Treatment Beliefs Research Articles

Ethnobotanical Survey of Traditional Medicinal Plants in Shekhawati Region, Rajasthan, India

This ethnobotanical study explores the traditional medicinal practices in the Shekhawati region of Rajasthan, India. It highlights the utilization of various plant species by local communities for disease treatment, sacred rituals and magico-religious beliefs. The study underlines the importance of preserving this ethnomedicinal knowledge and integrating it with modern medicine. It also emphasizes the significance of sustainable practices and biodiversity conservation. The findings shed light on the profound connection between people, plants and the environment, offering insights into traditional and modern healthcare approaches.

“I wasn’t interested until I actually had that consultation”: Exploring the acceptability of a community pharmacy-based hypertension visualisation intervention

Abstract Introduction Hypertension affects around 30% of the UK population and is the leading modifiable cause of cardiovascular disease1. Despite available evidence-based treatments, nonadherence to antihypertensive medication is prevalent. Health psychology theory suggests that beliefs about a condition and its treatment influence health-related behaviours such as medication adherence through the formation of ‘illness representations’, a lay perception of the health threat. Accurate illness representations and an increased belief in the necessity for medication are associated with greater medication adherence2. Visualisation of the internal process of an illness has been shown to support the accuracy of illness representations3. ViSTA-BP (Visualisation to Support Treatment Adherence for High Blood Pressure) is a digital intervention used within a healthcare consultation, enabling individuals to visualise and conceptualise hypertension and the resulting changes to the circulatory system using real-time animations. The purpose is to support medication adherence through the improved understanding of hypertension and increased perception of medication necessity. Aim To explore the acceptability of a community pharmacy-based hypertension visualisation intervention (ViSTA-BP) with community pharmacists and patients. Methods Acceptability of ViSTA-BP was investigated in a community pharmacy setting in South Wales by conducting semi-structured qualitative interviews with pharmacists and patients. Ethical approval was granted by NHS Research Ethics Committee Wales (REC) 5 (20/WA/0280) and Cardiff Metropolitan University Ethics Committee (PGR-3806). Template analysis, a form of qualitative thematic analysis, was used to guide data interpretation. The Theoretical Framework of Acceptability (TFA) provided a lens through which to investigate acceptability, considering affective attitude towards the intervention burden, intervention coherence, ethicality, opportunity costs, perceived effectiveness and self-efficacy. Patients were purposely selected, incorporating a range of locations, adherence and treatment beliefs, thus minimising bias. Results Interviews were conducted with fifteen patients and eight pharmacists who provided feedback. Both groups demonstrated a positive attitude towards ViSTA-BP. Patients were both interested in and reassured by the intervention. They showed good intervention coherence, articulating an increased understanding of hypertension and suggesting patient groups that could benefit from ViSTA-BP. Pharmacists felt ViSTA-BP illustrated the necessity for medication, demonstrating that hypertension could be managed effectively. Patients and pharmacists were positive about ViSTA-BP’s potential for effectiveness. Patients felt it provided context for their understanding of hypertension and could prompt action. Pharmacists liked the visual elements, with ViSTA-BP providing a useful addition to their consultation ‘toolkit’. Patients felt that ViSTA-BP fits well within a community pharmacy setting. Intervention accessibility and facilitator knowledge were key; patients found the intervention duration acceptable. Pharmacists felt that ViSTA-BP fits within their current practice. However, the evolving role of the community pharmacy workforce and time pressures from competing workloads created uncertainty regarding the future feasibility of ViSTA-BP within this setting. Discussion/Conclusion Both patients and pharmacists were positive about ViSTA-BP, acknowledging the potential effectiveness of the personalised interactive visual to engage the viewer and conceptualise hypertension through visual-based communication. However, pharmacists’ perceptions of future roles supported by the community pharmacy contractual framework in Wales and staff time constraints provide potential barriers to future implementation.

Assessment of Knowledge, Perceptions, and Attitudes During the Global Mpox Outbreak in June 2022: A Cross-Sectional Study From the United Arab Emirates.

Objectives: To examine knowledge, worry, anxiety, and vaccine acceptance for mpox among UAE adults. Methods: An online survey, advertised on academic and social media platform in June 2022 collected data from 959 participants (aged 18 and above) on mpox beliefs, risks, knowledge, worry, anxiety, COVID-19 infection, vaccination, and willingness to receive the mpox vaccine. Bivariate and logistic regression analysis identified associations and predictors between variables. Results: 56% had optimal knowledge of mpox transmission and symptoms. 54% were worried, and 27% experienced anxiety related to the outbreak. Knowledge scores were higher among women, healthcare workers, and those with reliable information sources. High perceived infection risk, changes in precautionary measures, and belief in difficult treatment predicted more worry and anxiety. Higher worry and two or more doses of the COVID-19 vaccine predicted higher likelihood of taking the mpox vaccine. Conclusion: The UAE population showed low knowledge and high worry and anxiety during the global mpox outbreak. Increasing public awareness through targeted educational campaigns is vital. Promoting better understanding of infectious diseases, addressing concerns, and encouraging vaccine uptake can prepare for future outbreaks.

Psychometric evaluation of the Chinese version of the breast cancer perception scale for community women: a translation and validation study.

Breast cancer perception is closely associated with the incidence of breast cancer among community-dwelling women. Consequently, it is crucial to enhance their breast cancer survival rate by assessing their cognitive status and implementing targeted interventions. This study aimed to translate the breast cancer perception scale into Chinese and validate its psychometric properties among community women. A cross-sectional study method was introduced in this study. After obtaining the original author's authorization, the breast cancer perception scale was translated into Chinese using the Brislin back-translation method. Item analysis was employed to examine the discriminative power of the items, and the Delphi method was utilized to assess content validity. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted to evaluate the scale's construct validity. Internal consistency and test-retest reliability were calculated to analyze reliability. A total of 24 items were retained in the item analysis, and the content validity index of the translated scale was 0.964. In the EFA, six common factors were extracted, namely perceived knowledge, perceived treatment belief, perceived need for health checks, perceived stigma, perceived fear, and perceived risk, accounting for 74.911% of the cumulative variance. The CFA results were as follows: χ2/df = 1.301, GFI = 0.903, NFI = 0.913, TLI = 0.975, CFI = 0.978, IFI = 0.979, RMSEA = 0.037. The Cronbach's α coefficients, split-half reliability, and test-retest reliability of the translated scale were 0.895, 0.661, and 0.865, respectively. The Chinese version of the breast cancer perception scale demonstrated suitable psychometric properties among community women. By evaluating results according to the scale, medical staff can enhance breast cancer prevention awareness and care for community-dwelling women and subsequently implement corresponding modifications.

Transcultural Adaptation and Psychometric Validation of the Spanish Version of the Pain Attitudes and Beliefs Scale for Physiotherapists.

Low back pain (LBP) is one of the main musculoskeletal pain conditions, and it affects 23-28% of the global population. Strong evidence supports the absence of a direct relationship between the intensity of pain and tissue damage, with psychosocial factors also playing a crucial role. In this context, the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT) is a useful tool for evaluating physiotherapists' treatment orientations and beliefs regarding the management of low back pain (LBP). It helps identify practitioners who may benefit from additional education in modern pain neuroscience. However, there is not a Spanish validation of this scale for physiotherapists. Thus, the aims of this study were to translate and culturally adapt the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT) into Spanish and to evaluate its psychometric properties. This validation study used three convenience samples of physiotherapists (PTs) (n = 22 for the pilot study, n = 529 for the validity study and n = 53 for assessing the instrument's responsiveness). The process of translating and adapting the PABS-PT into Spanish followed international guidelines and produced a satisfactory pre-final version of the questionnaire. Factor analysis confirmed the two-factor structure of the original version, with the biomedical (BM) factor explaining 39.4% of the variance and the biopsychosocial (BPS) factor explaining 13.8% of the variance. Cronbach's alpha values were excellent for the BM factor (0.86) and good for the BPS factor (0.77), indicating good internal consistency. Test-retest reliability was excellent for both factors, with intraclass correlation coefficients (ICCs) of 0.84 for BM and 0.82 for BPS. The standard error of measurement (SEM) was acceptable for both factors (3.9 points for BM and 2.4 points for BPS). Concurrent validity was moderate and in the expected direction and had significant correlations with the Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS) and Revised Neurophysiology Pain Questionnaire (R-NPQ). Sensitivity to change was demonstrated by significant improvements in both factors after an educational intervention, with medium-to-large effect sizes. The PABS-PT also showed good discriminative ability, as it was able to distinguish between physiotherapists with and without pain education. Cut-off values for the BM and BPS factors were determined. In conclusion, the translated and adapted Spanish version of the PABS-PT demonstrated good psychometric properties and can be reliably used to assess the attitudes and beliefs of Spanish-speaking physiotherapists regarding LBP. The questionnaire is recommended for use in clinical and educational research in the Spanish language context.

Socio-cultural and Economic Determinants of Delayed Reporting of Breast Cancer Among Ghanaian Women: A Qualitative Study

Delayed reporting of breast cancer continues to increase in African countries, including Ghana, which is attributable to socio-cultural and economic factors. However, there is a paucity of data on socio-cultural and economic determinants of delayed reporting of breast cancer in Ghana. This study aimed to explore the socio‐cultural and economic determinants of delayed reporting of breast cancer among Ghanaian women. The study adopted an exploratory descriptive qualitative design with purposive sampling to recruit 17 women with breast cancer from the Tamale Teaching Hospital, Ghana. Data were collected through in-depth interviews. Analysis: Data analysis was done using the thematic analysis approach. Delayed reporting was due to inaccurate information, the influence of social networks, cultural misconceptions, belief in alternative treatment, high cost of treatment, and extreme poverty. A combination of socio‐cultural and economic factors influences the delay in reporting breast cancer in Ghana. Culturally appropriate and adequate health information and education, integration of alternative treatment into the formal healthcare system in Ghana, and financial support from the government are needed to promote early reporting for treatment.

Using an Intervention Mapping Approach to Improve Adherence to Disease-Modifying Treatment in Multiple Sclerosis.

Up to 50% of individuals with multiple sclerosis (MS) who are prescribed disease-modifying treatments (DMTs) do not take them as advised. Although many studies report on DMT adherence rate, few studies report on interventions involving individuals with MS. The current paper describes the development of an intervention aimed at improving adherence to DMTs among identified nonadherent individuals with MS. An intervention was developed using an Intervention Mapping approach, recommendations from reviews on medication adherence, and input from individuals with MS. Its content was determined by theories of health behavior (specifically, a perceptions and practicalities approach), empirical evidence collected among the specific target population (an observational "needs assessment" stage [n = 186]), and other studies. A personalized intervention was tailored to the reasons for nonadherence, uncovered during the observational needs assessment stage, to be delivered sequentially by a neurologist and a psychologist. After the intervention objectives were identified, components of the intervention were set: psychoeducation and ways of coping with adverse effects; modification of unhelpful treatment beliefs (such modifications were found predictive of adherence in the observational phase of the study); improving confidence and self-efficacy; and developing strategies for remembering to take DMTs. These components were embedded within motivational interviewing. Intervention Mapping was useful in developing an intervention grounded both in the theoretical approach of perceptions and practicalities and in empirical evidence from the literature and the target sample; concurrently, identifying determinants that the intervention did not address. The effectiveness of the intervention-which could potentially improve adherence among individuals with MS-needs to be examined.

Mutual Role of Patients and the Healthcare System in the Control of Cutaneous Leishmaniasis

Leishmaniasis is a neglected and old emerging/reemerging disease that has extremely increased and expanded in the different geographical areas. Cutaneous leishmaniasis (CL) is a common global public health concern in the tropics and subtropics reported from the Eastern Mediterranean Region, Africa, Latin America, and the Indian subcontinent. The presence of numerous epidemiological and clinical characteristics of the disease present a challenge in managing and controlling it. Despite wonderful efforts to control the disease in endemic areas, it appears that the burden of CL is still high. There is no comprehensive survey considering the interactive role of patients and medical services in the international CL control system. In the present study, the effective and mutual responsibility of the patients and the healthcare management in controlling the CL are reviewed, described, and discussed. Some patient-related factors that have a remarkable impact on the proper treatment and control strategies are low-socioeconomic condition, lack of sufficient knowledge about the disease, absence of personal protection, disregarding adherence to treatment, culture and incorrect beliefs about disease and therapy, depression, and lack of appropriate support from the family. On the other hand, some healthcare system-related factors that have an important effect on the suitable therapy and management of the disease are the economic burden of healthcare and drug preparation, unsuitable follow-up assessments, health education, early detection, and the right treatment, handling of unresponsive cases, active case detection, and monitoring/evaluation. Improving the socioeconomic conditions and living standards supports longstanding elimination approaches, and facilitates the wide-ranging control of the disease. Trained health staff and experienced clinicians should strengthen the building capacity for appropriate control programs throughout the healthcare system. These measures need sustained encouragement and appropriate multifunctional activities through all government segments including policymakers, the health system, clinical physicians, researchers, and also the private sector. In a suitable strategy, it is essential to understand precisely all the aspects of control strategies to respond correctly to the requests. Nevertheless, due to the complexity of the causative agent, major challenges/gaps remain, and vigorous conservative control plans should be continued until novel tools become available.

Placebo effects of transcranial direct current stimulation on motor skill acquisition

Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique used in neurorehabilitation to enhance motor training. However, its benefits to motor training can be difficult to reproduce across research studies. It is possible that the observed benefits of tDCS are not directly related to the intervention itself but rather to the brain-mind responses elicited by the treatment context, commonly known as a placebo effect. This study investigated the presence of a placebo effect of tDCS on motor training and explored potential underlying factors. Sixty-eight participants who were right-handed were randomly assigned to active tDCS, sham tDCS, or a no-stimulation control group. Double-blind active or sham tDCS was applied to the right primary motor cortex, while the unblinded control group received no stimulation. All participants completed 30 training trials of a functional upper-extremity motor task. Participants’ beliefs of tDCS, along with their prior knowledge of tDCS, were also collected. There was no significant difference in the amount of improvement on the motor task between the active and sham tDCS groups; however, both active and sham tDCS groups improved more than the control group, indicating a placebo effect. More motor task improvement was also associated with higher beliefs of tDCS (regardless of whether active or sham tDCS was received). This demonstrates a measurable placebo effect of tDCS on motor training, driven at least in part by treatment expectations or beliefs. Future tDCS studies should control for beliefs and other placebo-related factors.

Characterizing patients reporting unchanged or worsened mental health symptoms after completing a partial hospital program: A mixed-methods study.

Research is needed to better understand and characterize individuals who do not benefit from evidence-based psychiatric services or whose symptoms worsen following treatment. This study aimed to compare clinical severity at admission, treatment outcomes, treatment beliefs, and satisfaction with care among patients (N = 5,129) with perceived improved, unchanged, or worsened mental health at discharge from a partial hospital program. Chi-square tests, one-way analyses of variances (ANOVAs), analyses of covariances (ANCOVAs), and qualitative analyses were used to probe study aims. Patients perceiving overall unchanged or worsened mental health at discharge did not appear more clinically severe at admission compared to patients perceiving overall improved mental health at discharge; however, they did report more negative beliefs about treatment, poorer outcomes across specific clinical severity indices, and poorer patient satisfaction at discharge. Patients most frequently attributed their unchanged or worsened mental health to engaging with difficult emotions for the first time, being a poor fit for an otherwise helpful program, and/or needing more time to apply new skills. Findings suggest that patients who do not perceive benefit from evidence-based acute psychiatric care may not be more clinically severe at admission, yet they may enter care with more negative treatment perceptions and report poorer outcomes on specific psychiatric indices at discharge compared to those perceiving treatment benefit. Efforts are needed to improve treatment for patients who do not benefit from psychiatric services; yet, for some, unchanged or worsened mental health in the short term may represent a step along the trajectory to long-term recovery. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

People's experiences living with peripheral neuropathy: a qualitative study.

Peripheral neuropathy is a neurological disorder characterised by pain, numbness, or tingling due to nerve damage. Peripheral neuropathy is one of the main health issues in Kuwait and is a rising concern which affects a large proportion of the population, therefore the lived experience needs to be explored to identify areas for improvement in care. This qualitative study explored the experiences of people living with peripheral neuropathy in Kuwait. Semi-structured interviews were conducted with 25 participants recruited from the Neurology Outpatient Clinic of the Ibn Sina Hospital in Kuwait. The interview questions explored their experiences and understanding of pain along with the impact on their daily life. The interviews were audio recorded, transcribed and translated into English then coded using NVivo 12. Thematic analysis was conducted to identify patterns and themes in the data. Three major themes were identified including treatment beliefs (perceived effectiveness of treatment and seeking alternative treatments), the barriers to pain management (medication side effects, relationships with healthcare professionals and lack of information and access to healthcare), and the impact on quality of life (impact on work and social, physical, and psychological consequences). Self-efficacy was a key construct and over-arching theme that was discussed in all aspects, which finds reflection in the protection motivation theory. This paper presents the experiences of people living with peripheral neuropathy and highlights there is scope for improvement of current treatments in Kuwait. Self-management strategies are recommended alongside prescribed medication and healthcare professionals are encouraged to use a patient-centered approach. More importantly, information and support on the condition to promote coping strategies and self-efficacy should be adopted to improve quality of life. These findings can be implemented locally and globally to improve the quality of care provided to people living with peripheral neuropathy.

Knowledge of fertility and perception of fertility treatment among adults with sickle cell disease (KNOW FERTILITY).

This study assessed fertility knowledge in adults with sickle cell disease using the Cardiff Fertility Knowledge Scale and Fertility Treatment Perception Survey and compared knowledge scores in respondents with sickle cell disease to previously reported unaffected cohorts. This cross-sectional study surveyed adults over age 18 with sickle cell disease at an adult sickle cell disease center using a 35-question survey addressing infertility risk factor knowledge and perceptions of fertility treatment. Analyses included summary statistics for continuous and categorical variables, univariate linear regression, and Mann-Whitney U tests for group comparisons of Fertility Knowledge Scale scores. Fertility Treatment Perception Survey scores were measured by medians of the two positive statements and four negative statements to generate separate positive and negative treatment belief scores. Statistical significance was set at p < 0.05 for all analyses. Ninety-two respondents (71 female, 21 male) with median age of 32 years (IQR: 25.0, 42.5) completed the survey between October 2020-May 2021. Sixty-five percent of respondents reported taking sickle cell disease treatment and 18% reported refusing at least one sickle cell disease treatment due to fertility concerns. The mean Fertility Knowledge Score was 49% (SD: 5.2), lower than reported in an international cohort (57% vs. 49%, p = 0.001), and higher than in a cohort of reproductive-aged Black women in the USA (49% vs. 38%, p = 0.001). Less than 50% of respondents correctly identified common infertility risk factors including sexually transmitted infections, advanced age, and obesity. Mean positive fertility perception score was 3 (IQR 3, 4), and negative fertility perception score was 3.5 (IQR 3, 4). Factors associated with agreement with negative fertility perception statements included: trying to conceive, refusing sickle cell disease treatment, and undergoing fertility treatment. Opportunities exist to improve knowledge of infertility risk factors among adults with sickle cell disease. This study raises the possibility that nearly one in five adults with sickle cell disease refuse SCD treatment or cure due to infertility concerns. Education about common infertility risks factors needs to be addressed alongside disease- and treatment- associated fertility risks.

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

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

Factors influencing readiness of patients for the use of exogenous insulin for the management of type 2 diabetes mellitus.

Objective: This study aimed to explore the T2DM patients’ reasons for refusing insulin therapy and their initial barriers to use insulin. Study Design: Cross-sectional Observational study. Setting: Primary Outpatient Health Care Center Karachi. Period: 15th October 2022 to 15th January 2023. Material &amp; Methods: Total 800 diagnosed patients of type-II diabetes mellitus having HbA1c level about 7.0% were included in study, participants were interviewed and necessary data and their response against insulin was recorded on designed questionnaire. Results: Total 800 number of patients were enrolled in study, 434 were female (54.25%) while 366 were male (45.75%) participants. The average age of total patients was 45.6±10.5. Study reported that 28.5% patients mentioned that its painful procedure. 25% patients were unaware about insulin, 15% mentioned that it is difficult to self-inject, 10.5% lack of technical person or medical staff that can inject over there, 7.5% patients believe that insulin is last resort of treatment, 5% needle phobia, 4.5% reluctant due to un affordability of insulin, 3% insulin would be addictive, and 1% patients with religious restriction was reported. Conclusion: Study explore many reason that are mainly influencing use of exogenous insulin for the treatment of diabetes mellitus. Insulin therapy is painful procedure consideration have been recorded more common while other factors unawareness about insulin, needle phobia, lack of technical people in home specially in backward areas and insulin is last resort of treatment beliefs are also major important factors reported during study.

The relationship between trust, belief and adherence among patients who complain of hypertension in Ghana.

We determined the relationship between trust, belief and adherence among patients who complain of hypertension in Ghana. A cross-sectional design was used. We sampled 447 Ghanaians with hypertension receiving care at the Korle Bu Teaching Hospital. Data were collected using a pre-tested self-administered questionnaire. Data analyses were conducted with the aid of Stata 15.0. There is low belief and trust in the biomedical treatment for hypertension. Only 36.9% of the respondents said they adhered to treatment with females expressing higher level of adherence. Trust and belief in allopathic care were associated with adherence to treatment. It is recommended that health workers identify effective ways of improving patients' trust in the allopathic care for hypertension through teaching and re-enforcement models to enhance treatment adherence and reduce the complications of hypertension. Patient or Public Contribution.

Patient Perspectives and Side-Effects Experience on Chemotherapy of Non-Small Cell Lung Cancer: A Qualitative Study.

This study aimed to explore patients' experiences of palliative chemotherapy for non-small cell lung cancer (NSCLC), how patients adapt to their new and challenging life after chemotherapy, their beliefs, and their quality of life. The study used an exploratory descriptive qualitative approach that was designed to explore the experiences and side effects of NSCLC patients on chemotherapy in Pakistan. The study was designed to obtain a deeper understanding of 22 NSCLC patients' experiences, using a face-to-face approach and interviews were conducted. Patients who have completed chemotherapy agreed to participate in semi-structured interviews. The data were arranged into five themes: hospital facilities and environment, patient's beliefs in alternative treatments, presenting a positive/negative face, life is for living, and health insurance coverage. The major complaints related to bad experiences of chemotherapy-induced side effects, but these patients still managed to complete the full course of their respective chemotherapy. Additionally, the current study revealed the real experience of patients with NSCLC which had been less studied. The patient's experience was summarized into four themes and several subthemes. This study aid healthcare providers when deciding on treatment options that will improve shared decision-making between clinicians and treatment outcomes.

Patient and public involvement to inform the protocol of a clinical trial comparing total hip arthroplasty with exercise: an exploratory qualitative case study

ObjectiveTo explore patient, clinician and decision-maker perceptions on a clinical trial evaluating the effectiveness of total hip arthroplasty (THA) compared with exercise to inform the trial protocol.DesignThis is an exploratory...

ASOC Osuntokun Award Lecture 2022: Partnership for stroke prevention and treatment in Africa: Qualitative research processes and findings

Background/ObjectivesAfrica has one of the highest rates of stroke and stroke deaths in the world. The burden of stroke is increasing with a 3-year mortality rate of up to 84%. Stroke disproportionately affects the young and middle-aged population contributing to morbidity and mortality affecting families, communities, health systems, and economic progress. My objectives of the 2022 Osuntokun Award Lecture at the African Stroke Organization Conference were to explore our qualitative research findings from our communities and to propose future qualitative methods for improving stroke outcomes in Africa. MethodsQualitative research processes and findings related to stroke prevention, treatment/ongoing care, recovery, and knowledge and attitudes influencing ethical, legal and social implications related to stroke neuro-biobanking were explored. For each qualitative study, methods were developed by the research team including: (1) plans to implement aims and ethics review; (2) guides and detailed steps for implementation; (3) training for team; (4) pilot testing, data collection, transport, transcription, storage; (5) data analysis and manuscript development. ResultsThe research focused on genetics, genomics and phenomics of stroke and more recently on exploring the ethical, legal, and social implications of stroke neuro-biobanking. All included a qualitative component to obtain input and guidance from the community. As in quantitative research, questions were developed by the research team, reviewed for clarity by a small group of community members, and 1,289 community members (ages 22–85) participated in the focus groups and key informant interviews from 2014 through 2022. Answers to questions were diverse with some knowledgeable about the science of stroke prevention and treatment, but many had ideas about prevention and causes of stroke that were not supported by science and many reported using traditional healers for treatment and religious beliefs preventing brain biobanking. ConclusionsIn addition to our current qualitative research related to stroke in Africa and beyond, we must form research partnerships with communities that not only answer researchers’ and community members’ questions but identify and implement ways to prevent stroke and improve stroke outcomes.

Medication beliefs, adherence, and outcomes in people with asthma: The importance of treatment beliefs in understanding inhaled corticosteroid nonadherence-a retrospective analysis of a real-world data set.

Poor adherence to inhaled corticosteroids (ICSs) increases asthma morbidity and mortality and is influenced by patients' treatment beliefs. This study maps patients' beliefs about ICSs across 6 countries examining variations in beliefs, and their relationship with adherence and outcomes. We sought to explore the relationship between patient treatment beliefs, and adherence and outcomes in asthma across 6 countries. Patients 18 years or older with asthma, receiving ICS alone or in combination with a long-acting β2-agonist, were included from a point-in-time paper survey of patients with asthma in Europe and the United States. Clinical characteristics, such as adherence and asthma control, were collected by self- and physician-report. Patients completed the Beliefs about Medicines Questionnaire, adapted for ICSs. Relationships between patient treatment beliefs, adherence, and outcomes were examined using regression analyses. Data from 1312 patients were analyzed. Patients were from Germany (24%), the United States (21%), France (21%), Spain (16%), Italy (10%), and the United Kingdom (9%). Most had physician-reported mild-intermittent asthma (87%), and mean age was 40± 15.5 years. There was considerable variation in necessity beliefs between countries, with respondents in Italy having more doubts about treatment necessity and respondents in Spain showing higher concerns. Patients with doubts about ICS necessity and high concerns had lower self-reported (necessity: χ2(2)= 34.31, P< .001; concerns: χ2(2)= 20.98, P< .001) and physician-reported adherence (necessity: χ2(2)= 11.70, P= .003; concerns: χ2(2)= 34.45, P< .001). Patients with high necessity beliefs (F(2, 483)= 3.33; P= .037) and high concerns (F(2,483)= 23.46; P< .001) reported poorer control. Physician estimates of adherence did not correlate well with patient self-report (ρ= 0.178, P< .001). ICS necessity beliefs and concerns were associated with adherence and asthma control. This has implications for the design of adherence interventions.

Existential Isolation as a Correlate of Mental Health Problems, Predictor of Treatment Outcome, and Moderator of a Patient-Therapist Match Effect

Introduction: Ample research has established that interpersonal isolation—the objective separateness from others—is a correlate of maladaptive psychological outcomes. However, existential isolation (EI)—the feeling of aloneness in one's subjective experience—has received less empirical attention. From the limited existing research, higher EI has been associated with greater severity of mental health concerns and more negative beliefs about treatment. Yet, these investigations have largely been conducted with non-clinical samples. Further, virtually no studies have examined EI as a predictor of current psychotherapy outcomes. Moreover, given their risk of holding negative treatment beliefs, it is plausible that therapy would be most effective if more existentially isolated individuals experienced being well matched to their therapist. This study extended EI research to a clinical sample and provided a novel test of EI as a direct predictor of outcome and moderator of a patient-therapist match system in naturalistic psychotherapy. Method: Data derived from a randomized trial comparing the effectiveness of prospectively matching patients (N = 218) to therapists (N = 48) with empirical strengths in treating the patient's specific presenting problem(s) versus case assignment as usual (Constantino et al., 2021). Patients rated EI at baseline and mental health outcomes repeatedly through treatment. We conducted correlations to examine baseline EI-symptom associations and multilevel modeling to test EI as a predictor of symptom change and moderator of the known beneficial match effect on outcome. Results: As predicted, higher EI was associated with greater depression, anxiety, and distress at baseline, as well as poorer therapy outcome across and at the end of treatment. In the expected direction, though not to a statistically significant level, the positive match effect was stronger for patients with higher versus lower EI. Discussion: We discuss research and practice implications at the intersection of social and clinical psychology.