The effectiveness of health belief model intervention on tuberculosis medication adherence in rural Indonesia: a pre-experimental study

Seventy-two hypertensive patients visiting an emergency department (ED) were randomized to one of four study groups to test the effect on compliance of a health belief model (HBM) intervention: a control group, a group receiving an HBM clinical intervention in the ED, a group receiving an HBM telephone call two days after the ED visit, and a combination clinical plus telephone intervention. Patients receiving any HBM intervention were 50% more likely to make, and 47% more likely to keep, a follow-up referral appointment than control group patients.

The sample included 74 asthmatic patients presenting to an emergency department with an acute asthmatic attack. The purposes of the study were: to assess demographic and situational variables associated with compliance, and to test the impact of a Health Belief Model (HBM) intervention to increase compliance. Compliance was operationalized as making and/or keeping a follow-up referral appointment for the patient's asthmatic condition. Demographic and situational variables associated with compliance included age, sex, marital status, previous treatment experience, seriousness of the asthmatic condition, and need for child care. Most important, the HBM intervention was very effective in increasing compliance in both making and keeping a follow-up referral appointment.

BackgroundThe Medication Adherence Rating Scale (MARS) is a rapid, non-intrusive way of measuring adherence to medication in order to improve management of patients with schizophrenia. The current study evaluated the reliability of the Chinese (Mandarin) version of the MARS and explored clinical and demographic correlates to medication adherence in a large sample of patients with recurrent schizophrenia in China.Methods1198 patients with recurrent schizophrenia were recruited from 37 different hospitals in 17 provinces/municipalities of China and evaluated with the Medication Adherence Rating Scale (MARS), Clinical Global Impression-Severity of illness (CGI-S) and Sheehan Disability Scale-Chinese version (SDS-C). Socio-demographic data included gender, age, marital status, education level, employment status and living with others or alone. Clinical data included duration of illness, number of relapses, and medication use, as well as current stage of disease evaluated by SCID. Pearson correlations were used to examine associations between MARS, socio-demographic, and clinical characteristics. Independent sample T-tests were used to compare MARS score between different socio-demographic and clinical characteristics. Finally, a cut-off score of 6 on the MARS (ranged from 1 to 10) was used to divide the sample into two groups (i.e. MARS score≥ 6 identified good adherence and MARS score< 6 indicated poor adherence). Bivariate logistic regression models with the two groups (MARS score<6 and MARS score≥6) as the dependent variable was used to identify influencing factors of medication adherence. Data processing and analyses were conducted on SPSS 22.0 and Mplus 7.4.ResultsThe MARS showed good internal consistency and psychometric properties. MARS outcomes varied by demographic and clinical characteristics; only 28.5% recurrent schizophrenia patients met the criteria of good adherence to antipsychotic medication. Findings indicated older age (OR=1.04, 95%CI=1.02–1.06), unsteady income (OR=1.79, 95%CI=1.29–2.49), acute period (OR=4.23, 95%CI=3.21–5.59) and a higher CGI-S score (OR=1.44, 95%CI=1.03–2.01) had significantly predictive effects on poor medication adherence. MARS demonstrated good reliability in our sample (Cronbach’s α =0.83; Spearman-Brown = 0.72).DiscussionThis study of the MARS is unique for a few reasons. First, comparative reports on MARS use in mainland China have not been published internationally; similar tests on reliability and correlation have only been reported in Hong Kong and Taiwan (Hui et al., 2006; Kao and Liu, 2010). Second, in considering demographic and clinical correlates of medication adherence in patients with recurrent schizophrenia, our MARS study broadly represents China with 17 of 27 provinces/municipalities reporting data from multiple geographic regions, with the participation of hundreds of psychiatrists across China.Only 28.5% recurrent schizophrenia patients met the criteria of good adherence to antipsychotic medication in this study. Low levels of good medication adherence in schizophrenia patients are found across Asia, with 27% in Korea meeting the criteria of good adherence (Kim et al., 2006) and 26% in Hong Kong (Hui et al., 2006). Overall MARS total score in our study (3.68 ±2.90) is comparably lower to that of developed countries, as MARS total score had a mean of 6.0 to 7.7 in a UK sample (Fialko et al., 2008; Jaeger et al., 2012), and 5.5 for schizophrenia patients in France (Zemmour et al., 2016).Medication adherence of patients affected by recurrent schizophrenia in China was found to be relatively low. Risk factors for non-adherence to medication in recurrent schizophrenia patients include older age, unsteady income, acute period and severity of illness.

Purpose: This study was conducted to investigate the effect of tuberculosis-related knowledge and family support on medication adherence in tuberculosis patients.Methods: The data were collected from 175 patients diagnosed with tuberculosis at three general hospitals located in two provincial cities in South Korea from September 1 to November 31, 2020. The 160 questionnaires were analyzed using IBM SPSS WIN 25.0.Results: The patients’ average score for tuberculosis-related knowledge was 15.85±5.87 (out of 25), for family support it was 22.03±9.20 (out of 35), and for medication adherence it was 5.11±2.68 (out of 8). There were significant differences in tuberculosis-related knowledge, family support, and medication adherence according to patients’ general characteristics and significant positive relationships among tuberculosis-related knowledge, family support, and medication adherence. Factors affecting patients’ tuberculosis medication adherence were history of stopping the medication, the importance of treatment among tuberculosis-related knowledge and family support, and these factors could explain 78% of patients’ taking tuberculosis drugs.Conclusion: It could be concluded that the importance of tuberculosis treatment and family support are very important for improving patients’ rates of medication adherence. Therefore, medical staffs caring for tuberculosis patients need to manage patients’ medication of tuberculosis drugs with continuous consultation.

Medication adherence behavior plays a central role in the success of tuberculosis (TB) treatment. Conventional motivation is not optimal in strengthening long-term medication adherence. A motivational interviewing (MI) communication motivation model based on the Health Belief Model (HBM) was designed with the main objective of improving medication adherence and treatment success. This study used an experimental design with a randomized posttest-only control group design. The intervention and control groups consisted of 107 TB patients each, who were selected by random cluster sampling. The study was conducted from November 2020 to June 2021 at 38 public health centers in Bali Province. The HBM-based MI model intervention was given in seven counseling sessions, pill count percentages were used to measure medication adherence, and treatment success was based on sputum examination results. Logistic regression was used to assess the effect of the intervention on medication adherence and treatment success. Logistic regression analysis showed that MI-based HBM and knowledge were the most influential variables for increasing medication adherence and treatment success. Medication adherence was 4.5 times greater (ARR = 4.51, p = 0.018) and treatment success was 3.8 times greater (ARR = 3.81, p < 0.038) in the intervention group compared to the control group, while the secondary outcome of knowledge of other factors together influenced medication adherence and treatment success. The conclusion is that the HBM-based MI communication motivation model creates a patient-centered relationship by overcoming the triggers of treatment barriers originating from the HBM construct, effectively increasing medication adherence and treatment success for TB patients, and it needs further development by involving families in counseling for consistent self-efficacy of patients in long-term treatment.

ObjectiveTo explore the influence of parents on the medication adherence of their children.Study DesignA cross-sectional online investigation.MethodsA questionnaire with 41 questions was designed based on the health belief model (HBM) distributed and collected online in 28 cities around China through multi-stage stratified sampling. The reliability of the questionnaire was assessed with Cronbach's α coefficient and split-half reliability, and its validity was evaluated with exploratory factor analysis and content validity index. The structural equation model (SEM) was constructed to explore the relationship between the parents' health beliefs and their children's medication adherence. Subgroup analysis was conducted to study the differences between parents with different demographic characteristics (male and female, rural and urban).Results573 questionnaires were included for analysis, with an effective rate of 62.97%. The Cronbach'α coefficient of the questionnaire was 0.821 > 0.6, the split-half reliability was 0.651 > 0.6, the I-CVI of each dimension were >0.78, and the S-CVI/AVE (I-CVI average) was 0.95 > 0.9. The result of the questionnaire exploratory factor analysis met the standard. According to the SEM, self-efficacy (λ = 0.177), perceived susceptibility (λ = −0.244), and perceived severity (λ = 0.243) were direct influencing factors of children's medication adherence. In the subgroup analysis, the model established by each subgroup was consistent with the model established by the overall sample. The absolute values of females' perceived susceptibility, severity, and self-efficacy for their children's medication adherence path coefficients were higher than males'.ConclusionParents' perceived severity and self-efficacy may positively impact on their children's medication adherence, while parents' susceptibility to children's medication non-adherence may negatively impact on children's medication adherence. Objective constraints, perceived barriers, and benefits may in directly impact on children's medication adherence. Women's health beliefs appear to have a more significant impact on their children's medication adherence than men's. It may be an effective strategy to increase their children's medication adherence by improving parents' health beliefs. Medical staff should explain medication adherence knowledge to the parents of children, and inform the children of the possible consequences of non-adherence with medication, to improve the subjective perception of parents on the severity of children's non-adherence with medication, and improve parents' self-efficacy in rational medication for children. In addition, attention should be paid to the mental health of the parents, and more social and psychological support.

The degree of human health can be influenced by behavior. This behavior factor still becomes a health problem in Indonesia. Unhealthy behavior causes various kinds of infectious diseases and non-infectious diseases. Various efforts to change the behavior of people who do not know, do not want to, and cannot afford it, have been carried out t by the government. However, Clean and Healthy Behavior is still a concern and not optimal yet. Health Belief Model (HBM) is applied as a model in efforts to overcome PHBS. The purpose of this study was to identify the effectiveness of the application of Health Belief Model to PHBS. This research is a quasy experiment with the design of one group pre-post test design. The population in this study was 40 respondents. The method of sampling used was purposive sampling method. The treatment was carried out once per week for 3 weeks. The results showed a difference in the effect of Health Belief Model (HBM) on Clean and Healthy Life Behavior (PHBS). The results of the Wilcoxon test analysis for 3 interventions in 3 weeks showed: the knowledge of PHBS (p ^ 0.00), the attitude of PHBS (0.01) and PHBS Behavior (p ^ 0.00), which means there are differences in the effect of changes in knowledge, attitudes and behavior of PHBS after HBM intervention. Health workers, especially nurses, are expected to make HBM as an effort to promote health and change hygienic and healthy living behavior in families or communities.

IntroductionCurrent knowledge regarding tuberculosis (TB) medication adherence largely stems from scientific publications. However, to date, the volume and characteristics of studies specifically focused on TB medication adherence in Southeast Asia have not yet been systematically assessed. This study aims to conduct a comprehensive bibliometric analysis of research on medication adherence in TB treatment within this region.MethodsA bibliometric analysis was conducted using the Scopus database to identify research articles related to medication adherence in TB treatment in Southeast Asia, published in English between 2015 and 2024. The analysis included the number of publication trends, country of origin, citation metrics, co-authorship networks, keyword co-occurrence, and the most frequently cited documents.ResultsA total of 146 journal articles were retrieved. Indonesia emerged as the most prolific contributor and demonstrated strong international collaboration. Keyword co-occurrence analysis revealed four major research themes: (1) clinical and demographic characteristics, (2) pharmacological management and disease burden, (3) socio-behavioral factors related to adherence, and (4) digital health-based treatment evaluation. Burst analysis of reference and keyword highlighted emerging research trends, particularly in “primary-community based care” and “digital health interventions”, indicating potential trajectories for future research in TB medication adherence.ConclusionThis study provided an overview of the evolving research landscape on TB medication adherence in Southeast Asia. These findings highlight the growing emphasis on primary-community based care and digital health interventions, pointing toward shaping future research and practice.

Assessing the impact of telephone call intervention on medication adherence in individuals with mental health disorders: A longitudinal study in a tertiary facility in Volta Region

Tuberculosis (TB) is an infectious disease and nonadherence to medication can lead to new cases, multi-drug resistant TB, or potential death. Additionally, healthcare professionals and individuals with TB’s knowledge of the disease and medication adherence are crucial for successful completion of medication therapy. Patient education is one of the most important aspects of care provided in healthcare settings (CDC, 1994). TB tends to disproportionally affect minority and economically disadvantaged patient populations. The purpose of this mixed method study was to explore the relationship between spirituality, knowledge, and TB medication adherence among African Americans and Haitians. The primary research question was: What is the relationship between spirituality, knowledge and TB medication adherence among African Americans and Haitians? Quantitative data were gathered from 33 questionnaires and analyzed by two ANOVAs and four chi square analyses. The null hypothesis was not rejected; there was not a statistically significant relationship between spirituality and TB medication adherence (p =.208) among the study’s African Americans and Haitians. Qualitative data concerning participants’ knowledge of TB, gathered from 16 individual interviews further informed this analysis. Secondary research questions examined the role of spirituality, knowledge of TB and medication adherence among African Americans and Haitians. Four common themes emerged across both groups to answer the secondary research questions. Interviews revealed the themes: (a) God is in control, (b) stigmatization of TB, (c) lack of knowledge, and (d) fear of death. The theme lack of knowledge about TB was found to contribute to stigmatization of TB patients. However, in this study stigma and lack of knowledge were related to initial denial of symptoms and delayed diagnosis, but not found to be related to TB medication adherence. This study could help adult educators and health educators enhance their educational interventions, develop a better understanding of adult learning, resulting in early diagnosis and treatment ultimately decreasing transmission of TB, drug resistance, and potential death. Educators should be aware that TB patients’ spirituality may be an important part of how they cope with having TB. A larger scale study, conducted at multiple locations should be conducted to extend the findings of this small scale exploratory study. Further studies should be done to better determine what patient, healthcare provider and health care system factors might mediate relationships that may exist between lack of knowledge of TB, stigma and TB medication adherence.

Medication adherence and its correlates among patients affected by schizophrenia with an episodic course: A large-scale multi-center cross-sectional study in China.

A large-scale validation study of the Medication Adherence Rating Scale (MARS)

Objective: Poor adherence to medication in individuals with schizophrenia has a series of adverse consequences. The aim of this study was to explore the efficacy of Team Skills Training Model (TSTM) on medication adherence in individuals with schizophrenia. Methods: Sixty individuals with schizophrenia from Tongde Hospital of Zhejiang Province were divided into a Research Group and a Control Group. The Research Group completed a TSTM intervention and the Control Group completed a Psychological Education program. The Medication Adherence Rating Scale (MARS) and Rating of Medication Influences (ROMI) were used to evaluate medication adherence, and the brief psychiatric rating scale (BPRS) was used to measure severity of disease. T-tests statistical method was used to compare the score of scales before and after the intervention, and Pearson correlation coefficient to analyze correlations between the MARS, ROMI and BPRS scores. Results: After 5-week intervention, both the Research Group and Control Group exhibited significant improvements in MARS(2.5 ± 1.10, 4.1 ± 1.78, t=6.649, P=0.000; 2.4 ± 0.93, 3.7 ± 1.42, t=6.547, P=0.000, respectively) and BPRS(47.2 ± 3.68, 40.4 ± 4.25,t=-15.827, P=0.000; 45.7 ± 2.73, 42.3 ± 3.96, t=-6.774, P=0.000, respectively). Research Group had significant improvements in ROMI scores in terms of perceived benefit from medication (1.03 ± 0.19, 1.45 ± 0.51, t=4.446, P=0.000), positive influence of a clinician (1.02 ± 0.17, 1.93 ± 0.46, t=9.878, P=0.000), positive relationship with a therapist (1.04 ± 0.18, 1.62 ± 0.49, t=6.298, P=0.000), positive family belief (1.03 ± 0.19, 1.48 ± 0.51, t=4.770, P=0.000), and fear of rehospitalization (1.37 ± 0.49, 1.83 ± 0.60, t=4.780, P=0.000). We found no correlations between changes in MARS, ROMI and BPRS scores. Conclusions: The TSTM may improve medication adherence in individuals with schizophrenia through increased adherence-related attitudes and integration of interpersonal communication.

Medication nonadherence constitutes a major problem in adolescent psychiatry. Previous studies have identified various factors associated with nonadherent behavior. The aim of this study is to explore adolescents' health beliefs and subjective perceptions relating to psychotropic medication, and to statistically link these to reported medication adherence. The findings presented in this study are part of the multicenter SEMA study (Subjective Experience and Medication Adherence in Adolescents with Psychiatric Disorders). Patients 12-18 years of age were included, who had been treated with a psychotropic medication for at least 2 weeks. The validated MARS (Medication Adherence Rating Scale) and the QATT (Questionnaire on Attitudes Toward Treatment) were used to measure adherence, and a qualitative semi-structured interview was conducted to examine patients' subjective experiences and perceptions. A conventional content analysis was conducted, and Fisher's exact tests were performed to analyze group differences between completely adherent and not completely adherent patients. A total of 64 patients were included in the study. 40.6% (n = 26) were classified as not completely adherent. Distribution patterns of answers to 7 out of 64 questions showed statistically significant group differences between completely and not completely adherent patients. Patients with lower adherence reported the following: feeling worse after taking medication; a lower sense of self-efficacy concerning the improvement of their symptoms; a less trustful physician-patient relationship; a worsened attitude toward medication after experiencing adverse events/"side effects"; less support from their relatives; and fewer individuals in their family who were fully informed about their condition. To our knowledge, this is the first interview-based study to investigate subjective experiences and health beliefs of adolescents with psychiatric disorders and to correlate these findings with rates of medication adherence. The study results will be useful for the development of tools and approaches to increase medication adherence, for example, psychoeducation programs and personalized treatment concepts.

Beyond Survival in Solid Organ Transplantation: A Summary of Expert Presentations from the Sandoz 6th Standalone Transplantation Meeting, 2018.