Treatment Adherence Questionnaire Research Articles

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.

Predicting Adherence to Treatment in the Elderly With Type 2 Diabetes Based on Interpersonal Conflicts and Self-compassion

Background and Aims Treatment adherence is a key factor in improving patient safety and the quality of care according to the needs of older people. Non-adherence prevents older adults from accessing the best treatment, and this issue may be especially problematic in chronic medical conditions. Therefore, the present study aims to determine the relationship between interpersonal conflicts and self-compassion with treatment adherence in the elderly with type 2 diabetes. Methods The method of this research was descriptive and correlational. The study’s statistical population included all older people with type 2 diabetes referred to the endocrinology clinic of the fifth district of Tehran City, Iran, during the first 6 months of 2023. Based on the formula of Tabachnick and Fidell (2007), 138 people were randomly selected as a sample. In this research, Rahim’s standard interpersonal conflict resolution style questionnaire, self-compassion scale, and treatment adherence questionnaire were used. Finally, the data was entered into SPSS software, version 26 to check the correlation between the variables, and the Pearson correlation coefficient and multiple regression were used simultaneously to analyze the data. Results This research showed that interpersonal conflicts predict 29.9% and self-compassion 26.5% of changes in treatment adherence. Among these, the components of interpersonal conflict styles included integrity (r=0.24), avoidant (r=-0.33), and required (r=-0.17), and the components of self-compassion, including self-kindness (r=0.24), avoiding self-judgment (r=0.21) and absence of over-identification (r=0.17) can predict treatment compliance in older people with type 2 diabetes Conclusion This research has shown that interpersonal conflicts and self-compassion have a positive and significant relationship with treatment adherence in older people with type 2 diabetes and can predict treatment compliance in these older people.

Factors Influencing Adherence to Treatment in Adult Patients with Hypertension

Introduction Adherence to treatment including medication and lifestyle modification is crucial for improving health outcomes in patients with hypertension. However, there is limited research investigating the factors influencing adherence to medication and lifestyle modification, particularly among adult patients diagnosed with hypertension. Objective To investigate adherence to treatment and the predictive power of work status, comorbidity, complexity of medication regimens, perceived severity and risk of hypertension complications, and quality of care affecting adherence to treatment in adult patients with hypertension. Design Cross-sectional correlational predictive research using the multidimensional adherence model as the conceptual framework. Methodology The sample included 156 adult patients with essential hypertension aged 18 to 59 years old who had received antihypertensive medication and lifestyle modification treatment for at least six months at a super-tertiary hospital’s hypertension clinic. Data were collected between April and July 2023. The research instruments consisted of a general profile questionnaire, a treatment adherence questionnaire for patients with hypertension, a perceived severity and risk of hypertension complications questionnaire, a patient assessment of chronic illness care, the Charlson Comorbidity Index, a medication regimen complexity index, and an illness record form. These instruments were examined for content validity by experts and tested for reliability prior to use in data collection. The reliability ranged from .77-1.00. The data were analyzed using descriptive statistics and multiple linear regression. Results The sample had an average age of 46.50 years (SD = 9.65); 63.46% were female. The average score for adherence to treatment was 87.97 (SD = 9.02), with the highest score for average medication adherence of 34.37 (SD = 2.52) and the lowest score for average exercise adherence of 4.33 (SD = 1.89). Additionally, 14.74% were overweight, and 71.80% were obese. The majority were employed (83.33%), without any comorbidities (62.82%), and had a low level of medication regimen complexity (68.59%). Furthermore, they demonstrated a high level of perceived severity and risk of hypertension complications (96.15%) and reported a high level of quality of care (61.54%). In the Multiple linear regression, 30.9% of the variance in adherence to treatment was explained (Adjusted R2 = .309 F(5,150) = 14.858, p < .001). Work status (β = -.262, p < .001), comorbidity (β = -.184, p = .020), perceived severity and risk of hypertension complications (β = .466, p < .001), and quality of care (β = .165, p = .017) together were significant predictors of adherence to treatment in adult patients with hypertension. Recommendation To promote adherence to treatment in adult patients with hypertension, nurses should develop strategy to improve quality of care within hypertension clinics and enhance the perceived severity and risk of hypertension complications as well as enhance lifestyle modifications particularly regarding diet and exercise for overweight and obese adults with hypertension.

Effects of Self-Care Training Combined with Stress Management on Treatment Adherence in Type 2 Diabetes People


 
 
 Objective: Diabetes is a chronic metabolic disorder that can be exacerbated by stress, poor compliance and self-care practices. This study investigated the effects of self-care training combined with stress management on treatment adherence in type 2 diabetes mellitus (T2DM) people.
 Materials and Methods: This is a randomized clinical trial with repeated measures. The study sample included 30 T2DM who were purposively selected among the eligible members of the Kerman Diabetes Association. The participants were randomized to the experimental group (stress management based on cognitive-behavioral therapy and self-care training) (n=15) and the control group (no intervention) (n=15). Both groups completed the Medanlo Treatment Adherence Questionnaire at the pretest, posttest, and follow-up time points. Data were analyzed statistically using ANOVA.
 Results: The post-test and follow-up mean scores of treatment adherence significantly increased in the experimental group compared with the control group (P< 0.001). In addition, the results demonstrated that treatment adherence improved in follow-up (P< 0.001).
 Conclusion: According to the study results, psychological training should be integrated with self-care training to achieve long lasting treatment adherence in T2DM people.
 
 

Structural Model for Explaining Quality of Life Based on Early Maladaptive Schemas and the Role of Treatment Adherence and Coping Strategies in Patients with Type 2 Diabetes

Objective: The objective of the present research was to explain the structural model for quality of life based on early maladaptive schemas and the role of treatment adherence and coping strategies in patients with type 2 diabetes. Methods and Materials: This study, in terms of research methodology, falls into the category of descriptive-correlational research using structural equation modeling. The research population consisted of all patients with type 2 diabetes in Tehran who visited medical centers during the year 2021. The sample of the current study included 350 patients with type 2 diabetes in Tehran in 2021, selected through convenience sampling based on inclusion and exclusion criteria of the study. Data were collected using the short form of the World Health Organization Quality of Life Questionnaire, Young's Early Maladaptive Schemas Short Form Questionnaire, Treatment Adherence Questionnaire, and Young's Avoidance Coping Strategies Questionnaire. Data were analyzed using Structural Equation Modeling (SEM) and Pearson correlation statistical methods, employing SPSS 22 and AMOS 22 software. Findings: The results showed that the fit indices PCFI=0.655, PNFI=0.661, CMIN/DF=2.90, RMSEA=0.089, IFI=0.917, CFI=0.914, and GFI=0.903 indicate a good fit of the proposed model with the data. The highest coefficient (-0.47) was attributed to the path from autonomy and impaired performance to quality of life. The coefficient of determination for the quality variable of marital relationship in the proposed structural model is 0.889, indicating that the external variables can predict 89 percent of the variance in quality of life, which is considered strong. Conclusion: Therefore, it can be concluded that the structural model for explaining quality of life based on early maladaptive schemas and the role of treatment adherence and coping strategies in patients with type 2 diabetes fits appropriately.

Взаимосвязь типа личности D и приверженности к лечению у пациентов, перенесших острый коронарный синдром

Many patients who have suffered from acute coronary syndrome do not fully comply with their prescribed medication regimen. Adherence to treatment depends on many factors, including psychosocial ones. The Morisky — Green questionnaire is used to determine the adherence level. Personality type D is one of the factors associated with an increased risk of adverse events, including a need for revascularization, myocardium infraction and death among people with cardiovascular diseases. The personality type D scale is used to identify this risk. The study objective was to identify the relationship between psychosocial factors that form personality type D and the level of adherence to treatment in patients who have suffered from acute coronary syndrome. The study involved 50 patients who had acute coronary syndrome in the recent month. All patients underwent standard examination used in acute coronary syndrome. The Russian-language version of the scale DS14 and the Morisky — Green treatment adherence questionnaire were used as special methods. Significant differences were found depending on the positive or negative response to the MG-1 (Morisky — Green) question when evaluating DS14-7 (p = 0.027) and DS14-9 (p = 0.038) indicators. The analysis of DS14-3 revealed significant differences depending on the answer to the MG-3 question (p = 0.009). When evaluating DS14-2, statistically significant differences were found depending on MG-4 (p = 0.008). The results showed a direct link between low adherence to treatment and a high level of negative excitability. Thus, the identification of various characteristics of personality type D, especially those related to negative excitability, allows identifying a range of people with low adherence to treatment among patients who have suffered acute coronary syndrome.

The effect of a mobile education application (MobilMS) developed for multiple sclerosis patients in Turkey on symptom management and quality of life: A randomized controlled study

BackgroundMultiple sclerosis (MS) is a neurodegenerative disease that affects the central nervous system (CNS) and is caused by immune dysfunction. MS results in a variety of symptoms that affect physical, emotional, social, and cognitive functioning. Effective symptom management is a critical factor in improving the quality of life (QoL) of patients with MS. PurposeTo determine the effects of a comprehensive mobile education application developed for Turkish patients with MS on symptom management and QoL. MethodsThe study was conducted as a randomized controlled trial and included 63 patients with MS older than 18 years who had an Expanded Disability Status Scale score of ≤6 and were actively using smart phones (intervention group, n = 31; control group, n = 32). Data were collected using a patient information form, the Multiple Sclerosis-Related Symptom (MS-RS) checklist, the Multiple Sclerosis Quality of Life Scale (MSQoL-54), and the Multiple Sclerosis Treatment Adherence Questionnaire (MS-TAQ). The scales were administered three times: at baseline, first month, and third month. Patients with MS in the intervention group were followed up for three months using MobilMS. ResultsIn the intervention group, the mean rating of MobilMS was 8.74±1.29. Most patients indicated that MobilMS was an “informative and useful application”. None of the patients in the study reported any side effects or difficulties when using MobilMS application. The mean MSQL-54 score of the intervention group was significantly higher compared to that of the control group at the first and third months (p = 0.001). The mean scores on the MS-RS checklist (p = 0.985), MS-TAQ subscale, Disease modifying therapies (DMT) barriers (p = 0.237), DMT side effects (p = 0.994), DMT coping strategies (p = 0.469), and Missing Doze Rate (MDR) (p = 0.765) were lower in the intervention group than in the control group, but these results were not statistically significant. ConclusionThe results of the study showed that MobilMS was highly appreciated, accepted, and used by patients with MS. MobilMS has the potential to meet the requirements for a free and accessible symptom management tool for patients with MS. The innovative MobilMS-based education intervention for support and symptom management is recommended as part of supportive care for this patient population. It is hoped that this study will pave the way for future studies on the utility of mobile applications for symptom management in patients with MS.

The Evaluation of Treatment Adherence and Its Association with Perceived Social Support in Patients with Mood Disorders in Hospitals Affiliated with Isfahan University of Medical Sciences in 2022

Background: Considering the importance of perceived social support and adherence to treatment in improving the treatment process of mood disorders, our aim was to determine the degree of adherence to treatment and its relationship with perceived social support in patients with mood disorders. Methods: This was a cross-sectional correlational study performed on 120 patients with mood disorders recruited by the convenience sampling method. Data were collected using the treatment adherence questionnaire developed by Heydari et al. and the multidimensional scale of perceived social support. The collected data were analyzed by SPSS 16 software using descriptive indices, Pearson correlation, ANOVA, and independent t-test. Results: The results revealed that the average age of the participants was 39.54 ± 13.13 years. Patients with mood disorders had a moderate level of treatment adherence and perceived social support (mean ± SD of 51.53 ± 8.31 and 54.75 ± 11.23, respectively). The Pearson correlation test indicated a significant association between the treatment adherence level and perceived social support among patients with mood disorders (P < 0.001), meaning that with an increase in the level of adherence to treatment, the level of perceived social support increased as well. Conclusions: Perceived social support has a significant impact on treatment adherence in patients with mood disorders. Larger studies with larger sample sizes are necessary to confirm our findings.

Assessing Adherence to Adjuvant Hormone Therapy in Breast Cancer Patients in Routine Clinical Practice.

Adjuvant hormone therapy (HT) in patients with hormone receptor-positive breast cancer (BC) increases overall survival (OS). A lack of adherence to adjuvant endocrine therapy is common, 31.0-73.0% of women discontinue endocrine treatment before 5 years. The aim of the study was to assess adherence to HT in routine clinical practice in patients assisted at the Clinical Oncology Department of the Hospital de Clinicas - Universidad de la Republica, Uruguay. Patients treated with HT for stage 0-III BC between 2017 and 2019 were included. The medication possession (MPR) rate was calculated using pharmacy records, and the Morisky-Green Scale was applied to assess adherence. Adherent patients were those with MPR ≥ 0.80 and who correctly answered the Morisky-Green treatment adherence questionnaire. The association of adherence with polypharmacy, treatment, and patient characteristics was assessed using simple logistic models. The associations between qualitative variables and adherence were assessed using simple logistic regression model or Fisher's exact test. The association between quantitative variables and adherence was assessed using the Student's t-test. The odds ratio (OR) for non-adherence to treatment and its 95% confidence interval were estimated. Totally, 118 patients were included; 65.2% were treated with aromatase inhibitors (AIs), 36.0% presenting polypharmacy. The adherence rate at the end of 2 years was 81.0 %; and it was associated with age (P = 0.03, OR = 0.96 for non-adherence), with adherent and non-adherent patients having a mean age of 65.0 and 60.3 years, respectively; however, adherence was not associated with polypharmacy, territory of origin, marital status, living alone, level of education, occupation, or stage. The adherence profile was similar for both drugs, but homemakers and retired women showed greater adherence to AI. Adherence to HT was assessed in real life, with 19.0% of the patients not adhering to the treatment, despite the known benefit for OS, being a well-tolerated treatment, and being provided free of charge. Older patients were associated with being more adherent. The results show the need of the Pharmacy Service and Department of Clinical Oncology Medical Oncology combining efforts to develop coordinated strategies and interventions to increase adherence, given the impact that this may have on patients' OS.

Treatment adherence and its relationship with health literacy in patients with mood disorders in hospitals affiliated with Isfahan University of Medical Sciences in 2022: A cross-sectional study

Background and aims: Mood disorders include major depression and bipolar disorder. Treatment adherence and health literacy are very important in these patients because they may affect their quality of life, performance, and recovery. Therefore, this study aims to determine the level of treatment adherence and its relationship to health literacy in patients with mood disorders. Methods: This cross-sectional-correlation study was conducted on 120 patients with mood disorders in 2021-2022. Data were collected using the treatment adherence questionnaire of Ziaee et al and the Health Literacy of Iranian Adults (HELIA) questionnaire. Finally, the collected data were analyzed in SPSS-16 software. Results: Findings showed that patients with mood disorders had moderate treatment adherence (51.53±8.31) and insufficient health literacy (61.31±15.91). The results indicated that treatment adherence had a significant relationship with health literacy in patients with mood disorders (P<0.05, r: 0.298). Conclusion: Inadequate health literacy in patients with mood disorders shows that health literacy should be considered in improving mental health. Therefore, it is recommended that by promoting the health literacy of these patients and identifying its challenges, treatment adherence in patients with mood disorders be improved.

The Effectiveness of Cognitive Behavioral Stress Management on Health-Related Quality of Life, Diabetes Management Self-Efficacy, and Treatment Adherence in Type 2 Diabetes

Objective: This study aimed to investigate the effectiveness of cognitive behavioral stress management (CBSM) on health-related quality of life (HRQOL), self-efficacy of diabetes management, and adherence to treatment of patients with type 2 diabetes.
 Materials and Methods: The present study was a semi-experimental study with a control group. The research samples included 30 patients with type 2 diabetes. Data collection tools in this study included the Boyer & Earp quality of life (QOL) scale for patients with diabetes (D-39), the diabetes management self-efficacy scale (DMSES), and treatment adherence questionnaire in patients with chronic diseases. The CBSM therapy was performed in 8 sessions for the experimental group. To analyze the data, a univariate analysis of covariance was used with SPSS-23 software.
 Results: The results showed that the CBSM had a significant effect on the overall health-based QOL (F=8.620; P=0.007), diabetes management self-efficacy (F=12.021; P=0.002), and treatment adherence (F=83.253; P=0.0001). In addition, the CBSM has a significant effect on diabetes control (F=8.932; P=0.007), anxiety and worry (F=5.023; P=0.035), and sexual functioning (F=7.611; P=0.011), diet (F=10.041; P=0.004), therapeutic regimen (F=24.250; P=0.0001), making effort for treatment (F=22.987; P=0.0001), intention to take the treatment (F=108.001; P=0.0001), adaptability (F=28.704; P=0.0001), and integrating illness into life (F=38.263; P=0.0001).
 Conclusion: The CBSM intervention can be used to improve health-based QOL, diabetes management self-efficacy, and treatment adherence in type 2 diabetes patients.

Effect of Education Based on the Health Belief Model on Treatment Adherence in Patients With Heart Valve Replacement Surgery

Background: Adherence to the treatment regimen reduces complications of surgery after heart valve replacement. Educating the patient can improve treatment adherence. This study thus aimed to evaluate the effect of education based on the health belief model (HBM) on treatment adherence in patients with heart valve replacement surgery. Methods: In this quasi-experimental research, a total of 90 patients undergoing valve replacement surgery were studied. The subjects were selected randomly and then divided into an intervention and a control group using the permutation blocks method. The data were collected using a demographic questionnaire, an HBM- based questionnaire, and a treatment adherence questionnaire during two stages before and one month after the education. Three 60-minute sessions on HBM- based education were held based on a need assessment for the intervention group. The collected data were analyzed using the chi-square test, paired t test, independent t test, and linear regression in SPSS software version 16.0. Results: Most of the patients in the two groups were male, married, and employed, had reading and writing literacy and lived in an urban area. Both groups were similar in terms of demographic data except for marital status, disease history, and familial disease history. The mean scores of knowledge, HBM constructs (e.g., perceived susceptibility, perceived severity, perceived benefits, perceived barriers, perceived self-efficacy, and cues to action), and treatment adherence were greater in the control group than in the intervention group pre-intervention. However, the mean scores of all variables improved in the intervention group, and there were significant differences in the knowledge, all HBM constructs (except for perceived susceptibility and perceived self-efficacy), and medical adherence between the two groups post-intervention (P<0.05). Conclusion: Considering the positive effect of HBM-based educational intervention on the patients’ treatment adherence, HBM-based education could be suggested for patients with heart valve replacement surgery.

Evaluation of antiglaucoma drug treatment awareness and patient-reported medication adherence: Determinants of glaucoma management.

Primary open angle glaucoma (POAG) treatment is characterized by long-duration therapy, prescription variability, and non-adherence. Patient awareness toward drug treatment is crucial to ensure adherence. The present study was planned to evaluate drug treatment awareness, patient-perceived drug adherence, and prescription patterns in POAG patients. This was a cross-sectional, single-center, questionnaire-based study conducted in the ophthalmology out patient department of a tertiary care hospital from April 2020 to November 2021. Patients of either gender, aged 40-70 years, with a confirmed diagnosis of POAG, who had records of POAG medications for at least last 3 months and who provided written informed consent, were included. Prescription details were recorded, and subsequently, patients were administered a pre-validated drug treatment awareness (14 items) questionnaire, a self-reported medication adherence (9-item) questionnaire, and then they performed eye drop instillation in a simulated setting. The total number of patients enrolled was 180, which yielded 200 prescriptions. The mean drug treatment awareness score was 8.18 ± 3.30, and 135 (75%) patients scored more than 50% (≥7/14). Similarly, 159 patients (83.33%) had scored >50% (i.e. >5/9), with a mean score of 6.30 ± 1.70 in the medication treatment adherence questionnaire. The mean eye drop instillation performance score was 7.18 ± 1.20. The 200 POAG prescriptions containing 306 drugs were analyzed, with beta blockers (184/200, 92%) and timolol (168/200, 84% encounters) being the highest prescribed classes/drugs. POAG patients did have adequate treatment awareness with good self-reported medication adherence and performance of eye drop instillation technique. Around 25% patients lacked awareness; hence, reinforcement education programs on medication regimens need to be implemented.

Development and Validation of the Patient/Caregiver Reported Hydroxyurea Evaluation of Adherence for Life (HEAL) Scale.

Hydroxyurea reduces the incidence of vaso-occlusive episodes, stroke, and respiratory, cardiac, and renal damage in sickle cell disease by increasing fetal hemoglobin. However, because suboptimal adherence to hydroxyurea limits its effectiveness, understanding patient-specific barriers to hydroxyurea adherence could help improve adherence and health outcomes in patients with sickle cell disease. The aim of this single-site, prospective, IRB-approved study was to validate a 24-item patient- and caregiver-reported hydroxyurea treatment adherence questionnaire, the Hydroxyurea Evaluation of Adherence for Life (HEAL) scale. A sample of 24 adults with sickle cell disease and 16 caregivers of children with sickle cell disease completed the HEAL scale, and a subset of the original sample provided a second HEAL scale for test-retest reliability. HEAL scale results were validated against global adherence ratings from participants and health-care providers, records of access to pill bottles, and laboratory values for fetal hemoglobin and absolute neutrophil count. Results demonstrated excellent internal consistency for the HEAL Total score and eight (3-item) subscale scores (Dose, Remember, Plan, Cost, Understand, Effectiveness, Laboratory, and Pharmacy), as well as strong test-retest reliability for all HEAL scores except the Cost subscale. HEAL Total scores correlated significantly with validity measures, including global adherence ratings and lab values. The HEAL scale offers significant clinical potential for understanding adherence in individual sickle cell disease patients and significant research potential for characterizing adherence in persons with sickle cell disease who are treated with hydroxyurea.

The Quality of Life and Medication Adherence in Patients with Multiple Sclerosis-Cross-Sectional Study.

Multiple sclerosis (MS) is a chronic, degenerative autoimmune inflammatory disease of the central nervous system. MS is characterized by a wide range of symptoms and unpredictable prognosis, which can severely affect patient quality of life (QOL). The treatment strategy includes acute relapse treatment, disease-modifying treatment (DMT), and symptomatic therapy. Adherence to long-term DMTs is essential in order to maximize the therapeutic effects for MS and is crucial to health-related quality of life (HRQOL). This study aimed to evaluate the relationship between QOL and adherence to DMTs in MS patients. A group of 344 patients (73% females) aged 39.1 years with relapsing-reemitting MS were included. The Multiple Sclerosis International Quality of Life (MusiQOL) and the Multiple Sclerosis Treatment Adherence Questionnaire (MS-TAQ) were used. An injection of interferon (IFN)-β1b was used in 107 patients, IFN-β1a in 94 patients, and glatiramer acetate in 34 patients. The oral treatment includes teriflunomide in 14 patients, dimethyl fumarate in 86 patients, and fingolimod in nine patients. No statistically significant differences (p > 0.05) were observed in adherent (ADH) vs. non-adherent patients (non-ADH) in MusiQOL. The total adherence rate was 72% (MS-TAQ). An analysis of the univariate logistic regression model showed an effect of only the activities of daily living (ADL) and relationship with the healthcare system (RHCS) domains on the level of adherence to treatment recommendations. The other variables studied do not affect the level of adherence. Higher QOL levels in the ADL and RHCS domains affect medication adherence in MS patients. Our findings could help manage MS patients, promoting interventions on ADLs and good relationships with healthcare providers to improve their adherence to therapy and result in better QOL.

Factors associated with treatment adherence to treatment among in patients with type 2 diabetes in Iran: A cross-sectional study.

Diabetes is a chronic metabolic disorder that affects millions of people worldwide. Adherence to treatment is a key determinant to proper management. This study aimed to assess the factors associated treatment adherence in patients with type 2 diabetes. We conducted this cross-sectional study on 704 patients with type 2 diabetes referred to three diabetes clinics in Kerman, Iran. We used treatment adherence questionnaire and functional communicative critical health literacy (FCCHL) to collect data and descriptive statistics, as well as Pearson correlation coefficient and multivariate regression analysis to analyze data. Significance level was <0.05. The study results showed that health literacy, HbA1c, and income were main predictors of diabetes treatment adherence. The patients' adherence increased as their health literacy increased. The patients' HbA1c decreases as their adherence increased. We found a 2.54-point increase in the treatment adherence score for those with sufficient income and a 0.76-point increase in the treatment adherence score for those with relatively sufficient income compared with those with insufficient income. We found several factors affecting diabetes treatment adherence. Planning theory-based interventions can be helpful to improve the determinants.

The Effect of Metacognitive Therapy on Treatment Adherence and Life Expectancy of Patients with Gastrointestinal Cancers

Background: Cancer as a chronic and severe disease, causes a lot of psychological distress in patients. One of the psychological interventions to control distress is metacognitive therapy. The aim of this study was to evaluate this type of treatment on life expectancy and consequently adherence to the treatment of the patients.Methods: This study was a quasi-experimental two-group study. A total of 70 patients with gestational cancer were selected by convenience sampling and randomly divided into the intervention (n = 35) and control (n = 35) groups. The intervention group received 5 sessions (45-60 min) of metacognitive therapy, but the control group received the routine intervention. Data were collected using three questionnaires including: demographic and disease data questionnaire, Madanloo Treatment Adherence Questionnaire and Snyder’s Hope Scale.Results: Metacognitive therapy made significant changes in life expectancy and adherence to treatment in the intervention group compared to the control group (P < 0.0001). The results of an adjusted analysis of covariance to compare the scores of treatment adherence and life expectancy after the intervention in the intervention group were 15.55 and 19.6 higher on average, respectively.Conclusion: The study indicates that metacognitive therapy has been effective in improving life expectancy and adherence to treatment of patients with gastrointestinal cancer. This intervention can be considered as an effective psychological intervention for these patients. Therefore, it is suggested that this intervention be established and promoted in counseling and psychotherapy centers in hospitals and treatment centers to accelerate the recovery process of these patients.

The Effectiveness of Acceptance and Commitment Therapy and Mindfulness-Based Cognitive Therapy on Illness Perception and Adherence to the Treatment of Patients With Multiple Sclerosis

Background: Multiple sclerosis (MS) is a common disease of the central nervous system. The main cause of this disease is related to the myelin damage of nerve cells. This study aimed to compare the effectiveness of acceptance and commitment therapy (ACT) and mindfulness-based cognitive therapy (MBCT) on illness perception and adherence to the treatment of patients with MS. Methods: This is a quasi-experimental study with a pre-test, post-test, and follow-up design with a control group. The statistical population of this study included all patients with MS under the auspices of the MS Society of Tehran (Iran) in 2019. Forty-five women with MS were purposefully selected and randomly divided into MBCT, ACT, and control (n=15) groups. Data were obtained using the revised illness perception questionnaire (IPQ-R) and the MS treatment adherence questionnaire (MS-TAQ). The repeated measurement analysis of variance and SPSS.22 were used to analyze data. Results: The results showed that the effect of MBCT was greater than that of the acceptance and commitment-based therapy group on illness perceptions (P&lt;0.001) and treatment adherence (P&lt;0.001). Conclusion: Overall, the effectiveness of MBCT was greater than that of the ACT group on illness perceptions and adherence to treatment. MBCT and ACT can be employed as effective methods for patients with MS.

Development and Psychometric Evaluation of the Heart Failure Treatment Adherence Questionnaire (HFAQ) for Military Personnel and Their Family: A Mixed, Exploratory, and Sequential Study

Background: Heart failure (HF) is an important public health issue whose prevalence, hospitalization rate, and costs have increased over the years. Treatment adherence is the behavior of the patient in taking medications, correcting diet, and ability to change lifestyle with the recommendations of the health care provider. Poor treatment adherence contributes to worsening disease outcomes. Currently, according to the literature, no specific instrument is available to measure treatment adherence of HF patients. Objectives: The aim of this study was to develop and evaluate the heart failure treatment adherence questionnaire (HFAQ) for military (Artesh) personnel and their family. Methods: Items were generated by literature review, patient field interviews, and expert opinions. Content validity was assessed by measuring CVR and CVI, while face validity was evaluated by measuring the impact score of each item. The research team performed EGA, bootEGA, and CFA to assess the construct validity, and reliability was assessed by measuring ICC and Cronbach’s alpha. Results: Item pool with 86 items was generated consisting of 45 medications, 10 lifestyles, nine diet items, and 22 common items between these three categories. Forty-three items with CVR score lower than 0.62 were removed from the HFAQ. All remained items had acceptable face validity. Cronbach’s alpha and ICC of HFAQ were reported as 0.73 and 0.97, respectively. EGA results represented a four-dimension model for HFAQ with a relatively narrow confidence interval (CI 95% [3.769, 4.231]), and the stability of items, in constructs, ranged from 0.96 to 1. Goodness-of-fit results was reported as χ2 = 535.657, df = 293, χ2/df = 1.828, P-value &lt; .001, CFI = 0.851, and RMSEA = 0.050. Conclusions: HFAQ is the first treatment adherence questionnaire developed specifically for assessing treatment adherence of HF patients and is a valid and reliable 26-item questionnaire that evaluates patients' treatment adherence in three main contexts of medication, physical activity, and diet. HFAQ has four dimensions of health literacy, social and economic, barrier, and patient-provider relationship, which can be used as an intervention for improving treatment outcomes and disease burden.

Evaluation of adherence to treatment in patients with multiple sclerosis from Latin America

Introduction and aimSeveral factors have been associated with poor adherence to disease-modifying drugs (DMD). The aim of this study is to evaluate the adherence to DMD in people with multiple sclerosis (PwMS) in Argentina and Ecuador. MethodsA cross-sectional study was performed. The study was carried out between June 2020 and October 2020, and 303 PwMS treated with DMD were included. Patients undergoing immune reconstitution treatments were excluded. Two definitions of DMD adherence were previously determined. Adherence to MS treatments was assessed using the multiple sclerosis treatment adherence questionnaire (MS-TAQ). The logistic regression model was used to evaluate factors related to adherence, and p < 0.05 was considered significant. ResultThe mean age at study entry for patients was 40.7 ± 11.2 years, 207 (68.3%) were female, and the mean EDSS score was 2.2 ± 1.9. The overall adherence in our sample was 78.1% (79.7% in Argentina and 76% Ecuador, p = 0.23). Patients using infusion therapies significantly more often belonged to the adherent group (p = 0.042). Sharing decision-making (OR = 3.4, 95% CI: 1.7–6.9, p = 0.01), lower EDSS (OR = 0.8, 95% IC: 0.6–0.9, p = 0.004), and lower treatment duration (OR = 0.8, 95% IC: 0.6–0.9, p = 0.001) were independent predictors of adherence in our multivariate model. ConclusionWe found a prevalence of non-adherence similar to that previously reported. Furthermore, new factors associated with lower adherence were identified.