Dissertations / Theses on the topic 'Research adherence'

Poor adherence to medication wastes resources and can lead to reduced exposure to and effectiveness of pharmacological treatments. Poor adherence to medication in clinical research can dilute treatment effects, obscuring the true benefits that medication can provide. The study of medication adherence comprises significant methodological challenges. The aim of my thesis was to investigate several methodological challenges encountered when studying medication adherence in clinical research using data from five clinical studies. Several methods for measuring adherence were compared using both correlation and agreement approaches. I proposed extensions to data visualisation techniques for comparing agreement. As an alternative to reporting summary measures, I explored the use of advanced modelling techniques to model adherence data collected via electronic monitors. I also moved beyond comparisons of measures and investigated approaches for predicting disagreement and calibration techniques. I investigated various methods for modelling the determinants of adherence, considering determinants according to type of measure used, type of condition being studied, different study designs, and different conceptualisations of adherence. I explored, quantitatively, the extent to which the treating clinician influenced whether a patient adhered to their treatment. I also established the feasibility of calculating randomisation-based efficacy estimators in randomised controlled trials with non-adherence, scrutinising the implementation of these approaches during placebo-controlled trials and non-inferiority trials involving two active treatments. My findings emphasise the need for considering the impact of medication adherence when designing a study, rather than leaving it as an afterthought, as it would appear to be much of the time. Such considerations include selecting an appropriate mode (or modes) of medication adherence ascertainment, agreeing adherence definitions of interest, measuring variables that are likely to be associated with adherence, and, particularly for trials, determining whether it is feasible to adjust findings for non-adherence while maintaining a comparison of groups as randomised.

Thesis (Ph.D.)--University of Florida, 2004.
Typescript. Title from title page of source document. Document formatted into pages; contains 94 pages. Includes Vita. Includes bibliographical references.

The lack of transparency and accuracy of research reports has been pointed out as one of the main factors causing research waste. Reporting guidelines (RGs) are sets of recommendations for authors on how to report research methods and findings in a way that no relevant information is missing. Nowadays, there exist more than 400 RGs for different study types, data, and clinical areas. However, biomedical authors’ adherence to RGs has been shown to be poor. For this reason, it is warranted to explore what strategies to improve adherence to RGs can be implemented at different points in the research process. This thesis has three objectives: (i) to identify, classify, and analyse interventions to improve adherence to RGs that have been described in the biomedical literature, and to determine the existing gaps in research on the evaluation of interventions, (ii) to explore biomedical editors’ perceptions of different interventions that have been or can be implemented at various points in the editorial process (iii) to evaluate in a real editorial context the impact of an intervention designed based on the studies that address objectives (i) and (ii). For the first objective, we performed a scoping review of interventions to improve adherence to RGs and identified 31 interventions (11 evaluated, 20 non-evaluated). These were grouped into five categories: training on the use of RGs; improving understanding; encouraging adherence; checking adherence and providing feedback; and involvement of experts. Research gaps identified included the evaluation of interventions (i) on training on the use of RGs and improving understanding of these, (ii) at early stages of research (education, grant writing or protocol writing), and (iii) after the final acceptance of the manuscript (copyediting or post-publication peer review). Furthermore, we showed that one of the most widespread editorial interventions, the requirement for authors to submit a completed RG checklist together with their manuscript, does not guarantee adherence. To address the second goal, we performed a survey for biomedical journal editors with experience and interest in the topic of improving authors’ adherence to RGs. These editors generally believed that engaging trained professionals in the process of checking adherence to RGs would be the most effective, yet moderately resource intensive, editorial intervention. Also, they thought that standard peer reviewers should not be asked to check RG requirements as they generally lack time and training on the content of RGs. For other promising interventions that could potentially be implemented and evaluated in biomedical journals, we also identified their barriers and facilitators, as well as different types of incentives to encourage the use of RGs. For our third goal, we carried out a randomised controlled trial. Our goal was to analyse, in a sample of 24 trials submitted to the medical journal BMJ Open, the effect of involving a CONSORT expert in the process of evaluating the submitted checklist and providing feedback to authors. Our results showed that the manuscripts that received this intervention were more completely reported than the ones following the standard process. Based on this, we propose that journals consider revising their peer review processes in order to find ways to make this intervention workable. In this thesis, we have shown the effectiveness of engaging a reporting expert in the editorial process of a biomedical journal, and we have identified and explored in detail various interventions that future research may consider evaluating. Developing and implementing effective solutions to improve adherence to RGs is a key step to increase the societal impact of biomedical research and reduce research waste.
La falta de transparencia y precisión de los informes de investigación es uno de los principales factores asociados al derroche de recursos financieros invertidos en investigación. Las guías de publicación (¿Reporting Guidelines¿, RGs) especifican cómo los investigadores han de informar de los métodos y resultados de sus estudios, de tal forma que los manuscritos contengan toda la información esencial para los lectores. Hoy en día, existen más de 400 RGs para distintos tipos de estudios, datos y áreas clínicas. Sin embargo, el nivel de adherencia a las RGs es deficiente. Por tanto, es necesario explorar qué estrategias para mejorar la adherencia a las RGs se pueden implementar en distintos momentos del proceso de investigación. Esta tesis tiene tres objetivos: (i) identificar, clasificar y analizar qué intervenciones para mejorar la adherencia a las RGs han sido descritas en la literatura biomédica, y determinar qué lagunas existen en la evaluación de intervenciones, (ii) explorar las percepciones de los editores biomédicos expertos sobre distintas intervenciones que afectan a los procesos editoriales, y (iii) evaluar el impacto de una intervención diseñada a partir de los estudios relativos a los objetivos (i) y (ii). Para alcanzar el primer objetivo, realizamos una revisión exploratoria. Esta revisión nos permitió identificar 31 intervenciones que agrupamos en cinco categorías: formación en el uso de RGs; mejora de la comprensión de las RGs; verificación de la adherencia a las RGs y propuestas de mejora para los autores; y colaboración de expertos. Además, identificamos algunas lagunas en las evaluaciones de intervenciones (i) relativas a la formación y mejora de la comprensión de las RGs, (ii) en fases iniciales del proceso de investigación (educación, solicitud de financiación o elaboración de protocolos), y (iii) después de la aceptación para publicación del manuscrito de investigación (durante el proceso de edición, o la revisión post-publicación del artículo). Por otro lado, mostramos que una de las intervenciones editoriales más populares, que consiste en requerir que los autores completen y envíen la lista de verificación de la RG adecuada junto con su manuscrito, no garantiza la adherencia a esta RG. En relación con el segundo objetivo, realizamos una encuesta para editores expertos de revistas biomédicas. Estos expresaron mayoritariamente que la intervención potencialmente más efectiva sería involucrar a profesionales formados en el contenido de las RGs, aunque podría requerir un gran volumen de recursos. Además, los participantes apuntaron que los revisores por pares no deberían encargarse de verificar la adherencia a las RGs ya que normalmente carecen de la formación y el tiempo necesarios para realizar esta labor. Finalmente, identificamos las ventajas e inconvenientes de diversas intervenciones prometedoras, así como distintos tipos de incentivos para promover el uso de las RGs. De cara al tercer objetivo, llevamos a cabo un ensayo aleatorizado con el propósito de analizar, en 24 ensayos aleatorizados recibidos por la revista médica BMJ Open, el efecto de involucrar en el proceso editorial a un experto en CONSORT (la RG para ensayos aleatorizados) que evaluase las guías de verificación enviadas por los autores y les propusiese mejoras. Los resultados señalaron que los manuscritos que pasaban por este proceso eran más completos que los que seguían el proceso estándar. A raíz de esto, proponemos que las revistas ajusten sus procesos de revisión y busquen formas de hacer viable esta intervención. En esta tesis, hemos demostrado la eficacia de la inclusión en los procesos editoriales de expertos en la presentación de informes científicos. Además, hemos analizado diversas intervenciones que pueden ser evaluadas en el futuro. Desarrollar soluciones efectivas para mejorar la adherencia a las RGs es clave para aumentar el impacto social de la investigación biomédica y reducir el derroche de recursos financieros.
La manca de transparència y precisió dels informes d’investigació és un dels principals factors associats al malbaratament de recursos financers invertits en investigació. Les guies de publicació ("Reporting Guidelines", RGs) especifiquen com els investigadors han d'informar dels mètodes i resultats dels seus estudis, de manera que els manuscrits continguin tota la informació essencial per als lectors. Avui dia, n’hi ha més de 400 RGs per a diferents tipus d'estudis, dades i àrees clíniques. Tanmateix, el nivell d’adherència a les RGs és deficient. Per tant, és necessari explorar quines estratègies per millorar l'adherència a les RGs es poden implementar en diferents moments del procés d'investigació. Aquesta tesi té tres objectius: (i) identificar, classificar i analitzar quines intervencions han estat descrites per millorar l'adherència a les RGs en la literatura biomèdica, i determinar quines mancances existeixen en l'avaluació d'intervencions, (ii) explorar les percepcions dels editors biomèdics experts sobre diferents intervencions que afecten als processos editorials, i (iii) avaluar, en un context editorial real, l'impacte d'una intervenció dissenyada a partir dels estudis relatius als objectius (i) i (ii). Per assolir el primer objectiu, vam realitzar una revisió exploratòria. Aquesta revisió ens va permetre identificar 31 intervencions que vam agrupar en cinc categories: formació en l'ús de RGs; millora de la comprensió de les RGs; verificació de l'adherència a les RGs i propostes de millora per als autors; i col·laboració d'experts. Encara més, vam detectar mancances en l’avaluació d'intervencions (i) relatives a la formació i millora de la comprensió de les RGs, (ii) en fases inicials del procés de recerca (formació, sol·licitud de finançament o elaboració de protocols), i (iii) després de l'acceptació per a publicació dels manuscrits de recerca (durant el procés d'edició, o la revisió post-publicació de l’article). D’altra banda, vam demostrar que una de les intervencions editorials més populars, que consisteix en requerir que els autors completin i enviïn la llista de verificació de la RG adequada amb el seu manuscrit, no garanteix l’adherència a aquesta RG. Per al segon objectiu, vam efectuar una enquesta dirigida a editors experts de revistes biomèdiques. Una majoria dels editors van expressar que la intervenció potencialment més efectiva seria involucrar professionals formats en el contingut de les RGs, encara que això podria requerir un gran volum de recursos. Així mateix, els participants van opinar que els revisors per parells no haurien d’encarregar-se de verificar l'adherència a les RGs ja que normalment no tenen el temps i la formació necessaris per realitzar aquesta tasca. Així mateix, vam identificar els avantatges i inconvenients de diverses intervencions prometedores, així com diferents tipus d'incentius per promoure l'ús de les RGs. En relació amb el tercer objectiu, vam portar a terme un assaig aleatoritzat amb la finalitat d’analitzar, en 24 assaigs aleatoritzats rebuts per la revista mèdica BMJ Open, l’efecte d’involucrar en el procés editorial a un expert en CONSORT (la guia per a assaigs aleatoritzats) que avalués les guies de verificació enviades pels autors i els hi proposés millores. Els resultats van indicar que els manuscrits que passaven per aquest procés eren més complets que els que seguien el procés estàndard. Arran d’això, proposem que les revistes ajustin els seus processos de revisió i busquin formes de fer viable aquesta intervenció. En aquesta tesi, hem demostrat l’eficàcia de la inclusió en els processos editorials de experts en la presentació d'informes científics. A més, hem analitzat en detall diverses intervencions que poden ser avaluades en el futur. Desenvolupar solucions efectives per millorar l'adherència a les RGs és un pas clau per augmentar l'impacte social de la recerca biomèdica i reduir el malbaratament de recursos financers.

Thesis (M.S)--University of Florida, 2005.
Typescript. Title from title page of source document. Document formatted into pages; contains 35 pages. Includes Vita. Includes bibliographical references.

Objectives: Adherence to psychotropic medication is poor among individuals with bipolar disorder (BD). To understand treatment experiences and associated adherence among these individuals, we developed a novel construct of Clinical Net Benefit (CNB) using psychiatric symptoms, adverse effects and overall functioning assessments. We tested whether adherence differed across classes of CNB, whether individuals transitioned between classes over time, and whether these transitions were differentially associated with adherence. Methods: Data come from individuals aged 18+ during five years of the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). Latent class analysis identified groups of CNB. Latent transition analysis determined probabilities of transitioning between classes over time. Adherence was defined as taking 75%+ of medications as prescribed. Associations between CNB and adherence were tested using multiple logistic regression adjusting for sociodemographic characteristics. Results: Five classes of CNB were identified during the first two years (high, moderately high, moderate, moderately low, low), and four classes (removing moderately high) during the last three years. Adherence did not differ across classes or time points. Medication regimens differed by class; those with higher CNB taking fewer medications had lower odds of adherence while those with lower CNB taking more medications had higher odds of adherence compared with monotherapy. Probability of transitioning from higher to lower CNB, and lower to higher CNB was greatest over time. Conclusions: CNB is heterogeneous in individuals treated for BD, and movement between classes is not uncommon. Understanding why individuals adhere despite suboptimal CNB may provide novel insights into aspects influencing adherence.

Includes abstract.
Includes bibliographical references (p. 116-140).
Lynch syndrome (LS), the most common form of inherited colorectal cancer (CRC), carries with it a lifetime risk of approximately 80% of developing CRC. This study identified unexpected findings with regard to the relationships between neuropsychological functioning, knowledge and non-adherence within the context of LS, and highlights ways in which this might be investigated in the future.

Optimal antiretroviral treatment (ART) adherence is critical in achieving virologic suppression. Most people living with HIV (PLWH) experience HIV-related challenges which may be compounded by the experience of stressful life events (SLE) with adverse effects on their ART adherence and therefore affecting viral suppression. The highest concentration of people living with HIV (PLWH) is in low-and-middle income countries (LMIC) which are challenged with high rates of poverty and unemployment. Limited published data is available on the impact of the stressful life events experienced by PLWH in LMIC on ART adherence and viral load. A secondary analysis was conducted using data collected in a randomised control trial (RCT) which investigated the impact of a real-time electronic adherence monitoring device (EAMD) on ART adherence in ART-naïve individuals to assess the impact of SLE on ART adherence and viral load. Part A of this dissertation includes the study proposal/ protocol as approved by the Departmental Research Committee and the Human Research Committee at the University of Cape Town. Part B details the literature review which examined all published studies which report on stressful life events in PLWH, with ART adherence or a viral load as an outcome. The review included published literature from 2008 to 2019. Part C includes the publish-ready manuscript which details the statistical analysis, results and interpretation of the secondary analysis of impact of SLEs on ART adherence and viral load among 200 individuals living with HIV. Part D, appendices were included as supporting documentation necessary for the conduct of this research and as required for the completion of this dissertation. The American Psychological Association (APA) 6th Edition referencing style was used for Part A and B. The Vancouver referencing style was used for Part C as per the instructions for authors by the Aids and Behaviour journal guidelines.

Introduction: This thesis comprises a systematic review and a pharmacoepidemiological study aimed at improving the understanding about medication non-adherence to antimalarials (AM) in Systematic Lupus Erythematosus (SLE). AM is the conventional and effective long-term treatment option that has resulted in substantial decreases in deaths associated with SLE disease activity. However, there seems to be no such decline in the deaths associated with the sequelae of SLE (such as circulatory disease). Since deriving therapeutic effects from AM depends not only on physicians prescribing the appropriate treatment, but also on patients’ adherence with selected treatment, there is the need for a better understanding of medication non-adherence to AM in SLE. Objective: 1) To systematically review and synthesize the literature on medication adherence in SLE to identify key gaps in the literature; and 2) to evaluate the burden and determinants of medication non-adherence to AM in SLE. Methods: To address Objective 1, I have conducted a systematic review. I conducted a mapped search of Medline, Embase, and Web of Science to identify original, observational studies that indicated the data source and measurement tool to assess medication adherence in a SLE patient sample. To address Objective 2, I have conducted a longitudinal pharmacoepidemiological study of a population-based SLE cohort. I used a Cox’s proportional hazard ratio model to examine factors that were significantly associated with discontinuation of AM. Results: 1) 11 studies were included in the systematic review, and the majority of these studies reported that less than 50% of SLE patients are sufficiently adherent to their medications; 2) After five years, only 33% of patients remained on AM therapy; and 3) Higher SES and the following time-varying covariates updated monthly: glucocorticoids use, traditional NSAIDs use, rate of rheumatologist visits, and rate of dermatologists were statistically significantly protective against discontinuation of AM therapy. Conclusion: Altogether as a collective work, this thesis provides evidence that demonstrates medication non-adherence is a substantial problem in SLE. In addition, it highlights the importance of developing adherence interventions to help support patients taking their medications as prescribed.
Pharmaceutical Sciences, Faculty of
Graduate

Approximately 85% of the global cervical cancer deaths occur in women living in developing countries. In South Africa, cervical cancer is the second most common cancer amongst women, with Black South African women having the highest risk of developing cervical cancer. Previous research with the same population group found that there are structural (time, health education, age) and psychosocial (fear of screening and stigmatization) influences to cervical screening. The purpose of this research was to identify socio-cultural factors affecting cervical cancer screening adherence within a disadvantaged community in South Africa, a developing country. To identify the social-cultural factors four focus groups consisting of men and women between the ages of 18 and 60 were conducted. A combination of the Health Belief Model (HBM) and Theory of Reasoned Action (TRA) provided a theoretical framework for this study. Thematic analysis was used to identify themes that emerged from the focus groups and participant observation. Through conducting these focus groups, themes emerged which strongly highlighted the role of cultural norms, gender roles, the western medical model and traditional medicine in a woman’s decision to adhere to cervical screening. It was found that factors such as knowledge and stigma, found previously in research, were also shared amongst this sample group. However, spiritual and religious beliefs (traditional healers, religion, and balancing paradigms), gender beliefs, social construction and acceptance of disease were factors which also emerged as exerting influence in a woman’s decision to adhere to cervical screening.

Anthropology
M.A.
Medical tourism is not a new phenomenon but in its current form, medical tourism or health travel is a practice that stems from the structures of the healthcare system. For citizens of countries with primarily private healthcare and citizens of countries with socialized healthcare the forces behind seeking international healthcare are economic (cheaper prices) and temporal (long queues), respectively. The foreign nation-state/patient relationship is an integral part in facilitating the medical tourist/hospital relationship and is also a way to discern discrepancies in welcomed versus unwelcomed visitors. On the one hand, medical tourists are welcomed visitors while other types of "tourists" are not. During my fieldwork as a volunteer at a private Costa Rican hospital, I was quickly made aware of the popular discourse that denigrated Nicaraguans entering Costa Rica while simultaneously catering to Euro-American tourists. This is a clear example of the discrepancy between neoliberal doctrine and neoliberal practices in that the free market promotes the transnational flow of capital while slowing or stopping altogether the flow of (certain) bodies. The United States and South Korea both issue special medical visas to medical tourists and these practices have thus far made international borders even more penetrable by the global elite and/or those with the capital to afford medical care in another country; thus graying the distinction between citizen and non-citizen. The means by which the medical tourism industry, from a marketing standpoint, attracts this global elite is through the accreditation process, which is the act of an accrediting body legitimizing a business, medical facility or school through an intense, expensive, and lengthy process. Within the medical tourism industry, hospitals located in developing nation-states are clamoring for accreditation from agencies based in the U.S. and Europe. Many in this industry believe that such accreditation will increase the number of foreign, primarily Western, patients. I argue that accreditation is a form of subjectification, because many international hospitals that cater to Western patients want to legitimize themselves through an American and/or European body even though their healthcare systems rank higher than the U.S. Accreditation makes international hospitals "qualified" to provide medical services in the eyes of Western medical tourists and the medical tourism industry as a whole, which underscores the quality and superiority of many healthcare systems in the developing world. The problems that I have undertaken is the discrepancy between neoliberalism and the flow of (certain) bodies and capital vis medical tourism and public policy as well as how accreditation is used as a form of surveillance, gaze, and subject making that renders hospitals nearly powerless to the standards set by accrediting bodies.
Temple University--Theses

The study aimed to assess the level of adherence and to identify the barriers to adherence and the motivations for good adherence to antiretroviral therapy, amongst women who commenced treatment while pregnant at research clinics in Molepolole, Mochudi, Lobatse and Gaborone.

Sub-Saharan Africa is home to two thirds of the 33 million HIV infected individuals worldwide. In 2007 there were an estimated 1.5 million Kenyans infected with HIV, and 166 000 new infections in 2008. The introduction of antiretroviral therapy [ART] brought new hope to HIV patients. It has transformed a fatal disease to a chronic manageable condition. Kenya has made great strides in ensuring access to ART and by 2009, 308 610 patients in the country were receiving ART - which is the second highest number worldwide. The success of ART requires a sustained adherence rate to medication of more than 95% to prevent viral replication and the development of drug resistant HIV strains. Identifying the factors that influence adherence, is essential for the long-term success of public ART programmes. The current study explored patient, socio-economic, cultural, and religious and health systems factors that influence adherence to ART at the Coast Provincial General Hospital [CPGH] in Mombasa, Kenya.

Magister Psychologiae - MPsych
The aim of this study was to explore how HIV positive people understand and describe their experience of taking antiretroviral treatment consistently in a strictly organised regimen. Eight participants were recruited from Ikhwezi Clinic. The participants were interviewed using an in depth interview guide. A Phenomenological data analysis was employed through which six themes emerged. The themes are forgetting and memory aids, fitting treatment into daily routine, belief in effectiveness of medication, experiences of side effects, disclosure and social support and relationship with the health care provider. The health belief model and the self-efficacy theory were applied in the study. These theories helped to understand that the decision to take treatment is not only based on the individual experiences and beliefs but the interaction with the social and environmental factors as well. Family, community and health care factors are all interconnected and play a vital role in the decision to commence and continue with HAART. The study revealed that PLWHA can adhere to antiretroviral medication if they believe in the benefits of doing so. Furthermore it became clear that experiences of men and women differ when it comes to HAART. The involvement of the inlaws as experienced by the women in this study had a negative influence in the participants' adherence routine. Further studies are needed to explore the influence of culture in decision making by women with regards to their health.

Includes bibliographical references.
The recent scale-up of ART coverage in resource-limited settings has greatly improved access to treatment. However, literature indicates that patients on ART have high rates of non-adherence (32% to 67%), virological failure (5.2%, to 47%) and resistance to ARVs (5.4% to 80%). These patients are failing first- and second-line ART, leaving no treatment options for successful virus suppression. Yet, literature addressing facilitators and barriers faced by patients on secondline ART is scarce. This study examined factors affecting adherence to second-line ART from the perspective of clinic staff as well as second-line failure patients, assessing both individual and structural barriers. Research was conducted at a large primary-care clinic in Khayelitsha, a periurban township in Cape Town, South Africa. A literature review was conducted to present 1) rates of non-adherence, virological failure and resistance and 2) to present known facilitators & barriers faced by patients on ART, with a specific focus on second-line patients. The literature was found via PubMed and Cochrane Central Register of Controlled Trials (CENTRAL), with a preference for studies in low and middle income countries and those including second-line ART populations. The primary research used participants who were drawn from an MSF-run program to support patients failing second-line treatment.

The type 2 diabetes (T2DM) epidemic is a global health issue that is especially severe among Pacific Islanders in the United States (U.S.) and U.S. Associated Pacific Islands (USAPI) including Chuukese living in their homeland of Chuuk and the state of Hawaii. Although there are diabetes prevention and management programs in Hawai'i and the Pacific, success is limited due in part to the lack of tailoring for the Pacific audience. In spite of numerous recommendations to incorporate Pacific cultural constructs into health interventions, there are no studies in Chuuk or the Pacific that examine the integration of cultural constructs into diabetes prevention and management. To address this research need, the four studies in this dissertation used Grounded Theory and Community Based Participatory Research (CBPR) processes to explore the relationships between constructs such as culture, religion, family, and diabetes prevention and control. The aims were to obtain perspectives on diabetes prevention, screening and management (Study1) and identify socio-cultural influences that hinder or facilitate adherence to diabetes prevention and management behaviors specifically adherence to nutrition therapy (Study 2), physical activity (Study 3) and prescription medication (Study 4). Data where gathered through key informant interviews (faith leaders and health care providers) and focus group discussions (individual with diabetes and care takers). Results from Study 1 showed that participants perceived T2DM as a major problem and the discussion followed four significant narratives: (1) the need for specific information on "how to" operationalize diabetes treatment recommendations; (2) the practice of seeking medical help only when in pain; (3) the role spirituality plays in etiology disease beliefs and its influence on help-seeking behaviors; and (4) the role emotions play in treatment compliance. Study 2 revealed barriers to nutrition therapy adherence that were similar to other minority populations in the U.S. such as cost of healthy foods, taste preference, low availability of healthy food choices, lack of ideas for healthy meals/cooking, and lack of culturally appropriate nutrition modification options. It also elucidated: (1) food consumption and preparation practices; (2) the need for culturally tailored interventions; and (3) contextually appropriate approaches to address nutrition issues, including a plan for future research and interventions. Study 3 revealed a variety of behaviors, personal factors and environmental influences related to adherence to physical activity recommendations. Although the study was focused on physical activity, participants spent the majority of their time discussing sedentary behaviors and contextually appropriate interventions. Study 4 exposed vital factors that inclined patients' to comply with prescribed medication. Factors associated with the healer (messenger), medicine/remedy, and focus of healing. Furthermore, this study revealed that many patients not only seek multiple healing types (western, traditional, local and new), they also rotate among the types. These findings were communicated through two narratives: healer characteristics and medication-specific features. Overall, the most salient topics in all the focus group and interview discussions were on diabetes as a major problem and the pervasiveness of hopelessness. Woven into these conversations were narratives on how to address these two issues with stewardships of the spirit, mind and body. This became the foundation of a framework to address the diabetes epidemic in Pacific.

Daily use of inhaled preventer medication is recommended for most people with asthma. However, research suggests many do not adhere to this regime. The current thesis comprises two research studies utilising the common-sense model of self-regulation as the theoretical basis to explore how people make decisions about inhaled preventer use in asthma. The purpose of Study One was to compare a self-report and an objective measure of adherence to preventer medication for asthma and to examine the illness representations and treatment beliefs associated with these measures. Accordingly, 1,936 U.K. General Practice patients who were using preventer medication for asthma completed a questionnaire assessing illness and medication perceptions and gave consent for information to be obtained from their medical records. Adherence to preventer medication was calculated from the Medication Adherence Report Scale (MARS) and an objective measure, the proportion of prescribed medication that the participant collected over the previous year. Results show that nearly nine out of ten participants (88.4%) reported some non-adherence to their preventer medication. The most common form of non-adherence was using preventer inhaler only when feeling breathless. The relationships between participants’ representations of their asthma and their beliefs about their preventer medication and adherence measures were tested using structural equation modelling. Seeing asthma as a condition that was not present when asymptomatic was associated with more non-adherence (β=.22 p<.001) and also with collecting a smaller proportion of prescribed preventer medication over the past year (β=-.15, p<.001). Seeing asthma as an acute condition, as a condition without serious consequences, and as a condition that could not be controlled by treatment were also representations associated with non-adherence. Those who did not see the need for preventer medication at all, or did not see the need for preventer medication when asymptomatic were more likely to be non-adherent. The relationship between illness representations and self-report adherence was mediated by the belief that medication was necessary. Having identified a number of key beliefs that were associated with use of preventer medication in asthma, Study Two explored the way in which these beliefs may be developed through the process of appraisal of the influence of medication use on symptom experience. Using quantitative methods, 77 patients from a New Zealand General Practice completed a questionnaire measuring the reasons for experimenting and stopping medication, illness representations and treatment beliefs. Thirty percent of the sample reported actively experimenting with their medication. These participants were more likely to hold the belief that medication did not help in the absence of symptoms (Mann-Whitney U=343.5, p<.05) and to report trying to avoid thinking about asthma (Mann-Whitney U=330.5, p<.05). Fifty-one of the participants were subsequently interviewed about their experiences with using medication and transcripts of these interviews were subjected to a qualitative analysis. Participants’ responses suggested that the process of appraising whether medication is necessary was influenced by the match between what the participant expects to happen when using the medication and what actually does happen. The process of deciding when medication is necessary is influenced by the threshold at which medication is deemed to be necessary and the speed at which symptoms return if medication is stopped. These findings have implications for the development of interventions to improve adherence to preventer medication for asthma. They suggest that a key component of self-management education is educating patients about the nature of asthma as a chronic condition that is present even in the absence of symptoms. Additionally, they provide evidence that many patients are involved in an active process of appraising the success of their medication. Health professionals should be aware of that this process is likely to be influenced by patients’ expectations of medication, the level of symptoms at which they believe action is required to control asthma and the speed at which symptoms return if medication is discontinued. Future research could take the form of a randomised controlled intervention to assess whether discussion of these factors with patients could improve quality of life for people with asthma.
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Background Drug use has increased over recent decades, and is especially great among women and among people with mental health problems. To take advantage of the full potential of drugs and to avoid drug-related problems, drug prescription needs to be correct and the drugs need to be taken according to the prescribed regimens. Research on drug utilization is thus important to the public health. Aim To study the influence of gender and depression on drug utilization, prescription of drugs and self-reported use of drugs, i.e. adherence. Methods The thesis included two population-based questionnaires and data from the Swedish Prescribed Drug Register (SPDR) covering Swedish citizens 18-84 years. The questionnaire in Study I and II included items on prescription drug use and adherence to treatment regimens; Study II also included the Hospital Anxiety and Depression Scale (HADS) for self-estimation of anxiety/depression. The questionnaire in Study III included the HADS and data from the SPDR on prescribed antidepressants. Study IV included data from the SPDR on all types of prescribed drugs. Results Men and women differed in non-adherent behaviours and reasons for non-adherence, for example, men were more likely to report forgetting to take the drug, while women were more likely to report adverse drug reactions (ADRs) as a reason for non-adherence. Further, both anxiety and depression were associated with non-adherence and with ADRs as a reason for non-adherence. In addition, men reported depression to a greater extent than women did but used antidepressants to a lesser extent, while women used antidepressants without reporting depression more often than men did, which may be a sign of under-treatment among men and over-treatment among women. Moreover, the associations between antidepressants and other types of drugs differed by gender; they were often specific, or stronger, in women than in men, which may be a sign of a gender difference in comorbidity between depression and other conditions. Conclusions Although the cross-sectional study design prevented confirmation of causality, the thesis found that gender and depression influence both prescription of drugs and adherence, and are thus important to pay attention to in clinical practice as well as research.

Adherence is considered a prerequisite for the success of exercise programs for musculoskeletal disorders. The negative effects of non-adherence to exercise recommendations impact the cost of care, and also treatment effectiveness, treatment duration, the therapeutic relationship, waiting times, the efficiency of personnel and use of equipment. Adherence to therapeutic exercise intervention is a multifaceted problem. The World Health Organization (WHO) established the multidimensional adherence model (MAM). The MAM describes five interactive dimensions (socioeconomic, healthcare team and system, condition-related, therapy-related, and patient-related factors) that have an effect on patient adherence. The first purpose of this dissertation was to explore the MAM dimension of condition-related factors to determine the Quick Disabilities of the Arm Shoulder and Hand (QDASH) minimal clinical important difference (MCID) for three distal upper extremity conditions. The second purpose was to explore the MAM dimension of personal factors to learn from individuals who expressed incongruence between their QDASH and GROC scores; how they described their perceived change in therapy. The third purpose was to explore the MAM dimension of therapy-related factors to examine the effect of patient-therapist collaborative goal setting on patient adherence to treatment and QDASH outcomes. Results demonstrated in the first study that diagnosis specific MCID’s differed from the global MCID using multiple diagnoses. In the second study results demonstrated that patients expect to have a dedicated therapist who they can trust to work collaboratively with them to establish goals and spend time with them to achieve these goals. In the third study, our first hypothesis was not supported for all three measures of adherence. The median for home exercise program diary adherence was found to trend towards significance by 8.7 percent favoring the experimental group Mann-Whitney U (p < .100). Our second hypothesis was not supported. The experimental group receiving collaborative goal setting intervention had similar QDASH mean change scores 45.9±27.6 compared to the control group 46.1±23.8, Mann-Whitney U (p < .859).

Background: Improved clinical effectiveness and therefore positive modification of multiple sclerosis (MS) with basic therapy can be achieved by long-term regular intake of drugs as prescribed but investigations have shown that a high percentage of patients do not take their medications as prescribed. Objectives: We assessed the satisfaction and adherence of patients with MS with their current disease-modifying treatment under clinical practice conditions. We compared different facets of satisfaction as well as their internal relationship and identified predictors in an exploratory manner. Methods: Therapy satisfaction in patients with relapsing–remitting multiple sclerosis (THEPAMS) was a noninterventional, prospective cross-sectional study performed throughout Germany in 2013 and 2014, and included patients with clinically isolated syndrome or relapsing–remitting MS. We applied a standardized approach to document satisfaction and adherence by patient-reported outcomes (Treatment Satisfaction Questionnaire for Medication) as well as by physician ratings. Results: Of 3312 patients with a mean age of 43.7 years, 73.3% were women and the mean level of disability according to the Expanded Disability Status Scale was 2.29; 13.3% did not receive any medication at the time of documentation, 21.3% received interferon β1a intramuscularly, 20.7% had interferon β1a subcutaneously, 17.0% had interferon β1b subcutaneously and 23.7% had glatiramer acetate. Adherence rates varied between 60% (lifetime) and 96.5% (current medication). Differences between current medications were found for side effects and convenience scores but not for effectiveness, satisfaction and adherence. Higher global satisfaction and effectiveness were associated with fewer relapses, longer duration of medication, lower disability score and the absence of several side effects. Conclusion: In a connected model of patient satisfaction, effectiveness, side effects, convenience and adherence, patients’ individual needs and concerns have to be addressed. Most differences were found with respect to side effects and convenience of treatment. Therefore, an improvement in these two domains seems to be the most promising proximate approach to elevate adherence levels.

Rapporten handlar om icke följsamhet i samband med medicinering och de stora problem som medföljer om en patient inte följer sin medicinska rådgivning. Icke följsamhet är ett stort problem i dag, både för samhället och individen. För samhället är det mycket kostsamt att hantera alla felmedicineringar och för individen kan det handla om liv eller död. Syftet med detta arbetet är att utveckla en IT-artefakt med ändamålet att förbättra följsamheten för patienter som dagligen tar medicin. Detta med hjälp av en mobilapplikation som använder Bluetooth för positionering av medicinen. IT-artefakten ska fungerar som ett stöd och hjälpmedel genom att underlätta för en patient i samband med medicinering. Denna forskning använder sig av Design Science Research Methodology (DSRM). Medverkande företag i detta arbete har varit konsultföretaget Knowit Luleå. Arbetet resulterade i en IT-artefakt, samt sex stycken designprinciper, samtliga utifrån problemet icke följsamhet i syfte att bidra till förbättrad följsamhet.
The thesis deals with non-adherence in connection with medication and the major problems that arise if a patient does not follow the medical advice. Non-adherence is a major problem today, both for society and for the individual. For society is is very costly to handle all medication errors and for the individual it can be about life or death. The purpose of this thesis is to develop an IT artifact with the purpose of improving adherence for patients taking medication daily. This is done by using a mobile application that uses Bluetooth for positioning the medicine. The artifact will serve as a support and aid by facilitating a patient that is taking medication. This research uses Design Science Research Methodology (DSRM). Contributing company in this work have been Knowit Luleå. The work resulted in an IT artifact, as well as six design principles, all based on the problem of non-adherence in order to contribute to improved adherence.

Introdução: As doenças cardiovasculares são atualmente a principal causa de mortalidade no país e também o conjunto de doenças que provoca o maior gasto no sistema de saúde. Dentre elas, há uma que merece especial atenção por estar vinculada a diversas origens e ser fator de agravamento para outras patologias: a hipertensão arterial. O modelo assistencial vigente caracteriza-se por ações curativas, pelo atendimento ao paciente com patologia já instalada e visão extremamente limitada em especificidades dos problemas. O Programa de Saúde da Família propõe um modo diferente de atendimento, estruturada no atendimento ambulatorial contínuo e integral, se valendo da interação com a comunidade o que permite ações mais efetivas na promoção da saúde. A presença de um programa de atenção farmacêutica no PSF promove um maior trânsito, riqueza e percepção de informações a respeito de medicamentos, fazendo com que a terapia medicamentosa seja mais efetiva, com a promoção do uso correto. Objetivos: Desenvolver uma metodologia que permita identificar e analisar práticas terapêuticas medicamentosas anti-hipertensivas (Momento terapêutico ? MT). Estimar resultados e tendências na evolução da pressão arterial dos pacientes hipertensos acompanhados pelo NSF-III. Estimar o nível de adesão ao tratamento anti-hipertensivo e a influência desse fator no resultado terapêutico dos pacientes. Casuística e Métodos: População - Indivíduos cadastrados no Núcleo de Saúde da Família III (NSF-III) do PSF de Ribeirão Preto, com diagnóstico de hipertensão arterial e acompanhamento da patologia realizado no referido núcleo. Amostra: prontuários de 73 pacientes. Métodos - Foram coletados dados retrospectivos dos prontuários dos indivíduos, relativos ao período de 1.º de julho de 2001 a 30 de junho de 2005. Foram avaliados ?Conduta Diagnóstica? e os valores de pressão arterial. Resultados: Observou-se a redução de MT nos quais nenhum anti-hipertensivos (AH) foi utilizado, redução no uso de um AH isoladamente e aumento no número médio de AH por MT anos após ano (1,35 no Ano 1 até 1,89 no Ano 4). Analisando-se o percentual de MT de acordo com a classe de AH envolvida, verificou-se a predominância de prescrição da classe dos IECA (58,8%), seguida pelos diuréticos (54,4%) e BBloq e BloqCa em proporções próximas (19% e 18,2%, respectivamente). Foram encontradas indicações de uso irregular da medicação nos prontuários de 35 (48%) pacientes. O percentual médio de pacientes com controle de PA adequado foi de 34,2% no geral, 42.1% nos pacientes Aderentes e 25,7% nos Não Aderentes. Conclusões: A metodologia dos momentos terapêuticos se mostrou adequada na caracterização do padrão de prescrição do NSF-III, que segue as recomendações de tratamento de hipertensão baseada nos consensos, ou seja, a terapêutica medicamentosa praticada tende a ser racional. A maioria dos pacientes do PSF que faz acompanhamento em hipertensão arterial apresenta valores de pressão arterial fora dos limites internacionalmente estabelecidos. O presente trabalho também permitiu demonstrar que o problema de adesão ao tratamento no NSF-III é similar ao que já foi descrito na literatura mas a tendência a indiferenciação entre os grupos de pacientes aderentes e não aderentes indica que abordagem do programa tem conseguido resultados positivos
Introduction: Cardiovascular diseases are the currently leading cause of mortality in Brazil and also the set of illnesses that is the largest expense in health system. Amongst them, there is one that deserves special attention for being tied the diverse origins and to be factor of aggravation for other pathologies: hypertension. The actual model of care is characterized for curative actions and vision extremely limited in specificities of the problems. The Family Health Care Program (FHCP) considers a different way of care, structured in continuous and integral ambulatory care, considering the interaction with community as crucial for more effective actions on health promotion. The presence of a pharmaceutical care program in the FHCP promotes a better flow, quality, and perception of information regarding medicines, making drug therapy more effective with the promotion of the correct use. Objectives: To develop a methodology that allows to identify and analyze therapeutical pratices of antihypertensive drugs (Therapeutic Moment - TM). Esteem results and trends in the evolution of the blood pressure (BP) of the hypertensive patients followed by the NFHCIII. Esteem the level of adherence to the hypertension treatment and the influence of this factor in the therapeutic result of the patients. Casuistry and Methods: Population - Individuals registered in the Nucleus of Family Health Care III (NFHC-III) of the FHCP of Ribeirão Preto, with diagnosis of hypertension and accompaniment of the pathology. Sample: medical records of 73 patients. Methods - Data had been retrospectively collected relative to the period of 1.º of July of 2001 to 30 of June of 2005. Results: It was observed TM reduction in which no antihypertensives (AH) were used, reduction in the use of one single AH and increase in the average number of AH for TM (1,35 in Year 1 up to 1,89 in Year 4). Analyzing the percentage of TM in accordance with the class of AH involved, verified it predominance of prescriptions on the class of ACE (58.8%), followed for diuretics (54.4%), with betablockers and calcium channel blockers in next (19% and 18.2%, respectively). Indications of irregular use of medication in medical records of 35 (48%) patient had been found. Average percentage of the 73 patients with adequate control of BP was of 34,2%, 42,1% in the Adherent group of patients and 25.7% in Not Adherent. Conclusions: The methodology of therapeutic moments showed adequate results in the characterization of the practices of AH prescribing in the NFHC-III. This health care facility follows the recommendations of treatment of hypertension based on the Brazilian guidelines, suggesting that the drug practices tends to be rational. The majority of the patients of the NFHC-III that makes accompaniment in hypertension present values of blood pressure above of the limits internationally established. The present work also demonstrate that the problem of adherence to the treatment in the NFHC-III is similar of the already described in literature but trends of BP reduction values between the groups of adherent and not adherent patients indicates the approach of the program has obtained positive results

The overarching goal of this dissertation was to elucidate the psychosocial and behavioral determinants of medication nonadherence among African Americans with hypertension. One in three Americans in the United States has hypertension, and the prevalence of hypertension among African Americans is among the highest in the world. In addition to healthy behaviors such as following a low-salt and low-fat diet, getting regular exercise, and reducing stress, patients with hypertension must also adhere to antihypertensive medications. Poor medication adherence may be driven by psychosocial and behavioral factors; however, the impact of these factors on medication adherence is unclear especially within the African American community. To date, a paucity of research has examined the relationship between psychosocial and behavioral factors such as reported racial discrimination, John Henryism (a measure of active coping and an unhealthy response to stress) and home remedies with medication nonadherence. However, each of these factors has individually been linked with poorer health outcomes among African Americans. Using data from the TRUST study (2006-2008) the association between these constructs and medication adherence was assessed within our sample of 788 African Americans and a comparison group of 137 White participants with hypertension. Ordinal logistic regression was used to assess the association between racial discrimination, John Henryism, home remedies, and medication adherence. The findings from this research indicated more reported racial discrimination, higher John Henryism scores, and greater use of home remedies were associated with lower medication adherence. These findings yield new knowledge about medication adherence and provide practical insights about the psychosocial and behavioral determinants of medication adherence.

Introdução: A fidelidade das intervenções trata do grau com que as intervenções são oferecidas conforme o planejado. É uma variável que deve ser investigada como uma fonte de dados sobre a validade e a confiabilidade dos resultados obtidos em estudos de intervenção de boa qualidade. Avaliar a fidelidade das intervenções requer a observação dos comportamentos do interventor durante o oferecimento da intervenção, por meio de instrumentos padronizados. Objetivo: Desenvolver um instrumento válido e confiável para mensurar a fidelidade de uma intervenção psicoeducativa oferecida por telefone. Método: Este estudo metodológico foi realizado em sete passos: identificação dos elementos do programa de intervenção, construção dos itens do instrumento, desenvolvimento da escala de mensuração dos itens, identificação das unidades de codificação, teste e revisão dos itens, especificação das qualificações e desenvolvimento do programa de treinamento dos avaliadores, desenvolvimento e execução do teste piloto para verificação da validade e confiabilidade do instrumento. Os materiais usados no desenvolvimento do instrumento foram o Manual do interventor e os 128 áudios das sessões de intervenção de um ensaio clínico controlado randomizado em que se testou a efetividade de uma intervenção psicoeducativa oferecida por telefone a cuidadores familiares. Resultados: O instrumento elaborado foi denominado Nursing Intervention Fidelity Evaluation Tool (NIFE Tool) e foi estruturado em quatro partes: abertura da sessão, apresentação do conteúdo da sessão, encerramento da sessão, avaliação das habilidades na comunicação, empatia, transmissão de confiança e credibilidade, compostas por 49 itens específicos sobre a intervenção testada e por 18 itens comuns às intervenções psicoeducativas. O escore do instrumento pode ser calculado item a item, para o conjunto de itens específicos de cada sessão de intervenção, para o conjunto de itens comuns de cada sessão ou para o conjunto de itens comuns considerando todas as sessões. A validade de conteúdo do instrumento foi estabelecida por 14 expertos. Como indicativos da confiabilidade do instrumento, o alfa de Cronbach foi de 0,51 para o conjunto de itens comuns, e variou entre 0,59 e 0,81 para o conjunto de itens específicos; a concordância interavalidores segundo resultados do Kappa, ficou entre moderada a substancial para 35 específicos e 15 itens comuns. Conclusões: O presente estudo permitiu o desenvolvimento de instrumento para mensurar a fidelidade de intervenção psicoeducativa e os itens comuns do instrumento podem ser usados na avaliação de outras intervenções da mesma natureza oferecidas por telefone.
Introduction: The intervention fidelity involves analyzing in which extent interventions are offered as planned. It is a variable that must be investigated as a source of data on the validity and reliability of the results obtained in good quality intervention studies. Intervention fidelity assessment requires observation of the providers\' behavior during the intervention offer by means of standardized instruments. Objective: To develop a valid and reliable instrument to measure the fidelity of a psychoeducational intervention offered by telephone. Method: This methodological study was conducted in seven steps: identification of the elements of the intervention program, construction of the instrument items, development of items scaling, identification of the units for coding, item testing and review, specification of rater qualifications and development of rater training program, development and completion of the pilot testing to test validity and reliability of the instrument. The material used to develop the instrument were the Intervention Manual and 128 audios of the intervention sessions of a randomized controlled clinical trial in which the effectiveness of a psychoeducational intervention offered by telephone to family caregivers was tested. Results: The instrument developed was called Nursing Intervention Fidelity Evaluation Tool (NIFE Tool) and was divided into four parts: opening session, presentation of session content, session closure, evaluation of skills in communication, empathy, and thrustiwortiness, with 49 unique items of the tested intervention and by 18 items common to psychoeducational interventions. The instrument score can be calculated item by item, for the set of unique items of each intervention session, for the set of common items of each session or for the set of common items taken in all sessions. The instrument\'s content validity was performed by 14 experts. As indicative of the instrument\'s reliability, Cronbach\'s alpha was 0.51 for the set of common items, and ranged between 0.59 and 0.81 for the set of unique items; inter-raters agreement, according to Kappa coefficients, was moderate to substantial for 35 unique and 15 common items. Conclusion: This study allowed the development of an instrument to measure the fidelity of a psychoeducational intervention and their common items can be used in the evaluation of other interventions of the same nature offered by telephone.

Since the Institute of Medicine highlighted the devastating impact of medical errors in their seminal report, “To Err is Human” (2000), efforts have been underway to improve patient safety. A portion of medical errors are due to medication errors, and a large portion of these can be attributed to inadequate laboratory monitoring. In this thesis, I attempt to address this small but important corner of this patient safety endeavor. Why are patients not getting their laboratory monitoring tests? Do they fail to complete them or do doctors not order the tests in the first place? Which prescribers and which patients are least likely to do what is needed for testing to happen and what interventions would be most promising? To address these questions, I conducted a systematic review of existing interventions. I then proceeded with three aims: 1) To identify reasons that patients give for missing monitoring tests; 2) To identify patient and provider factors associated with monitoring test ordering; and 3) To identify patient and provider factors associated with completion of ordered testing. To achieve these aims, I worked with patients and data at the Fallon Clinic. For aim 1, I conducted a qualitative analysis of their reasons for missing tests as well as reporting completion and ordering rates. For aims 2 and 3, I used electronic medical record data and conducted a regression with patient and provider characteristics as covariates to identify factors contributing to test ordering and completion. Interviews revealed that patients had few barriers to completion, with forgetting being the most common reason for missing a test. The quantitative studies showed that: older patients with more interactions with the health care system were more likely to have tests ordered and were more likely to complete them; providers who more frequently prescribe a drug were more likely to order testing for it; and drug-test combinations that were particularly dangerous, indicated by a black box warning, were more likely to have appropriate ordering, though for these combinations, primary care providers were less likely to order tests appropriately, and patients were less likely to complete tests. Taken together, my work can inform future interventions in laboratory monitoring and patient safety.

Introdução: O emprego da terapia antirretroviral (TARV) proporcionou dramático impacto na mortalidade por aids e aumento na sobrevida. Entretanto, esse panorama depende da manutenção de altas taxas de adesão ao tratamento medicamentoso. A relevância da adesão tem sido reconhecida pelo Programa Nacional de DST e Aids desde o final dos anos 1990. Em que pese o destaque que o plano propositivo do Programa tem dado para a questão, ainda não dispõe de estudo atualizado sobre o número e tipo das atividades que estão em curso nos serviços. Este estudo teve por objetivo descrever as atividades de adesão em curso nos serviços de HIV/aids do Estado de São Paulo. Métodos: Foi enviado um questionário semi-estruturado para todos os 179 ambulatórios de HIV/aids do Estado, com perguntas sobre o tipo de serviço, pessoas sob TARV, formas e frequências de avaliação de adesão, atividades desenvolvidas (individuais, coletivas e para grupos específicos) e parcerias com organizações não governamentais. Para testar associação entre variáveis categóricas utilizou-se o teste Qui-quadrado de Pearson ou os testes exato de Fisher ou teste da razão de verossimilhanças, no nível de significância de p<0,05. A análise de agrupamento foi utilizada para investigar cada uma das associações de cada resposta com as variáveis: tamanho do município, tipo e tamanho das clínicas. Resultados: 136 dos ambulatório (76%) responderam à pesquisa. Quase todos (96,3%) relataram incentivar a adesão na prática clínica, predominantemente nas consultas de médicos (94,1%) e enfermeiros (67,6%). A maioria (78,7%) relatou avaliar a adesão através de registros da farmácia. Grupos (38,2%) e palestras (28,7%) foram as atividades de grupo mais conduzidas. A análise de agrupamento identificou três grupos de ambulatórios, dois deles muito distintos. Grupo 1 (27 ambulatórios) foi composto predominantemente por unidades de saúde básica, com menos de 100 pacientes, apresentaram a menor freqüência de avaliação da adesão e menos atividades individuais e em grupo. Grupo 2 (51 ambulatórios) foi constituído principalmente por ambulatórios especializados em HIV/aids, com mais de 500 pacientes, com maior freqüência de avaliação da adesão, maior participação de psicólogos, assistentes sociais e farmacêuticos e mais atividades individuais e em grupo. Grupo 3 (56 ambulatórios) foi composto em sua maioria por ambulatórios de especialidades e de médio porte, com a maioria das atividades semelhantes ao Grupo 2, exceto pela ausência de atividades para grupos específicos e menos envolvimento multidisciplinar. Conclusão: Dado o amplo reconhecimento da importância da adesão por parte das clínicas, ainda há poucas atividades específicas de adesão no Estado. As clínicas maiores e mais especializadas tendem a oferecer mais atividades individuais e em grupo, utilizando abordagens multidisciplinares. Maior atenção deve ser dada para a descentralização do atendimento às pessoas vivendo com HIV para assegurar cuidados de qualidade mais homogêneos em toda a rede ambulatorial.
Introduction: The use of antiretroviral therapy (HAART) has provided dramatic impact on AIDS mortality and improved survival. However, this scenario depends on maintaining high rates of adherence to HAART. The relevance of adherence has been recognized by the National STD/AIDS Program since the late 1990s. Despite the emphasis that the Program has given to the issue, there have been no study to date on the number and type of activities that are underway in the services. This study aimed to describe the HAART adherence support activities in Sao Paulo State HIV/AIDS clinics. Methods: We sent a semi structured questionnaire to all 179 HIV/AIDS clinics with questions about type of clinic, people on HAART, adherence assessment, activities (individual, group and for specific groups). To test association between categorical variables used the chi-square test or Fisher exact test or likelihood ratio test at a significance level of p <0.05. Cluster analysis was used to investigate each association of each answer with the variables: municipality size, type and size of the clinics. Results: 136 clinics (76%) answered the survey. Almost all (96.3%) reported encouraging adherence in clinical practice, particularly in the medical (94.1%) and nurse (67.6%) visits. Most (78,7%), reported assessing adherence by pharmaceutical records. Groups (38.2%) and lectures (28.7%) were the group activities most developed. Cluster analysis identified three groups of clinics; two of them were too different. Group 1 (27 clinics) was predominately composed by primary care clinics, with less than 100 patients, the lowest frequency of assessing adherence and fewer individual and group activities. Group 2 (51 clinics) predominately composed by HIV specialized clinics specializing, HIV/AIDS, with more than 500 patients, assessing adherence more frequently, with greater involvement of psychologists, social workers and pharmacists developing more individual and group activities. Group 3 (56 clinics) was predominately composed by medium size specialized clinics, with majority of activities similar to Group 2, except by the absence of activities to specific groups and less multidisciplinary involvement. Conclusion: Given the broad recognition of the adherence importance by the clinics, there are still few specific adherence activities. The larger and more specialized clinics tend to provide more individual and group activities, using multidisciplinary approaches. Greater attention should be given to the decentralization of care offered to people living with HIV to ensure more homogeneous quality care across the ambulatory network.

A adesão do paciente ao tratamento é crucial para a efetividade dos programas de aids. O Programa Brasileiro recomenda monitorar a adesão e incorporar ao cuidado atividades de promoção, tais como atendimentos individuais com foco em adesão. Revisões sistemáticas apontam maior efetividade das intervenções complexas, que incluem sessões de conversas entre profissional-paciente: informativas, educativas e aconselhamentos motivacionais. Criticam: insuficiente explicitação das bases teóricometodológicas das intervenções; enfoque excessivo no nível individual com baixa incorporação do contexto sociocultural; insuficiência de informação acerca da fidelidade aos protocolos. Poucos estudos descrevem a \"intimidade\" das sessões. Planejada para o cuidado individual, uma modalidade de intervenção psicossocial de apoio à adesão teve seu protocolo implementado em ensaio clínico com pacientes adultos, com carga viral detectável, em serviço especializado do SUS, em São Paulo- Brasil. Suas bases teórico-metodológicas: Quadro da Vulnerabilidade e Direitos Humanos na dimensão psicossocial do Cuidado, filiados a uma perspectiva construcionista de psicologia social na saúde. Focada na noção de sucesso prático, a intervenção objetivou contribuir para que as pessoas construíssem formas de conviver melhor com o tratamento que lhes fossem mais convenientes. Baseada na interação profissional-paciente buscou intensificar a dialogia mediante a exploração dos sentidos intersubjetivos que as \"tomadas\" das medicações adquirem em diferentes cenas/cenários. Para avaliar qualitativamente a implementação selecionaram-se 12 casos (4 de cada uma das profissionais que conduziram a intervenção) entre os 44 pacientes do grupo experimental. A análise contemplou dois eixos interdependentes: a) fidelidade da implementação ao protocolo; b) qualidade dialógica das conversações. Apresentamse os resultados em três artigos. A variação nas modalidades e enfoques comunicacionais implementados permitiu a classificação em quatro níveis crescentes de fidelidade ao protocolo: nível 1 (3 casos), nível 2 (6), nível 3 (1), nível 4 (2). A inflexão na direção da dialogia não ocorreu plenamente. Princípios relacionais como solidariedade, não repreensão, foram bem desenvolvidos. As conversas valorizaram experiências singulares de dificuldades com o tratamento e produziram coentendimentos sobre o que acontecia cotidianamente. Entretanto, a decodificação de sentidos na compreensão \"dos problemas\" e criação de \"soluções\" priorizou o nível individual cognitivo-comportamental. Por exemplo, ao invés de dialogar sobre atrasos/perdas de doses em situações sociais relacionadas ao estigma/discriminação, o sentido \"problemas de memória\" prevaleceu na decodificação das falhas no tratamento. Foi incipiente a incorporação de dimensões socioculturais e programáticas ao entendimento das situações e construção/imaginação de estratégias para lidar com \"impasses\" que implicavam prejuízos à adesão. Mesclados à comunicação de enfoque cognitivo-comportamental ocorreram momentos dialógicos que se mostraram mais promissores à construção pelos participantes de enunciados de satisfação, bem-estar, intenções e mudanças práticas benéficas à adesão. Situações psicossociais dos pacientes influíram sobre a comunicação. Quanto mais complexas, desafiam \"o como dialogar\" sobre aspectos graves, sinérgicos e multidimensionais que prejudicam a saúde. São necessárias, mas insuficientes, estratégias que aprimorem a qualidade comunicacional e o enfoque psicossocial das intervenções em adesão nos serviços. Devem complementálas: a coordenação do Cuidado em equipe e ações clínicas e sociais, imediatas e objetivas, para mitigar situações que implicam graves vulnerabilidades, prejudiciais tanto à adesão ao tratamento da aids como à saúde integral
Patient\'s adherence to treatment is essential to the effectiveness of AIDS programs. The Brazilian Program recommends monitoring adherence and incorporating activities to care that promote adherence, such as individual care focusing adherence. Systematic reviews point towards greater effectiveness of complex interventions, which include conversation sessions - educational, informative, motivational counseling - between the health professional and the patient. They criticize: incomplete explanation of the theoretical-methodological bases of interventions; excessive focus on the individual level, with low incorporation of the sociocultural context; insufficient information on the fidelity to protocols. Few studies describe the \"intimacy\" of the conversation sessions. Planned for the individual care, a modality of psychosocial intervention supporting adherence had its protocol implemented in a clinical trial with adult patients with detectable viral load in a specialized care service of the Brazilian Unified Health System (SUS), in São Paulo. The following theoretical-methodological bases were adopted: the Framework of Vulnerability and Human Rights in the psychosocial dimension of Care, affiliated to a social psychology constructionist perspective in health. Focused on the notion of practical success, the intervention aimed at contributing so that people would build ways of coping better with the treatment which was the most convenient for them. Based on the health professional-patient interaction, it sought to intensify dialogic in exploring intersubjective meanings that the medication intake acquires in different scenes/scenarios. In order to qualitatively evaluate implementation, 12 cases (4 cases of each one of the health professionals who conducted the intervention) were selected among 44 cases of the experimental group. The analysis comprised two interdependent axes: a) implementation fidelity to protocol; and b) dialogic quality of conversations. The findings are presented in three papers. Variation in the implemented modalities and communicational approaches allowed the classification in four levels of increasing fidelity to protocol: level 1 (3 cases), level 2 (6 cases), level 3 (1 case), and level 4 (2 cases). Inflection towards dialogic has not completely occurred. Relational principles, such as solidarity and no reprimand, were well developed. The conversations valued singular experiences of difficulties with the treatment. Furthermore, they produced co-understandings on what happened in the daily routine. Nevertheless, the decoding of meanings in understanding \"problems\" and creating \"solutions\" prioritized the cognitive-behavioral individual level. For example, rather than dialoguing on delays/abolishing doses of medication intake in social situations concerning stigma/discrimination, it prevailed the sense of \"memory problems\" in decoding treatment failures. Programmatic and sociocultural dimensions were incipiently incorporated to the understanding of contexts and construction/imagination of strategies to cope with \"impasses\" which implied adherence losses. Mingled with the communication of cognitive-behavioral approach, there were more dialogic moments which showed to be more promising to the construction by the participants of utterances regarding satisfaction, well-being, intentions, and beneficial and practical changes to adherence. The psychosocial situations of patients influenced communication. The more complex, the more they challenge \"how to have a conversation\" about multidimensional, synergistic, serious issues which harm health. It is necessary, but insufficient, to have strategies which enhance the communication quality and psychosocial approach of adherence interventions in care. The coordination of Care as a team and social and clinical actions, both immediate and objective, should complement them in order to mitigate situations which imply serious vulnerabilities that impair AIDS treatment adherence as well as the overall health

Introdução: A adesão à terapia antirretroviral (TARV) é essencial para o sucesso do tratamento do HIV/aids. Apesar das recomendações fornecidas para a promoção da adesão nos serviços de assistência ambulatorial ao HIV/aids do Sistema Único de Saúde (SUS), não há medidas padronizadas para o monitoramento da adesão nos serviços e há pouca informação disponível sobre as atividades de adesão efetivamente realizadas. Este estudo teve como objetivos: descrever medidas nacionais de adesão à TARV e atividades de adesão conduzidas nos serviços de HIV/aids do SUS; investigar relações entre adesão e características dos serviços. Métodos: Entre 2009 e 2011, conduziu-se um estudo transversal da adesão à TARV em amostra nacional de pacientes em tratamento em serviços do SUS. Foram sorteados para participar do estudo: 1) serviços de diferentes níveis de qualidade (segundo avaliação nacional prévia da organização da assistência ao HIV/aids), localizados nas diferentes regiões do país; 2) pacientes sob TARV em acompanhamento nos serviços selecionados, maiores de 18 anos, não gestantes. Para medir a adesão à TARV, utilizou-se o Questionário WebAd-Q, instrumento de autorrelato em linguagem \"Web\", previamente validado, que aborda três dimensões da adesão: medicamentos, dose (número de comprimidos) e horários de tomada. As respostas foram ponderadas de acordo com a probabilidade de seleção amostral dos pacientes. Características dos serviços foram obtidas com base em dois instrumentos autorrespondidos pelos gerentes e equipes de saúde: 1) o Questionário Qualiaids, voltado para a avaliação geral da qualidade organizacional da assistência ao HIV/aids; 2) o Questionário de Atividades de Adesão, que enfoca aspectos especificamente voltados para a promoção da adesão. Outras características dos serviços analisadas foram: região geográfica, porte do serviço (número de pacientes em TARV) e porte do município (número de habitantes). O desempenho dos serviços em relação às atividades de adesão realizadas foi avaliado segundo cinco domínios: monitoramento; investigação da adesão; cuidado multidisciplinar; atividades de grupo e para populações específicas; capacitação e atualização dos profissionais. Associações entre medidas de adesão e características dos serviços foram testadas em modelos de regressão logística (IC 95%, p < 0,05). Associações entre atividades de adesão e demais características dos serviços também foram investigadas. Resultados: De um total de 2.424 participantes, acompanhados em 55 serviços, 61,1% (IC 95% 58,5-63,7) reportaram não adesão a uma ou mais das dimensões analisadas. A dimensão com maior proporção de não adesão foi o horário (50,9%). Os serviços apresentaram desempenho geral mediano em relação às atividades de adesão. Serviços de boa qualidade organizacional e de pequeno porte associaram-se ao melhor desempenho e/ou à realização de atividades específicas. Ao contrário do esperado, houve predomínio de associações inversas da adesão com a qualidade, a complexidade assistencial (segundo o porte) e a realização de atividades de adesão. Discussão: O estudo indicou a necessidade de ações para aprimorar o trabalho em adesão realizado nos serviços, incluindo: promoção da adesão ao horário; priorização de pessoas com dificuldades de adesão e de populações que requerem intervenções específicas; padronização do monitoramento; maior investimento no gerenciamento técnico, no enfoque multidisciplinar, em atividades específicas de apoio à adesão, e em parcerias com a sociedade civil organizada. A exploração de novos modelos de análise em futuros estudos deverá contribuir para a melhor compreensão das relações entre adesão e características dos serviços
Background: Adherence to antiretroviral therapy (ART) is crucial for HIV/AIDS treatment success. In spite of recommendations provided for adherence promotion in HIV outpatient care facilities of the Brazilian Unified Health System (Sistema Único de Saúde - SUS), there are no standard measures for adherence monitoring in the facilities and there is little information available about adherence strategies actually implemented. This study aimed at: describing national ART adherence measures and adherence strategies conducted in public HIV care facilities; investigating relationships between adherence and care site characteristics. Methods: Between 2009 and 2011, a cross-sectional study of ART adherence was conducted with a national sample of patients treated in public health care facilities. Randomly selected study participants were: 1) care sites of different quality levels (according to a previous national evaluation of HIV care organization), located in different country regions; 2) patients receiving ART at selected sites, 18 years or older, non-pregnant. Adherence measurement was based on the WebAd-Q Questionnaire, a pre-validated web-based self-report tool that approaches three adherence dimensions: drugs, dose (number of pills) and time schedule. Answers were weighted according to patients\' probability of selection. Site characteristics were obtained based on two self-report tools answered by managers and health care teams: 1) the Qualiaids Questionnaire, which evaluates HIV care overall organizational quality; 2) the Adherence Strategies Questionnaire, which focuses on aspects specifically related to adherence promotion. Other site characteristics analyzed were: geographic region, site size (number of patients receiving ART) and municipality size (number of inhabitants). Care site performance in relation to adherence strategies was evaluated based on five domains: monitoring; adherence investigation; multidisciplinary care; group activities and strategies for special populations; professionals\' training and update. Associations between adherence measures and site characteristics were tested in logistic regression models (CI 95%, p < 0.05). Associations between adherence strategies and other site characteristics were also investigated. Results: From a total of 2,424 participants, who were receiving care at 55 facilities, 61.1% (CI 95% 58.5-63.7) reported non-adherence to one or more of the dimensions analyzed. The dimension with the largest non-adherence proportion was timing (50.9%). Overall, the facilities presented a medium performance on adherence strategies. Good organizational quality and small size were associated with better site performance and/or with conduction of specific strategies. Contrary to expectations, inverse associations of adherence with quality, care complexity (according to size) and implementation of adherence strategies were predominant. Discussion: This study indicated actions required to improve adherence work developed in the facilities, including: timing adherence promotion; prioritization of people facing adherence difficulties and populations requiring specific interventions; monitoring standardization; more efforts focusing on technical management, multidisciplinary approach, specific strategies to support adherence, and partnerships with organized civil society. The development of new analysis models in future studies should contribute to improve understanding of the relationships between adherence and care site characteristics

碩士
國立雲林科技大學
休閒運動研究所碩士班
92
ABSTRACT The purposes of this study were to investigate the current situation of the swimmers’ benefits of leisure and wellbeing, and to explore its relationship with demographic characteristics and exercise of adherence. The subjects used in this study were 352 swimmers; the ratio of men and women was 7: 3, and the average age of the swimmers was 35.95 years old. The instruments administered to the subjects were Inventory of Leisure Benefits and Happiness. The collected data were analyzed by descriptive statistics, t-test (independent), one- way analysis of variance, person product-moment correlation, stepwise multiple regression analysis, and so on. The results of this study were as follows: 1) Wholly, the benefits of leisure of the swimmers were high. The well-being of them was medium-high degree. For the obstacles, the degrees of difficulty and overcoming were medium degree. The main obstacle was “no time.” 2) The percentage of the adherence swimmers was 69%--it was 243. According to this research, the continuous swimmers obviously had more benefits of leisure and well-being than the ones who did not exercise of adherence swimming. 3) In benefits of leisure, demographic characteristics were significant differences because of marriage, education, occupation, income, and continuity. In well-being, demographic characteristics consisted of different marriage, age, occupation, income, and adherence. 4) Evidently, benefits of leisure had much to do with well-being. 5) The results of multi- regression analyses indicate benefits of leisure, weekly times, and participating time or years were the best explanation for well-being. The explain variance of these three was 30.8%. The explanations of the findings were offered, and the applications of the study were discussed. Finally, some suggestions for future studies were provided.

碩士
美和技術學院
健康照護研究所
95
TB has occupied 70% cases in reported infectious disease by CDC in Taiwan. It is curable if patients have treatment adherence. Since Though the side effects of medications and uncertainty of disease nature are major reasons for the non-adherence treatments, the multiple drug resistance is 2.2%, which is ten times more than 0.2% ten years prior. The purpose of this research was to examine family support and adherence of pulmonary tuberculosis patients, and to further explore the relationship among them and factors in prediction of treatment adherence. A cross- section design was investigated, purposive sampling.78 patients that had been diagnosed as TB by legal doctors and reported to CDC, treated for 3 months period were taken as samples. Quantitative structure questionnaire were interviewed, which included TB knowledge, family support and patients adherence. The result showed that there was significant correlated between the medical adherence and spouse, history of TB, and drug side effects. Emotional support is the best and message support is the worse beyond family support. The function of family support can contributes to 31% variations, is the number one predictor. Finding from this research can could help community medical TB care units that improve patient''s health education, pay attention to the discomfort caused by drug side effects, and combined family strength can also improve the treatment adherence and national disease control.

碩士
亞洲大學
生物資訊與醫學工程學系碩士在職專班
105
As the development of advanced technology and the enhancement of life quality, the population of people suffering from cardiovascular disease is rising due to unhealthy dietary habits and scarcity of doing exercise. Stent implantation which can make patients recover rapidly has already become one of the main treatment. After the treatment, patients need to follow doctor’s prescription to take the medicine correctly to prevent restenosis. However, the highly researchable NHIRD can inspect patients’ medical history. As a result, the purpose of the study is to verify the relevance of patients’ medication adherence and heart in-stent restenosis. This study adopts patients who have implanted one stent based on Bare Metal Stent(BMS) or Drug Eluting Stent(DES) from 2008 to 2011 as the sample and then tracks their dual medication possession ratio(MPR) as their medication adherence. Using appropriate statistical analysis investigates restenosis between BMS and DES. Finally, analyze the relations between restenosis and patients’ medication adherence on using BMS or DES. It turns out that the percentage of heart in-stent restenosis on using DES is lower than using BMS and patients’ medication adherence on using BMS or DES has no correlations with heart in-stent restenosis. This study also shows other results from two different stent types and patients’ medication adherence on using BMS or DES. First, on two different stent types: 1.More men than women have implanted heart stents and the median of patients’ age are 67 and 64 on BMS and DES. 2.The risk of smoking and the alcohol intake is increasing on patients using BMS; while patients using DES have higher risk of suffering from hyperlipidemia and obesity. 3.Most BMS patients live in central Taiwan and the area of lower urbanization. Their comorbidity is higher on account of lower socioeconomic status; while most DES patients live in north Taiwan and the area of higher urbanization. Their comorbidity is lower on account of higher socioeconomic status. Second, on patients’ medication adherence on using BMS or DES: 1.From selected BMS patients who can be tracked more than six months and use dual anti-platelet agents(DAPT), there was no correlation between medication adherence and restenosis of patients using BMS. 2.From selected DES patients who can be tracked more than one year and use dual anti-platelet agents(DAPT), there was no correlation between medication adherence and restenosis of patients using DES.

碩士
國立臺東大學
教育學系(所)
101
This study adopted qualitative research method, based on the researcher’s own narrative life story, supplemented by significant others’ semi-structured interviews. This research discussed the influences of stray dogs adoption on family relationships, social interaction, marriage life and career planning, and learned about the difficulty of self-esteem building for stray dogs’ caregivers, and finally to reflected on the significance of this experience in life. The study found that long-term stray dogs carergivers, not only his own life was compressed into the invisible, family relationships, social interaction, marriage life and career planning will lead to great changes. They found it difficult to build self-esteem when blamed and alienated by the public. The reason they adhered to guard the vulnerable life so persistently was hoping that the situation of Taiwan's stray dogs can be better someday.

碩士
國防醫學院
公共衛生學研究所
98
In 2007, the World Cancer Research Fund (WCRF) and American Institute for Cancer Research (AICR) published “Food, Nutrition, Physical Activity, and the Prevention of Cancer: A Global Perspective” It suggests that body fatness, physical activity, foods and drinks that promote weight gain, plant foods, animal foods, processing preparation, alcoholic drinks, and dietary supplements can contribute to the incidence of cancer. The present study has examined the association between compliance with WCRF/AICR recommendations and cancer incidence in Taiwanese. Datasets used for analysis were the Nutrition and Health Survey in Taiwan (NAHSIT 1993-1996), and Elderly Nutrition and Health Survey in Taiwan (NAHSIT Elderly, 1999-2000). Participants’ cancer incidence data were obtained from the Cancer Registry (up to 2006), National Health Insurance Research Database (up to 2006), and National Death Certification data (up to 2008). Cox proportional hazards regression models was used to estimate hazard ratios (HR) and 95% confidence intervals (95% CI). The means of follow-up years were 11.2 in NAHSIT 1993-1996 and 5.93 in NAHSIT Elderly, the crude cancer incidence rates were 7.02 per 1000 person-years and 22.4 per 1000 person-years respectively. After adjustment for gender, age, region, education, smoking status, and betel nut chewing, the subjects aged 30-64 years who adhered to the processing preparation recommendation in WCRF/AICR had a hazard ratio for cancer incidence of 0.62 (95%CI:0.15-0.97). We also adjusted for the eight recommendations, and found that compliance with processing preparation recommendations had a significantly reduced overall cancer risk (HR:0.37, 95% CI:0.15-0.95) and malignant neoplasm of digestive organs and peritoneum (HR:0.22, 95% CI:0.07-0.70) respectively in NAHSIT 1993-1996 and NAHSIT Elderly. In conclusion, adherence to WCRF/AICR recommendations to maintain healthier dietary patterns and life styles can prevent cancer in adult population.

博士
高雄醫學大學
藥學研究所
102
Background: The influence of interruption of and non-adherence to hormone therapy (HT) on Asian women with breast cancer has not been extensively evaluated. Aim: A Taiwanese population-based database is used to investigate HT utilization patterns and risk factors of the interruption of and non-adherence to HT and to evaluate the association between interruption/non-adherence and long-term clinical outcomes and economic outcomes in women with breast cancer. Method: This study was conducted using the Taiwan Health Insurance Research Database from 2002 to 2011. Women newly diagnosed with breast cancer that was treated with HT, including tamoxifen and aromatase inhibitors, were included. Cox and competing risk regressions were used to assess the interruption risk factors (prescription gap>180 days). Logistic regression was used to evaluate the factors associated with non-adherence (medication possession ratio<80%) in patients consistently receiving HT. The hazard ratios (HR) of treatment interruption and non-adherence in mortality were estimated with Cox regression. Cost effectiveness analysis (CEA) was conducted to evaluate the economic aspect of HT non-adherence in women with breast cancer from the perspective of Taiwan’s National Health Insurance. Results: The rates of interruption of and non-adherence to HT were 13.6% and 23.5%, respectively. A younger age (younger than 50 years old at the time of diagnosis), switching HT treatments, and adverse events all influenced HT interruption. Furthermore, the risk factors of non-adherence also included women in the primary HT group and administrated chemotherapy (CT) and tamoxifen users. Interruption of (HR: 1.32; 95% CI: 1.20, 1.46; p<0.0001) and non-adherence to (HR: 1.45; 95%CI: 1.32, 1.59; p<0.0001) adjuvant HT were significantly associated with increased mortality. Higher breast cancer-related healthcare costs were significantly associated with HT non-adherence (p<0.0001), and the incremental cost-effectiveness ratios for adherence compared to non-adherence were New Taiwan Dollars -(NTD) 17,478 and -NTD 18,340 per follow-up year in surgery (OP) with CT group and OP group, respectively. Conclusion: Treatment interruption and non-adherence to adjuvant HT were found in Taiwanese breast cancer women and associated with increasing all-cause mortality and healthcare costs; increasing HT adherence was cost-effective for one year of follow-up.

Indiana University-Purdue University Indianapolis (IUPUI)
BACKGROUND: The pathophysiology of diabetes mellitus and the need for vigilant monitoring of serum glucose levels lends itself well to prompt medical intervention by healthcare providers that can significantly reduce morbidity and mortality and improve patient quality of life. The effect of intervention in diabetes can be assessed by following objective laboratory measurements such as hemoglobin A1C, which is abnormal with poorly controlled diabetes and returns to normal with proper management. There are mobile technologies now available that allow for self-monitoring and intervention in this patient population. Using a systematic approach this paper will assess the benefits of Short Message Services and mobile technology in managing patients with diabetes and improving adherence and other outcomes. OBJECTIVE: To assess the benefits and disadvantages the use of mobile technology could have in the management of diabetes. METHODOLOGY: A systematic review of articles on this topic was performed. A total of 759 articles were initially identified by searching various search engines, from which only 39 articles met all of the inclusion/exclusion criteria of this systematic review. FINDINGS: The initial review of literature indicated that the use of mobile technology in patients with diabetes resulted in improved disease outcomes as indicated by parameters such as a decrease in hemoglobin A1C, and an increase in sustainable blood glucose levels. CONCLUSION: Mobile technology is found to be a promising tool in the management of diabetes, but further research is needed because there is a lack of reliable studies, trials, and systematic reviews. Physicians and other healthcare professionals are rapidly adopting mobile technology for use in clinical practice because they understand the rising phenomenon of mobile technology.

Thesis (M.S.)--University of Florida, 2004.
Typescript. Title from title page of source document. Document formatted into pages; contains 36 pages. Includes Vita. Includes bibliographical references.

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2021
Introdução: A aplicação do Experience Sampling Method (ESM) tem vindo a aumentar no contexto de perturbações psiquiátricas. Apesar das múltiplas vantagens, este método pode causar um fardo (burden) demasiado alto. Assim, é importante o estudo do fardo em estudos utilizando o ESM em pessoas com primeiro episódio psicótico. O objetivo deste estudo é avaliar o fardo momentâneo através de informação obtida pelo ESM e a sua relação com 1) fardo avaliado retrospetivamente, 2) crítica para a sua perturbação, 3) adesão à metodologia. Métodos: Realizou-se um estudo em indivíduos com primeiro episódio psicótico (n=28) utilizando o ESM através de smartphone durante 10 dias, com 8 questionários por dia. O fardo avaliado retrospetivamente, a adesão e o nível de crítica foram avaliados, assim como a sua relação com o fardo ao longo do estudo. Resultados: O uso de ESM no contexto de primeiro episódio psicótico não foi percecionado pelos indivíduos como oneroso e o fardo não foi considerado preditor de abandono do estudo. Conclusão: Este estudo demonstra que o ESM parece ser bem tolerado por indivíduos com diagnóstico recente de psicose, embora a existência de heterogeneidade inter-indivíduos aconselhe ainda alguma precaução.
Background: The use of smartphone-based Experience Sampling Method (ESM) in the context of psychiatric disorders has been increasing. A more exhaustive understanding of perceived momentary burden in patients with a first episode of psychosis in ESM studies is crucial. The objective of this study was to investigate patient-perceived momentary burden through ESM and clinician assessment ratings. Methods: Patients with a first episode of psychosis (n = 28) participated in a smartphone-based ESM 10-day monitoring period, signaled eight times per day. Our primary outcome was the momentary perceived burden. Results: The findings suggest that the use of ESM in the context of first episode of psychosis was not, on average, perceived by patients as burdensome and the momentary burden was not found to be a predictor of the drop-out status. Conclusion: This study demonstrates that ESM is overall well tolerated by patients with a first episode of psychosis, however, inter-individual heterogeneity warrants some caution.

The main purpose of this study was to explore the influence of social support and self-efficacy on the physical activity beliefs and behaviours of participants in a peer-mentoring intervention embedded in a community-based exercise program. A second purpose was to explore social support, self-efficacy, and perceived barriers and facilitators to exercise program adherence for study participants within the community-based exercise program setting. Participants (N=10, plus 6 mentors) were adults with chronic health conditions living in a low-income neighbourhood. Intervention (n=4) and comparison (n=6) groups completed self-report measures of physical activity, social support, and barrier self-efficacy at baseline, 6-weeks, and 12-weeks. Interviews were used post-intervention to explore the impact of peer mentoring, perceived social support and self-efficacy within the exercise setting, and barriers and facilitators to physical activity for study participants. Intervention participants showed greater exercise program adherence than comparison participants at 6-weeks. Qualitative findings suggest the peer mentoring intervention increased motivation and sense of obligation to adhere to the exercise program, and provided vicarious learning opportunities that may have indirectly influenced exercise program adherence for intervention and mentor participants. Findings also suggest that the exercise program was highly influential to participants’ social support and self-efficacy beliefs. Multiple barriers and facilitators to physical activity were reported. Overall, the current study supports the use of peer mentoring as an intervention strategy in combination with additional strategies to promote exercise program adherence in the study population. Practical implications are discussed in relation to the promotion of exercise program adherence in older adults with chronic health conditions participating in a community-based exercise program in a low-income neighbourhood.
Thesis (Master, Kinesiology & Health Studies) -- Queen's University, 2011-09-29 10:44:19.343

Indiana University-Purdue University Indianapolis (IUPUI)
Given the numerous benefits of a healthy diet and exercise for cancer survivors, there has been an increase in the number of lifestyle intervention trials for this population in recent years. However, the extent to which adherence to a diet and exercise intervention predicts health-related outcomes among cancer survivors is currently unknown. To address this question, data from the Reach out to ENhancE Wellness in Older Cancer Survivors (RENEW) diet and exercise intervention trial were analyzed. RENEW was a yearlong telephone and mailed print intervention for 641 older (>65 years of age), overweight (body mass index: 25.0-39.9), long-term (>5 years post-diagnosis) survivors of colorectal, breast, and prostate cancer. Participants were randomized to the diet and exercise intervention or a delayed-intervention control condition. The RENEW telephone counseling sessions were based on determinants of behavior derived from Social Cognitive Theory (SCT) (e.g., building social support, enhancing self-efficacy). These factors have been hypothesized to improve health behaviors, which in turn should improve health outcomes. Thus, drawing on SCT and prior diet and exercise research with cancer survivors, I hypothesized that telephone counseling session attendance would be indirectly related to health-related outcomes (i.e., physical function, basic and advanced lower extremity function, mental health, and body mass index) through intervention-period strength and endurance exercise and dietary behavior (i.e., fruit and vegetable intake, saturated fat intake). The proposed model showed good fit to the data; however, not all of the hypothesized relationships were supported. Specifically, increased telephone counseling session attendance was related to engagement in all of the health behaviors over the intervention period. In turn, (a) increased endurance exercise was related to improvement in all of the health-related outcomes with the exception of mental health; (b) increased strength exercise was solely related to improved mental health; (c) increased fruit and vegetable intake was only related to improved basic lower extremity function; and (d) saturated fat intake was not related to any of the health-related outcomes. Taken together, these findings suggest that SCT determinants of behavior and the importance of session attendance should continue to be emphasized in diet and exercise interventions. Continued exploration of the relationship between adherence to a diet and exercise intervention and health-related outcomes will inform the development of more cost-effective and efficacious interventions for cancer and other medical populations.

This non-experimental, retrospective, descriptive and correlational study investigated adherence to antiretroviral drugs among HIV positive patients at Mpilo Central Hospital in Bulawayo Zimbabwe. Data among 118 patients was extracted from clinic registers and patient facility held medical records to determine level of adherence to ART using pharmacy refills (a non-immunological adherence parameter) and compared to CD4 cell count ( an immunological adherence parameter). Adherence levels obtained in this study using pharmacy refills was low (62.7%) and a relatively high non-adherence level of 37.3%. The pharmacy refill adherence level obtained was comparable to CD4 cell count adherence level of 64.6% (as indicated by a 50% CD4 cell count gain). These findings would seem to indicate the need for more education on the importance of adherence and further the need for better adherence monitoring systems
Health Studies
M.A. (Public Health)