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.     

Exploring Perceived Social Support from Peer Facilitators in an HIV Treatment Adherence Intervention for African American Patients: A Content Analysis of Participant Perspectives

HIV treatment adherence interventions increasingly rely on peer facilitators to promote treatment adherence and improve patient retention, yet little is known about how participants perceive the role performed by peer facilitators. The present study examined participant perceptions in terms of the social support from peer facilitators in a hospital‐based intervention in Chicago. Content analysis was conducted with reference to four types of social support (instrumental, informational, emotional and affiliational) on exit interviews with 11 participants enrolled in the intervention that targeted African‐American patients living with HIV/AIDS. We examined how the type of social support perceived by participants was related to their self‐reported behaviours in three domains: adherence, sexual safety and general coping. Our analysis revealed that most participants perceived informational and emotional support from their peer facilitators, followed by instrumental support. Affiliational support was the least frequently perceived type of social support. We found that perceived informational support from peer facilitators with regard to adherence had greater impact and credibility amongst participants than the same type of support from medical providers. Informational support was cited most frequently with regard to influencing adherence and sexual safety behaviours, whereas perceived emotional support was cited primarily with helping participants cope with HIV. Copyright © 2015 John Wiley & Sons, Ltd.     

Apathy is Associated with Critical Psychological Determinants of Medication Adherence in HIV Disease

Apathy is common in HIV, separable from depression, and has been associated with non-adherence to antiretroviral therapy (ART). We examined the associations between apathy and critical psychological determinants of ART adherence, as per the information-motivation-behavioral model, in 85 persons living with HIV. Apathy was measured using a composite of the apathy subscale of the Frontal Systems Behavioral Scale and the vigor-activation scale of the Profile of Mood States. Independent of major depressive disorder, apathy was related at small-to-medium effect sizes with motivation to adhere and self-efficacy for health-related decision-making and medication management, but not with HIV knowledge or medication management skills. These findings suggest that apathy plays a unique role in several critical health adherence determinants and support the importance of assessment and management of apathy to maximize health outcomes among individuals with HIV disease.

     

Parenting Self‐Construals of Mothers With a Serious Mental Illness: Efficacy,Burden, and Personal Growth1

We explored parenting self‐construals among mothers with serious mental illness (n= 379). Mothers reported feeling moderately positively about themselves as parents, more efficacious than inefficacious, more positive than negative, more valued than disvalued; but also at least somewhat restricted and burdened by motherhood. Factor analyses revealed 3 parenting self‐construal factors: efficacious, burdened, and parenting as a personal growth experience. In hierarchical regression analyses, parenting self‐construal factors significantly added to prediction of parenting behaviors and attitudes (nurturance, explanatory parenting style, and parenting stress), once demographic, mental health history, and current social context variables (support, stress, and current mental health) were taken into account. Maternal parenting self‐efficacy increased (while self‐construal of parenting as a burden decreased) positive parenting style.     

Spousal Influence on CPAP Adherence: Applications of Health‐related Social Control

Obstructive sleep apnea (OSA) is one of the most prevalent sleep disorders in the United Sates and is a risk factor for poor health outcomes. Continuous positive airway pressure (CPAP) therapy is an effective treatment for OSA, but adherence rates are poor. Although the spouses of patients with OSA have high potential to influence adherence, there has been minimal research to date. The purpose of this review is to summarize key findings regarding spousal influence on health‐related behavior change and treatment adherence from other medical fields (e.g., type 2 diabetes and cardiovascular disease) in which this line of inquiry has been more thoroughly developed. Recommendations are presented to guide future research investigating spousal influence on CPAP adherence based on findings from other patient populations. In particular, we emphasize the use of spousal health‐related social control as it applies to adherence and provide guidance regarding conceptual and methodological moderators.     

Church‐Based Social Relationships and Change in Self‐Esteem Over Time

This study has two goals. The first goal is to see if church‐based social relationships are associated with change in self‐esteem. Emotional support from fellow church members and having a close personal relationship with God serve as measures of church‐based social ties. The second goal is to see whether emotional support from fellow church members is more strongly associated with self‐esteem than emotional support from secular social network members. The data come from an ongoing nationwide survey of older adults. The findings reveal that having a close personal relationship with God is associated with a stronger sense of self‐esteem at the baseline and follow‐up interviews. In contrast, emotional support from fellow church members was not associated with self‐esteem at either point in time. However, emotional support from secular social network members is related to self‐esteem at the baseline but not the follow‐up interview.     

Values and helping behavior: A study in four cultures

Values are important factors in determining individuals' behaviours. Previous studies have examined the relations between values and helping behaviour, but usually in the context of a single culture. The current study examines the relations between personal value types and helping behaviour among university students (N = 722) in four cultures (Germany, Scotland‐UK, Israel and Turkey). Across cultures, the value types of self‐transcendence versus self‐enhancement and conservation versus openness to change were positively related to helping. Specifically, self‐transcendence values were positively related, and self‐enhancement and openness to change values negatively related, to helping behaviour. The correlations pattern did not differ significantly between cultures.     

Mindfulness and integrative self‐knowledge: Relationships with health‐related variables

This study examined how mindfulness and integrative self‐knowledge were related to health‐related issues. Men in general population (n = 103) and coronary heart disease samples (n = 101) completed the Mindful Attention Awareness Scale, the Integrative Self‐knowledge Scale, the Type 2 subscale of the Interpersonal Reactions Inventory, the Perceived Stress Scale, and the Anxiety and Depression Scales. In both samples, there was a moderate positive correlation between mindfulness and integrative self‐knowledge and they were negatively correlated with all health‐related variables. However, only integrative self‐knowledge explained independent variance in health‐related variables. Specifically, in both samples, the relationship between mindfulness and health‐related variables was mediated by integrative self‐knowledge. Mindfulness and integrative self‐knowledge are related domains of self‐awareness that are associated with a range of health‐related variables. These relationships are robust across samples drawn from general population and patients with coronary heart disease. The finding that integrative self‐knowledge explained additional variance in the health‐related variables after the contribution of mindfulness had been accounted for suggests that reflective self‐awareness in integrative self‐knowledge may make a unique contribution to the explanation of individual differences in health variables.     

Social Support in Cardiac Rehabilitation Exercise Maintenance: Associations with Self‐Efficacy and Health‐Related Quality of Life1

This study examined whether cardiac rehabilitation (CR) maintenance exercise participants who were high and moderate in social support (SS) differed in their types of self‐efficacy and health‐related quality of life, and whether SS was related to self‐efficacy. Measures of SS, self‐efficacy (i.e., walking, scheduling, in‐class efficacy), and health‐related quality of life (HRQL) were administered to 64 CR maintenance exercise participants. A one‐way, between‐groups MANOVA was significant (p < .01), indicating that CR participants higher in SS reported significantly greater self‐efficacy and physical HRQL than did their moderate counterparts. In addition, social support predicted significant variance in task self‐efficacy. The findings suggest that differential perceptions of SS are related to differences in walking, in‐class and scheduling self‐efficacy, and the physical component of HRQL among CR exercise maintainers.     

Perceived discrimination is associated with poorer health and well‐being outcomes among Pacific peoples in New Zealand

Our study investigated the association between perceived discrimination and outcomes related to health and well‐being for Pacific adults in New Zealand. We examined personal and group discrimination from the 2013 wave of the New Zealand Attitudes and Values Study (n = 429 women and 196 men). Personal discrimination was associated with poorer health and well‐being outcomes (higher psychological distress and lower self‐esteem, subjective evaluation of health, satisfaction with life and personal well‐being). Group discrimination, in contrast, was associated with poorer well‐being but not health outcomes (lower subjective evaluation of health and personal well‐being). These findings corroborate previous research and highlight the corrosive effect of discrimination towards health and well‐being among Pacific communities in New Zealand.     

The impact of a rural or urban context in eating awareness and self‐regulation strategies in children and adolescents from eight European countries

Complex relationships exist between eating behaviour and personal and environmental factors. Rural and urban geographic contexts seem to play a role in eating behaviour, and therefore deserve a deeper study. A healthy eating behaviour and the conditions that promote it are a major issue in the promotion of adolescent health. The study aims to investigate the associations between the area of residence (urban vs. rural), self‐regulation strategies (TESQ‐E) and eating behaviours among children and adolescents. A total of 11,820 adolescents (50.6% girls) participated in the study, with a mean age of 13.30 years (SD= 2.13). Nine countries (The Netherlands, United Kingdom, Poland, Portugal, Denmark, Romania, Germany, Finland and Belgium) completed a questionnaire in the school context, asking about the use of self‐regulation strategies, eating behaviour awareness/care and sociodemographic questions such as age, gender and residential area. Both areas of residence (urban vs. rural) are associated with eating awareness/care in Romania and Portugal, controlling for age, gender and self‐regulation strategies. In some European countries at least, and most probably around the world, health promotion should focus on an ecological approach that includes the understanding of the effect of both environmental factors and personal skills on eating behaviour/awareness.     

Old Wine in New Bottles? The Case of Self‐compassion and Neuroticism

Research on self‐compassion, which is defined as being understanding and kind to oneself when confronted with negative experiences, has produced an impressive number of articles in recent years. This research shows that individual differences in self‐compassion, as measured by the Self‐Compassion Scale (SCS), are positively related to life satisfaction, health and social functioning. However, a critical and systematic test of self‐compassion from a personality perspective has not yet conducted so far. In the present study (N = 576), we (i) tested the factor structure of the SCS, (ii) examined the distinctiveness of self‐compassion with regard to the five‐factor model of personality, focusing on neuroticism, and (iii) tested the incremental predictive power of self‐compassion beyond the five‐factor model in the context of life satisfaction. Confirmatory factor analyses supported a two‐factor plus six facets solution of self‐compassion (a positive factor and a negative factor). Additional analyses revealed that the negative factor was redundant with facets of neuroticism (rs ≥ .85), whereas the positive factor had some unique variance left. However, neither the negative factor nor the positive factor could explain substantial incremental variance in life satisfaction beyond neuroticism. Recommendations for how to use the SCS are provided, and the future of research on self‐compassion is discussed. Copyright © 2017 European Association of Personality Psychology     

Personal initiative,commitment and affect at work

This paper reports two studies on the relationships between employees' personal initiative, affect and commitment. The results of Study 1 among 390 health care sector employees show that individuals' self‐rated personal initiative is related to affect as well as affective commitment to four distinguishable foci, namely the organization, supervisor, work‐group and career. Commitment explains unique variance in personal initiative, even when controlling for demographic variables and positive and negative work affect. As Study 1 relied solely on self‐report data, multi‐source data were gathered for Study 2 (N = 80). This allowed retesting the hypotheses using both self‐ and manager‐ratings of initiative. Results showed that commitment explains variance in both self‐ and manager‐rated initiative beyond demographics and affect. For self‐rated initiative, team commitment explains most variance, whereas for manager‐rated initiative, organizational commitment does.     

what helps and hinders workers in managing change

This research responds to calls for increased understanding of workers' experiences of their work and work contexts. Informed by positive psychology, this study focused on a seldom‐studied subset of working individuals who self‐identified as doing well with change affecting their work and on strategies that helped or hindered them in doing well, factors that would have helped, and their experiences of change within the context of volatile and changing work situations. Using the enhanced critical incident technique methodology, the authors extracted 790 incidents from 45 participant interviews. These data were organized into the following 10 categories: support from friends and family, support from colleagues, support from professionals, personal attitudes/traits/emotional set, self‐care, internal framework and boundaries, taking action, skill/role competence, management style and work environment, and personal life changes/issues. The implications of these categories for research, theory, practice, and organizations are discussed.     

Political ideology,helping mechanisms and empowerment of mental health self‐help/mutual aid groups

Self‐help/mutual aid groups share common attributes such as they are peer‐led, address a common problem or condition, have a voluntary character and little or no connection with professionals. However, these groups may vary according to their political ideology and focus on personal or/and societal change. This study examines the role of political ideology of self‐help/mutual aid groups and differences in psychosocial characteristics of group members. Fourteen mental health self‐help/mutual aid groups in England were studied. On the basis of stated aims and principles and following semi‐structured interviews with group leaders (facilitators/chairpersons), these were classified according to Emerick's typology as conservative (eight groups), combined (three groups), and radical (three groups). Group members (n = 67) completed questionnaires to assess personal empowerment, mental wellbeing, social networks and support, group identification and helping processes in the groups. Findings suggested that all self‐help group members experienced a large number of naturally occurring helping process and felt empowered whilst they shared limited social networks and support and marginal mental wellbeing. Different ideological types of self‐help groups may be related to specific helping processes and particular aspects of personal empowerment. Specifically, members of conservative and combined groups reported more expressive group processes like sharing of feelings and self‐disclosure, while radical group members reported more optimism/control over their lives. Furthermore, group identification was associated with specific helping processes and aspects of personal empowerment in the three group categories. Copyright © 2002 John Wiley & Sons, Ltd.     

Injury Representations,Coping, Emotions,and Functional Outcomes in Athletes With Sports‐Related Injuries: A Test of Self‐Regulation Theory1

This study examined the influence of injury representations on emotions and outcomes of athletes with sports‐related musculoskeletal injuries using self‐regulation theory. Participants were athletes (N= 220; M age = 23.44 years, SD= 8.42) with a current sports‐related musculoskeletal injury. Participants self‐reported their cognitive and emotional injury representations, emotions coping procedures, physical and sports functioning, attendance at treatment centers, and 3‐week follow‐up attendance. Participants’ negative and positive affect were influenced by emotional representations. Identity, causal attributions, and emotional representations influenced physical functioning; and identity, serious consequences, causal attributions, and emotional representations predicted sports functioning. Injury severity, identity, and personal control predicted attendance at treatment centers, but the effect of personal control was mediated by problem‐focused coping. Problem‐focused coping predicted 3‐week follow‐up attendance. Results support self‐regulation theory for examining injury representations in athletes.     

Correlates of Regimen Adherence in Cystic Fibrosis

The present investigation studied psychological and familial factors associated with self-care adherence in a sample of 50 children (ages 9 to 17 years) with cystic fibrosis (CF). Children and their parents were recruited through an outpatient pediatric pulmonary medicine clinic at a metropolitan children's hospital. Participants were interviewed and administered measures of family behavior and child psychological variables. Regimen adherence was measured using a telephone interview approach across three occasions per participant. Hierarchical multiple regression with age, perceived family behaviors, health locus of control, and self-competency as predictors, accounted for 53.8% of the variance in regimen adherence. Findings suggest that higher self-esteem and younger age are related to higher rates of regimen adherence among children with CF.     

Are Norms of Disclosure of Online and Offline Personal Information Associated with the Disclosure of Personal Information Online?

This study investigated whether norms of self‐disclosure of one's online and offline identity are linked to online disclosure of personal and intimate information. We expected online disclosure of personal and intimate information to be associated with norms of online disclosure. Secondary analysis of the 2006 Pew and American Life Survey of parents and teens data set was conducted to test the study's hypotheses. A weak relationship emerged between adherence to norms supporting the disclosure of offline and online personal information. Supporting theories of computer‐mediated communication, our findings show a strong relationship between adherence to norms of online identity disclosure and the disclosure of personal information online through the posting of personal photos, videos, and an online profile.