Treatment Adherence Behaviors Research Articles

Predictors of treatment adherence in patients with type 2 diabetes: a cross-sectional study in Southern Iran based on Pender’s Health Promotion Model using structural equation modelling

ObjectivesTreatment adherence in type 2 diabetes (T2D) is an important factor in optimal diabetes control and prevention of mortality. The present study aimed to determine the predictability of Pender’s Health...

Nomogram model for predicting medication adherence in patients with various mental disorders based on the Dryad database

ObjectiveTreatment compliance among psychiatric patients is related to disease outcomes. How to assess patient compliance remains a concern. Here, we established a predictive model for medication compliance in patients with...

The Effectiveness of an Intervention Based on the Information, Motivation, and Behavioral Skills Model on Treatment Adherence and Self-Efficacy in Patients with Coronary Artery Diseases: An Explanatory Mixed Method Study

Background: Promoting adherence to treatment and self-efficacy in patients with coronary artery diseases helps to improve patient outcomes. The present study was conducted to explain the effectiveness of interventions based on information, motivation, and behavioral skills model on treatment adherence and self-efficacy in patients with coronary artery diseases. Methods: This explanatory-sequential study was conducted on patients with coronary artery diseases in Shiraz, Iran. First, a quasi-experimental study was conducted on 112 patients who were randomly assigned to two intervention and control groups. The intervention consisted of ten motivational training sessions that were designed based on Information, Motivation, and Behavioral Skills (IMBS) model and continued with six months of telephone follow-up and counseling. Data were collected before, three months, and six months after the end of the intervention. Then, in the second phase, a qualitative study including 20 in-depth interviews with 18 participants from the intervention group was conducted. The data were analyzed by deductive and inductive qualitative content analysis. Finally, quantitative findings were explained with the help of qualitative findings. Results: The findings showed that the mean score of treatment adherence, medication adherence, and self-efficacy in the intervention group was significantly higher than the control group 3 and 6 months after the intervention (p<0.001). The results of the qualitative phase of the study also showed that the four main categories include receiving targeted information, encouragement to care, gained self-efficacy/doubt in care, and improvement/non-improvement of treatment adherence behaviors can explain quantitative phase results. Conclusion: The results showed that receiving training with effective methods, strengthening the support system, self-confidence and positive attitudes about care, and promoting self-management and proper management of emotional distress contributed to the effectiveness of the interventions. However, receiving conflicting information, limited financial resources, and the inability to face challenges were among the obstacles to strengthening self-efficacy and adherence to treatment.

Psychometrics properties of type 2 diabetes treatment adherence questionnaire (DTAQ): a study based on Pender’s health promotion model

BackgroundManagement of type 2 diabetes (T2D) as a chronic disease requires treatment adherence such as controlling the blood glucose level and adopting a healthy lifestyle. The present study aimed to develop and psychometrically evaluate a questionnaire based on the Pender’s Health Promotion Model (HPM) to measure treatment adherence and the associated factors among T2D patients.MethodsThe present study was conducted in qualitative and the quantitative phases between March 2022 and March 2023. The participants were T2D patients visiting Shahid Mohammadi hospital Diabetes Clinic in Bandar Abbas in the south of Iran. The first draft of items was extracted from the qualitative phase. The present study used interviews with T2D patients, item construction, validity and reliability evaluation of the instrument, and the relevant statistical analyses. It emphasized the significance of content, face, and construct validity, along with reliability testing using Cronbach’s alpha and test-retest method. Data were analyzed using SPSS software, V16 and AMOS, V23.ResultsA 97-item questionnaire was developed through the qualitative phase and, after content validity, it was reduced to 86 items. Five items were removed in face validation, and after the test-retest method, 79 items were retained. The confirmatory factors analysis confirmed a 65-item model with appropriate fitness of data. Cronbach’s alpha coefficient showed an acceptable reliability of the diabetes treatment adherence questionnaire (α = 0.92).ConclusionThe questionnaire developed based on the HPM model provides a standard and comprehensive measurement of the degree of adherence to treatment and the associated factors among Iranian T2D patients. This is especially valuable in the Iranian healthcare context, where effective management of chronic diseases such as diabetes is of a top priority. Questionnaires can help identify barriers and facilitators of treatment adherence to inform systematic and goal-oriented interventions. The proposed questionnaire had good psychometric properties, and can be used as a valid and practical instrument to measure the factors related to treatment adherence behaviors.

The Effect of the Fear of COVID-19 on Treatment Adherence and Health-Seeking Behavior in Individuals with Type 2 Diabetes

Objective: This descriptive and cross-sectional study aimed to determine the impact of COVID-19 induced fear on the treatment adherence and health-seeking behavior of individuals with type 2 diabetes. Methods: The sample for this research consisted of 150 type 2 diabetes patients who attended the Mersin City Training and Research Hospital endocrinology outpatient clinics for treatment and follow-up. Data collection involved the use of a Personal Information Form, the COVID-19 Fear Scale, the Type 2 Diabetes Mellitus Patient Treatment Adherence Scale, and the Health-Seeking Behavior Scale. Data was analyzed using Student’s t-test, One Way ANOVA and Multiple Linear Regression analysis. Findings: Among the individuals participating in the study, it was determined that while 54.7% were female, 48.7% had an HbA1c level of 8.1 and above, 64% used insulin, 80.7% developed complications related to diabetes and the average age of the participants were 62.9±11.9. Furthermore, the majority were not diagnosed with COVID-19, and they did not require hospitalization due to COVID-19. The adherence to diabetes treatment among the patients was found to be moderate, with the lowest adherence was observed in terms of lifestyle changes and the highest adherence was observed in terms of the emotional and behavioral adherence dimensions. Multiple regression analysis revealed that the fear of COVID-19 did not affect diabetes treatment adherence levels of the patients (p>0.05). It was found that only those patients who were using insulin and those who were not adhering to medical nutritional treatment had lower adherence to diabetes treatment (p

A health promotion model-based intervention to enhance treatment adherence in patients with type 2 diabetes

BackgroundThe present study aimed to determine the effect of an intervention based on Pender’s health promotion model (HPM) on treatment adherence in patients with type 2 diabetes (T2D).MethodsThe present quasi-experimental study with a 3-month follow-up was conducted in Bandar Abbas, a city in the south of Iran in 2023. The intervention group (IG) with a total number of 95 T2D patients was selected from Hormuz diabetes clinic and the control group (CG) with 95 T2D patients was selected from comprehensive health centers through a clustering sampling method. The educational intervention was implemented in 10 sessions to improve patients’ treatment adherence. The teaching methods in training sessions were lectures, joint discussions, Q&A, role-play and peer training. The participants were evaluated using a researcher-made questionnaire including the constructs of Pender’s HPM about T2D treatment adherence, hemoglobin A1C (HbA1C), and BMI. Independent-samples t-test, paired-samples t-test, covariance analysis and stepwise regression analysis were used. Data analysis was done in SPSS 26.FindingsThree months after the intervention, in comparison to the CG, the mean and standard deviation of treatment adherence benefits (p = 0.002), treatment adherence self-efficacy (p = 0.010), treatment adherence related affect (p = 0.001), interpersonal influences (p = 0.012), commitment to plan of action (p < 0.001), treatment adherence behavior (p = 0.022), treatment adherence experiences (p = 0.001) was higher in the IG. The mean and standard deviation of situational influences (p < 0.001), immediate competing demands and preferences (p = 0.018) were lower than the CG. The results obtained from the analysis of covariance proved the effectiveness of the intervention in the constructs of Pender’s HPM and HbA1C in participants of the IG (p < 0.001). The regression analysis showed, after the intervention, for every 1 unit of change in commitment to behavior planning, action related affect and perceived self-efficacy, compared to before the intervention, there were 0.22 units, 0.16 units and 0.26 units of change in the behavior score in the IG.ConclusionThe findings proved the effectiveness of the educational intervention in improving the constructs in Pender’s HPM and the blood sugar level of T2D patients. As the results of the educational intervention showed, the use of a suitable educational approach as well as the development of appropriate educational content for the target population can significantly improve the treatment adherence behavior.Trial registrationThis study is registered on the Iranian Registry of Clinical Trials (IRCT20211228053558N1: https://www.irct.ir/trial/61741) and first release date of 17th March 2022.

Can Support Groups Improve Treatment Adherence and Reduce Sexual Risk Behavior among Young People Living with HIV? Results from a Cohort Study in South Africa.

Adolescents and young adults living with HIV (AYLHIV) in sub-Saharan Africa experience poorer HIV outcomes than adults, including lower ART adherence and virologic suppression. They also have high rates of unprotected sex, increasing the risk of adverse sexual health outcomes and onward transmission. This one-arm, pre-post study investigates a structured 14-session support group aiming to boost treatment adherence and sexual protective behavior for AYLHIV in South Africa. Logistic and Poisson regression analyses were performed on self-reported pre- and post-intervention survey data collected approximately 7.5 months apart from a cohort of 548 AYLHIV. Participants were significantly more likely to report at least 95% adherence at follow-up and rate their health as "good;" they also demonstrated greater treatment knowledge and had fewer absences from school overall and due to illness. Among sexually active AYLHIV, contraception use at last sex increased significantly, while condom use did not. Effects were small, and greater programmatic emphasis on adherence and multifaceted service packages is likely necessary to promote viral suppression. Nonetheless, the intervention addresses an important gap in service provision for AYLHIV in South Africa. Findings denote the potential for incorporating care and treatment components into sexual and reproductive health interventions tailored for AYLHIV.

Perceived social support and treatment adherence in Chileans with Type 2 diabetes.

This study aimed to determine if greater perceived social support was directly associated with better Type 2 diabetes (T2D) treatment adherence and if better T2D treatment adherence was related to lower HbA1c levels in Chilean adults with T2D. For this purpose, 200 adults were recruited from the Chilean Diabetic Association. Participants were asked to complete self-report instruments and provide a capillary blood sample to measure HbA1c. Structural equation model analyses were performed to determine direct associations. The study's results indicate that greater perceived social support was associated with healthier dietary habits, regular foot care, more frequent physical activity, and lower medication intake. Likewise, blood sugar testing and physical activity were related to HbA1c. These findings provide evidence of how perceived social support relates to T2D treatment adherence behaviors in Latino patients from South America and could be used for interventions to enhance social support from patients' families, partners, and friends.

The Causes and Consequences of Stigma among Individuals Involved in the Criminal Legal System: A Systematic Review.

The purpose of this study was to systematically review the types of stigmatized attributes that have been assessed and the causes and consequences of stigma for individuals involved in the criminal legal system. PubMed, GoogleScholar, and PsycInfo databases were searched to identify studies for inclusion through March 2021. Eligible studies were peer-reviewed, quantitative, and assessed stigma from the perspective of the person involved in the criminal legal system. 59 studies were included (total n=21,738), assessing stigma associated with criminal involvement, HIV, substance use, race/ethnicity, help-seeking, and others. Experiencing criminal involvement stigma was linked to poor well-being, but less so for racial/ethnic minorities. Experiencing racial/ethnic stigma was associated with recidivism risk, and substance use stigma was associated with substance use risk. Several stigmas intersected to impact treatment engagement and well-being. In conclusion, individuals involved in the criminal legal system experience many stigmatized statuses that impact their well-being, treatment adherence, community integration, and criminal behavior. Stigma must be addressed among individuals involved in the criminal legal system and the systems they interact with to reduce health inequity and recidivism risk.

Examining associations between goal and attribute framing, HIV treatment motivation, and affective responses: A mixed methods study of patient thoughts and perceptions

AbstractThe use of framing in persuasive health communications considerably affects health behaviour, but our understanding of how framing influences patient motivation to take HIV treatments remains limited. This study examined how goal and attribute framing are related to the motivational and affective responses linked to HIV treatment adherence behaviours. The predominantly low‐income, African American sample (n = 30) consisted of HIV patients living in Chicago and Los Angeles who reported their thoughts and perceptions regarding HIV treatment in two previous studies. We performed content analysis on data consisting of a total of 119 thoughts and perceptions, categorized the data by type of framing expressed (goal, attribute), and determined correlations between framing type, treatment‐related motivation (i.e., intrinsic, extrinsic, approach, avoidance) and affective responses (i.e., positive, negative). Goal framed thoughts were classified as either gain‐ or loss‐framed. We found that goal framed thoughts highlighting the gains associated with medication adherence were associated with higher levels of intrinsic motivation than either goal framed thoughts highlighting losses or attribute framed thoughts (p &lt; .02). There were no significant associations between type of framing and patients' extrinsic, approach, or avoidance treatment motivations. Negative affect related more strongly to attribute framed thoughts and perceptions than to either gain‐ or loss‐framed thoughts (p &lt; .001). Findings suggest that gain framing may be associated with stronger and more consistent adherence and treatment engagement among HIV patients with a promotion‐oriented self‐regulatory focus. Future studies are needed to evaluate the relative effect of framing manipulations on actual changes in HIV treatment adherence across time.

Trajectory model of adherence to cervical cancer treatment in central Mexico during the COVID-19 era

Background: Cervical Uterine Cancer is a disease that explains the vulnerability in which women find themselves in terms of reproductive health with an impact on occupational health and public health, even though in Mexico the prevalence rate is lower than the other member countries. of the OECD, its impact on Human Development and Local Development shows the importance that the disease has in communities more than in cities where prevention policies through check-ups and medical examinations seem to stop the trend, but they show the lack opportunities and capabilities of health centers in rural areas.Target: To establish the reliability, validity and correlations between the variables reported in the literature with respect to their weighting in a public hospital.Method: A non-experimental, cross-sectional, and exploratory study was carried out with a non-probabilistic selection of 104 patients from a public hospital in the State of Mexico. The Scale of Psychosocial Variables Determining Adherence to Treatment of Cervical Cancer was constructed.Results: From a structural model [χ2 = 490.330 (28 df) p = 0.000; GFI = 0.927; CFI = 0.970; RMSEA = 0.003] the fit of the trajectories of determinant relationships in which knowledge influenced treatment adherence behavior was demonstrated (β = 0.50).Conclusion: The limits of the design, sampling and analysis of the study are noted, and it is recommended to include organizational and psychological variables based on theories of organizations and theories of personality.

Psychometric properties of End Stage Renal Disease-Adherence Questionnaire-Sinhalese version among patients receiving haemodialysis.

The chronic kidney disease is a leading public health concern, particularly in low-to middle-income countries, while the number of patients receiving haemodialysis is rapidly increasing. Adherence to a complex treatment regimen is vital for those patients on maintenance haemodialysis though the precise evaluation is reported inadequately. This study aimed to evaluate the psychometric properties of Sinhalese version of End Stage Renal Disease-Adherence Questionnaire (SINESRD-AQ) to assess treatment adherence behaviour among patients receiving haemodialysis in a Sri Lankan hospital. The cultural adaptation of ESRD-AQ involved forward and back translation, expert committee consolidation and pretesting among patients (n = 10). Face and content validity of the questionnaire was evaluated using a modified Delphi technique. Construct validity of the subscales of SINESRD-AQ was evaluated using confirmatory factor analysis (CFA). A descriptive cross-sectional study among a consecutive sample of 150 patients receiving haemodialysis in a selected Teaching hospital, Sri Lanka was involved in performing CFA. Reliability was confirmed with test-retest reliability. Excellent face and content validity were reported with Item level content validity index (0.83-1.0), Average Item level content validity index for whole scale (0.93), Item level content validity ratio (0.67-1.0) and modified kappa statistic coefficient (0.81-1.0). CFA of two subscales demonstrated better indices closure to the model fit with five- item two factor model for direct adherence behaviour subscale and eight-item two factor model for attitude/perception subscale. The intra class correlation coefficient of 0.837 (p<0.001) and 0.752 (p<0.001) indicated acceptable test-retest reliability of direct adherence behaviour and attitude/perception subscale respectively. The study confirmed SINESRD-AQ as a valid and reliable measure which enables periodic assessment of treatment adherence behaviour of the patients receiving haemodialysis in a Sri Lankan hospital.

The efficacy of theory driven treatment adherence promotion program among type 2 diabetic patients: application of intervention mapping and mHealth.

Mobile health interventions (mHealth) may improve health-related lifestyle behaviors and disease management. Successful management of diabetes is patient-centered responsibility. The aim of this research was to determine the efficacy of the theory driven program of promoting treatment adherence in type 2 diabetes (T2DM) patients based on mHealth. This quasi-experimental research was conducted on 70 T2DM patients in Tehran, Iran. Participants were randomly divided into intervention (n = 35) or control (n = 35) groups. The data collection tool was a questionnaire based on some of constructs Social Cognitive Theory (SCT) which elicit from formative evaluation. The SCT theory-based intervention program was developed, implemented, and evaluated based on Intervention Mapping (IM) as a framework in 8 sessions using online WhatsApp application. The data was collected through by online interviews before and one month after the implementation of the program and analyzed in SPSS version 16. After the implementation of the program, a significant increase in self-efficacy (P = 0.009), outcome expectations (P < 0.001), and also diabetes treatment adherence behaviors (P = 0.024) were indicated in the intervention group. The estimated effect sizes for self-efficacy, outcome expectations, social support, and diabetes treatment adherence behaviors were 0.78, 0.06, 0.07, and 0.62, respectively. Estimated effect size of the implemented intervention was evaluated as "large" effect for diabetes treatment adherence behaviors. Findings indicated the usefulness and efficacy of the mHealth educational program based on SCT constructs and the IM approach in treatment adherence behaviors promotion among T2DM patients in Iran. The online version contains supplementary material available at 10.1007/s40200-023-01291-5.

Health behaviour change and activation in e-health weight loss intervention for elderly: a randomised clinical trial

ABSTRACT Patient activation is associated with treatment adherence, self-accountability for healthcare and a healthy lifestyle change. Mobile health (m-Health) apps can lead to greater patient treatment adherence and health behaviour change. This study aimed to evaluate the health behaviour change of elderly people through a healthcare programme focused on activation with the support of technology. Three phases were conducted: (1) pre-intervention – design of the intervention protocol and the app, (2) intervention – randomised clinical trial with 41 overweight/obese elderly people. m-Health app-supported group psychotherapy was compared with group psychotherapy only and individual psychotherapy (control) and (3) post-intervention – statistical analysis, intervention’s assistant interviews and app heuristics evaluation. By crossing the results, the study has shown that there was no significant difference in the activation level before and after intervention between groups. However, there was a significant increase from the initial mean score to the final one when considering the three groups together. Group therapy, whether with or without the support of the app, was more effective for behaviour change measured by the achievement of the goals, than individual psychotherapy. The lack of impact on group therapy with app support calls into question which and how much technology support is useful.

Psychometric Properties of an Instrument to Determine the Factors Affecting Treatment Adherence Among Patients Receiving Hemodialysis in Sri Lanka.

Nonadherence is a widespread problem among patients receiving hemodialysis, while contributing factors are underexplored due to lack of a validated instrument. The study aimed to develop and validate a new disease-specific instrument determining the factors affecting treatment adherence behaviors among patients receiving hemodialysis in a Sri Lankan hospital. The content validation process using a modified Delphi technique suggested 42-item instrument with an average Item-level Content Validity Index (I-CVI) of 0.94. Subsequent principal component analysis (PCA) revealed 5 components with 17 items (patient-centered psychological and physical factors, factors associated with health care, hemodialysis therapy-related factors, socioeconomic factors, and factors associated with the continuity of the treatment), explaining 67.24% total variance. The reliability estimate based on Mislevy and Bock for each component greater than 0.8 and overall standardized Cronbach's alpha of 0.605, indicated acceptable internal consistency reliability. Root mean square residual (RMSR) and weighted root mean square residual (WRMR) indices of 0.084 and 0.059, respectively, indicated acceptable model fit. The final 17-item instrument provides a valid measure for the factors affecting treatment adherence behaviors of the patients receiving hemodialysis in a Sri Lankan hospital.

The Use of Second-Generation Antipsychotics in Patients with Severe Schizophrenia in the Real World: The Role of the Route of Administration and Dosage-A 5-Year Follow-Up.

To assess the impact of the route of administration and doses of second-generation antipsychotics (SGAs) on treatment adherence, hospital admissions, and suicidal behaviour in patients with severe schizophrenia (Clinical Global Impression-Severity-CGI-S ≥ 5), we implemented an observational 5-year follow-up study. A total of 37.5% of the patients on oral antipsychotics (Aps) and 11.5% of those on long-acting injectables (LAIs) abandoned the treatment (p &lt; 0.001). There were no differences in treatment discontinuation between the LAI-AP standard and high-dose groups. A total of 28.1% of the patients on oral Aps had at least one hospitalisation, as well as 13.1% of patients on LAIs (p &lt; 0.001). There were fewer hospitalisations of patients on LAIs in the high-dose group (p &lt; 0.05). Suicide attempts were recorded for 18% of patients on oral Aps but only for 4.6% of patients on LAIs (p &lt; 0.001). No differences were found between the dosage groups on LAIs. Tolerability was good for all Aps and somewhat better for LAIs than oral Aps in terms of side effects (p &lt; 0.05). There were no differences between the standard and high-dose groups. More patients discontinued treatment due to side effects in the oral AP group (p &lt; 0.01). LAI SGA treatment was more effective than oral AP in terms of adherence and treatment outcomes for managing people with severe schizophrenia. Moreover, significant improvements were found that favour high-dose LAI SGA treatment for some of these patients. This study highlights the need to consider LAI antipsychotics and high-dose strategies for patients with severe schizophrenia.

Patient Trust in Physicians Matters—Understanding the Role of a Mobile Patient Education System and Patient-Physician Communication in Improving Patient Adherence Behavior: Field Study

The ultimate goal of any prescribed medical therapy is to achieve desired outcomes of patient care. However, patient nonadherence has long been a major problem detrimental to patient health and, thus, is a concern for all health care providers. Moreover, nonadherence is extremely costly for global medical systems because of unnecessary complications and expenses. Traditional patient education programs often serve as an intervention tool to increase patients' self-care awareness, disease knowledge, and motivation to change patient behaviors for better adherence. Patient trust in physicians, patient-physician relationships, and quality of communication have also been identified as critical factors influencing patient adherence. However, little is known about how mobile patient education technologies help foster patient adherence. This study aimed to empirically investigate whether and how a mobile patient education system (MPES) juxtaposed with patient trust can increase patient adherence to prescribed medical therapies. This study was conducted based on a field survey of 125 patients in multiple states in the United States who have used an innovative mobile health care system for their health care education and information seeking. Partial least squares techniques were used to analyze the collected data. The results revealed that patient-physician communication and the use of an MPES significantly increase patients' trust in their physicians. Furthermore, patient trust has a prominent effect on patient attitude toward treatment adherence, which in turn influences patients' behavioral intention and actual adherence behavior. Based on the theory of planned behavior, the results also indicated that behavioral intention, response efficacy, and self-efficacy positively influenced patients' actual treatment adherence behavior, whereas descriptive norms and subjective norms do not play a role in this process. Our study is one of the first that examines the relationship between patients who actively use an MPES and their trust in their physicians. This study contributes to this context by enriching the trust literature, addressing the call to identify key patient-centered technology determinants of trust, advancing the understanding of patient adherence mechanisms, adding a new explanation of the influence of education mechanisms delivered via mobile devices on patient adherence, and confirming that the theory of planned behavior holds in this patient adherence context.

Locus of control, self-efficacy perception and treatment adherence in kidney transplant patients

ObjectiveAmong the factors forming the health behavior are the concept of locus of control and the perception of health self-efficacy. Studies investigating self-efficacy beliefs and the impact of health locus of control on immunosuppressive drugs are not adequate in number. Therefore the study sought to determine locus of control, self-efficacy perception and treatment adherence in kidney transplant patients. MethodsThe sample of the study comprised 276 kidney transplant patients who applied to a university hospital. We collected the data using the Personal Information Form, the Multidimensional Health Locus of Control Scale, the Health Self-efficacy Perception Scale and the Compliance to Immunosuppressive Treatment Scale. ResultsThe study found the patients' mean Multidimensional Health Locus of Control scale external locus of control score to be 21.51 ± 3.74, mean Internal locus of control score to be 21.36 ± 3.92 and mean chance/fate score to be 15.48 ± 5.43. This result in the study demonstrates that kidney transplant individuals tend to believe in external forces in the disease management. The study determined the mean Health Self-efficacy Perception scale score of the kidney transplant patients to be 25.34 ± 3.89 and the patients had moderate level of self-efficacy perception. The study found that the patients' mean Compliance to Immunosuppressive Treatment Scale score was 11.26 ± 0.96 and their immunosuppressive treatment adherence was high but not adequate. The study found a significant negative weak correlation between the Health Self-efficacy Perception scale and the Multidimensional Health Locus of Control scale chance/fate subscale (p < 0.01). The study found no significant correlation between the Health Self-efficacy Perception scale and the Compliance to Immunosuppressive Treatment Scale (p > 0.05). ConclusionIn order to increase drug adherence, we recommend that patients be supported to reinforce their self-efficacy perception. It is necessary to develop internal locus of control in kidney transplant patients in terms of treatment adherence and positive health behaviors.

Psychometric Validation of the Spanish Version of the Caregiver Contribution to Self-Care of Heart Failure Index ( CC-SCHFI)

Abstract Funding Acknowledgements Type of funding sources: None. Background The Caregiver Contribution to Self-Care of Heart Failure Index (CC-SCHFI) is a theoretically driven instrument to measure the extent to which caregivers support Heart Failure ( HF) patients to perform self-care. The CC-SCHFI measures caregivers' contribution to the self-care maintenance and self-care management and caregiver confidence in contributing to heart failure patients, self-care. To date, the CC-SCHFI was never tested in Spanish speaking populations. Purpose To translate the CC-SCHFI from English into Spanish and to test its psychometric characteristics. Method CC-SCHFI translation and back-translation was performed according to the Beaton el al. Methodology. Data from a cross-sectional study conducted in an outpatient clinic in Spain were used for the analysis. Psychometric analysis was performed with Exploratory factor analysis (EFA) with oblique rotation. Cronbach’s alpha coefficient was used to test CC-SCHFI reliability. Results Caregivers had a mean age of 60,5 and the majority was female (85%) Data from 220 caregivers were analyzed. From EFA, using the principal axis factoring method, we extracted two factors in self-care maintenance subscale ("treatment adherence behaviors" and "symptom control and maintenance behaviors" factors) and self-care monitoring subscale ("Illness behaviors" and "Prevention behaviors" factors) and one factor for self-efficacy subscale. The Cronbach’s alpha coefficient was = 0.838)

Perceived Family Stress Predicts Poor Metabolic Control in Pediatric Patients with Type 1 Diabetes: A Novel Triadic Approach.

Objective Poor metabolic control and low treatment adherence remain major issues for many pediatric patients with type 1 diabetes. Important risk factors for both include psychosocial variables such as stress. To date, stress in type 1 diabetes patients and their parents has been investigated at an individual level. The present study tested the hypothesis that patients', mothers', and fathers' perceived stress is positively related to each other and therefore is a factor common to the family. This factor was then hypothesized to be related to patients' poorer treatment adherence behavior and metabolic control. Research Design and Methods. This cross-sectional study at the University Children's Hospital Zurich included 190 type 1 diabetes patients (age: 7–18 years; illness duration: ≥1 year) and their families. The Perceived Stress Scale was used to measure the self-reported stress of patients, mothers, and fathers. Patients' treatment adherence was rated by their endocrinologists. HbA1c served as indicator of metabolic control. A structural equation model (SEM) was conducted for analysis. Results The SEM showed adequate model fit. Patients' (β = .567, p ≤ .001), mother's (β = .621, p ≤ .001), and father's (β = .585, p ≤ .001) perceived stress loaded all on a single factor, perceived family stress. This factor was significantly associated with treatment adherence (β = −.384, p ≤ .001) and with HbA1c (β = .210, p = .012) of patients. Conclusions Results confirmed perceived family stress to be a common family construct. Because perceived family stress might have a negative impact on patients' treatment adherence and HbA1c, subjective stress appraisals of patients and both parents should be considered when counseling children and adolescents with type 1 diabetes.