Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 243

Search results for: adherence

243 The Diet Adherence in Cardiovascular Disease Risk Factors Patients in the North of Iran Based on the Mediterranean Diet Adherence

Authors: Marjan Mahdavi-Roshan, Arsalan Salari, Mahboobeh Gholipour, Moona Naghshbandi

Abstract:

Background and objectives: Before any nutritional intervention, it is necessary to have the prospect of eating habits of people with cardiovascular risk factors. In this study, we assessed the adherence of healthy diet based on Mediterranean dietary pattern and related factors in adults in the north of Iran. Methods: This study was conducted on 550 men and women with cardiovascular risk factors that referred to Heshmat hospital in Rasht, northern Iran. Information was collected by interview and reading medical history and measuring anthropometric indexes. The Mediterranean Diet Adherence Screener was used for assessing dietary adherence, this screener was modified according to religious beliefs and culture of Iran. Results: The mean age of participants was 58±0.38 years. The mean of body mass index was 27±0.01 kg/m2, and the mean of waist circumference was 98±0.2 cm. The mean of dietary adherence was 5.76±0.07. 45% of participants had low adherence, and just 4% had suitable adherence. The mean of dietary adherence in men was significantly higher than women (p=0. 07). Participants in rural area and high educational participants insignificantly had an unsuitable dietary Adherence. There was no significant association between some cardiovascular disease risk factors and dietary adherence. Conclusion: Education to different group about dietary intake correction and using a Mediterranean dietary pattern that is similar to dietary intake in the north of Iran, for controlling cardiovascular disease is necessary.

Keywords: dietary adherence, Mediterranean dietary pattern, cardiovascular disease, north of Iran

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242 Social Support in Adherence to Therapy in Bioenterics Intragastric Balloon

Authors: Mariela González, Zoraide Lugli

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Objective: to determine the relationship between perceived social support and adherence to therapy in patients who have been placed BioEnteric intragastric balloon (BIB). Material and method: 75 obese (56 women and 19 men) between 18 and 65 years (M = 39.29, SD = 11.82), who attended five centers in the city of Caracas, where he carried out this procedure. We used Social Support Scale and treatment adherence behavior respectively. The procedure was contacted the centers and the sample was selected. Subsequently, the inventories were applied before and the month after the before and three months after the balloon set. Results: Show that participants were characterized by moderate levels in the variables. On the other hand, those who perceive that they perceived support from friends are those who report adherence to therapy. Conclusions: From the results, it is suggested promote social support networks, which could be essential to achieve and maintain adherence to therapy in patients with BioEnterics intragastric balloon.

Keywords: BioEnteric intragastric balloon, perceived social support, adherence to therapy, patients

Procedia PDF Downloads 226
241 Factors Associated with Recruitment and Adherence for Virtual Mindfulness Interventions in Youths

Authors: Kimberly Belfry, Shavon Stafford, Fariha Chowdhury, Jennifer Crawford, Soyeon Kim

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Intervention programs are mostly delivered online during the pandemic. Screen fatigue has become a significant deterrent for virtually-deliveredinterventions, and thus, we aimed to examine factors associated with recruitment and adherence toan online mindfulness program for youths. Our preliminary analysis indicated that 40% of interested youths enrolled in the program. No difference in gender and age was found for those enrolled in the program. Adherence rate was approximately 25%, which warrants further examination. Grounding on the preliminary findings, we will conduct a binary logistic regression analysis to identify elements associated with recruitment and adherence. The model will include predictors such as age, sex, recruiter, mental health status, time of the year. Odds ratios and 95% CI will be reported. Our preliminary analysis showed low recruitment and adherence rate. By identifying elements associated with recruitment and adherence, our study provides transferrable information that can improve recruitment and adherence of online-delivered interventions offered during the pandemic.

Keywords: virtual interventions, recruitment, youth, mindfulness

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240 Prevalence of Non-Adherence among Psychiatric Patients in Jordan: A Cross Sectional Study

Authors: Tareq L. Mukattash, Karem H. Alzoubi, Ejlal Abu El-Rub, Anan S. Jarab, Sayyer I. Al-Azzam, Maher Khdour, Mohammed Shara, Yazid N. Alhamarneh

Abstract:

Background: It has been estimated that up to 50% of any patient population is at least partially non-adherent to their prescribed treatment. Identifying barriers to adherence is required to develop effective interventions for psychiatric patients. Objective: To explore the prevalence and factors of non-adherence among psychiatric patients present at four psychiatric clinics. Method: A cross-sectional questionnaire-based study. A sample of psychiatric patients attending outpatient psychiatric clinics was enrolled between March and April 2011. Results: A total of 243 psychiatric patients took part in this study with the majority of patients (92.5%) being prescribed more than one psychiatric disorder. The majority (64.2%) of the patients was classified as non-adherent according to the Morisky adherence questionnaire and forgetfulness was the most prevalent reason for that. Conclusions: Non-adherence is a common and important issue among psychiatric patients. Polypharmacy, safety concerns and lack of insight towards the prescribed treatment were reported as the main reasons of non-adherence.

Keywords: medication adherence, psychiatric disorders, clinical pharmacy, polypharmacy

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239 Non-Adherence to Antidepressant Treatment and Its Predictors among Outpatients with Depressive Disorders

Authors: Selam Mulugeta, Barkot Milkias, Mesfin Araya, Abel Worku, Eyasu Mulugeta

Abstract:

In Ethiopia, there is inadequate information on non-adherence to antidepressant treatment in patients with depressive disorders. Having awareness of the pattern of adherence is important in future prognosis, quality of life, and functionality in these patients. This hospital-based cross-sectional quantitative study was done on a sample of 216 consecutive outpatients with depressive disorders. Data were collected using questionnaires through in-person and phone call interviews. The 8-item Morisky scale was used to assess the pattern of medication adherence. Other specially developed tools were used to obtain sociodemographic and clinical information from electronic medical records and patient interviews. Data were analyzed using the Statistical Package for the Social Sciences Version - 25. Univariate and multivariable analyses were carried out to assess factors associated with non-adherence. 90% of the participants had a primary diagnosis of major depressive disorder. Based on the 8-item Morisky Medication Adherence Scale, the prevalence of non-adherence was found to be 84.7%. Living distance between 11 to 50 km from the hospital (AOR= 11, 95% CI (29,46.6)), post-secondary level of education (AOR= 8.3, 95% CI (1, 64.4)) and taking multiple medications (AOR= 6.1, 95% CI (1, 34.9)) were found to have significantly increased odds of non-adherence. Non-adherence was significantly associated with factors such as increased living distance from the hospital, relatively higher educational level, and polypharmacy. Proper and patient-centered psychoeducation, addressing the communication gap between patients and doctors, adherence to prescribing guidelines, avoiding polypharmacy unless indicated & working on accessibility of treatment is essential to decrease non-adherence.

Keywords: depressive disorders, Ethiopia, medication adherence, Addis Ababa

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238 The Role of Defense Mechanisms in Treatment Adherence in Type 2 Diabetes Mellitus: An Exploratory Study

Authors: F. Marchini, A. Caputo, J. Balonan, F. Fedele, A. Napoli, V. Langher

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Aim: The present study aims to explore the specific role of defense mechanisms in persons with type 2 diabetes mellitus in treatment adherence. Materials and methods: A correlational study design was employed. Thirty-two persons with type 2 diabetes mellitus were enrolled and assessed with Defense Mechanism Inventory, Beck Depression Inventory-II, Toronto Alexithymia Scale and Self-Care Inventory-Revised. Bivariate correlation and two-step regression analyses were performed. Results: Treatment adherence negatively correlates with hetero-directed hostility (r= -.537; p < .01), whereas it is positively associated with principalization (r= .407; p < .05). These two defense mechanisms overall explain an incremental variance of 26.9% in treatment adherence (ΔF=4.189, df1=2, df2 =21, p < .05), over and above the control variables for depression and alexithymia. However, only higher hetero-directed hostility is found to be a solid predictor of a decreased treatment adherence (β=-.497, p < .05). Conclusions: Despite providing preliminary results, this pilot study highlights the original contribution of defense mechanisms in adherence to type 2 diabetes regimens. Specifically, hetero-directed hostility may relate to an unconscious process, according to which disease-related painful feelings are displaced onto care relationships with negative impacts on adherence.

Keywords: alexithymia, defense mechanisms, treatment adherence, type 2 diabetes mellitus

Procedia PDF Downloads 225
237 Patient-Reported Adverse Drug Reactions, Medication Adherence and Clinical Outcomes among major depression disorder Patients in Ethiopia: A Prospective Hospital Based Study.

Authors: Tadesse Melaku Abegaz

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Background: there was paucity of data on the self-reported adverse drug reactions (ADRs), level of adherence and clinical outcomes with antidepressants among major depressive disorder (MDD) patients in Ethiopia. Hence, the present study sought to determine the level of adherence for and clinical outcome with antidepressants and the magnitude of ADRs. Methods: A prospective cross-sectional study was employed on MDD patients from September 2016 to January 2017 at Gondar university hospital psychiatry clinic. All patients who were available during the study period were included under the study population. The Naranjo adverse drug reaction probability scale was employed to assess the adverse drug reaction. The rate of medication adherence was determined using morisky medication adherence measurement scale eight. Clinical Outcome of patients was measured by using patient health questionnaire. Multivariable logistic carried out to determine factors for adherence and patient outcome. Results: two hundred seventy patients were participated in the study. More than half of the respondents were males 122(56.2%). The mean age of the participants was 30.94 ± 8.853. More than one-half of the subjects had low adherence to their medications 124(57.1%). About 186(85.7%) of patients encountered ADR. The most common ADR was weight gain 29(13.2). Around 198(92.2%) ADRs were probable and 19(8.8%) were possible. Patients with long standing MDD had high risk of non-adherence COR: 2.458[4.413-4.227], AOR: 2.424[1.185-4.961]. More than one-half 125(57.6) of respondents showed improved outcome. Optimal level of medication adherence was found to be associated with reduced risk of progression of the diseases COR: 0.37[0.110-5.379] and AOR: 0.432[0.201-0.909]. Conclusion: Patient reported adverse drug reactions were more prevalent in major depressive disorder patients. Adherence to medications was very poor in the setup. However, the clinical outcome was relatively higher. Long standing depression was associated with non-adherence. In addition, clinical outcome of patients were affected by non-adherence. Therefore, adherence enhancing interventions should be provided to improve medication adherence and patient outcome.

Keywords: adverse drug reactions, clinical outcomes, Ethiopia, prospective study, medication adherence

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236 Factors Associated with Non-Adherence to Antiretroviral Treatment among HIV Infected Patients in Ukraine

Authors: Larissa Burruano, Sergey Grabovyj, Irina Nguen

Abstract:

The study aimed to assess the level of adherence to anti retroviral therapy (ART) and to examine the relationship between adherence and risk behavior factor (drug use) among patients infected with HIV. The patients with newly diagnosed or established HIV infection under follow-up at the Sumskij Regional Centre for AIDS Prevention in Ukraine were eligible for this study. Medical records were used to measure the patient’s adherence to medication. Measurements were obtained at month 6 and at month 12 to calculate the number of medication omission during the past 30 days: (on a 2-point scale – once until three in a month – were considered adherent, three and more in a month – were considered non-adherent). Of the 50 study participants, 27 (54.0%) were men and 23 (46.0%) women. The mean age is 35.2 years (SD= 5.1). A majority of the patients (82.0%) is in the age group of 25-30 years. The main level of adherence was 74.0% and 66.0% at 6 and 12 months, respectively. The main routes of HIV transmission were drug injection among men 12 (44.4%) and sexual contact among women 11 (47.8%). Univariate analyses indicated that patients who had lower level of education were more likely to have been non-adherent at month 6- (X2 =5.1, n=50, p < .05) and at month 12 (X2 = 4.34, n=50, p < .05). Multivariate tests showed that only age (OR= 1.163 [95% CI 0.98–1.370]) was significant independent predictor of treatment adherence, while gender, education, employment status were not predictive for the risk of developing non-compliance. There was not a significant interaction between non-adherence and intravenous drug use. Consistent with these findings, younger people were more likely to have missed a dose of their medication because they had a greater sense of invulnerability than older patients. The study indicates that the socio demographic characteristic should be taken into an account in the future research regarding adherence in the case of HIV infection. If the patient anti retroviral adherence can be improved by qualitatively better medical care in all regions of the Ukraine, behavioral changes in the population can to be expected in the long term.

Keywords: HIV, antiretroviral therapy, adherence, Ukraine, Eastern Europe

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235 Correlation between Adherence to Islamic Principles of Success and Academic Achievement

Authors: Zuwaira Abubakar

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Islam is the Divine religion which guides Man ways of leading a prosperous life in this life and the hereafter. This study was conducted in order to investigate the possible relationship between adherence to Islamic principles of success and academic performance of university students. Accordingly, a questionnaire based on Islamized principles of success (referred to as 'Islamic character quotient inventory (ICQi)') was correlated with CGPA (Cumulative Grade Point Averages) of 343 students of Usmanu Danfodiyo University Sokoto. The empirical testing indicates that the total score on ICQi correlated positively and significantly with academic performance of the respondent. Students with either high or medium adherence have a significantly (P<0.01) higher CGPA than their counterparts with the low-adherence level. However, the result did not show a significant relationship between the CGPA of highly adherent individuals and that of those with medium adherence level. This may suggests that Islam is not for spiritual life only but also relevant and useful for our practical life.

Keywords: academic, Islam, principles, success

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234 Effect of Mobile Phone Text Message Reminders on Adherence to Routine Prenatal Iron/Folic Acid Supplement among Pregnant Women: A Pilot Study

Authors: Nneka U. Igboeli, Maxwell O. Adibe

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Iron and folate supplementation in pregnancy are important interventions that prevent maternal anaemia and fetal anomaly. Thus, daily oral doses of iron and folic acid are recommended throughout pregnancy as part of antenatal care. However, low adherence has been a major drawback leading to low effectiveness of these programs. The effect of mobile text message reminders to pregnant women to take their routine medications on adherence was evaluated in this study. The first 100 women who consented to the study were recruited and randomized to either receive a text message reminder on adherence to routine medications or not. Adherence was assessed using the 8-item Modified Morisky Adherence Scale (8-MMAS). The folders of successfully recruited women were tagged with the a study number assigned to each of them. The womens’ phone numbers were collected and these were used to send text messages reminders on adhering to routine drugs only to women in the intervention group. The text messages were sent three times per week for a period of four weeks with an adherence reassessment at the one month follow-up antenatal visit for recruited women. At one month follow-up, the lost to follow-up were 6 (16%) women for the intervention group and 17 (34%) for the control group. The across group mean difference in adherence score was 0.07 (-0.96 – 1.10) at baseline and 0.3 (-0.31 – 0.92) after intervention, both insignificant at p > 0.05. The within group change were increases of 0.58 (0.00 – 1.16) (p = 0.05) from baseline for the intervention group and a 0.35 (-0.51 – 1.20) (p = 0.395) for the control group. Non-significant increase in adherence scores were recorded for both groups. However, the increase in adherence scores of women in the intervention group was greater and may be potentially transformed into more positive results if the study period is increased with possibly reduced study drop-outs shows great promise for more positive results.

Keywords: adherence, mobile phone, pregnant women, reminders

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233 Adherence Induced Formwork Removal in Small-Scale Pull-Off Tensile Tests

Authors: Nicolas Spitz, Nicolas Coniglio, Mohamed El Mansori, Alex Montagne, Sabeur Mezghani

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Nowadays buildings' construction is performed by pouring concrete into molds referred to as formworks that are usually prefabricated metallic modules. Defects such as stripping may possibly form during the removal of the formwork if the interfacial bonding between the concrete and the formwork is high. A new pull-off tensile test was developed in our laboratory to simulate small-scale formwork removals. The concrete-to-formwork adherence force was measured on bare and coated formworks with different surface signatures. The used concrete was a mixture largely used on building sites and contains CEM I Portland cement and calcareous filler. The concrete surface appearance and the type of failures at the concrete-formwork interface have been investigated. The originality of this near-to-surface test was to compare the laboratory-measured adherence forces to the on-site observations. Based upon the small-scale laboratory test results, functional formwork specifications with low adherence to concrete was proposed in terms of superficial signature characteristics.

Keywords: concrete-formwork adherence, interfacial bonding, skin formwork functionality, small-scale pull-off tensile test

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232 Effect of Family-Based DOTS Support Program on Adherence to Health Behaviors among Patients with Pulmonary Tuberculosis in Bandung, Indonesia

Authors: D. I. Yani, S. Isaramalai, C. Kritpracha

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Adherence to health behaviors is essential to achieve successful TB treatment. This study aimed to examine the effect of a family-based DOTS support program on adherence to health behaviors in patients with pulmonary TB. Sixty TB patients and their families were selected using cluster randomization of community health centers. The subjects were assigned into a control group, who received the routine care, and an experimental group, who received both routine care and care from the family-based DOTS support program. Paired t-test and the independent t-test were applied. The total score of adherence to health behaviors in the experimental group was significantly higher after receiving care from the family-based DOTS support program than the pretest score (t = -10.34, p < .001). Suggestions were made to expand the application of this program in various contexts and to extend knowledge for nursing practices and research.

Keywords: self-care deficit nursing theory, family-based DOTS program, pulmonary tuberculosis, adherence, health behaviors

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231 Improving Depression Symptoms and Antidepressant Medication Adherence Using Encrypted Short Message Service Text Message Reminders

Authors: Ogbonna Olelewe

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This quality improvement project seeks to address the background and significance of promoting antidepressant (AD) medication adherence to reduce depression symptoms in patients diagnosed with major depression. This project aims to substantiate using daily encrypted short message service (SMS) text reminders to take prescribed antidepressant medications with the goal of increasing medication adherence to reduce depression scores in patients diagnosed with major depression, thereby preventing relapses and increasing remission rates. Depression symptoms were measured using the Patient Health Questionnaire-9 (PHQ-9) scale. The PHQ-9 provides a total score of depression symptoms from mild to severe, ranging from 0 to 27. A -pretest/post-test design was used, with a convenience sample size of 35 adult patients aged 18 years old to 45 years old, diagnosed with MDD, and prescribed at least one antidepressant for one year or more. Pre- and post-test PHQ-9 scores were conducted to compare depression scores before and after the four-week intervention period. The results indicated improved post-intervention PHQ-9 scores, improved AD medication adherence, and a significant reduction in depression symptoms.

Keywords: major depressive disorder, antidepressants, short message services, text reminders, Medication adherence/non-adherence, Patient Health Questionnaire 9

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230 Method for Improving Antidepressants Adherence in Patients with Depressive Disorder: Systemic Review and Meta-Analysis

Authors: Juntip Kanjanasilp, Ratree Sawangjit, Kanokporn Meelap, Kwanchanok Kruthakool

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Depression is a common mental health disorder. Antidepressants are effective pharmacological treatments, but most patients have low medication adherence. This study aims to systematic review and meta-analysis what method increase the antidepressants adherence efficiently and improve clinical outcome. Systematic review of articles of randomized controlled trials obtained by a computerized literature search of The Cochrane, Library, Pubmed, Embase, PsycINFO, CINAHL, Education search, Web of Science and ThaiLIS (28 December 2017). Twenty-three studies were included and assessed the quality of research by ROB 2.0. The results reported that printing media improved in number of people who had medication adherence statistical significantly (p= 0.018), but education, phone call, and program utilization were no different (p=0.172, p=0.127, p=0.659). There was no significant difference in pharmacist’s group, health care team’s group and physician’s group (p=0.329, p=0.070, p=0.040). Times of intervention at 1 month and 6 months improved medication adherence significantly (p= 0.0001, p=0.013). There was significantly improved adherence in single intervention (p=0.027) but no different in multiple interventions (p=0.154). When we analyzed medication adherence with the mean score, no improved adherence was found, not relevant with who gives the intervention and times to intervention. However, the multiple interventions group was statistically significant improved medication adherence (p=0.040). Phone call and the physician’s group were statistically significant improved clinical outcomes in number of improved patients (0.025 and 0.020, respectively). But in the pharmacist’s group and physician’s group were not found difference in the mean score of clinical outcomes (p=0.993, p=0.120, respectively). Times to intervention and number of intervention were not significant difference than usual care. The overall intervention can increase antidepressant adherence, especially the printing media, and the appropriate timing of the intervention is at least 6 months. For effective treatment, the provider should have experience and expert in caring for patients with depressive disorders, such as a psychiatrist. Medical personnel should have knowledge in caring for these patients also.

Keywords: depression, medication adherence, clinical outcomes, systematic review, meta-analysis

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229 Novel Oral Anticoagulants (NOACS) Adherence and Bleeding Events in Atrial Fibrillation Patients: A Systematic Review and Meta-Analysis

Authors: Tadesse Melaku Abegaz, Akshaya Srikanth Bahagavathula, Abdulla Shehab Sheab, Asim Hassen

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Objectives: Non-adherence and discontinuation of anticoagulant therapy lead to increased ischemic stroke risk and contributes to suboptimal outcomes of the anticoagulant treatment. This systematic review and meta-analysis were aimed to investigate the adherence to NOACs and adverse events in patients with AF. Methods: Original research articles conducted on patients with AF and using any NOACs (dabigatran, rivoraxaban and apixaban) reporting adherence for at least 35 days were included. Scientific databases including PubMed, Web of Science, and Google Scholar were searched using MeSH keywords to obtaining literature researched between 2008 to till June, 2016. Study characteristics, patient’s sociodemographic and clinical characteristics, medication adherence levels and bleeding events reported were recorded. Results: The overall sample size of the six studies is 1,640,157, with CHADS2 scores < 2 in 551 patients, CHADS2-VASc ≥ 2 in 62,232 AF patients. Three-forth [75.6% (95%CI= 66.5-84.8), p < 0.001] are adherent to NOACs. However, a higher rate [72.7% (62.5-82.9), p < 0.001] of adherence was observed with Dabigatran than Apixaban [59.9% (3.2-123.1), p=0.063] and Rivaroxaban [59.3% (38.7-80.0), p<0.001]. Sub-group analysis revealed that nearly 57% of the AF patients on NOACs have CHADS2 scores < 2 and 20% of these patients were non-adherent to NOACs. Overall bleeding events rate associated with NOACs non-adherent AF patients was found to be 7.5% (0.2-14.8), p=0.045. However, nearly 11.2% of AF patients experienced bleeding events were non-adherent to NOAC medications. A higher proportion of bleeding events were noticed with Dabigatran (14.7%). Conclusions: Adherence rates, while uniformly suboptimal, nevertheless varied considerably, lowest at 59.3% for rivaroxaban and 59.9% for apixaban, followed by dabigatran (75.6%). Overall bleeding events associated with NOACs rates were 7.5%. However, lower adherence to NOACs was associated with worse outcomes among patients with greater stroke risk.

Keywords: atrial fibrillation, bleeding events, meta-analysis, novel oral anticoagulants

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228 Cancer Survivor’s Adherence to Healthy Lifestyle Behaviours; Meeting the World Cancer Research Fund/American Institute of Cancer Research Recommendations, a Systematic Review and Meta-Analysis

Authors: Daniel Nigusse Tollosa, Erica James, Alexis Hurre, Meredith Tavener

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Introduction: Lifestyle behaviours such as healthy diet, regular physical activity and maintaining a healthy weight are essential for cancer survivors to improve the quality of life and longevity. However, there is no study that synthesis cancer survivor’s adherence to healthy lifestyle recommendations. The purpose of this review was to collate existing data on the prevalence of adherence to healthy behaviours and produce the pooled estimate among adult cancer survivors. Method: Multiple databases (Embase, Medline, Scopus, Web of Science and Google Scholar) were searched for relevant articles published since 2007, reporting cancer survivors adherence to more than two lifestyle behaviours based on the WCRF/AICR recommendations. The pooled prevalence of adherence to single and multiple behaviours (operationalized as adherence to more than 75% (3/4) of health behaviours included in a particular study) was calculated using a random effects model. Subgroup analysis adherence to multiple behaviours was undertaken corresponding to the mean survival years and year of publication. Results: A total of 3322 articles were generated through our search strategies. Of these, 51 studies matched our inclusion criteria, which presenting data from 2,620,586 adult cancer survivors. The highest prevalence of adherence was observed for smoking (pooled estimate: 87%, 95% CI: 85%, 88%) and alcohol intake (pooled estimate 83%, 95% CI: 81%, 86%), and the lowest was for fiber intake (pooled estimate: 31%, 95% CI: 21%, 40%). Thirteen studies were reported the proportion of cancer survivors (all used a simple summative index method) to multiple healthy behaviours, whereby the prevalence of adherence was ranged from 7% to 40% (pooled estimate 23%, 95% CI: 17% to 30%). Subgroup analysis suggest that short-term survivors ( < 5 years survival time) had relatively a better adherence to multiple behaviours (pooled estimate: 31%, 95% CI: 27%, 35%) than long-term ( > 5 years survival time) cancer survivors (pooled estimate: 25%, 95% CI: 14%, 36%). Pooling of estimates according to the year of publication (since 2007) also suggests an increasing trend of adherence to multiple behaviours over time. Conclusion: Overall, the adherence to multiple lifestyle behaviors was poor (not satisfactory), and relatively, it is a major concern for long-term than the short-term cancer survivor. Cancer survivors need to obey with healthy lifestyle recommendations related to physical activity, fruit and vegetable, fiber, red/processed meat and sodium intake.

Keywords: adherence, lifestyle behaviours, cancer survivors, WCRF/AICR

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227 Predictors of Non-Adherence to Pharmacological Therapy in Patients with Type 2 Diabetes

Authors: Anan Jarab, Riham Almrayat, Salam Alqudah, Maher Khdour, Tareq Mukattash, Sharell Pinto

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Background: The prevalence of diabetes in Jordan is among the highest in the world, making it a particularly alarming health problem there. It has been indicated that poor adherence to the prescribed therapy lead to poor glycemic control and enhance the development of diabetes complications and unnecessary hospitalization. Purpose: To explore factors associated with medication non-adherence in patients with type 2 diabetes in Jordan. Materials and Methods: Variables including socio-demographics, disease and therapy factors, diabetes knowledge, and health-related quality of life in addition to adherence assessment were collected for 171 patients with type 2 diabetes using custom-designed and validated questionnaires. Logistic regression was performed to develop a model with variables that best predicted medication non-adherence in patients with type 2 diabetes in Jordan. Results: The majority of the patients (72.5%) were non-adherent. Patients were found four times less likely to adhere to their medications with each unit increase in the number of prescribed medications (OR = 0.244, CI = 0.08-0.63) and nine times less likely to adhere to their medications with each unit increase in the frequency of administration of diabetic medication (OR = 0.111, CI = 0.04-2.01). Patients in the present study were also approximately three times less likely (OR = 0.362, CI = 0.24-0.87) to adhere to their medications if they reported having concerns about side effects and twice more likely to adhere to medications (OR = 0.493, CI = 0.08-1.16) if they had one or more micro-vascular complication. Conclusion: The current study revealed low adherence rate to the prescribed therapy among Jordanians with type 2 diabetes. Simplifying dosage regimen, selecting treatments with lower side effects along with an emphasis on diabetes complications should be taken into account when developing care plans for patients with type 2 diabetes.

Keywords: type 2 diabetes, adherence, glycemic control, clinical pharmacist, Jordan

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226 The Relationship between Depression, HIV Stigma and Adherence to Antiretroviral Therapy among Adult Patients Living with HIV at a Tertiary Hospital in Durban, South Africa: The Mediating Roles of Self-Efficacy and Social Support

Authors: Muziwandile Luthuli

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Although numerous factors predicting adherence to antiretroviral therapy (ART) among people living with HIV/AIDS (PLWHA) have been broadly studied on both regional and global level, up-to-date adherence of patients to ART remains an overarching, dynamic and multifaceted problem that needs to be investigated over time and across various contexts. There is a rarity of empirical data in the literature on interactive mechanisms by which psychosocial factors influence adherence to ART among PLWHA within the South African context. Therefore, this study was designed to investigate the relationship between depression, HIV stigma, and adherence to ART among adult patients living with HIV at a tertiary hospital in Durban, South Africa, and the mediating roles of self-efficacy and social support. The health locus of control theory and the social support theory were the underlying theoretical frameworks for this study. Using a cross-sectional research design, a total of 201 male and female adult patients aged between 18-75 years receiving ART at a tertiary hospital in Durban, KwaZulu-Natal were sampled, using time location sampling (TLS). A self-administered questionnaire was employed to collect the data in this study. Data were analysed through SPSS version 27. Several statistical analyses were conducted in this study, namely univariate statistical analysis, correlational analysis, Pearson’s chi-square analysis, cross-tabulation analysis, binary logistic regression analysis, and mediational analysis. Univariate analysis indicated that the sample mean age was 39.28 years (SD=12.115), while most participants were females 71.0% (n=142), never married 74.2% (n=147), and most were also secondary school educated 48.3% (n=97), as well as unemployed 65.7% (n=132). The prevalence rate of participants who had high adherence to ART was 53.7% (n=108), and 46.3% (n=93) of participants had low adherence to ART. Chi-square analysis revealed that employment status was the only statistically significant socio-demographic influence of adherence to ART in this study (χ2 (3) = 8.745; p < .033). Chi-square analysis showed that there was a statistically significant difference found between depression and adherence to ART (χ2 (4) = 16.140; p < .003), while between HIV stigma and adherence to ART, no statistically significant difference was found (χ2 (1) = .323; p >.570). Binary logistic regression indicated that depression was statistically associated with adherence to ART (OR= .853; 95% CI, .789–.922, P < 001), while the association between self-efficacy and adherence to ART was statistically significant (OR= 1.04; 95% CI, 1.001– 1.078, P < .045) after controlling for the effect of depression. However, the findings showed that the effect of depression on adherence to ART was not significantly mediated by self-efficacy (Sobel test for indirect effect, Z= 1.01, P > 0.31). Binary logistic regression showed that the effect of HIV stigma on adherence to ART was not statistically significant (OR= .980; 95% CI, .937– 1.025, P > .374), but the effect of social support on adherence to ART was statistically significant, only after the effect of HIV stigma was controlled for (OR= 1.017; 95% CI, 1.000– 1.035, P < .046). This study promotes behavioral and social change effected through evidence-based interventions by emphasizing the need for additional research that investigates the interactive mechanisms by which psychosocial factors influence adherence to ART. Depression is a significant predictor of adherence to ART. Thus, to alleviate the psychosocial impact of depression on adherence to ART, effective interventions must be devised, along with special consideration of self-efficacy and social support. Therefore, this study is helpful in informing and effecting change in health policy and healthcare services through its findings

Keywords: ART adherence, depression, HIV/AIDS, PLWHA

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225 Prospective Study to Determine the Efficacy of Day Hospital Care to Improve Treatment Adherence for Hospitalized Schizophrenic Patients

Authors: Jin Hun Choi, So Hyun Ahn, Seong Keun Wang, Ik-Seung Chee, Jung Lan Kim, Sun Woo Lee

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Objectives: The purpose of the study is to investigate the effects of day hospital care in hospitalized schizophrenic patients in terms of treatment adherence and treatment outcomes. Methods: Among schizophrenic patients hospitalized between 2011 and 2012, 23 day hospital care patient and 40 control subjects were included in the study. All candidates underwent Beck Cognitive Insight Scale, Drug Attitude Inventory, World Health Organization Quality of Life Assessment and Psychological Well-Being Scale when their symptoms were stabilized during hospitalization, and after being discharged, 23 patients received day hospital care for two months and then changed to out-patient care while 40 patients received out-patient care immediately after discharge. At the point of two months of out-patient care, the treatment adherence of the two groups was evaluated; tracking observation was performed until February, 2013, and survival rates were compared between the two groups. Results: Treatment adherence was higher in the day hospital care group than in the control group. Kaplan-Meier survival analysis showed a higher survival rate for the day hospital care group compared to the control group. Levels of cognitive insight and quality of life were higher after day hospital care than before day hospital care in the day hospital care group. Conclusions: Through the study, it was confirmed that when hospitalized schizophrenic patients received continuous day hospital care after being discharged, they received further out-patient care more faithfully. The study is considered to aid in the understanding regarding schizophrenic patients’ treatment adherence issues and improvement of treatment outcomes.

Keywords: schizophrenia, day hospital care, adherence, outcomes

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224 Service Blueprint for Improving Clinical Guideline Adherence via Mobile Health Technology

Authors: Y. O’Connor, C. Heavin, S. O’ Connor, J. Gallagher, J. Wu, J. O’Donoghue

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Background: To improve the delivery of paediatric healthcare in resource-poor settings, Community Health Workers (CHW) have been provided with a paper-based set of protocols known as Community Case Management (CCM). Yet research has shown that CHW adherence to CCM guidelines is poor, ultimately impacting health service delivery. Digitising the CCM guidelines via mobile technology is argued in extant literature to improve CHW adherence. However, little research exist which outlines how (a) this process can be digitised and (b) adherence could be improved as a result. Aim: To explore how an electronic mobile version of CCM (eCCM) can overcome issues associated with the paper-based CCM protocol (poor adherence to guidelines) vis-à-vis service blueprinting. This service blueprint will outline how (a) the CCM process can be digitised using mobile Clinical Decision Support Systems software to support clinical decision-making and (b) adherence can be improved as a result. Method: Development of a single service blueprint for a standalone application which visually depicts the service processes (eCCM) when supporting the CHWs, using an application known as Supporting LIFE (Low cost Intervention For disEase control) as an exemplar. Results: A service blueprint is developed which illustrates how the eCCM solution can be utilised by CHWs to assist with the delivery of healthcare services to children. Leveraging smartphone technologies can (a) provide CHWs with just-in-time data to assist with their decision making at the point-of-care and (b) improve CHW adherence to CCM guidelines. Conclusions: The development of the eCCM opens up opportunities for the CHWs to leverage the inherent benefit of mobile devices to assist them with health service delivery in rural settings. To ensure that benefits are achieved, it is imperative to comprehend the functionality and form of the eCCM service process. By creating such a service blueprint for an eCCM approach, CHWs are provided with a clear picture regarding the role of the eCCM solution, often resulting in buy-in from the end-users.

Keywords: adherence, community health workers, developing countries, mobile clinical decision support systems, CDSS, service blueprint

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223 The Association between Self-Efficacy and Hypertension Self-Care Behavior among Patients with Hypertension

Authors: Fazel Zinat Motlagh, Reza Chaman, Rashid Ghafari, Zahra Behzad, Ahmad Ali Eslami

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Background: Chronic disease management requires the individual to perform several self-care behaviors. Self-efficacy, a widely used psychosocial concept, is associated with the ability to manage chronic disease. In this study, we examine the association between self-efficacy and self-care behaviors related to hypertension. Methods: In this cross-sectional study, conducted in Kohgiluye Boyer Ahmad province, the south of Iran, a total of 1836 hypertension patients, were randomly selected and participated in the study. Self-care behavior was measured with using H-SCALE (Hypertension Self-Care Activity Level Effects). Logistic regression conducted to detect correlation between self-efficacy and adherence to hypertension self-care behaviors. Results: Less than half (40.8%) of the participants reported that they have good self-efficacy to manage hypertension. Good self-efficacy was significantly associated with improve in adherence to medication (95% CI: 1.68, 1.83), eating a low-salt diet (95% CI: 1.44–1.73), physical activity (95% CI: 1.39–1.55), quit smoking (95% CI: 0.38–0.47), and weight management techniques (95% CI: 0.66–0.82). Conclusion: Hypertension self-efficacy was associated with adherence to self-care behaviors among adult with hypertension. According to our finding hypertension is a manageable condition. Self-efficacy is important factor in adherence with self-care behaviors related with hypertension.

Keywords: self-efficacy, hypertension, self-care, Iran

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222 Effects of Self-Management Programs on Blood Pressure Control, Self-Efficacy, Medication Adherence, and Body Mass Index among Older Adult Patients with Hypertension: Meta-Analysis of Randomized Controlled Trials

Authors: Van Truong Pham

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Background: Self-management was described as a potential strategy for blood pressure control in patients with hypertension. However, the effects of self-management interventions on blood pressure, self-efficacy, medication adherence, and body mass index (BMI) in older adults with hypertension have not been systematically evaluated. We evaluated the effects of self-management interventions on systolic blood pressure (SBP) and diastolic blood pressure (DBP), self-efficacy, medication adherence, and BMI in hypertensive older adults. Methods: We followed the recommended guidelines of preferred reporting items for systematic reviews and meta-analyses. Searches in electronic databases including CINAHL, Cochrane Library, Embase, Ovid-Medline, PubMed, Scopus, Web of Science, and other sources were performed to include all relevant studies up to April 2019. Studies selection, data extraction, and quality assessment were performed by two reviewers independently. We summarized intervention effects as Hedges' g values and 95% confidence intervals (CI) using a random-effects model. Data were analyzed using Comprehensive Meta-Analysis software 2.0. Results: Twelve randomized controlled trials met our inclusion criteria. The results revealed that self-management interventions significantly improved blood pressure control, self-efficacy, medication adherence, whereas the effect of self-management on BMI was not significant in older adult patients with hypertension. The following Hedges' g (effect size) values were obtained: SBP, -0.34 (95% CI, -0.51 to -0.17, p < 0.001); DBP, -0.18 (95% CI, -0.30 to -0.05, p < 0.001); self-efficacy, 0.93 (95%CI, 0.50 to 1.36, p < 0.001); medication adherence, 1.72 (95%CI, 0.44 to 3.00, p=0.008); and BMI, -0.57 (95%CI, -1.62 to 0.48, p = 0.286). Conclusions: Self-management interventions significantly improved blood pressure control, self-efficacy, and medication adherence. However, the effects of self-management on obesity control were not supported by the evidence. Healthcare providers should implement self-management interventions to strengthen patients' role in managing their health care.

Keywords: self-management, meta-analysis, blood pressure control, self-efficacy, medication adherence, body mass index

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221 Promoting Patients' Adherence to Home-Based Rehabilitation: A Randomised Controlled Trial of a Theory-Driven Mobile Application

Authors: Derwin K. C. Chan, Alfred S. Y. Lee

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The integrated model of self-determination theory and the theory of planned behaviour has been successfully applied to explain individuals’ adherence to health behaviours, including behavioural adherence toward rehabilitation. This study was a randomised controlled trial that examined the effectiveness of an mHealth intervention (i.e., mobile application) developed based on this integrated model in promoting treatment adherence of patients of anterior cruciate ligament rupture during their post-surgery home-based rehabilitation period. Subjects were 67 outpatients (aged between 18 and 60) who undertook anterior cruciate ligament (ACL) reconstruction surgery for less than 2 months for this study. Participants were randomly assigned either into the treatment group (who received the smartphone application; N = 32) and control group (who receive standard treatment only; N = 35), and completed psychological measures relating to the theories (e.g., motivations, social cognitive factors, and behavioural adherence) and clinical outcome measures (e.g., subjective knee function (IKDC), laxity (KT-1000), muscle strength (Biodex)) relating to ACL recovery at baseline, 2-month, and 4-month. Generalise estimating equation showed the interaction between group and time was significant on intention was only significant for intention (Wald x² = 5.23, p = .02), that of perceived behavioural control (Wald x² = 3.19, p = .07), behavioural adherence (Wald x² = 3.08, p = .08, and subjective knee evaluation (Wald x² = 2.97, p = .09) were marginally significant. Post-hoc between-subject analysis showed that control group had significant drop of perceived behavioural control (p < .01), subjective norm (p < .01) and intention (p < .01), behavioural adherence (p < .01) from baseline to 4-month, but such pattern was not observed in the treatment group. The treatment group had a significant decrease of behavioural adherence (p < .05) in the 2-month, but such a decrease was not observed in 4-month (p > .05). Although the subjective knee evaluation in both group significantly improved at 2-month and 4-month from the baseline (p < .05), and the improvements in the control group (mean improvement at 4-month = 40.18) were slightly stronger than the treatment group (mean improvement at 4-month = 34.52). In conclusion, the findings showed that the theory driven mobile application ameliorated the decline of treatment intention of home-based rehabilitation. Patients in the treatment group also reported better muscle strength than control group at 4-month follow-up. Overall, the mobile application has shown promises on tackling the problem of orthopaedics outpatients’ non-adherence to medical treatment.

Keywords: self-determination theory, theory of planned behaviour, mobile health, orthopaedic patients

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220 Multilevel of Factors Affected Optimal Adherence to Antiretroviral Therapy and Viral Suppression amongst HIV-Infected Prisoners in South Ethiopia: A Prospective Cohort Study

Authors: Terefe Fuge, George Tsourtos , Emma Miller

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Objectives: Maintaining optimal adherence and viral suppression in people living with HIV (PLWHA) is essential to ensure both preventative and therapeutic benefits of antiretroviral therapy (ART). Prisoners bear a particularly high burden of HIV infection and are highly likely to transmit to others during and after incarceration. However, the level of adherence and viral suppression, as well as its associated factors in incarcerated populations in low-income countries is unknown. This study aimed to determine the prevalence of non-adherence and viral failure, and contributing factors to this amongst prisoners in South Ethiopia. Methods: A prospective cohort study was conducted between June 1, 2019 and July 31, 2020 to compare the level of adherence and viral suppression between incarcerated and non-incarcerated PLWHA. The study involved 74 inmates living with HIV (ILWHA) and 296 non-incarcerated PLWHA. Background information including sociodemographic, socioeconomic, psychosocial, behavioural, and incarceration-related characteristics was collected using a structured questionnaire. Adherence was determined based on participants’ self-report and pharmacy refill records, and plasma viral load measurements which were undertaken within the study period were prospectively extracted to determine viral suppression. Various univariate and multivariate regression models were used to analyse data. Results: Self-reported dose adherence was approximately similar between ILWHA and non-incarcerated PLWHA (81% and 83% respectively), but ILWHA had a significantly higher medication possession ratio (MPR) (89% vs 75%). The prevalence of viral failure (VF) was slightly higher (6%) in ILWHA compared to non-incarcerated PLWHA (4.4%). The overall dose non-adherence (NA) was significantly associated with missing ART appointments, level of satisfaction with ART services, patient’s ability to comply with a specified medication schedule and types of methods used to monitor the schedule. In ILWHA specifically, accessing ART services from a hospital compared to a health centre, an inability to always attend clinic appointments, experience of depression and a lack of social support predicted NA. VF was significantly higher in males, people of age 31-35 years and in those who experienced social stigma, regardless of their incarceration status. Conclusions: This study revealed that HIV-infected prisoners in South Ethiopia were more likely to be non-adherent to doses and so to develop viral failure compared to their non-incarcerated counterparts. A multitude of factors was found to be responsible for this requiring multilevel intervention strategies focusing on the specific needs of prisoners.

Keywords: Adherence , Antiretroviral therapy, Incarceration, South Ethiopia, Viral suppression

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219 Real-World Comparison of Adherence to and Persistence with Dulaglutide and Liraglutide in UAE e-Claims Database

Authors: Ibrahim Turfanda, Soniya Rai, Karan Vadher

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Objectives— The study aims to compare real-world adherence to and persistence with dulaglutide and liraglutide in patients with type 2 diabetes (T2D) initiating treatment in UAE. Methods— This was a retrospective, non-interventional study (observation period: 01 March 2017–31 August 2019) using the UAE Dubai e-Claims database. Included: adult patients initiating dulaglutide/liraglutide 01 September 2017–31 August 2018 (index period) with: ≥1 claim for T2D in the 6 months before index date (ID); ≥1 claim for dulaglutide/liraglutide during index period; and continuous medical enrolment for ≥6 months before and ≥12 months after ID. Key endpoints, assessed 3/6/12 months after ID: adherence to treatment (proportion of days covered [PDC; PDC ≥80% considered ‘adherent’], per-group mean±standard deviation [SD] PDC); and persistence (number of continuous therapy days from ID until discontinuation [i.e., >45 days gap] or end of observation period). Patients initiating dulaglutide/liraglutide were propensity score matched (1:1) based on baseline characteristics. Between-group comparison of adherence was analysed using the McNemar test (α=0.025). Persistence was analysed using Kaplan–Meier estimates with log-rank tests (α=0.025) for between-group comparisons. This study presents 12-month outcomes. Results— Following propensity score matching, 263 patients were included in each group. Mean±SD PDC for all patients at 12 months was significantly higher in the dulaglutide versus the liraglutide group (dulaglutide=0.48±0.30, liraglutide=0.39±0.28, p=0.0002). The proportion of adherent patients favored dulaglutide (dulaglutide=20.2%, liraglutide=12.9%, p=0.0302), as did the probability of being adherent to treatment (odds ratio [97.5% CI]: 1.70 [0.99, 2.91]; p=0.03). Proportion of persistent patients also favoured dulaglutide (dulaglutide=15.2%, liraglutide=9.1%, p=0.0528), as did the probability of discontinuing treatment 12 months after ID (p=0.027). Conclusions— Based on the UAE Dubai e-Claims database data, dulaglutide initiators exhibited significantly greater adherence in terms of mean PDC versus liraglutide initiators. The proportion of adherent patients and the probability of being adherent favored the dulaglutide group, as did treatment persistence.

Keywords: adherence, dulaglutide, effectiveness, liraglutide, persistence

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218 Improving Self-Administered Medication Adherence for Older Adults: A Systematic Review

Authors: Mathumalar Loganathan, Lina Syazana, Bryony Dean Franklin

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Background: The therapeutic benefit of self-administered medication for long-term use is limited by an average 50% non-adherence rate. Patient forgetfulness is a common factor in unintentional non-adherence. With a growing ageing population, strategies to improve self-administration of medication adherence are essential. Our aim was to review systematically the effects of interventions to optimise self-administration of medication. Method: Database searched were MEDLINE, EMBASE, PsynINFO, CINAHL from 1980 to 31 October 2013. Search terms included were ‘self-administration’, ‘self-care’, ‘medication adherence’, and ‘intervention’. Two independent reviewers undertook screening and methodological quality assessment, using the Downs and Black rating scale. Results: The search strategy retrieved 6 studies that met the inclusion and exclusion criteria. Three intervention strategies were identified: self-administration medication programme (SAMP), nursing education and medication packaging (pill calendar). A nursing education programme focused on improving patients’ behavioural self-management of drug prescribing. This was the most studied area and three studies highlighting an improvement in self-administration of medication. Conclusion: Results are mixed and there is no one interventional strategy that has proved to be effective. Nevertheless, self-administration of medication programme seems to show most promise. A multi-faceted approach and clearer policy guideline are likely to be required to improve prescribing for these vulnerable patients. Mixed results were found for SAMP. Medication packaging (pill calendar) was evaluated in one study showing a significant improvement in self-administration of medication. A meta-analysis could not be performed due to heterogeneity in the outcome measures.

Keywords: self-administered medication, intervention, prescribing, older patients

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217 Factors Associated with Treatment Adherence among Pulmonary Tuberculosis Patients in New Delhi

Authors: Ilham Zaidi, P. Sankara Sarma, Quazi Taufique Ahmed, V. Raman Kutty, Khalid Umer Khayyam, Gurpreet Singh, Abhishek Royal

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Introduction: Tuberculosis is a global public health emergency, but it is particularly acute in India, which has the world's highest tuberculosis burden. Due to overpopulation, lack of sanitation, malnutrition, low living standards, and poor socioeconomic status, among other factors, it is India's most common infectious disease. The long period of treatment is one of the main reasons for considering it as a public health emergency. Consequently, there is an increase in patient noncompliance, which leads to treatment failure, adverse treatment outcomes, and deaths. This could lead to the growth of anti-TB drug resistance. According to the WHO, approximately 558 thousand new cases of Multi-Drug Resistance Tuberculosis were diagnosed worldwide, with 8.5 percent developed Extensively Drug Resistance Tuberculosis. Methodology: This study is a program-based cross-sectional descriptive survey of adult tuberculosis patients enrolled in the Delhi-based Revised National Tuberculosis Program. The study setting was 27 NTEP districts of Delhi. (N=65,893) and Sample size- was 200; the sampling method which is used in the study was the systemic random sampling method. Results: Most of the demographic factors (age, gender, residence, and family type) were not significantly associated with adherence; marital status was found statistically significant with the treatment compliance. Hesitation while telling people about the disease and motivation to strictly follow drug schedule by healthcare workers were other factors where a significant association with drug adherence was observed. The study findings also suggest that provision of food, minimal financial and other moral support from family, counseling, discussion and politeness by healthcare providers might also facilitate adherence. Discussion and Conclusions: For TB treatment, adherence, age, sex, socioeconomic status, types of accommodations, malnutrition, and personal hygiene should all be considered; similar results were observed in previous studies. In the care of TB patients, DOTS services, health workers, and family support play a significant role. According to the country's National Strategic Plan, the Indian government has set a goal of eliminating tuberculosis by 2025 and patients' compliance with TB care and treatment adherence is very crucial to achieve this aim. A cohort study will be able to give a better understanding of factors associated with adherence since this study may have missed some defaulters who were absconding and could not be reached. Important Terms: RNTCP, NTEP, DOTS, DS-TB, DR-TB, RR-TB, MDR-TB, XDR-TB, Treatment failure, Treatment relapse, Treatment adherence.

Keywords: treatment adherence, treatment relapse, treatment failure, drug resistance tuberculosis

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216 Effects of Medication Reminder Innovation on Adherence and the Quality of Medicine

Authors: Suparpit von Bormann, Winai Sayorwan, Sirichai Channim, Sararat Rungruangkhanarak, Premchai Suksamran, Piyaporn Srisuk, Piyatida Phosri

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The best medicine will not work if the patient does not take them. There are several methods developed to help patients to be adherent to medicine. However, non-adherent rate still high: 24% in physically ill and 42% in mentally ill patients. Moreover, patients might feel less confident when carrying medicine around. Normal medicine box has no alarm; whereas the one with alarm is not handy and might be left at home. Therefore, Medication Reminder (MR) was invented. MR is a medicine pocket that has an alarm clock to remind the patient when it is the time to take medicine. It also has a small light indicating the medicine the patient has to take. This pocket is attached within a purse or wallet because most people forget medicine but do not forget to take their money. This research was conducted to develop innovation assisting patients to take their medicine on time. Samples were 24 volunteers who went out to work every day. Uncoated tablets, coated tablets, and capsules were filled in three types of containers: MR, plastic bag with ziplock, and normal plastic box. Each volunteer carried three types of containers everywhere during day time. After three days, medicines were tested for physical quality (appearance, odor, color, hardness, and weight) in laboratory. Medication adherence and satisfaction questionnaires were completed by participants. The results showed that MR showed significant improvement in participants’ adherence than plastic bag with ziplock, and normal plastic box at p < .001 (x̄(SD) = 11.16(0.75), 7.83(0.98), 8.83(1.32), respectively). Based on the quality test, MR and normal plastic box significantly better protected medicine than plastic bag with zip lock at p < .001 (x̄(SD) = 4(0.00), 4(0.00), 2.5(0.54), respectively). Most participants were satisfied with the innovation in highest level (4.50 out of 5). MR has a potential to improve adherent rates of participants and therefore to be an innovation that helps reducing the cost of treatment due to non-adherence. MR also has a potential in commercial aspect due to its effects in preserving quality of medicine. MR can be integrated with local products such as silk purse that can increase income for local people.

Keywords: medication, reminder, adherence, satisfaction

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215 Socio-Cultural Factors Influencing Adherence to Anti-Retroviral Therapy among HIV Patients in a University Teaching Hospital in South-Western Nigeria

Authors: Okunola Oluseye Ademola

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The study investigated various socio-cultural factors influencing adherence to antiretroviral drugs among people living with HIV in a University Teaching Hospital in South-western Nigeria. The objectives are to examine the perception of people living with HIV/AIDS (PLWHA) of antiretroviral therapy (ART) in Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, investigate the influence of socio-cultural factors on adherence of PLWHA to treatment regimen in the study area and assess the prevalence of adherence to ART among PLWHA in the study area. It was a cross-sectional where both qualitative and quantitative research methods were adopted. The participants were HIV diagnosed patients attending clinic at the Obafemi Awolowo University Teaching Hospitals Complex in Ile-Ife between the ages of 18 and 60 years. Also three healthcare delivery personnel working in the clinic were interviewed. Out of the 3007 patients receiving treatment, using Fischer’s formula of sampling technique, 336 patients living with HIV/AIDS were selected for the study. These participants had been on antiretroviral drugs for more than six months prior to the study and were selected using simple random sampling technique. Two focus group discussion sessions comprising of 10 male and 10 female living with HIV and currently on ART were conducted. These groups were purposively selected based on their being on ART for more than one year. Also in-depth interviews were conducted among three purposively selected healthcare givers (an experienced nurse, a doctor and a pharmacist) who are working in this clinic. All the participants were interviewed at the clinic on the various clinic days. Data were collected using a structured questionnaire, an interview guide and tape-recorder. The quantitative data were analysed using descriptive and inferential statistics. Content analysis was employed to analyse responses from IDI and FGD sessions. The findings from the study revealed a very positive perception to ART among PLWHA which was about 86.3% while the level of adherence to ART was 89.0% among the respondents. There was a very strong relationship between social and family supports and the degree of adherence to ART in the PLWHA. Nutrition, polygamy, difficulty in financing transportation fare to the clinic, unemployment, drug hawkers, religion, excuse duty from work and waking up very early were highlighted as socio-cultural barriers to adherence to ART. Fear of death, strong family support, religion belief, not seeking alternative treatment, absence of rituals and perceived improved health status were identified as very strong facilitators to adherence. The study concluded that to achieve a very optimal outcome in the management of HIV among PLWHA, various social and cultural contexts should be taken into consideration as this study was able to ascertain the influence of various socio-cultural factors militating and facilitating adherence to ART.

Keywords: ART, HIV, PLWHA, socio-cultural

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214 A Novel Mediterranean Diet Index from the Middle East and North Africa Region: Comparison with Europe

Authors: Farah Naja, Nahla Hwalla, Leila Itani, Shirine Baalbaki, Abla Sibai, Lara Nasreddine

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Purpose: To propose an index for assessing adherence to a Middle-Eastern version of the Mediterranean diet as represented by the traditional Lebanese Mediterranean diet (LMD), to evaluate the association between the LMD and selected European Mediterranean diets (EMD); to examine socio-demographic and lifestyle correlates of adherence to Mediterranean diet (MD) among Lebanese adults. Methods: Using nationally representative dietary intake data of Lebanese adults, an index to measure adherence to the LMD was derived. The choice of food groups used for calculating the LMD score was based on results of previous factor analyses conducted on the same dataset. These food groups included fruits, vegetables, legumes, olive oil, burghol, dairy products, starchy vegetables, dried fruits, and eggs. Using Pearson’s correlation and scores tertiles distributions agreement, the derived LMD index was compared to previously published EMD indexes from Greece, Spain, Italy, France, and EPIC. Results: Fruits, vegetables and olive oil were common denominators to all MD scores. Food groups, specific to the LMD, included burghol and dried fruits. The LMD score significantly correlated with the EMD scores, while being closest to the Italian (r=0.57) and farthest from the French (r=0.21). Percent agreement between scores’ tertile distributions and Kappa statistics confirmed these findings. Multivariate linear regression showed that older age, higher educational, female gender, and healthy lifestyle characteristics were associated with increased adherence to all MD studied. Conclusion: A novel LMD index was proposed to characterize Mediterranean diet in Lebanon, complementing international efforts to characterize the MD and its association with disease risk.

Keywords: mediterranean diet, adherence, Middle-East, Lebanon, Europe

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