Medication barriers and anti-hypertensive medication adherence: the moderating role of locus of control

Locus of control as a moderator of the relationship between medication barriers (e.g., side-effects, forgetting to take medication, and keeping track of pills) and anti-hypertensive medication adherence was examined. Baseline data were obtained from 588 hypertensive veterans. In general, fewer medication barriers, higher internal locus of control and lower external locus of control was associated with better hypertensive medication adherence. Furthermore, internal locus of control served as a moderator (beta = -.74, p < .01) for the relationship between medication barriers and medication adherence; effect size was large. Decomposition of the interaction revealed that the relationship between medication barriers and medication adherence was strongest when internal control was high (b = -.24, p < .01). Higher internal locus of control was beneficial when barriers to medication adherence are low, but at high perceived barriers, locus of control plays less of a role in medication adherence. Future efforts to improve medication adherence should consider the patient's perceived level of medication barriers in conjunction with their locus of control.     

Medication adherence and diabetes control in urban African Americans with type 2 diabetes.

In 181 urban African Americans with Type 2 diabetes, medication adherence was assessed using a measure designed specifically for an urban, impoverished sociodemographic population. Hemoglobin A-sub(1c), blood pressure and cholesterol levels, medication-related beliefs, and depression were assessed. Seventy-four percent of the sample reported adherence to diabetes medication. Adherence, adjusted for age, was associated with lower hemoglobin A-sub(1c). The specific behaviors associated with poorer diabetes control were forgetting to take medications and running out of medications. Knowledge of blood glucose goals differed for adherers and nonadherers. Blood pressure and cholesterol medication adherence rates were not associated with actual levels of blood pressure or lipids, respectively. These data suggest that specific medication-taking behaviors are important to diabetes control and constitute logical targets for interventions. ((c) 2005 APA, all rights reserved).     

Assessing theoretical predictors of long-term medication adherence: Patients’ treatment-related beliefs,experiential feedback and habit development

Patient non-adherence to medication is a pervasive problem that contributes to poor patient health and high healthcare costs. Basic research and interventions have focused thus far on behaviour initiation factors, such as patients’ illness and treatment beliefs. This paper proposes two processes that occur after behaviour initiation that are theorised to contribute to prediction of long-term medication adherence: ‘coherence’ of patients’ beliefs from experiences with treatment and habit development. Seventy-one hypertensive patients reported their treatment-related beliefs, experiences related to treatment efficacy and medication-taking habit strength in a baseline interview. Patients then used an electronic monitoring pill bottle for approximately one month. Patients’ medication habit-strength was the strongest predictor of all adherence measures, explaining 6–27% incremental variance in adherence to that explained by patients’ treatment-related beliefs. Patients’ beliefs and experiences did not predict overall adherence, even for patients with ‘weaker’ habits. However, patients’ experiences were found to predict intentional non-adherence and habit strength was found to predict unintentional adherence. Practitioners may assess patients’ medication-taking habits to get an initial view of their likely adherence to long-term medications. Future research should assess the current theoretical predictions in a hypertension inception sample and in populations with symptomatic conditions.     

Depression and medication adherence among breast cancer survivors: Bridging the gap with the theory of planned behaviour

Evidence suggests that more depressed breast cancer patients will less likely adhere to treatment plans. This study presents evidence that the theory of planned behaviour mediates the relation between depression and intentions to adhere to treatment plans and between depression and lack of adherence to medication regime. Two hundred and thirteen women undergoing breast cancer treatment participated in this study. Measures of depressive symptoms and planned behaviour variables were collected at the first time point; measures of medication adherence were collected at the second time point. Structural equation models were utilised to fit the data to the proposed models. Depressive symptoms were significantly correlated to both intentions and medication adherence. In support of hypotheses, the relation between depressive symptoms and treatment intention was mediated by attitudes towards health maintenance plans. The relation between depressive symptoms and medication adherence was fully mediated by the planned behaviour process. Conditions under which treatment intentions and perceptions of control in adhering to treatment were most related to medication adherence were elucidated. The results point to avenues for interventions to increase medication adherence among breast cancer patients. Manipulating attitudes and perceptions of control towards treatment plans will potentially serve to increase medication adherence.     

Depression and medication adherence among breast cancer survivors: bridging the gap with the theory of planned behaviour

Evidence suggests that more depressed breast cancer patients will less likely adhere to treatment plans. This study presents evidence that the theory of planned behaviour mediates the relation between depression and intentions to adhere to treatment plans and between depression and lack of adherence to medication regime. Two hundred and thirteen women undergoing breast cancer treatment participated in this study. Measures of depressive symptoms and planned behaviour variables were collected at the first time point; measures of medication adherence were collected at the second time point. Structural equation models were utilised to fit the data to the proposed models. Depressive symptoms were significantly correlated to both intentions and medication adherence. In support of hypotheses, the relation between depressive symptoms and treatment intention was mediated by attitudes towards health maintenance plans. The relation between depressive symptoms and medication adherence was fully mediated by the planned behaviour process. Conditions under which treatment intentions and perceptions of control in adhering to treatment were most related to medication adherence were elucidated. The results point to avenues for interventions to increase medication adherence among breast cancer patients. Manipulating attitudes and perceptions of control towards treatment plans will potentially serve to increase medication adherence.     

Utility of the Millon Behavioral Medicine Diagnostic to Predict Medication Adherence in Patients Diagnosed with Heart Failure

Medication non-adherence is common and a primary reason for poor medical outcomes among individuals with heart failure (HF). This study's aims were to determine whether depression, hostility, and the personality-based Millon Behavioral Medicine Diagnostic (MBMD) Medication Abuse scale were associated with medication adherence (e.g., beta-blockers, ACE inhibitors, diuretics, statins) beyond contributions of demographic, medical, and psychosocial variables in an ethnically-diverse sample of 105 men and women diagnosed with HF. In hierarchical regression, greater MBMD Medication Abuse scale scores were associated with poorer adherence above and beyond both depression (β?=?.236, t[102]?=?2.113, p?=?.037) and hostility (β?=?.244, t[102]?=?2.506, p?=?.014). The Medication Abuse scale also completely mediated the relationship between adherence and depression. These findings suggest that personality measures such as the MBMD and hostility scales might be utilized in future studies investigating predictors of adherence and also used clinically to predict medication adherence among HF patients.     

Adherence to pharmacological treatment of non-malignant chronic pain: The role of illness perceptions and medication beliefs

The objective was to identify the degree to which illness perceptions and medication beliefs explain variations in reported adherence to medication prescribed for the treatment of non-malignant chronic pain and to test the applicability of an extended version of the self-regulatory model to the chronic pain population. A cross-sectional design included 217 clinic patients completing validated questionnaires assessing their illness perceptions, medication beliefs and reported adherence to medication. Perceptions of illness (pain) as chronic, uncontrollable and unremitting were associated with greater adherence, fewer medication concerns and a belief that treatment was necessary. Structural equation modelling supports an extended SRM for chronic pain. It suggests that patients holding perceptions of serious consequences of pain and high emotion levels have more concerns about medication and are less adherent. Perceptions of serious illness consequences are also associated with stronger beliefs about the necessity of medicines and greater adherence. Beliefs about illness and medication are associated with adherence to treatment in chronic pain and this can be explained by an extended SRM. Results are preliminary and require replication. Further studies should explore the role that emotion has on coping strategies in chronic pain. Interventions should focus on altering unhelpful beliefs that reduce adherence.     

Type D personality predicts poor medication adherence in myocardial infarction patients

Type D personality, the combination of negative affectivity (NA) and social inhibition (SI), is an emerging risk factor in cardiovascular disease. This study aimed to examine one possible behavioural mechanism to explain the link between Type D and ill-health. It was hypothesised that Type D personality would predict medication adherence in myocardial infarction (MI) patients. In a prospective study, 192 MI patients (54 females and 138 males) completed measures of Type D personality and provided demographic and medical information 1 week post-MI, and then 131 patients went on to complete a self-report measure of medication adherence 3 months post-MI. It was found that Type D personality predicts adherence to medication, after controlling for demographic and clinical risk factors. Critically, the constituent components of Type D, NA and SI, interact to predict medication adherence, after controlling for the effects of each component separately. Poor adherence to medication may represent one mechanism to explain why Type D cardiac patients experience poor clinical outcome, in comparison to non-Type D patients. Interventions, which target the self-management of medication, may be useful in these high-risk patients.     

Type D personality predicts poor medication adherence in myocardial infarction patients

Type D personality, the combination of negative affectivity (NA) and social inhibition (SI), is an emerging risk factor in cardiovascular disease. This study aimed to examine one possible behavioural mechanism to explain the link between Type D and ill-health. It was hypothesised that Type D personality would predict medication adherence in myocardial infarction (MI) patients. In a prospective study, 192 MI patients (54 females and 138 males) completed measures of Type D personality and provided demographic and medical information 1 week post-MI, and then 131 patients went on to complete a self-report measure of medication adherence 3 months post-MI. It was found that Type D personality predicts adherence to medication, after controlling for demographic and clinical risk factors. Critically, the constituent components of Type D, NA and SI, interact to predict medication adherence, after controlling for the effects of each component separately. Poor adherence to medication may represent one mechanism to explain why Type D cardiac patients experience poor clinical outcome, in comparison to non-Type D patients. Interventions, which target the self-management of medication, may be useful in these high-risk patients.     

Patient Adherence With Medical Treatment Regimens: An Interactive Approach

Inadequate patient adherence to treatment regimens is a ubiquitous problem in health care and carries a profound personal, societal, and economic cost. This article illustrates a general theoretical framework we believe to be useful for the interpretation, conception, and design of adherence research. The core tenet of this framework is that factors that influence adherence can be better understood by considering the interactive effects of patients' characteristics, type of adherence intervention, and characteristics of the illness and medical treatment context. This framework represents an extension and application of previous theory and research from personality, social, and clinical psychology concerning the value of an interactionalist perspective. We illustrate the framework using some of our past work involving treatment adherence among patients with chronic renal failure.     

Electronic monitoring and counseling to improve medication adherence

Electronic caps, pill caps that record the date and time of pill bottle opening provide an objective measure of adherence to prescribed medication. A promising intervention to improve adherence, cue-dose training, involves reviewing patients' pill cap-generated reports concerning their medication-taking and offering individualized recommendations for remembering to take medications at specific times of day. In this preliminary study, 79 patients prescribed the antihyperglycemic medication metformin had adherence assessed during a 4-week baseline period. Adherence, defined as proportion of prescribed doses taken within a predetermined 4-h window, was measured using electronic MEMS caps. Those who had less than 80% baseline adherence (n = 33) were randomly assigned to either receive 4 months of cue-dose training (n = 16) or to a control group (n = 17). Cue-dose training was associated with significantly better adherence to metformin (mean improvement of 15%). The effects of cue-dose training on adherence to other antihyperglycemic medication did not reach statistical significance. Glycosylated hemoglobin (a measure of blood sugar control) did not differ between groups. Data from nine patients who reviewed pill cap-generated data with their primary care providers suggested that both patients and providers found the discussion moderately helpful and not at all uncomfortable.     

‘A necessary evil’: associations with taking medication and their relationship with medication adherence

Cognitive factors, like beliefs, have been studied extensively as determinants of medication adherence, while affect associated with taking medicines has been studied much less. In the present study (N = 525), we investigated affect by assessing patients’ first associations with taking their medicines. Results showed that these associations were related to self-reported medication adherence: Patients who associated taking medicines with negative affect were the least adherent, while those associating taking medicines with the need to take medicines were the most adherent. Our results support the idea that affect should be considered an important determinant of adherence.     

Mishandling the Gift of Life: Noncompliance in Renal Transplant Patients1

Two studies investigating renal transplant patients compliance with their post-transplant medical regimen are presented. Compliance was operationalized as a multidimensional construct incorporating behaviors that represent adherence to the regimen. Study 1 examined the association of noncompliance with clinically significant outcomes and the medical and demographic predictors of noncompliance. Noncompliance was associated with rejection episodes, graft loss, and multiple transplants. The best predictors of noncompliance were medication side effects, age, education, and insurance coverage. Study 2 examined the psychosocial predictors of noncompliance. After age and side-effects complaints, self-efficacy and threat appraisal were the best predictors of compliance. The implications of these results for expectancy-value models of health behaviors (e.g., protection motivation theory; Rogers, 1983) and their ability to predict compliance in patients following long-term regimens are discussed.     

Age-associated predictors of medication adherence in HIV-positive adults: health beliefs, self-efficacy, and neurocognitive status.

OBJECTIVE: Although most agree that poor adherence to antiretrovirals is a common problem, relatively few factors have been shown to consistently predict treatment failure. In this study, a theoretical framework encompassing demographic characteristics, health beliefs/attitudes, treatment self-efficacy, and neurocognitive status was examined in relationship to highly active antiretroviral therapy adherence. DESIGN: Prospective, cross-sectional observational design. MAIN OUTCOME MEASURES: Neuropsychological test performance, health beliefs and attitudes, and medication adherence tracked over a 1-month period using electronic monitoring technology (Medication Event Monitoring System caps). RESULTS: The rate of poor adherence was twice as high among younger participants than with older participants (68% and 33%, respectively). Results of binary logistic regression revealed that low self-efficacy and lack of perceived treatment utility predicted poor adherence among younger individuals, whereas decreased levels of neurocognitive functioning remained the sole predictor of poor adherence among older participants. CONCLUSION: These data support components of the health beliefs model in predicting medication adherence among younger HIV-positive individuals. However, risk of adherence failure in those ages 50 years and older appears most related to neurocognitive status.     

Resilience,religiosity and treatment adherence in hemodialysis patients: a prospective study

Resilience and religiosity have received attention as an important process in the experience and management of chronic comorbidities; however, there is no study evaluating resilience in hemodialysis patients and its association with other psychological dimensions or with treatment adherence. This observational prospective study assessed resilience (25 item Wagnild and Young Resilience Scale), religiosity under three dimensions (organizational, non-organizational and intrinsic) using DUREL scale, depressive symptoms (Patient Health Questionnaire-9) and health-related quality of life (Short Form-36 questionnaire). The main outcomes were medication adherence using the Morisky Medication Adherence Scale-8 (MMAR-8) and the missing/shortened dialysis sessions in the following six months. Of 208 patients approached, 202 (97.1%) agreed to participate. One hundred twenty-three patients (60.9%) were males and mean age was 52.8 ± 14.8 years-old. The median time on hemodialysis was 36 months (IQR, 12, 84). 82 (40.6%) patients obtained a MMAS-8 score <6 and were considered as having ‘poor adherence’. Overall, the mean score of medication adherence was low (5.7 ± 2.1). About adherence to hemodialysis sessions, patients missed a total of 234 (1.6%) hemodialysis sessions. Forty-eight patients (23.7%) missed an average of at least three sessions in six months. Regarding adherence to medication, there was no association in the uni- or multivariate analysis between religiosity dimensions and MMAS-8 score. After adjustment, resilience was positively associated with MMAS-8 score (standardized β coefficient .239, p = .016). Organized and intrinsic religiosity were associated with adherence to dialysis sessions (standardized β coefficient .258, p = .004 and .231, p = .026, respectively). Interestingly, opposite to medication adherence, more resilient patients were associated with less adherence to hemodialysis sessions (standardized β coefficient ?.296, p = .001). Religiosity was associated with dialysis adherence but not with medication adherence. Resilience was associated with higher medication adherence but lower adherence to dialysis sessions.     

Faster forgetting contributes to impaired spatial memory in the PDAPP mouse: Deficit in memory retrieval associated with increased sensitivity to interference?

Two experiments were conducted to investigate the possibility of faster forgetting by PDAPP mice (a well-established model of Alzheimer's disease as reported by Games and colleagues in an earlier paper). Experiment 1, using mice aged 13-16 mo, confirmed the presence of a deficit in a spatial reference memory task in the water maze by hemizygous PDAPP mice relative to littermate controls. However, after overtraining to a criterion of equivalent navigational performance, a series of memory retention tests revealed faster forgetting in the PDAPP group. Very limited retraining was sufficient to reinstate good memory in both groups, indicating that their faster forgetting may be due to retrieval failure rather than trace decay. In Experiment 2, 6-mo-old PDAPP and controls were required to learn each of a series of spatial locations to criterion with their memory assessed 10 min after learning each location. No memory deficit was apparent in the PDAPP mice initially, but a deficit built up through the series of locations suggestive of increased sensitivity to interference. Faster forgetting and increased interference may each reflect a difficulty in accessing memory traces. This interpretation of one aspect of the cognitive deficit in human mutant APP mice has parallels to deficits observed in patients with Alzheimer's disease, further supporting the validity of transgenic models of the disease.     

Measuring the effectiveness of psychoeducation on adherence,depression, anxiety and stress among patients with diagnosis of schizophrenia. a control trial

Despite evidence of the impact of depression and stress on attitudes towards medication in general medical pathology regimens, little is known of the effects of depression and stress on attitudes towards medication in schizophrenia. This study explores the effects of a hope-based psychoeducation on attitudes towards medication, depression, anxiety and stress, and predictors of attitudes towards medication. The participants in the study (n = 29) were randomly allocated to either the psychoeducation group or the control group. Results from the psychoeducation group revealed that attitudes towards medication were significantly improved and anxiety was significantly reduced. Given the small sample, which was recruited from among patients of a day mental health centre, findings should be interpreted tentatively. Being longer in pharmacotherapy, having experienced fewer occurrences of hospitalisation, and being less depressed predicted positivity towards medication. Patients in the control group did not exhibit significant change in any of the studied variables. Findings were interpreted in the light of research on stigma and insight into illness, and add modestly to literature arguing for the importance of patients’ retention of hope, empowerment and sense of control over illness. This study proposed that psychoeducation is an appropriate intervention to address a wide range of factors that compound adherence to medication and patients’ symptoms, such as patients’ interpretations of causal models, their sense of hope and control over the illness, and their insight into illness and self-stigma.

     

An “Opting In” Paradigm for Kidney Transplantation

Almost 60,000 people in the United States with end stage renal disease are waiting for a kidney transplant. Because of the scarcity of organs from deceased donors live kidney donors have become a critical source of organs; in 2001, for the first time in recent decades, the number of live kidney donors exceeded the number of deceased donors. The paradigm used to justify putting live kidney donors at risk includes the low risk to the donor, the favorable risk-benefit ratio, the psychological benefits to the donor, altruism, and autonomy coupled with informed consent; because each of these arguments is flawed we need to lessen our dependence on live kidney donors and increase the number of organs retrieved from deceased donors.

An “opting in” paradigm would reward people who agree to donate their kidneys after they die with allocation preference should they need a kidney while they are alive. An “opting in” program should increase the number of kidneys available for transplantation and eliminate the morally troubling problem of “organ takers” who would accept a kidney if they needed one but have made no provision to be an organ donor themselves. People who “opt in” would preferentially get an organ should they need one at the minimal cost of donating their kidneys when they have no use for them; it is a form of organ insurance a rational person should find extremely attractive.

An “opting in” paradigm would simulate the reciprocal altruism observed in nature that sociobiologists believe enhances group survival. Although the allocation of organs based on factors other than need might be morally troubling, an “opting in” paradigm compares favorably with other methods of obtaining more organs and accepting the status quo of extreme organ scarcity. Although an “opting in” policy would be based on enlightened self-interest, by demonstrating the utilitarian value of mutual assistance, it would promote the attitude that self-interest sometimes requires the perception that we are all part of a common humanity.     

An "opting in" paradigm for kidney transplantation

Almost 60,000 people in the United States with end stage renal disease are waiting for a kidney transplant. Because of the scarcity of organs from deceased donors live kidney donors have become a critical source of organs; in 2001, for the first time in recent decades, the number of live kidney donors exceeded the number of deceased donors. The paradigm used to justify putting live kidney donors at risk includes the low risk to the donor, the favorable risk-benefit ratio, the psychological benefits to the donor, altruism, and autonomy coupled with informed consent; because each of these arguments is flawed we need to lessen our dependence on live kidney donors and increase the number of organs retrieved from deceased donors. An "opting in" paradigm would reward people who agree to donate their kidneys after they die with allocation preference should they need a kidney while they are alive. An "opting in" program should increase the number of kidneys available for transplantation and eliminate the morally troubling problem of"organ takers"who would accept a kidney if they needed one but have made no provision to be an organ donor themselves. People who "opt in" would preferentially get an organ should they need one at the minimal cost of donating their kidneys when they have no use for them; it is a form of organ insurance a rational person should find extremely attractive. An "opting in" paradigm would simulate the reciprocal altruism observed in nature that sociobiologists believe enhances group survival. Although the allocation of organs based on factors other than need might be morally troubling, an "opting in" paradigm compares favorably with other methods of obtaining more organs and accepting the status quo of extreme organ scarcity. Although an "opting in" policy would be based on enlightened self-interest, by demonstrating the utilitarian value of mutual assistance, it would promote the attitude that self-interest sometimes requires the perception that we are all part of a common humanity.     

Noncompliance in hemodialysis patients as measured with the MBHI

Abstract

Fifteen patients beginning maintenance hemodialysis due to renal failure were administered the Millon Behavioral Health Inventory, the Family Environment Scale and Beck Depression Inventory at the outset of treatment. They were then followed regarding their compliance with fluid, diet and medication, using weight change and serum potassium and phosphorus levels. Statistically significant differences were found on independence/dependence conflicts and between patients showing at least moderate noncompliance with weight and/or phosphorus limitations. Significantly higher levels of depression were associated with consistently poorer compliance patterns.