Adherence Factors Research Articles

Evaluation of Hypertension-Related Knowledge, Medication Adherence, and Associated Factors Among Hypertensive Patients in the Aljouf Region, Saudi Arabia: A Cross-Sectional Study

Background and Objectives: Hypertensive patients’ knowledge and adherence to prescribed medicines are critical in managing their condition, as poor adherence may lead to adverse cardiac and cerebrovascular events. The present study assessed hypertension-related knowledge and medication adherence among hypertensive patients attending primary health centers (PHCs) in the Aljouf Province, Saudi Arabia. Materials and Methods: Using a cross-sectional design, we conducted this survey on 390 patients. Self-reported hypertension knowledge was assessed using the Hypertension Knowledge Level Scale (HK-LS), and medication adherence was determined using the Hill–Bone Medication Adherence Scale. We used binomial regression analysis (adjusted with other variables) to find the associated factors of medication adherence. Results: This study found that nearly half (49.2%) of the participants had inadequate knowledge, and poor medication adherence was noted in 40.8% of the participants. We found a positive correlation between HK-LS and the Hill–Bone Medication Adherence Scale scores (Spearman’s rho = 0.312, p = 0.002). Medication adherence was significantly associated with job status (private sector (ref: public sector, adjusted odds ratio [AOR] = 2.02, 95% CI = 1.18–3.62, p = 0.005)), living in an urban region (ref: rural, AOR = 3.61, 95% CI = 1.85–5.72, p = 0.002), and duration since diagnosis of more than 5 years (ref: ≤1 year, AOR = 3.53, 95% CI = 2.36–4.95, p = 0.001). Conclusions: The present study findings indicate that there is still a critical gap in managing hypertension at the PHCs in this region, and this may lead to poor health outcomes among the patients and burden the healthcare system. Hence, continuous patient education and targeted counseling are recommended for those with poor medication adherence.

The effect of cognitive emotion regulation on direct-acting antivirals adherence in patients with hepatitis C

IntroductionAdherence to direct-acting antivirals (DAAs) could be a predictor of chronic viral hepatitis C (HCV) therapeutic failure. We examined the perceptions of patients receiving DAAs to determine how cognitive factors influence their decision to maintain adherence. Also, we explored the threshold of DAAs adherence for obtaining sustained virologic response (SVR) among patients with HCV, in order to better implement a strategy that improves the DAAs adherence in the future clinical practice.MethodsA single-arm prospective study was performed. Patients with HCV that started and completed DAAs treatment in the County Hospital of Craiova, Dolj, Romania, were enrolled. Patients’ medication adherence was assessed using the HCV-AD10 questionnaire, and the cognitive emotion regulation was measured with CERQ questionnaire (five positive/adaptive cognitive emotion-regulation domains and four negative/maladaptive domains). Spearman correlation analysis was conducted to explore the relationships between adherence and different factors. ROC-curves were used to evaluate the adherence threshold to achieve SVR. A linear regression model was performed to analyze the primary outcome (DAAs adherence) to be the target variable based on given independent variables (age, treatment duration, severity of HCV, the nine adaptive and maladaptive strategies).Results368 patients (mean age: 61 years) with HCV diagnosed 4.05 ± 6.38 (average) years ago were enrolled. Mean (±SD) adherence via HCV-AD10 was 91.51 ± 8.34, and the proportion of the participants achieving SVR was 96%. Patients with an adherence less than 84% (5 patients, 1.36%) was considered nonadherent and they have a high probability of not achieving response (sensitivity and specificity of 83% and 80%, respectively). We obtained significantly higher values of three adaptive strategies between adherent and nonadherent patients following DAAs treatment: in positive refocusing (p-value = 0.044), refocus on planning (p-value = 0.037), and positive reappraisal (p-value = 0.047).DiscussionThe interplay between the three adaptive strategies of the cognitive emotion regulation and the enhancement of DAAs adherence contributes to a more holistic comprehension of patient behavior in the context of HCV treatment. Increasing refocusing and planning using goal setting and assisting patients in establishing specific, achievable goals can be crucial strategies for clinicians aiming to improve adherence among their patients.

Study of mathematical models of type 2 diabetes mellitus and its complications

The rapid increase in type 2 diabetes mellitus (DM) cases in Indonesia, driven by hereditary factors and unhealthy lifestyles, poses significant health challenges. This study develops a compartmental model to analyze the progression of type 2 DM and the onset of complications, classifying individuals into susceptible, patients without complications, patients with complications, and those disabled due to complications. The model examines the influence of two key factors on the recovery from complications: habitual factors, including medication adherence, physical activity, dietary habits, smoking history, and environmental factors, such as stress levels, environmental support, patient trust, and compliance. The results indicate that habitual factors have a more substantial impact on mitigating complications compared to environmental factors, suggesting that lifestyle interventions are crucial in improving patient outcomes. The model also shows that an increase in behavioral interactions leading to disease progression results in instability, emphasizing the need for early and consistent behavioral interventions. This research offers valuable insights for healthcare providers and policymakers. By identifying the most influential factors in managing complications, the model can guide the development of targeted interventions that prioritize habitual changes, such as medication adherence and physical activity. Public health strategies can be tailored to emphasize the importance of these habitual factors, potentially reducing the burden of type 2 DM complications. Overall, this study highlights the critical role of personalized, behavior-focused interventions in the management and prevention of complications in patients with type 2 DM, offering a practical framework for improving patient care.

Medication adherence in geriatric patients attending medical outpatient department.

Adherence to medication represents a challenge in managing chronic conditions in the geriatric population. This study assessed adherence rates and factors affecting adherence of geriatric patients attending the Helen Joseph Hospital outpatient department. This was a prospective cross-sectional study of 130 patients aged 65 years and older, with at least two chronic conditions. Participants were administered a survey incorporating the Medication Adherence Rating Scale and the Adherence Barrier Questionnaire to identify medication adherence and patient-specific barriers to adherence, respectively. These instruments are reliable and valid. Descriptive statistics and logistic regression were used for analysis. Most patients were female (63%) with a mean age of 72 (67-78) years. Common comorbidities included type 2 diabetes mellitus (63%), hypertension (98%), dyslipidaemia (92%) and congestive cardiac failure (38%). Polypharmacy was prevalent, affecting 53% of the participants. Despite 96% of participants being adherent, all had at least one barrier to adherence, with the majority (65%) having more than one barrier. The main barriers were forgetfulness (59%), fear of side effects (39%), problems with taking the medications (26%) and believing medications are poisonous (22%). Although most participants accessed the pharmacy easily, only 83% reported consistent medication availability and 11% could not afford to collect their medication. Polypharmacy is common in the population. Despite high adherence rates, barriers such as believing medications are poisonous remain significant. A good patient-doctor relationship improves adherence.Contribution:Understanding the barriers to adherence in older adults with polypharmacy and multimorbidity can assist practitioners improve patient care.

Socio-demographic and genetic risk factors for drug adherence and persistence across 5 common medication classes

Low drug adherence is a major obstacle to the benefits of pharmacotherapies and it is therefore important to identify factors associated with discontinuing or being poorly adherent to a prescribed treatment regimen. Using high-quality nationwide health registry data and genome-wide genotyping, we evaluate the impact of socio-demographic and genetic risk factors on adherence and persistence for 5 common medication classes that require long-term, regular therapy (N = 1,814,591 individuals from Finnish nationwide registries, 217,005 with genetic data from Finland and Estonia). Need for social assistance and immigration status show a notable negative effect on persistence and adherence across the examined medications (odd ratios between 0.48 and 0.82 for persistence and between 1.1% to 4.3% decrease in adherence) while demographic and health factors show comparably modest or inconsistent effects. A genome-wide scan does not identify genetic variants associated with the two phenotypes, while some pharmacogenes (i.e. CYP2C9 and SLCO1B1) are modestly associated with persistence, but not with adherence. We observe significant genetic correlations between medication adherence and participation in research studies. Overall, our findings suggest that socio-economically disadvantaged groups would benefit from targeted interventions to improve the dispensing and uptake of pharmacological treatments.

Whole-genome sequencing of toxigenic Clostridioides difficile reveals multidrug resistance and virulence genes in strains of environmental and animal origin

BackgroundClostridioides difficile has been recognized as an emerging pathogen in both humans and animals. In this context, antimicrobial resistance plays a major role in driving the spread of this disease, often leading to therapeutic failure. Moreover, recent increases in community-acquired C. difficile infections have led to greater numbers of investigations into the animal origin of the disease. The aim of this study was to evaluate the genetic similarities between 23 environmental and animal isolates by using whole-genome sequencing and to determine antimicrobial resistance and virulence factor genes in toxigenic C. difficile strains to provide important data for the development of diagnostic methods or treatment guidelines.ResultsThe most common sequence type was ST11 (87%), followed by ST2 (9%) and ST19 (4%). In addition, 86.95% of the strains exhibited multidrug resistance, with antimicrobial resistance to mainly aminoglycosides, fluoroquinolones, tetracycline and B-lactams; nevertheless, one strain also carried other resistance genes that conferred resistance to lincosamide, macrolides, streptogramin a, streptogramin b, pleuromutilin, oxazolidinone and amphenicol. In addition, a wide range of virulence factor genes, such as those encoding adherence factors, exoenzymes and toxins, were found. However, we observed variations between toxinotypes, ribotypes and sequence types.ConclusionsThe results of this study demonstrated significant genetic similarity between ST11 strains isolated from environmental sampling and from animal origin; these strains may represent a reservoir for community-acquired C. difficile infection, which is becoming a growing public health threat due to the development of multridug resistant (MDR) bacteria and the number of virulence factors detected.

Determinants of medication non-adherence among patients with chronic diseases at community pharmacy settings in South Gondar Zone, Northwest Ethiopia: a multicenter cross-sectional study.

Medication non-adherence is a significant public health concern in managing patients with chronic diseases, and community pharmacists are on the frontline in the management of chronic medications. Chronic diseases require lifelong pharmacotherapy and understanding the determinants of medication adherence has paramount importance to develop strategies that improve medication adherence and treatment outcomes. Thus, this study aimed to assess the magnitude of medication non-adherence and its contributing factors among patients with chronic diseases attending community pharmacies in South Gondar Zone, Northwest Ethiopia. A multicenter cross-sectional study was conducted at community pharmacies in South Gondar Zone from September 01 to October 30, 2023. Medication adherence was assessed using a structured questionnaire using the Adherence in Chronic Diseases Scale (ACDS). Statistical Package for Social Sciences (SPSS) version 25 was used for analysis. Association between the outcome variable and independent variables was performed using binary logistic regression and a p-value of <0.05 was considered statistically significant. Among three hundred and eighty six (386) study participants recruited in this study, more than half of them 222 (57.51%, 95%CI: 52.4% - 62.5%) were low adherent to their medications. Concerning determinants of medication non-adherence; the presence of side effects (AOR =2.1, 95%CI=1.33-3.29), unable to get ever counseling from community pharmacists (AOR=2.3, 95%CI= 1.46-3.58), and poor about their medications (AOR=3.1, 95% CI= 1.96-4.82) were significantly associated with patients' non-adherence to medications. The medication adherence level in this study was suboptimal, with a significant proportion of the patients being non-adherent to their medications. The presence of side effects, unable to get ever counseling, and poor knowledge about their medications were statistically significant factors of poorer medication adherence. Hence, healthcare professionals, especially community pharmacists, have a crucial role in designing the schedule for health education concerning the needs of these patients in community pharmacy settings.

Antibiotics and Pesticides Enhancing the Transfer of Resistomes among Soil-Bayberry-Fruit Fly Food Chain in the Orchard Ecosystem.

While substantial amounts of antibiotics and pesticides are applied to maintain orchard yields, their influence on the dissemination and risk of antibiotic resisitome in the orchard food chain remains poorly understood. In this study, we characterized the bacterial and fungal communities and differentiated both antibiotic resistance genes (ARGs) and virulence factor genes (VFGs) in the soil, Chinese bayberry (matured and fallen), and fruit fly gut, collected from five geographic locations. Our results showed that fruit fly guts and soils exhibit a higher abundance of ARGs and VFGs compared with bayberry fruits. We identified 112 shared ARGs and 75 shared VFGs, with aminoglycoside and adherence factor genes being among the most abundant. The co-occurrence network revealed some shared microbes, such as Bacillus and Candida, as potential hosts of ARGs, highlighting the vector risks for both above- and below-ground parts of the orchard food chain. Notably, the elevated levels of antibiotics and pesticide residues in orchard soils increase ARGs, mobile genetic elements (MGEs), and VFGs in the soil-bayberry-fruit fly food chain. Our study highlighted that agricultural management, including the overuse of antibiotics and pesticides, could be the key factor in accumulating resistomes in the orchard food chain.

A qualitative dyad analysis of barriers and facilitators of antiretroviral therapy (ART) adherence among people who inject drugs (PWID) with HIV in Kazakhstan.

People with HIV (PWH) who inject drugs (PWID) face many barriers to ART adherence. Kazakhstan has one of the fastest growing HIV epidemics in the world, primarily fueled by injection drug use, yet ART adherence among PWID is low. Social support can help address these barriers, but ART adherence among PWID is rarely examined within the relationship context. We conducted interviews with 20 PWID with HIV and 18 of their intimate partners and performed a qualitative dyad analysis to examine ART adherence factors. The results indicated many barriers and facilitators of ART adherence at the individual level (e.g., substance use), interpersonal level (e.g., social support) and structural level (e.g., stigma, transportation). Reported adherence barriers and facilitators had high congruence between dyad members; however, some notable differences were found between dyads. Compared to PWH, partners without HIV had a lack of awareness about the role of stigma in impeding ART adherence. Different manifestations of social support to facilitate ART adherence were noted between seroconcordant dyads (e.g., taking pills together, attending appointments together) and serodiscordant dyads (e.g., reminders to take pills, providing babysitting to enable attendance at doctor appointments). Future research and programs may benefit from integrating dyad approaches into ART adherence interventions.

Treatment Adherence in Pediatric Atopic Dermatitis: A Systematic Review.

Adherence to pediatric atopic dermatitis (AD) treatment regimens can be complex and a major challenge to optimizing treatment outcome. We aimed to review factors associated with nonadherence in pediatric AD and propose interventions to improve adherence. PubMed and EMBASE databases were systematically searched for articles from 2000 to February 2023 related to AD and adherence, with an additional update in December 2023. Non-human studies, reviews, commentaries, and meta-analyses were excluded. Articles were sorted into pediatric versus adult study population based on volume. Herein, we examine the results of papers discussing adherence factors related to pediatric patients. A total of 62 studies met inclusion criteria. Thirty-six studies surveyed patients and caregivers (N = 10,268) to identify barriers to treatment adherence. None of the included studies were specific to systemic medications. Barriers includedpoor caregiver quality of life, inadequate AD-related education, topical corticosteroid (TCS) phobia, unclear therapy-related instructions, and dissatisfaction with physician interaction. Five studies solely measured adherence using medication electronic monitoring systems, Morisky medication adherence scale, or self-reported adherence to measure adherencetotopical medications. Twenty-one studies described interventions involving nurse-led or web-based education programs, text message or email reminders, and TCS education. Adherence was improved with caregiver education programs, daily text-message reminders, eczema action plans, TCS potency "traffic light" color system, and frequent follow-up visits. Adherence to pediatric AD treatment poses a multifactorial challenge for caregivers and patients. This study provides an index of strategies to optimize adherence, as it is essential for prevention of long-term sequela associated with AD in children. As the AD treatment landscape rapidly expands, further studies are vital to assess pediatric adherence to new topical, oral, and injectable medications. PROSPERO: CRD42023488557.

Medication adherence patterns and factors associated with non – adherence among patients receiving psychotropic medication in a tertiary care hospital

Medication adherence patterns and factors associated with non – adherence among patients receiving psychotropic medication in a tertiary care hospital

An advocacy based cross sectional study of healthcare professionals of factors impacting on medication adherence across nine Sub-Saharan African countries

BackgroundAdherence to anti-seizure medication (ASM) by people diagnosed with epilepsy in sub-Saharan Africa remains low. The factors for low adherence are not well understood. To improve adherence, it is important to understand the perceptions and views of healthcare professionals delivering epilepsy care to this population. The aim was to investigate the factors influencing ASM adherence. MethodsThis study uses a brief online questionnaire which asked healthcare professionals (both from nursing and medical backgrounds) who work in sub-Saharan African countries to rate a set of pre-established options designed with the feedback of a local focus group of epilepsy experts from countries targeted. The questionnaire consisted of six questions and was a mix of multiple choice and Likert scale questions. ResultsThere were 217 healthcare professionals who replied to the questionnaire. The most important factors believed to be influencing adherence from a healthcare professional perspective are; lack of availability of medication for epilepsy (71%), affordability of medication (60%), the patient, family, carer lacking in understanding of medication (43%), cultural misconceptions about epilepsy (40%) and side effects of the medication (32%). The survey was answered by many different healthcare professionals; 65 participants were doctors and 152 were other healthcare professionals such as nurses (59%) pharmacists (10%) and when comparing them, the three most important categories were consistent across groups. ConclusionHealthcare workers in Sub-Saharan Africa identify that the primary factors impacting adherence to ASMs, in their view, is affordability and availability of ASMs.Addressing this issue may reduce the treatment gap.

Impact of Cancer Care Financial Assistance Program on client financial toxicity and emotional distress.

204 Background: The financial impact of cancer can include high out-of-pocket costs, compensatory trade-offs (e.g., postponing treatment), and emotional distress. Cancer Care developed its Financial Assistance (FA) Program to assist with cancer-related costs and reduce client financial and emotional burden. We examined the impact of Cancer Care ’s FA Program on financial toxicity and emotional distress in clients undergoing cancer treatment. Methods: 731 patients enrolled in Cancer Care ’s FA Program (1/23-12/23) completed an evaluation survey. Clients were primarily women (71%); mean age=58 ( SD =13); 47% were non-Hispanic White, 33% non-Hispanic Black, 12% Hispanic. 84% were not employed; median household income $20K; 98% insured. Most frequent diagnoses: breast (26%), multiple myeloma (8%), and colon (5%) cancers; mean years since diagnosis=3 ( SD =6). All were on treatment (85% chemo; 38% radiation; 13% hormone; 11% immunotherapy). We used descriptive and multivariable regression analyses to examine the impact of FA and the correlates of reduced financial stress (yes/no) and emotional distress (not at all–extremely), controlling for socio-demographics. Results: The median grant award was $300 (max: $3000). FA was most often used for transportation (48%), household costs (43%), food (40%), and medical costs (30%). Only 38% of clients were aware of non-insurance financial resources during treatment. Financial compensatory trade-offs included delaying treatment (19%), choosing a less expensive treatment (7%), and stopping treatment (5%). Regarding financial toxicity, 61% reported that FA reduced their financial stress. In logistic regression, factors associated with greater likelihood of reduced financial stress after FA were larger grant amounts ( OR =1.05; p =.04), using FA for transportation ( OR =1.59; p =.00) or medical costs ( OR =1.44; p =.04), and unemployment ( OR =1.69; p =.02). Regarding emotional distress, 67% were distressed/extremely distressed before FA, vs. 25% after FA ( t =-21.72; p =.00). In linear regression, using FA for medical costs was associated with lower distress ( B =-.29; p =.00), and stopping treatment due to finances was associated with higher distress ( B =.52; p =.00), controlling for baseline distress. Using FA for other needs was not significantly associated with reduced financial/emotional distress. 50% said FA met their needs well/very well; 78% were satisfied/very satisfied with the program. Conclusions: Our results show the impact of Cancer Care ’s FA Program on reducing client financial toxicity and emotional distress, known factors in treatment adherence, quality of life, and survival. Notably, use of FA for medical and transportation costs, and grant amount, were significantly associated with improved client outcomes. Clients using funds for other basic needs may have multiple stressors requiring comprehensive multilevel support beyond FA alone.

Health Literacy and Adherence to Therapy in Type 2 Diabetes: A Cross-Sectional Study in Portugal.

Therapy adherence is a key factor in the control of type 2 diabetes mellitus (T2DM). Optimal self-care requires skills in health literacy (HL). This study aims to analyze the relationship between HL and adherence to therapy and to understand the possible influence of other sociodemographic and disease variables. A multicenter, cross-sectional study was conducted in Portuguese in 13 different primary health care units in both rural and urban environments. A sociodemographic questionnaire and two validated instruments, "Medical Term Recognition Test" and "Summary of Diabetes Self-Care Activities," were applied. The last value of hemoglobin A1c (HbA1c) and the number of chronic medications were collected from clinical records. Descriptive statistics and bivariate correlations were performed as well as multivariable linear regression to assess the association between HL and adherence to therapy. Participants (n = 354) were on average age 63.67 ± 10.39 years, 57.1% male and 42.9% female, 68.4% with inadequate HL and an average HbA1c of 7 ± 1.18%. Better HL was correlated with higher adherence to the total of self-care activities, nonpharmacological therapy, and foot care. In multivariable linear regression analyses, better HL (β = 0.176, p = .003), less than minimum wage (β = -0.197, p = .001) and insulin therapy (β = 0.272, p = .001) were independently associated with increased adherence to overall self-care activities. In a representative sample of people with T2DM in Portugal, HL was a key factor for greater adherence to demanding self-care activities. [HLRP: Health Literacy Research and Practice. 2024;8(4):e194-e203.].

The Impact Of The Family Support Network On Adherence And Continuity Of Treatment For Women With Breast Cancer

Background: Breast cancer is the second most common type of cancer in women in Brazil. If diagnosed and treated early, there is a significant increase in favorable prognoses and chances of cure. However, the stigma of the disease and the difficulties resulting from treatment directly impact all aspects of a woman's life. In this context, the family support network can be an essential factor for treatment adherence and continuity. The objective of this study was to investigate the influence of the family support network on treatment adherence in women diagnosed with breast cancer. Materials and Methods: This is an integrative literature review in which the search for articles was conducted in the PubMed and Virtual Health Library (VHL) databases between July and August 2023, using the combination of descriptors "breast neoplasm", "treatment", "treatment adherence", "breast cancer", "family", and "family support". The inclusion criteria were: articles published in the last five years, in Portuguese or English, focusing on women with breast cancer. After several filtering stages, 334 article titles and abstracts were reviewed, of which 24 articles were selected for full reading, and 10 were included in this review. Results: The analysis of the articles indicated that family support plays an essential role in breast cancer treatment adherence, particularly with regard to emotional support, but it also impacts other aspects of the patients' lives. Additionally, the results showed that a lack of adequate communication between patients, family members, and healthcare professionals can hinder coping with the diagnosis and treatment. Family support not only helps to alleviate emotional distress but also influences the continuity of treatment. Conclusion: Further studies are needed to better understand the relationship between the quality of family support and breast cancer treatment adherence.

Assessing factors of adherence and efficacy: A randomized controlled trial of a fully automated self-help A-EBT website.

Treatment for trichotillomania is notably limited, preventing suffering individuals from having access to treatment. To address this need, researchers have developed and tested asynchronous online interventions for adults with trichotillomania. A factor that may impact the efficacy of these programs is the use of phone check-ins (or similar coaching support) to improve treatment adherence in website treatment delivery. In the current study we evaluated the role of check-ins on treatment adherence and efficacy of a website delivering acceptance and commitment therapy-enhanced behavior therapy (A-EBT). A sample of 101 adults with trichotillomania were randomly assigned to an A-EBT web-based intervention with or without phone check-in support. Adherence to the web-based program was not significantly improved by check-ins and treatment outcomes did not vary by condition (with or without check-ins). However, adherence to the program across conditions, did predict treatment outcomes. The program was found to be effective at decreasing trichotillomania symptom severity and improving trichotillomania specific psychological inflexibility over time across check-in conditions. Our findings suggest that check-ins did not improve adherence to or efficacy of the program, thus supporting recent literature suggesting that check-ins do not necessarily improve program adherence.

Investigating the adherence factors of Escherichia coli at the bovine recto-anal junction.

E. coli strains that produce Shiga toxin cause foodborne illness in humans but colonize cattle asymptomatically. The molecular mechanisms that E. coli uses to adhere to cattle cells are largely unknown. Various strategies are used to control E. coli in livestock and limit the risk of outbreaks. These include vaccinating animals against common E. coli strains and supplementing their feed with probiotics to reduce the carriage of pathogens. No strategy is completely effective, and probiotics often fail to colonize the animals. We sought to clarify the genes required for E. coli adherence in cattle by quantifying the attachment to bovine cells in a diverse set of bacteria. We also isolated nonpathogenic E. coli from healthy cows and showed that a representative isolate could outcompete pathogenic strains in cocultures. We propose that the focused study of these strains and their adherence factors will better inform the design of probiotics and vaccines for livestock.

Study of Medication Adherence in Patients with Schizophrenia

Introduction: Non-adherence to treatment is a major issue in the management of schizophrenia. Objectives: To evaluate medication adherence among patients with schizophrenia and to identify predictive factors of poor therapeutic adherence. Methods: This is a cross-sectional study conducted among patients with schizophrenia at Ar-Razi Hospital in Salé, Morocco, from January 1 to March 31, 2024. Data collection (sociodemographic, clinical, and therapeutic) was carried out using a specifically designed questionnaire. Medication adherence was assessed using the Medication Adherence Rating Scale (MARS), and insight was evaluated using the Q8 scale. Results: In our study, 44.4% of the included schizophrenia patients were non-adherent. Poor therapeutic adherence was associated with lower socioeconomic status, lack of employment, lack of family support, substance use, negative insight, and a higher number of medication doses. Conclusion: The implementation of therapeutic and preventive strategies to address substance use, structured psychoeducational strategies to improve insight, and training for therapists to enhance the therapeutic alliance should be established to improve medication adherence among patients with schizophrenia.

Factors Related to Rehabilitation Adherence in Pediatric Cancer: A Systematic Review

Background: Rehabilitation is crucial for improving the functional outcomes of children and adolescents with cancer. An understanding of factors related to rehabilitation adherence is needed to improve intervention design and effectiveness, and decrease healthcare costs. Therefore, this systematic review aims to identify factors related to pediatric cancer rehabilitation adherence. Methods: Based upon the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, a search of MEDLINE and CINAHL was completed in January 2023, including terms of pediatrics, cancer, rehabilitation, and adherence. Study eligibility included: (1) published after 2011, (2) English language, (3) a physical therapy, occupational therapy, speech-language pathology, cognitive or exercise intervention or service, (4) mean age ≤18 years old, within 5 years of a cancer diagnosis, and (5) measurement and reporting of adherence factors. Study quality was evaluated using the Joanna Briggs Critical Appraisal Tools. Results: The review included 13 studies providing interventions to 318 children. Most of the interventions were related to exercise. Adherence levels of supervised sessions ranged from 61% to 91%. Unsupervised intervention adherence was not a common outcome, but the reported measurements ranged widely (&lt;1-72%). The classification of factors associated with adherence included organizational, treatment, and personal factors. Common barriers to adherence were fatigue, illness, time and motivation. Facilitators of adherence included peer or caregiver support and supervision. Conclusion: Additional research is needed to investigate the factors related to rehabilitation intervention adherence, especially factors beyond exercise and those associated with unsupervised interventions. Standardized measures are crucial to ensure the reliability and comparability of findings.

Treatment adherence priorities: Results of an online survey of doctors providing outpatient services

BACKGROUND: The opinion of doctors regarding the current issue of low patient adherence to modern medicine will help identify weaknesses in the system and methods to improve them. AIM: To assess the doctors’ opinion regarding the problem of adherence to outpatient treatments. MATERIALS AND METHODS: Using an online survey form (nine questions regarding adherence to outpatient treatments), 105 doctors were surveyed, including general practitioners (GPs; 51%), therapists (27%), cardiologists (21%), and other specialties (1%). The survey results were processed using hierarchical cluster analysis. RESULTS: The following clusters were identified: cluster 1 (K1), which included 62 respondents (GPs, 63% and therapists, 32%); and cluster 2 (K2), which included 43 respondents (cardiologists, 47%; and GPs, 35%). Doctors in both the clusters correctly determined the adherence to treatment (K1=77%, K2=88%; p=0.531), followed clinical practice guidelines when diagnosing a patient with cardiovascular disease (K1=66%, K2=88%; p=0.020), believed that the doctor’s behavior influences the patient’s adherence (K1=86%, K2=98%; p=0.045), and believed that patients should be educated regarding their disease (K1=84%, K2=100%, p=0.005). They believed that the most significant topics to be taught were arterial hypertension, heart failure (HF), coronary artery disease, arrhythmia, and chronic kidney disease (K1=81%, K2=86%; p=0.876). Furthermore, they agreed that the use of technology and mobile apps (K1=61%, K2=70%, p=0.371) could increase patient adherence to treatment. Twenty doctors correctly identified the medications indicated for HF with reduced ejection fraction to improve patient prognosis (K1=2, K2=18; p 0.001). The remaining respondents answered partially correctly (K1=97%, K2=58%; p 0.001). The respondents identified that the lack of time at appointments to explain and improve the patient’s motivation for treatment (K1=47%, K2=47%, p=0.226) and the patient’s low health literacy (K1=26%, K2=35%; p=0.226) were the most significant reasons for low adherence. CONCLUSION: Most physicians providing outpatient services are aware of the concept of medication adherence and following clinical practice guidelines when managing patients with cardiovascular pathology. The lack of sufficient time for outpatient appointments and the patient’s low health literacy are the leading factors of low adherence to treatment. Thus, the doctors unanimously believe that educating patients regarding their disease will increase adherence to treatment.