminary qualitative observations of treatment feasibility and acceptability.

Association of Continuity of Primary Care and Statin Adherence.

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James R Warren

Full Text Available Deficiencies in medication adherence are a major barrier to effectiveness of chronic condition management. Continuity of primary care may promote adherence. We assessed the association of continuity of primary care with adherence to long-term medication as exemplified by statins.We linked data from a prospective study of 267,091 Australians aged 45 years and over to national data sets on prescription reimbursements, general practice claims, hospitalisations and deaths. For participants having a statin dispense within 90 days of study entry, we computed medication possession ratio (MPR and usual provider continuity index (UPI for the subsequent two years. We used multivariate Poisson regression to calculate the relative risk (RR and 95% confidence interval (CI for the association between tertiles of UPI and MPR adjusted for socio-demographic and health-related patient factors, including age, gender, remoteness of residence, smoking, alcohol intake, fruit and vegetable intake, physical activity, prior heart disease and speaking a language other than English at home. We performed a comparison approach using propensity score matching on a subset of the sample.36,144 participants were eligible and included in the analysis among whom 58% had UPI greater than 75%. UPI was significantly associated with 5% increased MPR for statin adherence (95% CI 1.04-1.06 for highest versus lowest tertile. Dichotomised analysis using a cut-off of UPI at 75% showed a similar effect size. The association between UPI and statin adherence was independent of socio-demographic and health-related factors. Stratification analyses further showed a stronger association among those who were new to statins (RR 1.33, 95% CI 1.15-1.54.Greater continuity of care has a positive association with medication adherence for statins which is independent of socio-demographic and health-related factors.

Association of Continuity of Primary Care and Statin Adherence.

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Warren, James R; Falster, Michael O; Tran, Bich; Jorm, Louisa

2015-01-01

Deficiencies in medication adherence are a major barrier to effectiveness of chronic condition management. Continuity of primary care may promote adherence. We assessed the association of continuity of primary care with adherence to long-term medication as exemplified by statins. We linked data from a prospective study of 267,091 Australians aged 45 years and over to national data sets on prescription reimbursements, general practice claims, hospitalisations and deaths. For participants having a statin dispense within 90 days of study entry, we computed medication possession ratio (MPR) and usual provider continuity index (UPI) for the subsequent two years. We used multivariate Poisson regression to calculate the relative risk (RR) and 95% confidence interval (CI) for the association between tertiles of UPI and MPR adjusted for socio-demographic and health-related patient factors, including age, gender, remoteness of residence, smoking, alcohol intake, fruit and vegetable intake, physical activity, prior heart disease and speaking a language other than English at home. We performed a comparison approach using propensity score matching on a subset of the sample. 36,144 participants were eligible and included in the analysis among whom 58% had UPI greater than 75%. UPI was significantly associated with 5% increased MPR for statin adherence (95% CI 1.04-1.06) for highest versus lowest tertile. Dichotomised analysis using a cut-off of UPI at 75% showed a similar effect size. The association between UPI and statin adherence was independent of socio-demographic and health-related factors. Stratification analyses further showed a stronger association among those who were new to statins (RR 1.33, 95% CI 1.15-1.54). Greater continuity of care has a positive association with medication adherence for statins which is independent of socio-demographic and health-related factors.

Adherence and health care costs

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Iuga AO

2014-02-01

Full Text Available Aurel O Iuga,1,2 Maura J McGuire3,4 1Johns Hopkins Bloomberg School of Public Health, 2Johns Hopkins University, 3Johns Hopkins Community Physicians, 4Johns Hopkins University School of Medicine, Baltimore, MD, USA Abstract: Medication nonadherence is an important public health consideration, affecting health outcomes and overall health care costs. This review considers the most recent developments in adherence research with a focus on the impact of medication adherence on health care costs in the US health system. We describe the magnitude of the nonadherence problem and related costs, with an extensive discussion of the mechanisms underlying the impact of nonadherence on costs. Specifically, we summarize the impact of nonadherence on health care costs in several chronic diseases, such as diabetes and asthma. A brief analysis of existing research study designs, along with suggestions for future research focus, is provided. Finally, given the ongoing changes in the US health care system, we also address some of the most relevant and current trends in health care, including pharmacist-led medication therapy management and electronic (e-prescribing. Keywords: patient, medication, adherence, compliance, nonadherence, noncompliance, cost

Medication adherence in patients with rheumatoid arthritis: the effect of patient education, health literacy, and musculoskeletal ultrasound.

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Joplin, Samantha; van der Zwan, Rick; Joshua, Fredrick; Wong, Peter K K

2015-01-01

Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease affecting educational levels and limited health literacy are contributory factors. Psychological models may assist in explaining medication nonadherence. Increasing patient knowledge of their disease seems sensible. Existing educational interventions appear ineffective at improving medication adherence, probably due to an overemphasis on provision of biomedical information. A novel approach to patient education using musculoskeletal ultrasound is proposed.

Facilitators and barriers of medication adherence in pediatric liver and kidney transplant recipients: a mixed-methods study.

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Claes, Anouck; Decorte, Anneloes; Levtchenko, Elena; Knops, Noel; Dobbels, Fabienne

2014-12-01

Many young transplant patients (≤11 years old) struggle to take their immunosuppressive and co-medications correctly, yet it remains unclear which factors positively or negatively affect medication adherence. Research studies on determinants in this age group are scarce, have methodological flaws, and focus exclusively on immunosuppressants or on barriers rather than on facilitators. This study used a consecutive mixed-methods (qualitative + quantitative) design. Semistructured interviews with parents of 10 pediatric liver or kidney transplant recipients 2 to 11 years old on adherence facilitators and barriers were conducted, complemented by quantification of adherence to the immunosuppressants and co-medications, and completion of the "immunosuppressive medication adherence barriers" self-report instrument. A median of 19 (range, 10-29) barriers was reported: the most commonly encountered were forgetfulness (70%), vomiting (70%), bad taste (60%), and interruptions in routine (60%). Parents reported a median of 15 facilitators (range, 6-26), including using practical aids (100%), having medication with you at all times (100%), having to take fewer medications (80%), and experiencing fewer regimen changes over time (80%). No clear distinction between immunosuppressants or co-medications was made. This study provides several new insights based on peer experience to support future patients and their parents in medication adherence.

Medication adherence and persistence in type 2 diabetes mellitus: perspectives of patients, physicians and pharmacists on the Spanish health care system

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Labrador Barba E

2017-04-01

Full Text Available Elena Labrador Barba,1 Marta Rodríguez de Miguel,1 Antonio Hernández-Mijares,2,3 Francisco Javier Alonso-Moreno,4 Maria Luisa Orera Peña,1 Susana Aceituno,5 María José Faus Dader6 1Department of Medicine, Mylan, Madrid, 2Department of Endocrinology and Nutrition, Doctor Peset University Hospital, Valencia, 3Department of Medicine, University of Valencia, Valencia, 4Department for Primary Health Care, Centro de Salud Sillería, Toledo, 5Outcomes’10, Castellon, 6Department of Biochemistry and Molecular Biology, Faculty of Pharmacy, University of Granada, Granada, Spain Objective: A good relationship between diabetes patients and their health care team is crucial to ensure patients’ medication adherence and self-management. To this end, we aimed to identify and compare the views of type 2 diabetes mellitus (T2DM patients, physicians and pharmacists concerning the factors and strategies that may be associated with, or could improve, medication adherence and persistence.Methods: An observational, cross-sectional study was conducted using an electronic self-administered questionnaire comprising 11 questions (5-point Likert scale concerning factors and strategies related to medication adherence. The survey was designed for T2DM patients and Spanish National Health System professionals.Results: A total of 963 T2DM patients, 998 physicians and 419 pharmacists participated in the study. Overall, a lower proportion of pharmacists considered the proposed factors associated with medication adherence important as compared to patients and physicians. It should be noted that a higher percentage of physicians in comparison to pharmacists perceived that “complexity of medication” (97% vs 76.6%, respectively and “adverse events” (97.5% vs 72.2%, respectively were important medication-related factors affecting adherence. In addition, both patients (80.8% and physicians (80.8% agreed on the importance of “cost and co-payment” for adherence

Suboptimal treatment adherence in bipolar disorder: impact on clinical outcomes and functioning

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Montes JM

2013-01-01

Full Text Available Jose Manuel Montes1, Jorge Maurino2, Consuelo de Dios3, Esteban Medina21Department of Psychiatry, Hospital Universitario del Sureste, 2AstraZeneca Medical Department, 3Department of Psychiatry, Hospital Universitario La Paz, Madrid, SpainBackground: The primary aim of this study was to assess drug treatment adherence in patients with bipolar disorder and to identify factors associated with adherence. The secondary aim was to analyze the impact of suboptimal adherence on clinical and functional outcomes.Methods: A cross-sectional study was conducted in a sample of outpatients receiving an oral antipsychotic drug. Medication adherence was assessed combining the 10-item Drug Attitude Inventory, the Morisky Green Adherence Questionnaire, and the Compliance Rating Scale. Logistic regression was used to determine significant variables associated with suboptimal adherence to medication.Results: Three hundred and three patients were enrolled into the study. The mean age was 45.9 ± 12.8 years, and 59.7% were females. Sixty-nine percent of patients showed suboptimal adherence. Disease severity and functioning were significantly worse in the suboptimal group than in the adherent group. Multivariate analysis showed depressive polarity of the last acute episode, presence of subsyndromal symptoms, and substance abuse/dependence to be significantly associated with suboptimal treatment adherence (odds ratios 3.41, 2.13, and 1.95, respectively.Conclusion: A high prevalence of nonadherence was found in an outpatient sample with bipolar disorder. Identification of factors related to treatment adherence would give clinicians the opportunity to select more adequately patients who are eligible for potential adherence-focused interventions.Keywords: bipolar disorder, treatment adherence, functioning, polarity, subsyndromal symptoms

Renal Transplant Recipients: The Factors Related to Immunosuppressive Medication Adherence Based on the Health Belief Model.

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Kung, Pen-Chen; Yeh, Mei Chang; Lai, Ming-Kuen; Liu, Hsueh-Erh

2017-10-01

Kidney transplant failures are caused primarily by lack of adherence to immunosuppressive medication regimens by patients after transplantation. A number of studies have indicated that health-related beliefs are an effective predictor of health-related behavior. The aim of this study is to understand the influence of the personal characteristics and health-related beliefs of patients on adherence to treatment with immunosuppressive medication based on the Health Belief Model. This cross-sectional study distributed questionnaires to patients who had been recruited via purposive sampling at one medical center in Taipei. All of the potential participants had undergone kidney transplantation at least 6 months previously. The self-developed questionnaire collected data in three areas: personal characteristics, health-related beliefs regarding transplant rejection, and adherence to the immunosuppressive medication regimen. One hundred twenty-two valid questionnaires were received. The collected data were analyzed using descriptive statistics, independent t test, one-way analysis of variance, Pearson's correlation, and multiple regression. Participants who had received dialysis treatment or had experienced rejection perceived susceptibility to rejection more strongly than those who had not. Participants who had undergone transplantation in Taiwan, had experienced more drug-related symptoms, or had contracted severe to extremely severe infections in the past showed lower rates of adherence to treatment with immunosuppressive medication. Adherence to medication regimens correlated negatively with length of time since transplantation. Length of time since transplantation, drug-related symptoms, perceived susceptibility to rejection, and perceived benefits of treatment were identified as major predictors of adherence to immunosuppressive medication regimens. The results partially conformed to the concepts of the Health Belief Model. Perceived susceptibility to rejection and

Measurement complexity of adherence to medication

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Galato D

2012-04-01

Full Text Available Dayani Galato, Fabiana Schuelter-Trevisol, Anna Paula PiovezanMaster Program in Health Sciences, University of Southern Santa Catarina (Unisul Tubarão, Santa Catarina, BrazilAdherence to pharmacologic therapy is a major challenge for the rational use of medicines, particularly when it comes to antiretroviral drugs that require adherence to at least 95% of prescribed doses.1 Studies in this area are always important and contribute to medication adherence understanding, even though there is no reference test for measuring this. Recently, an article was published in this journal that proposes the determination of lamivudine plasma concentration to validate patient self-reported adherence to antiretroviral treatment.2 In that study, serum levels obtained after 3 hours of ingestion of the last dose of the drug were compared with patient reports that were classified into different levels of adherence, based on their recall of missed doses in the previous 7 days.It was hypothesized by the authors that the use of a biological marker for drug adherence was extremely important, given the relevance of the topic. However, we would like to draw attention to some points that may determine the success of the use of similar methods for this purpose. The formation of groups with similar anthropometric characteristics is relevant since the dose of lamivudine may have to be changed, depending, for example, on sex, weight, and age.3 Even information considered important by the authors of that study was not provided. There is a need for greater clarity on the eligibility criteria, especially with regard to the clinical stage of the disease, CD4 counts and viral load, associated diseases, and comorbidity, as well as the evaluation of kidney function and other medications used that can affect lamivudine pharmacokinetics.3View original paper by Minzi and colleagues

Contemporary issues on the epidemiology and antiretroviral adherence of HIV-infected adolescents in sub-Saharan Africa: a narrative review

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Adejumo, Olurotimi A; Malee, Kathleen M; Ryscavage, Patrick; Hunter, Scott J; Taiwo, Babafemi O

2015-01-01

Introduction Adolescents are a unique and sometimes neglected group in the planning of healthcare services. This is the case in many parts of sub-Saharan Africa, where more than eight out of ten of the world's HIV-infected adolescents live. Although the last decade has seen a reduction in AIDS-related mortality worldwide, largely due to improved access to effective antiretroviral therapy (ART), AIDS remains a significant contributor to adolescent mortality in sub-Saharan Africa. Although inadequate access to ART in parts of the subcontinent may be implicated, research among youth with HIV elsewhere in the world suggests that suboptimal adherence to ART may play a significant role. In this article, we summarize the epidemiology of HIV among sub-Saharan African adolescents and review their adherence to ART, emphasizing the unique challenges and factors associated with adherence behaviour. Methods We conducted a comprehensive search of online databases for articles, relevant abstracts, and conference reports from meetings held between 2010 and 2014. Our search terms included “adherence,” “compliance,” “antiretroviral use” and “antiretroviral adherence,” in combination with “adolescents,” “youth,” “HIV,” “Africa,” “interventions” and the MeSH term “Africa South of the Sahara.” Of 19,537 articles and abstracts identified, 215 met inclusion criteria, and 148 were reviewed. Discussion Adolescents comprise a substantial portion of the population in many sub-Saharan African countries. They are at particular risk of HIV and may experience worse outcomes. Although demonstrated to have unique challenges, there is a dearth of comprehensive health services for adolescents, especially for those with HIV in sub-Saharan Africa. ART adherence is poorer among older adolescents than other age groups, and psychosocial, socio-economic, individual, and treatment-related factors influence adherence behaviour among adolescents in this region. With

Contemporary issues on the epidemiology and antiretroviral adherence of HIV-infected adolescents in sub-Saharan Africa: a narrative review.

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Adejumo, Olurotimi A; Malee, Kathleen M; Ryscavage, Patrick; Hunter, Scott J; Taiwo, Babafemi O

2015-01-01

Adolescents are a unique and sometimes neglected group in the planning of healthcare services. This is the case in many parts of sub-Saharan Africa, where more than eight out of ten of the world's HIV-infected adolescents live. Although the last decade has seen a reduction in AIDS-related mortality worldwide, largely due to improved access to effective antiretroviral therapy (ART), AIDS remains a significant contributor to adolescent mortality in sub-Saharan Africa. Although inadequate access to ART in parts of the subcontinent may be implicated, research among youth with HIV elsewhere in the world suggests that suboptimal adherence to ART may play a significant role. In this article, we summarize the epidemiology of HIV among sub-Saharan African adolescents and review their adherence to ART, emphasizing the unique challenges and factors associated with adherence behaviour. We conducted a comprehensive search of online databases for articles, relevant abstracts, and conference reports from meetings held between 2010 and 2014. Our search terms included "adherence," "compliance," "antiretroviral use" and "antiretroviral adherence," in combination with "adolescents," "youth," "HIV," "Africa," "interventions" and the MeSH term "Africa South of the Sahara." Of 19,537 articles and abstracts identified, 215 met inclusion criteria, and 148 were reviewed. Adolescents comprise a substantial portion of the population in many sub-Saharan African countries. They are at particular risk of HIV and may experience worse outcomes. Although demonstrated to have unique challenges, there is a dearth of comprehensive health services for adolescents, especially for those with HIV in sub-Saharan Africa. ART adherence is poorer among older adolescents than other age groups, and psychosocial, socio-economic, individual, and treatment-related factors influence adherence behaviour among adolescents in this region. With the exception of a few examples based on affective, cognitive, and

Adherence to physical activity in adults with chronic diseases: ELSA-Brasil

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Ludimila Forechi

2018-04-01

Full Text Available ABSTRACT OBJECTIVE The objective of this study is to investigate the adherence and the factors that influence adherence to physical activity in adults with dyslipidemia, hypertension, or diabetes. METHODS The analyses were based on data collected at the baseline of the 14,521 participants from the study ELSA-Brasil aged between 35 and 74 years. The level of leisure time physical activity was determined using the International Physical Activity Questionnaire. Logistic regression analyses were performed to examine the influence of the demographic data, socioeconomic conditions, perceived health status, and access to exercise facilities in the neighborhood on adherence to physical activity. RESULTS Men with hypertension and dyslipidemia were more active than women. The results show that 17.8%, 15.1%, and 13.9% of the subjects who reported dyslipidemia, hypertension, and diabetes, respectively, adhere to the physical activity recommendations. The factors positively associated with adherence were higher education and income. Older individuals who reported poor perceived health, were overweight and obese, regularly smoked, and had fewer opportunities to exercise in the neighborhood presented lower adherence. CONCLUSIONS The number of adults with dyslipidemia, hypertension, and diabetes who adhere to the physical activity recommendations is very low. Higher education and income are positively associated with adherence, while age, excess body weight, negative perceived health, regular smoking, and lack of opportunity to exercise in the neighborhood were considered barriers to physical activity.

An integrative review of the methodology and findings regarding dietary adherence in end stage kidney disease.

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Lambert, Kelly; Mullan, Judy; Mansfield, Kylie

2017-10-23

Dietary modification is an important component of the management of end stage kidney disease (ESKD). The diet for ESKD involves modifying energy and protein intake, and altering sodium, phosphate, potassium and fluid intake. There have been no comprehensive reviews to date on this topic. The aims of this integrative review were to (i) describe the methods used to measure dietary adherence (ii) determine the rate of dietary adherence and (iii) describe factors associated with dietary adherence in ESKD. The Web of Science and Scopus databases were searched using the search terms 'adherence' and 'end stage kidney disease'. Of the 787 potentially eligible papers retrieved, 60 papers of 24,743 patients were included in this review. Of these papers, 44 reported the rate of dietary adherence and 44 papers described factors associated with adherence. Most of the evidence regarding dietary adherence is derived from studies of hemodialysis patients (72% of patients). The most common method of measuring dietary adherence in ESKD was subjective techniques (e.g. food diaries or adherence questionnaires). This was followed by indirect methods (e.g. serum potassium, phosphate or interdialytic weight gain). The weighted mean adherence rate to ESKD dietary recommendations was 31.5% and 68.5% for fluid recommendations. Adherence to protein, sodium, phosphate, and potassium recommendations were highly variable due to differences in measurement methods used, and were often derived from a limited evidence base. Socioeconomic status, age, social support and self-efficacy were associated with dietary adherence. However, factors such as taste, the impact of the diet on social eating occasions; and dietetic staffing also appear to play a role in dietary adherence. Dietary adherence rates in people with ESKD are suboptimal. Further research is required on dietary adherence in patients with ESKD from different social, educational, economic and ethnic groups. This research may identify other

Age Learning Factors Affecting Pilot Education.

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Torbert, Brison

This document, intended for pilot education and flight safety specialists, consists chiefly of a review of the literature on physiological factors that affect pilot education and an examination of environmental factors that should be scrutinized in order to improve the effectiveness of aviation learning facilities. The physiological factors…

Perceived Factors Affecting Performance Of Extension Workers In ...

African Journals Online (AJOL)

The study focused on perceived factors affecting performance of extension workers in Imo State, Nigeria. Data for the study was collected from 83 Extension agents from the Imo State Agricultural Development Programme (ADP). Results of the study revealed that the organizational factors that affect performance are ...

Medication Adherence Among Elderly Patients with High Blood Pressure in Gweru, Zimbabwe.

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Wariva, Elizabeth; January, James; Maradzika, Julita

2014-02-04

High blood pressure is a global health concern which is mainly managed by taking anti-hypertensive medications. Although medication is available to control high blood pressure, adhering to treatment is a major problem among hypertensive patients. The purpose of the study was to assess the predisposing, enabling and reinforcing factors to medication adherence among hypertensive patients in Gweru urban aged 40-70 years. A descriptive cross sectional study was used with a sample size of 110 conveniently sampled hypertensive patients. We used an interviewer administered questionnaire designed using phase 4 of the PRECEDE model. The modal age was 70 years and mean age was 58 years (SD=10.29). There were 61.8% females and 38.2% males. Variables associated with medication adherence were: age (P=0.0059), marital status (P=0.015), average monthly income (P=0.0002), support group (P=0.027) and knowledge (P=0.0058). Providing information to patients with high blood pressure and having a good patient-provider relationship improves medication adherence. There is need to focus on the predisposing, enabling and reinforcing factors of medication adherence since demographic and socio-economic factors may be more difficult to change.

Emotional functioning, barriers, and medication adherence in pediatric transplant recipients.

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McCormick King, Megan L; Mee, Laura L; Gutiérrez-Colina, Ana M; Eaton, Cyd K; Lee, Jennifer L; Blount, Ronald L

2014-04-01

This study assessed relationships among internalizing symptoms, barriers to medication adherence, and medication adherence in adolescents with solid organ transplants. The sample included 72 adolescents who had received solid organ transplants. Multiple mediator models were tested via bootstrapping methods. Bivariate correlations revealed significant relationships between barriers and internalizing symptoms of depression, anxiety, and posttraumatic stress, as well as between internalizing symptoms and medication adherence. Barriers indicative of adaptation to the medication regimen (e.g., forgetting, lack of organization) were related to medication adherence and mediated the relationship between internalizing symptoms and medication adherence. These findings indicate that barriers may serve as a more specific factor in the relationship between more general, pervasive internalizing symptoms and medication adherence. Results may help guide areas for clinical assessment, and the focus of interventions for adolescent transplant recipients who are experiencing internalizing symptoms and/or who are nonadherent to their medication regimen.

Interventions to improve medication adherence in adult kidney transplant recipients: a systematic review.

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Low, Jac Kee; Williams, Allison; Manias, Elizabeth; Crawford, Kimberley

2015-05-01

In kidney transplantation, adherence to immunosuppressive therapy is paramount for long-term graft survival. This systematic review aimed to assess the effectiveness of interventions to improve medication adherence in adult kidney transplantation. Eight electronic databases were searched from inception to November 2013. Only primary intervention studies, which reported measurement of adherence to immunosuppressive medications after kidney transplantation, were included. The quality of all studies was assessed using the Consolidated Standards of Reporting Trials and Transparent Reporting of Evaluations with Non-randomized Designs checklists. A synthesis was undertaken to tease out the domains targeted by interventions: (i) educational/cognitive, (ii) counselling/behavioural, (iii) psychologic/affective and (iv) financial support. For each study, key information, such as population, location, methods of measurements, comparison group, type of intervention and outcomes, were extracted and tabulated. Twelve intervention studies were identified. Quality of studies ranged from 16.0 to 80.5%. Effective interventions were implemented for 3, 6 and 12 months. Medication adherence rates were greatly enhanced when multidimensional interventions were implemented whereas one-off feedback from a nurse and financial assistance programmes offered little improvement. Dose administration aids when used in conjunction with self-monitoring also improved adherence. The number of patients who had a drug holiday (at least 1-day interval without a dose) was higher in a once-daily regimen than a twice-daily regimen. The findings of this review suggest an intervention targeting behavioural risk factors or a combination of behavioural, educational and emotional changes is effective in enhancing medication adherence. Effectiveness of an intervention may be further enhanced if patients are encouraged to participate in the development process. © The Author 2014. Published by Oxford University

Prevalence and Factors Associated with Fixed-Dose Combination Antiretroviral Drugs Adherence among HIV-Positive Pregnant Women on Option B Treatment in Mpumalanga Province, South Africa

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Shandir Ramlagan

2018-01-01

Full Text Available The possibility for all babies to be born and remain HIV-negative for the first year of life is achievable in South Africa. HIV-positive mothers’ adherence to their antiretroviral medication is one of the crucial factors to achieve this target. Cross-sectional data were collected at 12 community health centres, over 12 months (2014–2015, from 673 HIV-positive women, less than 6 months pregnant, attending antenatal care, and on Option B treatment. Adherence measures included the Adults AIDS Clinical Trials Group (AACTG four-day measure, as well as the Visual Analog Scale (VAS seven-day measure. Bivariate analyses and multivariate logistic regressions are presented. 78.8% of respondents were adherent on AACTG, while 68.8% reported VAS adherence. Bivariate analyses for increased adherence show significant associations with older age, less/no alcohol usage, disclosure of HIV status, higher HIV knowledge, no desire to avoid ARV side effects, low stigma, and low depression. AACTG showed a negative association with intimate partner violence. Multivariable logistic regression on AACTG and VAS adherence rates resulted in unique contributions to increased adherence of older age, less/no alcohol usage, higher HIV knowledge, lack of depression, and non-disclosure. Programs targeting closer side effect monitoring, HIV disclosure, pre-natal depression, alcohol intake, and HIV knowledge need consideration.

Adherencia terapéutica y factores psicosociales en pacientes hipertensos Therapeutic adherence and psychosocial factors in hypertensive patients

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Yadmila Rosa Matos La

2007-03-01

Full Text Available La terapéutica de las enfermedades cardiovasculares requiere de la modificación de ciertos hábitos y comportamientos, de ahí la importancia del cumplimiento de las prescripciones médicas. Con la finalidad de describir los factores psicosociales asociados a la adherencia terapéutica se realizó un estudio descriptivo, de corte transversal, en una muestra de 263 pacientes hipertensos distribuidos en 13 consultorios del Médico de Familia del Policlínico Docente “Edor de los Reyes Martínez”, en el Consejo Popular Sur, del área urbana del municipio Jiguaní, provincia Granma. La información se obtuvo a través de la aplicación de un cuestionario elaborado para este fin. Los resultados más relevantes fueron: las creencias que tiene el paciente acerca del tratamiento como beneficio para su salud, los conocimientos adecuados sobre las características de la enfermedad, los afrontamientos al tratamiento con autoeficacia y la percepción de suficientes redes de apoyo social, que son los que más se asocian a la adherencia terapéutica.The therapeutics of the cardiovascular diseases requires the modification of certain habits and behaviors, that's why the fulfillment of the medical prescriptions is so important. With the objective of describing the psychosical factors associated with therapeutical adherence, a descriptive, cross-sectional study was undertaken in a sample of 263 hypertensive patients distributed in 13 family physicians' offices of “Edor de los Reyes Martínez” Teaching Polyclinic in the Southern People's Council of the urban area of Jiguaní municipality, Granma province. The information was obtained by applying a questionnaire made to this end. The most relevant results were: the patient's belief that the treatment benefits his health, the adequate knowledge of the characteristics of the disease, the facing of the treatment with self-efficiency, and the perception of enough social support networks. These outcomes are

ANALYSIS OF THE FACTORS AFFECTING THE AVERAGE