Strategies to promote medication adherence in children with asthma.

Asthma, the most common chronic disease in childhood, continues to be associated with high rates of morbidity and mortality, despite improved treatment protocols. Lack of adherence to individual treatment plans has been implicated in these poor outcomes. The purpose of this article is to assist the nurse in identifying obstacles that might limit adherence to treatment, and offer practical suggestions for promoting adherence in pediatric patients. The reasons that children and children's families fail to adhere to individual treatment plans include financial barriers, misconceptions about asthma, cultural influences, and mistaken health beliefs. In addition, family education about asthma management can be inadequate. An efficiently run asthma program, which includes family education, easy telephone access to the provider, prompt attention during exacerbations, and frequent follow-up, can improve adherence. By eliminating barriers to adherence and maintaining open communication and consistent positive support, nurses can help children with asthma attain and maintain the highest quality of life.     

Antiretroviral therapy adherence among patients living with HIV/AIDS in Thailand

The importance of antiretroviral therapy adherence for patients living with HIV/AIDS has been well documented. Despite this critical need, many do not follow prescribed regimens. To examine the barriers that lead to non‐adherence, we used cross‐sectional survey data from a randomized controlled intervention trial in northern and north‐eastern Thailand. Of the 507 patients that were enrolled in the trial, we analyzed 386 patients on antiretroviral therapy in order to examine the barriers to adherence. In addition to demographic characteristics, depressive symptoms, physical health, access to care, social support, and internalized shame, HIV disclosure and family communication were examined. The correlation analysis revealed that adherence is significantly associated with internalized shame, access to care, depressive symptoms, and family communication. Based on the multiple logistic regression analysis, depressive symptoms, access to care, HIV disclosure, and family communication were significant predictors of adherence. Having depressive symptoms remains a significant barrier to adherence, while access to care, HIV disclosure, and family communication play important positive roles. Our findings underscore the critical importance of addressing these various challenges that can influence adherence to antiretroviral therapy.     

Mediating roles of medication-taking self-efficacy and depressive symptoms on self-reported medication adherence in persons with HIV: a questionnaire survey

BACKGROUND: To date, only a few studies have examined the mediating role of self-efficacy on the relationship between depressive symptoms or perceived social support and medication adherence in persons with HIV. OBJECTIVES: The purpose of this study was to examine the impact of perceived social support, depressive symptoms and medication-taking self-efficacy on self-reported medication adherence in persons with HIV. A proposed comprehensive model included three mediation hypotheses in order to examine the mediating roles of medication-taking self-efficacy and depressive symptoms. METHOD: Baseline data from "Adherence to Protease Inhibitors" were used. The 215 persons with HIV aged 19-61 (mean=40.7, S.D.=7.58) were recruited from multiple sites in Pittsburgh, PA (USA) and through self-referral. The participants were assessed using the Beck Depression Inventory, Interpersonal Support Evaluation List, the Medication Taking Self-Efficacy Scale, and the modified Morisky Self-report Medication Taking Scale. Structural equation modeling (EQS version 6.1) was used. The Satorra-Bentler Scaled chi(2) test statistics (S-B chi(2)), Comparative Fit Index (CFI), and the Standardized Root Mean Squared Residual (SRMR) were used to assess the fit of a comprehensive model including three mediation hypotheses. RESULTS: A comprehensive model with the three hypotheses showed a good model fit (S-B chi(2) (24, N=215)=69.06, p<.001; CFI=.95; SRMR=.057). Medication adherence self-efficacy fully mediated the prediction of self-reported medication adherence by perceived social support and depressive symptoms. Depressive symptoms partially mediated the prediction of medication-taking self-efficacy by perceived social support. CONCLUSIONS: The findings of this study provide researchers with increased understanding of the mediating role of medication-taking self-efficacy beliefs between selected psychological variables and self-reported medication adherence in persons with HIV. Future studies need to test the moderating effect of gender, ethnicity and risk factors for HIV on this model and the intervention effect of self-efficacy beliefs using longitudinal data.     

Patient-reported perceptions of side effects of antihyperglycemic medication and adherence to medication regimens in persons with diabetes mellitus

BACKGROUND: With recent media attention to drug safety, patients may have heightened concerns about the side effects of medications that may affect their compliance with treatment. OBJECTIVES: The purpose of this study was to determine the proportion of patients with type 2 diabetes mellitus who perceived having experienced side effects of antihyperglycemic medications, the proportion of these patients who communicated their concerns to physicians, and the potential association between the perception of experiencing side effects and adherence to medication regimens. METHODS: Patients with diabetes were identified through the claims of a Midwest US managed care organization, using Health Plan Employer Data and Information Set criteria. Questionnaires were mailed to randomly selected patients. Patients receiving oral antihyperglycemic medications were selected as prospective subjects. Patients were excluded if they were receiving insulin. RESULTS: The responses of 445 patients meeting the study criteria were collected and analyzed. The subjects were pre-dominantly white, with a mean (SD) age of 56 (11) years and a mean duration of diabetes of 7.3 (8.8) years. One hundred forty-eight (33%) subjects reported a perception of having experienced side effects of antihyperglycemic medication; 126 (85%) subjects reported that they had communicated these concerns to their physicians. Analysis of the subjects' responses indicated an association between the perception of having experienced side effects and nonadherence to antihyperglycemic medication regimens (beta=-0.15; P < 0.010). CONCLUSIONS: Nearly one third of subjects with diabetes receiving oral noninsulin antihyperglycemic medications reported a perception of having experienced medication-related side effects. Despite the large portion of subjects who reported that they had communicated these concerns to their physicians, the perception of experiencing medication-related side effects was significantly associated with nonadherence to antihyperglycemic drug regimens.     

Designing a culturally based intervention to reduce HIV sexual risk for Latino adolescents.

There is a pressing need to develop effective interventions to prevent sexually transmitted HIV infection among Latino adolescents. Although there have been few models to direct the design of culturally effective interventions, the processes of recognizing the influence of specific cultural and contextual variables, building on "what works," and integrating community perspectives are important elements. These processes were used in the development of a Latino culturally based curriculum designed to reduce the risk of sexually transmitted HIV among Latino youth. Specific examples are provided to illustrate how these processes were used and how the curriculum evolved.     

Adventure-based training to promote physical activity and reduce fatigue among childhood cancer survivors: A randomized controlled trial

BackgroundCancer-related fatigue is one of the most distressing symptoms reported by childhood cancer survivors. Despite the body of evidence that regular physical activity helps alleviate cancer-related fatigue, insufficient participation in physical activity is frequently observed among childhood cancer survivors.ObjectivesThis study examined the effectiveness of an adventure-based training programme in promoting physical activity, reducing fatigue, and enhancing self-efficacy and quality of life among Hong Kong Chinese childhood cancer survivors.DesignA prospective randomised controlled trial.SettingsA paediatric oncology outpatient clinic, a non-governmental organisation, and a non-profit voluntary organisation.ParticipantsHong Kong Chinese childhood cancer survivors aged 9–16 years who reported symptoms of fatigue and had not engaged in regular physical exercise in the past 6 months.MethodsThe experimental group underwent a 4-day adventure-based training programme. The control group received a placebo intervention. The primary outcome was fatigue at 12 months. Secondary outcomes were physical activity levels, self-efficacy and quality of life at 12 months. Data collection was conducted at baseline, and 6 and 12 months after the intervention began. We performed intention-to-treat analyses.ResultsFrom 6 January, 2014 to 8 June, 2015, we randomly assigned 222 eligible childhood cancer survivors to either an experimental (n = 117) or a control group (n = 105). The experimental group showed statistically significantly lower levels of cancer-related fatigue (P < 0.001), higher levels of self-efficacy (P < 0.001) and physical activity (P < 0.001), and better quality of life (P < 0.01) than the control group at 12 months.ConclusionsThis study provides evidence that adventure-based training is effective in promoting physical activity, reducing cancer-related fatigue, and enhancing self-efficacy and quality of life among Hong Kong Chinese childhood cancer survivors. These results may help inform parents and healthcare professionals that regular physical activity is crucial for the physical and psychological wellbeing and quality of life of childhood cancer survivors.     

Intervening to identify and reduce drug use and sexual HIV risk patterns among men who have sex with men in three provinces in South Africa

Formative work to inform interventions aimed at addressing drug and sexual risk behaviours among men who have sex with men (MSM) in South Africa highlighted the need to target drug-using MSM with prevention interventions addressing both sexual and drug-related HIV risk. From 2007, in collaboration with two local NGOs, intervention activities were rolled out to vulnerable drug-using MSM. Over the first two years, 3475 drug-using MSM were reached through community outreach that promotes HIV/AIDS prevention and addresses drug risk behaviours and 745 among them were tested for HIV and received their results and 239 of them were referred from HCT to other services. Additionally, 66 individuals were trained to promote HIV/AIDS prevention services and 15 were trained in HCT. Twelve new targeted condom and lubrication services and 7 new HCT outlets were established. MSM reported a variety of high-risk activities including not using condoms for anal sex, having sex while under the influence of alcohol or drugs and sharing needles (among injection drug users). However, MSM were willing to develop risk reduction strategies. Year one and two of the intervention has demonstrated the willingness of the NGOs to broaden their service delivery, improved integration of drug treatment, HIV intervention and other services, and has shown positive results across a number of risk behaviours among MSM.     

HIV treatment adherence in women living with HIV/AIDS: research based on the Information-Motivation-Behavioral Skills model of health behavior.

Close and consistent adherence to anti-HIV medication regimens is necessary to achieve the maximum benefit of these potentially effective treatments. The authors examined cognitive and behavioral factors associated with HIV treatment adherence in a convenience sample of 112 women, 72 of whom were currently taking HIV treatments at the time of the study. Women completed confidential surveys and interviews to assess HIV-related health status, treatment regimens, and cognitive behavioral characteristics derived from the Information-Motivation-Behavioral Skills model of health promotion behaviors. Results showed that women who had missed at least one dose of their HIV medications in the past week reported lower intentions (motivation) to remain adherent and lower adherence self-efficacy (skills). Structural equation modeling showed that motivational and skills-building factors significantly predicted the number of medication doses missed. However, treatment-related information did not predict treatment adherence. In addition, women who had missed a dose of medication in the past week were more likely to have ever used devices and strategies to remind them of doses, but were no more likely to currently use such strategies. Interventions that enhance treatment adherence motivation and build adherence skills may help improve HIV treatment adherence in women receiving anti-HIV therapies.     

Cognitive reorganization and stigmatization among persons with HIV

BACKGROUND: A diagnosis of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) is a life-changing event, where persons must deal with a life-threatening, debilitating disease and its associated stigma and isolation. Studies over the past decade have shown that writing and talking about stressful and traumatic experiences, such as a life-threatening illness, causes emotions surrounding the trauma to change and to become cognitively reorganized. The result is a reduction in inhibition and change in basic cognitive and linguistic processes, which have contributed to meaningful behavioural, psychological, and physical health benefits across a variety of populations. AIMS: To describe the construction of the Integrated Model of Health Promotion for persons with HIV/AIDS, and present initial empirical support of the model from a feasibility pilot study of women with HIV/AIDS. APPROACH: The Integrated Model of Health Promotion is described and relevant literature in the field is reviewed. The model is implemented in a feasibility pilot study utilizing the emotional writing disclosure intervention. RESULTS: Participants in the experimental condition demonstrated a promising pattern of cognitive reorganization, a reduced perception of stigma, and an improvement in mental health scores compared with the control condition. CONCLUSION: Implications of these findings are discussed within the framework of the Integrated Model of Health Promotion. The model explores health and behavioural benefits associated with emotional writing in individuals with HIV/AIDS. The limited sample size of this pilot study precludes testing for significance. Further studies are required prior to the development of practice guidelines.