Psychological and relational factors in ESRD hemodialysis treatment in an underserved community

ObjectiveThe researchers investigated the association of depression with treatment adherence, and examined the possible moderating roles of social support and of the physician-patient working alliance (PPWA) on treatment adherence, satisfaction with treatment, and quality of life.MethodsThe current study sampled ninety-five patients with End Stage Renal Disease who were receiving outpatient hemodialysis (HD) treatment.ResultsFindings indicated that higher levels of depression were significantly associated with lower ratings of adherence, quality of life, and social support. In contrast, higher levels of social support and of the PPWA were significantly associated with higher ratings of adherence, satisfaction with treatment, and quality of life. Analyses of moderation showed no effect for PPWA between depression and adherence, satisfaction, or quality of life; however, there was a significant moderation effect for social support.ConclusionThere are mild but significant associations between PPWA and social support. Positive associations between the PPWA and social support on adherence, satisfaction, and quality of life indicate that each one, PPWA and social support, plays its own role on patients’ experiences of and behavior in treatment. Affective social support significantly limits the negative influence of depression on adherence.Practice ImplicationsAssessment of depression and social support is essential in hemodialysis treatment.     

Relationship between beliefs about medicines and adherence in elderly patients with cardiovascular and respiratory diseases: A cross-sectional study in Romania

ObjectivesThe aim of this study was to explore elderly patients’ beliefs about medicines in general, and specific towards their treatment and the relationship between beliefs and adherence.MethodsA cross-sectional study was performed by administering a questionnaire developed to meet the study’s objectives. Elderly patients were recruited from three different settings.Results167 patients agreed to participate to our study, having a mean age of 73 years. Patients were aware of the necessity for treatment, but they also showed concern over the potential for the adverse outcomes. Only 15% of the patients were completely accepting their treatment having high necessity and low concerns, while 40% were ambivalent, having high necessity beliefs, but also high concerns, with 89% being adherent in this group. Overall, higher adherence was significantly correlated with higher necessity and with higher necessity-concern differential.ConclusionPatients beliefs have an impact on adherence, thus patients’ concerns and necessities should be addressed in order to improve adherence and treatment outcome.Practice implicationsHigher necessity positively influenced adherence to treatment, suggesting the fact that healthcare professionals could improve patients’ adherence by outlining and educating the patients on the necessity of the treatment, while also managing patients’ concerns.     

The boomerang effect of tuberculosis knowledge and self-efficacy on Chinese parents’ intention to seek timely treatment and adhere to doctors’ regimens

ObjectiveThe present study tested the level of tuberculosis (TB) knowledge of Chinese parents whose children attended kindergarten, primary school, and middle school, and examined whether their TB knowledge and self-efficacy in TB management exhibited a curvilinear relationship with their intention to seek timely TB treatment and adhere to doctors’ regimens if their children are infected with TB.MethodsAn online cross-sectional survey (N = 1129) was conducted. TB knowledge was assessed based on the manual provided by the Chinese Center for Disease Control and Prevention (CDC). Hierarchical polynomial regression was conducted to test the proposed curvilinear relationships.ResultsChinese parents lacked knowledge about risks of TB and how to prevent TB. TB knowledge and self-efficacy in TB management motivated Chinese parents to seek timely TB treatment and adhere to doctors’ regimens, but too much knowledge and self-efficacy predicted both intentions negatively.ConclusionExcessive levels of self-efficacy in self-management and health knowledge could backfire.Practice implicationPractitioners should elevate Chinese parents’ perceptions of severity of TB and susceptibility to TB. Additionally, health education should not be limited to providing medical facts but offer guidance on how to access professional medical resources. Self-efficacy in self-management should not be elevated.     

AN ELASTIC EXERCISE BAND MOUNTED WITH A BANDCIZER? CAN DIFFERENTIATE BETWEEN COMMONLY PRESCRIBED HOME EXERCISES FOR THE SHOULDER

Background

Home‐exercise is commonly prescribed for rehabilitation of the shoulder following injury. There is a lack of technology available to monitor if the patient performs the exercises as prescribed.

Purpose

The purpose of this study was to investigate the validity of using three dimensional (3D) gyroscope data recorded with the Bandcizer™ sensor to differentiate between three elastic band exercises performed in the shoulder joint: abduction, flexion, and external rotation.

Design

Concurrent validity study.

Methods

This study was performed over two phases. In the first phase, 20 subjects performed three sets of 10 of shoulder abduction, external rotation and flexion exercises with a Thera‐Band mounted with a Bandcizer, while supervised by a physical therapist. The Bandcizer has an inbuilt three‐dimensional gyroscope, capable of measuring angular rotation. Gyroscope data were analyzed in Matlab, and a one‐way ANOVA was used to test for significant differences between each of the three exercises. An algorithm was then created in Matlab based on the exercise‐data from the gyroscope, to enable differentiation between the three shoulder exercises. Twenty new subjects were then recruited to cross‐validate the algorithm and investigate if the algorithm could differentiate between the three different shoulder exercises.

Results

A blinded assessor using the Matlab algorithm could correctly identify 56 out of 60 exercise sets. The kappa agreement for the three exercises ranged between 0.86‐0.91.

Conclusion

The ability to differentiate between the home exercises performed by patients after shoulder injury has great implications for future clinical practice and research. When home exercises are the treatments‐of‐choice, clinicians will be able to quantify if the patient performed the exercise as intended. Further research should be aimed at investigating the feasibility of using the Bandcizer™ in a home‐based environment.

Word count

2429

Level of Evidence

2     

Social support a key factor for adherence to multidrug-resistant tuberculosis treatment

Background

Multidrug-resistant tuberculosis (MDR-TB) is emerging as a major public health problem globally. Treatment success rates in MDR-TB across the globe are not encouraging as completing MDR-TB treatment successfully is challenging due to high proportion of lost to follow up.

1 + 1 = 3? The systematic development of a theoretical and evidence-based tailored multimedia intervention to improve medication adherence

ObjectiveTo describe the development of a theoretical and evidence-based tailored multimedia intervention to improve medication intake behavior in patients with inflammatory bowel disease (IBD). The intervention integrates interpersonal and technology-mediated strategies with the expectation that this will work synergistically.MethodsThe development followed the Medical Research Council's framework. Three literature reviews and three pre-tests among 84 IBD patients and eight nurses were conducted to guide the development of the intervention. A feasibility study was carried out among four nurses and 29 patients.ResultsThe components include: (1) an online preparatory assessment (OPA); (2) tailored interpersonal communication; and (3) tailored text messaging. To support the development, the feasibility was tested. Results indicated that the OPA was comprehensive and could be a helpful tool for both patients and nurses to prepare for the consultation. The training was evaluated as being instructive and applicable with a mean mark of 8.5. Of the developed messages, 65.6% received positive evaluations and were used in the intervention.ConclusionBy applying the framework, we were able to describe the logic behind the development of a tailored multimedia intervention to improve medication intake behavior.Practice implicationsThis study could serve as a guide for the development of other health interventions.