Dataset Information

Demographic, Clinical, and Psychosocial Predictors of Change in Medication Adherence in the Support, Educate, Empower Program.

ABSTRACT:

Purpose

To investigate whether demographic, clinical, or psychosocial factors act as moderators of change in medication adherence in the Support, Educate, Empower (SEE) program.

Design

Prospective, single-arm pilot study with a pre-post design.

Participants

Patients with glaucoma aged ≥ 40 years and taking ≥ 1 glaucoma medication were recruited from the University of Michigan Kellogg Eye Center. Those who had electronically measured adherence ≤ 80% in the 3-month eligibility monitoring period were enrolled in the SEE program.

Methods

Medication adherence was monitored electronically during the 7-month intervention and calculated as the percentage of doses taken correctly. Change in adherence at different points in the SEE program and cumulative change in adherence were modeled with linear regression, and baseline demographic, clinical, and psychosocial factors were investigated for significant associations.

Main outcome measures

Demographic, clinical, and psychosocial variables associated with change in medication adherence in the SEE program.

Results

Thirty-nine participants completed the SEE program. These participants were on average 63.9 years old (standard deviation [SD], 10.7 years), 56% (n = 22) were male, 44% (n = 17) were White, and 49% (n = 19) were Black. Medication adherence improved from an average of 59.9% (SD, 18.5%) at baseline to 83.6% (SD, 17.5%) after the final SEE session, for an increase of 23.7% (SD, 17.5%). Although participants with lower income (< $25 000 and $25 000-50 000 vs. >$50 000) had lower baseline adherence (48.4% and 64.1% vs. 70.4%), these individuals had greater increases in adherence during the first month of medication reminders (19.6% and 21.6% vs. 10.2%; P = 0.05 and P = 0.007, respectively). Participants taking fewer glaucoma medications also had significantly greater increases in adherence with medication reminders (P < 0.001). Those with higher levels of glaucoma-related distress (GD) had lower baseline adherence and greater increases in adherence with glaucoma coaching (P = 0.06).

Conclusions

Patient-level factors associated with relatively greater improvements in medication adherence through the SEE Program included lower income, fewer glaucoma medications, and increased GD. These findings demonstrate that the SEE program can improve glaucoma self-management even among participants with social and psychological barriers to medication adherence.

SUBMITTER: Miller DJ

PROVIDER: S-EPMC8716681 | biostudies-literature | 2022 Jan-Feb

REPOSITORIES: biostudies-literature

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Publications

Demographic, Clinical, and Psychosocial Predictors of Change in Medication Adherence in the Support, Educate, Empower Program.

Miller David J DJ Niziol Leslie M LM Elam Angela R AR Heisler Michele M Lee Paul P PP Resnicow Kenneth K Musch David C DC Darnley-Fisch Deborah D Mitchell Jamie J Newman-Casey Paula Anne PA

Ophthalmology. Glaucoma 20210630 1

<h4>Purpose</h4>To investigate whether demographic, clinical, or psychosocial factors act as moderators of change in medication adherence in the Support, Educate, Empower (SEE) program.<h4>Design</h4>Prospective, single-arm pilot study with a pre-post design.<h4>Participants</h4>Patients with glaucoma aged ≥ 40 years and taking ≥ 1 glaucoma medication were recruited from the University of Michigan Kellogg Eye Center. Those who had electronically measured adherence ≤ 80% in the 3-month eligibilit ...[more]

PMID: 34098169

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Project description:PurposeTo assess the efficacy of the Support, Educate, Empower (SEE) glaucoma coaching program on medication adherence among poorly adherent patients with glaucoma for 12 months after cessation of the intervention.DesignUncontrolled intervention study with a pre-post design.ParticipantsThe SEE cohort was recruited from the University of Michigan and included patients with glaucoma aged ≥ 40 years, taking ≥ 1 medication, who self-reported poor adherence. Electronic medication monitoring of those who completed the program continued for up to 1 year after the coaching intervention.MethodsAdherence was monitored electronically (AdhereTech) during the 7-month program and 12-month follow-up period. Adherence was the percentage of doses taken on time. Participants were censored for surgery, change in glaucoma medications, or adherence monitor disuse. The SEE program included automated medication reminders, 3 in-person motivational interviewing-based counseling sessions with a glaucoma coach, and 5 phone calls with the coach for between-session support. There was no contact between the study team and participants during the 12-month follow-up after program cessation. Baseline participant characteristics were summarized with descriptive statistics. Paired t tests and Wilcoxon signed rank tests were used to investigate significant changes in monthly adherence during follow-up.Main outcome measuresChange in electronically monitored medication adherence over the 12 months following the conclusion of the SEE program.ResultsOf 48 participants, 39 (81%) completed the SEE program and continued electronic medication monitoring for up to 1 year after program cessation. The mean age of the participants was 64 years (standard deviation [SD], 10); of the 39 participants, 56% were male, 49% were Black, and 44% were White. The mean length of follow-up was 284 days (SD, 110; range, 41-365 days). Censoring occurred in 18 (56%) participants. The mean adherence during the follow-up period was 67% (SD, 22%). This was significantly lower than the adherence during the SEE program (mean, 81%; SD, 18%; P < 0.0001) but significantly higher than the baseline preprogram adherence (mean, 60%; SD, 18%; P = 0.0393). The largest monthly losses occurred at months 1 (mean, 7%; P = 0.0001) and 4 (mean, 6%; P = 0.0077).ConclusionsGlaucoma medication adherence decreased significantly in the year after cessation of the SEE coaching program but remained significantly higher than baseline adherence. To maintain excellent long-term medication adherence, intermittent reinforcement sessions may be necessary.

Project description:PurposeTo understand patients' qualitative experiences with the Support, Educate, Empower (SEE) personalized glaucoma coaching program, provide a richer understanding of the components of the intervention that were useful in eliciting behavior change, and understand how to improve the SEE Program.DesignA concurrent mixed-methods process analysis.ParticipantsThirty-nine patients with a diagnosis of any kind of glaucoma or ocular hypertension who were aged ≥40 years, were taking ≥1 glaucoma medication, spoke English, self-administered their eye drops, and had poor glaucoma medication adherence (defined as taking ≤80% of prescribed medication doses assessed via electronic medication adherence monitors) who completed the 7-month SEE Program.MethodsAll participants who completed the study were interviewed in-person using a semistructured interview guide after the intervention. Coders conducted qualitative analysis of transcribed interviews using Grounded Theory. Participants were then stratified into groups based on change in adherence, and thematic differences between groups were examined.Main outcome measuresThemes that emerged from interviews categorized by the number of participants who expressed a theme and the number of representative citations.ResultsParticipants expressed positive views toward the program overall (95%, n = 37/39). They perceived program components as working together to improve their medication adherence. Interactions with the glaucoma coach (38 participants, 184 citations), motivation to aid personal change (38 participants, 157 citations), personalized glaucoma education (38 participants, 149 citations), electronic reminders, and hearing their adherence score (37 participants, 90 citations) were most commonly cited by participants as helpful program elements contributing to improved adherence. Patients expressed a desire for personalized education to be a standard part of glaucoma care. Participants who demonstrated more improvement in adherence had a more trusting attitude toward the adherence score and a greater magnitude of perceived personal need to improve adherence.ConclusionsParticipants reported a highly positive response to the in-person glaucoma education and motivational interviewing intervention used in conjunction with automated adherence reminders.

Project description:PurposeTo assess the efficacy of the Support, Educate, Empower (SEE) glaucoma coaching program on medication adherence among glaucoma patients with low adherence.DesignUncontrolled intervention study with a pre-post design.ParticipantsGlaucoma patients ≥ age 40, taking ≥1 medication, who self-reported poor adherence were recruited from the University of Michigan Kellogg Eye Center. Adherence was monitored electronically for a 3-month baseline period; participants with median adherence of ≤80% were enrolled in the SEE program.MethodsParticipants' adherence was monitored electronically (AdhereTech, New York, NY) during the 7-month program. Adherence was calculated as the percentage of doses taken on time of those prescribed. The SEE program included (1) automated medication reminders, (2) 3 in-person counseling sessions with a glaucoma coach who had training in motivational interviewing (MI), and (3) 5 phone calls with the same coach for between-session support. The coach used a web-based tool to generate an education plan tailored to the patient's glaucoma diagnosis, test results, and ophthalmologist's recommendations (www.glaucomaeyeguide.org). The tool guided an MI-based conversation between coach and patient to identify barriers to adherence and possible solutions. Descriptive statistics were used to summarize baseline patient characteristics, and differences between those who did and did not complete the SEE program were tested with 2-sample t tests, chi-square tests, and Fisher exact tests. Adherence was compared before and after the SEE program with paired t tests.Main outcome measureChange in electronically monitored medication adherence.ResultsA total of 48 participants were enrolled. The participants were 54% male, 46% white, and on average 64 years of age (standard deviation [SD], 10.8 years), with an average worse-eye mean deviation (MD) of -7.9 dB (SD, 8.8 dB). Those completing the SEE program (n = 39) did not differ significantly from those who dropped out (n = 9) on gender, race, age, MD, or baseline adherence. Medication adherence improved from 59.9% at baseline to 81.3% (P < 0.0001) after completing the SEE program. Ninety-five percent of participants showed an improvement in adherence (mean relative improvement, 21.4%; SD, 16.5%; range, -3.2% to 74.4%; median, 20.1%). Fifty-nine percent of participants showed adherence of >80% on completing the SEE program.ConclusionsThe SEE program participants showed clinically meaningful, statistically significant improvement in glaucoma medication adherence.

Project description:PrecisHigher levels of near vision-related quality of life (VRQoL) were associated with higher adherence to glaucoma medications after adjusting for important confounding variables among participants in the Support, Educate, Empower (SEE) personalized glaucoma coaching pilot study.PurposeTo investigate the association between VRQoL and glaucoma medication adherence.Materials and methodsSubjects were recruited for the SEE program, a prospective noncontrolled cohort study examining the impact of a personalized coaching program on glaucoma medication adherence. Glaucoma patients seen at the University of Michigan over 40 years old, taking ≥1 glaucoma medication, and self-reported poor adherence on 2 validated scales were recruited. Demographic details and VRQoL using the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) were collected. Participants' medication use for each prescribed glaucoma medication was captured electronically using a medication events monitoring system. The association between VRQoL and medication adherence was assessed with Pearson correlation coefficient (r) and linear regression.ResultsAmong the 95 eligible participants 49.5% were female, 55.3% were Caucasian, and mean age (±SD) was 63.8±10.5 years. Mean adherence to glaucoma medication was 73.8%±21.0%. Mean NEI VFQ-25 composite score was 81.6±14.5. Better medication adherence was significantly and positively correlated with better functioning in domains of ocular pain (r=0.20, P=0.048), near activities (r=0.29, P=0.004), and role difficulties (r=0.22, P=0.036). Linear regression models adjusting for known correlates of medication adherence (age, sex, race, income), showed a 10-unit increase in self-perceived near activities function was associated with a 2.2% increase in medication adherence (95% confidence interval, 1.0%-5.4%; P=0.0056).ConclusionBetter self-perceived near activities function was associated with increased glaucoma medication adherence.

Project description:BackgroundGlaucoma is a chronic disease that affects 3 million Americans. Glaucoma is most often asymptomatic until very late in its course when treatment is more difficult and extensive peripheral vision loss has already occurred. Taking daily medications can mitigate this vision loss, but at least half of people with glaucoma do not take their prescribed medications regularly. The purpose of this study is to improve glaucoma medication adherence among those with medically treated glaucoma and poor self-reported adherence using the Support, Educate, Empower personalized coaching program.Methods/designThis study is a two-site randomized controlled trial enrolling 230 participants with poor self-reported glaucoma medication adherence. The trial has two arms, an intervention arm and a control arm. Participants in the intervention arm receive personalized glaucoma education and motivational interviewing-based coaching over 6 months from a trained non-physician interventionist for three in-person sessions with between visit phone calls for check-ins where current adherence level is reported to participants. Participants also can elect to have visual, audio, text or automated phone call medication dose reminders. Participants in the control arm continue usual care with their physician and receive non-personalized glaucoma educational materials via mail in parallel to the three in-person coaching sessions to control for glaucoma knowledge content. All participants receive a medication adherence monitor. The primary outcome is the proportion of prescribed doses taken on schedule during the 6-month period. The secondary outcome is glaucoma related distress. The exploratory outcome is intraocular pressure.DiscussionThe personalized education and motivational-interviewing-based intervention that we are testing is comprehensive in that it addresses the wide range of barriers to adherence that people with glaucoma encounter. Leveraging a custom-built web-based application to generate the personalized content and the motivational-interviewing-based prompts to guide the coaching sessions will make this program both replicable and scalable and can be integrated into clinical care utilizing trained non-physician providers. Although this type of self-management support is not currently reimbursed for glaucoma as it is for diabetes, this trial could help shape future policy change should the intervention be found effective.

Project description:PurposeTo assess the Support, Educate, Empower (SEE) personalized glaucoma coaching program impact on (1) eye drop instillation technique and (2) eye drop instillation self-efficacy.DesignProspective pre-post pilot study.ParticipantsPatients with a diagnosis of glaucoma or ocular hypertension taking ≥1 glaucoma medication, ≥40 years old, spoke English, self-administered their eye drops, and ≤80% adherent to their glaucoma medication by electronic monitoring.MethodsEye drop administration was video recorded before the first SEE in-person coaching session, which included teaching eye drop instillation techniques using a motivational interviewing-based approach. At the third and final in-person counseling session 6 months later, eye drop administration was video recorded. Participants' self-efficacy was assessed using the validated Eye Drop Technique Self-Efficacy Scale (EDTSES) survey at baseline and 1 month after completion of the program. Before and after intervention videos were assessed by an observer masked to time point. Before versus after intervention comparisons were made using McNemar's and paired t tests.Main outcome measuresThe main outcome was change in participants' eye drop instillation technique as measured by (1) accuracy of an eye drop landing on the eye, (2) ability to instill an eye drop on the first attempt, and (3) contaminating the bottle by contact with ocular surface, eyelashes, and skin. The secondary outcome measure was before versus after change in the EDTSES score (6 items, each assessed on a 3-point Likert scale, with higher scores indicating better self-efficacy).ResultsThirty-nine participants completed the SEE intervention, 38 with before and after EDTSES scores and 31 with video recordings. Six of 31 participants instilling drops outside the eye before intervention improved their technique after intervention, whereas 2 participants worsened (P = 0.157). From before to after intervention, participants demonstrated significant improvement in not touching the ocular surface (P = 0.046), the eyelashes (P = 0.020), or the skin (P = 0.025) with the bottle tip. A significant increase was found in eye drop instillation self-efficacy from an average score of 2.6 (standard deviation [SD], 0.3) to 2.8 (SD, 0.2) on the EDTSES score (P = 0.007).ConclusionsThe SEE program significantly decreased eye drop bottle contamination, increased eye drop instillation self-efficacy, and demonstrated an insignificant increase in ability to instill drops successfully and accurately.

Project description:OBJECTIVE:Estimates indicate that 20-70% of renal transplant recipients are medication non-adherent, significantly increasing the risk of organ rejection. Medication adherence is negatively impacted by lower everyday problem solving ability, and associations between depressive symptoms, self-efficacy, and adherence are reported in renal transplant recipients. Nonetheless, to date, these associations have not been examined concurrently. Given the relationship between non-adherence and organ rejection, it is critical to gain a better understanding of the predictors of adherence in renal transplant recipients. To this end, we modeled relationships among cognitive abilities, depressive symptoms, self-efficacy, and adherence in this group. METHODS:Participants (N = 211) underwent renal transplant at least one year prior to participation. Adherence was measured via self-report, medication possession ratio, and immunosuppressant blood-level. Traditionally-measured neurocognitive and everyday problem-solving abilities were assessed. Depressive symptoms were measured via self-report, as were general and medication adherence related self-efficacy. Structural equation modeling was used to assess the fit of the model to available data. RESULTS:Everyday problem solving and self-efficacy had direct positive associations with adherence. Depressive symptoms were negatively associated with self-efficacy, but not adherence. Traditionally-measured neurocognitive abilities were positively associated with self-efficacy, and negatively associated with depressive symptoms. CONCLUSIONS:We present a comprehensive investigation of relationships between cognitive and psychosocial factors and adherence in medically stable renal transplant recipients. Findings confirm the importance of everyday problem solving and self-efficacy in predicting adherence and suggest that influences of depressive symptoms and neurocognitive abilities are indirect. Findings have important implications for future development of interventions to improve medication adherence in renal transplant recipients.

Project description:BackgroundAlthough evidence shows that poor air quality can harm human health, we have a limited understanding about the behavioural impact of air quality forecasts. Our aim was to understand to what extent air quality warning systems influence protective behaviours in the general public, and to identify the demographic and psychosocial factors associated with adherence and non-adherence to the health advice accompanying these warnings.MethodIn August 2016 literature was systematically reviewed to find studies assessing intended or actual adherence to health advice accompanying air quality warning systems, and encouraging people to reduce exposure to air pollution. Predictors of adherence to the health advice and/or self-reported reasons for adherence or non-adherence were also systematically reviewed. Studies were included only if they involved participants who were using or were aware of these warning systems. Studies investigating only protective behaviours due to subjective perception of bad air quality alone were excluded. The results were narratively synthesised and discussed within the COM-B theoretical framework.ResultsTwenty-one studies were included in the review: seventeen investigated actual adherence; three investigated intended adherence; one assessed both. Actual adherence to the advice to reduce or reschedule outdoor activities during poor air quality episodes ranged from 9.7% to 57% (Median = 31%), whereas adherence to a wider range of protective behaviours (e.g. avoiding busy roads, taking preventative medication) ranged from 17.7% to 98.1% (Median = 46%). Demographic factors did not consistently predict adherence. However, several psychosocial facilitators of adherence were identified. These include knowledge on where to check air quality indices, beliefs that one's symptoms were due to air pollution, perceived severity of air pollution, and receiving advice from health care professionals. Barriers to adherence included: lack of understanding of the indices, being exposed to health messages that reduced both concern about air pollution and perceived susceptibility, as well as perceived lack of self-efficacy/locus of control, reliance on sensory cues and lack of time.ConclusionWe found frequent suboptimal adherence rates to health advice accompanying air quality alerts. Several psychosocial facilitators and barriers of adherence were identified. To maximise their health effects, health advice needs to target these specific psychosocial factors.

Dataset Information

Demographic, Clinical, and Psychosocial Predictors of Change in Medication Adherence in the Support, Educate, Empower Program.

Purpose

Design

Participants

Methods

Main outcome measures

Results

Conclusions

Publications

Demographic, Clinical, and Psychosocial Predictors of Change in Medication Adherence in the Support, Educate, Empower Program.

Similar Datasets

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