Nonadherent Behavior Research Articles

Factors Influencing Therapeutic Non-Adherence Behavior Among Patients with Type 2 Diabetes in Two Public Hospitals in the Gambia: A Cross-Sectional Study.

Type 2 Diabetes Mellitus (DM) is a significant public health problem in The Gambia. While therapeutic non-adherence is widely recognized as a common and costly problem, very little is known about therapeutic adherence behavior among patients with diabetes in The Gambia. The objective of this study was to determine the prevalence and factors that influence diabetic therapeutic non-adherence behavior among patients with type 2 diabetes in The Gambia. A cross-sectional study design was used, and participants were recruited from Edward Francis Small Teaching Hospital (EFSTH) and Kanifing General Hospital (KGH). The sample size of 145 patients with type 2 diabetes was included and data was collected using a structured questionnaire. Adherence to anti-diabetic medications was measured using the Morisky Medications Adherence Scale (MMAS-8). Logistic regression was used to determine the factors associated with diabetic therapeutic non-adherence. The prevalence of non-adherence to anti-diabetic treatment was 27.6%. Perceived barrier (forgetfulness, long-term medication use, and medication side effects) to diabetic treatment (OR = 0.265, 95% CI: 0.113-0.621, p = 0.041) was statistically significantly associated with non-adherence to anti-diabetic treatment. However, the frequency of doctor's visits (OR = 0.310, 95% CI: 0.046-2.111) was not significantly associated with non-adherence to anti-diabetic treatment. The rate of non-adherence to antidiabetic treatment in this study was high. Perceived barriers to antidiabetic treatment such as forgetfulness, long-term medication use, and medication side effects influenced therapeutic non-adherence to antidiabetic treatment. While interventions should focus on how to eliminate these barriers, health education on diabetic self-care may help reinforce the importance of medication adherence to prevent complications.

Effectiveness Of Psychoeducation And Assertive Training (PEAT) Combined For Improving Medication Adherence In Patients With Schizophrenia

Background: Non-adherence behaviors have a variety of causes, from suffering negative drug side effects to having scepticism regarding the effectiveness of recommended treatments. Recognising these complex relationships is essential to creating strategies that effectively manage the psychosocial as well as medical components of schizophrenia. The purpose of this study is to investigate how a combination of psychoeducation and assertive training can improve medication adherence in people with schizophrenia. Methods: A pretest-posttest quasi-experiment design was employed in this study as part of a quantitative research technique. Demographics and the Morisky Medication Adherence Questionnaire were used in conjunction with observation to collect data. Based on room-based simple random sampling, 80 patients with schizophrenia who met the inclusion criteria were split into two groups. Of these, 38 patients in the intervention group and 36 responders in the control group finished the study. This study made use of the five-stage Psychoeducation and Assertive Training (PEAT) module. Results: A combination of psychoeducation and assertiveness training (PEAT) was found to have an effect on medication adherence in this study. Following PEAT, patients with schizophrenia had a mean medication adherence of 5.92±1.29. The statistical test findings showed that the mean medication adherence of schizophrenic patients receiving PEAT differed significantly (p value <0x7E>0.001) from those who did not. Conclusion: Studies show that putting more of an emphasis on PEAT can help hospitals treat patients with schizophrenia more consistently by helping them take their medications as prescribed. Additionally, patients with schizophrenia should have a treatment plan that includes PEAT.

Non Adherence to Fluid Restriction among Patients who Undergoing Hemodialysis and Influencing Factors: Study at RSI Sakinah Mojokerto

Background: Nonadherence to Fluid Restriction is main problem among chronic renal failure patients who undergoing hemodialysis, it causingan undesirable effect on health and risk of death. Several factors such as sociodemographic, knowledge, susceptibility of illness, perceived treat, perceived controlare some factors influencing Nonadherence behavior. Purpose: The aim of this study was to analyze the factors influencing Non-adherence to Fluid Restriction who undergoing hemodialysis at RSI Sakinah Mojokerto. Methods: A descriptive analytic with crossectional techniques was conducted among 73 patients undergoing hemodialysis at RSI Sakinah Mojokerto by using purposive sampling technique. Data were collected through checklist and questionnaires. Descriptive statistic was used for data analysis and logistic regression test was used analysis the predictor of factors relating with Non-adherence to Fluid Restriction who undergoing hemodialysis. Results: The results of this study showed 37% patients were Non-adherence to Fluid Restriction and 63% patients were adherence. There were three risk factors for non-adherencee, namely (Health Belief Model) HBM, history of disease and length of time undergoing hemodialysis. HBM 0.132 times higher (95% CI: 0.132, 0.035), history of disease 0.072 times higher (95% CI: 0.072, 0.012), and length of time undergoing hemodialysis 0.071 times higher (95% CI: 0.071, 0.016). Conclusion: HBM, history of disease and length of time undergoing hemodialysis were risk factors for Non-adherence to Fluid Restriction. The nurse should consider the patient's adherence with fluid restrictions in providing nursing care.

Anxious Attachment Style Predicts Dietary Adherence 1-Year Post-bariatric Surgery.

Adherence to dietary guidelines is critical for optimizing health and weight outcomes after metabolic and bariatric surgery, yet many patients have difficulty. The purpose of this study was to identify the types and frequency of post-surgery non-adherent dietary behaviors and to determine pre-surgery predictors of adherence at 1-year post-surgery. We completed a prospective cohort study of 348 adults who underwent sleeve gastrectomy (n = 25) or Roux-en-Y gastric bypass (n = 323) at an academic medical center between 2013 and 2017. Pre- and post-surgery parameters were demographics, adherence to dietary recommendations and mental health symptoms. Descriptive statistics and regression analyses were used. Pre-surgery, 264 (75.9%) participants were classified as adherent to nutrition recommendations by a Registered Dietitian (RD). At 1-year post-surgery, 203 (58.3%) were adherent, a statistically significant decrease (p < 0.05). The three most frequent non-adherent eating behaviors were insufficient protein intake (32.4%), inadequate vitamin intake (26.1%), and grazing (21.1%). Pre-surgery predictors in the bivariate regression analysis were anxious attachment (p = 0.01), poorer emotion regulation (p = 0.01), poorer perceived social support (p = 0.01), and RD disposition of dietary adherence (p = 0.02). In the best subset multivariate regression analysis, anxious attachment emerged as the significant predictor. Several types of non-adherent eating behaviors were identified. Pre-surgery, anxious attachment style, dietary adherence, emotion regulation, and perceived social support were predictors of adherence to dietary guidelines 1-year post-surgery. These factors should be assessed and patients provided with relevant support and education.

Inconclusiveness of psychometric testing of medication adherence questionnaires

PurposeTo propose a paradigm change for the validation procedures of medication adherence questionnaires.MethodsA total of 121 validation procedures of unique questionnaires for medication adherence were analyzed.Results“Construct validity” and “internal consistency” were most often assessed, and test results varied largely. A more in-depth analysis indicated that the assessment of medication non-adherence included distinct but related constructs, such as the extent to which doses are missed, and the attempt to identify different facets of medication-taking behavior. Consequently, each construct requires a different measurement approach with different psychometric tests for establishing its validity and reliability.ConclusionResults show that assessing the validity and reliability of adherence questionnaires with standard procedures including statistical tests is inconclusive. Refinement of the constructs of non-adherence is needed in pharmacy and medical practice. We suggest a distinction between the (i) extent of missed doses over the past 2 weeks, (ii) modifiable reasons for non-adherence behavior, and (iii) unmodifiable factors of non-adherence. Validation procedures and corresponding statistical methods should be selected according to the specific single constructs.

Medication non-adherence and self-inflicted violence behaviors among 185,800 patients with schizophrenia in the community: a 12-year cohort study

BackgroundDespite the importance of medication adherence in treatment effectiveness, little is known about the association between medication non-adherence and self-inflicted violence behaviors. We aimed to assess whether medication non-adherence increased the risk of self-inflicted violence behaviors among schizophrenics in communities (hypothesis 1) and whether the dose–response relationship existed (hypothesis 2).MethodsThis 12-year cohort study in western China recruited 292,667 community-dwelling schizophrenics. The proportion of regular medication (PRM) was calculated by dividing the time of “regular adherence” by the total time of antipsychotic treatment during follow-up period as an indicator of medication adherence. For hypothesis 1, medication adherence was designated as a binary variable with a threshold of 0.8 (PRM); for hypothesis 2, medication adherence was specified as five-category and continuous variables, respectively. Inverse probability weighting and mixed effects Cox proportional hazards models were conducted for confounders control and survival analyses.ResultsOne hundred eighty-five thousand eight hundred participants were eligible for the final analyses, with a mean age of 47.49 years (SD 14.55 years), of whom 53.6% were female. For hypothesis 1, the medication non-adherence group (PRM < 0.8) had a lower risk of suicide (HR, 0.527, 95% CI, 0.447–0.620), an increased risk of NSSI (HR, 1.229, 95% CI, 1.088–1.388), and non-significant risk of attempted suicide compared with adherence group (PRM ≥ 0.8). For hypothesis 2, the lowest medication adherence (PRM < 0.2) was associated with increased risks of suicide attempt (HR, 1.614, 95% CI, 1.412–1.845), NSSI (HR, 1.873, 95% CI, 1.649–2.126), and a decreased risk of suicide (HR, 0.593, 95% CI, 0.490–0.719). The other non-adherence groups had lower risks for all three self-inflicted violence behaviors. The associations between medication adherence in continuous-variable and three outcomes were consistent with the categorical medication adherence results.ConclusionsAlmost no medication taken as prescribed was associated with an increased risk of suicide attempt and NSSI. However, medication adherence did not appear to prevent completed suicide. Besides, patients with moderate adherence had a lower incidence of suicide attempt and NSSI. These findings highlight the need for a more detailed portrayal of medication adherence and the need to be vigilant for suicide intent in schizophrenics with good medication adherence who may be overlooked previously.

Beliefs and practices of the nursing team related to pressure injury preventive measures: A analysis of social representations.

To analyse the process of elaborating social representations about pressure injury preventive measures by the nursing team (nurses and nurse technicians) and how this process relates to preventive practices for hospitalized patients. Qualitative study, with the application of the theory of social representations in its procedural methodological approach. The study was carried out in an inpatient clinic of a public hospital in the state of Rondônia, Brazil. Totally, 28 nursing professionals in the medical clinic sectors who had worked directly with patient care for more than 6 months participated. The data were collected between July and September 2021 via in-depth interviews with the application of a semi-structured instrument. Analysis was carried out with the help of ALCESTE software, which performed a lexicographic analysis, and also via thematic analysis. The COREQ guided the presentation of the research report. The social representations were developed based on the professionals' symbolic beliefs about the visibility/invisibility of the results of applying preventive care. These symbolic constructions mobilized positive and negative feelings among the nursing team, which guided the classification of prevention practices as being of greater or lesser priority among other care activities. There were favourable attitudes among professionals, which included applying prevention measures in their daily routines, and unfavourable attitudes of non-adherence to the institution's protocol for preventing pressure injuries. The nursing team's perception of pressure injury prevention is influenced by symbolic, affective, values, and social dimensions. Non-adherence behaviours are attributed to the belief in the invisibility of prevention outcomes, resulting in a reluctance to implement preventive measures. Understanding the subjective logic that explains the thinking and actions of the nursing team suggests the need to incorporate discussions on beliefs, values, sentiments, and attitudes of nursing professionals into educational programs on pressure injury prevention. No public contribution.

Immunosuppressant medication behaviours in solid organ transplant recipients: a cross-sectional study from south-central China during COVID-19 reopening period

ObjectiveMedication non-adherence to immunosuppressants threatens allograft survival and function maintenance among solid organ transplant (SOT) recipients. This study aimed to investigate the prevalence of immunosuppressant medication non-adherence and associated factors...

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.

A cross-sectional study of the factors influencing adherence to antiretroviral therapy among adults with human immunodeficiency virus infection in a tertiary care hospital in Puducherry, India.

Combating human immunodeficiency virus/acquired immunodeficiency syndrome epidemic has been possible due to advances in prevention strategies and Antiretroviral therapy (ART). Optimal adherence to ART is a major factor in achieving the desired immunological, virological, and patient well-being outcomes. Several socio-demographic, patient, treatment, and health-care system-related factors influence nonadherent behavior to ART. This study was planned to assess (1) ART adherence level, (2) factors and reasons associated with nonadherence, and (3) impact of suboptimal adherence on treatment outcomes. This was a cross-sectional analytical study of 300 patients in a tertiary care hospital in Puducherry, India. Random sampling was used to collect data from patient treatment cards and a predesigned structured questionnaire. The pill count method was used to calculate adherence level. Nonadherence was chosen as a dependent variable and factors affecting adherence were chosen as independent variables. Test for significance was carried out by Chi-square test and Fisher's exact test. Optimal adherence was seen in 68.3%. Factors significantly associated with nonadherence were lower education level, high prior CD4 count, irregular follow-up, missing doses in the past, and being late for pharmacy pill refills. Adherence was positively associated with mean increase in CD4 count over 6 months. In our study, the adherence rate is suboptimal which can lead to failure of ART. Nonadherence was associated with a decrease in CD4 count overtime. Most of the factors significantly affecting ART adherence were patient behavior related. These factors can be used for target intervention during reinforcement adherence counseling.

The Fully Understanding Eating and Lifestyle Behaviors (FUEL) trial: Protocol for a cohort study harnessing digital health tools to phenotype dietary non-adherence behaviors during lifestyle intervention.

Lifestyle intervention can produce clinically significant weight loss and reduced disease risk/severity for many individuals with overweight/obesity. Dietary lapses, instances of non-adherence to the recommended dietary goal(s) in lifestyle intervention, are associated with less weight loss and higher energy intake. There are distinct "types" of dietary lapse (e.g., eating an off-plan food, eating a larger portion), and behavioral, psychosocial, and contextual mechanisms may differ across dietary lapse types. Some lapse types also appear to impact weight more than others. Elucidating clear lapse types thus has potential for understanding and improving adherence to lifestyle intervention. This 18-month observational cohort study will use real-time digital assessment tools within a multi-level factor analysis framework to uncover "lapse phenotypes" and understand their impact on clinical outcomes. Adults with overweight/obesity (n = 150) will participate in a 12-month online lifestyle intervention and 6-month weight loss maintenance period. Participants will complete 14-day lapse phenotyping assessment periods at baseline, 3, 6, 12, and 18 months in which smartphone surveys, wearable devices, and geolocation will assess dietary lapses and relevant phenotyping characteristics. Energy intake (via 24-h dietary recall) and weight will be collected at each assessment period. This trial is ongoing; data collection began on 31 October 2022 and is scheduled to complete by February 2027. Results will inform novel precision tools to improve dietary adherence in lifestyle intervention, and support updated theoretical models of adherence behavior. Additionally, these phenotyping methods can likely be leveraged to better understand non-adherence to other health behavior interventions. This study was prospectively registered https://clinicaltrials.gov/study/NCT05562427.

A Three-Step Data-Driven Methodology to Assess Adherence to Basal Insulin Therapy in Patients With Insulin-Treated Type 2 Diabetes.

While health care providers (HCPs) are generally aware of the challenges concerning insulin adherence in adults with insulin-treated type 2 diabetes (T2D), data guiding identification of insulin nonadherence and understanding of injection patterns have been limited. Hence, the aim of this study was to examine detailed injection data and provide methods for assessing different aspects of basal insulin adherence. Basal insulin data recorded by a connected insulin pen and prescribed doses were collected from 103 insulin-treated patients (aged ≥18 years) with T2D from an ongoing clinical trial (NCT04981808). We categorized the data and analyzed distributions of correct doses, increased doses, reduced doses, and missed doses to quantify adherence. We developed a three-step model evaluating three aspects of adherence (overall adherence, adherence distribution, and dose deviation) offering HCPs a comprehensive assessment approach. We used data from a connected insulin pen to exemplify the use of the three-step model to evaluate overall, adherence, adherence distribution, and dose deviation using patient cases. The methodology provides HCPs with detailed access to previously limited clinical data on insulin administration, making it possible to identify specific nonadherence behavior which will guide patient-HCP discussions and potentially provide valuable insights for tailoring the most appropriate forms of support.

Non-Adherence to Anti-Retroviral Therapy Among Adult People Living with HIV in Ethiopia: Systematic Review and Meta-Analysis.

Human immunodeficiency virus remains a global public health problem. Despite efforts to determine the prevalence of non-adherence to ART and its predictors in Ethiopia, various primary studies presented inconsistent findings. Therefore, this review aimed to determine the pooled prevalence of non-adherence to ART and identify its predictors. We have searched PubMed, Google Scholar and Web of Science databases extensively for all available studies. A weighted inverse-variance random-effects model was used to compute the overall non-adherence to ART. The pooled prevalence of non-adherence to ART was 20.68% (95% CI: 17.74, 23.61); I2 = 98.40%; p < 0.001). Educational level of primary school and lower [AOR = 3.5, 95%CI: 1.7, 7.4], taking co-medications [AOR = 0.45, 95%CI: 0.35, 0.59], not using memory aids [AOR = 0.30, 95%CI: 0.13, 0.71], depression [AOR = 2.0, 95%CI: 1.05, 3.79], comorbidity [AOR = 2.12, 95%CI: 1.16, 3.09), under-nutrition [AOR = 2.02, 95%CI: 1.20, 3.43], not believing on ART can control HIV [AOR = 2.31, 95%CI: 1.92, 2.77], lack of access to health facilities [AOR = 3.86, 95%CI: 1.10, 13.51] and taking ART pills uncomfortably while others looking [AOR = 5.21, 95%CI: 2.56, 10.53] were significantly associated with non-adherence to anti-retroviral therapy. The overall pooled prevalence of non-adherence to ART was considerably high in Ethiopia. Educational status, taking co-medications, not using memory aids, depression, comorbidity, under nutrition, not believing on anti-retroviral therapy controls HIV, lack of access to health facilities and taking ART pills uncomfortably were independent predictors of non-adherence to ART in Ethiopia. Therefore, healthcare providers, adherence counselors and supporters should detect non-adherence behaviors and patients' difficulties with ART early, and provide intensive counseling to promote adherence.

Mental and behavioural disorders increase the risk of tendon rupture after flexor tendon repair in zone I and II.

The effect of mental and behavioural disorders (MBD) on the risk of tendon ruptures after flexor tendon repair is not well understood. This study aimed to analyse the association between MBD and tendon rupture after flexor tendon repair in zones I and II. Data from the Swedish National Registry for Hand Surgery (HAKIR) on patients with a complete flexor tendon repair at our department between 2012 and 2019 were followed for a minimum of 2years to assess the rate of rupture. Independent variables were collected from HAKIR and clinical records: prevalence MBD based on ICD-10 codes F0-F99, age, sex, injured tendon, number of injured fingers, day to surgery, core suture, digital nerve injury, smoking, injury mechanism, and rehabilitation method. Multiple logistic regression was used to assess the association between variables. A cohort of 593 patients with 49 ruptures (8.2%) was identified. Potential causes of rupture were non-adherence behaviour in 16 (33%), accidents in seven (14%), infections in six (12%), and no clear cause in 20 (41%) patients. Patients with MBD had an association to rupture (OR 3.6), 17.7% ruptures compared to 7.2% in patients with no diagnosed disorders. Patients >50years of age had a higher risk compared to patients <25years (OR 4.3), 15% compared to 3.9%' respectively. Men had a higher risk compared to women (OR 2.9), 10% compared to 4.3%' respectively. We identified an association between the prevalence of mental and behavioural disorders and rupture after flexor tendon repair.

Infection prevention and control in CT Part 2: Radiographers' and radiology nurses' perceptions of high-risk scenarios contributing to non-adherence to IPC protocols

IntroductionAdherence to standard and transmission-based precautions in the computed tomography (CT) setting is central to effective infection prevention and control (IPC), yet there is limited evidence about medical imaging (MI) professionals' self-reported predictors of IPC breaches. This is the second of a two-part series on IPC in the CT setting. Part 1 reported on Australian baseline data relating to intravenous contrast media administration and power injectors. Part 2 presents Australian radiographers' and radiology nurses' perceptions of clinical situations that reduce adherence to standard and transmission-based precautions in CT. MethodsA self-administered survey was distributed to Australian radiographers and radiology nurses working in CT. Responses to an open-ended question “If I was to not adhere to the standard and transmission-based precautions in the CT department, it is most likely when …” was analysed using inductive coding for themes, followed by deductive analysis mapped to the Systems Engineering Initiative for Patient Safety (SEIPS) model. ResultsStudy participants (n = 136) were radiographers (n = 119; 87.5%) and nurses (n = 17; 12.5%). ‘Four themes were derived from the inductive analysis: (1) high-risk working conditions, (2) compliance with good practice, (3) attitudes and practice, and (4) quality of communication. Deductive analysis, using the SEIPS domains revealed that predominant issues related to ‘Tasks’ (43.7%) and ‘Organisation’ (30.6%) followed by issues related to ‘Person’ (16.9%), ‘Tools and technology’ (6.9%) and ‘Environment’ (1.9%). ConclusionMulti-faceted pressures on radiology staff may compromise adherence to standard and transmission-based precautions in CT. Task difficulty, time pressures whilst undertaking tasks, and reduced staffing could lead to lower adherence to standard and transmission-based precautions. Implications for practiceFuture studies that focus on evaluation of ‘Tasks’ and ‘Organisation’ domains of the SEIPS model may provide further insights to non-adherence behaviours in MI.

Konseling Pencegahan Depresi Pada Ibu Rumah Tangga Dengan HIV/AIDS Di Kabupaten Cirebon

The problems that usually arise in people with HIV/AIDS (PLWHA) are that apart from physical problems, there is also stigma, namely the bad social reaction towards people with HIV/AIDS. Such complex problems in PLWHA are accompanied by loss of social support such as lack of attention from family and community. This reaction is a bad experience for PLWHA where when they need support there is no one to help them, so depression often occurs in PLWHA. Depression in HIV AIDS sufferers can increase the risk of non-adherence behavior towards treatment resulting in a high risk of shorter survival. Failure to recognize and treat depression in HIV/AIDS sufferers not only endangers the patient but also endangers society. Research related to depression in PLWHA at Cipto Mangunkusumo Hospital, Jakarta, found that more than half of the patients experienced depression, namely 51.1%. The general aim of providing this counseling is so that PLWHA are able to overcome the depression they are experiencing. The design used in this community service is counseling with communication, information and education methods. The targets of this community service activity are housewives with HIV/AIDS in Cirebon district. From the preliminary study carried out, it was found that data on the problems that arise among PLWHA in Cirebon district cannot be separated from the emergence of psychological problems, this occurs because of feelings of sadness, disappointment, shame, fear of being ostracized by friends and family and fear of being abandoned by their husbands.

Parent-reported child's close contact with non-household family members and their well-being during the COVID-19 pandemic: A cross-sectional survey.

In England (UK), at the start of the COVID-19 pandemic the public were required to reduce their physical contacts to slow the spread of COVID-19. We investigated the factors associated with children having: 1) close contact with family members from outside their household ('non-adherent behaviour'); and 2) low well-being (Revised Child Anxiety and Depression Scale). We conducted an online cross-sectional survey, completed at any location of the participant's choice between 8 and 11 June 2020 in parents (n = 2,010) who were aged eighteen years or over and had a school-aged child (4-18 years old). Parents reported that 15% (n = 309) of children had non-adherent contact and that 26% (n = 519) had low well-being. We used a series of binary logistic regressions to investigate associations between outcomes and child and parent characteristics. Children had higher odds of having non-household contact when they had special educational needs [adjusted odds ratio, 2.19 (95% CI, 1.47 to 3.27)], lower well-being [2.65 (95% CI, 2.03 to 3.46)], were vulnerable to COVID-19 [2.17 (95% CI, 1.45 to 3.25)], lived with someone who was over 70 years old [2.56 (95% CI, 1.55 to 4.24)] and their parent had low well-being [1.94 (95% CI, 1.45 to 2.58)]. Children had higher odds of lower well-being when they had special educational needs [4.13 (95% CI, 2.90 to 5.87)], were vulnerable to COVID-19 [3.06 (95% CI, 2.15 to 4.36)], lived with someone else who was vulnerable to COVID-19 [2.08 (95% CI, 1.64 to 2.64)], or lived with someone who was over 70 years old [2.41 (95% CI, 1.51 to 3.83)]. Many children came into contact with non-household family members, mainly for childcare. Factors relating to COVID-19, children's well-being and education were also important. If school closures are needed in future, addressing these issues may help reduce contact.

Rates and correlates of medication non-adherence behaviors and attitudes in adult patients with early psychosis.

Literature on antipsychotic medication adherence in early psychosis primarily assessed adherence behaviors and focused on young patients. There is a paucity of research investigating negative medication attitude and its determinants in the early illness course, particularly in older-aged sample. We aimed to examine prevalence and correlates of medication non-adherence behaviors and negative medication attitudes separately in adult patients with early psychosis. One hundred ninety-nine Chinese early psychosis patients aged 26-55years who had received three-year treatment for first psychotic episode in Hong Kong were examined. Assessments encompassing socio-demographics, premorbid adjustment, clinical and treatment profiles, self-stigma and therapeutic alliance were conducted. Patients were evaluated with Medication Compliance Questionnaire, which is a modified Chinese-translated version of Medication Adherence Rating Scale and includes items measuring adherence behaviors and attitudes towards medications. Rates of medication non-adherence and negative attitude towards medications were 38.7% and 50.8%, respectively. Multivariate regression analysis showed that more severe positive symptoms, greater self-stigma and negative medication attitude were independently associated with medication non-adherence. Negative attitude towards medications was significantly associated with younger age, higher educational attainment, diagnosis of other psychotic disorders, poorer insight, greater self-stigma and less satisfaction with communication with healthcare staff, which represented an index reflecting suboptimal therapeutic alliance. Antipsychotic non-adherence and negative medication attitudes are frequently observed in adult early psychosis patients. Our findings indicate that poor insight, elevated self-stigma and suboptimal therapeutic alliance may constitute potential treatment targets for promoting medication adherence and rectifying negative medication attitudes in the early illness stage.

MEMAHAMI PERILAKU KETIDAKPATUHAN PENGGUNAAN OBAT DI KALANGAN PENDERITA PENYAKIT HIPERTENSI: APLIKASI TEORI HEALTH BELIEF MODEL

Hypertension disease is one of the risk factors for cardiovascular and blood vessel disease which is increasing constantly through the world and it is the main cause of premature death. Currently, the therapy that used for hypertension is antihypertensive treatment and applying the healthy lifestyle. Adherence in using antihypertensive medications is very important to achieve controlled hypertension. However, there are many nonadherence behaviors in the use of drugs that can cause a decrease in the patient’s quality of life. This study aimed to explore factors related to patient’s adherence in antihypertensive medications using Health Belief Model theory. This research is a qualitative study through deep interviews with open-ended questions. Respondents were all hypertension patients with minimum 3 months treatment of antihypertensive medications. Interviews were conducted using an interview guide compiled based on HBM constructs. Data were analyzed with content analysis. Result: 34 respondents were interviewed. Most respondents have high adherence in antihypertensive treatment 62% and 38% respondents have low adherence. This behavior is influenced by the low perception of susceptibility and severity to hypertension, which is caused by a lack patient knowledge. In addition, the high perception of barrier and the lack of perceived benefits when taking medication regularly also affects the level of patient nonadherence. Conclusion: Nonadherence behavior to antihypertensive medications was noticed in 38% of the respondents studied. Interventions strategies aiming to improve adherence can be done through patient education and using the electronic reminders.

Association of the Stanford Integrated Psychosocial Assessment for Transplant and 1-Year Outcome of Living Kidney Transplantation in Japan

Since most kidney transplantations in Japan are performed on the basis of living donors, after-transplant outcomes should achieve optimum results, overcoming participants' possible reduced adherence. This study investigated the association between the Japanese version of the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT-J) and outcomes, one year after the patient's living kidney transplant (LKT). The prospective cohort study was undertaken at Tokyo Women's Medical University Hospital from January 2020 to July 2021, with a one-year follow-up period. The SIPAT-J assesses 18 psychosocial risk factors: (A) Patient's Readiness Level and Illness Management (SIPAT A), (B) Social Support System Level of Readiness (SIPAT B), (C) Psychological Stability and Psychopathology (SIPAT C), and (D) Lifestyle and Effect of Substance Use (SIPAT D). The evaluators, a psychiatrist and three clinical psychologists, conducted an independent, blinded application of the SIPAT-J using participants' medical records. The study focused on physical composite outcomes, psychiatric outcomes, and non-adherent behaviors. The participants were 173 LKT recipients (median age (IQR) 51 (38-59)); 67.1% were male, and 67.1% were employed. The median (IQR) SIPAT scores were SIPAT A [7 (5-9)], SIPAT B [7 (5-9)], SIPAT C [2 (0-4)], SIPAT D [3 (3-4)], and SIPAT total [20 (16-23)]. The physical composite outcome was 25 (14.5%), psychiatric outcome 9 (5.2%), and non-adherent behavior 17 (9.8%). SIPAT C (odds ratio [OR]=1.34, 95% confidence interval [Cl]=1.06-1.72, p=0.02) was significantly associated with the psychiatric outcome. SIPAT B (OR=1.49, 95% Cl=1.12-1.98, p=0.01) and SIPAT total (OR=1.13, 95% Cl=1.03-1.24, p=0.01) were significantly associated with non-adherent behaviors. There was no significant association between the SIPAT and physical composite outcomes. This study is the first to examine the association between SIPAT and physical and psychiatric outcomes one year after LKT, controlling for follow-up periods and factors other than SIPAT. Comprehensive psychosocial assessment before LKT and early identification of factors that may negatively affect transplant success can allow targeted interventions to be implemented and increase the likelihood of favorable recipient outcomes.