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Results for “Adherence Interventions”

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At least 937 records · Page 52Linked to original sources

PubMed2002

Partners for Life: a theoretical approach to developing an intervention for cardiac risk reduction.

Long-term maintenance of behavioral change to reduce health risk factors is essential to producing a positive effect on medical outcomes. This study examines whether an ongoing, long-term relationship can be used to help patients diagnosed with coronary artery disease adhere to a risk-reducing behavioral intervention and maintain healthy behavioral changes. One hundred and sixty patients with diagnosed coronary artery disease will be randomized to a standard behavioral treatment group or to a standard behavioral treatment group including a couples intervention and followed for 18 months. The treatment in both groups follows tenets of cognitive behavioral and Self-Determination Theories as well as the Transtheoretical Model of Behavior Change. In addition, the couples intervention is designed to (1) change the patient's environment to facilitate cardiac risk-reducing behavioral changes, (2) optimize social reinforcement and motivation for behavior change, and (3) decrease relationship stress. Behavioral outcomes assessed include adherence to an exercise regimen, adherence to dietary recommendations and adherence to lipid-lowering medication. Lipid values, psychological variables and relationship variables are assessed throughout the study and at follow-up. While we expect both groups of cardiac patients to successfully adapt new health behaviors, we expect the couples intervention to be superior in helping maintain long-term health behaviors.

Coronary Disease↗

PubMed1988

Psychological aspects of non-compliance.

Research evidence reviewed suggests that psychological variables may be associated with non-compliance. Studies involving patients with epilepsy are limited but indicate that psychological reasons may underlie treatment non-adherence in this group. It seems likely that reasons for non-compliance are multifactorial with the contribution of various factors varying between patients and possibly varying for the same individual at different points in time. Further research is clearly indicated but recent research undertaken by the present author on memory illustrates that intervention may be possible to improve adherence to treatment regimens.

Anticonvulsants↗

PubMed1997

Measuring adherence and competence of dynamic therapists in the treatment of cocaine dependence.

This article presents the development of a new 82-item rating scale of therapist adherence and competence for supportive-expressive (SE) dynamic psychotherapy for the treatment of cocaine dependence. Sixty-four items are rated for adherence, appropriateness, and quality of prescribed interventions. As part of the pilot/training phase of the National Institute on Drug Abuse Collaborative Cocaine Treatment Study, two independent expert judges rated 32 audiotapes of SE therapy sessions with cocaine-dependent patients, 10 tapes of cognitive therapy (CT) sessions, and 10 tapes of individual drug counseling (IDC) sessions. Reliability was acceptable for adherence but poor for quality and appropriateness. SE therapists used more expressive (interpretative) techniques than did either CT therapists or IDC counselors, and they used more supportive techniques than did IDC counselors.

Cocaine↗

PubMed2002

Prevention of nonadherence to nonsteroidal anti-inflammatory medications for newly diagnosed patients with juvenile rheumatoid arthritis.

Adherence to medications for chronic pediatric diseases decreases overtime. This randomized controlled trial evaluated a clinic-based, nurse-administered educational and behavioral intervention to prevent the anticipated drop in adherence to nonsteroidal medications among newly diagnosed patients with juvenile rheumatoid arthritis. Thirty-four participants completed the study (mean age = 8.44 years, SD = 3.96), including 19 in the experimental group and 15 in the standard-treatment (education) control group. There were significant group and Group x Time effects for adherence (assessed with an electronic monitor over a 13-month period) favoring the experimental group. In contrast, the groups did not differ significantly in disease activity or functional limitations. Factors that may have prevented detection of differences in these health parameters are dicussed.

Adolescent↗

PubMed2005

Group discussions with parents have long-term positive effects on the management of asthma with good cost-benefit.

AIM: To investigate if an intervention with extra information and support in a group setting to parents of preschool children could improve adherence and clinical outcome. METHODS: This is a controlled, prospective study where the parents of 60 newly diagnosed preschool asthmatic children aged 3 mo-6 y were randomized to either a control group or to an intervention that consisted of four group sessions in close connection with the diagnosis. The basic education on asthma and the written treatment plan were the same in both groups. The outcome measures were questionnaires to the parents and classification of the children according to symptoms and medication. The adherence rate and the burden of asthma were calculated with the help of diaries and weighing of the MDIs used between 12 and 18 mo after inclusion. RESULTS: The follow-up rate was 85% after 18 mo. The parents' presence in the sessions was around 70%, with no gender difference. The parents' view on adherence issues improved significantly in the intervention group. In the control group, 30% had poor adherence compared to 8% in the intervention group (p=0.015). Both the parents and the paediatricians underestimated the number of children with poor adherence. The children in the intervention group had significantly fewer exacerbation days during the last 6 mo-2.1 compared to 3.9 d/child-although they had lower inhaled steroid doses after 18 mo. An economic calculation showed that the intervention was profitable. CONCLUSION: This intervention resulted in an improvement in the parents' view on adherence, in the measured adherence rates and in the clinical outcome.

Adult↗

PubMedDate not supplied

Factors that influence adherence to HIV medications: perceptions of women and health care providers.

The purpose of this pilot study was to explore factors that influence adherence to antiretroviral therapy (ART) in women with human immunodeficiency virus (HIV) disease. Antiretroviral medications that reduce viral count and prolong the time between a diagnosis of HIV disease and acquired immunodeficiency syndrome (AIDS) are expensive, numerous, and have multiple side effects. Common reasons for not adhering to the medication regimen include ART side effects and a dosage schedule that disrupts daily activities. Failure to take or errors in taking ART can result in an exacerbation of symptoms and disease progression or the development of drug-resistant strains of HIV. Women and providers in separate focus groups identified factors that facilitated and hindered adherence to ART. Knowledge of factors that influence adherence to ART will facilitate the development of interventions. Patient-provider relationships and side effects of weight gain are discussed as factors that influence adherence to ART.

Adult↗

PubMed2006

Evaluation of a community mental health carepath for early psychosis.

PURPOSE: To implement a carepath for early psychosis across all community mental health centres through the Early Psychosis Intervention Programme in the Fraser South Area of British Columbia, Canada. METHODS: Prior to developing the carepath, chart reviews and interviews were performed to assess for adherence to published guidelines for early psychosis intervention. This assessment revealed the inadequacies of narrative recording and that core psychosocial interventions were inconsistently provided. The carepath developed included prompts for interventions and standardized assessments and ultimately replaced the charting system used in the mental health centres for early psychosis clients. RESULTS AND CONCLUSIONS: One-year evaluation revealed some improvements in clinical practice but also identified other areas that require further improvement. This project demonstrated that it is possible to successfully implement a carepath in community mental health and that doing so provides a standardized method for ongoing improvements in care.

Community Mental Health Services↗

PubMed1996

Effects of a personal trainer and financial incentives on exercise adherence in overweight women in a behavioral weight loss program.

Exercise is important for long-term weight loss, but few studies have examined ways to improve exercise adherence in overweight subjects participating in a behavioral weight loss program. This paper presents two studies, one conducted at the University of Pittsburgh and one at the University of Minnesota, that sought to improve exercise adherence by exerting more direct control over the environmental antecedents and consequences controlling exercise. Study 1 investigated the use of a personal trainer who called participants regularly and met them at their home or office at scheduled times for a walk. Study 2 investigated the effect of a lottery incentive for exercise adherence. In both studies, the effect of these manipulations was examined in the context of a 24-week standard behavioral weight control program with three supervised exercise sessions per week. Neither intervention achieved statistically significant improvements in exercise adherence compared to control conditions, perhaps due in part to the limited statistical power of the studies. Future studies should focus on better understanding the barriers to exercise and designing behavioral interventions that address these barriers.

Adult↗

PubMed2005

Do guidelines guide pneumonia practice? A systematic review of interventions and barriers to best practice in the management of community-acquired pneumonia.

Successful guideline implementation programs need to understand local barriers, incorporate multiple component interventions, and proceed within a framework of continuous quality improvement. We found few intervention studies to improve CAP guideline adherence and no controlled studies that used certain practice changes strategies that have proven effective for other conditions, such as face-to-face educational outreach, use of local opinion leaders, and individualized audit with peer-comparison feedback. Future studies in CAP management need to use rigorous study designs, use multiple evidence-based strategies to change practice, and convincingly demonstrate to front-line health care providers that the suggested interventions are safe and improve patient outcomes. Paper does not change practice, and the creation and mailing out of a practice guideline for the treatment of CAP is only the first necessary step in translating good evidence into everyday clinical practice.

Alberta↗

PubMed1997

Older adults' experiences of a strength training program.

Despite the recognized benefits of strength training in preventing physical and functional decline among older adults, little information exists on their views of this exercise modality. This study used focus groups to obtain an in-depth understanding of older adults' attitudes and concerns about a strength training intervention and to identify factors that determined their adherence to this exercise program. Three focus groups were conducted with 24 former participants after the completion of the 16-week intervention. Major themes that emerged from the focus group discussions were categorized according to Dishman, Sallis, and Orenstein's [1] framework of factors influencing adherence, including personal, activity, and environmental characteristics. The most frequently reported factors were enjoyment of strength training, accessibility of the exercise facility, and the social reinforcement provided by exercise leaders and partners. Recommendations for strength training program development with older adults are discussed in light of these factors.

Aged↗

PubMed2005

Evaluating fidelity: predictive validity for a measure of competent adherence to the Oregon model of parent management training.

When efficacious interventions are implemented in real-world conditions, it is important to evaluate whether or not the programs are practiced as intended. This article presents the Fidelity of Implementation Rating System (FIMP), an observation-based measure assessing competent adherence to the Oregon model of Parent Management Training (PMTO). FIMP evaluates 5 dimensions of competent adherence to PMTO (i.e., knowledge, structure, teaching skill, clinical skill, and overall effectiveness) specified in the intervention model. Predictive validity for FIMP was evaluated with a subsample of stepfamilies participating in a preventive PMTO intervention. As hypothesized, high FIMP ratings predicted change in observed parenting practices from baseline to 12 months. The rigor and scope of adherence measures are discussed.

Journal Article↗

PubMed2006

Impact of breast cancer screening intervention on Korean-American women in Maryland.

BACKGROUND: Adherence to mammography guidelines among Korean-American women (KAW) is lower than that of Caucasian-Americans, and disparities in breast cancer screening related to lack of English proficiency is under-researched. This study examined the impact of a breast cancer intervention on intentions to use mammography among KAW. METHODS: Face-to-face pre-intervention surveys were conducted in control (n=95) and intervention groups (n=105), and were followed by implementation of a breast cancer education program. At 6 months, both groups were re-interviewed by phone (92 control and 94 intervention participants). Generalized estimating equation (GEE) analysis was used to assess the intervention effect before and after the breast cancer educational program. RESULTS: The intervention effect was statistically significant. Women in the intervention reported 2.96 times greater posttest intentions to have mammogram than those in the control group (95% CI, 1.13-7.66). Prior intentions, age, and positive attitudes toward mammography were associated with follow-up intentions to have a mammogram. CONCLUSION: This culturally and linguistically tailored educational intervention was effective in increasing breast cancer awareness in a non-English speaking population.

Adult↗

PubMed1999

A randomised trial of the impact of counselling on treatment adherence of tuberculosis patients in Sialkot, Pakistan.

SETTING: Tuberculosis Department, Bethania Hospital, Sialkot, Pakistan. OBJECTIVE: To determine whether intensive counselling can improve treatment adherence. DESIGN: In a randomised controlled intervention trial of 1,019 adult tuberculosis patients, 49% were assigned to the intervention group and 51% to the control group. Baseline data were obtained through semi-structured interviews. Patients were followed until the end of treatment (cure, default, referral or death). The intervention included counselling at the start of treatment and at each subsequent visit for ambulatory patients, or weekly for hospitalised patients. Counselling combined health education with strategies to strengthen patients' self-efficacy. Control group patients received the usual care. The outcome measure was treatment default. RESULTS: The default rate was 54% in the control group and 47% in the intervention group: the default risk ratio was 0.87, implying a reduction in defaulting of 13%. The impact was stronger in women, ambulatory patients, re-treatment patients, women who worked in the home, and patients who were not the main provider, those with a poor knowledge of the disease or those with a short treatment delay. CONCLUSIONS: Intensive counselling has a significant, although limited, impact on treatment adherence.

Adolescent↗

PubMed2002

Does mindfulness meditation contribute to health? Outcome evaluation of a German sample.

OBJECTIVES: This exploratory study is the first systematic outcome evaluation to examine the effects of an 8-week meditation-based program in mindfulness in a German sample. DESIGN: Twenty-one (21) participants with chronic physical, psychologic, or psychosomatic illnesses were examined in a longitudinal pretest and post-treatment design with a 3-month follow-up. OUTCOME MEASURES: Both quantitative and qualitative data were gathered. Emotional and general physical well-being, sense of coherence, overall psychologic distress, and satisfaction with life were measured with standardized instruments. RESULTS: Overall, the interventions led to high levels of adherence to the meditation practice and satisfaction with the benefits of the course, as well as effective and lasting reductions of symptoms (especially in psychologic distress, well-being, and quality of life). Changes were of moderate-to-large effect sizes. Positive complementary effects with psychotherapy were also found. CONCLUSIONS: These findings warrant controlled studies to evaluate the efficacy and cost effectiveness of mindfulness-based stress reduction as an intervention for chronic physical and psychosomatic disorders in Germany.

Adult↗

PubMed2006

Do prevention interventions reduce HIV risk behaviours among people living with HIV? A meta-analytic review of controlled trials.

OBJECTIVE: To conduct a meta-analytic review of HIV interventions for people living with HIV (PLWH) to determine their overall efficacy in reducing HIV risk behaviours and identify intervention characteristics associated with efficacy. METHODS: Comprehensive searches included electronic databases from 1988 to 2004, hand searches of journals, reference lists of articles, and contacts with researchers. Twelve trials met the stringent selection criteria: randomization or assignment with minimal bias, use of statistical analysis, and assessment of HIV-related behavioural or biologic outcomes at least 3 months after the intervention. Random-effects models were used to aggregate data. RESULTS: Interventions significantly reduced unprotected sex [odds ratio (OR), 0.57; 95% confidence interval (CI) 0.40-0.82] and decreased acquisition of sexually transmitted diseases (OR, 0.20; 95% CI, 0.05-0.73). Non-significant intervention effects were observed for needle sharing (OR, 0.47, 95% CI, 0.13-1.71). As a whole, interventions with the following characteristics significantly reduced sexual risk behaviours: (1) based on behavioural theory; (2) designed to change specifically HIV transmission risk behaviours; (3) delivered by health-care providers or counsellors; (4) delivered to individuals; (5) delivered in an intensive manner; (6) delivered in settings where PLWH receive routine services or medical care; (7) provided skills building, or (8) addressed a myriad of issues related to mental health, medication adherence, and HIV risk behaviour. CONCLUSION: Interventions targeting PWLH are efficacious in reducing unprotected sex and acquisition of sexually transmitted diseases. Efficacious strategies identified in this review should be incorporated into community HIV prevention efforts and further evaluated for effectiveness.

Adult↗

PubMed2006

Adherence to positive airway pressure therapy.

PURPOSE OF REVIEW: The purpose of this review is to discuss the nature of adherence to continuous positive airway pressure (CPAP), identify measurement modalities, consider factors that have been identified in the literature associated with nonadherence and present interventions that may promote use. RECENT FINDINGS: Patient characteristics associated with CPAP adherence include self-reported daytime sleepiness, level of disease severity, nasal resistance and perception of symptomatic benefit. Heated humidification and flexible pressure also promote use. Feelings of claustrophobia affect adherence in a small proportion of patients. Adherence was better with nasal mask than nasal pillows and full face mask and equal to oral interface. Patients who employed an active coping style and those with perceived self-efficacy, especially following exposure to treatment, had higher levels of adherence. A videotape targeted to improve self-efficacy and other interventions to enhance cognitions related to CPAP has generated greater use. Intensive support utilizing several days of titration, education and home visits also improves adherence. SUMMARY: Adherence to CPAP treatment is an important clinical issue that needs to be routinely assessed and addressed. Frequent patient contact to troubleshoot problems will contribute to adherence. Further study is needed to identify factors that affect adherence and cost-effective interventions.

Continuous Positive Airway Pressure↗

PubMed2005

Methods to improve medication adherence in patients with hypertension: current status and future directions.

PURPOSE OF REVIEW: Efficacious pharmacologic treatments are available for the management of hypertension, yet only about 50% of patients treated with antihypertensive medications have their blood pressure controlled. A key factor contributing to poor blood pressure control is suboptimal adherence to prescribed therapy. Despite numerous studies conducted over the last 50 years to identify the best method for increasing patient compliance, no single intervention has emerged as superior to the others. This article reviews the effectiveness of methods to improve antihypertensive medication adherence, discusses the effect of drug benefit caps on compliance, and proposes a framework for future clinical and research directions. RECENT FINDINGS: Several recent systematic reviews and meta-analyses have attempted to quantify the effectiveness of various methods to improve adherence. As a result of the multiple factors influencing medication adherence, a patient-centered approach that tailors interventions aimed at overcoming barriers to adherence may be necessary. SUMMARY: Physicians and other health care professionals should consider nonadherence to medication when evaluating a patient with poor blood pressure control. In selecting an intervention to improve compliance to medications, clinicians should consider engaging the patient in an intervention that overcomes patient-specific barriers. Future research should target development of adherence models, which simultaneously examine the effects and interactions of social, psychological, and biologic variables on antihypertensive medication adherence.

Antihypertensive Agents↗

PubMed2026

Program to Avoid Cerebrovascular Events Through Systematic Electronic Tracking and Tailoring of an Eminent Risk Factor: A Randomized Trial.

BACKGROUND: Individuals residing in the southeastern United States experience disproportionately worse stroke outcomes. Although blood pressure (BP) reduction is among the most effective strategies for improving stroke outcomes, fewer than one third of survivors of stroke achieve BP control within 1 year of the index event. METHODS: The PACESETTER (Program to Avoid Cerebrovascular Events Through Systematic Electronic Tracking and Tailoring of an Eminent Risk Factor) trial enrolled patients with stroke and uncontrolled BP from 3 safety-net health care systems in South Carolina. Patients were randomized 1:1 to the PACESETTER intervention, which included a Bluetooth-enabled electronic pill tray, a BP monitor, and a smartphone application for automated data transmission of medication adherence and BP data to a central server or to usual care. The primary outcome was systolic BP <130 mm Hg at 12 months, analyzed according to the intention-to-treat principle. RESULTS: The trial was stopped early due to low recruitment during the COVID-19 and funding constraints. Between September 2019 and February 2023, 120 participants were randomized to PACESETTER (n=60) or the usual care arm (n=60). At 4 months, systolic BP <130 mm Hg favored the PACESETTER arm (48.8% versus 29.3%, P=0.07), but no significant difference was observed at 12 months (50% versus 47.2%, P=0.82). CONCLUSIONS: Because the trial was terminated prematurely, the effect of the PACESETTER intervention on 12-month BP control after stroke remains uncertain. A trial completed to its full term and sufficiently powered to also evaluate key short-term end points is needed. REGISTRATION: URL: https://www.clinicalstrial.org; Unique Identifier: NCT03401489.

Aged↗