Medication Adherence Behavior Research Articles

Self-management behavior strategy based on behavioral economics in patients with hypertension: a scoping review.

Hypertensive patients often do not make the most favorable choices and behaviors for managing disease. Behavioral economics strategies offer new ideas for guiding patients toward health behavior. The scoping review aimed to summarize behavioral economics strategies designed to improve hypertension self-management behaviors. A literature search was conducted in September 2022 using the following electronic databases: Embase, Medline, CINAHL, PsycINFO, Web of Science, Cochrane Library, CNKI, Wan Fang Database for Chinese Periodicals, and CBM-SinoMed. We screened the literature for experimental studies written in Chinese or English reporting on BE strategies designed to improve self-management behavior in hypertension. We searched 17820 records and included 18 articles in the final scoping review. We performed qualitative synthesis by the categories of choice architecture. The most common BE strategies were those targeting decision information and decision assistance, such as changing the presentation of information, making information visible, and providing reminders for actions. Most strategies targeted BP, diet, medication adherence, and physical activity behavior. Ten out of 18 studies reported statistically significant improvement in self-management behavior. Further research on BE strategies should focus on addressing the challenges, including changing the decision structure, encompassing a more comprehensive range of target behaviors, and examining the long-term effects of BE strategies.

Pain medication beliefs in individuals with headache.

To evaluate pain medication beliefs in a community sample of individuals with headache. Previous studies of medication adherence for individuals with headache have identified a high rate of prescription nonfulfillment, frequent medication discontinuation, and widely varying levels of medication-related satisfaction. Still, there is a limited understanding of how these individuals view their medications and their relationships with health-care providers. Insight into these perceptions could prove useful in explaining medication adherence behaviors. In this secondary analysis of a cross-sectional study, data from N = 215 adults with headache were analyzed. Participants completed the Pain Medication Attitudes Questionnaire (PMAQ), Center for Epidemiologic Studies Depression Scale (CES-D), State-Trait Anxiety Inventory Form Y-2, Weekly Stress Inventory Short Form, and Migraine Disability Scale. These participants also provided a list of their current pain medications. Using the PMAQ, participants could be characterized as having medication beliefs that were "trusting and unconcerned" (n = 83/215 [38.6%]), "skeptical and somewhat worried" (n = 99/215 [46.0%]), or "skeptical and concerned" (n = 33/215 [15.3%]). Individuals with skeptical and concerned beliefs expressed elevated concerns (z > 1.15) about side effects, scrutiny, perceived need, tolerance, withdrawal, and addiction. Individuals who were trusting and unconcerned expressed low levels (z < -0.40) of these beliefs. Increasing levels of mistrust and medication concerns were correlated with higher depression scores on the CES-D, with values ranging from r = 0.23 to r = 0.38. Subgroups of pain medication beliefs were identified, including two groups of patients with at least some concerns about their medical providers. Beliefs ranged from a lack of concern about using pain medications to worries about scrutiny and harm. It is unclear if poor experiences with pain medications cause these beliefs or if they prevent individuals from effectively utilizing medications. Additionally, more negative beliefs about pain medications were associated with more depressive symptoms.

THE RELATIONSHIP BETWEEN STRESS, ANXIETY, DEPRESSION AND MEDICATION ADHERENCE BEHAVIOR IN PATIENTS WITH EPILEPSY : A SYSTEMATIC REVIEW

Background: While epilepsy is a disorder characterized by unprovoked seizures, epileptic status refers to recurrent seizures without any improvement in between episodes or seizure activity that does not improve on its own. Aims : This systematic review is to review the association of stress, anxiety, depression and medication adherence behavior in patients with epilepsy. Methods: This study demonstrated compliance with all requirements by means of a comparison with the standards established by the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020. Thus, the specialists were able to guarantee that the research was as current as feasible. Publications released between 2014 and 2024 were considered for this search strategy. This was accomplished by utilizing a number of distinct online reference sites, including Pubmed, ScienceDirect, and SagePub. It was determined that reviews, previously published works, and partially completed works would not be included. Result: In the PubMed database, the results of our search brought up 415 articles, whereas the results of our search on SAGEPUB brought up 573 articles, our search on SCIENCE DIRECT brought up 600 articles. The results of the search conducted for the last year of 2014 yielded a total 285 articles for PubMed, 275 articles for SAGEPUB and 391 articles for SCIENCE DIRECT. In the end, we compiled a total of 5 papers, 3 of which came from PubMed, 1 of which came from SAGEPUB and 1 of which came from SCIENCE DIRECT. We included five research that met the criteria. Conclusion: In summary, the anxiety, stress or depression can be the appear at epilepsy patients as the absence of the adherence of epilepsy therapeutic.

The value of a mobile educative Application additional to Standard counselling on aspirin Adherence in Pregnancy: the ASAP study, a randomised controlled trial

ObjectiveTo assess the added value of a novel, mobile educative application to standard counselling on aspirin adherence during pregnancy versus standard counselling alone. MethodsParticipants were randomly assigned for additional use of a mobile educative application or standard counselling alone. Main outcome measures were adherence to aspirin measured by two validated questionnaires: Simplified Medication Adherence Questionnaire (SMAQ), Believes and Behaviour Questionnaire (BBQ), and patients reported tablet intake >90%. ResultsA total of 174 women with an indication for aspirin during pregnancy were included. The questionnaires were filled in by 126 out of the 174 participants (72.4%). Similar results were found in the app group and the standard counselling groups for both validated questionnaires. Tablet intake >90% was seen in 88.7% and 87.5% (p = 0.834) of the app group and standard counselling group respectively. Subgroup analyses demonstrated a negative effect of BMI and a positive effect of educational level on adherence. ConclusionsOur study revealed no added effect of a novel, mobile educative application to standard counselling on aspirin adherence during pregnancy. Tablet intake was equally high in both groups probably explained by our high educated population. InnovationFuture studies should focus on tailored counselling on medication to pregnant women's needs including medication reminders, addressing concerns, adequate health literacy and side effects, offering rewards to further stimulate aspirin adherence in pregnancy with optimal outcome for mother and their neonate.

The relationship between stress, anxiety, depression and medication adherence behavior in patients with epilepsy: A cross-sectional study

ObjectiveTo investigate the relationships between stress, anxiety, and depression and medication adherence behavior in patients with epilepsy (PEW). MethodsA cross-sectional study design was conducted on 235 PEW in the Qazvin's Boo Ali Sian Hospital. Data collection tools included socio demographic and clinical data form, morisky medication adherence scale (MMAS-8), depression anxiety stress scales -21(DASS-21). We used adjusted multivariate logistic regression model for statistical analysis. ResultsA considerable proportion of patients reported mild, moderate, severe and extremely severe symptoms of depression (177 [75/3%]), anxiety (169 [71.9 %]), and stress (158 [67.2 %]). However, 61/8% of the participant had proper medication adherence and 38/3% had poor medication adherence. The results of adjusted multivariate logistic regression showed that in patients who had severe and extremely severe depression and anxiety, the probability of poor medication adherence was higher (P < 0.05). The levels of stress were not significant predictors for medication adherence behavior (P > 0.05). ConclusionAccording to this study, severe and extremely severe depression and anxiety can be considered as an important predicting factor in the lack of adherence to antiepileptic medication. Practice ImplicationsHealthcare professionals can improve care of patients with PEW by considering patients’ mental and psychological health problems in educational, counseling and supportive programs.

Adherence to secondary stroke prevention medications in Singapore: a single center study

ObjectivesRecurrent strokes are associated with greater disability and mortality than first-time strokes. However, adherence to secondary stroke prevention medications has been reported to be suboptimal. We assessed medication adherence to antihypertensives, antiplatelets, and statins after acute ischemic stroke and identified factors associated with non-adherence behavior to each drug class. MethodsThis single center study is an extension of a larger prospective cohort study of ischemic stroke patients assessed at an outpatient post stroke clinic. Medication adherence behavior and medication knowledge was determined by direct questioning, and perceptions towards medications via the Beliefs about Medicines Questionnaire. Factors associated with non-adherence in each drug class were determined using logistic regression. ResultsRates of adherence differed between antihypertensives (77.9%), antiplatelets (80.3%), and statins (64.7%) (p < 0.001) amongst the 193 patients surveyed. Non-adherence to antihypertensives was associated with living alone, taking < 5 medications, and stronger beliefs that medications are harmful. For antiplatelets, non-diabetic patients and patients with stronger beliefs that medications are harmful were more likely to be non-adherent. Patients non-adherent to statins were more likely to have a longer time since ischemic event and have a transient ischemic attack as the index event. ConclusionsOverall, medication adherence behavior to secondary stroke prevention medications was poor, with statins the least adhered to. Factors associated with non-adherence to each drug class could guide the development of tailored interventions to improve adherence to secondary stroke prevention medications.

Investigating the Relationship between Medication Adherence Behaviors and the Achievement of Sustained Viral Load Suppression among People Living with HIV (PLHIV) on Antiretroviral Therapy (ART) in Akwa Ibom State, from 2018 - 2022

Background: Nigeria is still endemic for Human Immuno-Deficiency Virus (HIV), and currently among the top five countries with the highest burdens of HIV infection. For a successful HIV program, there should be good access to antiretroviral therapy (ART) and record of viral load suppression (VLS). This study aimed at investigating the relationship between medication adherence behavior (MAB) and sustained VLS among people living with HIV (PLHIV) receiving ART in Akwa Ibom State. Methods: This was a retrospective cohort study of the medical records of 1,763 PLHIV receiving ART services from January 2018 to December 2022, in selected ten health facilities in Akwa Ibom State. Relevant demographic, clinical, immunological, viral load (VL) information were obtained from the patients’ medical records and databases. The proportion of VLS and associated variables were then analyzed. Results: Out of the 2,550 PLHIV whose medical records were accessed, data for 1,763 PLHIV was accepted for analysis. A total of 795 (45.1%) male and 968 (54.9%) female participated in the study, with a mean age of 38.4 ± 5 years. While 23.8% (n = 420) have unsuppressed VL of &gt;1,000 copies/mL; 76.2% (n = 1,343) of participants achieved VLS of &lt;1,000 copies/mL. 90.4% (n = 1,213) of the virally suppressed participants recorded moderate to high medication adherence levels (X2 = 94.977, df = 2, p-value = 2.2 x 10-16). CD4 counts and HAART regimen have significant impact on VLS (p &lt; 0.05), while pregnancy status, TB Infection, duration on HAART, and WHO disease stage do not have significant effects on VLS (p &gt; 0.05). Conclusion: There was a strong evidence to reject the null hypothesis, which states that there is no positive association between MAB and sustained VLS among PLHIV on ART (p &lt; 0.05). The VLS rate in this study indicates a good HIV epidemic control. Good medication adherence level, high baseline CD4 count, and being on first line HAART regimen were strongly associated with VLS.

Medication Adherence Among Hypertensive Patients in Kurdistan Region of Iraq: An Observational Follow-Up Study

Background: Adherence to medications is a main concern to hypertension control and incidence of CVD complications. This study aimed to measure the level of medication adherence of hypertensive patients after one month follow-up. Methods: An observational one-month follow-up study was conducted in 93 hypertensive patients in Kurdistan Region. Results: Patients’ mean age was 55.03 (25-85 years). The mean value of the MARS score of adherences was 7.68 out of 10. The mean values of dimensions of adherence were 3.20 of 4 (medication adherence behavior), 2.92 of 4 (attitude toward taking medication), and 1.55 of 2 (negative side effects and attitudes to medication). We found that the males, single and married, urban, those with no chronic disease, and those with higher levels of education were more likely to adhere to medication. The patients with shorter disease duration and treatment had higher adherence scores. The patients with no experience of the medication side effects had higher levels of medication adherence (8.80 vs. 7.00; P&lt;0.0001) and patients who took fewer tablets/day. Conclusions: We observed high-adherence level among hypertensive patients. Prolong disease duration, long treatment duration, increase number of tablets/days, and increase number of comorbidities may significantly decrease the medication adherence rate.

MEDICATION ADHERENCE: UNDERSTANDING THE CHALLENGES AMONG THE ELDERLY

This study explores medication adherence challenges in the elderly population, focusing on the complexities and dynamics of managing polypharmacy in a geriatric care setting. The research was conducted in One Stop Home Care Centre, Sri Damai, Kuantan, Malaysia, involving 10 participants aged between 45 and 72. It employs a mixed-methods approach, utilizing structured questionnaires and in-depth interviews to assess medication adherence behaviours and the influencing factors. The findings indicate a significant discrepancy between self-reported medication adherence and actual practices. While 50% of participants reported managing a single medication, observational data revealed a more intricate medication regimen, with some managing up to four different medications. The study highlights the critical role of social support systems in promoting medication adherence, with all participants adhering to their prescribed schedules due to robust caregiver involvement. However, 30% reported occasional lapses due to the complexity of their medication regimens. Notably, side effects like headaches and sleepiness were identified as key factors affecting medication adherence, underscoring the need for tailored approaches to manage side effects. The study emphasizes the importance of understanding the unique characteristics and challenges of medication adherence in the elderly, especially in the context of polypharmacy. The research also points out the socio-economic impact of an aging population and the growing demand for age-appropriate healthcare services. It emphasises the need for strategic health policy and planning to cater to the unique needs of the elderly. The findings advocate for comprehensive patient education, shared responsibility between residents and caregivers, and the implementation of systems to monitor medication intake and side effects. The study therefore provides valuable insights into medication adherence among the elderly, highlighting the necessity for personalised interventions and strategies to enhance health outcomes in this demographic. The research also acknowledges limitations, including a one-time visit for data collection and the lack of long-term follow-up, suggesting areas for future research.

Decomposition of socioeconomic inequalities in glaucoma knowledge in Taiwan.

Glaucoma knowledge is strongly associated with medication adherence and preventive behavior. Studies have frequently reported socioeconomic inequalities in glaucoma knowledge. This study aimed to decompose such inequalities. Decomposition analysis enables the design of policies directly targeting the underlying causes of inequality. We performed a cross-sectional survey from January 1, 2019 to June 30, 2019, at the departments of ophthalmology of 2 medical centers belonging to a hospital chain in northern Taiwan. Socioeconomic inequalities in glaucoma knowledge were ranked based on 3 aspects of socioeconomic status (SES): (1) education, (2) income, and (3) self-perceived financial status. The concentration index was calculated and decomposed using decomposition analysis. Elasticity and marginal effects were estimated for each decomposed factor. In total, 1,203 patients completed the survey. Both measures of glaucoma knowledge and overall glaucoma knowledge score significantly contributed to the progressivity of knowledge inequalities (pro-high-SES inequalities). The concentration index for overall knowledge score with respect to education was 0.166 (p<0.001). Both objective and subjective measures of SES were associated with pro-high-SES inequalities. Our decomposition analysis revealed that demographic factors and attitudinal factors such as the level of concern regarding developing glaucoma contributed significantly to SES-based inequalities in glaucoma knowledge. Our decomposition analysis provided empirical evidence regarding the underlying causes of SES-based inequalities in glaucoma knowledge. Efforts to improve glaucoma knowledge should consider specific factors that drive SES-based inequalities, such as age, sex, and concern about vision health, to ultimately achieve low SES-based inequalities.

Illness Perception and Stigma Among Children and Adolescents with Sickle Cell Disease

Background: Stigma and illness perceptions surrounding adolescents and young adults (AYA) with sickle cell disease (SCD) are not well-studied. The psycho-social and emotional factors may have implications on overall patient-reported outcomes, including health-related quality of life (HRQOL) and medication adherence behavior. Aims: (1) Evaluate the impact of patients' perceptions of SCD and their medications on HRQOL and adherence (2)Examine the relationship of illness perception and stigma among AYA with SCD Methods: In this longitudinal, single-institution study, 68 participants were enrolled from outpatient hematology clinic at Lurie Children's Hospital of Chicago. Patients were approached if they were between 10 to 25 years old, English-speaking, and taking hydroxyurea, voxelotor and/or crizanlizumab for SCD treatment. Participants completed the Brief-Illness Perception Questionnaire (B-IPQ), Patient Reported Outcomes Measurement Information System (PROMIS) HRQOL Domains, Measure of Sickle Cell Stigma Questionnaire (MoSCS), Visual Analogue Scale (VAS) and Adherence to Refills and Medications Scale 7 (ARMS-7) every 3-4 months. Patient statistics were evaluated utilizing Wilcoxon (Mann-Whitney) rank sum tests, spearmen rho correlations (r s), and chi-square analysis. The data presented in this abstract represent baseline analysis for all enrolled, active study participants. Results: Sixty-eight participants completed study assessments (90% Black; 53% Female) with a median age of 14 years old (IQR 11-17) and 84% HbSS, homozygous hemoglobin S. In Table 1, patients with less perceived personal control of SCD and more emotional response to SCD reported worse social isolation (r s= -0.32, p=0.01; r s =0.31, p&amp;lt;0.01), mobility (r s =0.34, p&amp;lt;0.01; r s = -0.27, p=0.03), anxiety (r s = -0.29, p=0.02; r s =0.38, p&amp;lt;0.01), depression (r s = -0.29, p=0.02; r s =0.42, p&amp;lt;0.001), and fatigue (r s = -0.41, p0.001; r s =0.3, p=&amp;lt;0.01), respectively. Further, more perceived personal control was associated with less physical stress (r s = -0.49, p&amp;lt;0.001), pain (r s = -0.26, p=0.03), fatigue (r s = -0.41, p= &amp;lt;0.001), and greater mobility (r s =0.34, p &amp;lt;0.01). Participants with more negative perceptions of SCD consequences and concerns reported more physical stress (r s=0.29, p=0.02; r s =0.27, p=0.03), depression (r s =0.32, p&amp;lt;0.01; r s =0.40, p=0.001), and fatigue (r s=0.33, p=0.01; r s=0.37, p&amp;lt;0.01) (Table 1). Additionally, the B-IPQ correlating with PROMIS baseline data indicated patients who had greater understanding of their SCD reported better self-efficacy in both managing their medication and symptoms (r s =0.29, p=0.01; r s =0.29, p=0.02). In Table 2, patients with higher self-reported medication adherence using VAS, had better treatment control (5 vs 4, p = &amp;lt;0.001) and less perceived SCD-related symptoms (2 vs 3, 0.03). Utilizing ARMS-7, patients with higher self-reported medication adherence perceived less SCD-related consequences (2 vs 3, p =&amp;lt;0.01), symptoms (5 vs 4, p =0.01), displayed better treatment control (10 vs 8, p=0.03), but greater emotional response (1 vs 3, p = 0.04) (Table 2). Most patients (82%) endorsed ≥1 statement related to stigma. Patients frequently indicated that they are very careful who they tell they have SCD (64%), telling someone they have SCD is risky (38%), no one knows that they have SCD (52%), and they worry about people discriminating against them because they have SCD (31%). Patients with greater levels of stigma reported worse social isolation (r s= 0.38, p&amp;lt;0.01) and self-efficacy managing symptoms (r s= -0.30, p=0.01). Summary/Conclusion: The multifaceted relationship between medication adherence, illness perception and stigma related to HRQOL in adolescents and young adults relies upon patients' perceived control over their illness. Future evaluation of influential factors involving patients' perceived control are needed to improve SCD-clinical outcomes.

Barriers and enablers to medication adherence in glaucoma: A systematic review of modifiable factors using the Theoretical Domains Framework.

Nonadherence to medication reduces treatment effectiveness, and in chronic conditions it can significantly reduce health outcomes. In glaucoma, suboptimal adherence can lead to sight loss, which places a greater financial burden on society and reduces patients' quality of life. Interventions to improve adherence have so far had limited success and lack robust theoretical underpinnings. A better understanding of the determinants of medication adherence behaviour is needed in order to develop interventions that can target these factors more effectively. This systematic review aims to identify modifiable barriers and enablers to glaucoma medication adherence and identify factors most likely to influence adherence behaviour. We searched CINAHL, MEDLINE, PsycINFO, EMBASE, the Cochrane Library and sources of grey literature up to August 2022 for studies reporting determinants of glaucoma medication adherence. Data describing modifiable barriers/enablers to adherence were extracted and analysed using the Theoretical Domains Framework (TDF), a behavioural framework consisting of 14 domains representing theoretical factors that most likely influence behaviour. Data were deductively coded into one of the TDF domains and inductively analysed to generate themes. Key behavioural domains influencing medication adherence were identified by frequency of study coding, level of elaboration and expressed importance. Eighty-three studies were included in the final synthesis. Four key domains influencing glaucoma medication adherence were identified: 'Environmental Context and Resources', 'Knowledge', 'Skills' and 'Memory, Attention and decision processes'. Frequently reported barriers included complex eyedrop regimens, lack of patient understanding of their condition, forgetfulness and difficulties administering eyedrops. Whereas simplified treatments, knowledgeable educated patients and good patient-practitioner relationships were enablers to adherence. We identified multiple barriers and enablers affecting glaucoma medication adherence. Four theoretical domains were found to be key in influencing adherence behaviour. These findings can be used to underpin the development of behaviour change interventions that aim to improve medication adherence.

Using machine learning for analyzing medication adherence behavior among multimorbidity patients

This study explores how clustering or unsupervised machine learning can be used, for discovering hidden relationships in Morisky Medical Adherence Scale (MMAS-8) questionnaire behavior data of multimorbidity patients. The clustering results of this study can help clinicians identify the unique characteristics of each cluster in patients to provide targeted interventions. Thus the study objectives are two-fold i) cluster patient’s medication adherence behavior with multimorbidity, and ii) describe the characteristics of the patients in each cluster based on their demographic characteristics. This study is based on 201 outdoor patients having mean age of 43.65 years (range 18…87 years), median age of 45 years at three government hospitals located in Islamabad region. First the patients were asked to answer a 13-item questionnaire in Urdu concerning the factors that could have affected adherence to the recommended medical treatment. Subsequently, each patient answered the Urdu language version of the Morisky Medical Adherence Scale (MMAS-8) questionnaire. After data preprocessing, the response of each participant was scored to ascertain the adherence to the recommended medical treatment and finally all variables were statistically analyzed and all records clustered. The overall mean MMAS-8 score was 4.55. Two variables were found to be statistically considerably associated with low adherence i.e. i) number of dependent children (p = 0.005) and ii) age (p = 0.02), however, clustering revealed mostly unmarried patients obviously without Maternal/Child issues who, never or rarely forgot to take medication.

Effectiveness of an algorithm-driven home telemonitoring system on the metabolic control and self-care behaviour of Asian adults with type-2 diabetes mellitus: A randomised controlled trial.

Healthcare professionals are leveraging on telehealth to manage patients with type-2 diabetes mellitus (T2DM). This study aimed to determine the clinical outcomes of patients using a novel tele-monitoring system (OPTIMUM) as compared to the standard of care. An open-labelled randomised controlled trial involving 330 Asian patients with T2DM, aged 26-65 years, and suboptimal glycaemic control (HbA1c = 7.5-10%) was conducted in a Singapore public primary care clinic. The patients were assigned in a 1:1 ratio by block randomization to the intervention group to receive: in-app video-based tele-education, tele-monitoring of the blood pressure (BP), capillary glucose and weight via Bluetooth devices and mobile application, followed by algorithm-based tele-management by the OPTIMUM telehealth care team for abnormal parameters. Patients received usual care in the control group. Clinical assessments and self-care-related questionnaires were administered for both groups at baseline and 6 months. Complete data of 159 (intervention) and 160 (control) patients with comparable demographic profiles were analysed. Those in the intervention group showed significantly lower HbA1c by 0.34% (95%CI = -0.57 to -0.11; p = 0.004); first measurement of systolic BP decreased by 2.98 mmHg (95%CI:-5.8 to -0.08; p = 0.044) and diastolic BP by 4.24 mmHg (95%CI = -6.0 to -2.47; p = 0.001); and total cholesterol by 0.18 mmol/L (95%CI: -0.34 to -0.01; p = 0.040) compared to the control group, after adjusting for baseline variables. Questionnaire scores showed significant improvements in medication adherence and self-care behaviour in the intervention group. No significant weight change was noted between groups. The OPTIMUM tele-monitoring system improved the glycaemic, BP and total cholesterol control in patients with suboptimal T2DM control by enhancing their medication adherence and self-care over 6 months.

Effectiveness of an Innovative Nursing Approach Through a Smartphone Application in Promoting Medication Adherence Among Patients with Schizophrenia

Objective: This study aimed to investigate the effects of an innovative nursing approach using a smartphone application, namely “Kin Ya Kan Na” or “Let’s take Medications,” on medication adherence behaviors among patients with schizophrenia. Material and Methods: Purposive sampling was used to recruit the participants (n=84). They were randomly assigned into either an experimental (n=42) or control (n=42) group. The experimental group installed this application on their smartphones and used it for one month, along with usual nursing care while the control group received only the usual nursing care. Data were collected before and after the intervention using: 1) a demographic data form, 2) the Medication Adherence Scale in Thai (MAST), and 3) a satisfaction towards application usability’ scale. These two scales yielded Cronbach alpha coefficients of 0.94 and 0.86, respectively. Descriptive statistics and analysis of covariance (ANCOVA) were employed for data analyses. Results: The post-intervention analysis showed that the medication adherence behaviors between the two groups were significantly different (F1,81=65.225, p-value&lt;0.001), with higher mean scores for medication adherence behaviors in theexperimental group. The application users reported that they were highly satisfied with the application (M=4.51, S.D.=0.38).Conclusion: The study found that use of this innovative nursing approach significantly improved medication adherence behaviors among these patients. Therefore, nurses and related healthcare providers could apply this approach to promote medication adherence behaviors in patients with mental illness, particularly schizophrenia.

Medication adherence trajectory of patients with chronic diseases and its influencing factors: A systematic review.

To synthesize the published studies on medication adherence trajectories among patients with chronic diseases and identify the influencing factors. Systematic review. Medline (Ovid), Embase (Ovid) and Web of Science core collection were searched from database inception to 1 July 2022. Potentially eligible articles were independently screened by three reviewers using set inclusion and exclusion criteria. The Joanna Briggs Institute critical appraisal checklist for cohort studies was used to appraise the quality of the included articles. Three reviewers independently evaluated the quality, extracted data and resolved differences by consensus. Results were presented using descriptive synthesis, and the prevalence of recategorised medication adherence trajectories was calculated from the published data. Fifty studies were included. Medication adherence trajectories among patients with chronic diseases were synthesized into six categories: adherence, non-adherence, decreasing adherence, increasing adherence, fluctuating adherence and moderate adherence. Low and moderate evidence showed that (1) patient-related factors, including age, sex, race, marital status and mental status; (2) healthcare team and system-related factors, including healthcare utilization, insurance and primary prescriber specialty; (3) socioeconomic factors including education, income and employment status; (4) condition-related factors including complications and comorbidities and (5) therapy-related factors including the number of medications, use of other medications, and prior medication adherence behaviours were factors influencing the medication adherence trajectory. Marital status and prior medication adherence behaviour were the only influencing factors with moderate evidence of an effect. The medication adherence trajectory among patients with chronic diseases varied widely. Further studies are warranted to determine contributory factors. Healthcare providers should be aware that patients' medication adherence has different trajectories and should take appropriate measures to improve patients' medication adherence patterns. None. As a systematic review, patients and the public were not involved.

Toward the Design of Sensing-Based Medication Adherence Aids That Support Individualized Activities of Daily Living: Survey and Interviews With Patients and Providers

Background Nearly half of Americans taking prescription medications do not take them properly. The resulting implications have a broad impact. Nonadhering patients develop worsened medical conditions and increased comorbidity of disease or die. Objective Clinical studies have shown that the most effective strategies for addressing adherence are those that are individualized to the context that each patient and situation require. However, existing aids for adherence are relatively ridged and poorly support adaptation to individual behaviors and lifestyles. The aim of our study was to better understand this design tension. Methods A series of 3 qualitative studies was conducted: a web-based survey of 200 Americans that investigated existing adherence strategies and behaviors and perception of how hypothetical in-home tracking technologies would assist adherence; in-person semistructured interviews with 20 medication takers from Pittsburgh, PA, that investigated personal adherence behaviors, which included demonstration of medication locations and routines as well as an assessment of hypothetical technologies; and semistructured interviews with 6 pharmacists and 3 family physicians to gain a provider perspective on patient adherence strategies, which included feedback on hypothetical technologies in the context of their patient populations. Inductive thematic coding of all interview data was performed. Studies were conducted consecutively, with the results informing the subsequent studies. Results Synthesized, the studies identified key medication adherence behaviors amenable to technological interventions, distilled important home-sensing literacy considerations, and detailed critical privacy considerations. Specifically, 4 key insights were obtained: medication routines are heavily influenced and adapted by and through the physical location and placement of medications relative to activities of daily living, routines are chosen to be inconspicuous to maintain privacy, the value of provider-involved routines is motivated by a desire to build trust in shared decision-making, and the introduction of new technologies can create further burden on patients and providers. Conclusions There is considerable potential to improve individual medication adherence by creating behavior-focused interventions that leverage emerging artificial intelligence (AI), machine learning (ML), and in-home Internet of Things (IoT) sensing technologies. However, success will be dependent on the technology’s ability to learn effectively and accurately from individual behaviors, needs, and routines and tailor interventions accordingly. Patient routines and attitudes toward adherence will likely affect the use of proactive (eg, AI-assistant routine modification) versus reactive (eg, notification of associated behaviors with missed dosages) intervention strategies. Successful technological interventions must support the detection and tracking of patient routines that can adjust to variations in patient location, schedule, independence, and habituation.

Factors Influencing Medication Adherence in Elderly Patients with Hypertension: A Single Center Study in Western China.

To develop and empirically test a conceptual model that explains the factors influencing antihypertensive medication adherence behavior in elderly patients in a city in western China. The conceptual model was based on the Theory of Planned Behavior and the Health Belief Model and was empirically tested using cross-sectional survey data from Nanchong City, a city in western China, collected between October and December 2020. Data were analyzed using structural equation modeling. Behavioral intentions were the main predictor of medication adherence behavior (path coefficient of 0.353). Perceived benefits and perceived barriers directly (path coefficient = 0.201 and -0.150, respectively), and indirectly (path coefficient = 0.118 and -0.060) through behavioral intentions, influenced medication adherence behavior. Perceived susceptibility (path coefficient = 0.390) and perceived severity (path coefficient = 0.408) influenced behavioral attitudes, which influenced behavioral intentions (path coefficient = 0.298). The conceptual model demonstrates a robust ability to predict and explain medication adherence behavior among elderly patients with hypertension, facilitating the adoption and maintenance of changes in adherence behavior and the potential for preventing disease progression and improving quality of life.

Assessing the interrelationship between asthma and obesity self-management behaviors.

Asthma and obesity are common coexisting conditions with increasing prevalence and substantial morbidity. This study examines the inter-relationship between illness and treatment beliefs in asthma and obesity and how they influence self-management behaviors. Overweight and obese adults ≥ 18years with asthma were recruited from primary care and pulmonary practices in New York, NY and Denver, CO (n = 219). Path analysis was used to examine the relationship between asthma, weight and exercise-related illness and medication beliefs and SMB. Necessity beliefs about asthma medications and diet were associated with better medication adherence and healthier dietary behaviors (β = 0.276, p = < 0.001, β = 0.148, p = 0.018 respectively) whereas concerns about these self-care activities were associated with poorer adherence and worse dietary behaviors (β = - 0.282, p < 0.001, β = - 0.188, p = 0.003 respectively). We found no statistically significant association of exercise behaviors with any other weight or asthma illness or treatment beliefs. Our study demonstrates that necessity and concerns about treatment are associated with adherence in asthma and obesity. The lack of association of exercise behaviors with any asthma or weight related beliefs may reflect limited awareness of the impact of weight on asthma and warrants additional research.

Development and evaluation of DiabeText, a personalized mHealth intervention to support medication adherence and lifestyle change behaviour in patients with type 2 diabetes in Spain: A mixed-methods phase II pragmatic randomized controlled clinical trial

BackgroundDespite the increasing interest in text-messaging interventions to support healthcare delivery, the available evidence about their effectiveness is still limited. Objectives1) to develop DiabeText, an intervention delivering automated, tailored brief text messages to support diabetes self-management; 2) to explore the potential impact of DiabeText on self-management behavior and glycaemic control, and; 3) to examine the feasibility of conducting a future phase III randomized clinical trial to evaluate the effectiveness of DiabeText. Methods3-month, two-arm, randomized feasibility trial (ClinicalTrials.gov: NCT04738591) with patients with type 2 diabetes (HbA1c > 8%). Participants were allocated to the control (usual care) or DiabeText group (usual care + five text messages per week). Outcomes were: recruitment rate; follow-up rate, missing data; medication adherence; adherence to Mediterranean diet; physical activity; and HbA1c. In addition, after delivering the intervention, we conducted a qualitative study involving 14 semi-structured interviews with participants allocated to the DiabeText group, to understand their views about the intervention. ResultsFrom 444 screened people, we recruited 207 participants (recruitment rate = 47%), of which 179 completed the post-intervention interview (follow-up rate = 86%). We sent 7,355 SMS during the intervention period, of which 99% successfully reached the participants. At post-intervention, DiabeText was associated with non-statistically significant (p > 0.05) improvements in adherence to medication (OR = 2.0; 95%CI 1.0 to 4.2), Mediterranean diet (1.7; 0.9 to 3.2), and physical activity (1.7; 0.9 to 3.1). No between-group differences were observed in mean HbA1c (p = 0.670). The qualitative study indicated that participants perceived DiabeText as a helpful resource because it increased their awareness about the importance of adequate self-management and the sense of being cared for. ConclusionsDiabeText is the first system in Spain to integrate patient-generated and routinely collected clinical data to deliver tailored text messages to support diabetes self-management. More robust trials are needed to determine its effectiveness and cost-efficacy.