Comparing the effects of interactive and conventional video education on activation, treatment adherence, and weight changes in dialysis patients: A randomized clinical trial protocol

Patients with end-stage renal disease undergoing hemodialysis face substantial challenges in adhering to complex therapeutic regimens, significantly impacting morbidity, mortality, and quality of life. While conventional educational methods offer some benefit, interactive digital tools may yield deeper engagement and sustained behavioral change. This study assesses and compares the impact of interactive and conventional video-based education, as well as usual care, on patient activation, treatment adherence, and inter-dialytic weight gain in individuals undergoing hemodialysis. A three-arm, parallel-group, randomized clinical trial will be conducted in three academic hospitals in Tehran, Iran. A sample of patients will be enrolled and distributed into one of three categories: (1) interactive video education, (2) conventional video education, or (3) typical nurse-led education. The 13-item Patient Activation Measure will be used to measure the primary outcome of patient activation. Secondary outcomes will encompass treatment adherence, as measured by the End Stage Renal Disease Adherence Questionnaire, and inter-dialytic weight gain. Evaluations will occur at baseline, immediately post-intervention, and at 1- and 3-month follow-up intervals. Data will be analyzed using intention-to-treat principles with mixed-effects modeling. This trial is among the first to rigorously compare interactive and conventional video education in a dialysis population. Findings may inform scalable, cost-effective strategies for improving self-management and adherence in patients with end-stage renal disease. This protocol was registered prospectively at ClinicalTrials.gov (Registration No. NCT07099326) on July 31, 2025. The National Research Ethics Committee also approved the study with the ethics code: IR.SBMU.PHARMACY.REC.1404.067.

Multiple factors affect treatment adherence in individuals with cardiovascular disease. However, information on the relationships among treatment adherence, family functioning, and self-care agency in these patients and their families is limited. This study was developed to determine the relationships among treatment adherence, family functioning, self-care agency, and sociodemographic variables in patients with cardiovascular disease. Self-care agency, as defined by Orem, is the dynamic process patients use to engage in their own healthcare that involves discerning and addressing factors that allow their making decisions that improve self-care abilities. This cross-sectional, observational-analytical study enrolled 151 adult patients with cardiovascular diseases who had undergone pharmacological and nonpharmacological treatments and 108 family members of these patients who had consented to participate. Measurements were performed using the "Questionnaire for measuring treatment adherence in patients with cardiovascular disease," the "Family Functioning Assessment Scale," and the "Self-care Agency Scale." Of the 151 patients, 119 (78.8%) were assessed as having a low risk of nonadherence, 60 (39.7%) as having low family functioning, and 131 (86.8%) as having high self-care agency. Treatment adherence and self-care agency showed a moderate and significant correlation ( r = .66, p < .001). Similarly, treatment adherence and family functioning showed a low but significant correlation ( r = .35, p < .001). Moreover, significant multivariate associations were found among the variables of interest. Patients with a low risk of nonadherence were found to be more likely to have a secondary or postsecondary education, not to have vision or hearing problems, and to have a contributory affiliation mode with the health system or private health insurance. In addition, participants with moderate or high levels of family functioning were less likely to be workers or to not have hearing or vision problems. Finally, significant differences were noted between patients with low self-care agency and those with high self-care agency in terms of kinship relationship with family members and affiliation mode with the health system. The results of this research help clarify the issue of treatment adherence in patients with cardiovascular disease. Although family functioning and self-care agency were found to be low to moderately correlated with treatment adherence, relevant information regarding these variables and sociodemographic variables is presented in this study. Nurses may use these results as a reference to design nursing care plans and interventions to address the conditions of their patients more appropriately.

Effects of Depression and Anxiety Improvement on Adherence to Medication and Health Behaviors in Recently Hospitalized Cardiac Patients

Depression is an important contributor to low medication adherence in hemodialyzed patients and transplant recipients

Introduction Assessing treatment adherence in patients with type 2 diabetes mellitus (T2DM) is crucial in primary care. It enables the identification of adherence barriers, facilitates treatment optimization, prevents complications, reduces healthcare costs, and strengthens the physician-patient relationship. Objectives To identify factors associated with treatment adherence in T2DM patients at a Family Medicine Clinic in Veracruz, Mexico. Methods A prospective, cross-sectional study was conducted among T2DM patients attending a specialized primary care module. Independent variables included satisfaction with medical consultation, emotional stress (PSS-10), socioeconomic status (AMAI-NSE), and social support (DUKE-UNC). The dependent variable was treatment adherence, measured using the ARMS-e scale. A probabilistic sample size was calculated, and non-probabilistic sampling was applied. Statistical significance was set at p &amp;lt; 0.05. Association strength was expressed as odds ratios (OR) with 95% confidence intervals. Results Of 208 participants, 37.01% showed optimal adherence. No significant associations were found with sex, age, socioeconomic status, treatment type, disease duration, residence, self-rated health, or satisfaction with consultation (p &amp;gt; 0.05). However, adherence scores significantly differed by perceived quality of care-"very good,” “good,” or “fair"-with mean scores of 14.33, 13.64, and 16.0, respectively (p &amp;lt; 0.05). No correlations above 0.3 were observed between stress, social support, and adherence. Parameters were also analyzed in patients aged &amp;gt;65 and &amp;lt;65, with no significant differences found. Conclusions Perceived quality of care appears to impact treatment adherence more than sociodemographic or psychosocial factors. High-quality, patient-centered care should be prioritized to improve adherence in T2DM. Key messages • Strengthening patient-centered care in primary settings can improve adherence and reduce diabetes complications. • Measuring the adherence to treatment periodically, it's an action that should be considered for preventing complications and reducing healthcare costs.

Clinical symptoms and treatment adherence are one of the most important problems in dialysis patients. Psychological treatments can be effective in reducing the problems of these patients. Therefore, this study aimed at investigating the effectiveness of acceptance and commitment therapy (ACT) on clinical symptoms and treatment adherence in these patients. This study was a quasi-experimental study with the experimental and control groups in the dialysis clinic of Torbat-e Heydarieh City in 2012. The sample consisted of 40 people who were referred to the dialysis clinic, and the available sampling method was used to randomly assign participants to the experimental and control groups. In the experimental group, ACT was performed in eight sessions of 90 minutes. Questionnaires of Depression, Anxiety, and Stress Scale (DASS-21) and general adherence scale were used. Data were analyzed using Statistical Package for the Social Sciences (SPSS 21) software and multivariate analysis of covariance (MANCOVA) test. There was a significant difference between the mean scores of clinical symptoms and treatment adherence variables in the experimental and control groups (P < 0.05). The effect of this treatment on reducing the clinical symptoms score was 48%, and on increasing the treatment, the adherence score was 44%. ACT can reduce clinical symptoms and increase treatment adherence in dialysis patients, so it is suggested to use this intervention in the design of treatment plans for dialysis patients.

Background: The rate of treatment adherence in patients with schizophrenia is lower than average, and they have insufficient insight in this regard. Objectives: The present study was designed to assess the effectiveness of group cognitive behavioral therapy (GCBT) in the improvement of insight and treatment adherence in schizophrenic patients. Methods: In this randomized controlled trial, accomplished in Shiraz Psychiatric Hospital, Shiraz, Iran, from October 2021 to January 2022, 22 eligible participants were assigned to either intervention, therapist’s attention placebo, and control groups via simple randomization. In the intervention group, a treatment program was performed in seven 90-minute sessions based on a treatment protocol adapted from Robert Paul Lieberman’s 16-session community return program. The therapist’s placebo group also watched documentaries for seven sessions. The control group received only their usual treatments, which included a visit to a psychiatrist. The data were gathered using the Insight and Treatment Attitudes Questionnaire and the Medication Adherence Rating Scale at three different time points. Results: At baseline, the mean scores of insight and medication adherence were not significantly different between all the groups. After the intervention, the results showed significant differences in insight levels (P = 0.001) and medication adherence (P = 0.003). Three months after the intervention, the results showed significant differences in insight levels and medication adherence (P = 0.001). The differences in the mean scores of insight levels and medication adherence in post-intervention and 3-month follow-up were only significant in the intervention group (P = 0.001). Conclusions: Based on the evidence from this study, GCBT is an effective treatment for improving insight and medication adherence in schizophrenic patients. Therefore, it is necessary to pay attention to the use of GCBT to increase compliance with drug treatment.

Background: Low treatment adherence in patients with type 2 diabetes mellitus (T2DM) hinders the effective use of anti-diabetic agents and the achievement of glycemic control, reducing their quality of life and outcomes. Assessment of treatment adherence can help to identify and manage factors and barriers that affect therapy and treatment satisfaction.Aim: To assess the treatment adherence of patients with T2DM, to identify the main barriers to adherence, and patient satisfaction with the treatment.Materials and methods: FORSIGHT-T2DM was a Russian multiregional, multicenter observational epidemiological study in 2014 patients with T2DM. The patients were assessed with the FORSIGHT- T2DM Patient Questionnaire, Moriski Medication Adherence Scale (MMAS), and Diabetes Treatment Satisfaction Questionnaire (DTSQ).Results: The mean (± SD) treatment adherence estimated using the MMAS was 5.86±1.39 points. The main barriers to adherence were high treatment costs, medication side effects, forgetfulness when taking drugs, complexity of the therapy or treatment regimen. The average number of daily medications was four. There was also a lack of contact with a doctor, poor awareness of the disease and its complications. Ninety (90) per cent of the respondents trusted the recommendations from their doctors, 7.6% followed the advice of relatives or friends. The patient's choice of medication was influenced by information about its effectiveness, its cost, and reimbursement, ease of administration, and information on the absence of side effects. Seventy eight (78) per cent of the respondents were “completely” or “rather” satisfied with their treatment. About 15% of patients rated the quality of care as unsatisfactory.Conclusion: The results of the study identified an intermediate level of treatment adherence in most patients with T2DM, as well as multiple adherence barriers, including comorbidities and the need for continuous intake of various agents. Most patients showed high treatment satisfaction, which could be due to the high availability of outpatient consultations by an endocrinologist and inpatient treatment, free access to anti-diabetic medications. However, it may also be a result of biased assessment of problems due to insufficient patient awareness of the therapy goals and a low level of knowledge about their disease. To study the factors affecting the adherence to medical recommendations among patients with T2DM, it is necessary to develop a specific questionnaire for this patient category, which would allow for an evaluation both drug intake and other aspects of their comprehensive treatment, including the identification and analysis of the main barriers to adherence.

Aim of the studyTreatment nonadherence in patients with mental illnesses recurs and exacerbates the complications of the disease and disrupts the treatment process. Experienced stigma may aggravate treatment nonadherence while spiritual well-being may improve stigma and treatment adherence. This study aimed to determine the relationship of stigma with treatment adherence and spiritual well-being in patients with mental illnesses in Iran in 2019.Subject or material and methodsThis cross-sectional correlational study was performed on patients with mental illnesses who referred to Farshchian Psychiatry Hospital of Hamadan, from December 2018 to March 2019. A total of 250 available patients were selected and asked to complete demographic, stigma, treatment adherence, and spiritual well-being questionnaires under the supervision of a researcher. Data were analyzed using descriptive statistics and path analysis in SPSS22 and AMOS23.ResultsMean stigma, treatment adherence, and spiritual well-being scores were calculated as 2.2±0.5, 139.89±27.52, and 83.12±19.5, respectively. The results showed a significant negative correlation between stigma and treatment adherence (r=-0.54, P&lt;0.001). In addition, there was a significant direct relationship between treatment adherence and spiritual well-being (r=0.44, P&lt;0.001) and a significant negative relationship between stigma and spiritual well-being (r=-0.48, P&lt;0.001)DiscussionThe results showed a relationship between stigma and treatment adherence, stigma and spiritual well-being, and spiritual well-being and treatment adherence.ConclusionsThen can be suggested that treatment teams can improve treatment adherence by undertaking several interventions to reduce stigma and promote spiritual well-being to prevent the adverse individual and social effects of treatment nonadherence

IntroductionSchizophrenia has a clinical course that has a great negative impact on the daily life of the person due to the cognitive and social problems it causes. Internalised stigmatisation is a very common negative phenomenon in individuals diagnosed with schizophrenia. It is known that treatment adherence is low in schizophrenia patients with high levels of internalised stigma. Lack of adequate treatment adherence in these patients is a negative factor in terms of recovery. Reducing the level of internal stigmatisation and reinforcing treatment adherence in schizophrenia has a positive effect on recovery. Considering this situation, it is important to determine the relationship between internal stigmatisation, treatment adherence and recovery in schizophrenia patients. In the literature review, there were no studies in which the relationship between internal stigmatisation, recovery and treatment adherence in individuals diagnosed with schizophrenia was carried out together.ObjectivesIn this study, it was aimed to fill the existing gap in the relevant field and to be a resource for further intervention programmes.MethodsThe study was planned as descriptive. The sample of the study consisted of individuals diagnosed with schizophrenia aged 18 years and over who met the inclusion criteria and accepted to participate in the study by purposive sampling method. In the power analysis, the sample number was calculated as (N=80) with a margin of error of 0.5. Personal information form, Internalised Stigma Scale in Mental Illness (ISMI), Recovery Assessment Scale (RAS) and Medication Adherence Rating Scale (MARS) were used for data collection. IBM SPSS 27.0 package programme was used for statistical analysis.ResultsThe data are still being analysed in detail by the researchers. The findings and relational results of the study will be presented.ConclusionsIt is thought that the results of the study will contribute to the reporting of the relationship between intrinsic stigma, recovery and treatment adherence in individuals diagnosed with schizophrenia, and by revealing the relationship between the variables, it is thought that it will be a source for planning interventions that will increase the treatment adherence and recovery perceptions of schizophrenia patients and reduce their intrinsic stigma.Disclosure of InterestNone Declared

BackgroundNumerous factors are likely to result in poor treatment adherence, which is one of the important factors contributing to increased complications and the low efficacy of hemodialysis (HD), particularly inadequate knowledge of patients. This study aimed to compare the effects of a mobile health (mHealth) app (the Di Care app) use and face-to-face training on the clinical and laboratory parameters of dietary and fluid intake adherence in patients undergoing HD.MethodsThis single-blinded, two-stage/two-group randomized clinical trial was fulfilled in 2021-22 in Iran. Seventy HD patients were recruited, using the convenience sampling method, and were then randomized into two groups: mHealth (n = 35) and face-to-face training (n = 35). ​ The patients in both groups received the same educational materials via the Di Care app and face-to-face training for one month. Before and 12 weeks after the intervention, the mean interdialytic weight gain (IDWG), potassium (K), phosphorus (P), total cholesterol (TC), triglyceride (TG), albumin (AL), and ferritin (FER) levels were measured and compared. The data were analyzed using the SPSS via descriptive statistics (mean, SD, frequency, and percentage) and analytical tests (independent-samples t-test, paired-samples t-test, Wilcoxon signed-rank test, Mann-Whitney U test, Chi-square test, and Fisher’s exact test).Results​Prior to the intervention, the mean IDWG and the K, P, TC, TG, AL, and FER levels, were not significantly different in both groups (p > 0.05). The mean IDWG (p < 0.0001), and the K (p = 0.001), P (p = 0.003), TC/TG (p < 0.0001), and FER (p = 0.038) levels in the HD patients in the mHealth group decreased. ​As well, the mean IDWG (p < 0.0001), and the K (p < 0.0001) and AL (p < 0.0001) levels showed a descending trend in the face-to-face group. The fall in the mean IDWG (p = 0.001) and the TG level (p = 0.034) in the patients in the mHealth group was significantly greater than that in the face-to-face group.ConclusionsThe Di Care app use and the face-to-face training could improve dietary and fluid intake adherence in patients. However, mHealth could have more effect on the laboratory parameters than face-to-face training, largely reducing the IDWG.Trial registrationThis study was registered in the Iranian Registry of Clinical Trials (No. ID IRCT20171216037895N5).

The objective of this study is to investigate treatment adherence and factors influencing adherence in patients with keloid disease (KD). A treatment adherence questionnaire was administered to 141 patients with KD treated at Department of Dermatology, Wuhan Asia General Hospital. We analyzed treatment adherence rates and explored the association between adherence and various factors such as sex, age, monthly income, disease course, number of lesions, skin lesion diameter and width, educational background, presence of pruritus or pain symptoms, professional knowledge, and patient training with medication guidance. Univariate and multivariate logistic regression analyses of these factors were performed using SPSS software. The overall treatment adherence rate among patients with KD was 55.32%, with a non-adherence rate of 44.68%. Univariate analysis revealed that sex, age, education level, marital status, monthly personal income, associated symptoms, professional knowledge, patient training with medication guidance, and the number of attending physicians were factors associated with treatment adherence, with significant differences (P < 0.05) between the adherent and non-adherent groups. Sex, age, monthly personal income, presence of pruritus or pain, and patient training with medication guidance were identified as independent factors contributing to poor adherence in patients with KD through our multivariate analysis (P < 0.05). In this study, we noted that treatment adherence in patients with KD was influenced by multiple factors (Sex, monthly personal income, age, presence of accompanying symptoms, patient training with medication guidance). All significantly affected treatment adherence in patients, with age and the presence of pruritus or pain being primary contributors to low treatment adherence.

The mediating role of psychological well-being in the relationship between the light triad of personality and sense of concordance with treatment adherence in patients with type 2 diabetes: A network analysis and structural equation modeling study

To investigate the effects of comprehensive nursing interventions on psychological well-being and rehabilitation treatment adherence in patients with dementia. A retrospective analysis was conducted on 90 dementia patients treated at the First Hospital of Fuyang Hangzhou. Patients were divided into an observation group (n=45) and a control group (n=45). The control group received standard nursing care, while the observation group received comprehensive nursing interventions. Key outcomes included negative emotions, treatment adherence, quality of life, sleep quality, caregiver emotional well-being, and caregiver satisfaction. The observation group had significantly lower Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) scores than the control group (both P<0.001). Treatment adherence, including disease awareness, medication compliance, and nutritional support, was significantly higher in the observation group (all P<0.05). The observation group showed better quality of lifeand lower Pittsburgh Sleep Quality Index (PSQI) scores (all P<0.001). Caregivers in the observation group reported higher satisfaction, with significantly lower SAS and SDS scores (all P<0.05). Mini-Mental State Examination (MMSE) scores were also higher in the observation group post-intervention (P<0.05). Additionally, the observation group had a better prognosis with fewer complications (P<0.05). Comprehensive nursing interventions significantly improve psychological well-being, treatment adherence, cognitive function, and overall quality of life for dementia patients. They also reduce anxiety, depression, and complications, and improve caregiver satisfaction. These findings support the benefits of comprehensive nursing interventions.

IntroductionTo identify factors associated with treatment adherence and satisfaction in patients with type 2 diabetes (T2DM) in Japan.MethodsA web-based questionnaire survey was conducted from 6 to 17 March 2019 in patients with T2DM aged ≥ 20 years receiving diabetes treatment. Treatment adherence and satisfaction were self-assessed/reported by the patients. A multiple logistic regression model and the chi-square test were used to assess associated factors.ResultsResponders (N = 1000) were aged 63.8 (standard deviation 11.9) years, and 739 (73.9%) were male. Adherence to treatment was reported in 941 (94.1%) patients and was significantly associated with higher household income (odds ratio [OR] 2.07, 95% confidence interval [CI] 1.11–3.86), age (OR 1.04, 95% CI 1.02–1.07), employment (OR 0.30, 95% CI 0.15–0.60) and having ≥ 1 impaired basic activity of daily living (BADL) (OR 0.33, 95% CI 0.13–0.82). Satisfaction with treatment was reported by 575 (57.5%) and was significantly associated with receiving/understanding guidance on how pharmacologic therapies are tailored (OR 1.73, 95% CI 1.19–2.51), male sex (OR 1.55, 95% CI 1.10–2.19), higher household income (OR 1.45, 95% CI 1.09–1.94) and age (OR 1.02, 95% CI 1.00–1.03). Treatment adherence was negatively associated with lower household income and having ≥ 1 impaired BADL in patients aged < 65 years, but not in those aged ≥ 65 years. Treatment satisfaction was positively associated with higher household income and receiving/understanding guidance on exercise therapy and the importance of achieving target haemoglobin A1c levels in patients aged ≥ 65 years, but with receiving/understanding guidance on the tailoring of pharmacologic therapies in patients aged < 65 years.ConclusionLower age, lower household income, employment and impaired BADL may negatively impact treatment adherence in patients with T2DM. Appropriate physician guidance may promote treatment satisfaction. Differences in perspectives between patients aged < 65 and those aged ≥ 65 years should be considered.Trial RegistrationJapan Pharmaceutical Information Center, JapicCTI-194636.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13300-021-01100-3.