No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Physicians' Communication of the Common-Sense Self-Regulation Model Results in Greater Reported Adherence Than Physicians' Use of Interpersonal Skills
Abstract
Interventions that address patients' illness and treatment representations have improved patient adherence and outcomes when administered by psychologists and/or health educators and focused on a single chronic illness. The current study assesses the potential feasibility/effectiveness of an intervention based on the common-sense self-regulation model (CS-SRM) when administered by providers in a primary care setting.
We designed a prospective, correlational study in order to optimize patients' and providers' time and to gain initial evidence of the CS-SRM-approach's feasibility/effectiveness.
Patients (n= 243) were recruited from a primary care waiting room and reported on objective behaviours of their providers (providers' CS-SRM-related behaviours and interpersonal skills) and other theoretically related measures directly after the medical encounter and reported on adherence, presenting problem resolution, and emergency care usage 1 month later.
The more providers gave their patients an adaptive understanding of their presenting problem/treatment (the greater the number of CS-SRM-related behaviours they engaged in), the more adherent were patients in the month following the encounter and the better was their problem resolution 1 month later. The CS-SRM-related behaviours were more predictive of these outcomes and emergency care usage than were the providers' interpersonal skills.
In the time-limited encounter, interventions may have to prioritize theoretical approaches for attaining patient adherence. The current study, although correlational, indicates that addressing the patients' illness/treatment representations is more important than the providers' interpersonal skills for attaining patient adherence and provides preliminary evidence that a CSM-based intervention in the primary care setting may be both feasible and effective.
... Partindo disso, uma forma possível de compreender melhor os impactos causados pela doença cardíaca, seria por meio da exploração das crenças que o indivíduo possui sobre a doença que, por sua vez, determinarão seu comportamento de enfrentamento. Dessa forma, o modelo teórico de autorregulação em saúde, o chamado Modelo do Senso Comum (MSC), vem sendo amplamente utilizado para compreender como as crenças e percepções subjetivas, que as pessoas mantêm sobre determinada doença, relacionam-se com seus comportamentos em saúde (Leventhal, Nerenz, & Steele, 1984;Phillips, Leventhal, & Leventhal, 2012). Esse modelo considera que as percepções e expectativas que o indivíduo tem sobre a sua doença, seus sintomas e representações cognitivas, orientam seus comportamentos frente às ameaças à sua saúde (Petrie & Weinman, 2012;Phillips et al., 2012). ...
... Dessa forma, o modelo teórico de autorregulação em saúde, o chamado Modelo do Senso Comum (MSC), vem sendo amplamente utilizado para compreender como as crenças e percepções subjetivas, que as pessoas mantêm sobre determinada doença, relacionam-se com seus comportamentos em saúde (Leventhal, Nerenz, & Steele, 1984;Phillips, Leventhal, & Leventhal, 2012). Esse modelo considera que as percepções e expectativas que o indivíduo tem sobre a sua doença, seus sintomas e representações cognitivas, orientam seus comportamentos frente às ameaças à sua saúde (Petrie & Weinman, 2012;Phillips et al., 2012). Nessa perspectiva, o conhecimento prévio que o indivíduo possui sobre determinada doença, oriundo de suas vivências e de sua cultura, exercerá um papel fundamental na forma como ele irá percebê-la e interpretá-la (Phillips et al., 2012). ...
... Esse modelo considera que as percepções e expectativas que o indivíduo tem sobre a sua doença, seus sintomas e representações cognitivas, orientam seus comportamentos frente às ameaças à sua saúde (Petrie & Weinman, 2012;Phillips et al., 2012). Nessa perspectiva, o conhecimento prévio que o indivíduo possui sobre determinada doença, oriundo de suas vivências e de sua cultura, exercerá um papel fundamental na forma como ele irá percebê-la e interpretá-la (Phillips et al., 2012). ...
This systematic review of literature aimed to investigate articles published between 2009 and 2015 about illness perception in cardiac patients, based on the Common Sense Model (CSM). Searches were performed at the databases PsycInfo, Medline e PubMed. The descriptors used were cardiac disease, illness perception, illness representation and illness beliefs. The results showed that cardiac disease is associated to serious consequences to patients life, with causes attributed to factors regardless of the individuals behavior (psychological causes, hereditary, virus, bad luck, etc.). Furthermore, cardiac patients tend to believe more in treatment to control than in personal control.
... First, research in primary care [15] and in populations with hypertension [16] and type 2 diabetes [17] finds that discussing components of illness and treatment representations (beliefs/perceptions) promotes better patient care and adherence. Representations include perceptions, or mental models, regarding the cause, duration, consequences, diagnosis/label, associated symptoms, and treatment for the illness, as posited by the Commonsense Self-Regulation Model (CS-SRM) [18] and the Necessities-Concerns Framework [19]. ...
... Phillips et al. [15] found that when patients reported that their primary care providers (PCPs) discussed components of illness and treatment representations (e.g., such as how long the condition would last and the cause of the condition; 'CS-SRM communication'), they were more satisfied, more likely to agree with the provider, more adherent to prescribed treatment, more likely to experience problem resolution, and less likely to utilize emergency care services for the problem in the subsequent month (and predicted these outcomes more strongly than reports of the providers' interpersonal skills). ...
... Providers' interpersonal skills may also be particularly important for patients with MUS. Some research, as described above [15], as well as others [e.g., 24], shows that interpersonal skills and interventions to promote them are not linked with better adherence or outcomes. However, other research has shown that these skills do promote adherence in chronically ill populations [25], including in patients with MUS [26]. ...
Objectives:
Medically unexplained symptoms (MUS) are common, with particularly high rates observed in military veterans. Effective patient-provider-communication is thought to be a key aspect of care; however there have been few empirical studies on the association between communication and outcomes for patients with MUS. We evaluate whether discussing veterans' MUS-illness representations and good interpersonal skills have the potential to promote MUS-treatment adherence and improvement.
Methods:
Veterans experiencing MUS (n=204) reported on their primary care providers' communication about illness representations and interpersonal skills; correlation, regression, and bootstrap-mediation analyses were conducted to test hypotheses regarding veteran-reported outcomes. Main outcomes included satisfaction with the provider, MUS-treatment adherence, intentions to adhere, and expectations for MUS improvement.
Results:
Veterans reported infrequent discussion of MUS illness representations but high degrees of provider interpersonal skills. Communication regarding patients' illness representations and treatment expectations was significantly related to treatment adherence and adherence intentions; provider interpersonal skills were not. Both were related to veteran satisfaction.
Conclusions and practice implications:
Providers' interpersonal skills may be important in chronic illness contexts, such as MUS, by contributing to satisfaction with the provider. The current study suggests that providers may better promote MUS-treatment adherence through discussing MUS illness representations and treatment expectations.
... Partindo disso, uma forma possível de compreender melhor os impactos causados pela doença cardíaca, seria por meio da exploração das crenças que o indivíduo possui sobre a doença que, por sua vez, determinarão seu comportamento de enfrentamento. Dessa forma, o modelo teórico de autorregulação em saúde, o chamado Modelo do Senso Comum (MSC), vem sendo amplamente utilizado para compreender como as crenças e percepções subjetivas, que as pessoas mantêm sobre determinada doença, relacionam-se com seus comportamentos em saúde (Leventhal, Nerenz, & Steele, 1984;Phillips, Leventhal, & Leventhal, 2012). Esse modelo considera que as percepções e expectativas que o indivíduo tem sobre a sua doença, seus sintomas e representações cognitivas, orientam seus comportamentos frente às ameaças à sua saúde (Petrie & Weinman, 2012;Phillips et al., 2012). ...
... Dessa forma, o modelo teórico de autorregulação em saúde, o chamado Modelo do Senso Comum (MSC), vem sendo amplamente utilizado para compreender como as crenças e percepções subjetivas, que as pessoas mantêm sobre determinada doença, relacionam-se com seus comportamentos em saúde (Leventhal, Nerenz, & Steele, 1984;Phillips, Leventhal, & Leventhal, 2012). Esse modelo considera que as percepções e expectativas que o indivíduo tem sobre a sua doença, seus sintomas e representações cognitivas, orientam seus comportamentos frente às ameaças à sua saúde (Petrie & Weinman, 2012;Phillips et al., 2012). Nessa perspectiva, o conhecimento prévio que o indivíduo possui sobre determinada doença, oriundo de suas vivências e de sua cultura, exercerá um papel fundamental na forma como ele irá percebê-la e interpretá-la (Phillips et al., 2012). ...
... Esse modelo considera que as percepções e expectativas que o indivíduo tem sobre a sua doença, seus sintomas e representações cognitivas, orientam seus comportamentos frente às ameaças à sua saúde (Petrie & Weinman, 2012;Phillips et al., 2012). Nessa perspectiva, o conhecimento prévio que o indivíduo possui sobre determinada doença, oriundo de suas vivências e de sua cultura, exercerá um papel fundamental na forma como ele irá percebê-la e interpretá-la (Phillips et al., 2012). ...
A presente revisão sistemática da literatura teve por objetivo investigar estudos publicados entre 2009 e 2015 que examinaram a percepção da doença em pacientes cardíacos a partir do Modelo do Senso Comum. As buscas foram feitas nas bases de dados PsychInfo, Medline e PubMed. Foram utilizados os descritores: cardiac disease, illness perception, illness representation e illness beliefs. Os resultados mostraram que a percepção da doença cardíaca é associada a consequências graves à vida do paciente, com causas atribuídas a fatores independentes dos comportamentos do indivíduo (causas psicológicas, hereditariedade, vírus, má sorte etc.). Além disso, os pacientes cardíacos acreditam mais no tratamento para o controle da doença do que no seu controle pessoal.
... O Modelo Teórico do Senso Comum (MSC) tem sido utilizado na tentativa de compreender o que os indivíduos pensam sobre sua saúde e as doenças -suas crenças ou percepções sobre a doença. Os indivíduos possuem esquemas mentais relacionados às características das doenças, e diante de uma situação de risco para sua saúde, o paciente recorrerá a estes esquemas mentais para identificar e interpretar os sinais, as possibilidades de cura, como se comportar e o que deve fazer para que tenha um estado de saúde como o que vivia anteriormente (Leventhal, Brissette, & Leventhal, 2003;Leventhal, Nerenz, & Steele, 1984;Phillips, Leventhal, & Leventhal, 2012). Portanto, as crenças em saúde podem ter relação com atitudes e hábitos que as pessoas doentes e saudáveis adotam para manter sua saúde e /ou alcançar a cura, autorregulandoseu comportamento frente à doença (Brito, Mondelo, & Remor, 2018;Phillips, Leventhal, & Leventhal, 2012). ...
... Os indivíduos possuem esquemas mentais relacionados às características das doenças, e diante de uma situação de risco para sua saúde, o paciente recorrerá a estes esquemas mentais para identificar e interpretar os sinais, as possibilidades de cura, como se comportar e o que deve fazer para que tenha um estado de saúde como o que vivia anteriormente (Leventhal, Brissette, & Leventhal, 2003;Leventhal, Nerenz, & Steele, 1984;Phillips, Leventhal, & Leventhal, 2012). Portanto, as crenças em saúde podem ter relação com atitudes e hábitos que as pessoas doentes e saudáveis adotam para manter sua saúde e /ou alcançar a cura, autorregulandoseu comportamento frente à doença (Brito, Mondelo, & Remor, 2018;Phillips, Leventhal, & Leventhal, 2012). ...
... It is very difficult to change behavior when the social environment is not supportive of the change [26]. In the face of these circumstances, the treating clinician's role for patients is overwhelmingly as a health educator, acknowledging the many influences that may mislead a patient even as she corrects them [27]. The foregoing assessment strongly suggests an agenda of specific issues to be addressed in an iterative process, as treatment progresses (Table 2). ...
... The coping process is initiated and sustained by a woman's implicit awareness that she is managing a life-threatening illness [4]. It is notable that in one study patients who identify their clinic visits as focused on common-sense problem-solving were more adherent than those who experienced their visit as psycho-social support [27]. ...
The primary and secondary benefits of tamoxifen as adjuvant therapy in women with hormone-receptor-positive breast cancer are substantial: a 1% decrease in the risk of death each year for 10 years with each additional year of treatment during the first 5 years. Considerable data, however, indicate that these benefits are lost to many patients because of treatment nonadherence. Nonadherence is examined within the framework of the Common-Sense Model of Self-Regulation to describe patients' models of disease and treatment that organize their thinking and behavior, and the crucial role of the practitioner in addressing and altering these models. Common patient education and social communications about patients' hormone-receptor-positive breast cancer and tamoxifen treatment promote an acute disease paradigm in which cancer occurs within specific locations and is either present or absent. We recommend that clinicians communicate the concepts of hormone-receptor-positive breast cancer as follows: i. a non-dichotomous systemic disorder entailing a treatment goal of homeostasis and disease quiescence and ii. a disorder undetectable by currently available tests in subclinical states. Equally important, the clinician can provide a comprehensive picture of the well-documented secondary effects of tamoxifen, noting in particular the beneficial effects. Specific action plans, grounded in individual patient understanding, can be developed and reinforced, in an ongoing process that validates and integrates patient values and goals as they change over time.
... In our study, HCPs identified the need for training and reflected that theory models could be better used to guide consultations. Theory based interventions with advanced skills have been tested and held high in improving patient-clinician relationship [24]. Allowing opportunity to generate an improved engagement and increase the likelihood of wide adoption of self-management by patients [25]. ...
... Our data suggest an opportunity to help embed skills in clinical practice, and develop advanced techniques to move forward. Transfer of training theory proposes that higher levels of shared care decision making might increase the likelihood of the successful outcomes [24]. This was found in research into brief cognitive-behavioural training for clinicians working in cancer [26], where clinical consultation was based on necessity and needs https://mc.manuscriptcentral.com/rheumap of patients HCPs trained to address concerns effectively, maintain skills and build confidence. ...
Objective
To explore rheumatology healthcare professionals’ (HCPs) perceptions of interacting with patients of South Asian origin attending early inflammatory arthritis (EIA) clinics.
Methods
We used face to face semi structured interviews, designed in partnership with clinician partner to interview ten HCPs involved in running of EIA clinics across seven centres in the UK. Data were recorded, transcribed by an independent company and were analysed using inductive thematic analysis.
Results
Three emerging themes were identified that characterised consulting experiences of HCPs. [1] Varied approaches were used in early inflammatory arthritis clinic, [2] Rheumatology HCP’s challenges in managing and delivering information to patients of South Asian origin in early inflammatory arthritis clinic [3] Moving towards good practice: views on managing future patients of South Asian origin in early inflammatory arthritis clinics. Overall, HCPs found that they required additional skills to support the engagement and management for patients of South Asian origin living with inflammatory arthritis. HCPs felt that they were less effective in addressing self-management issues for this patient group and they found it difficult to determine adherence to medication. In such consultations, HCPs perceived their own limitation of inadequate training contributed towards poor consultations.
Conclusion
For the first time, our data demonstrates that the management of patients of South Asian origin in EIA clinics is under served. To address this, HCPs have identified training needs to improve knowledge and skills in engaging with and supporting patients of South Asian origin. These findings provide a good direction for future research.
... Nessa etapa do ciclo vital, os filhos são independentes e os idosos estão menos ativos no mercado de trabalho, portanto o impacto emocional da doença cardíaca tende a ser menor do que em pessoas jovens. Este fato pode conferir às pessoas mais velhas a crença de maior controle autorregulatório sobre a sua doença (Phillips et al., 2012). ...
... Partindo disso, pode-se compreender que quando o indivíduo se sente mais esclarecido sobre a sua doença, sua capacidade de avaliar a sua condição de saúde se torna mais clara e mais precisa e esse aspecto o torna mais consciente, melhorando sua capacidade de avaliação realista da doença. De acordo com Phillips et al. (2012), o fato do indivíduo acreditar que pode ser capaz de controlar a sua doença pode torná-lo mais motivado e fazer com que o mesmo mantenha maior equilíbro autoregulatório, o que pode vir a melhorar sua capacidade de resolução dos problemas que derivam da sua doença. O estudo possibilitou conhecer as percepções dos pacientes cardíacos sobre a sua doença e a verificação de que elas são independentes das informações sobre sintomas, causas, consequências, controle, duração, representação emocional e entendimento que o paciente tem sobre a sua doença que os médicos informam no diagnóstico. ...
... A importância da comunicação entre profissionais da saúde e pacientes/usuários tem sido foco crescente de estudos e debates nos âmbitos nacional (Miranda, Feliciano & Sampaio, 2014;Ramos & Bortagarai, 2012) e internacional (Phillips, Leventhal & Leventhal, 2012;Brundage, Feldman-Stewart & Tishelman, 2010). Uma comunicação eficaz facilita as condutas de autocuidado e de adesão ao tratamento (Albuquerque et al., 2011). ...
... Solicitou-se que as participantes pegassem um papel contendo uma frase sobre aspectos relacionados à comunicação e, após lerem, debatessem sobre o tópico sorteado e propusessem soluções possíveis para o problema. Os tópicos debatidos foram: No quinto e último encontro, primeiramente, foi abordado o modelo de Autorregulação do Senso Comum (Phillips, Leventhal & Leventhal, 2012), retomando os objetivos do estudo maior: auxiliar profissionais da saúde a aprimorar a comunicação com as pacientes, visando ao aumento da percepção de risco de Câncer de Colo de Útero e o aperfeiçoamento de condutas de autocuidado para auxiliar na prevenção dessa enfermidade. Posteriormente, houve uma discussão sobre os conteúdos pensados para compor uma cartilha informativa (aspectos envolvidos na comunicação profissional-paciente; o que comunicar; como comunicar), direcionada aos profissionais de saúde, sobre o tema comunicação profissional-usuário. E também foi realizado um fechamento das oficinas. ...
Health education is an educative process for constructing knowledge about health, which contributes to increase people's selfcare autonomy. The objective of this research was report the realization of workshops on the communication between health professionals and the users, as well as the humanization at work. For that, five workshops were made, with ten professionals who work with women's health at a Basic Health Unit in Rio Grande do Sul, Brazil. The focused themes relate to the difficulties of the work context (lack of exchange spaces for professionals and of support from the managers, bureaucracy of the system) and the difficulties of the relationship with users (passive attitude and communication issues). From these results, a booklet was produced to qualify the communication between professionals and users. Another founding of this research is the importance of constructing interaction spaces for the professionals' teams.
... In the face of a threat to one's health, people refer to their schemes to identify and assess their possibilities for cure of and/or recovery from their health condition, as well as what behaviors they are supposed to adopt to cope with it (Leventhal et al., 1984;Leventhal, Leventhal, & Breland, 2011). The CSMR is structured according to nine dimensions: 1) identity (symptoms); 2) cyclical timeline; 3) acute/chronic timeline; 4) causes (what individuals believe caused the disease); 5) consequences (real or imaginary); 6) personal control (what an individual believes s/ he can do to manage the disease and/or aid its cure); 7) treatment control (how much an individual believes in the treatment); 8) illness coherence (how much an individual understands the disease); and 9) emotional representation (emotional impact caused by the disease) (Moss- Morris et al., 2002;Phillips, Leventhal, & Leventhal, 2012). ...
... Prior representations originating from an individual's culture regarding cancer, added to his/her experiences, play an essential role in the way the individual perceives and copes with a disease (Phillips et al., 2012). In the case of childhood cancer, the disease strongly affects the child's family and especially the mother, who is an important source of care during treatment and whose mental health may be affected (Bemis et al., 2015;Lawrenz, Peuker, & Castro, 2016). ...
Beliefs regarding a disease refer to mental schemes people construct based on their direct or indirect experiences and that are related to their health behavior and self-regulation. Such beliefs help childhood cancer survivors understand their behavior in their follow-up treatment. This study's purpose was to examine the beliefs concerning childhood cancer among 27 survivors and 49 mothers, who completed sociodemographic surveys and questionnaires addressing disease perceptions via an online platform. Results reveal that mothers, more frequently than survivors, perceived childhood cancer as a chronic disease with cyclical symptoms, with more negative consequences and emotional representations. The mothers also reported having greater understanding regarding the disease and more strongly believed in personal and treatment control in comparison to survivors. The conclusion is that the fact that survivors more positively perceived childhood cancer may indicate they re-signified their experiences in an adaptive manner.
... In addition, clinicians may be able to provide better care if they are mindful of and responsive to women's representations. Understanding individuals' representations allow clinicians to provide new information in a specific, relevant, and individualized manner (de Ridder, Theunissen, & van Dulmen, 2007;Phillips et al., 2012). Research demonstrates that addressing patients' lay beliefs has resulted in more discussion about patients' concerns and preferences, which has led to an overall improvement in patient-clinician communication and self-management behaviors (de Ridder et al., 2007;Phillips et al., 2012). ...
... Understanding individuals' representations allow clinicians to provide new information in a specific, relevant, and individualized manner (de Ridder, Theunissen, & van Dulmen, 2007;Phillips et al., 2012). Research demonstrates that addressing patients' lay beliefs has resulted in more discussion about patients' concerns and preferences, which has led to an overall improvement in patient-clinician communication and self-management behaviors (de Ridder et al., 2007;Phillips et al., 2012). ...
... The results of this assessment was summarised in an individual "feedback form", which was used by physicians and psychologists as a guide for tailoring the information. Overall, such commonsense model of self-regulation-based interventions have produced encouraging results, [56][57][58][59][60][61][62] in the (psychosomatic) rehabilitation context as well. 39,55 Despite these efforts, the explicit and focused clinical addressing of patients beliefs and expectations may have been undervalued so far 30 -also in the treatment of mental illnesses. ...
Purpose: Patients’ illness and treatment beliefs have been shown to predict health outcomes in many health care settings. However, information about their impact on patient satisfaction is scarce. The aim of this study was to investigate illness- and rehabilitation-related treatment beliefs and met rehabilitation-related treatment expectations and their relationship with patient satisfaction in psychosomatic rehabilitation.
Methods: In a repeated measures study design, patients filled out questionnaires 2 to 3 weeks before the start of rehabilitation and at the end of an inpatient rehabilitation 6 to 7 weeks later. The predictive value of illness beliefs, treatment beliefs, and fulfilled treatment expectations regarding patient satisfaction was analyzed with multiple hierarchical regression analyses controlling for sociodemographic and clinical variables.
Results: Two hundred sixty-four patients participated. The sample was composed of equal numbers of men and women (n = 129 each). The mean age was 50.4 years. Most patients had diagnoses from the ICD– 10 diagnostic group F3 (affective disorders; n = 145) or F4 (neurotic, stress-related and somatoform disorders; n = 94). Sociodemographic and clinical variables were not associated with patient satisfaction. The explained variance of patient satisfaction increased to 10% by adding illness beliefs (namely personal control and coherence) (p = 0.006), to 5% by adding rehabilitation-related treatment beliefs (namely concerns) (p = 0.063), and to 49% by adding fulfilled expectations (namely a positive discrepancy between expectations and experiences related to outcome expectations and related to participation and treatment structure, and a negative discrepancy between expectations and experiences related to concerns) (p < 0.001) as predictor variables.
Conclusion: This study highlights the relationship of fulfilled (rehabilitation-related) treatment expectations with patient satisfaction in psychosomatic rehabilitation. Given the evidence underlining the importance of patients’ illness and treatment beliefs and expectations, it is vital that these constructs are addressed in corresponding interventions.
... There had been several research studies that explored the relationship between various chronic diseases such as the health-care system-related factor [11][12][13], condition-related factor [14,15], treatment-related factor [16][17][18][19], socioeconomic-related factor [20][21][22], and patient-related factor [23][24][25]. The findings of these studies suggest that patients' adherence behavior is due to many complex and interrelated factors. ...
Objectives:
This systematic review aims to identify influencing factors of medication adherence behavior in patients with end-stage renal disease (ESRD), with a special interest in patient-related factors based on the World Health Organization adherence model.
Materials and methods:
Primary electronic databases comprising PubMed, Scopus, Web of Science, Embase and Cochrane Library, as well as ProQuest (Health and Medical), ProQuest (Psychology), and EBSCOHost (APA PsychARTICLES) were used to search for literature on patient-related factors in medication adherence, from inception till August 31, 2021.
Results:
479 articles were identified and six articles meeting eligibility criteria were reviewed and remained in this systematic review. The present review found that despite different tools being used to measure ESRD's perception of medication's necessity and beliefs, there was a profound association between perception and beliefs with medication adherence behavior. There is a positive relationship between knowledge, belief, educational level, ethnicity, female, and medication adherence behavior. Mixed finding was reported between perception, age, and medication adherence behavior. However, there were no studies on patients' attitudes and medication adherence behavior as suggested in the WHO adherence model.
Conclusion:
Only a limited number of patient-related factors were available for evaluation in the current systematic review. Additional research is needed to advance the understanding of medication adherence behavior affected by patient-related factors on the medication and illness. However, the findings must be taken with caution because of the limited studies included in this review.
... However, exploring the personal factors which might influence the adoption of self-management practices is likely to facilitate treatment adherence. In a study which explored the role which the content of clinical communications may have on treatment adherence, when patients perceived the visit to have a common sense rather than medical purpose (i.e., focusing on treatment monitoring and the individual's ability to manage their condition, as opposed to patient feelings of treatment effects), visits which were deemed to have a common sense purpose resulted in greater treatment adherence and better management of their condition [66]. Practitioners who give time to explore patient beliefs about when and how to do the treatment and their expectations of own self-efficacy may be more effective at empowering individual self-management because they set the stage for action and evaluation of treatment efficacy [67]. ...
Purpose
Parkinson’s disease (PD) is a condition which causes significant difficulties in physical, cognitive and psychological domains. It is a progressive condition which people have to live with for a long time; consequently, there is a need to understand what contributes to individual adjustment. This review aimed to answer the question “how do individuals adjust to PD?”
Method
A systematic search of three databases (MEDLINE, CINAHL and PsycINFO) was carried out of papers documenting the adjustment process when living with PD and the findings were synthesised using a meta-ethnographic approach.
Results
After exclusion based on eligibility criteria, 21 articles were included and were assessed for quality prior to analysing the data. Three main themes are proposed relating to the process of adjustment: “maintaining a coherent sense of self”, “feeling in control” and “holding a positive mindset”. Although many of the studies described challenges of living with PD, the results are dominated by the determination of individuals to self-manage their condition and maintain positive wellbeing.
Conclusion
The results highlight the need to empower patients to self-manage their illness, mitigating the effects of Parkinson’s disease and supporting future wellbeing.
•
IMPLICATIONS FOR REHABILITATION
• Individual identity disruption impacts on the self-value and sense of self coherence in individuals living with Parkinson’s disease.
• Healthcare professionals should appreciate the complexity of the adjustment process which is related to the ability to maintain a coherent sense of self, to feel in control and to hold a positive mindset.
• Healthcare professionals should ensure information and knowledge related to self-management is tailored to an individual’s understanding and experience of the disease.
... Persistent beliefs that the pain is associated with tissue damage, and that the rest is required to enable tissue recovery can prevent the successful implementation of rehabilitation (McAndrew et al., 2008). Such an appraisal could lead to activity avoidance behavior, the prevention of necessary rehabilitation engagement, and adherence (Phillips et al., 2012). In this case, reliance is dependent on the adoption of a therapeutic alliance where concerns and worries can be expressed by the patient, with the reassurance offered by the physiotherapist, including an appropriate explanation of the cause of the problem (Littlewood et al., 2012). ...
Musculoskeletal disorders such as tendinopathy are having an increasing burden on society and health systems. Tendinopathy is responsible for up to 30% of musculoskeletal disorders, having a high incidence in athletes and the general population. Although resistance training has shown short-term effectiveness for treating lower limb tendinopathy, more comprehensive exercise protocols and progression methods are required due to poor long-term outcomes. The most common resistance training protocols are pre-determined and standardised, which presents significant limitations. Current standardized protocols do not adhere to scientific resistance training principles and do not consider individual factors or take the importance of individualised training into account. Resistance training programs in tendinopathy are currently not achieving required intensity and dosage, leading to high recurrence rates. Therefore, better methods for individualising and progressing resistance training are required to improve outcomes. One potential method is autoregulation, which allows individuals to progress training at their own rate, taking individual factors into account. Despite being found effective for increasing strength in healthy athletes, autoregulation methods have not been investigated in tendinopathy. The purpose of this narrative review was threefold: first to give an overview and critical analysis of individual factors involved in tendinopathy and current resistance training protocols and their limitations. Secondly, to give an overview of the history, methods and application of autoregulation strategies both in sports performance and physiotherapy. Finally, a theoretical adaptation of a current tendinopathy resistance training protocol with autoregulation methods is presented, providing an example of how the method could be implemented in clinical practice or future research.
... A more promising conceptual framework for understanding and explaining the mechanisms by which AA-ITB operate comes from adherence research. Horne's Medication Necessity and Concerns Beliefs Model of medication adherence [44] is grounded in a common sense approach to adherence [45][46][47][48]. Figure 2 illustrates Horne's [44] conceptualization of the Necessity and Concerns Beliefs Model as adapted for AA-ITB. Simply stated, adherence is ultimately determined by the relative balance between patient perceptions of how necessary it is to take medications weighed against patient concerns about taking medications. ...
The successful treatment of HIV infection relies on adherence to antiretroviral therapy (ART). Alcohol use remains a threat to ART adherence, including the beliefs held by people who drink alcohol that it is harmful to take ART when consuming alcohol (i.e., alcohol-ART interactive toxicity beliefs, AA-ITB). We reviewed the current research that has investigated AA-ITB and their relationship to intentional ART nonadherence. The review of 17 published studies found that AA-ITB are prevalent among people receiving ART and that AA-ITB are directly associated with ART nonadherence and incomplete HIV suppression. Family, friends and healthcare providers are common sources and reinforcers of AA-ITB. Studies suggest that AA-ITB may best be explained by the Medication Necessity and Concerns Beliefs Model, treating AA-ITB as a specific circumstance of medication concerns. Interventions are needed to communicate the realities of potential medication interactions and dispel myths that it is harmful to mix alcohol with ART, while not inadvertently suggesting that it is safe to drink with all medications, which could undermine adherence to ART by increasing alcohol use.
... For instance, if a patient thinks hypertension is a serious disease, the patient will be more likely to engage in a health-related behavior (e.g., taking antihypertensive medication) to manage the disease. The Self-Regulation Model has been found to be successful in improving medication adherence among patients with chronic conditions, such as rheumatoid arthritis and cardiovascular disease [31][32][33]. However, none of the interventions among adults with hypertension found significant improvement in medication adherence, possibly, due to the low use of the model (e.g., not tailoring techniques to the model). ...
Medication adherence is a major problem in the treatment of hypertension. Approximately half of the patients who use antihypertensive medications are not adherent. Several interventions have endeavored to improve medication adherence among patients with hypertension, and some have used health behavioral models/theories. However, the quality and effectiveness of using health behavioral models/theories in improving medication adherence among patients with hypertension remain unknown. The main aim of this systematic review was to describe study characteristics and types of health behavioral models/theories used in interventions for improving medication adherence among adults with hypertension. PubMed, Scopus, Ovid MEDLINE, CINAHL, and PsycINFO databases were searched for randomized clinical trial interventions using any health behavioral models/theories published in English from 1979 to 2019. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, two independent reviewers searched, screened abstracts and articles, extracted data, and assessed the risk of bias and the use of the model/theory using the Theory Coding Scheme. A total of 11 articles were included in this systematic review. Two studies reported significant improvement in medication adherence. The Self-Regulation Model and Social Cognitive Theory were the most common types of models/theories. Nine studies used a single model/theory, and four studies measured the constructs of a model/theory. Risk of bias was good (n = 4) and fair (n = 5) in interventions. Using health behavioral models/theories may be an efficient way for health care professionals to improve adherence to medications among patients with hypertension. More interventions with rigorous designs are needed that appropriately utilize health behavioral models/theories for improving medication adherence among adults with hypertension.
... Persistent beliefs that the pain is a sign of tissue damage and that rest is required to enable the tissue to recover can prevent rehabilitation being implemented successfully [281]. Such an appraisal would result in avoidance behaviour and prevent any level of engagement [282]. In this situation, reliance is placed upon the development of a therapeutic alliance where doubts and concerns can be expressed by the patient and reassurance offered by the physiotherapist along with an acceptable explanation of the cause of the problem [283]. ...
Musculoskeletal disorders such as tendinopathy are having an increasing burden on society and health systems. Tendinopathy is responsible for up to 30% of musculoskeletal disorders, having a high incidence in athletes and the general population. Although resistance training has shown short-term effectiveness for treating lower limb tendinopathy, more comprehensive exercise protocols and progression methods are required due to poor long-term outcomes. The most common resistance training protocols are pre-determined and standardised, which presents significant limitations. Current standardized protocols do not adhere to scientific resistance training principles and do not consider individual factors or take the importance of individualised training into account. Resistance training programs in tendinopathy are currently not achieving required intensity and dosage, leading to high recurrence rates. Therefore, better methods for individualising and progressing resistance training are required to improve outcomes. One potential method is autoregulation, which allows individuals to progress training at their own rate, taking individual factors into account. Despite being found effective for increasing strength in healthy athletes, autoregulation methods have not been investigated in tendinopathy. The purpose of this article was threefold: first to give an overview of individual factors in tendinopathy and current resistance training protocols in tendinopathy and their limitations. Secondly, to give an overview of the history, methods and application of autoregulation strategies both in sports performance and physiotherapy. Finally, a theoretical adaptation of a tendinopathy resistance training protocol with autoregulation methods is presented, providing an example of how the method could be implemented in clinical practice or future research.
... Estos planteamientos son utilizados en investigaciones que han encontrado relación entre adherencia, percepción de enfermedad y creencias relacionadas con el tratamiento. (3,4,5,6) En ese sentido, Phillips y Leventhal (7) proponen que intervenciones que busquen explorar el conocimiento de los pacientes en relación a los puntos anotados, podrían mejorar la forma como las personas se adaptan a la enfermedad (adaptive understanding), y facilitar la adherencia al tratamiento farmacológico y a las demás recomendaciones del médico. ...
Introducción:
En la práctica clínica es frecuente la pregunta acerca del porqué algunos pacientes con enfermedades crónicas no siguen las recomendaciones dadas por los profesionales de la salud, a pesar de la información que obtienen acerca de la enfermedad.
Objetivo:
Comprender como se construyen las posturas de autocuidado y su articulación con el significado de hipertensión arterial y la relación médico-paciente.
Método:
Estudio cualitativo, con diseño narrativo. Se analizaron espacios conversacionales con pacientes y profesionales de la salud.
Resultados:
La construcción de la experiencia en el espacio conversacional asistencial no tiene un punto de convergencia; ya que es parte de conversaciones unidireccionales centradas en la vivencia del médico frente al paciente y el diálogo de este último consigo mismo acerca de su enfermedad, experiencias que no logran transformaciones en el estilo de vida sostenibles en el tiempo, y que favorecen la emergencia de rótulos limitantes para la construcción de relaciones que posibiliten al paciente asumir su autocuidado.
Conclusiones:
El diálogo en la relación médico-paciente facilita el surgimiento de nuevos significados de la enfermedad y la activación de procesos, donde las personas pueden asumir la experiencia desde la responsabilidad y el autocuidado.
... Research supports concordance (i.e., agreement between provider and patient on the cause of and treatment for MUS) as an important predictor of patient treatment outcomes such as treatment adherence and symptom improvement [45][46]. For example, Phillips, Leventhal, & Leventhal [47] found that when providers understood their patients' presenting problems and treatment, patients reported significantly better treatment outcomes including improved adherence to treatment recommendations. Discordance, on the other hand, can have negative impacts on patient health, including negative emotions related to feeling misunderstood or invalidated by healthcare providers and the larger healthcare system [48][49][50]. ...
Background
Illness beliefs are significant contributors to health outcomes. Beliefs about the cause of physical symptoms are considered particularly important among those with medically unexplained symptoms and illnesses (MUS); yet little is known about causal beliefs among those with the most severe MUS (i.e., Veterans). The goal of the current study was to examine Veteran's causal attributions of their physical symptoms.MethodA total of 91 combat Veterans with MUS were surveyed using a mixed-methods design about the cause of their physical symptoms, physical symptom severity, and PTSD symptoms. Causal attributions of physical symptoms were analyzed through thematic response analysis and grouped into categories. Chi-square analysis was used to assess the distribution of causal attribution types across Veterans with varying physical symptom severity and PTSD symptom severity.ResultsVeterans with MUS reported an average of 7.9 physical symptoms, and attributed the cause of their symptoms to seven different categories (“Do not Know,” “Stress/Mental Health,” “Deployment/Environment,” “Functional/Symptom,” “Medically Explained,” “Medically Unexplained Syndrome,” and “Lifestyle”). Exploratory chi-square analysis revealed significant differences in causal attributions across physical symptom severity and severity of PTSD symptoms. Veterans with more severe PTSD and Veterans with more severe physical symptoms were more likely to attribute their MUS to stress/mental health or to a medically unexplained syndrome compared with those with low/no PTSD symptoms and physical symptom severity. Veterans with minimal PTSD and Veterans with minimal physical symptom severity were more likely to attribute the cause of their MUS to lifestyle choices (e.g., exercise/diet) compared with those with high PTSD and physical symptom severity.Conclusion
Veterans with MUS endorse multiple, varied causal attributions for their physical symptoms, suggesting more complex causal beliefs than typically assumed. This has important implications for patient-provider communication and development of concordance around MUS treatment.
... Although there is limited research examining the effectiveness of these interventions on promoting T2DM adherence, some studies evidenced positive results, 39 especially in SMBG, 40 and when the intervention was physician-led. 41 Therefore, it might be worthwhile to develop healthcare provider-led CSM-centric patient education strategies focused on correcting negative beliefs about their causes, symptoms, treatment, and illness consequences. ...
Objectives The main purpose of this article is to synthesize qualitative research exploring experiences of the factors that facilitated and hindered adherence among patients with type 2 diabetes mellitus (T2DM).
Methods Twenty-six qualitative studies were purposefully included in the final sample. The Critical Appraisal Skills Program criteria for quality assessment of the studies was conducted. A meta-ethnographic approach proposed by Noblit and Hare (1988) was employed to analyze the studies. Using the “reciprocal translation” process, the authors searched for and consolidated the common themes.
Results Three major themes were observed: (1) psychological determinants comprising illness beliefs, locus of control, and being forgetful; (2) sociocultural determinants of family and community, culture, and financial aspects; and (3) patients’ relationship with their physicians.
Discussion The meta-ethnography underlines the importance of cultural nuances in the subjective experiences of the barriers and enablers of diabetes adherence. The findings support the need to include qualitative research methods to develop and evaluate interventions to improve T2DM adherence in patients. Clinical implications of this meta-ethnography include engaging in psychoeducation sessions for patients and caregivers, helping set reminders for patients, introducing communication skills training for healthcare providers, and including female caregivers/patients actively in diabetes care.
... Further, among patients with medically known conditions, concordance between patients and providers has been associated with (a) greater satisfaction with the medical consultation (Perreault, Pawliuk, Veilleux, & Rousseau, 2006;Sewitch, Abrahamowicz, Dobkin, & Tamblyn, 2003), (b) better treatment outcomes (Perreault et al., 2006), (c) greater adherence to treatment recommendations (Maly, Leake, Frank, DiMatteo, & Reuben, 2002), and (d) more favorable perceptions of recovery (Stewart, McWhinney, & Buck, 1979). Phillips et al. (2011Phillips et al. ( , 2012, for example, showed that primary care patients' perceptions of concordance with the provider regarding their presenting problem and prescribed treatment predicted their adherence to that treatment and their problem resolution in the subsequent month, as well as their satisfaction with the provider. ...
Medically unexplained symptoms (MUS) are common among veterans and are difficult to treat. Optimal treatment entails continued care from providers, yet this care may be influenced negatively by nonconcordance between veterans’ and providers’ views of MUS. We surveyed 243 veterans with MUS and evaluated the degree of nonconcordance perceived by veterans and their primary care providers regarding their MUS, as well as the effect of perceived nonconcordance on treatment behaviors and outcomes. Approximately 20% of veterans in our sample perceived nonconcordance with their provider regarding their MUS. In turn, perceived nonconcordance predicted important outcomes of interest, particularly veterans’ satisfaction with their provider. Perceived concordance with primary care doctors may be required for sufficient adherence to MUS treatment recommendations, such as seeking and maintaining psychological counseling. We discuss future research directions for counseling psychologists.
... Estos planteamientos son utilizados en investigaciones que han encontrado relación entre adherencia, percepción de enfermedad y creencias relacionadas con el tratamiento. (3,4,5,6) En ese sentido, Phillips y Leventhal (7) proponen que intervenciones que busquen explorar el conocimiento de los pacientes en relación a los puntos anotados, podrían mejorar la forma como las personas se adaptan a la enfermedad (adaptive understanding), y facilitar la adherencia al tratamiento farmacológico y a las demás recomendaciones del médico. ...
RESUMEN Introducción: En la práctica clínica es frecuente la pregunta acerca del porqué algunos pacientes con enfermedades crónicas no siguen las recomendaciones dadas por los profesionales de la salud, a pesar de la información que obtienen acerca de la enfermedad. Objetivo: Comprender como se construyen las posturas de autocuidado y su articulación con el significado de hipertensión arterial y la relación médico-paciente. Método: Estudio cualitativo, con diseño narrativo. Se analizaron espacios conversacionales con pacientes y profesionales de la salud. Resultados: La construcción de la experiencia en el espacio conversacional asistencial no tiene un punto de convergencia; ya que es parte de conversaciones unidireccionales centradas en la vivencia del médico frente al paciente y el diálogo de este último consigo mismo acerca de su enfermedad, experiencias que no logran transformaciones en el estilo de vida sostenibles en el tiempo, y que favorecen la emergencia de rótulos limitantes para la construcción de relaciones que posibiliten al paciente asumir su autocuidado. Conclusiones: El diálogo en la relación médico-paciente facilita el surgimiento de nuevos significados de la enfermedad y la activación de procesos, donde las personas pueden asumir la experiencia desde la responsabilidad y el autocuidado.
... Therefore, brief interventions that address patient concerns while raising patient awareness of need for MTX may improve adherence. Previous research demonstrated primary care patients whose general practitioners directly addressed patient beliefs and concerns were more likely to adhere to medical advice [42]. ...
Objective:
In order to develop interventions to optimize MTX use for the treatment of RA we evaluated the rate of, reasons for and predictors of MTX non-adherence during the first 6 months of therapy.
Methods:
The Rheumatoid Arthritis Medication Study (RAMS) is a prospective multicentre cohort study of incident MTX users in the UK. Prior to MTX commencement demographic, clinical and psychological data were collected. A weekly patient-completed diary recorded MTX dose, possible side effects and adherence over 26 weeks. The number of non-adherent weeks was calculated. Potential baseline predictors of ever non-adherence (⩾1 week non-adherent) during the first 6 months of MTX therapy were identified using logistic regression analyses.
Results:
606 patients with RA were included; 69% female, mean (s.d.) age 60 (13) years and DAS28 score 4.2 (1.2). Over the first 6 months following MTX initiation, 158 (26%) patients were ever non-adherent (71% intentional, 19% non-intentional, 10% unexplained) and mean (s.d.) number of non-adherent weeks was 2.5 (2.1). Multivariable predictors of ever non-adherence included DAS28 [odds ratios (OR) 1.1, 95% CI 1.0, 1.4], fatigue (OR 1.1, 95% CI 1.0, 1.2 per cm), ⩾2 comorbidities vs no comorbidities (OR 1.9, 95% CI 1.1, 3.5) and high medication concerns despite perceived need (OR 1.1, 95% CI 1.0, 1.1 per unit decrease in need/concern differential).
Conclusion:
This is the largest study evaluating early intentional and non-intentional non-adherence to MTX, which has identified that patient beliefs and multi-morbidity strongly link with non-adherence. These findings can direct the design of and provide potential targets for interventions to improve patient adherence.
... Future work should aim to develop more standardized approaches to assessing and labeling content as misinformative. Sixth, further studies are needed on the impact of illness beliefs and representation on patient-provider communication and subsequent information seeking on YouTube [77][78][79]. It is possible that people who are watching health-related videos on YouTube are doing so because they (1) want to confirm the information given by their physicians, (2) simply want more information to better understand their health condition, or (3) disagree with the treatment plan recommended by their doctor and are exploring other options and knowledge sources that support their beliefs. ...
Background:
Approximately 73% of US adults use YouTube, making it the most popular social media platform. Misinformation on social media is a growing concern; recent studies show a high proportion of misinformative health-related videos. Several studies on patient-provider communication and general health information seeking have been conducted. However, few studies to date have examined the potential association between patient-provider communication and health information seeking on specific social media platforms such as YouTube. A better understanding of this relationship may inform future health communication interventions.
Objective:
The aim was to use nationally representative cross-sectional data to describe the association between perceived patient-provider communication quality and sociodemographic factors on watching YouTube health-related videos.
Methods:
Data from the 2018 Health Information National Trends Survey were analyzed (N=3504). The primary outcome was whether participants watched a health-related video on YouTube over the past 12 months. A patient-provider communication composite score was created by summing responses about how often providers did the following: (1) gave you the chance to ask all the health-related questions you had, (2) gave attention to your feelings, (3) involved you in health care decisions as much as you wanted, (4) made sure that you understood the things you needed to do to take care of your health, (5) explained things in a way that you could understand, (6) spent enough time with you, and (7) helped you deal with feelings of uncertainty. Sociodemographic factors included age, gender, race/ethnicity, and education. Descriptive statistics and multivariable logistic regression were conducted.
Results:
Approximately 1067 (35% weighted prevalence) participants reported watching a health-related video on YouTube. Higher perceived quality of patient-provider communication on the composite score was significantly associated with lower odds of watching health-related videos on YouTube. Regarding sociodemographic factors, increasing age and being a high school graduate (compared with college graduate) were associated with lower odds of watching health-related videos on YouTube; whereas, Hispanic and non-Hispanic Asians were more likely to have watched a health-related video on YouTube. For individual aspects of patient-physician communication, two of seven patient-provider communication variables were significant. Those who reported that providers "sometimes" spent enough time with them had higher odds of watching a health-related video on YouTube, compared with those who said providers "always" spent enough time with them. Participants reporting that they "never" have a chance to ask all their health-related questions also had higher odds of watching health-related videos on YouTube compared with those who reported "always."
Conclusions:
Higher perceived quality of patient-provider communication is associated with lower odds of watching health-related videos on YouTube. When providers do not spend enough time or give an opportunity to ask questions, patients are more likely to pursue health information on social media.
... The patient-doctor relationship and communication were tested with the CS-SRM questionnaire which assess whether doctors provide patients with the appropriate information to fully understand their illness and treatment [19]. The questionnaire consists of seven questions refer to specific domain of representations of the disease: causes, identification, timing, control and consequences. ...
Background: Compliance with medication in patients who have suffered stroke is usually not-optimal. This study aims to measure the level of compliance with the treatment and to identify socio-demographic, clinical, and subjective factors related to the long-term compliance of stroke patients with their treatment. Methods: 140 patients (66.4% males) suffered an ischemic stroke at least six months old, participated in the survey. Compliance was measured using the Medication Adherence Report Scale and the quality of life by the Stroke Specific Quality of Life questionnaire. Furthermore, the Beliefs about Medicines Questionnaire and the Brief Illness Perception Questionnaire on perceptions about the disease were assessed. The doctor–patient relationship was assessed by the Common-Sense Model of Self-Regulation questionnaire and the family support was assessed by the FSS scale. Univariate and multivariate analysis was employed to identify the significant factors affecting compliance in these stroke patients. Results: In 68.6% of patients the compliance was classified as optimal, in 25.7% as partial and as poor in 5.7%; the last two categories were treated as sub-optimal compliance in multivariate analysis. The high compliance was related to patient’s mental state (OR:3.94 95% CI: 1.84–4.46), the perception medication necessity (OR:1.26 95% CI: 1.01–1.56), and the doctor–patient communication (OR:1.76 95% CI: 1.15–2.70). Men showed a lower compliance than women, as well as increased concerns about taking medication (OR: 0.83, 95% CI: 0.69–0.99). Paradoxically, the work /productivity related quality of life was inversely associated with compliance (OR (95% CI): 0.44 (0.23 to 0.82)). Conclusions: The perception of medication necessity and the doctor–patient communication are manageable factors associated with compliance in treating patients who have suffered stroke. In addition, rehabilitation and return to work programs should consider these factors when providing support to those persons.
... Our findings indicate that for some HCPs, their 'personal models' of pain associated with JIA may not be congruent with research findings which suggest pain acts independently to levels of disease activity in JIA (7;16;17). A personal model of illness can be defined as an individuals' beliefs, emotions, knowledge, experiences and behaviours (29) and are important in shaping CYPs' and parents' own conceptualisations of their condition (30). In JIA, the importance of developing a comprehensive understanding of pain, including how and when to treat it and when to ignore or persist with activities despite pain is essential for effective pain management. ...
Objective
Reducing pain is one of the main health priorities for children and young people with Juvenile Idiopathic Arthritis (JIA), however some studies indicate that pain is not routinely assessed in this patient group. The aim of this study was to explore healthcare professionals’ (HCPs’) beliefs about the role of pain and the prioritisation of its assessment in children and young people with JIA.
Methods
Semi‐structured interviews were conducted with HCPs who manage children and young people (CYP) with JIA in the UK (including consultant and trainee paediatric rheumatologists, nurses, physiotherapists and occupational therapists). Data were analysed qualitatively following a framework analysis approach.
Results
Twenty‐one HCPs participated. Analyses of the data identified six themes; lack of training and low confidence in pain assessment, reluctance to engage in pain discussions, low prioritisation of pain assessment, specific beliefs about the nature of pain in JIA, treatment of pain in JIA, and undervaluing pain reports. Assessment of pain symptoms was regarded as a low priority and some HCPs actively avoided conversations about pain.
Conclusion
These findings indicate that the assessment of pain in CYP with JIA may be limited by knowledge, skills and attitudinal factors. HCPs’ accounts of their beliefs about pain in JIA and their low prioritisation of pain in clinical practice suggest that a shift in perceptions about pain management may be helpful for professionals managing CYP with this condition.
This article is protected by copyright. All rights reserved.
... This group might benefit from additional support that focuses on eliciting and addressing unresolved medication concerns. 21 Treatment expectations have been shown to increase the risk of treatment-specific side effects and nonadherence in the context of secondary breast cancer prevention. 22 Our study shows how previous treatment expectations can influence primary prevention decision-making and emphasizes the need for clinicians to address concerns and ensure realistic treatment expectations. ...
Introduction
Uptake of preventive therapies for breast cancer is low. We examined whether women at increased risk of breast cancer can be categorized into groups with similar medication beliefs, and whether belief group membership was prospectively associated with uptake of preventive therapy.
Patients and Methods
Women (n = 732) attending an appointment to discuss breast cancer risk were approached; 408 (55.7%) completed the Beliefs About Medicines and the Perceived Sensitivity to Medicines questionnaires. Uptake of tamoxifen at 3 months was reported in 258 (63.2%). The optimal number of belief groups were identified using latent profile analysis.
Results
Uptake of tamoxifen was 14.7% (38/258). One in 5 women (19.4%; 78/402) reported a strong need for tamoxifen. The model fit statistics supported a 2-group model. Both groups held weak beliefs about their need for tamoxifen for current and future health. Group 2 (38%; 154/406 of the sample) reported stronger concerns about tamoxifen and medicines in general, and stronger perceived sensitivity to the negative effects of medicines compared with group 1 (62%; 252/406). Women with low necessity and lower concerns (group 1) were more likely to initiate tamoxifen (18.3%; 33/180) than those with low necessity and higher concerns (group 2) (6.4%; 5/78). After adjusting for demographic and clinical factors, the odds ratio was 3.37 (95% confidence interval, 1.08-10.51; P = .036).
Conclusion
Uptake of breast cancer preventive therapy was low. A subgroup of women reported low need for preventive therapy and strong medication concerns. These women were less likely to initiate tamoxifen. Medication beliefs are targets for supporting informed decision-making.
... This group may benefit from additional support that focuses on eliciting and addressing unresolved medication concerns. 22 Treatment expectations have been shown to increase the risk of treatment-specific side-effects and nonadherence in the context of secondary breast cancer prevention. 23 Our study demonstrates how prior treatment expectations can influence primary prevention decision-making and emphasises the need for clinicians to address concerns and ensure realistic treatment expectations. ...
Introduction: Uptake of preventive therapies for breast cancer is low. We examined whether women at increased risk of breast cancer can be categorized into groups with similar medication beliefs, and whether belief group membership was prospectively associated with uptake of preventive therapy. Patients and Methods: Women (n = 732) attending an appointment to discuss breast cancer risk were approached; 408 (55.7%) completed the Beliefs About Medicines and the Perceived Sensitivity to Medicines questionnaires. Results: Uptake of tamoxifen at 3 months was reported in 258 (63.2%). The optimal number of belief groups were identified using latent profile analysis. Uptake of tamoxifen was 14.7% (38/258). One in 5 women (19.4%; 78/402) reported a strong need for tamoxifen. The model fit statistics supported a 2-group model. Both groups held weak beliefs about their need for tamoxifen for current and future health. Group 2 (38%; 154/406 of the sample) reported stronger concerns about tamoxifen and medicines in general, and stronger perceived sensitivity to the negative effects of medicines compared with group 1 (62%; 252/406). Women with low necessity and lower concerns (group 1) were more likely to initiate tamoxifen (18.3%; 33/180) than those with low necessity and higher concerns (group 2) (6.4%; 5/78). After adjusting for demographic and clinical factors, the odds ratio was 3.37 (95% confidence interval, 1.08-10.51; P = .036). Conclusion: Uptake of breast cancer preventive therapy was low. A subgroup of women reported low need for preventive therapy and strong medication concerns. These women were less likely to initiate tamoxifen. Medication beliefs are targets for supporting informed decision-making.
... Knowing that many patients' representations are dynamic and based on experiences, pharmacists, and other healthcare professionals could employ patient-centred communication [41,42]. Patient-centred communication involves inviting the patient to share their perspective, addressing concerns about treatment, regularly monitoring asthma medications and level of control in individual patients [20,43,44]. Patients knowledge and experiences should be recognized as valid during routine encounters to make interactions more meaningful and patient-focused [45]. ...
Asthma control can be achieved with effective and safe medication use; however, many patients are not controlled. Patients’ perceptions of asthma, asthma treatment, and pharmacist roles can impact patient outcomes. The purpose of this study was to explore patients’ experiences and patient–pharmacist relationships in asthma care. Qualitative Interpretive Description method guided the study. Semi-structured individual interviews were conducted with 11 patients recruited from personal contacts, pharmacies, and asthma clinics. Categories and themes were identified using inductive constant comparison. Themes indicated patients had a personalized common sense approach to asthma management, “go-to” health care provider, and prioritized patient–pharmacist relationships. Patients described their illness experiences and asthma control based on personal markers similar to the common sense model of self-regulation. Patients chose a family physician, asthma specialist, respiratory therapist, or pharmacist as an expert resource for asthma management. Patient perceived pharmacists’ roles as information provider, adviser, or care provider. Pharmacists who develop a collaborative relationship with their asthma patients are better positioned to provide tailored education and self-management support. Inviting patients to share their perspective could increase patient engagement and uptake of personalised asthma action plans to achieve asthma control.
... This demonstrates how family and friend's experiences contribute to women's beliefs towards their breast cancer risk and the use of preventive therapies. Although individuals' beliefs about disease and treatment are amenable to change within a healthcare setting [31], it is important to recognise that beliefs and feelings are constructed and embedded within the social context. This study had limitations. ...
Purpose:
Uptake of preventive therapy for women at increased breast cancer risk in England is unknown following the introduction of UK clinical guidelines in 2013. Preventive therapy could create socioeconomic inequalities in cancer incidence if it is more readily accepted by particular socio-demographic groups. In this multicentre study, we investigated uptake of tamoxifen and evaluated socio-demographic and clinical factors associated with initiation. We explored women's experiences of treatment decision-making using qualitative interview data.
Methods:
Between September 2015 and December 2016, women (n = 732) attending an appointment at one of 20 centres in England to discuss breast cancer risk were approached to complete a survey containing socio-demographic details and nulliparity. Of the baseline survey respondents (n = 408/732, 55.7% response rate), self-reported uptake of tamoxifen at 3-month follow-up was reported in 258 (63.2%). Sixteen women participated in semi-structured interviews.
Results:
One in seven (38/258 = 14.7%) women initiated tamoxifen. Women who had children were more likely to report use of tamoxifen than those without children (OR = 5.26; 95%CI: 1.13-24.49, p = 0.035). Interview data suggested that women weigh up risks and benefits of tamoxifen within the context of familial commitments, with exposure to significant other's beliefs and experiences of cancer and medication a basis for their decision.
Conclusions:
Uptake of tamoxifen is low in clinical practice. There were no socio-demographic differences in uptake, suggesting that the introduction of breast cancer preventive therapy is unlikely to create socioeconomic inequalities in cancer incidence. Women's decision-making was influenced by familial priorities, particularly having children.
... Intentional non-adherence was most common in this group. This group may benefit most from interventions targeting key medication beliefs (Petrie et al., 2012;Phillips et al., 2012). The UK National Institute for Health and Care Excellence (2009) Medicines Adherence Guidelines provides recommendations for supporting shared medication decision-making and adherence. ...
Medication non-adherence is a missed opportunity for therapeutic benefit. We assessed 'real-world' levels of self-reported non-adherence to conventional and biologic systemic therapies used for psoriasis and evaluated psychological and biomedical factors associated with non-adherence using multivariable analyses. Latent profile analysis (LPA) was used to investigate whether patients can be categorised into groups with similar medication beliefs. LPA categorises individuals with similar profiles on a set of continuous variables into discrete groups represented by a categorical latent variable. 811 patients enrolled in the British Association of Dermatologists Biologic Interventions Register (BADBIR) were included. 617 patients were using a self-administered systemic therapy; 22.4% were classified as 'non-adherent' (12% intentionally and 10.9% unintentionally). Patients using an oral conventional systemic agent were more likely to be non-adherent compared to those using etanercept or adalimumab (29.2% vs. 16.4%; p ≤ 0.001). LPA supported a 3-group model; all groups held strong beliefs about their need for systemic therapy but differed in levels of medication concerns. Group 1 (26.4% of the sample) reported the strongest concerns, followed by Group 2 (61%), with Group 3 (12.6%) reporting the weakest concerns. Group 1 membership was associated with intentional non-adherence (odds ratio (OR) 2.27; 95% confidence interval: 1.16 - 4.47) and weaker medication-taking routine or habit strength was associated with unintentional non-adherence (OR 0.92; 95% CI: 0.89 - 0.96). Medication beliefs and habit strength are modifiable targets for strategies to improve adherence in psoriasis.
... In a systematic review of prospective cohorts of patients attending primary care, 3 high levels of patientperceived affective reassurance (generic positive messages indicating empathy, confidence, and optimism) from their clinician was associated with worse symptom outcome in 3 high-quality studies, 4-6 whereas greater perceived cognitive reassurance (delivering information about etiology, prognosis, and treatment) was linked to improved clinical outcomes in 4 high-quality 4,5,7 and 3 lower-quality studies. [8][9][10] Subsequent studies in LBP 11,12 suggest that affective reassurance includes both implicit and explicit behaviors (Fig. 1). Information-eliciting and relationship-building behaviors provide implicit reassurance, which aims to establish trust, elicit patients' concerns, and convey the impression that the practitioner cares and is listening, 13 whereas explicit affective reassurance includes generic statements (you should not be worried about anything serious). ...
Objectives
Reassurance is an essential part of treatment for low back pain (LBP), but evidence on effective methods to deliver reassurance remains scarce. The interaction between consultation-based reassurance and patients’ psychological risk is unknown. Our objective was to investigate the relationship between consultation-based reassurance and clinical outcomes at follow-up, in people with and without psychological risk.
Methods
We tested the associations between specific reassurance components (data gathering, relationship building, generic reassurance, and cognitive reassurance), patients’ psychological risk (the presence of depression, anxiety, catastrophizing, or fear-avoidance), and postconsultation outcomes including, satisfaction and enablement, disability, pain, and mood at 3-month follow-up.
Results
Adjusted linear regression models using data from patients who had recently consulted for LBP in primary care (n=142 in 43 practices) indicated that all reassurance components were strongly associated with increased satisfaction, whereas generic reassurance was significantly associated with postconsultation enablement. Generic reassurance was also associated with lower pain at 3 months, whereas cognitive reassurance was associated with increased pain. A significant interaction was observed between generic reassurance and psychological risk for depression at 3 months: high rates of generic reassurance were associated with lower depression in low-risk patients, but with higher rates of depression for high-risk groups.
Discussion
The findings support the hypothesis that different components of reassurance are associated with specific outcomes, and that psychological risk moderates this relationship for depression. Clinicians reassuring behaviors might therefore have the potential to improve outcomes in people with LBP, especially for patients with higher psychological risk profiles.
... Higher scores indicate greater reported adherence. The Medication Adherence Report Scale-5 has been administered successfully over the telephone 30 to assess medication adherence. ...
... This framework advocates that indivi-duals faced with a health threat have a tendency to form emotional and cognitive images about their condition. These representations are important determinants of the coping strategies and behaviours individuals adopt in response to their perceived health problem (27). ...
Alexithymia, defined as difficulty in describing or recognizing emotions, has been shown to be connected with psoriasis, but its relationship with self-management of psoriasis has not been explored. The aim of this study was to assess the frequency of alexithymia and its relationship with self-management and illness perception in the context of psoriasis. A total of 163 patients participating in 3 weeks of climate heliotherapy (CHT) at Gran Canaria were assessed for alexithymia using the Toronto Alexithymia Scale (TAS-20) at baseline. Self-reported measures for self-management (Health Education Impact Questionnaire; heiQ), and disease severity and illness perception (Brief Illness Perception Questionnaire; BIPQ) were assessed twice. Of all patients, 14.1% were characterized as alexithymic and 22.1% scored in the intermediate range. Alexithymic patients scored significantly worse in all heiQ domains, and reported worse illness perception. However, there were no between-group differences in heiQ or BIPQ change from baseline to after CHT. In conclusion, this study shows that alexithymia indicates inferior self-management and reaffirms the associations with illness perception. Further research is required into these relationships.
... In order to support shared medication decision-making and adherence, they recommend that individual's beliefs about their condition and medication should be appropriately elicited and incorporated by the clinician within the consultation. This approach has been shown to be effective in supporting medication adherence [8,9]. According to the Necessity-Concerns Framework [10,11], key beliefs that influence medication adherence are perceptions of personal need for medication for current and future health (necessity beliefs) and concerns about potential negative consequences. ...
Background
An estimated 50% of patients do not take their medication as prescribed, with medication adherence associated with adverse outcomes and higher costs of care. The Necessity-Concerns Framework identified individual’s beliefs about their medication as playing a key role in adherence, and UK Clinical Adherence Guidelines recommend eliciting and incorporating individual’s perceptions of their medication within the consultation. The Beliefs about Medicines Questionnaire (BMQ) is widely used to assess medication beliefs, however, given the condition-specific nature of some self-management regimens, it is unknown whether this tool is able to fully capture beliefs about more complex medication regimens. Methods
We examined the challenges of assessing medication beliefs using the BMQ in 20 people with a complex relapsing-remitting condition recruited from community sources. Data were collected from people with psoriasis; a patient group characterised by complex medication regimens, which include therapies that are applied topically, phototherapy/photochemotherapy, and therapies that are administered orally or via subcutaneous or intravenous injections. Semi-structured cognitive interviews were undertaken, with responses coded using established schedules and analysed using Content analysis. ResultsIndividual’s beliefs about their condition specific therapies were not accurately captured by the BMQ. Medication beliefs as expressed during ‘real-time’ completion of the BMQ were underestimated, or failed to be captured, by the corresponding scores given by participants.There was mismatch between the terminology used in the scale and individuals perceptions of their condition and the complexity of its management and treatment outcomes. Currently the BMQ cannot represent beliefs about medicines underuse, even though some individuals with psoriasis viewed access to therapies as overly restrictive. Some the BMQ items were misinterpreted in part due to ambiguous item wording or due to misreading by participants. Conclusions
This is the first study to identify general and condition-specific difficulties experienced by individuals completing the BMQ in ‘real time’. The main implication of this research is the need to develop condition-specific versions of the BMQ in order that this important instrument can capture the full range of medication beliefs in individuals living with a complex relapsing-remitting condition. Access to condition-specific versions could significantly increase our understanding of beliefs which facilitate or reduce medication adherence.
... At a practical level, our results shed light on specific illness representations that lead to virologic failure in HIV positive patients. Perceived consequences and emotional representations are potentially modifiable factors that may be targeted in future interventions to enhance patient adherence to HAART therapy, as already done for other illness and outcomes Llewellyn et al., 2007;Phillips et al., 2012). As reported by Llewellyn et al. (2007) in a study on patients with head and neck cancer, illness representations could be targeted for intervention in the time period between diagnosis and shortly after treatment in order to maximize longitudinal outcomes. ...
Introduction: It is important for HIV positive patients to be engaged in their care and be adherent to treatment in order to reduce disease progression and mortality. Studies found that illness representations influence adherence through the mediating role of coping behaviors. However, no study has ever tested if patient engagement to the visits mediate the relationship between illness perceptions and adherence. This study aimed to explore illness representations of HIV positive patients and test the hypothesis that illness representations predict adherence through the mediating role of a component of behavioral engagement.
Methods: HIV-positive patients treated with highly active antiretroviral therapy (HAART) for at least one year and presenting to a check-up visit were eligible to participate in the study. Patients completed the Illness Perception Questionnaire-Revised. Behavioral engagement was measured based on the patients’ clinical attendance to the check-up visits; adherence to HAART was measured by viral load. Undetectable viral load or HIV-RNA < 40 copies/ml were considered indexes of virologic success.
Results: A total of 161 patients participated in the study. Most of them coherently attributed the experienced symptoms to HIV/HAART; perceived their condition as chronic, stable, coherent, judged the therapy as effective, and attributed their disease to the HIV virus and to their behavior or bad luck. The majority of patients (80.1%) regularly attended check-up visits and 88.5% of them reached virologic success. The mediation model did not show good fit indexes. However, a significant direct effect of two independent variables on virologic success was found. Specifically, the perception that the disease does not have serious consequences on patient’s life and the prevalence of negative emotions toward HIV were associated with virologic success. On the contrary, the patient’s perception that the disease has serious consequences on his/her life and the prevalence of positive emotions were associated with virologic failure. This model showed good fit indexes (CFI = 1; TLI = 1; RMSEA = 0.00; and WRMSR = 0.309).
Discussion: Results do not support the mediating role of behavioral engagement in the relationship between illness representations and adherence. As perception of serious consequences coupled with positive emotions are directly associated with virologic failure, clinicians should take them into account to promote treatment adherence.
Mobile health interventions are widely used to facilitate individuals’ management of their health behavior. A notable issue is that health interventions with obvious persuasive intent may cause negligence and reactance. In this study, we propose a subtle but powerful way to bolster self-regulation in maintaining healthy behavior by leveraging embodied interaction design. Our study shows that bodily actions in interacting with digital devices can trigger thoughts about prior associated experiences and, thus, be strategically designed to affect individuals’ judgments, decisions, and behavior. Specifically, in three experiments, we find that firmly pressing a touchscreen during mobile interaction (as compared with gently tapping a touchscreen) can activate users’ approach motivation and, thus, induce their preference for a healthy over a tasty beverage, lead to more challenging exercise goals and more exercise, and reduce personal hygiene lapses after receiving hygiene education. Hence, designers of digital health products may consider designing interaction with pressing gestures to facilitate users’ self-regulation and attainment of health-related goals. Policymakers can also encourage the adoption of relevant app designs to improve citizens’ health wellbeing.
Adherence to safety behaviours during the COVID-19 pandemic has become substantial in mitigating the viral spread. However, recently several countries entering into the deadly COVID-19 waves pointed out the issue of non-adherence to recommended COVID-19 guidelines and demand addressing the process of adherence from a different perspective. Approaching the pandemic only from an illness perspective and focusing mainly on symptom reduction is making the process of adherence even more challenging as a result of which COVID-19 cases are spiking daily and increasing the mortality rate globally. Therefore, this paper aims to address adherence behaviour during the Covid crisis, from the perspective of an individual’s perception of self, infection and treatment plan, which may provide a theoretical explanation for the process of adherence, using the Common-Sense Model of Self-Regulation (CSM). This health model highlights the constructs such as prototypes and representations, specific for self, illness and its treatment, in generating an action plan which may be continued or discontinued depending upon its efficacy and thereby explains the reason for varied responses of people towards the pandemic. CSM can be used to explain the prominence of concrete behavioural guidelines (action plan) during an infectious outbreak, the significance of providing concrete illness and treatment representation of the infection, the role of appraisal of treatment efficacy in long-term adherence and the essentiality of interventions focusing on self-prototypes. Therefore, understanding adherence during COVID-19 from all these aspects and appropriately adopting a holistic approach integrating the teamwork of medical practitioners, government policymakers, psychologists, social workers and other related experts may prove to be vital in improving adherence behaviour during this pandemic.
Over-the-counter (OTC) products such as pharmaceuticals, dietary supplements, vitamins, and herbal remedies are widely available and copiously used by older adults for health maintenance and symptom management. Owing to physiology, multimorbidity, and polypharmacy, this population is particularly vulnerable to inappropriate use of OTC products, adverse effects, and drug interactions. While OTC pharmaceuticals are bound by FDA-approved standards, dietary supplements are regulated differently, resulting in variable quality and increased possibility for adulteration. Internationally, standards for OTC products vary widely. Accessible educational information, improved provider-patient communication, and revision of regulatory policy could improve safety for older adult users of OTC products.
Background:
Research implicates psychological factors in low uptake of lung cancer screening. We developed and psychometrically tested a standardised measure of these psychological determinants in preparation for a prospective, longitudinal cohort study of screening uptake.
Methods:
Leventhal's Common-Sense Model of Self-Regulation of Health and Illness provided the theoretical framework to generate the initial item pool. Items were refined during expert review and cognitive interviews which tested for face validity, redundancy, acceptability and comprehensibility. An online survey piloted the refined pool with 1500 current and former (quit ≤ 15 years) smokers aged 55-80. The response distributions, internal reliability and factor structure determined the final retained constructs. Regression analyses examined these constructs' associations with screening intention, smoking status and demographics.
Results:
The final measure included seven factor-derived subscales (consequences, personal control, treatment control, illness coherence, emotional representation, behavioural response and appraisal, risk perception) with Cronbach's alphas ranging from 0.59 to 0.91 and four single-item questions (response efficacy for smoking cessation, treatment intention, perceived stigma and lung cancer survival). Most constructs were associated with smoking status and screening intention (p's < .05).
Conclusions:
The Self-Regulatory Questionnaire for Lung Cancer Screening (SRQ-LCS) is an acceptable, reliable and valid measure for investigating the psychological determinants of screening uptake.
Objectives: This is a protocol for a Cochrane Review (qualitative). The objectives are as follows:. The overall aim of this qualitative evidence synthesis is to describe and explore the perceptions and experiences of women, community members, lay health workers, and skilled healthcare providers who have experience with postpartum haemorrhage (PPH) or with preventing, identifying and managing PPH, in both community and health facility settings. The review has the following specific objectives. To synthesise qualitative studies exploring women’s, community members', lay health workers', healthcare providers' and other key stakeholders' understanding about PPH and their perceptions regarding the causes and consequences of PPH To develop a conceptual understanding of a woman's journey of surviving a PPH, including her experiences, values, and challenges To identify how lay health workers prevent, identify and manage PPH at home or in community settings, or during transfer or referral to health facilities To synthesise the factors affecting the implementation of different PPH prevention, identification and management strategies in health facility settings, including perceptions, experiences, values, acceptability, and feasibility. Copyright © 2020 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
L’Accident Vasculaire Cérébral (AVC) est une pathologie fréquente et grave, constituant la première cause de handicap acquis chez l’adulte. Le retentissement de l’AVC sur le quotidien des patients est multiple du fait de la nature polymorphe des séquelles post-AVC et peut engendrer des conséquences dramatiques sur la vie des personnes. Les patients se retrouvent souvent seuls et démunis au moment du retour à domicile et doivent se réadapter à la vie quotidienne en s’ajustant à leur nouvelle condition. Confrontés à l’AVC et ses conséquences, les patients vont développer des représentations de l’AVC influençant les comportements d’autogestion et l’adoption de comportements favorables à la santé. L’objectif de ce travail de thèse était d’identifier à l’aide d’une revue systématique de la littérature et d’une étude quantitative les facteurs contextuels associés à la participation sociale du patient AVC. Les facteurs contextuels sont à la fois relatifs au patient (caractéristiques socio-comportementales, psychosociales, sociodémographiques) et à l’environnement de vie des personnes. De façon complémentaire, une étude qualitative, a été mobilisée dans le but de mieux comprendre l’expérience vécue de l’AVC et notamment d’appréhender les représentations individuelles de l’AVC. La revue de la littérature a montré l’importance des facteurs socio-comportementaux et psychosociaux (estime de soi, motivation, acceptation) ainsi que l’influence des facteurs environnementaux (soutien social, attitudes des autres à l’égard du patient, environnement physique, accès aux soins et services) sur la participation sociale du patient AVC. L’étude quantitative (TYBRA-quanti) a montré de façon additionnelle que le genre, les stratégies d’ajustement à l’AVC et la satisfaction de l’environnement de vie rapportée par le patient représentaient des déterminants indépendants de la participation sociale du patient AVC. Dans un design imbriqué, l’étude qualitative (TYBRA-quali) a permis d’apporter des informations complémentaires quant à l’expérience vécue de l’AVC et notamment concernant les représentations individuelles développées par les patients ne présentant pas de handicap majeur (mRs ≤ 2). Tous rapportaient des problèmes dans la construction d’une identité autour de l’AVC à la fois à la phase aiguë et à la phase chronique. Ils avaient des difficultés à reconnaître que des facteurs de risque liés à des habitudes de vie (tabac, alcool et régime alimentaire) pouvaient avoir un rôle dans la survenue de l’AVC. Le manque d’information ou une information délivrée à un temps inapproprié par les professionnels de santé engendraient une faible connaissance relative aux médicaments de la part des patients et un faible contrôle perçu sur le risque de récidive d’AVC provoquant anxiété et peur. Les patients considérant l’AVC comme une maladie chronique rapportaient plus de difficultés à gérer les conséquences au quotidien. Le soutien de la part des proches mais aussi des professionnels de santé représentait un élément majeur dans le processus de récupération et dans l’adoption de comportements favorables à la santé. Ce travail de recherche avait pour objectif de mieux cerner les répercussions d’un AVC sur la vie quotidienne des patients et la façon dont les personnes y font face. Basée sur trois opérations de recherche aux méthodes variées cette thèse a permis d’apporter des connaissances quant au processus de réadaptation des personnes après un AVC. Cette thèse ouvre la voie à de futures pistes de recherche et cliniques relatives à l’amélioration de l’accompagnement des patients dans la phase de réadaptation. En complément de la prise en charge des déficits fonctionnels et cognitifs des patients, proposer un accompagnement centré sur des processus psychosociaux, socio-comportementaux et écologiques inhérents aux patients permettrait une optimisation du processus de réadaptation (amélioration de la participation sociale et des capacités d’autogestion notamment)
Living with breast cancer is a difficult situation and it may be potentialized when woman have children. Cancer affects the mother-child relationship and it may have a negative impact on their lives. In this sense, the illness experience and motherhood altogether of children who depend on them could impact how the woman perceives her illness. The aim of the study is to understand illness perception of women with breast cancer who have children until ten years old. This exploratory qualitative study has been done with six women interviewed in their homes about their cancer experience and motherhood. The interviews were submitted to content analysis and categories were created based on illness perception dimensions according to Common Sense Model. Results indicated the illness perception is intimately tied to motherhood, especially regarding emotional representation of leaving the child orphan. Participants mentioned that their illness had impact in their motherhood routine, mainly attributed to the physical fragility and their unavailability in certain activities with their children. The illness attribution to genetic causes worries women their daughter's future and illness prevention. Nevertheless, women see their children as a source of strength to cope with the disease. Illness and motherhood are inseparable in these women's lives
The way as the doctor communicates cardiac illness diagnosis to patient may have implications on the patient's perception of his disease, which, in turn, possibly influence on its care. The purpose of this study is to evaluate illness perception on cardiac patients and it's relation with diagnosis communication content perception (identity, causes, consequences, timeline, treatment and personal control, coherence and emotional representation). The study was carried out with 71 adult cardiac patients, undergoing treatment in a regional hospital in the south of Brazil, who answered a sociodemographic questionnaire, a questionnaire of illness perception and a questionnaire about the perception of the information supplied during diagnosis. No significant correlation between cardiac illness perception and the content of the information supplied with diagnosis was found. However, gender related differences were found; women assigned more symptoms to the disease and perceived the symptoms as more cyclical than man. Conclusions: illness perception does not depend of the doctors diagnosis communication, finding signs that it may be produce prior to the disease itself.
Background: Resistant hypertension is a chronic condition in which the arterial blood pressure remains persistently above goal despite concurrent treatment with three or more antihypertensive agents of different classes. It appears relatively common in clinical practice, despite the established effectiveness of antihypertensive medications. Clinical factors such as inadequate dosing of antihypertensive medications, white coat hypertension (the phenomenon in which blood pressure is higher in clinical settings versus other settings), improper blood pressure measurement, and poor adherence to antihypertensive treatment all preclude a diagnosis of resistant hypertension. Poor adherence is considered the most common cause of pseudo-resistance to treatment among patients with apparent treatment-resistant hypertension and can result in unnecessary treatment escalation and referral to specialist hypertension clinics at significant cost to the patient and the healthcare system. Despite forming a core component of the definition and diagnosis of resistant hypertension, the extent, predictors and patient perspectives of non-adherence have not been extensively examined for this group.
Aim: The aim of this research is to examine the extent, theoretical predictors, and patient perspectives of non-adherence to antihypertensive medications for apparent treatment-resistant hypertension in primary care.
Methods: This research comprised: (1) a systematic review and meta-analysis to examine the extent of medication non-adherence in the published literature, and the study-level predictors thereof; (2) a quantitative cross-sectional study to examine the extent of poor adherence among a large sample of patients with apparent treatment-resistant hypertension receiving treatment in primary care using multiple diverse adherence measures, as well as the predictive value of theoretical constructs drawn from the Common-Sense Model of Self-Regulation (i.e., treatment-favourable beliefs, coherence of beliefs resulting from experience with treatment, and medication-taking habit strength); and (3) a qualitative comparison of high and low adherers to delineate factors associated with good and poor adherence using thematic analysis.
Findings: (1) The systematic review and meta-analysis revealed that approximately one-third of patients classed as having apparent treatment-resistant hypertension in the published literature may be more appropriately classed as pseudo-resistant due to poor adherence. Subgroup analysis further revealed that adherence estimates were dependent on the type of adherence assessment method used, with the highest non-adherence observed for physical tests for medications in bodily fluids. There was a small but significant difference in adherence estimates across study settings, with lowest non-adherence estimates observed in primary care settings, suggesting that a proportion of patients may be prematurely referred for specialist treatment without adequate assessment of adherence in primary care. (2) The cross-sectional quantitative study indicated that, even among a single sample of participants, the measure used to assess adherence has a considerable impact on the adherence estimates obtained. Habit strength was demonstrated to be the strongest predictor of adherence behaviour across all analyses. Treatment-related beliefs and coherence of beliefs did not predict adherence, even for patients with relatively weak habits. Treatment burden was also not associated with adherence or habit strength for this sample. (3) The qualitative comparison of high and low adherers identified that illness- and treatment-related beliefs, coherence of beliefs, and medication-taking habits are all important factors in determining whether a patient will adhere to treatment. Most patients described the important role of the general practitioner in promoting good adherence, but highlighted system-related factors as potentially diminishing people’s confidence in their care. Overall differences between high and low adherers were subtly nuanced, highlighting the challenges for healthcare practitioners in clearly identifying poor adherence and potential determinants.
Conclusion: The findings of this research provide important new insights into adherence among patients with apparent treatment-resistant hypertension. The quantification of the problem of non-adherence and identification of methodological limitations in the existing literature, quantitative examination of theoretical predictors of adherence, and qualitative investigation into characteristics of high and low adherers with apparent treatment-resistant hypertension together contribute to the evidence base for the development of targeted behavioural interventions to promote antihypertensive adherence in primary care.
Objectives
To cluster the adherence behaviours of patients with type 2 diabetes based on their beliefs in medicines and illness perceptions and examine the psychosocial, clinical and sociodemographic characteristics of patient clusters.
Design
Cross-sectional study.
Setting
A face-to-face survey was administered to patients at two family medicine clinics in the Midwest, USA.
Participants
One hundred and seventy-four ≥20-year-old, English-speaking adult patients with type 2 diabetes who were prescribed at least one oral diabetes medicine daily were recruited using convenience sampling.
Primary and secondary outcome measures
Beliefs in medicines and illness perceptions were assessed using the Beliefs about Medicines Questionnaire and the Brief Illness Perception Questionnaire, respectively. Self-reported medication adherence was assessed using the Morisky Medication Adherence Scale. Psychosocial correlates of adherence, health literacy and self-efficacy were measured using the Newest Vital Sign and the Self-efficacy for Appropriate Medication Use, respectively. Two-step cluster analysis was used to classify patients.
Results
Participants’ mean age was 58.74 (SD=12.84). The majority were women (57.5%). Four clusters were formed (non-adherent clusters: ambivalent and sceptical; adherent clusters: indifferent and accepting). The ambivalent cluster (n=30, 17.2%) included low-adherent patients with high necessity beliefs, high concern beliefs and high illness perceptions. The sceptical cluster (n=53, 30.5%) included low adherent patients with low necessity beliefs but high concern beliefs and high illness perceptions. Both the accepting (n=40, 23.0%) and indifferent (n=51, 29.3%) clusters were composed of patients with high adherence. Significant differences between the ambivalent, sceptical, accepting and indifferent adherent clusters were based on self-efficacy, illness perception domains (treatment control and coherence) and haemoglobin A1c (p<0.01).
Conclusions
Patients with diabetes in specific non-adherent and adherent clusters still have distinct beliefs as well as psychosocial characteristics that may help providers target tailored medication adherence interventions.
According to Information-Motivation-Behavioural Skills model (IMB), accurate Information, strong Motivation and adequate Behavioural skills are prerequisites of treatment adherence. This model has been verified among chronically ills patients, usually suffering from one particular disorder. No studies report how the model fits data from a more diverse group. The aim of the study was to analyze adherence and its barriers in a group of three hundred patients suffering from various, common chronic disorders. They filled out IMB and Adherence Questionnaire. Information and Motivation correlated moderately (.35). Behavioural Skills was the strongest predictor of adherence (.24). An additional relationship was found: Information and Motivation interacted and the role of either of these dimensions vanished if the indices of the other were high enough. The relationships between IMB dimensions and adherence were confirmed in a varied clinical sample. Behavioural skills must be considered when working with non-adherent patients, as they are the strongest predictor of adherence. Other interventions may be limited to either Information or Motivation only if there is a chance of raising one of them to extreme levels. This may be useful with special cases, when increasing both is problematic.
The goal of therapy is typically to improve clients’ self-management of their problems, not only during the course of therapy but also after therapy ends. Although it seems obvious that therapists are interested in improving clients’ self-management, the psychotherapy literature has little to say on the topic. This article introduces Leventhal’s Common-Sense Model of Self-Regulation, a theoretical model of the self-management of health, and applies the model to the therapeutic process. The Common-Sense Model proposes that people develop illness representations of health threats and these illness representations guide self-management. The model has primarily been used to understand how people self-manage physical health problems, we suggest it may also be useful to understand self-management of mental health problems. The Common-Sense Model’s strengths-based perspective is a natural fit for the work of counseling psychologists. The model has important practical implications for addressing how clients understand mental health problems over the course of treatment and self-manage these problems during and after treatment.
Lay representations of illness and treatment are too often ignored because of the preconception that lay concepts are inherently unscientific and/or of interest only to anthropologists. The subtitle of this chapter, “A Framework for Action,” defines lay representations as perceptions and concepts that generate and specify the behavioral environment for action. The behavioral environment provides the affordances, or targets and pathways, for patients’ self-management (Gibson, 1977). Our approach addresses the details of the perceptual framework in which behavioral management of current and future illness threats is performed (i.e., primary, secondary, and tertiary prevention). It is focused on the mechanisms underlying expertise in self-management by patients and the expertise needed by practitioners to assist patients and families in improving self-management. These processes are pointed to but not described in operational detail by concepts such as “perceived control,” “self-efficacy,” “medical literacy,” and “shared decision-making.” Focusing on underlying mechanisms means identifying the perceptual cues involved in initiating and validating whether one is well or ill, deciding how and when to perform treatment, and how and when to evaluate whether it is working. These apply to practitioners (clinicians and interventionists) as well as to patients and families.
The main sections of our chapter will (1) provide a brief description of the common-sense model of illness representations and its key features; (2) discuss the main challenges faced by behavioral medicine researchers; and (3) spell out some basic principles for using lay representations of illness and treatment for cross-sectional and longitudinal studies, and for the design of interventions.
Describes the development of a 38-item self-report Adherence Determinants Questionnaire (ADQ) to assess 7 elements of patients' adherence to medical treatment and prevention: (1) perceptions of interpersonal care, (2) beliefs about susceptibility to disease, (3) beliefs about severity of disease, (4) assessments of perceived utility of adhering (efficacy and benefits vs costs of adhering), (5) perceptions of subjective social norms for adhering, (6) intentions to adhere, and (7) perceptions of supports available for and absence of barriers to adherence. Past adherence and health value were also assessed. In 4 diverse field settings, intentions to adhere were most highly correlated with the perceived utility of adhering. Adherence (self-reported and objectively measured) was related most strongly to the presence of supports for and the absence of barriers to adherence. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This chapter reviews the empirical results and theoretical underpinnings of studies of fear arousing communications. It focuses on the interrelationship of emotional and instrumental behavior. The chapter presents an overview of the key components of fear communication experiments and introduces the two major theoretical paradigms that can be used to interpret the findings. The first and historically most important of the paradigms is the fear drive model, a variant of the classic drive reduction model used in many animal learning studies. It assumes that the emotional response of fear functions as a drive that mediates belief change and behavior change. The second paradigm was suggested by the experimental data. This model assumes that the communication produces both persuasion and fear; fear does not cause persuasion. The chapter reviews the evidence regarding interactions between the level of fear elicited by the communication and other factors such as personality variables and recommendation effectiveness. It reveals that the outcomes are often influenced by complex contingencies. But despite the complexity, serious effort has been made to identify empirical regularities and presents a theoretical model to provide conceptual integration.
Objective To assess the effect of additional training of practice nurses and general practitioners in patient centred care on the lifestyle and psychological and physiological status of patients with newly diagnosed type 2 diabetes.
Design Pragmatic parallel group design, with randomisation between practice teams to routine care (comparison group) or routine care plus additional training (intervention group); analysis at one year, allowing for practice effects and stratifiers; self reporting by patients on communication with practitioners, satisfaction with treatment, style of care, and lifestyle.
Setting 41 practices (21 in intervention group, 20 in comparison group) in a health region in southern England.
Subjects 250/360 patients (aged 30-70 years) diagnosed with type 2 diabetes and completing follow up at one year (142 in intervention group, 108 in comparison group).
Intervention 1.5 days' group training for the doctors and nurses—introducing evidence for and skills of patient centred care and a patient held booklet encouraging questions.
Main outcome measures Quality of life, wellbeing, haemoglobin A1c and lipid concentrations, blood pressure, body mass index (kg/m2).
Results Compared with patients in the C group, those in the intervention group reported better communication with the doctors (odds ratio 2.8; 95% confidence interval 1.8 to 4.3) and greater treatment satisfaction (1.6;1.1 to 2.5) and wellbeing (difference in means (d) 2.8;
0.4 to 5.2). However, their body mass index was significantly higher (d=2.0; 0.3 to 3.8), as were triglyceride concentrations (d=0.4 mmol/l; 0.07 to 0.73 mmol/l), whereas knowledge scores were lower −2.74;−0.23 to −5.25. Differences in lifestyle and glycaemic control were not significant.
Conclusions The findings suggest greater attention to the consultation process than to preventive care among trained practitioners; those committed to achieving the benefits of patient centred consulting should not lose the focus on disease management.
A tremendous growth in the use of multi-item scales in marketing research has occurred over the past two decades. Concurrently, there is increasing concern about the quality of these measures. Although the majority of marketing-related articles now discuss the reliability of the scales administered, few address the issue of scale validity. One aspect of scale validity, which should be of particular concern to marketing researchers, is the potential threat of contamination due to social-desirability response bias. However, a careful review of nearly 20 years of published research suggests that social-desirability bias has been consistently neglected in scale construction, evaluation, and implementation. The purpose of this article is to discuss the nature of such a bias, methods for identifying, testing for and/or preventing it, and how these methods can and should be implemented in consumer-related research. ©: 2000 John Wiley & Sons, Inc.
To explore whether responses to questions in surveys of patients that purport to assess the performance of general practices or doctors reflect differences between practices, doctors, or the patients themselves.
Secondary analysis of data from a study of access to general practice, combining data from a survey of patients with information about practice organisation and doctors consulted, and using multilevel modelling at practice, doctor, and patient level.
Nine primary care trusts in England.
4573 patients who consulted 150 different doctors in 27 practices.
Overall satisfaction; experience of wait for an appointment; reported access to care; satisfaction with communication skills.
The experience based measure of wait for an appointment was more discriminating between practices (practice level accounted for 20.2% (95% confidence interval 9.1% to 31.3%) of variance) than was the overall satisfaction measure (practice level accounted for 4.6% (1.6% to 7.6%) of variance). Only 6.3% (3.8% to 8.9%) of the variance in the doctors' communication skills measure was due to differences between doctors; 92.4% (88.5% to 96.4%) of the variance occurred at the level of the patient (including differences between patients' perceptions and random variation). At least 79% of the variance on all measures occurred at the level of the patient, and patients' age, sex, ethnicity, and housing and employment status explained some of this variation. However, adjustment for patients' characteristics made very little difference to practices' scores or the ranking of individual practices.
Analyses of surveys of patients should take account of the hierarchical nature of the data by using multilevel models. Measures related to patients' experience discriminate more effectively between practices than do measures of general satisfaction. Surveys of patients' satisfaction fail to distinguish effectively between individual doctors because most of the variation in doctors' reported performance is due to differences between patients and random error rather than differences between doctors. Although patients' reports of satisfaction and experience are systematically related to patients' characteristics such as age and sex, the effect of adjusting practices' scores for the characteristics of their patients is small.
Our premise was that actions taken to reduce health risks are guided by the actor's subjective or common-sense constructions of the health threat. We hypothesized that illness threats are represented by their labels and symptoms (their identity), their causes, consequences, and duration. These attributes are represented at two levels: as concrete, immediately perceptible events and as abstract ideas. Both levels guide coping behavior. We interviewed 230 patients about hypertension, presumably an asymptomatic condition. When asked if they could monitor blood pressure changes, 46% of 50 nonhypertensive, clinic control cases said yes, as did 71% of 65 patients new to treatment, 92% of 50 patients in continuing treatment, and 94% of 65 re-entry patients, who had previously quit and returned to treatment. Patients in the continuing treatment group, who believed the treatment had beneficial effects upon their symptoms, reported complying with medication and were more likely to have their blood pressure controlled. Patients new to treatment were likely to drop out of treatment if: they had reported symptoms to the practitioner at the first treatment session, or they construed the disease and treatment to be acute. The data suggest that patients develop implicit models or beliefs about disease threats, which guide their treatment behavior, and that the initially most common model of high blood pressure is based on prior acute, symptomatic conditions.
To assess the effect of additional training of practice nurses and general practitioners in patient centred care on the lifestyle and psychological and physiological status of patients with newly diagnosed type 2 diabetes.
Pragmatic parallel group design, with randomisation between practice teams to routine care (comparison group) or routine care plus additional training (intervention group); analysis at one year, allowing for practice effects and stratifiers; self reporting by patients on communication with practitioners, satisfaction with treatment, style of care, and lifestyle.
41 practices (21 in intervention group, 20 in comparison group) in a health region in southern England.
250/360 patients (aged 30-70 years) diagnosed with type 2 diabetes and completing follow up at one year (142 in intervention group, 108 in comparison group).
1.5 days' group training for the doctors and nurses-introducing evidence for and skills of patient centred care and a patient held booklet encouraging questions.
Quality of life, wellbeing, haemoglobin A1c and lipid concentrations, blood pressure, body mass index (kg/m2).
Compared with patients in the C group, those in the intervention group reported better communication with the doctors (odds ratio 2.8; 95% confidence interval 1.8 to 4.3) and greater treatment satisfaction (1.6; 1.1 to 2.5) and wellbeing (difference in means (d) 2.8; 0.4 to 5.2). However, their body mass index was significantly higher (d=2.0; 0.3 to 3.8), as were triglyceride concentrations (d=0.4 mmol/l; 0.07 to 0.73 mmol/l), whereas knowledge scores were lower (d=-2.74; -0.23 to -5.25). Differences in lifestyle and glycaemic control were not significant.
The findings suggest greater attention to the consultation process than to preventive care among trained practitioners; those committed to achieving the benefits of patient centred consulting should not lose the focus on disease management.
Principles for reporting analyses using structural equation modeling are reviewed, with the goal of supplying readers with complete and accurate information. It is recommended that every report give a detailed justification of the model used, along with plausible alternatives and an account of identifiability. Nonnormality and missing data problems should also be addressed. A complete set of parameters and their standard errors is desirable, and it will often be convenient to supply the correlation matrix and discrepancies, as well as goodness-of-fit indices, so that readers can exercise independent critical judgment. A survey of fairly representative studies compares recent practice with the principles of reporting recommended here.
Low adherence with prescribed treatments is ubiquitous and undermines treatment benefits.
To systematically review published randomized controlled trials (RCTs) of interventions to assist patients' adherence to prescribed medications.
A search of MEDLINE, CINAHL, PSYCHLIT, SOCIOFILE, IPA, EMBASE, The Cochrane Library databases, and bibliographies was performed for records from 1967 through August 2001 to identify relevant articles of all RCTs of interventions intended to improve adherence to self-administered medications.
Studies were included if they reported an unconfounded RCT of an intervention to improve adherence with prescribed medications for a medical or psychiatric disorder; both adherence and treatment outcome were measured; follow-up of at least 80% of each study group was reported; and the duration of follow-up for studies with positive initial findings was at least 6 months. Information on study design features, interventions, controls, and findings (adherence rates and patient outcomes) were extracted for each article.
Studies were too disparate to warrant meta-analysis. Forty-nine percent of the interventions tested (19 of 39 in 33 studies) were associated with statistically significant increases in medication adherence and only 17 reported statistically significant improvements in treatment outcomes. Almost all the interventions that were effective for long-term care were complex, including combinations of more convenient care, information, counseling, reminders, self-monitoring, reinforcement, family therapy, and other forms of additional supervision or attention. Even the most effective interventions had modest effects.
Current methods of improving medication adherence for chronic health problems are mostly complex, labor-intensive, and not predictably effective. The full benefits of medications cannot be realized at currently achievable levels of adherence; therefore, more studies of innovative approaches to assist patients to follow prescriptions for medications are needed.
Changes in the organization of primary care in the UK are driven by a need to improve access and availability, but doctor-patient relationships may suffer. To investigate the importance of such relationships in a different setting, we analysed focus-group data obtained in a primary care facility in the USA (Rochester, NY). The findings pointed to three key factors in these relationships-namely, an asymmetry of perceptions on the two sides, belying the notion of a meeting of experts; the importance on both sides of 'liking'; and the value set by both parties on development of trust. The last two of these factors are probably related to continuity of care, now under threat.
Relationship-centered care reflects both knowing and feeling: the knowledge that physician and patient bring from their respective domains of expertise, and the physician's and patient's experience, expression, and perception of emotions during the medical encounter. These processes are conveyed and reciprocated in the care process through verbal and nonverbal communication. We suggest that the emotional context of care is especially related to nonverbal communication and that emotion-related communication skills, including sending and receiving nonverbal messages and emotional self-awareness, are critical elements of high-quality care. Although nonverbal behavior has received far less study than other care processes, the current review argues that it holds significance for the therapeutic relationship and influences important outcomes including satisfaction, adherence, and clinical outcomes of care.
Approximately 20% to 50% of patients are not adherent to medical therapy. This review was performed to summarize, categorize, and estimate the effect size (ES) of interventions to improve medication adherence in chronic medical conditions.
Randomized controlled trials published from January 1967 to September 2004 were eligible if they described 1 or more unconfounded interventions intended to enhance adherence with self-administered medications in the treatment of chronic medical conditions. Trials that reported at least 1 measure of medication adherence and 1 clinical outcome, with at least 80% follow-up during 6 months, were included. Study characteristics and results for adherence and clinical outcomes were extracted. In addition, ES was calculated for each outcome.
Among 37 eligible trials (including 12 informational, 10 behavioral, and 15 combined informational, behavioral, and/or social investigations), 20 studies reported a significant improvement in at least 1 adherence measure. Adherence increased most consistently with behavioral interventions that reduced dosing demands (3 of 3 studies, large ES [0.89-1.20]) and those involving monitoring and feedback (3 of 4 studies, small to large ES [0.27-0.81]). Adherence also improved in 6 multisession informational trials (small to large ES [0.35-1.13]) and 8 combined interventions (small to large ES [absolute value, 0.43-1.20]). Eleven studies (4 informational, 3 behavioral, and 4 combined) demonstrated improvement in at least 1 clinical outcome, but effects were variable (very small to large ES [0.17-3.41]) and not consistently related to changes in adherence.
Several types of interventions are effective in improving medication adherence in chronic medical conditions, but few significantly affected clinical outcomes.
This review of the current status of theoretically based behavioral research for chronic illness management makes the following points: (a) Behavioral interventions have demonstrated effectiveness for improving health outcomes using biomedical indicators, (b) current interventions are too costly and time consuming to be used in clinical and community settings, (c) translation of the conceptual models generated from studies of the problem-solving processes underlying self-management and the relationship of these processes to the self system and cultural and institutional contexts suggest new avenues for developing effective and efficient cognitive-behavioral interventions, and (d) it is proposed that integration of the conceptual developments in self-management with new approaches to the design of clinical trials can generate tailored, behavioral interventions that will improve quality of care.
Increasingly, marketing academics advocate the use of multiple-item measures. However, use of multiple-item measures is costly, especially for service researchers. This article investigates the incremental information of each additional item in a multiple-item scale. By applying a framework derived from the forecasting literature on correlated experts, the authors show that, even with very modest error term correlations between items, the incremental information from each additional item is extremely small. This study’s “information” (as opposed to “reliability”) approach indicates that even the second or third item contributes little to the information obtained from the first item. Furthermore, the authors present evidence that added items actually aggravate respondent behavior, inflating across-item error term correlation and undermining respondent reliability. Researchers may want to consider the issue of item information in addition to reliability. This article discusses ways in which researchers can construct scales that maximize the amount of information scale items offer without compromising measurement reliability.
This paper presents a novel method for assessing cognitive representations of medication: the Beliefs about Medicines Questionnaire (BMQ). The BMQ comprises two sections: the BMQ-Specific which assesses representations of medication prescribed for personal use and the BMQ-General which assesses beliefs about medicines in general. The pool of test items was derived from themes identified in published studies and from interviews with chronically ill patients. Principal Component Analysis (PCA) of the test items resulted in a logically coherent, 18 item, 4-factor structure which was stable across various illness groups. The BMQ-Specific comprises two 5-item factors assessing beliefs about the necessity of prescribed medication (Specific-Necessity) and concerns about prescribed medication based on beliefs about the danger of dependence and long-term toxicity and the disruptive effects of medication (Specific-Concerns). The BMQ-General comprises two 4-item factors assessing beliefs that medicines are harmful, addictive, poisons which should not be taken continuously (General-Horn) and that medicines are overused by doctors (General-Overuse). The two sections of the BMQ can be used in combination or separately. The paper describes the development of the BMQ scales and presents data supporting their reliability and their criterion-related and discriminant validity.
This study compares the predictive validity of single-item and multiple item measures of attitude toward the ad (AAd) and attitude toward the brand (ABrand), which are two of the most widely measured constructs in marketing. The authors assess the ability of AAd to predict ABrand in copy tests of four print advertisements for diverse new products. There is no difference in the predictive validity of the multiple-item and single-item measures. The authors conclude that for the many constructs in marketing that consist of a concrete singular object and a concrete attribute, such as AAd or ABrand, single-item measures should be used.
To successfully design and implement longitudinal faculty development programs at five medical schools, and to determine whether faculty participants were perceived to be more effective humanistic teachers.
Promising teachers were chosen from volunteers to participate in groups at each of the medical schools. Between September 2004 and September 2006, the facilitators jointly designed and implemented a curriculum for enhancing humanistic teaching using previously defined learning goals that combined experiential learning of skills with reflective exploration of values. Twenty-nine participants who completed 18 months of faculty development at the five medical schools were compared with 47 controls drawn from the same schools in the final six months of the two-year project. For comparison, the authors developed a 10-item questionnaire, the Humanistic Teaching Practices Effectiveness Questionnaire (HTPE), to be filled out by medical students and residents taught by participants or control faculty. Items were designed to measure previously identified themes and domains of humanism. Control faculty were similar to participants by gender, specialty, and years of experience.
Thirty-four (75%) of the original 45 enrollees completed the programs at the five schools. Faculty participants outperformed their peer controls on all 10 items of the HTPE questionnaire. Results were statistically significant (P < .05) and sufficiently robust (8%-13% differences) to suggest practical importance.
A longitudinal faculty development process that combines experiential learning of skills and reflective exploration of values in the setting of a supportive group process was successfully accomplished and had a positive impact on participants' humanistic teaching.
Problems in compliance with treatment and illness management have frequently been traced to differences between patients' explanatory models of illness and the biomedical model. We investigated the relationship of cultural beliefs about hypertension to compliance with treatment. Using semistructured interviews, we elicited the explanatory models of hypertension held by 60 black hypertensive women being treated at Charity Hospital in New Orleans. The patient sample was followed for 2 months to obtain data on compliance with antihypertensive treatment and blood pressure control. As described, 53% of the patient sample recognized two basic folk illness models: "high blood" and "high-pertension." Patients' illness models were significantly related to compliance with treatment at the P = .01 and .001 levels. Compliance was related to blood pressure control at the P = .05 level. These results indicate that culturally influenced health beliefs are an important influence on compliance and, in turn, blood pressure control. Improved understanding of these problems by physicians may improve the management of their patients' illness.
Measurement of patient compliance is essential if management of low compliance is to be performed efficiently. We assessed the value of several easily obtained clinical assessments compared to quantitative pill counts among 134 newly treated hypertensive male steelworkers during the first 6 months of their treatment with antihypertensive medication. Patient's self-reports obtained on structured interview correlated best with pill count compliance (r = 0.74, p less than 0.0001). Patients overestimated their compliance by an average of 17% but 90% of those who admitted to being noncompliant were found so. Qualitative urinary chlorthalidone and hydrochlorothiazide levels and changes in serum potassium, uric acid, and blood pressure also correlated with pill count compliance but were less accurate than interviews. Assessment of the patient's "health beliefs" and a variety of sociodemographic and health traits and perceptions did not provide useful information on compliance. Interviewing the patient is a simple and useful approach in assessing compliance with antihypertensive therapy.
The literature on communication, compliance, and patient satisfaction is selectively reviewed. As in earlier reviews, it is concluded that dissatisfaction with communication remains widespread, as does lack of compliance with medical advice. Related factors include poor transmission of information from patient to doctor, low understandability of communications addressed to the patient, and low levels of recall of information by patients. There does not appear to be any evidence that provision of additional information leads to adverse reactions by patients. Theoretical approaches to communication and compliance are described, and it is concluded that these should be used to direct future research.
This study was designed to examine whether a brief hospital intervention designed to alter patients' perceptions about their myocardial infarction (MI) would result in a better recovery and reduced disability.
In a prospective randomized study, 65 consecutive patients with their first MI aged were assigned to receive an intervention designed to alter their perceptions about their MI or usual care from rehabilitation nurses. Patients were assessed in hospital before and after the intervention and at 3 months after discharge from hospital.
The intervention caused significant positive changes in patients' views of their MI. Patients in the intervention group also reported they were better prepared for leaving hospital (p<.05) and subsequently returned to work at a significantly faster rate than the control group (p<.05). At the 3-month follow-up, patients in the intervention group reported a significantly lower rate of angina symptoms than control subjects (14.3 vs. 39.3, p<.03). There was no significant differences in rehabilitation attendance between the two groups.
An in-hospital intervention designed to change patients' illness perceptions can result in improved functional outcome after MI.
This article describes three families of effect size estimators and their use in situations of general and specific interest to experimenting psychologists. The situations discussed include both between- and within-group (repeated measures) designs. Also described is the counternull statistic, which is useful in preventing common errors of interpretation in null hypothesis significance testing. The emphasis is on correlation (r-type) effect size indicators, but a wide variety of difference-type and ratio-type effect size estimators are also described.
The evidence as to whether patient-centredness is associated with beneficial physical and psychological outcomes is inconsistent. This review of published research on health care communication in chronic illness investigates whether (i) studies of patient-centred consultations use distinctive concepts, (ii) different concepts are differentially associated with health outcomes. Studies of patients with a chronic illness consulting a health professional were included if they measured health professional-patient interaction and a physical or psychological outcome. Thirty studies were identified, falling into two, reliably distinct, categories. In the first, health professionals took the patient's perspective and in the second, they sought to "activate" the patient. The 10 studies taking the latter approach were more consistently associated with good physical health outcomes than were the 20 studies taking the former approach. The suggestion that different types of patient-centredness have different associations with physical health outcomes should be investigated further in experimental studies.
