Medication Beliefs Research Articles

Comparison of Multinational Medical School Students Experiences in the Face of the COVID-19 Pandemic: A Qualitative Analysis

Background: In the midst of the COVID-19 pandemic, countries, and governments around the world have implemented different measures and guidelines for the containment and mitigation of the COVID-19 virus. In addition to implemented policies and initiatives, social media and personal beliefs have affected medical students’ social, emotional, financial, and academic stability and success both domestically and internationally. The objective of this study was to assess medical student's perspectives, attitudes, and insight in the face of the COVID-19 pandemic and determine if differences exist between countries. Methods: This qualitative study, recruited students enrolled in the Global Seminar for Health and Environment elective course in their respective medical schools to complete a weekly, non-graded journaling assignment for 6 weeks. To measure outcomes, open-ended questions within the assignment asked students across four different countries questions regarding the COVID-19 pandemic including personal beliefs and knowledge, policies and initiatives within their country, global policies and initiatives, and social media presentations. Thematic analysis was then completed using the QCoder package in R Studio. Results: Both internationally and in the US, COVID-19 has had a large impact on medical students; however, their perspectives are distinct in personal beliefs, policies, and social media. International medical students believed that their country's COVID-19 response contained more restrictions than the global response, with the theme being expressed in 11 of 67 responses (16.4%) compared to 1 of 75 responses (1.3%) of US responses. This was enforced by the US medical students' views that the US had fewer COVID-19 restrictions. US medical students had a higher number of responses with the theme “more restrictions internationally” which was present in 21 of 75 responses (28%). US medical students were more likely to express a decrease in the number of academic opportunities and academic performance. The theme “decrease in academic opportunities and performance” was present in 15 of 75 US responses (20%) compared to 9 of 67 international responses (13.4%). A US response containing this theme was as follows: “I have had to adjust to a new way of doing school, mainly online, as well as coming to terms with the fact that I am not getting to experience many of the social aspects of medical school that I was looking forward to.” The US responses showed less of a mental health impact and expressed stronger negative views on how COVID-19 was handled with 40 of 75 US responses (53.3%) reporting the theme “need better initiatives and policies. Conclusion: The COVID-19 pandemic continues to affect medical students globally. The current study was limited by responses and student participation each week. Future studies aimed at analyzing specific COVID-19 policies around the world and the extent of the pandemic’s impact on mental health may provide greater insight into medical students' beliefs, attitudes, and well being which have been challenged over the last year. Regardless, it must be acknowledged that the medical school experience has changed for both international and United States medical students and affected them not only academically but mentally, socially, and financially.

Refining and optimising a behavioural intervention to support endocrine therapy adherence (ROSETA) in UK women with breast cancer: protocol for a pilot fractional factorial trial

IntroductionWomen with breast cancer who do not adhere to adjuvant endocrine therapy (AET) have increased risks of mortality and recurrence. There are multiple barriers to AET adherence, including medication side-effects,...

Medication beliefs, adherence, and outcomes in people with asthma: The importance of treatment beliefs in understanding inhaled corticosteroid nonadherence-a retrospective analysis of a real-world data set.

Poor adherence to inhaled corticosteroids (ICSs) increases asthma morbidity and mortality and is influenced by patients' treatment beliefs. This study maps patients' beliefs about ICSs across 6 countries examining variations in beliefs, and their relationship with adherence and outcomes. We sought to explore the relationship between patient treatment beliefs, and adherence and outcomes in asthma across 6 countries. Patients 18 years or older with asthma, receiving ICS alone or in combination with a long-acting β2-agonist, were included from a point-in-time paper survey of patients with asthma in Europe and the United States. Clinical characteristics, such as adherence and asthma control, were collected by self- and physician-report. Patients completed the Beliefs about Medicines Questionnaire, adapted for ICSs. Relationships between patient treatment beliefs, adherence, and outcomes were examined using regression analyses. Data from 1312 patients were analyzed. Patients were from Germany (24%), the United States (21%), France (21%), Spain (16%), Italy (10%), and the United Kingdom (9%). Most had physician-reported mild-intermittent asthma (87%), and mean age was 40± 15.5 years. There was considerable variation in necessity beliefs between countries, with respondents in Italy having more doubts about treatment necessity and respondents in Spain showing higher concerns. Patients with doubts about ICS necessity and high concerns had lower self-reported (necessity: χ2(2)= 34.31, P< .001; concerns: χ2(2)= 20.98, P< .001) and physician-reported adherence (necessity: χ2(2)= 11.70, P= .003; concerns: χ2(2)= 34.45, P< .001). Patients with high necessity beliefs (F(2, 483)= 3.33; P= .037) and high concerns (F(2,483)= 23.46; P< .001) reported poorer control. Physician estimates of adherence did not correlate well with patient self-report (ρ= 0.178, P< .001). ICS necessity beliefs and concerns were associated with adherence and asthma control. This has implications for the design of adherence interventions.

Magnitude of uncontrolled seizures and associated factors among people with epilepsy. Data from a major teaching hospital in Southwest Ethiopia

BackgroundEpilepsy is a major public health problem affecting 70 million people worldwide. 90% of global people with epilepsy were living in developing regions like Ethiopia. Due to the lack of clear guidelines for treatment selection and the difficulty of individualizing care in resource-poor settings, achieving seizure control can be challenging. Seizure control status among epileptic patients is affected by different factors. Accordingly, this study aimed to assess the magnitude of uncontrolled seizures and associated factors among people with epilepsy attending the outpatient clinic of Jimma Medical Center, Southwest Ethiopia. MethodsA hospital-based retrospective chart review and a respective patient interview conducted among people with epilepsy from October 2020 to June 2021. Sociodemographic, behavioral-related factors, medication adherence, and medication belief were obtained through patient interviews. Seizure control status in the last two years before the study period was retrospectively evaluated and recorded from the charts. Data were entered into Epi Data manager version 4.6 and then exported to SPSS version 23.0 for analysis. A backward logistic regression analysis was done to identify factors associated with uncontrolled seizures. ResultsFrom a total of 314 medical charts reviewed, 149(47.5 %) of patients were with uncontrolled seizures. 28.7 %,12.8 %, and 6 % of the patients experienced 1–5,6–10, and >10 seizure episodes during the last two years respectively. Comorbidity [adjusted odds ratio [(AOR): 2.13, 95 % confidence interval (CI):1.26–3.58], nonadherence [AOR: 2.41, 95 %CI: 1.46–3.9], possible adverse drug reaction (ADR) [AOR:1.79, 95 %CI: 1.107–3.01], and drug interaction [AOR: 3.06, 95 %CI: 1.24–7.57] were associated with an uncontrolled seizure. Conclusion and recommendationOur study showed that a substantial proportion of the patients were with uncontrolled seizures. Epileptic patients with comorbidities, nonadherence, adverse drug reactions, and drug interactions were more prone to have uncontrolled seizures. Hence, to overcome these problems, strategies like community-based education, treatment intensification, and routine assessment of adverse drug reactions and drug interaction may help to improve seizure control status.

Malaysian Women's Viewpoint on HPV Screening and Vaccination: A Study on Barriers.

Cervical cancer is the second most common cancer in low-income countries and the third most common cancer in Malaysia among women aged 15 to 44. This is a huge concern because of the high mortality rate compared to other countries. Cervical cancer is caused by a common sexually transmitted human papillomavirus (HPV). Of cervical cancer cases, 80% are attributed to serotypes 16 and 18; therefore, early detection of premalignant lesions and infections from these viruses is important. Diagnosis can be carried out by polymerase chain reaction (PCR)-based HPV DNA analysis and Pap smear, which act as a viable preventive strategy. (1) Background: This study determined the adoption of the human papillomavirus (HPV) vaccine and the willingness to get vaccinated in Malaysian women. (2) Methods: An online survey was conducted with women from across Malaysia to gather their views on the barriers that prevent them from accessing HPV services. Sentiment analysis was performed to detect and classify the comments into three groups (positive, neutral, and negative). (3) Results: A total of 449 opinions were received, and the findings revealed that 41.3% were not afraid to be diagnosed early, and were prepared to accept positive or negative screening results. In addition, 18.6% of those surveyed indicated that they feared a Pap smear and were very concerned that they would not get good results. Of the respondents, 36% believed in vaccination and preferred to know more about it; 43.24% claimed that their family members were very supportive towards screening and vaccination; and 21.3% felt embarrassed and were afraid to undergo the screening procedure, as they had no prior experience and were unsure of how the procedure was conducted. In addition, 40.5% indicated that they had no concerns about HPV testing and related procedures, as this information is widely available. Only a few respondents (8.1%) talked about the time constraints and busy work schedules that prevented them from going to medical appointments. The survey also revealed that women are prevented from participating in cervical cancer screening and vaccination programs due to a lack of knowledge, shyness, personal rumors, privacy issues, financial issues, a lack of access to medical services, and ignorance and beliefs about rumors spreading online. (4) Conclusion: Results indicate that awareness of HPV and related prevention measures among women is vague and that negative perceptions continue to exist. It is strongly advised to develop a well-designed and knowledge-based application on the efficacy of screening and vaccination among Malaysian women.

Self-Efficacy as Moderator and Mediator Between Medication Beliefs and Adherence in Elderly Patients with Type 2 Diabetes.

Poor antidiabetic medication adherence remains a great barrier to effective diabetes self-management among aging adults. This study investigates the mediation and moderation effects of self-efficacy on the relationship between medication beliefs and adherence in elderly patients with type 2 diabetes. This cross-sectional study evaluated a sample of 309 hospitalized elderly patients who completed the assessment of medication beliefs, self-efficacy for medication uses and medication adherence in a tertiary hospital in Shanghai, China. A bootstrapping sampling method and hierarchical moderator regression analysis were used to verify the hypothesis of mediation and moderation effects of self-efficacy on the relationship between medication beliefs and adherence. Self-efficacy for medication use acted as a moderator (B=-0.063, t=-2.215, p=0.028) and partial mediator (CItotal effect=4.5-16.63, p=0.001; CIindirect=1.524-5.323, p=0.014; CIdirect=2.151-11.817, p=0.001) on the relationship between general harm medication beliefs and medication adherence. Participants with lower general harm medication beliefs may develop higher self-efficacy, which, in turn, results in a higher level of medication adherence, and higher self-efficacy may attenuate the negative effect of high general harm medication beliefs on medication adherence. Self-efficacy for medication use not only mediated the relationship between general harm beliefs about medication and medication adherence, but moderated it negatively. The findings of this study indicate an opportunity to improve the prognosis of elderly Chinese patients with type 2 diabetes through improved medication adherence by strengthening factors such as self-efficacy for appropriate medication use and general harm beliefs about medication.

Medication Beliefs, Cognitive Defusion, and Valued Living in Hypertensive Patients with Varying Medication Adherence.

One of the most severe problems that patients with Hypertension (HPN) face are lack of medication adherence, which is influenced by psychological factors. Thus, the current survey sought to compare medication beliefs, cognitive defusion and valued living in hypertensive patients with varying medication adherence. A cross-sectional study with 162 HPN patients from three clinics at Isfahan University of Medical Sciences was conducted in 2019. Participants completed the BMQ (Beliefs about Medicines Questionnaire), MMAS (Morisky Medication Adherence Scale), CFQ (Cognitive Fusion Questionnaire), and VLQ (Valued Living Questionnaire). The data were analyzed using descriptive statistics, chi-square, and analysis of variance (ANOVA). Only 22.2% of patients scored high in medication adherence (MA). MA levels increased with age in a significant correlation (P=0.03). ANOVA results revealed that the three MA levels (low, medium, and high) had substantial differences in both VLQ subscales (importance of person-valued living and allotted time for values; P=0.002 and P=0.023). However, no significant differences in MA levels were found in the CFQ (cognitive defusion and cognitive fusion) and BMQ subscales (specific necessity, specific concern, general overuse, and general harm). This study discovered that a higher MA is associated with increasing age. In addition, patients with HPN who value living and devote more time to their values have higher MA.

Medication adherence, medication beliefs and social support among illiterate and low-literate community-dwelling older adults with polypharmacy

Medication adherence, medication beliefs and social support among illiterate and low-literate community-dwelling older adults with polypharmacy

Willingness to pay for treatment of complications associated with high blood pressure among hypertensive patients in Pakistan: A cross-sectional study

Background: Hypertension is the leading cause of cardiovascular mortality and morbidity around the globe. Willingness to pay (WTP) is the technique to evaluate the health care program from the consumer’s perspective. This technique is measured and valued for future perspective. The objective of this study is to investigate WTP for treatment of complications associated with high blood pressure among hypertensive patients in Pakistan. Methods: A cross sectional observational study was conducted for 6 months from April to September 2019. Well-designed questionnaires were developed to collect information on socio-demographic characteristics, medical belief and hypothetical scenario of willingness to pay. We distributed 320 questionnaires to hypertensive patients in Kashmir institute of cardiology linked with District Head Quarter hospital, Al-shifa hospital Mirpur, Noor memorial hospital &amp; Mohi-ud-Din hospital in Mirpur city, Pakistan. Results: We analyzed 280 questionnaires which were correctly and completely filled giving a response rate of 87.5% in which 69.6% were males and 30.4% were females. Around 39.6% of participants were 51-60 years old. About 81.8% were willing to pay for life time. Almost half 52.5% were willing to pay for stoke more than three thousand rupees. Occupation and monthly income had significant effects on WTP for the treatment of complications of hypertension. Conclusion: Majority of participants were willing to pay from their monthly income for the management of complications associated with hypertension. This indicates the awareness of patients about the importance of disease management for better healthcare.

Is Academic Medicine Prepared to Teach About the Intersection of Childhood Experiences and Health? An Exploratory Survey of Faculty.

Childhood experiences affect health across the lifespan. Evidence-based strategies targeting early-life stress are emerging. Nevertheless, faculty physicians' preparation to incorporate this science into practice has not been well studied. This study explores medical faculty knowledge and beliefs, timing and route of knowledge acquisition, perceived relevance and application of study topics, and characteristics associated with concept mastery. The authors developed and administered an exploratory survey to faculty from six departments at two medical schools. The team analyzed responses using quantitative and qualitative methods. Eighty-one (8.8%) eligible faculty completed the survey. Of respondents, 53 (65.4%) achieved high knowledge, 34 (42.0%) high beliefs, and 42 (59.1%) high concept exposure question scores, but only 6 (7.4%) through a formal route. Although 78 (96.8%) respondents indicated that survey concepts are relevant, only 18 (22.2%) reported fully incorporating them in their work, and 48 (59.2%) identified the need for additional coaching. Respondents reporting full incorporation were significantly more likely to attain high concept exposure scores (17 respondents, 94.4%, versus 25 respondents, 39.7%, P < .001). Quantitative and qualitative analysis highlighted limited respondent awareness of trauma prevalence among health care workers, lack of familiarity with interventions, and time and resource challenges addressing childhood adversity. Although survey respondents had some familiarity with study concepts and perceived their relevance, most are not fully applying them. Results suggest that exposure to study concepts is associated with full incorporation. Therefore, intentional faculty development is essential to prepare faculty to include this science in practice.

Pattern of anti-epileptic medications nonadherence and associated factors at ambulatory clinic of Jimma Medical Center, Southwestern Ethiopia: A prospective observational study.

This study is designed to assess the pattern of nonadherence, and associated factors among ambulatory patients with epilepsy at Jimma Medical Center, Southwestern Ethiopia, from November 2020 to April 2021. A hospital-based prospective observational study was employed. A consecutive sampling method was used to recruit study participants. Nonadherence was assessed by the Hill-Bone compliance to the high blood pressure therapy scale. A threshold of 18 scores was used to classify adherence status. Epi-Data manager version 4.6 was used for data entry and all statistical analysis was performed by Statistical Package for Social Science 25.0. Multivariable logistic regression was performed to explore associated factors. A survey included 334 patients with epilepsy. One hundred twenty-two (36.52%) of the study participants were found to be non-adherent. The factors associated with nonadherence were poor involvement of the patient in the therapeutic decision (adjusted odds ratio = 1.74; 95% confidence interval: 1.04-2.90; p = 0.034), per month income of lesser than1000 Ethiopian birr (adjusted odds ratio = 2.66; 95% confidence interval: 1.03-6.84; p = 0.042), recent seizure episodes (adjusted odds ratio = 1.97; 95% confidence interval: 1.20-3.23; p = 0.007), adverse drug reaction (AOR = 2.13; 95% confidence interval: 1.31-3.47; p = 0.002), and negative medication belief (adjusted odds ratio = 1.28; 95% confidence interval: 1.53-2.25; p = 0.043). In our setting, the magnitude of nonadherence was substantially high. Hence, providing regular health-related information about the disease and treatment, supplying free antiepileptic drugs, routine assessment of adverse drug reactions, and a multidisciplinary approach involving patients may improve adherence.

Disease belief, medication belief and adherence to treatment in patients with high blood pressure

Disease belief, medication belief and adherence to treatment in patients with high blood pressure

Gebelerin Doğum İnançları ile Travmatik Doğum Algı Düzeyleri, Doğum Sonuçları ve Doğum Sonu Depresyon Görülme Durumları Arasındaki İlişki

Introduction: From the beginning of pregnancy, pregnant women think about their birth and the birth is shaped according to the birth belief of the person. Objective: This study aims to determine the relationship between the birth beliefs of pregnant women and birth outcomes, traumatic birth perception levels and postpartum depression. Materials and Methods: This cross-sectional study was conducted in a province in eastern Türkiye. The data was collected using the Personal Information Form, Birth Beliefs Scale, Traumatic Birth Perception Scale, and Edinburgh Postpartum Depression Scale. Results: While there was no significant difference between the medical birth beliefs of women according to their descriptive characteristics (p&amp;gt;0.5), those who were at 28-36 weeks of gestation, who did not have a curettage, and those who went to pregnancy control ≥4 times, considered the birth more natural (p&amp;lt;0.05). While there was a positive and significant relationship between Natural Process Belief and Postpartum Depression (r=0.116, p=0.009), the regression model (stepwise) was also found to be significant (F=6.944, p=0.009). Conclusion: The study determined a positive and significant relationship between natural birth belief and postpartum depression, and the regression model established between these two was significant.

Influencing factors for decision-making delay in seeking medical care among acute ischemic stroke patients in rural areas

ObjectiveTo explore the factors influencing decision-making delay in seeking medical care for patients with acute ischemic stroke (AIS) in rural areas. MethodsFrom September to December 2021, we conducted a questionnaire survey of 260 patients with AIS who were hospitalized in the neurology departments of four county-level hospitals in Daqing. A decision-tree and logistic regression model was used to investigate the elements contributing to decision-making delays. ResultsThis study found that the decision-making delay rate for rural patients with AIS was 71.5%. The results of the univariate analysis showed that factors associated with decision-making delay included educational level, National Institute of Health stroke scale (NIHSS) score, self-assessed health, monthly income, social support, attitude toward medical help-seeking, health belief, and family dynamics (P < 0.05). Further, we combined logistic regression (LR) and decision-tree (DT) models for multivariate analysis, and finally obtained five factors affecting decision-making delay in AIS patients in rural areas: disease severity, health belief, monthly income (common factors), educational level (only DT model), and social support (only LR model). ConclusionsThis study found that a few variables, including disease severity, educational level, monthly income, health belief, and social support, affected rural AIS patients' decision-making delay in seeking medical care. Practice implicationsTo achieve the goal of reducing decision-delay and increasing thrombolysis rate, this study thoroughly examined the influencing factors of decision-making delay in seeking medical care of rural AIS patients from various angles. This analysis provides guidance for medical and healthcare professionals on how to best provide future health education for the high-risk population for stroke in rural areas.

1287. Understanding Factors Associated with Polypharmacy and Differential Medication Adherence in People with HIV

Abstract Background For people with HIV (PWH), number of chronic medications (meds) used to treat comorbidities may impact quality of life (QoL), illness perception, medication beliefs, and clinical outcomes. Factors associated with adherence to antiretrovirals (ARVs) may differ from adherence to other chronic meds. This study aims to assess these factors to promote better med management and adherence among PWH taking chronic meds and ARVs. Methods 174 participants (pts) were enrolled from an HIV program in a large health system. Inclusion criteria were age &amp;gt; 18 years, English speaking, prescribed ARVs, and having &amp;gt; 1 comorbidity requiring a chronic med (non-ARV). Measures included validated scales of QoL, illness perceptions, med beliefs, and adherence barriers (e.g., forgot, too many pills, avoiding side effects); and past 6-month emergency department (ED) use and hospitalization. Generalized linear models, ANOVA, and Wilcoxon sum rank tests assessed associations between number of chronic meds (&amp;lt; 4 vs &amp;gt; 5) and outcomes. Multivariable logistic regression models using backwards elimination were used to assess factors associated with adherence (overall, HIV-meds, non-HIV meds). Results Complete data from 160 pts were analyzed: 50% male; 84% US-born; 46% taking &amp;gt; 5 chronic meds. Pts taking &amp;gt; 5 meds were older, less likely to be employed, had significantly lower QoL (mean difference=5.23, 95%CI=0.19-10.27. p&amp;lt; .05), significantly higher med side effects (mean ranks=88.51 vs 73.77, p&amp;lt; .05), and 3-fold greater ED visits (mean estimate=2.99, 95%CI=1.52-5.89, p&amp;lt; .05). Regression models indicated that number of adherence barriers (but not other predictors) was consistently associated with lower adherence after controlling for demographics: (overall adherence: OR=0.85, 95%CI=0.79=0.91; HIV med adherence: OR=0.88, 95%CI=0.81-0.94; non-HIV med adherence: OR=0.86, 95%CI=0.80-0.92). Conclusion Adverse events (i.e., ED use, poor QoL, med side effects) are associated with number of chronic meds. Number of adherence barriers is associated with poor adherence across med type, highlighting the importance of interventions to address polypharmacy and the complexities of managing HIV and comorbidities. Assessment of barriers can contribute to the promotion of adherence for both HIV and non-HIV meds. Disclosures Amy Weinberg, DNP, MS, Gilead Sciences: Employee|Gilead Sciences: Stocks/Bonds.

1950. Factors Influencing COVID-19 Vaccine Uptake among Reproductive-Aged Women in Jamaica

Abstract Background Little is known about the factors which influence COVID-19 vaccine uptake among reproductive-aged women in Jamaica. Methods We conducted a cross-sectional, web-based survey of 192 reproductive-aged women in Jamaica from February 1- 8, 2022. Participants were recruited from a convenience sample of women (patients, providers and staff) at a tertiary care hospital whose demographic characteristics are shown in Table 1. We assessed self-reported COVID-19 vaccination status, vaccine confidence (defined as confidence in the safety and efficacy of vaccines and the system that delivers them) and medical mistrust beliefs (e.g., “I don’t trust the COVID-19 vaccine”). We conducted exploratory factor analysis using principal axis factoring and oblique equamax rotation on 22 survey items. Three factors were extracted which conceptually aligned with three subscales: lack of vaccine confidence, government-related COVID-19 medical mistrust, and race-based COVID-19 medical mistrust; we retained items with factor loadings &amp;gt; 0.40. The final subscale variables and their descriptive statistics are shown in Table 2. In addition, we used multivariable modified Poisson regression to calculate adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) for the association between vaccine uptake and pregnancy status adjusting for education and factors scores. Variables with a p value &amp;lt; 0.1 were retained in the final regression model. Results Of 192 respondents, 72(38%) were pregnant and 120 (62%) were non-pregnant. Pregnancy was negatively associated with vaccine uptake (aPR=0.70, 95%CI=0.51 - 0.96; p=0.029). Women with higher scores on the lack of vaccine confidence subscale (i.e., less confident in vaccine) were less likely to be vaccinated (aPR=0.72, 95%CI=0.61 - 0.86; p&amp;lt; 0.001). Government-related COVID-19 medical mistrust and race-based COVID-19 medical mistrust were not significantly associated with vaccine uptake (see Table 3). Conclusion Findings suggest that pregnancy and lack of vaccine confidence are factors associated with lower vaccine uptake among reproductive-aged women in Jamaica. Bolstering vaccine confidence, through the use of evidence-based interventions, may help to increase COVID-19 vaccine uptake in this population. Disclosures All Authors: No reported disclosures.

Effectiveness, usability and acceptability of a smart inhaler programme in patients with asthma: protocol of the multicentre, pragmatic, open-label, cluster randomised controlled ACCEPTANCE trial

IntroductionSuboptimal asthma control is associated with incorrect inhaler use and poor medication adherence, which could lead to unfavourable clinical and economic outcomes. Smart inhaler programmes using electronic monitoring devices (EMDs)...

Restrictions on contraceptive services for unmarried youth: a qualitative study of providers’ beliefs and attitudes in India

Sexual and reproductive health (SRH) of unmarried youth is an important issue, particularly in Indian society, where premarital sex is socially restricted. It is an uncomfortable subject for most people, including healthcare providers, who are responsible for catering to the reproductive health needs of youth. This is because of the prevailing social norms, where sex outside marriage is discouraged and stigmatised. These social norms give importance to virginity, and children outside marriage are not welcome. The present qualitative study was conducted in public health facilities (primary and secondary) to explore the attitudes of healthcare providers in providing contraceptive services to unmarried youth. In-depth interviews were conducted with family planning (FP) service providers (frontline healthcare workers [ASHAs] nurses and FP counsellors) between October 2017 and September 2018. Almost a quarter of the providers were either hesitant or against providing contraceptives to unmarried youth. Providers stated that they preferred emergency contraceptive pills for unmarried girls if they had already engaged in unprotected sex. Providers expressed strong personal views against premarital sex because they believed it was against existing social norms. Some providers were concerned about the possible negative reactions of the community if they recommended any contraceptive to unmarried youth. A few providers even considered it illegal to provide contraceptives to unmarried youth, though there is no such law in the country. Findings further indicated that though the country had launched programmes for improving adolescents and youth SRH, service providers were still conflicted between medical eligibility and social beliefs.

A feasibility pilot trial of a peer-support educational behavioral intervention to improve diabetes medication adherence in African Americans

BackgroundAfrican Americans are twice as likely to die from diabetes, compared to other racial and ethnic groups in the USA. Poor adherence to diabetes medications is common among African Americans and contributes to these disproportionally worse outcomes. A pilot study was conducted to determine the feasibility and acceptability of a peer-supported intervention targeting diabetes and medication beliefs, communication, and self-efficacy skills to enhance medication adherence among African Americans with type 2 diabetes.MethodsBased on the extended self-regulatory model and information-motivation-behavioral skills model, this intervention was piloted using a single group pre/post-intervention study design at two sites. Seventeen African Americans who self-reported as adherent to diabetes medicines (ambassadors) were paired with 22 African Americans with self-reported poor medication adherence (buddies). Feasibility outcomes evaluated recruitment, retention, and intervention adherence. Measures assessed at baseline and 1-month post-intervention included glycemic control (hemoglobin A1c), self-reported medication adherence, diabetes beliefs, concerns about diabetes medicines, and diabetes self-efficacy. Wilcoxon signed-rank tests assessed for differences in mean scores of outcome variables at baseline compared with a 3-month follow-up. Semi-structured 60-min interviews were conducted with each buddy to explore their acceptability of the intervention. To ensure the rigor of the qualitative data, we focused on analytic criteria such as credibility, confirmability, and transferability.ResultsMost buddies and ambassadors were female and about 56 years old. Feasibility outcomes included recruitment success rates of 73% for buddies and 85% for ambassadors relative to our goals. Retention rate for hemoglobin A1c and medication adherence outcome assessment was 95% for buddies. Both buddies and ambassadors had excellent intervention adherence, with buddies having a mean attendance of 7.76 out of 8 sessions/phone calls and ambassadors completing > 99% of the 105 intervention calls with Buddies. Results showed a signal of change in hemoglobin A1c (effect size = 0.14) and medication adherence (effect size = 0.35) among buddies, reduction in buddies’ negative beliefs about diabetes and an increase in necessity beliefs of diabetes medicines. Summative interviews with buddies showed they valued ambassador’s encouragement of self-management behaviors.ConclusionsResults support conduct of an efficacy trial to address medication adherence for African Americans with type 2 diabetes using a peer-supported tailored intervention.Trial registrationhttps://clinicaltrials.gov/ct2/show/NCT04028076.

Association between health literacy and medication adherence in chronic diseases: a recent systematic review.

Poor medication adherence is a serious barrier to successful chronic disease management. Previous reviews reported that low health literacy could be associated with medication non-adherence but conclusions were uncertain. The aim of this systematic review was to clarify the relationship between health literacy and medication adherence in adults with chronic diseases. A secondary objective was to identify the factors that influence medication adherence. Publications analyzing the relationship between health literacy and adherence in adults with chronic diseases were identified through 6 databases between 2015 and 2020. A quality assessment was conducted in order to improve the interpretation of the relationship between health literacy and medication adherence. A narrative synthesis was then performed to describe the relationship between health literacy and medication adherence. The factors influencing medication adherence were then analyzed as a secondary outcome. Among the 27 studies, 17 and 10 were considered to be of good and medium methodological quality, respectively. Concerning the relationship between health literacy and adherence, 14 reported a positive relationship, 1 study suggested a negative relationship, 3 found mixed results, and 9 reported not finding a relationship. Patient-related factors such as medication beliefs, self-efficacy, or medication knowledge, as well as demographic factors such as ethnic minority and incomes influence medication adherence. The present review confirms an unclear relationship between health literacy and medication adherence. Although health literacy plays a substantial role in medication adherence, other factors must be taken into account when addressing non-adherence.