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Green SMC, French DP, Graham CD, Hall LH, Rousseau N, Foy R, Clark J, Parbutt C, Raine E, Gardner B, Velikova G, Moore SJL, Buxton J, Smith SG. Supporting adjuvant endocrine therapy adherence in women with breast cancer: the development of a complex behavioural intervention using Intervention Mapping guided by the Multiphase Optimisation Strategy. BMC Health Serv Res 2022; 22:1081. [PMID: 36002831 PMCID: PMC9404670 DOI: 10.1186/s12913-022-08243-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 06/21/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Adjuvant endocrine therapy (AET) reduces the risk of breast cancer recurrence and mortality. However, up to three-quarters of women with breast cancer do not take AET as prescribed. Existing interventions to support adherence to AET have largely been unsuccessful, and have not focused on the most salient barriers to adherence. This paper describes the process of developing four theory-based intervention components to support adherence to AET. Our aim is to provide an exemplar of intervention development using Intervention Mapping (IM) with guidance from the Multiphase Optimisation Strategy (MOST). METHODS Iterative development followed the six-stage IM framework with stakeholder involvement. Stage 1 involved a literature review of barriers to adherence and existing interventions, which informed the intervention objectives outlined in Stage 2. Stage 3 identified relevant theoretical considerations and practical strategies for supporting adherence. Stage 4 used information from Stages 1-3 to develop the intervention components. Stages 1-4 informed a conceptual model for the intervention package. Stages 5 and 6 detailed implementation considerations and evaluation plans for the intervention package, respectively. RESULTS The final intervention package comprised four individual intervention components: Short Message Service to encourage habitual behaviours surrounding medication taking; an information leaflet to target unhelpful beliefs about AET; remotely delivered Acceptance and Commitment Therapy-based guided self-help to reduce psychological distress; and a website to support self-management of AET side-effects. Considerations for implementation within the NHS, including cost, timing and mode of delivery were outlined, with explanation as to how using MOST can aid this. We detail our plans for the final stage of IM which involve feasibility testing. This involved planning an external exploratory pilot trial using a 24-1 fractional factorial design, and a process evaluation to assess acceptability and fidelity of intervention components. CONCLUSIONS We have described a systematic and logical approach for developing a theoretically informed intervention package to support medication adherence in women with breast cancer using AET. Further research to optimise the intervention package, guided by MOST, has the potential to lead to more effective, efficient and scalable interventions.
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Affiliation(s)
- Sophie M. C. Green
- grid.9909.90000 0004 1936 8403Leeds Institute of Health Sciences, University of Leeds, Clarendon Way, Leeds, LS2 9NL UK
| | - David P. French
- grid.5379.80000000121662407Manchester Centre for Health Psychology, University of Manchester, Manchester, UK
| | - Christopher D. Graham
- grid.4777.30000 0004 0374 7521Department of Psychology, Queen’s University Belfast, Belfast, UK
| | - Louise H. Hall
- grid.9909.90000 0004 1936 8403Leeds Institute of Health Sciences, University of Leeds, Clarendon Way, Leeds, LS2 9NL UK
| | - Nikki Rousseau
- grid.9909.90000 0004 1936 8403Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Robbie Foy
- grid.9909.90000 0004 1936 8403Leeds Institute of Health Sciences, University of Leeds, Clarendon Way, Leeds, LS2 9NL UK
| | - Jane Clark
- grid.443984.60000 0000 8813 7132St. James’s University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Catherine Parbutt
- grid.443984.60000 0000 8813 7132St. James’s University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Erin Raine
- grid.9909.90000 0004 1936 8403Leeds Institute of Health Sciences, University of Leeds, Clarendon Way, Leeds, LS2 9NL UK
| | - Benjamin Gardner
- grid.13097.3c0000 0001 2322 6764Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Galina Velikova
- grid.443984.60000 0000 8813 7132Leeds Institute of Medical Research at St James’s, University of Leeds, St James’s University Hospital, Leeds, UK ,grid.443984.60000 0000 8813 7132Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, St James’s University Hospital, Leeds, UK
| | - Sally J. L. Moore
- grid.9909.90000 0004 1936 8403Leeds Institute of Health Sciences, University of Leeds, Clarendon Way, Leeds, LS2 9NL UK
| | - Jacqueline Buxton
- grid.9909.90000 0004 1936 8403Leeds Institute of Health Sciences, University of Leeds, Clarendon Way, Leeds, LS2 9NL UK
| | | | - Samuel G. Smith
- grid.9909.90000 0004 1936 8403Leeds Institute of Health Sciences, University of Leeds, Clarendon Way, Leeds, LS2 9NL UK
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Walburn J, Sainsbury K, Foster L, Weinman J, Morgan M, Norton S, Canfield M, Chadwick P, Sarkany B, Araújo-Soares V. Why? What? How? Using an Intervention Mapping approach to develop a personalised intervention to improve adherence to photoprotection in patients with Xeroderma Pigmentosum. Health Psychol Behav Med 2020; 8:475-500. [PMID: 34040882 PMCID: PMC8114411 DOI: 10.1080/21642850.2020.1819287] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background: Intervention Mapping (IM) is a systematic approach for developing theory-based interventions across a variety of contexts and settings. This paper describes the development of a complex intervention designed to reduce the dose of ultraviolet radiation (UVR) reaching the face of adults with Xeroderma Pigmentosum (XP), by improving photoprotection. XP is a genetic condition that without extreme UVR photoprotection, leads to high risk of developing skin cancer. Methods: The IM protocol of 6 steps was applied, involving comprehensive mixed-methods formative research. Key stakeholders (XP clinical staff and Patient and Public Involvement Panel), were instrumental at every step. Behaviour change methods were informed by the IM taxonomy, therapeutic approaches (e.g. ACT, CBT) and coded according to the taxonomy of behaviour change techniques (version 1). Results: We designed a personalised modular intervention to target psychosocial determinants of photoprotective activities that influence the amount of UVR reaching the face. Content was developed to target determinants of motivation to protect and factors preventing the enactment of behaviours. Participants received personalised content addressing determinants/barriers most relevant to them, as well as core ‘behaviour-change’ material, considered important for all (e.g. SMART goals). Core and personalised content was delivered via 7 one-to-one sessions with a trained facilitator using a manual and purpose designed materials: Magazine; text messages; sunscreen application video; goal-setting tools (e.g. UVR dial and face protection guide); activity sheets. Novel features included use of ACT-based values to enhance intrinsic motivation, targeting of emotional barriers to photoprotection, addressing appearance concerns and facilitating habit formation. Conclusion: IM was an effective approach for complex intervention design. The structure (e.g. use of matrices) tethered the intervention tightly to theory and evidence-based approaches. The significant amount of time required needs to be considered and may hinder translation of IM into clinical and non-academic settings.
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Affiliation(s)
- Jessica Walburn
- School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
| | - Kirby Sainsbury
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Lesley Foster
- National Xeroderma Pigmentosum Service, Guy's and St. Thomas' Hospital NHS Foundation Trust, London, UK
| | - John Weinman
- School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
| | - Myfanwy Morgan
- School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
| | - Sam Norton
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Martha Canfield
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Paul Chadwick
- Centre for Behaviour Change, University College London, London, UK
| | - Bob Sarkany
- National Xeroderma Pigmentosum Service, Guy's and St. Thomas' Hospital NHS Foundation Trust, London, UK
| | - Vera Araújo-Soares
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
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A theory-based intervention to promote medication adherence in patients with rheumatoid arthritis: A randomized controlled trial. Clin Rheumatol 2020; 40:101-111. [PMID: 32588274 PMCID: PMC7782392 DOI: 10.1007/s10067-020-05224-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 05/16/2020] [Accepted: 06/08/2020] [Indexed: 12/04/2022]
Abstract
Introduction/objectives Adherence to prescribed medication regimens is fundamental to the improvement and maintenance of the health of patients with rheumatoid arthritis. It is therefore important that interventions are developed to address this important health behavior issue. The aim of the present study was to design and evaluate a theory-based intervention to improve the medication adherence (primary outcome) among rheumatoid arthritis patients. Methods The study adopted a pre-registered randomized controlled trial design. Rheumatoid arthritis patients were recruited from two University teaching hospitals in Qazvin, Iran from June 2018 to May 2019 and randomly assigned to either an intervention group (n = 100) or a treatment-as-usual group (n = 100). The intervention group received a theory-based intervention designed based on the theoretical underpinnings of the health action process approach (HAPA). More specifically, action planning (making detailed plans to follow medication regimen), coping planning (constructing plans to overcome potential obstacles that may arise in medication adherence), and self-monitoring (using a calendar to record medication adherence) of the HAPA has been used for the treatment. The treatment-as-usual group received standard care. Results Data analysis was conducted based on the principle of intention to treat. Using a linear mixed-effects model (adjusted for age, sex, medication prescribed, and body mass index), the results showed improved medication adherence scores in the intervention group (loss to follow-up = 16) compared to the treatment-as-usual group (loss to follow-up = 12) at the 3-month (coefficient = 3.9; SE = 0.8) and 6-month (coefficient = 4.5; SE = 0.8) follow-up. Intervention effects on medication adherence scores were found to be mediated by some of the theory-based HAPA variables that guided the study. Conclusion The results of the present study support the use of a theory-based intervention for improving medication adherence among rheumatoid arthritis patients, a group at-risk of not adhering to medication regimens. Trial registration (in Iranian Registry of Clinical Trials) irct.ir, IRCT20180108038271N1Key Points • Theoretical underpinnings of the health action process approach are useful to improve medication adherence for RA patients. |
Electronic supplementary material The online version of this article (10.1007/s10067-020-05224-y) contains supplementary material, which is available to authorized users.
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van Heuckelum M, Hebing RCF, Vandeberg L, Linn AJ, Flendrie M, Nurmohamed MT, van Dulmen S, van den Ende CHM, van den Bemt BJF. Are Health Care Professionals' Implicit and Explicit Attitudes Toward Conventional Disease-Modifying Antirheumatic Drugs Associated With Those of Their Patients? Arthritis Care Res (Hoboken) 2020; 73:364-373. [PMID: 32166901 DOI: 10.1002/acr.24186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 03/03/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE It is generally unknown how the attitudes and beliefs of health care professionals (HCPs) might affect the attitudes, beliefs, and medication-taking behavior of patients with rheumatoid arthritis (RA). This study aims 1) to examine the attitudes, health-related associations (both implicit and explicit), and beliefs of HCPs about conventional disease-modifying antirheumatic drugs, and 2) to assess whether these attitudes, health-related associations, and beliefs of HCPs are associated with those of their patients, with their patients' medication-taking behavior, and disease activity. METHODS HCPs were recruited from 2 centers that specialized in rheumatology across The Netherlands, and patient recruitment followed. In this observational study, implicit outcomes were measured with single-category implicit association tests, whereas explicit outcomes were measured with a bipolar evaluative adjective scale and the Beliefs About Medicines Questionnaire-Specific. Spearman's rank correlations were used to describe correlations between implicit and explicit measures of the attitudes of HCPs. Multilevel, mixed-effects linear models were used to examine the association of HCP-related characteristics, including the implicit and explicit outcomes of HCPs, with those of their patients, their medication-taking behaviors, and disease activity. RESULTS Of the 1,659 initially invited patients, 254 patients with RA (mean age 62.8 years, mean disease duration 11.8 years, and 68.1% of the patients were female) who were treated by 26 different HCPs agreed to participate in this study. The characteristics, attitudes, health-related associations, and beliefs about medicines of HCPs were not significantly associated with those of their patients, nor with their medication-taking behaviors or disease activity scores. CONCLUSION This study demonstrated that the attitudes, health-related associations (as measured both implicitly and explicitly), and beliefs of HCPs were not significantly associated with the attitudes, beliefs, medication-taking behavior, and disease activity of patients with RA.
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Affiliation(s)
| | - Renske C F Hebing
- Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, The Netherlands
| | - Lisa Vandeberg
- Centre for Language Studies, Radboud University, Nijmegen, The Netherlands, and Amsterdam School of Communication Research, University of Amsterdam, Amsterdam, The Netherlands
| | - Annemiek J Linn
- Amsterdam School of Communication Research, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Mike T Nurmohamed
- Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, The Netherlands
| | - Sandra van Dulmen
- Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands, and University of South-Eastern Norway, Drammen, Norway
| | | | - Bart J F van den Bemt
- Sint Maartenskliniek and Radboud University Medical Center, Nijmegen, The Netherlands, and Maastricht University Medical Centre, Maastricht, The Netherlands
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Majid U, Kim C, Cako A, Gagliardi AR. Engaging stakeholders in the co-development of programs or interventions using Intervention Mapping: A scoping review. PLoS One 2018; 13:e0209826. [PMID: 30586425 PMCID: PMC6306258 DOI: 10.1371/journal.pone.0209826] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 12/12/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Health care innovations tailored to stakeholder context are more readily adopted. This study aimed to describe how Intervention Mapping (IM) was used to design health care innovations and how stakeholders were involved. METHODS A scoping review was conducted. MEDLINE, EMBASE, Cochrane Library, Scopus and Science Citation Index were searched from 2008 to November 2017. English language studies that used or cited Intervention Mapping were eligible. Screening and data extraction were done in triplicate. Summary statistics were used to describe study characteristics, IM steps employed, and stakeholder involvement. RESULTS A total of 852 studies were identified, 449 were unique, and 333 were excluded based on title and abstracts, 116 full-text articles were considered and 61 articles representing 60 studies from 13 countries for a variety of clinical issues were included. The number of studies published per year increased since 2008 and doubled in 2016 and 2017. The majority of studies employed multiple research methods (76.7%) and all 6 IM steps (73.3%). Resulting programs/interventions were single (55.4%) or multifaceted (46.4%), and 60.7% were pilot-tested. Programs or interventions were largely educational material or meetings, and were targeted to patients (70.2%), clinicians (14.0%) or both (15.8%). Studies provided few details about current or planned evaluation. Of the 4 (9.3%) studies that reported impact or outcomes, 3 achieved positive improvements in patient or professional behaviour or patient outcomes. Many studies (28.3%) did not involve stakeholders. Those that did (71.7%) often involved a combination of patients, clinicians, and community organizations. However, less than half (48.8%) described how they were engaged. Most often stakeholders were committee members and provide feedback on program or intervention content or format. CONCLUSIONS It is unclear if use of IM or stakeholder engagement in IM consistently results in effective programs or interventions. Those employing IM should report how stakeholders were involved in each IM step and how involvement influenced program or intervention design. They should also report the details or absence of planned evaluation. Future research should investigate how to optimize stakeholder engagement in IM, and whether use of IM itself or stakeholder engagement in IM are positively associated with effective programs or interventions.
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Affiliation(s)
- Umair Majid
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Claire Kim
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Albina Cako
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Anna R. Gagliardi
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
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[EULAR recommendations for patient education of people with inflammatory arthritis. Translation and evaluation in Germany]. Z Rheumatol 2016; 75:187-99. [PMID: 26744185 DOI: 10.1007/s00393-015-0020-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
In 2015 EULAR published recommendations for patient education of people with inflammatory arthritis. The recommendations included two superior principles and eight recommendations based on the level of evidence and expert knowledge. The German translation of the recommendations was evaluated by 15 German experts. Experts graded the strength of the recommendations (SOR) on an 11 point numerical rating scale (from 0 = no agreement to 10 = total agreement). The mean score was 8,8 ± 0,49.
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Brandstetter S, Riedelbeck G, Steinmann M, Loss J, Ehrenstein B, Apfelbacher C. Depression moderates the associations between beliefs about medicines and medication adherence in patients with rheumatoid arthritis: Cross-sectional study. J Health Psychol 2016; 23:1185-1195. [PMID: 27151068 DOI: 10.1177/1359105316646440] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The 'necessity-concerns framework' postulates that patients' adherence behaviour is influenced by beliefs about the necessity and the concerns patients have regarding their prescribed medicines. We hypothesized that depression moderates the associations between beliefs about medicines and medication adherence among people with rheumatoid arthritis. Using multivariate logistic regression, we observed that people experiencing more depressive symptoms showed stronger associations between necessity beliefs and adherence as well as attenuated associations between concerns and adherence, respectively, in a cross-sectional sample ( N = 361). Thus, depression moderates the associations postulated in the 'necessity-concerns framework' in a differential way in people with rheumatoid arthritis.
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The Efficacy of Motivational Interviewing in Adults With Chronic Pain: A Meta-Analysis and Systematic Review. THE JOURNAL OF PAIN 2016; 17:393-403. [DOI: 10.1016/j.jpain.2015.10.021] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 10/22/2015] [Accepted: 10/29/2015] [Indexed: 11/17/2022]
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Zuidema RM, van Gaal BG, van Dulmen S, Repping-Wuts H, Schoonhoven L. An Online Tailored Self-Management Program for Patients With Rheumatoid Arthritis: A Developmental Study. JMIR Res Protoc 2015; 4:e140. [PMID: 26706653 PMCID: PMC4706640 DOI: 10.2196/resprot.4571] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 07/22/2015] [Accepted: 07/24/2015] [Indexed: 11/15/2022] Open
Abstract
Background Every day rheumatoid arthritis (RA) patients make many decisions about managing their disease. An online, computer-tailored, self-management program can support this decision making, but development of such a program requires the active participation of patients. Objective To develop an online, computer-tailored, self-management program integrated with the nursing care, as nurses have an important role in supporting self-management behavior. Methods The intervention mapping framework was used to develop the program. Development was a multistep process: (1) needs assessment; (2) developing program and change objectives in a matrix; (3) selecting theory-based intervention methods and practical application strategies; (4) producing program components; (5) planning and adoption, implementation, and sustainability; and (6) planning for evaluation. Results After conducting the needs assessment (step 1), nine health-related problems were identified: (1) balancing rest and activity, (2) setting boundaries, (3) asking for help and support, (4) use of medicines, (5) communicating with health professionals, (6) use of assistive devices, (7) performing physical exercises, (8) coping with worries, and (9) coping with RA. After defining performance and change objectives (step 2), we identified a number of methods which could be used to achieve them (step 3), such as provision of general information about health-related behavior, self-monitoring of behavior, persuasive communication, modeling, and self-persuasion and tailoring. We described and operationalized these methods in texts, videos, exercises, and a medication intake schedule. The resulting program (step 4) consisted of an introduction module and nine modules dealing with health-related problems. The content of these modules is tailored to the user’s self-efficacy, and patients can use the online program as often as they want, working through a module or modules at their own speed. After implementation (step 5), the program will be evaluated in a two-center pilot trial involving 200 RA patients. Log-in data and qualitative interviews will used for a process evaluation. Conclusions The intervention mapping framework was used to guide development of an online computer-tailored self-management program via a process which could serve as a model for the development of other interventions. A pilot randomized controlled trial (RCT) will provide insight into the important outcome measures in preparation for a larger RCT. The process evaluation will provide insight into how RA patients use the program and the attrition rate. Trial Registration Netherlands Trial Register (NTR): NTR4871; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4871 [accessed 13-NOV-15]
http://www.webcitation.org/6d1ZyIoEy
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Affiliation(s)
- Rixt M Zuidema
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Nijmegen, Netherlands.
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Beauvais C. Include patient education in daily practice: Promoting the patient-centered care approach. Joint Bone Spine 2015; 82:219-21. [DOI: 10.1016/j.jbspin.2014.12.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 12/14/2014] [Indexed: 12/01/2022]
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Ferguson A, Ibrahim FA, Thomas V, Weinman J, Simpson C, Cope AP, Scott DL, Lempp H. Improving medication adherence in rheumatoid arthritis (RA): a pilot study. PSYCHOL HEALTH MED 2015; 20:781-9. [PMID: 25774559 DOI: 10.1080/13548506.2015.1009917] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The aim of this exploratory pilot study was to adapt a psychological intervention to improve adherence to medication for patients with rheumatoid arthritis (RA). The approach draws on cognitive behavioural therapy (CBT) techniques, including motivational interviewing . The current study aimed to (i) adapt the intervention for patients with RA, (ii) assess its effectiveness in improving adherence to medication and (iii) evaluate patients' experience of the intervention. Participants were randomly allocated to either the 'intervention group' (N = 10), receiving up to six weekly sessions of 'Compliance Therapy', or to the 'wait-list control' group (N = 8), who received standard care. Data was collected pre intervention (baseline), post intervention and at six weeks post intervention (follow-up). Eighteen female participants with a mean age of 48.78 years (SD 15.12) took part in the study. Comparisons across the two time points for each group found that only those in the 'intervention' group demonstrated significant improvement in mean scores on adherence measures. Between-group comparisons were not significant. The pilot study suggests that an intervention based on CBT may improve adherence in patients with RA, but further research is required.
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Affiliation(s)
- A Ferguson
- a Academic Rheumatology, Clinical Trials Group, Faculty of Life Sciences & Medicine , King's College London , Weston Education Centre 10, Cutcombe Road, London SE5 9RJ , UK
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Zangi HA, Ndosi M, Adams J, Andersen L, Bode C, Boström C, van Eijk-Hustings Y, Gossec L, Korandová J, Mendes G, Niedermann K, Primdahl J, Stoffer M, Voshaar M, van Tubergen A. EULAR recommendations for patient education for people with inflammatory arthritis. Ann Rheum Dis 2015; 74:954-62. [DOI: 10.1136/annrheumdis-2014-206807] [Citation(s) in RCA: 205] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 02/10/2015] [Indexed: 01/30/2023]
Abstract
ObjectivesThe task force aimed to: (1) develop evidence-based recommendations for patient education (PE) for people with inflammatory arthritis, (2) identify the need for further research on PE and (3) determine health professionals’ educational needs in order to provide evidence-based PE.MethodsA multidisciplinary task force, representing 10 European countries, formulated a definition for PE and 10 research questions that guided a systematic literature review (SLR). The results from the SLR were discussed and used as a basis for developing the recommendations, a research agenda and an educational agenda. The recommendations were categorised according to level and strength of evidence graded from A (highest) to D (lowest). Task force members rated their agreement with each recommendation from 0 (total disagreement) to 10 (total agreement).ResultsBased on the SLR and expert opinions, eight recommendations were developed, four with strength A evidence. The recommendations addressed when and by whom PE should be offered, modes and methods of delivery, theoretical framework, outcomes and evaluation. A high level of agreement was achieved for all recommendations (mean range 9.4–9.8). The task force proposed a research agenda and an educational agenda.ConclusionsThe eight evidence-based and expert opinion-based recommendations for PE for people with inflammatory arthritis are intended to provide a core framework for the delivery of PE and training for health professionals in delivering PE across Europe.
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van Bruinessen IR, van Weel-Baumgarten EM, Snippe HW, Gouw H, Zijlstra JM, van Dulmen S. Active patient participation in the development of an online intervention. JMIR Res Protoc 2014; 3:e59. [PMID: 25379679 PMCID: PMC4259996 DOI: 10.2196/resprot.3695] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 09/15/2014] [Accepted: 09/16/2014] [Indexed: 11/23/2022] Open
Abstract
Background An important and challenging part of living with cancer relates to the repeated visits to the hospital. Since how patients cope between these post-diagnostic visits depends partly on the information and support received from their physician during the visits, it is important to make the most of them. Recent findings reinforce the importance of training not only the health care professionals in communication skills, but providing patients with support in communication as well. Delivering such supportive interventions online can have potential benefits in terms of accessibility, cost-effectiveness, and ability to tailor information to personal needs. However, problems with attrition (dropout, non-usage) during the test phase and poor uptake after implementation are frequently reported. The marginal level of engagement of the patient as end user seems to play a role in this. Therefore, recent research suggests integrating theory-based development methods with methods that promote involvement of the patient at an early stage. This paper describes a participatory protocol, used to let patients guide a theory-informed development process. Objective The objective of this project was to apply a bottom-up inspired procedure to develop a patient-centered intervention with corresponding evaluation and implementation plan. Methods The applied development protocol was based on the intervention mapping framework, combined with patient participatory methods that were inspired by the participation ladder and user-centred design methods. Results The applied protocol led to a self-directed online communication intervention aimed at helping patients gain control during their communications with health care professionals. It also led to an evaluation plan and an implementation plan. The protocol enabled the continuous involvement of patient research partners and the partial involvement of patient service users, which led to valuable insights and improvements. Conclusions The applied protocol realized patient participation on different levels throughout the entire project. Early involvement, involvement on different levels, and flexibility in terms of planning and setup seem to be preconditions to creating a bottom-up inspired development procedure with (seriously ill) patients. Further research is necessary to find out if a more patient-centered approach improves the implementation and uptake of eHealth interventions. Trial Registration Netherlands National Trial Register ID number: NTR3779; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=3779 (Archived by WebCite at http://www.webcitation.org/6TdfALKxV).
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Zwikker HE, van den Ende CH, van Lankveld WG, den Broeder AA, van den Hoogen FH, van de Mosselaar B, van Dulmen S, van den Bemt BJ. Effectiveness of a group-based intervention to change medication beliefs and improve medication adherence in patients with rheumatoid arthritis: a randomized controlled trial. PATIENT EDUCATION AND COUNSELING 2014; 94:356-361. [PMID: 24388126 DOI: 10.1016/j.pec.2013.12.002] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 11/24/2013] [Accepted: 12/01/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To assess the effect of a group-based intervention on the balance between necessity beliefs and concern beliefs about medication and on medication non-adherence in patients with rheumatoid arthritis (RA). METHODS Non-adherent RA patients using disease-modifying anti-rheumatic drugs (DMARDs) were randomized to an intervention or control arm. The intervention consisted, amongst others, of two motivational interviewing-guided group sessions led by the same pharmacist. Control patients received brochures about their DMARDs. Questionnaires were completed up to 12 months follow-up. RESULTS 123 patients (mean age: 60 years, female: 69%) were randomized. No differences in necessity beliefs and concern beliefs about medication and in medication non-adherence were detected between the intervention and control arm, except at 12 months' follow-up: participants in the intervention arm had less strong necessity beliefs about medication than participants in the control arm (b: -1.0 (95% CI: -2.0, -0.1)). CONCLUSION This trial did not demonstrate superiority of our intervention over the control arm in changing beliefs about medication or in improving medication adherence over time. PRACTICE IMPLICATIONS Absent intervention effects might have been due to, amongst others, selection bias and a suboptimal treatment integrity level. Hence, targeting beliefs about medication in clinical practice should not yet be ruled out.
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Affiliation(s)
- Hanneke E Zwikker
- Departments of Rheumatology and Pharmacy, Sint Maartenskliniek, P.O. Box 9011, 6500 GM Nijmegen, The Netherlands.
| | - Cornelia H van den Ende
- Departments of Rheumatology and Pharmacy, Sint Maartenskliniek, P.O. Box 9011, 6500 GM Nijmegen, The Netherlands
| | - Wim G van Lankveld
- HAN University of Applied Sciences, Institute of Health Studies, The Netherlands
| | - Alfons A den Broeder
- Departments of Rheumatology and Pharmacy, Sint Maartenskliniek, P.O. Box 9011, 6500 GM Nijmegen, The Netherlands
| | - Frank H van den Hoogen
- Departments of Rheumatology and Pharmacy, Sint Maartenskliniek, P.O. Box 9011, 6500 GM Nijmegen, The Netherlands
| | - Birgit van de Mosselaar
- Departments of Rheumatology and Pharmacy, Sint Maartenskliniek, P.O. Box 9011, 6500 GM Nijmegen, The Netherlands
| | - Sandra van Dulmen
- NIVEL (Netherlands Institute for Health Services Research), The Netherlands; Department of Primary and Community Care, Radboud University Medical Centre, The Netherlands; Department of Health Science, Buskerud University College, Drammen, Norway
| | - Bart J van den Bemt
- Departments of Rheumatology and Pharmacy, Sint Maartenskliniek, P.O. Box 9011, 6500 GM Nijmegen, The Netherlands; Department of Pharmacy, Radboud University Medical Centre, The Netherlands.
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Al Rahbi HAM, Al-Sabri RM, Chitme HR. Interventions by pharmacists in out-patient pharmaceutical care. Saudi Pharm J 2013; 22:101-6. [PMID: 24648820 DOI: 10.1016/j.jsps.2013.04.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Accepted: 04/23/2013] [Indexed: 11/30/2022] Open
Abstract
Interventions by the pharmacists have always been considered as a valuable input by the health care community in the patient care process by reducing the medication errors, rationalizing the therapy and reducing the cost of therapy. The primary objective of this study was to determine the number and types of medication errors intervened by the dispensing pharmacists at OPD pharmacy in the Khoula Hospital during 2009 retrospectively. The interventions filed by the pharmacists and assistant pharmacists in OPD pharmacy were collected. Then they were categorized and analyzed after a detailed review. The results show that 72.3% of the interventions were minor of which 40.5% were about change medication order. Comparatively more numbers of prescriptions were intervened in female patients than male patients. 98.2% of the interventions were accepted by the prescribers reflecting the awareness of the doctors about the importance of the pharmacy practice. In this study only 688 interventions were due to prescribing errors of which 40.5% interventions were done in changing the medication order of clarifying the medicine. 14.9% of the interventions were related to administrative issues, 8.7% of the interventions were related to selection of medications as well as errors due to ignorance of history of patients. 8.2% of the interventions were to address the overdose of medications. Moderately significant interventions were observed in 19.4% and 7.5% of them were having the impact on major medication errors. Pharmacists have intervened 20.8% of the prescriptions to prevent complications, 25.1% were to rationalize the treatment, 7.9% of them were to improve compliance. Based on the results we conclude that the role of pharmacist in improving the health care system is vital. We recommend more number of such research based studies to bring awareness among health care professionals, provide solution to the prescription and dispensing problems, as it can also improve the documentation system, emphasize the importance of it, reduce prescribing errors, and update the knowledge of pharmacists and other health care professionals.
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Affiliation(s)
| | | | - Havagiray R Chitme
- Department of Pharmacy, Oman Medical College, Bausher Campus, Muscat, Oman
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