Strongest Predictor Of Adherence Research Articles

Quality, Replicability, and Transparency in Research in Social Psychology

Abstract: In 2020, the Division of Social Psychology of the German Psychological Society (DGPs) published 11 methodological recommendations for improving the quality, replicability, and transparency of social psychological research. We evaluate these recommendations in a quantitative and qualitative survey conducted with members of the division ( N = 54). Most – but not all – recommendations are well-known and understood by these members of the division. For 73% of the recommendations, researchers indicated that they tend to apply them in their research. Perceived behavioral control was the strongest predictor of adherence and was generally high (82%). In the open comments, challenges and suggestions for improvement were expressed. Overall, the implementation of the recommendations progresses and respective norms emerge, but substantial challenges remain to be solved requiring collective efforts.

Level of adherence to diet and physical activity among menopausal women and influencing factors in Jordan: a descriptive cross-sectional study.

During menopause, a woman's lifestyle may change significantly, which will have implications on her quality of life. Women will experience menopause for more than a third of their life; therefore, maintaining good health during this period is crucial. A healthy diet and physical activity can help women maintain their health during menopause. Hence, assessing adherence to a healthy diet and physical activity among menopausal women is important. This study aims to assess the degree of adherence to a healthy diet and physical activity of menopausal women in Jordan and determine the most influential factors. A descriptive cross-sectional design was used in this study, and an online self-administered questionnaire was sent to 299 menopausal women selected through simple random sampling. A valid and reliable questionnaire was used to assess the menopausal women's adherence to a healthy diet and physical activity. The questionnaire consisted of 14 items covering two domains: 12 questions for the diet domain and two questions for the physical activity domain. Descriptive statistics were obtained, mean weight and body mass index (BMI) were calculated, and stepwise regression was conducted for the data analysis. The overall degree of adherence to a healthy diet and physical activity of the women was moderate (49.25, SD = 7.17). Most of the participants reported eating refined food items once a month or less (n = 188, 62.9%) and not exercising weekly (n = 119, 39.8%), and only a few reported eating refined food items at least once a day (n = 5, 1.7%) and exercising 5-6 times a week (n = 15, 5%). The regression analysis showed that age (B = 0.145, p = 0.014), having two children (B = 0.123, p = 0.034) and completing primary or secondary education (B = 0.120, p = 0.038) were statistically significant and the strongest predictors of adherence. The predictors accounted for 68% of the variance in adherence to a healthy diet and physical activity (R2 = 0.068, F [343.54] = 7.123, p = 0.000). The majority of the middle-aged menopausal women in this study showed moderate adherence to a healthy diet and physical activity. Age, having two children and completing primary or secondary education were associated with degree of adherence to a healthy diet and physical activity. Therefore, healthcare intervention, such as physical activity and dietary control programs, should target women in this age group and stage in life.

Preventive Measures and Potential Risk Factors for Toxoplasmosis among ART Clients in Sunyani Municipality.

This current study looked at the risk factors and preventive measures among persons living with HIV who access ART care at the Sunyani Bono Regional Hospital. A cross-sectional study was used because it simultaneously assesses both outcome and exposure variables. 340 people out of the projected 5430 in the municipality were sampled. Convenience sampling was used to select currently well PLWHA attending the ART clinic in the Bono Regional Hospital for the study. The most prevalent potential risk factors identified were lack of purification of drinking water (88.5%), farming and gardening activities (42.9%), handling cat feces without personal protection (21.0%), not washing fruits before eating (3.1%), not washing vegetables before cooking (1.2%), and an unquantified consumption of undercooked meat. The preventive measures assessed were the use of co-trimoxazole preventive therapy (CPT) and antiretroviral therapy (ART), adherence to which was tested for their relationships with socio-demographic characteristics and challenges to adherence at the first four levels of the social-ecological model. Strong predictors of adherence were occupation and satisfaction with ARVs. However, in this study, no significant relationship was found with the multivariate analysis. Similarly, no significant relationship was identified between age and adherence to CPT at any stage of the analysis in this research study. It is recommended that clinicians who are involved in ART care encourage patients in all categories of occupations to make their treatment a priority since their health is vital to all other pursuits in their lives.

Determinants of Antiretroviral Treatment Success and Adherence in People With Human Immunodeficiency Virus Treated for Tuberculosis.

In people with human immunodeficiency virus [HIV] presenting with advanced disease, rates of virologic success may be lower than expected. The Reflate TB2 trial did not show non-inferiority of raltegravir versus efavirenz in people with HIV (PWH) treated for tuberculosis. We aimed to identify factors associated with virologic success and higher adherence in the trial. In this analysis, we included participants enrolled in the Reflate TB2 trial with adherence data available. The primary outcome was virologic success (HIV-1 ribonucleic acid [RNA] <50 copies/mL) at week 48, and the secondary outcome was adherence as assessed by the pill count adherence ratio. We used logistic regression to study determinants of virologic success and optimal adherence in 2 separate analyses. Four hundred forty-four participants were included in the present analysis. Over the 48-week follow-up period, 290 of 444 (65%) participants had a pill count adherence ratio ≥95%. At week 48, 288 of 444 (65%) participants were in virologic success. In the multivariate analysis, female sex (adjusted odds ratio [aOR], 1.77; 95% confidence interval [CI], 1.16-2.72; P = .0084), lower baseline HIV-1 RNA levels (<100 000; aOR, 2.29; 95% CI, 1.33-3.96; P = .0087), and pill count adherence ratio ≥95% (aOR, 2.38; 95% CI, 1.56-3.62; P < .0001) were independently associated with virologic success. Antiretroviral pill burden was the only factor associated with pill count adherence ratio ≥95% (OR, 0.81; 95% CI, .71-.92; P = .0018). In PWH with tuberculosis receiving raltegravir or efavirenz-based regimens, female sex, optimal adherence, and baseline HIV-1 RNA <100 000 copies/mL were associated with virologic success, and the number of antiretroviral tablets taken daily was a strong predictor of adherence.

Machine Learning Approaches to Understanding and Predicting Patterns of Adherence

In cognitive training of older adults, adherence is a major challenge, but appropriate just-in-time adaptive interventions can improve adherence. To understand adherence patterns and predictors of adherence lapses, we aggregated data from two previous trials (N > 230) involving home-based cognitive interventions. This dataset, detailing 40,000 intervention interactions, contains information about intervention engagement and measures of objective and subjective cognitive performance, demographics, technology proficiency, and attitudes. Exploratory analyses were conducted to understand patterns and predictors of faltering adherence, using classification models, together with feature selection to remove redundant variables. Adherence behaviors in a week were predictive of quitting the following week. Game parameters such as the time of play were weak indicators of future playing patterns, whereas game success was a strong predictor of adherence. These and other useful observations will be incorporated in the design and development of the smart reminder system to be deployed in the APPT project.

Drug- and patient-related factors are the strongest predictors of endocrine therapy adherence in breast cancer patients.

Medication non-adherence to treatment regimens can severely impact the mortality of patients afflicted with breast cancer.The purpose of this study was to identify factors that contribute to non-adherence to endocrine therapy in breast cancer treatment plans. Thirty-two women with a breast cancer diagnosis were surveyed by pharmacists and pharmacy students to identify the patient- related factors (e.g. patient personal beliefs, education level), drug-related factors (e.g. patient drug allergies), socio-economic factors (e.g. patient ability to pay for the medication) and healthcare system factors (e.g. poor patient-healthcare provider relationship) that may impact non-adherence to endocrine therapy in breast cancer treatment plans. Medication adherence rates were measured using the Medication Adherence Rating Scale (MARS-8) system. Associations between adherence rate scores and clinical variables (e.g. age, tobacco use, alcohol consumption, cost of treatment, education level, personal beliefs, drug allergies, patient/provider relationship, adverse events) were carried out using Spearman Correlation, T-Test, Mann-Whitney U Test, and X2 tests. A p value of ≤ 0.05 was considered statistically significant. Our study found that 59% of survey respondents were non-adherent to their endocrine therapy in breast cancer treatment plans. Drug allergies (p = 0.000069), patient ability to pay (p = 0.005), poor personal beliefs about the prescribed therapy (p = 0.009), low education level (p = 0.025), adverse drug events (p = 0.026), and poor patient-provider relationship (p = 0.05) were found to play a role in patient non-adherence to treatment. Our study found that drug- (e.g. allergies), socio-economic (e.g. patient ability to pay), and patient-related factors (e.g. personal beliefs) are the strongest predictors of adherence among breast cancer patients undergoing endocrine therapy. These findings support the need for a better relationship between breast cancer patients and their healthcare providers, including drug experts such as pharmacists.

Adherence to drug therapy among hypertensive patients attending two district hospitals in Ghana

A major drawback to the management of hypertension among patients is poor adherence to pharmacotherapy. Factors that influence non-adherence to antihypertensive drugs could vary, depending on the prevailing condition of patient and setting. Knowledge of adherence patterns and behavior of hypertensive patients to pharmacotherapy could improve health-directed policies towards hypertension management. The objective of this study was to determine factors that influence adherence to oral antihypertensive drugs among patients attending two district hospitals in the Volta Region of Ghana. The study was cross-sectional. Respondents were hypertensive patients attending Krachi West District (n=187) and Hohoe Municipal (n=183) hospitals between March 2016 to May 2016. Data was collected using a structured questionnaire and Morisky 8 Item Measurement of adherence scale. Adherence to oral antihypertensive drugs was 89.2%. However, more than half of these respondents appeared to have uncontrolled blood pressure; and this may be due to self-response bias, blood pressure being measured only on the day of the interview or use of fake drugs (which was not assessed in this study). The strongest predictors of adherence were; knowledge on hypertension, perception of severity of condition and the amount of alcohol consumed in a day by respondents. Good adherence to oral antihypertensive drugs was observed in this population despite uncontrolled hypertension in a number of the respondents. The three independent predictors of adherence to antihypertensive medications in this study were respondent's knowledge about hypertension, perception of severity of their condition and the amount of alcohol consumed in a day. Regular patient education and counseling by medical practitioners should be encouraged in these settings to improve patient adherence.

Abstract 2423: Longitudinal examination of breast cancer screening adherence among women in a prospective familial cohort

Abstract Background: Since 2007, U.S. national guidelines recommend cancer-free women at ≥20% lifetime risk of breast cancer (BC) undergo BC screening with mammogram and breast MRI. Little is known about long-term adherence to BC screening among young high-risk women. To address this knowledge gap, we examined predictors of screening adherence over time among women with varying BC risk. Methods: Eligible women were ≥ 30 years old, had no history of BC/ovarian cancer, an intact breast, are enrolled in the Breast and Ovarian Surveillance Service (BOSS) Cohort, and visited the Johns Hopkins Cancer Genetics Clinic for risk assessment ≥ 2004 but prior to cohort enrollment (N = 374). Screening recommendations were determined from Tyrer-Cuzick BC lifetime risk estimates obtained at the clinic visit. Screening was self-reported at baseline, 4, and 8 years. A subset has been validated. An adherent screen before 2007 was mammography for women &amp;lt;20% risk at age ≥ 40 years or ≥20% risk/BRCA1/2 positive (high-risk). After 2007, an adherent screen for high-risk women was mammography and MRI. Cumulative adherence up to 2017 was also calculated. Associations between estimated risk, patient characteristics, and screening adherence were quantified using logistic regression. Results: At baseline, the median age was 47 years, 31% had lifetime risk &amp;lt;20%, 60% had risk ≥20%, 8.8% were BRCA1/2 positive, and 69.5% were adherent to population BC screening recommendations. Over a median follow-up of 7.5 years, 9% of women underwent prophylactic bilateral mastectomy and 5% were diagnosed with BC. At each time point, proportion of mammography and MRI was ~80% and ~22.5%, respectively. The ≥20% group had better mammography adherence than the &amp;lt;20% group at 4 years [OR=2.0; 95%CI=1.1-3.7] and 8 years [OR=2.2; 95%CI=1.2-3.8], but was less adherent to risk-appropriate screening than the &amp;lt;20% group at 4 and 8 years [OR=0.2; 95%CI=0.1-0.4] [OR=0.4; 95%CI=0.2-0.6], respectively. Adherence was similar in the ≥20% and ≥30% high-risk groups. Risk-appropriate adherence at 4 years was predictive of adherence at 8 years [OR=11.1; 95%CI=5.5-22.5], adjusted for estimated risk, age, year of risk assessment, parity, other types of screening, comorbidities, and baseline adherence. In a multivariable model of cumulative risk-appropriate adherence, women with ≥20% risk (vs. &amp;lt;20%) or women with comorbidities (vs. no comorbidities) were less likely to consistently screen over 8 years [both OR=0.3; 95%CI=0.1-1.0], while women of older ages (vs. younger) were more likely [OR=1.2; 95%CI=1.1-1.3]. Conclusion: High-risk young women were not adherent to the more intensive screening regimen, and adherence did not improve over time. Other strong predictors of adherence included older age, prior adherence, and fewer comorbidities. New screening alternatives and interventions targeting reasons for non-adherence should be evaluated for high-risk women. Citation Format: Marcy L. Schaeffer, Betty J. May, Brenna C. Hogan, Mikiaila M. Orellana, Dana Petry, Katie Fiallos, Michelle S. McCullough, Deborah K. Armstrong, Kelly Myers, Kala Visvanathan. Longitudinal examination of breast cancer screening adherence among women in a prospective familial cohort [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 2423.

Determinants of adherence to tuberculosis treatment in Iranian patients: Application of health belief model.

Adherence to TB treatment is an important issue for TB control, with key health consequences. Identification of the factors associated with that adherence is also important. The objective of this study was to identify factors associated with adherence to tuberculosis treatment, using the health belief model (HBM). Overall 297 TB patients were recruited to the study using the census method. All patients completed a 40-question survey form anonymously. The questionnaire was developed based on the Health Belief Model. Data collection was carried out through interviews and questionnaires, as well as observing medical records and medical cards to be used in medical performance checklists. The participants comprised 159 men and 138 women with an average age of 56.8 years (range 19-72 years). The results showed that the variables of perceived threat, benefits, barriers, and self-efficacy accounted for 42% of the variance in therapeutic adherence. The strongest predictor of adherence was found to be self-efficacy. HBM appears to be a suitable model in predicting therapeutic adherence in TB patients. Our results emphasize the centrality of self-efficacy in treatment adherence, that health educators should consider when developing programs to motivate patients to adhere to treatment.

Medication adherence for resistant hypertension: Assessing theoretical predictors of adherence using direct and indirect adherence measures.

This study examined theoretical predictors of long-term medication adherence (i.e., treatment-related beliefs, coherence of beliefs from experience with medication, habit strength, and pill burden) for patients with apparent treatment-resistant hypertension in primary care, using a composite adherence score derived from direct and indirect measures (i.e., prescription refill, self-report, and bioanalytical assays of urine). Cross-sectional study. Individual patient records were screened for prescription refill adherence. Patients provided a urine sample for adherence screening and completed a battery of psychometric scales, including two self-report adherence measures (N=204). Convergence of adherence measures was assessed, a composite adherence score was calculated, and hierarchical multiple regression was used to examine the role of theoretical predictors of adherence. Non-adherence estimates ranged from 20.3 to 41.1%, depending on the assessment method used. Associations among adherence measures were weak to moderate (ρ=.00-.53). Medication-taking habit strength was the strongest predictor of adherence, explaining 19% incremental variance in adherence beyond treatment-related beliefs. Beliefs and coherence did not predict adherence, even for patients with weaker habits. Pill burden was not associated with habit strength or adherence for this sample. Associations among unique adherence measures were weak overall, providing further evidence that multiple measures are necessary to accurately assess adherence. Habit strength is a key predictor of adherence for chronic conditions. Both habit strength and pill burden represent important intervention targets for improving long-term medication adherence. Longitudinal inception studies are needed to properly test Common-Sense Model propositions and elucidate the role of beliefs, coherence, and habits in predicting adherence at various stages of the chronic illness trajectory. Statement of contribution What is already known on this subject? Non-adherence to antihypertensives is a leading cause of apparent treatment-resistant hypertension (aTRH). Behaviour maintenance (vs. initiation) factors may be more predictive of long-term adherence. What does this study add? Associations among direct and indirect measures of adherence are generally weak. Habit strength is the strongest predictor of long-term adherence for aTRH in primary care. Inception studies are needed to further validate Common-Sense Model propositions.

Improving patient adherence to secondary prevention medications 6 months after an acute coronary syndrome: observational cohort study.

Most patients are recommended secondary prevention pharmacotherapies following an acute coronary syndromes (ACS). To identify predictors of adherence at 6 months and strategies to improve adherence to these therapies. Patients in the CONCORDANCE registry who were discharged on evidence-based medications were stratified into those receiving ≥75% ('adherent') or <75% ('non-adherent') of indicated medications at 6 months. Baseline characteristics, hospital and post-discharge care were compared between groups. Multivariable logistic analysis identified independent predictors of adherence. The relative contribution of each clinical or treatment factor to 'adherence' was determined using an adequacy measure method. Follow-up data were available for 6595 patients, 4492 (68.1%) of whom were 'adherent'. Clinical factors predictive of adherence included previous stroke, percutaneous coronary intervention (PCI) and hypertension (odds ratios (OR) 1.36-1.56); factors predictive of non-adherence included discharge diagnosis of non-ST-segment elevation myocardial infarction (vs unstable angina) (OR 0.51) and atrial fibrillation (OR 0.59). Discharge on ≥75% of indicated medications was a strong predictor of adherence at 6 months (OR 10.23, 95% confidence interval 7.89-13.27); in-hospital management factors predicting non-adherence were medical management alone (OR 0.34) and coronary artery bypass graft (OR 0.50) (both vs PCI). Post-discharge predictors of adherence included cardiac rehabilitation (OR 1.36) and general practitioner attendance (OR 1.40). Failure to discharge patients on indicated therapies is the most important modifiable predictor of adherence failure 6 months after an ACS. Implementing protocols to automate prescription of indicated discharge therapies, has the potential to reduce non-adherence dramatically in the 6 months following discharge.

Adherence to treatment among chronically ill ambulatory patients

Abstract According to Information-Motivation-Behavioural Skills model (IMB), accurate Information, strong Motivation and adequate Behavioural skills are prerequisites of treatment adherence. This model has been verified among chronically ills patients, usually suffering from one particular disorder. No studies report how the model fits data from a more diverse group. The aim of the study was to analyze adherence and its barriers in a group of three hundred patients suffering from various, common chronic disorders. They filled out IMB and Adherence Questionnaire. Information and Motivation correlated moderately (.35). Behavioural Skills was the strongest predictor of adherence (.24). An additional relationship was found: Information and Motivation interacted and the role of either of these dimensions vanished if the indices of the other were high enough. The relationships between IMB dimensions and adherence were confirmed in a varied clinical sample. Behavioural skills must be considered when working with non-adherent patients, as they are the strongest predictor of adherence. Other interventions may be limited to either Information or Motivation only if there is a chance of raising one of them to extreme levels. This may be useful with special cases, when increasing both is problematic.

Risk factors for non-adherence to disease-modifying therapy in pediatric multiple sclerosis

Background: Adherence to disease-modifying therapies (DMTs) in pediatric multiple sclerosis (MS) is not well understood. We examined the prevalence and risk factors for poor adherence in pediatric MS. Methods: This cross-sectional study recruited youth with MS from 12 North American pediatric MS clinics. In addition to pharmacy-refill data, patients and parents completed self-report measures of adherence and quality of life. Additionally, patients completed measures of self-efficacy and well-being. Factor analysis and linear regression methods were used. Results: A total of 66 youth (mean age, 15.7 years) received MS DMTs (33% oral, 66% injectable). Estimates of poor adherence (i.e. missing >20% of doses) varied by source: pharmacy 7%, parent 14%, and patient 41%. Factor analysis yielded two composites: adherence summary and parental involvement in adherence. Regressions revealed that patients with better self-reported physical functioning were more adherent. Parents were more likely to be involved in adherence when their child had worse parent-reported PedsQL School Functioning and lower MS Self-Efficacy Control. Oral DMTs were associated with lesser parental involvement in adherence. Conclusion: Rates of non-adherence varied by information source. Better self-reported physical functioning was the strongest predictor of adherence. Parental involvement in adherence was associated with worse PedsQL School Functioning and lower MS Self-Efficacy-measured confidence in controlling MS.

Differences in motivation and adherence to a prescribed assignment after face-to-face and online psychoeducation: an experimental study

BackgroundAdherence to treatment homework is associated with positive outcomes in behavioral psychotherapy but compliance to assignments is still often moderate. Whether adherence can be predicted by different types of motivation for the task and whether motivation plays different roles in face-to-face compared to online psychotherapy is unknown. If models of motivation, such as Self-determination theory, can be used to predict patients’ behavior, it may facilitate further research into homework promotion. The aims of this study were, therefore, to investigate whether motivation variables could predict adherence to a prescribed assignment in face-to-face and online interventions using a psychotherapy analog model.MethodsA total of 100 participants were included in this study and randomized to either a face-to-face or online intervention. Participants in both groups received a psychoeducation session and were given an assignment for the subsequent week. The main outcome measurements were self-reported motivation and adherence to the assignment.ResultsParticipant in the face-to-face condition reported significantly higher levels of motivation and showed higher levels of adherence compared to participants in the online condition. Adherence to the assignment was positively associated with intrinsic motivation and intervention credibility in the whole sample and especially in the online group.ConclusionsThis study shows that intrinsic motivation and intervention credibility are strong predictors of adherence to assignments, especially in online interventions. The results indicate that intrinsic motivation may be partly substituted with face-to-face contact with a therapist. It may also be possible to identify patients with low motivation in online interventions who are at risk of dropping out. Methods for making online interventions more intrinsically motivating without increasing external pressure are needed.Trial registrationclinicaltrials.gov NCT02895308. Retrospectively registered 30 August 2016.

Adherence to Antiretroviral Therapy and Associated Factors Among Adult ARV Users in Arba Minch Hospital, Southern Ethiopia

The provision of Antiretroviral Therapy (ART), HIV/AIDS is becoming a chronic manageable disease; therefore to manage chronic disease, adherence to HIV medication is very important but a variety of other factors may complicate ART adherence that needs devotion from patients, provisions of health services and health care professionals, and having social support from the society. The purpose of this study was to determine the level of adherence to ART and associated factors among adult antiretroviral drugs (ARV) users. A cross sectional study was carried out at Arba Minch Hospital from March 5 to May 5, 2015. One month patients’ self-report and pharmacy refill records were used to assess adherence. Data were collected by a standard questionnaire after pre-tested and data abstraction format. The collected data were entered in to Epi-Info and it was exported in to SPSS for data analysis. Multiple logistic regressions analysis was applied and statistical significance test was declared at P-value &lt;0.05 and OR with 95% CI. Based on patients’ self-report dose adherence, among the 428 study participants, the magnitude of adherence to ART in a month before interview was 77.10%. Multivariable analysis showed that, adherence was positively associated with sex (male) (AOR=3.03, CI (1.69-5.42)), free from substance uses (AOR=3.49, CI (1.80-6.77)), absence of side effect of drugs (AOR =2.61, CI (1.19-5.73)), ART schedule fit to daily routines (AOR= 2.93, CI (1.24-6.91)) and feeling comfort on taking ART drug in front of others (AOR=3.32, CI (1.54-7.16)). The ART adherence rate of this study was relatively low compared with WHO standard and others study in Ethiopia. Sex, feeling comfort on taking the ART drugs, ART schedule fit to daily routines, substance use and drug side effects were strong predictors of adherence.

The predictors to medication adherence among adults with diabetes in the United Arab Emirates.

BackgroundDiabetes is a chronic medical condition and adherence to medication in adults with diabetes is important. Identifying predictors to medication adherence in adults with diabetes would help identify vulnerable patients who are likely to benefit by improving their adherence levels.MethodsWe conducted a cross-sectional study at the Dubai Police Health Centre between February 2015 and November 2015. Questionnaires were used to collect socio-demographic, clinical and disease related variables and the primary measure of outcome was adherence levels as measured by the Morisky Medication Adherence Scale (MMAS-8©). Multivariate logistic regression was carried out to identify predictors to adherence.ResultsFour hundred and forty six patients were interviewed. Mean age 61 year +/− 11. 48.4 % were male. The mean time since diagnosis of diabetes was 3.2 years (Range 1–15 years). Two hundred and eighty eight (64.6 %) patients were considered non-adherent (MMAS-8© adherence score < 6) while 118 (26.5 %) had moderate adherence (MMAS-8© adherence score 6 = <8) and 40 (9.0 %) high adherence (MMAS-8© adherence scores <8) to their medication respectively. The strongest predictor for adherence as predicted by the multi-logistic regression model was the patient’s level of education. A technical diploma certificate as compared to a primary school level of education was the strongest predictor of adherence (OR = 66.1 CI: 6.93 to 630.43); p < 0.001). The patient’s age was also a predictor of adherence with older patients reporting higher levels of adherence (OR = 1.113 (CI: 1.045 to 1.185; p = 0.001 for every year increase in age). The duration of diabetes was also a predictor of adherence (OR = 1.830 (CI: 1.270 to 2.636; p = 0.001 for every year increase in the duration of diabetes). Other predictors to medication adherence include Insulin use, ethnicity and certain cultural behaviours.ConclusionA number of important predictors to medication adherence in diabetics were identified in this study. Such predictors could help develop policies for improving adherence in diabetics.

Predicting Coaches' Adherence/Dropout: A Prospective Study

The objective of this study was to examine motivational variables based on self-determination theory (SDT) and positive psychology as predictors of coaches' adherence and dropout. A prospective study was performed using a sample of 286 coaches who were tracked over a two-year period. Initially coaches' motivation and psychological need satisfaction were measured; two years later they were contacted and asked if they were still coaching in their original sport. Those who did not were considered as drop-outs for the current study. Logistic binary regression analyses were performed to analyse predictors of persistence and dropout. Need Satisfaction Index (NSI), perceived competence and perceived usefulness were identified as protective factors for coaches' adherence, while amotivation was a risk factor of dropout. The fundamental psychological needs of competence and perceived usefulness were the strongest predictors of adherence. Discussions focused on the SDT-grounded predictive factors of coaches' adherence in order to further understand this phenomenon.

Impact of community pharmacist intervention discussing patients' beliefs to improve medication adherence.

Adherence to evidence based medicines in patients who have experienced a myocardial infarction remains low. Individual's beliefs towards their medicines are a strong predictor of adherence and may influence other factors that impact on adherence. To investigate if community pharmacists discussing patients' beliefs about their medicines improved medication adherence at 12 months post myocardial infarction. This study included 200 patients discharged from a public teaching hospital in Queensland, Australia, following a myocardial infarction. Patients were randomised into intervention (n = 100) and control groups (n = 100) and followed for 12 months. All patients were interviewed between 5 to 6 weeks, at 6 and 12 months post discharge by the researcher using the repertory grid technique. This technique was used to elicit the patient's individualised beliefs about their medicines for their myocardial infarction. In the intervention group, patients' beliefs about their medicines were communicated by the researcher to their community pharmacist. The pharmacist used this information to tailor their discussion with the patient about their medication beliefs at designated time points (3 and 6 months post discharge). The control group was provided with usual care. The difference in non-adherence measured using a medication possession ratio between the intervention and control groups at 12 months post myocardial infarction. There were 137 patients remaining in the study (intervention group n = 72, control group n = 65) at 12 months. In the intervention group 29 % (n = 20) of patients were non-adherent compared to 25 % (n = 16) of patients in control group. Discussing patients' beliefs about their medicines for their myocardial infarction did not improve medication adherence. Further research on patients beliefs should focus on targeting non-adherent patients whose reasons for their non-adherence is driven by their medication beliefs.

Adherence to prescribed artemisinin-based combination therapy in Garissa and Bunyala districts, Kenya

BackgroundFollowing the development of resistance to anti-malarial mono-therapies, malaria endemic countries in Africa now use artemisinin-based combination therapy (ACT) as recommended first-line treatment for uncomplicated malaria. Patients' adherence to ACT is an important factor to ensure treatment efficacy, as well as to reduce the likelihood of parasite resistance to these drugs. This study reports adherence to a specific ACT, artemether-lumefantrine (AL), under conditions of routine clinical practice in Kenya.MethodThe study was undertaken in Garissa and Bunyala districts among outpatients of five government health facilities. Patients treated with AL were visited at home four days after having been prescribed the drug. Respondents (patients ≥ 15 years and caregivers of patients < 15 years) were interviewed using a standardized questionnaire, AL blister packs were physically inspected and the adherence status of patients was then recorded. Multivariate logistic regression modelling was used to determine predictors of adherence.ResultsOf the 918 patients included in the study, 588 (64.1%) were 'probably adherent', 291 (31.7%) were 'definitely non-adherent' and 39 (4.2%) were 'probably non-adherent'. Six factors were found to be significant predictors of adherence: patient knowledge of the ACT dosing regimen (odds ratio (OR) = 1.76; 95% CI = 1.32-2.35), patient age (OR = 1.65; 95% CI = 1.02-1.85), respondent age (OR = 1.37; 95% CI = 1.10-2.48), whether a respondent had seen AL before (OR = 1.46; 95% CI = 1.08-1.98), whether a patient had reported dislikes to AL (OR = 0.62 95% CI = 0.47-0.82) and whether a respondent had waited more than 24 hours to seek treatment (OR = 0.73; 95% CI = 0.54-0.99).ConclusionOverall, adherence to AL was found to be low in both Garissa and Bunyala districts, with patient knowledge of the AL dosing regimen found to be the strongest predictor of adherence. Interventions aimed at increasing community awareness of the AL dosing regimen, use of child friendly formulations and improving health workers' prescribing practices are likely to ensure higher adherence to AL and eventual treatment success.

Abstract A11: Health information needs and predictors of cancer screening status among patients with limited health literacy

Abstract Background: Primary care physician (PCP) recommendation for cancer screening is a strong predictor of adherence to screening; however, patients with limited health literacy (HL) may have difficulty understanding information about screening. We implemented a continuing medical education program to train PCPs in cancer risk communication with limited HL patients. Our main study objective is to determine whether changes in PCP communication improve patients’ adherence to cancer screening. We examined baseline patient characteristics to assess whether patients’ cancer screening information needs vary across levels of limited HL and determine which factors may influence adherence to different types of cancer screening tests. Methods: This study is part of a 4-year randomized controlled trial of a communication skills training program targeting PCPs (11 intervention vs. 8 control) who practice in safety-net clinics in New Orleans, LA and their patients with limited HL (Rapid Estimate of Adult Literacy in Medicine [REALM] score &amp;lt; 60). For each PCP, we recruited 10 patients (men [age 50–75]; women [age 40–75]) who were overdue for at least one cancer screening test (mammography; pap smears; FOBT/ endoscopy/barium enema). We conducted baseline interviews to obtain socio-demographics, cancer knowledge, cancer screening status and ratings of physician communication style (Perceived Involvement in Care Scale). We conducted baseline chart reviews to confirm cancer screening status. Results: Of 871 clinic patients screened to date, 164 met eligibility criteria (target sample size: 180). The most common reasons for exclusion were HL too high (37%), up-to-date on cancer screening (20%), or new patients to the PCP (12%). Most eligible patients are African American (90%), female (77%), insured (61%) and read at the 7th-8th grade level (67%). Only 35% of the study sample was up-to-date by chart review on mammography, 34% on pap smears, and 29% on colorectal cancer screening. Patient ratings of the level of information exchange with their PCPs varied by level of HL with patients with &amp;lt; 3rd grade reading level rating their PCPs significantly lower (mean [SD]: 2.9 [1.4]) than patients with higher reading levels (7th-8th grade: 3.4 [1.0]; 5th-6th grade: 3.7 [0.6]). Overall, less than 1/3 of patients knew the age at which to start breast/cervical/CRC screening. Knowledge about the cancer screened for by mammography and the tests available for CRC screening varied significantly by level of HL (7th-8th grade vs. 5th-6th grade vs. &amp;lt;3rd grade: Breast, 83% vs. 69% vs. 41%; CRC, 51% vs. 32% vs. 12%). Only 10% of patients knew that pap smears screen for cervical cancer. There was no significant difference in cancer screening status by level of HL, cancer screening knowledge or perceptions of involvement in care. For mammography, the odds of being up-to-date increased with having insurance (OR, 95% CI: 3.2 [1.4–7.5]) and emotional/informational support (1.6 [1.2-2.2]) whereas receiving care in a community health center reduced the odds (0.42 [0.2-0.9]). For CRC screening, family history of CRC increased the odds of being up-to-date (5.7 [1.3-23.8]) whereas emotional/informational support reduced the odds (0.63 [0.5-0.9]). There were no significant factors that influenced cervical cancer screening status. Although patients’ perceptions of health information exchange and cancer screening knowledge may depend on their level of health literacy, psychosocial, familial and health system related factors may ultimately influence adherence to cancer screening. Message framing for cancer risk communication should take these factors into consideration. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A11.