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Ferreira PD, Simoes JA, Velho DC. Adherence to Antihypertensive Therapy and Its Determinants: A Systematic Review. Cureus 2024; 16:e59532. [PMID: 38826951 PMCID: PMC11144025 DOI: 10.7759/cureus.59532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2024] [Indexed: 06/04/2024] Open
Abstract
Hypertension is a globally prevalent condition, and low adherence to antihypertensive therapy is considered one of the main causes of poor blood pressure (BP) control. Non-adherence to antihypertensive treatment is a complex issue that can arise from various factors; however, gaining an understanding of this provides key targets for intervention strategies. This study aimed to provide an overview of the current status and recent developments regarding our understanding of the determinants of patients' adherence to antihypertensives. A systematic review was performed using the electronic databases MEDLINE/PubMed, Web of Science, Scientific Electronic Library Online (SciELO), and "Índex das Revistas Médicas Portuguesas", which included studies published between 2017 and 2021 following the PICOS model: (P) Adult patients with the diagnosis of primary hypertension, using at least one antihypertensive agent; (I) all interventions on both pharmacological and non-pharmacological level; (C) patient's adherence against their non-adherence; (O) changes in adherence to the therapeutic plan; and (S) any study design (except review articles) written in English, French, Spanish or Portuguese. Articles were reviewed by two researchers and their quality was assessed. Subsequently, determinants were classified according to their consistent or inconsistent association with adherence or non-adherence. Only 45 of the 635 reports identified met the inclusion criteria. Adherence was consistently associated with patient satisfaction with communication, patient-provider relationship, their treatment, and use of eHealth and mHealth strategies; a patient's mental and physical health, including depression, cognitive impairment, frailty, and disability, previous hospitalization, occurrence of vital events; drug treatment type and appearance; and unwillingness due to health literacy, self-efficacy, and both implicit and explicit attitudes towards treatment. There were discrepancies regarding the association of other factors to adherence, but these inconsistent factors should also be taken into account. In conclusion, the barriers to adherence are varied and often interconnected between socioeconomic, patient, therapy, condition, and healthcare system levels. Healthcare teams should invest in studying patients' non-adherence motives and tailoring interventions to individual levels, by using a multifaceted approach to assess adherence. Further research is needed to analyze the impact of implicit attitudes, the use of new technological approaches, and the influence of factors that are inconsistently associated with non-adherence, to understand their potential in implementing adherence strategies.
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Affiliation(s)
| | - Jose A Simoes
- Department of Medical Sciences, Faculty of Health Sciences, University of Beira Interior, Covilhã, PRT
| | - Denise C Velho
- Family Medicine, ULS de Leiria, USF Santiago, Leiria, PRT
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Antimisiaris D, Folz RJ, Huntington-Moskos L, Polivka BJ. Specific Medication Literacy in Older Adults with Asthma. J Nurse Pract 2024; 20:104979. [PMID: 38706630 PMCID: PMC11064973 DOI: 10.1016/j.nurpra.2024.104979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
Purpose To explore specific medication literacy (SML) of older adults and associations of SML strength. Methods This was an observational study. Participants were at least 60 years old, with an asthma diagnosis and in good health. Data were collected by a registered nurse researcher. The SML data collection instrument gathered information about each medication a participant used: name, purpose, how taken, special instructions, adverse effects, and drug-drug or drug-disease interactions. An SML scoring rubric was developed. Results All could provide name, and most provided purpose, how taken. The lowest SML domains were side effects and interactions. Age at time of asthma diagnosis correlated with stronger SML scores and living in a disadvantaged neighborhood correlated with lower SML scores. Discussion Gaps in medication literacy may create less ability to self-monitor. Patients want medication literacy but struggle with appropriate, individualized, information. Conclusion The study provides insights on gaps and opportunities for SML.
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Affiliation(s)
| | - Rodney J. Folz
- Jerald B. Katz Academy, Houston Methodist Research Institute, Houston TX
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Qiao L, Li J, Nam S, Duan Y, Cheng L, Zhong Z, Ding S, Zhang Q, Zheng F. The effect of health coaching on blood pressure control and disease self-management among patients in rural area in China: a randomized controlled trial. Hypertens Res 2024; 47:1184-1195. [PMID: 38228748 DOI: 10.1038/s41440-023-01550-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 11/24/2023] [Accepted: 12/02/2023] [Indexed: 01/18/2024]
Abstract
The self-management education for patients with hypertension has not been widely provided in rural areas of China. Our study aimed to examine the effect of health coaching intervention on controlling BP and improving self-management skills among rural resident of ≤6 month-history of hypertension. A total of 102 participants were enrolled in the RCT. The control group received usual health guidance and follow-up management; the experimental group received health coaching and follow up management. The primary outcomes were the difference in changes of BP and mean self-management scores. The secondary outcomes included waist circumference, body mass index (BMI), and medication literacy. Participants in the experimental group showed a significantly greater improvement with respect to systolic BP and diastolic BP respectively (133.85 ± 4.74 mmHg vs 127.96 ± 5.42 mmHg;80.94 ± 5.52 mmHg vs 77.37 ± 4.44 mmHg, P < 0.05) and BMI (24.66 ± 2.19 kg/m2 vs 23.44 ± 2.05 kg/m2, P < 0.05) compared with the control group. A significant difference was also observed between the experimental and control groups in terms of self-management and medication literacy at both 3 and 6 months (P < 0.05). However, there was no significant difference in changes of waist circumferences between the two groups (22.6% vs 38.8%). In conclusion, for patients with diagnosed with hypertension within the last 6 months, health coaching maybe is an effective approach to control blood pressure and improve medication literacy and self-management skills.
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Affiliation(s)
- Li Qiao
- Nursing Department, The Third Xiangya Hospital, Central South University, No.138 Tongzipo Road, Yuelu District, Changsha, 410013, China
- College of Nursing, Anhui University of Chinese Medicine, Hefei, 230012, China
| | - Jingle Li
- Department of Cardiovascular Medicine, The Third Xiangya Hospital, Central South University, No.138 Tongzipo Road, Yuelu District, Changsha, 410013, China
| | - Soohyun Nam
- School of Nursing, Yale University, 400 West Campus, Orange, CT, 06477, USA
| | - Yinglong Duan
- Nursing Department, The Third Xiangya Hospital, Central South University, No.138 Tongzipo Road, Yuelu District, Changsha, 410013, China
- Department of Emergency and Critical Care Medicine, The Third Xiangya Hospital, Central South University, No.138 Tongzipo Road, Yuelu District, Changsha, 410013, China
| | - Ling Cheng
- Xiangya School of Nursing, Central South University, Changsha, 410013, China
| | - Zhuqing Zhong
- Nursing Department, The Third Xiangya Hospital, Central South University, No.138 Tongzipo Road, Yuelu District, Changsha, 410013, China
| | - Siqing Ding
- Nursing Department, The Third Xiangya Hospital, Central South University, No.138 Tongzipo Road, Yuelu District, Changsha, 410013, China
| | - Qiuxiang Zhang
- Nursing Department, The Third Xiangya Hospital, Central South University, No.138 Tongzipo Road, Yuelu District, Changsha, 410013, China
| | - Feng Zheng
- Nursing Department, The Third Xiangya Hospital, Central South University, No.138 Tongzipo Road, Yuelu District, Changsha, 410013, China.
- Department of Cardiovascular Medicine, The Third Xiangya Hospital, Central South University, No.138 Tongzipo Road, Yuelu District, Changsha, 410013, China.
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Fadl Elmula FEM, Mariampillai JE, Heimark S, Kjeldsen SE, Burnier M. Medical Measures in Hypertensives Considered Resistant. Am J Hypertens 2024; 37:307-317. [PMID: 38124494 PMCID: PMC11016838 DOI: 10.1093/ajh/hpad118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 12/08/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Patients with resistant hypertension are the group of hypertensive patients with the highest cardiovascular risk. METHODS All rules and guidelines for treatment of hypertension should be followed strictly to obtain blood pressure (BP) control in resistant hypertension. The mainstay of treatment of hypertension, also for resistant hypertension, is pharmacological treatment, which should be tailored to each patient's specific phenotype. Therefore, it is pivotal to assess nonadherence to pharmacological treatment as this remains the most challenging problem to investigate and manage in the setting of resistant hypertension. RESULTS Once adherence has been confirmed, patients must be thoroughly worked-up for secondary causes of hypertension. Until such possible specific causes have been clarified, the diagnosis is apparent treatment-resistant hypertension (TRH). Surprisingly few patients remain with true TRH when the various secondary causes and adherence problems have been detected and resolved. Refractory hypertension is a term used to characterize the treatment resistance in hypertensive patients using ≥5 antihypertensive drugs. All pressor mechanisms may then need blockage before their BPs are reasonably controlled. CONCLUSIONS Patients with resistant hypertension need careful and sustained follow-up and review of their medications and dosages at each term since medication adherence is a very dynamic process.
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Affiliation(s)
- Fadl Elmula M Fadl Elmula
- Division of Medicine, Ullevaal University Hospital, Cardiorenal Research Centre, Oslo, Norway
- Heart Center, King Faisal Specialist Hospital and Research Center, Riyadh, KSA
| | | | - Sondre Heimark
- Division of Medicine, Ullevaal University Hospital, Cardiorenal Research Centre, Oslo, Norway
- Medical Faculty, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Nephrology, Ullevaal University Hospital, Oslo, Norway
| | - Sverre E Kjeldsen
- Division of Medicine, Ullevaal University Hospital, Cardiorenal Research Centre, Oslo, Norway
- Medical Faculty, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Ullevaal University Hospital, Oslo, Norway
| | - Michel Burnier
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
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Soares SM, Diniz MQDA, Davino DMBMC, Albieri FB, Santos AS, Jesus EMS, Lyra-Junior DP, Neves SJ, Oliveira-Filho AD. The Simplified Medication Adherence Questionnaire: validation of a Brazilian-Portuguese version in hypertensive adults. Front Pharmacol 2024; 15:1348917. [PMID: 38666030 PMCID: PMC11043597 DOI: 10.3389/fphar.2024.1348917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 03/06/2024] [Indexed: 04/28/2024] Open
Abstract
Background Self-reported adherence scales are widely used in research and practice because they are low in cost and easy to apply. A free version in Brazilian-Portuguese of the Simplified Medication Adherence Questionnaire (SMAQ) can be a useful alternative for determining the adherent behavior of hypertensive patients. Purpose To translate and evaluate the psychometric properties of the Brazilian-Portuguese version of the SMAQ therapeutic adherence scale for patients with arterial hypertension. Patients and methods A multicenter, cross-sectional study was conducted in five outpatient units in Maceió-AL and Aracaju-SE between January and July 2019. A total of 117 patients aged over 18 years using antihypertensive drugs were recruited. The cross-cultural adaptation followed international methodological recommendations. Internal consistency (Cronbach's alpha) was tested as a reliability parameter. Criterion and construct validity were verified by concurrent validation, exploratory factor analysis (EFA), and validation by known groups. Results The participants had a mean age of 56.6 years (SD = 10.7 years); most were female (72.6%). The mean number of antihypertensives prescribed per patient was 1.87 (SD = 0.87). There were 79.5% (n = 86) of patients considered non-adherent. Internal consistency was satisfactory (Cronbach's alpha = 0.63). A satisfactory correlation coefficient was verified with the Morisky-Green-Levine test as an external criterion (r = 0.56, p < 0.001). The scale's sensitivity measured through known group validity was 75.3%, specificity 29.5%, positive predictive value 63.9%, and negative predictive value 41.9%. We identified two factors of the instrument's construct from EFA: specific medication-taking behaviors and barriers to adherence. The initial KMO measure of sampling adequacy was 0.691, and Bartlett's test of sphericity was significant (χ2 = 118.342, p < 0.001). Conclusion The Brazilian-Portuguese version of the SMAQ scale proved valid and reliable for determining adherence to the pharmacotherapy in hypertensive patients. It showed more ability to detect non-adherent patients but with low specificity, possibly influenced by high social desirability.
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Affiliation(s)
- Simony M. Soares
- Department of Pharmacy, Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Brazil
| | - Mirela Q. de Almeida Diniz
- Pharmacotherapy Research Group, Institute of Pharmaceutical Sciences, Federal University of Alagos, Maceió, Brazil
| | | | - Fernanda B. Albieri
- Pharmacotherapy Research Group, Institute of Pharmaceutical Sciences, Federal University of Alagos, Maceió, Brazil
| | - Adriano S. Santos
- Department of Pharmacy, Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Brazil
| | - Elisdete M. S. Jesus
- Faculty of Pharmaceutical Sciences, State University of Campinas, Campinas, São Paulo, Brazil
| | - Divaldo P. Lyra-Junior
- Department of Pharmacy, Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Brazil
| | - Sabrina J. Neves
- Pharmacotherapy Research Group, Institute of Pharmaceutical Sciences, Federal University of Alagos, Maceió, Brazil
| | - Alfredo D. Oliveira-Filho
- Department of Pharmacy, Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Brazil
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Qin N, Yao Z, Shi S, Duan Y, Li X, Liu H, Zheng F, Zhong Z. Association between medication literacy and blood pressure control among hypertensive patients. Int J Nurs Pract 2024; 30:e13153. [PMID: 37062986 DOI: 10.1111/ijn.13153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 03/11/2023] [Accepted: 03/19/2023] [Indexed: 04/18/2023]
Abstract
AIM This study aimed to explore the association between medication literacy and blood pressure control among hypertensive patients. BACKGROUND Blood pressure control is a challenge for global health systems. Medication literacy is essential for medication self-management in hypertensive patients and a basis for managers to develop comprehensive intervention strategies for hypertension medication use. DESIGN A cross-sectional observational study was conducted. METHODS A total of 378 hypertensive patients was selected by convenience sampling from two tertiary hospitals and four community health service centres from December 2021 to January 2022 in Changsha, China. Associations between medication literacy and blood pressure control were identified with chi-square, independent samples t-tests and logistic regression analyses. RESULTS The average medication literacy score of the hypertensive patients investigated was low. Over a third of patients had uncontrolled blood pressure. Logistic regression analysis showed that medication literacy was an influencing factor for blood pressure control rate in hypertensive patients. CONCLUSIONS Medication literacy and blood pressure control among hypertensive patients was poor. Medication literacy was a facilitator of blood pressure control so improving medication literacy may be of value to improve blood pressure control in hypertensive patients.
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Affiliation(s)
- Ning Qin
- Nursing Department, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ziqiang Yao
- Xiangya Nursing School, Central South University, 172 Tongzipo Road, Changsha, 410013, China
| | - Shuangjiao Shi
- Cardiology Department, The Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, 410013, China
| | - Yinglong Duan
- Emergency Department, The Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, 410013, China
| | - Xiao Li
- Xiangya Nursing School, Central South University, 172 Tongzipo Road, Changsha, 410013, China
| | - Haoqi Liu
- Xiangya Nursing School, Central South University, 172 Tongzipo Road, Changsha, 410013, China
| | - Feng Zheng
- Cardiology Department, The Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, 410013, China
| | - Zhuqing Zhong
- Nursing Department, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
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Wu X, Cai S, Zhou Y, Lan Y, Lin Y. Development, Reliability and Validity of the Medication Literacy Scale for Parents of Children with Epilepsy. Patient Prefer Adherence 2024; 18:165-176. [PMID: 38249684 PMCID: PMC10800104 DOI: 10.2147/ppa.s446081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 12/21/2023] [Indexed: 01/23/2024] Open
Abstract
Purpose This study aimed to develop a medication literacy scale for parents of children with epilepsy (MLSPCE) and to test the reliability and validity of the scale. Patients and Methods The pilot scale was formulated based on the concept of medication literacy, the knowledge-attitude-practice model, and relevant literature reviews. It was formed through two rounds of expert consultations using the Delphi method. A survey of 657 parents of children with epilepsy, who were admitted to the neurology department or examined in the neuro-electrophysiological outpatient department of Guangzhou Women and Children Medical Center, using the pilot scale was conducted from October 2021 to January 2022 to test the reliability and validity of the scale questionnaire. The content validity of the scale questionnaire was assessed by consulting 20 neurology nursing, neurology clinician, and nursing education experts. Numbers, percentages, t-test, correlation analysis, Cronbach's alpha reliability coefficient and factor analysis were used for data analysis. Results The MLSPCE included 34 items in four dimensions. Ten factors were drawn from the explorative factor analysis, with a cumulative variance contribution rate of 62.32%. The content validity index of each item on the 34-item scale was between 0.81 and 1.0, and the scale-content validity index/ average was 0.97. The correlation coefficient between each item and its dimension was between 0.399 and 0.760, the correlation coefficients between dimensions were between 0.150 and 0.382, and the correlation coefficients between each dimension and the total scale were between 0.390 and 0.845. Differences for all comparisons were statistically significant (P < 0.05). Cronbach's alpha coefficient for the total scale was 0.864, and the split-half reliability of the total scale was 0.923. Conclusion All the statistical procedures performed in the validity and reliability stages of the study showed that MLSPCE is a valid and reliable tool for measuring medication literacy among Chinese parents of children with epilepsy.
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Affiliation(s)
- Xiaokun Wu
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, People’s Republic of China
| | - Shu Cai
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, People’s Republic of China
| | - Ye Zhou
- Department of Nursing, Luzhou Traditional Chinese Medicine Hospital, Luzhou, People’s Republic of China
| | - Yutao Lan
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, People’s Republic of China
| | - Yan Lin
- Department of Nursing, Guangzhou Women and Children’s Medical Center, Guangzhou, People’s Republic of China
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Lan L, Hai P, Luo J, Li R, Wang Y. Medical behaviours and medication adherence of older hypertensive patients in different medical insurance programs in Beijing, China: a cross-sectional study. BMC Geriatr 2023; 23:878. [PMID: 38124122 PMCID: PMC10734068 DOI: 10.1186/s12877-023-04476-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 11/10/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Grassroots medical institutions are the primary "battlefield" of hypertension management based on hierarchical diagnosis and treatment policies in China. There is a considerable difference in the insured population and reimbursement ratio between different medical insurance programs. The management of hypertension directly affects the development trend of cardiovascular and cerebrovascular diseases. METHODS To understand the difference between different medical insurance programs regarding the management of older hypertensive patients, all outpatients aged 60 and above with hypertension in the basic medical insurance database of Beijing, China, from April 1, 2019, to January 31, 2020, were included. Medical behaviours included patients' choice of hospital level, type of hospital, number of hospitals visited, grassroots medical institutions and cross-district visits. Medication adherence was evaluated by calculating the medication possession ratio of antihypertensive medications. First, we adopted a statistical description for medical behaviours and medication adherence. Then, multivariate logistic regression was used to analyse the influencing factors of medication adherence. RESULTS This study included 1.29 million patients with Urban Employee Basic Medical Insurance (UEBMI) and 0.31 million patients with Urban‒Rural Resident Basic Medical Insurance (URRBMI). The proportions of patients with UEBMI who chose tertiary hospitals, comprehensive hospitals, grassroots medical institutions and cross-district visits were 25.84%, 56.09%, 57.34% and 39.32%, respectively, while those of patients with URRBMI were 11.14%, 60.59%, 81.28% and 6.07%, respectively. The medication adherence rates of men and women taking one medication were 61.04% and 55.86%, respectively. UEBMI patients who took their medication accounted for 62.36%, while only 40.27% of URRBMI patients adhered to their medication. The percentages of young-old, old-old and oldest-old patients who took their antihypertensive medications were 58.05%, 59.09% and 56.78%, respectively. The adherence to taking ≥ 2 medications (35.47%) was lower than that to taking one medication (58.33%). The medication adherence rates of patients with UEBMI and URRBMI for taking ≥ 2 medications were 37.21% and 27.45%, respectively. CONCLUSIONS Patients with UEBMI were more inclined to choose tertiary hospitals and cross-district visits than patients with URRBMI. The adherence of patients with UEBMI was better than that of patients with URRBMI in China.
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Affiliation(s)
- Lan Lan
- IT Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Pengcheng Hai
- Department of Internal Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Jiawei Luo
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, 610044, China
| | - Rui Li
- IT Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.
- Chinese Institute for Brain Research, Beijing, 100070, China.
- National Center for Neurological Disorders, Beijing, 100070, China.
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, 100070, China.
- China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China.
- Beijing Laboratory of Oral Health, Capital Medical University, Beijing, 100070, China.
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, 100070, China.
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Wang A, Wan J, Zhu L, Chang W, Wen L, Tao X, Jin Y. Frailty and medication adherence among older adult patients with hypertension: a moderated mediation model. Front Public Health 2023; 11:1283416. [PMID: 38115848 PMCID: PMC10728772 DOI: 10.3389/fpubh.2023.1283416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 11/20/2023] [Indexed: 12/21/2023] Open
Abstract
Objective Medication adherence has a critical impact on the well-being of older adult patients with hypertension. As such, the current study aimed to investigate the mediating role of health literacy between frailty and medication adherence and the moderating role of educational level. Methods This cross-sectional study included patients admitted to the geriatric unit of a hospital. Participants were interviewed using the four-item Morisky Medication Adherence Scale, the Frailty Phenotype Scale, and the Health Literacy Management Scale. Spearman's correlation coefficients were used to assess the association between variables. Mediation and moderated mediation analyses were performed using Process version 4.1 via Model 4 and 14, respectively. Results Data from 388 participants were analyzed. The median (IQR [P25-P75]) score for medication adherence was 4.00 (2.00-4.00). Results revealed that after controlling for age, sex, hypertension complication(s) and body mass index, frailty significantly contributed to medication adherence (βtotal -0.236 [95% confidence interval (CI) -0.333 to -0.140]). Medication adherence was influenced by frailty (βdirect -0.192 [95% CI -0.284 to -0.099]) both directly and indirectly through health literacy (βindirect -0.044 [95% CI -0.077 to -0.014]). Educational level moderated the pathway mediated by health literacy; more specifically, the conditional indirect effect between frailty and medication adherence was significant among older adult hypertensive patients with low, intermediate, and high educational levels (effect -0.052 [95% CI -0.092 to -0.106]; effect -0.041 [95% CI -0.071 to -0.012]; effect -0.026 [95% CI -0.051 to -0.006]). The relationship between frailty and medication adherence in older adult patients with hypertension was found to have mediating and moderating effects. Conclusion A moderated mediation model was proposed to investigate the effect of frailty on medication adherence. It was effective in strengthening medication adherence by improving health literacy and reducing frailty. More attention needs to be devoted to older adult patients with hypertension and low educational levels.
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Affiliation(s)
- Anshi Wang
- School of Public Health, Wannan Medical College, Wuhu, China
- Institutes of Brain Science, Wannan Medical College, Wuhu, China
| | - Jingjing Wan
- Department of Nursing, Anhui College of Traditional Chinese Medicine, Wuhu, China
| | - Lijun Zhu
- School of Public Health, Wannan Medical College, Wuhu, China
| | - Weiwei Chang
- School of Public Health, Wannan Medical College, Wuhu, China
| | - Liying Wen
- School of Public Health, Wannan Medical College, Wuhu, China
| | - Xiubin Tao
- Nursing Department, Yijishan Hospital of Wannan Medical College, Wuhu, China
| | - Yuelong Jin
- School of Public Health, Wannan Medical College, Wuhu, China
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Liu T, Zhao X, Huang M, Yang Y, Chen Z, He X, Li X, Jiang W. Hypertension doctors' awareness and practice of medication adherence in hypertensive patients: a questionnaire-based survey. PeerJ 2023; 11:e16384. [PMID: 38047018 PMCID: PMC10693237 DOI: 10.7717/peerj.16384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 10/10/2023] [Indexed: 12/05/2023] Open
Abstract
Background Poor adherence to antihypertensive drugs is a major cause of unsatisfactory blood pressure control. Hypertension doctors play an integral role in improving medication adherence in hypertensive patients. Although most existing studies have recognized the status quo and influencing factors of medication adherence, little attention has been paid to hypertension doctors' awareness and practice in hypertension management. Therefore, in this study, we aimed to investigate hypertension doctors' awareness and practice of medication adherence in hypertensive patients. Methods This is a cross-sectional survey. A self-reported questionnaire was developed and sent to hypertension doctors in Hunan province, China, between May 1, 2022 and July 1, 2022. Univariate and generalized linear models were used to identify the factors influencing hypertension doctors' awareness and practice. The correlation between awareness and practice was determined using Spearman's correlation coefficient. Results In total, 236 valid questionnaires were collected (valid response rate, 73.5%). Of the respondents, 44.1% were chief physicians and 64.4% were females. Approximately half of the respondents were ≥40 years old and had over 14 years of working experience. Most respondents (87.7%) did not have hypertension, but 54.2% had a family history of hypertension. The average awareness and practice scores were 29.8 ± 8.8 and 39.4 ± 7.1, respectively, out of 50, with higher scores indicating higher levels of awareness or practice. More hypertension consultations and more antihypertensive prescriptions issued were associated with better awareness and practice among respondents (ps < 0.05). Respondents with higher education and professional titles had higher awareness (ps < 0.05). Moreover, respondents with 6-13 years of work experience had better practice than those with <5 years of work experience (p = 0.017). There was a significant correlation between hypertension doctors' awareness and practice of medication adherence in hypertensive patients (R = 0.682, p < 0.001). These findings indicate that misconceptions persist in hypertension doctors' awareness and practice of patient medication adherence. Conclusion Hypertension doctors lack sufficient and correct awareness and practice of medication adherence in hypertensive patients.
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Affiliation(s)
- Tao Liu
- Department of Cardiovascular Medicine, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiexiong Zhao
- Department of Cardiovascular Medicine, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Miao Huang
- Department of Cardiovascular Medicine, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yan Yang
- Department of Cardiovascular Medicine, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhi Chen
- Department of Cardiovascular Medicine, Xingsha hospital, Changsha, Hunan, China
| | - Xin He
- Department of Cardiovascular Medicine, The People’s Hospital of Liuyang, Changsha, Hunan, China
| | - Xiaogang Li
- Department of Cardiovascular Medicine, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Weihong Jiang
- Department of Cardiovascular Medicine, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hypertension Research Center of Hunan Province, Hunan, China (Mainland)
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11
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Liu H, Yao Z, Shi S, Zheng F, Li X, Zhong Z. The Mediating Effect of Self-Efficacy on the Relationship Between Medication Literacy and Medication Adherence Among Patients with Type 2 Diabetes. Patient Prefer Adherence 2023; 17:1657-1670. [PMID: 37465055 PMCID: PMC10351528 DOI: 10.2147/ppa.s413385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/07/2023] [Indexed: 07/20/2023] Open
Abstract
Background Patients with type 2 diabetes have poor medication adherence. Medication literacy is one of the influencing factors of medication adherence among patients with type 2 diabetes. However, the mechanism by which medication literacy affects medication adherence among patients with type 2 diabetes is unclear. The aim of this study was to verify the mediating role of self-efficacy in the relationship between medication literacy and medication adherence. Methods A total of 402 patients with type 2 diabetes were enrolled in this study. The Chinese versions of the Medication Literacy Scale, the Self-Efficacy for Appropriate Medication Use Scale and the Morisky Medication Adherence Scale-8 were used in the survey. Pearson correlation analysis was used to find correlations among medication literacy, self-efficacy and medication adherence. The PROCESS macro (Version 4.1) with Model 4 for SPSS was used to verify the mediating role of self-efficacy. Results Twenty-four percent of the participants had poor medication adherence. Self-efficacy and medication literacy (r=0.499, p < 0.01) and medication adherence (r=0.499, p < 0.01) were significantly and positively correlated. Self-efficacy partially mediated the relationship between medication knowledge and medication adherence among patients with type 2 diabetes, accounting for 36.7% of the total effect. Conclusion Self-efficacy had a partial mediating effect on the relationship between medication literacy and medication adherence among patients with type 2 diabetes. Self-efficacy should be improved through effective measures to increase patients' confidence in adherence to antihyperglycemic drugs.
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Affiliation(s)
- Haoqi Liu
- Nursing Department, The Third Xiangya Hospital, Central South University, Changsha, People’s Republic of China
- Xiangya Nursing School, Central South University, Changsha, People’s Republic of China
| | - Ziqiang Yao
- Nursing Department, The Third Xiangya Hospital, Central South University, Changsha, People’s Republic of China
- Xiangya Nursing School, Central South University, Changsha, People’s Republic of China
| | - Shuangjiao Shi
- Nursing Department, The Third Xiangya Hospital, Central South University, Changsha, People’s Republic of China
| | - Feng Zheng
- Nursing Department, The Third Xiangya Hospital, Central South University, Changsha, People’s Republic of China
- Xiangya Nursing School, Central South University, Changsha, People’s Republic of China
- Cardiology Department, The Third Xiangya Hospital, Central South University, Changsha, People’s Republic of China
| | - Xia Li
- Nursing Department, The Third Xiangya Hospital, Central South University, Changsha, People’s Republic of China
- Endocrinology Department, The Third Xiangya Hospital, Central South University, Changsha, People’s Republic of China
| | - Zhuqing Zhong
- Nursing Department, The Third Xiangya Hospital, Central South University, Changsha, People’s Republic of China
- Xiangya Nursing School, Central South University, Changsha, People’s Republic of China
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12
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Wang W, Luan W, Zhang Z, Mei Y. Association between medication literacy and medication adherence and the mediating effect of self-efficacy in older people with multimorbidity. BMC Geriatr 2023; 23:378. [PMID: 37337135 DOI: 10.1186/s12877-023-04072-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 05/26/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Multimorbidity has a significant impact on public health and primary care. Medication adherence is recognized as the most effective measure for managing and preventing multimorbidity. Studies have shown that medication literacy has a positive effect on medication adherence in patients with multimorbidity. However, limited knowledge exists regarding the underlying mechanisms of this relationship in older adults with multimorbidity. Therefore, the aim of this study was to investigate the mediating role of self-efficacy in the association between medication literacy and medication adherence in this population. METHODS This study employed a cross-sectional design and convenience sampling method to survey older patients with multimorbidity in six communities in Zhengzhou, China, from July 12, 2021, to December 15, 2021. Participants were assessed using a demographic questionnaire, the Chinese Version of the Medication Literacy Scale (C-MLS), the Self-Efficacy for Appropriate Medication Use Scale (SEAMS), and the Chinese Version of the Morisky Medication Adherence Scale-8 (C-MMAS-8). Data were analyzed using descriptive statistics, t-tests, one-way analysis of variance, Pearson correlation analysis, and mediation analysis. RESULTS A total of 350 elderly patients met the inclusion criteria, and 328 valid questionnaires were collected. The mean age of the participants was 74.90 ± 7.37 years, with a slightly higher proportion of males (55.8%) than females (44.2%). The mean score for medication adherence was 4.85 ± 1.57, indicating poor medication adherence among the participants. Medication adherence scores varied significantly among participants of different ages, education levels, employment statuses and kinds of medication (p < 0.01). Scores for medication literacy and self-efficacy showed a significant positive correlation with medication adherence scores (all p < 0.001). The standardized coefficient for the total effect and direct effect of medication literacy on medication adherence was 0.268 (95% CI: 0.201, 0.335) and 0.187 (95% CI: 0.123, 0.252), respectively. After introducing self-efficacy into the model, the standardized coefficient for the indirect effect was 0.081 (95% CI: 0.049, 0.120), indicating that self-efficacy partially mediated the relationship between medication literacy and medication adherence, accounting for 30.22% of the total effect. CONCLUSION This study might suggest that medication literacy indirectly affected medication adherence in older people with multimorbidity through self-efficacy. Health care providers should be aware of the importance of improving medication literacy and implement strategies aimed at increasing self-efficacy to achieve the goal of improving medication adherence in older adults with multimorbidity.
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Affiliation(s)
- Wenna Wang
- Academy of Medical Sciences, Zhengzhou University, Zhengzhou, Henan, China
- School of Nursing and Health, Zhengzhou University, No. 100, Kexue Road, Zhongyuan District, Zhengzhou, Henan, China
| | - Wenyan Luan
- School of Nursing and Health, Zhengzhou University, No. 100, Kexue Road, Zhongyuan District, Zhengzhou, Henan, China
| | - Zhenxiang Zhang
- School of Nursing and Health, Zhengzhou University, No. 100, Kexue Road, Zhongyuan District, Zhengzhou, Henan, China.
| | - Yongxia Mei
- School of Nursing and Health, Zhengzhou University, No. 100, Kexue Road, Zhongyuan District, Zhengzhou, Henan, China
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Lu T, Yang Z, Chen P, Li J, Zheng C, Kong L, Zhang H. Influencing factors of medication literacy among community-dwelling older adult patients with hypertension: a study based on social learning theory. Front Pharmacol 2023; 14:1184701. [PMID: 37332350 PMCID: PMC10272614 DOI: 10.3389/fphar.2023.1184701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 05/23/2023] [Indexed: 06/20/2023] Open
Abstract
Objective: This study aimed to examine the factors affecting medication literacy in community-dwelling older adults with hypertension, guided by social learning theory. It sought to analyze the pathways these factors influenced and provide a theoretical foundation for designing targeted intervention programs. Study design: This is a cross-sectional study. Methods: From October 2022 to February 2023, a total of 432 community-dwelling older adults with hypertension from Linghe District, Guta District, and Taihe District, Jinzhou City, Liaoning Province, China, were selected using convenience sampling. Data were collected using a socio-demographic questionnaire, a medication literacy questionnaire, the Brief Illness Perception Questionnaire, the General Self-efficacy Scale, and the Perceived Social Support Scale. The collected data were analyzed with Kruskal-Wallis and Mann-Whitney tests, correlation analysis, multiple stepwise regression analysis, and structural equation modeling (SEM). Results: The medication literacy score among the participants was 3.83 ± 1.91. Multi-factor analysis revealed key factors affecting their medication literacy, including blood pressure-control status, utilization of community health education resources, receiving guidance for medication usage, marital status, number of annual visits, social support, self-efficacy, and disease perception. The SEM based on social learning theory showed that general self-efficacy mediated the relationship between social support, disease perception, and medication literacy. Conclusion: The present study developed a model and provided potential intervention strategies to improve medication literacy, knowledge, and safety among community-dwelling older adults with hypertension, considering the relationships between the identified variables.
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Affiliation(s)
- Tingting Lu
- Department of Nursing, Jinzhou Medical University, Jinzhou, China
| | - Zhen Yang
- Department of Nursing, China Medical University, Shenyang, China
| | - Ping Chen
- Department of Nursing, Jinzhou Medical University, Jinzhou, China
| | - Jingyan Li
- Department of Nursing, Jinzhou Medical University, Jinzhou, China
| | - Chen Zheng
- Department of Nursing, Jinzhou Medical University, Jinzhou, China
| | - Linghui Kong
- Department of Nursing, Jinzhou Medical University, Jinzhou, China
| | - Huijun Zhang
- Department of Nursing, Jinzhou Medical University, Jinzhou, China
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Kustovs D, Urtāne I, Sevostjanovs E, Moreino E, Trušinskis K. Opportunities of Amlodipine as a Potential Candidate in the Evaluation of Drug Compliance during Antihypertensive Therapy. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020340. [PMID: 36837543 PMCID: PMC9962722 DOI: 10.3390/medicina59020340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 02/15/2023]
Abstract
Background and Objectives: Blood pressure measurement is essential evidence to establish that the chosen medicine and dosage are appropriate, and also indirectly indicates whether the medicine is being used at all. Therefore, current research compares adherence to the target blood pressure at home and in the hospital between different age groups, using similar combinations of the drugs prescribed by the doctor within ongoing antihypertensive therapy. Moreover, it is very important to develop a method for the determination of amlodipine and its metabolite, which would suitable for clinical applications, when the result is needed as quick as possible. Materials and Methods: This prospective study included patients aged ≥18 years who were diagnosed with hypertension. Subjects were divided into two age groups according to European Society of Cardiology (ESC) hypertension guidelines; older patients (≥65 years) and adult patients (<65 years). Assessment of adherence rate to antihypertensive medications was performed using a measurement of systolic blood pressure and comparing this to ESC hypertension guideline data. A simple liquid chromatography-tandem mass spectrometer (LC-MS/MS) method for determination of amlodipine and dehydroamlodipine was developed and validated according to the European Medicines Agency guideline on bioanalytical method validation at the Latvian Institute of Organic Synthesis. Results: A total of 81 patients with arterial hypertension were enrolled in this study. A significant number of patients were overweight (N = 33, 40.7%) and obese (N = 36, 44.4%). To control arterial hypertension, 70 (86.4%) patients used fixed-dose combinations, where one of the components was amlodipine. Practically, 36 (44.4%) hypertensive subjects were not able to comply with target blood pressure. Nonetheless, 38 (46.9%) patients who received fixed-dose combinations were able to comply with target blood pressure. Conclusions: Adherence to ESC hypertension guideline proposed target blood pressure was relatively low among hypertensive subjects even though a significant number of patients were taking fixed-dose combinations. Therefore, optimizing prevention, recognition, and care of hypertensive young adults require intensive educational interventions. Moreover, survey data suggest that therapeutic drug monitoring using the validated simple, sensitive LC-MS/MS method is pivotal for further understanding factors influencing adherence.
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Affiliation(s)
- Dmitrijs Kustovs
- Department of Pharmaceutical Chemistry, Riga Stradiņš University, LV-1007 Riga, Latvia
- Correspondence: ; Tel.: +371-26838461
| | - Inga Urtāne
- Department of Pharmaceutical Chemistry, Riga Stradiņš University, LV-1007 Riga, Latvia
| | - Eduards Sevostjanovs
- Laboratory of Physical Organic Chemistry, Latvian Institute of Organic Synthesis, LV-1006 Riga, Latvia
| | - Eva Moreino
- Department of Internal Disease, Riga Stradiņš University, LV-1007 Riga, Latvia
| | - Kārlis Trušinskis
- Department of Internal Disease, Riga Stradiņš University, LV-1007 Riga, Latvia
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Al-Ali NM, Telfah RK. The effect of health literacy in explaining medication adherence among patients with hypertension: A cross-sectional study of Syrian refugees in Jordan. Int J Nurs Pract 2023:e13136. [PMID: 36683246 DOI: 10.1111/ijn.13136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/09/2023] [Accepted: 01/09/2023] [Indexed: 01/24/2023]
Abstract
BACKGROUND Poor medication adherence is a concern among patients with hypertension. However, few studies have assessed the effect of health literacy on medication adherence among refugee patients. AIM The aim was to examine the effect of health literacy and associated factors in explaining medication adherence among Syrian refugee patients with hypertension. METHODS A cross-sectional study was used, recruiting 150 Syrian refugees with hypertension in February 2020. The Hill-Bone scale and the Health Literacy Questionnaire were used to collect data, which were analysed using descriptive and inferential statistics. RESULTS Participants had low levels of medication adherence and had low mean scores in eight of nine subscales of the health literacy scale, except in the appraisal of health information subscale. Factors including patient's age, marital status, the number of medications and co-morbid diseases were significantly associated with medication adherence. Age, understanding written health information and ability to engage with healthcare providers were predictive of medication adherence. CONCLUSION To increase medication adherence among refugee patients with hypertension, nurses need to improve patients' health literacy and understanding of health information about their disease.
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Affiliation(s)
- Nahla Mansour Al-Ali
- Community and Mental Health Department/Faculty of Nursing, Jordan University of Science & Technology, Irbid, Jordan
| | - Reem Khaled Telfah
- Community and Mental Health Department/Faculty of Nursing, Jordan University of Science & Technology, Irbid, Jordan
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Chang X, Wang K, Wang Y, Tu H, Gong G, Zhang H. Medication Literacy in Chinese Patients with Stroke and Associated Factors: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:620. [PMID: 36612941 PMCID: PMC9819866 DOI: 10.3390/ijerph20010620] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/22/2022] [Accepted: 12/27/2022] [Indexed: 06/17/2023]
Abstract
In China, stroke is characterized by high incidence, recurrence, disability, economic burden, and mortality. Regular and effective medication therapy can reduce stroke recurrence. High medication literacy is vital for the success of tertiary prevention measures aimed at preventing recurrence and minimizing disability. A cross-sectional survey using a medication literacy questionnaire was conducted between January and May 2022 on 307 inpatients of a Class III Grade A hospital in Hefei, Anhui Province, China. The demographic and clinical data of the patients were obtained from medical records. The health literacy of the patients was moderate, with 36.8% exhibiting adequate medication literacy. Univariate analysis identified significant differences in the medication literacy of the patients, depending on education level, annual income, family history of stroke, number of health problems, age, daily medication times, and brain surgery history. Multiple regression analysis revealed that education level, annual income, family history of stroke, and number of health problems significantly influenced medication literacy. In patients with stroke who are older and have a low education level, more health problems, no history of surgery, or no family history of stroke or medication guidance, medication knowledge and attitude can be improved to enhance medication safety and guarantee tertiary-level prevention of stroke.
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Affiliation(s)
- Xiao Chang
- The First Affiliated Hospital of Anhui Medical University, Hefei 230032, China
| | - Kai Wang
- The First Affiliated Hospital of Anhui Medical University, Hefei 230032, China
| | - Yuting Wang
- The First Affiliated Hospital of Anhui Medical University, Hefei 230032, China
| | - Houmian Tu
- The First Affiliated Hospital of Anhui Medical University, Hefei 230032, China
| | - Guiping Gong
- The First Affiliated Hospital of Anhui Medical University, Hefei 230032, China
| | - Haifeng Zhang
- School of Health Management, Anhui Medical University, Hefei 230032, China
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Poka MS, Chanyandura JT, Witika BA. Challenges faced by blind patients using chronic medication at a tertiary hospital in South Africa. Health SA 2022; 27:1900. [PMID: 36570091 PMCID: PMC9772741 DOI: 10.4102/hsag.v27i0.1900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 09/20/2022] [Indexed: 12/24/2022] Open
Abstract
Background Difficulties faced by blind patients in using medicines are largely unknown and underexplored. This limits the ability of health providers and health policy makers to plan and provide for medicine related needs of this special group. Objectives To describe the challenges faced by blind patients around Mankweng Hospital when taking chronic medications and to identify methods used to overcome the challenges. Methods Quantitative cross-sectional descriptive study, where questionnaires were administered to 82 blind patients, 18 years and older, and who were on chronic medications. Data was analysed using the Statistical Package for the Social Sciences (SPSS) software. Results Majority of participants were elderly (59%) and had partial blindness (78%). Challenges faced by participants included inability to locate and identify medication (60%), missing doses (64%), inaccurate dosing and spilling medicines (33%). A staggering 68.3% of the participants did not have specific methods to overcome challenges. Conclusions Challenges faced by the blind and visually impaired are similar across the world. However, participants are unaware of other simple, feasible methods available in the market. Current methods used by the participants to overcome the challenges encountered are minimal or caregiver dependent. Programs may be set up at clinics, hospitals and health care centers to teach the visually impaired simple and inexpensive methods to help administer medications. Contribution Results obtained may be used to raise awareness in health care policy makers of the under-explored challenges faced by the partially blind or completely blind patients in the use of medicines.
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Affiliation(s)
- Madan S. Poka
- Department of Pharmaceutical Sciences, Faculty of Health Sciences, Sefako Makgatho University, Pretoria, South Africa
| | - Jonathan T. Chanyandura
- Department of Pharmacy, Faculty of Health Sciences, University of Limpopo, Polokwane, South Africa
| | - Bwalya A. Witika
- Department of Pharmaceutical Sciences, Faculty of Health Sciences, Sefako Makgatho University, Pretoria, South Africa
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Shen Z, Ding S, Shi S, Zhong Z. Association between social support and medication literacy in older adults with hypertension. Front Public Health 2022; 10:987526. [PMID: 36419989 PMCID: PMC9677095 DOI: 10.3389/fpubh.2022.987526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 10/20/2022] [Indexed: 11/09/2022] Open
Abstract
Background Reduced physical function and reduced social networks place older adults with hypertension at high risk for medication-related harm. Medication literacy is one of the preventable factors that affect the success of drug therapy for hypertension. However, little is known about the level of medication literacy and its influencing factors in older adults with hypertension. Objective The purpose of this study was to investigate the levels of social support and medication literacy, and the association between them in older Chinese adult patients with hypertension. Methods A total of 362 older adult patients with hypertension were investigated using a demographic characteristics questionnaire, the Chinese Medication Literacy Scale for Hypertensive Patients (C-MLSHP) and the Social Support Rating Scale (SSRS). Pearson correlation analysis, canonical correlation analysis (CCA) and hierarchical linear regression were used to analyse the relationship between social support and medication literacy. Results Our results showed that the mean scores for the C-MLSHP and the SSRS for older adult patients with hypertension were 23.89 (SD = 4.66) and 39.22 (SD = 5.53), respectively. The results of the Pearson correlation analysis suggested that the score for social support was positively correlated with the score for medication literacy (r = 0.431, P < 0.01). The results of CCA demonstrate that older adult patients with hypertension who had more subjective (r s = 0.682) and objective support (r s = 0.817) performed better in knowledge (r s = 0.633), skills (r s = 0.631) and behavior literacy (r s = 0.715). Hierarchical linear regression indicated that two dimensions of subjective support (B = 0.252, P < 0.001) and objective support (B = 0.690, P < 0.001) in social support were found to be independent predictors of medication literacy (R2 = 0.335, F = 19.745, P < 0.001). Conclusion Social support is positively associated with medication literacy in older Chinese adult patients with hypertension. The study highlights the importance of social support in promoting medication literacy among older adult patients with hypertension.
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Affiliation(s)
- Zhiying Shen
- Department of Hematology, Third Xiangya Hospital, Central South University, Changsha, China,Clinical Nursing Safety Management Research Center of Central South University, Third Xiangya Hospital, Central South University, Changsha, China,Department of Nursing, Third Xiangya Hospital, Central South University, Changsha, China
| | - Siqing Ding
- Clinical Nursing Safety Management Research Center of Central South University, Third Xiangya Hospital, Central South University, Changsha, China
| | - Shuangjiao Shi
- Department of Hematology, Third Xiangya Hospital, Central South University, Changsha, China,Clinical Nursing Safety Management Research Center of Central South University, Third Xiangya Hospital, Central South University, Changsha, China,Department of Nursing, Third Xiangya Hospital, Central South University, Changsha, China,*Correspondence: Shuangjiao Shi
| | - Zhuqing Zhong
- Clinical Nursing Safety Management Research Center of Central South University, Third Xiangya Hospital, Central South University, Changsha, China,Department of Nursing, Third Xiangya Hospital, Central South University, Changsha, China,Zhuqing Zhong
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Ma J, Zeng F, Han L, Guan Q. Educational level differences in the primary and secondary prevention of stroke. Prev Med 2022; 164:107283. [PMID: 36181771 DOI: 10.1016/j.ypmed.2022.107283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 09/01/2022] [Accepted: 09/24/2022] [Indexed: 10/31/2022]
Abstract
The aim of this study is to estimate the educational level differences in the primary and secondary prevention of stroke among the Chinese population. Data were obtained from the China Kadoorie Biobank (CKB) survey of 512,891 people aged 30-79 years in 10 geographic regions of China, which was conducted from 2002 to 2008. The Prediction for Atherosclerotic Cardiovascular Disease Risk in China model was used to identify individuals with a high estimated 10-year stroke risk. A total of 8884 participants (1.7%) had established stroke and 218,972 (42.7%) had a high stroke risk. In both primary and secondary prevention, the participants' educational level was positively associated with the control of smoking, blood pressure, consuming a healthy diet, and the use of antiplatelet, BP-lowering medications but negatively associated with higher physical activity levels (all Ptrend < 0.001). In addition, the positive associations were observed with the control of drinking and use of anti-hyperglycaemia medication for primary prevention (all Ptrend < 0.001) and with the use of lipid-lowering medication for secondary prevention (Ptrend = 0.019). The results of the interaction between education level and prevention level showed that, compared with participants in primary prevention, educational level disparities in those with secondary prevention had significantly higher use of antiplatelets and lipid-lowering drugs, achieving the physical activity goal and non-current drinker (all Pfor interaction < 0.05). A higher education level was associated with an increased acceptance of primary and secondary prevention strategies (not smoking or drinking, consuming a healthier diet) except for engaging in a suitable level of physical activity.
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Affiliation(s)
- Junrong Ma
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou City, Guangdong Province, PR China
| | - Fangfang Zeng
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou City, Guangdong Province, PR China
| | - Liyuan Han
- Department of Global Health, Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo City, Zhejiang Province, PR China; Department of Neurology, Ningbo No. 2 Hospital, Ningbo City, Zhejiang Province, PR China.
| | - Qiongfeng Guan
- Department of Neurology, Ningbo No. 2 Hospital, Ningbo City, Zhejiang Province, PR China.
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Zhang Y, Wang X, Cai J, Yang Y, Liu Y, Liao Y, Zhou Y, He B, Wen W, Zhuang Q, Lin Y. Status and influencing factors of medication literacy among Chinese caregivers of discharged children with Kawasaki disease. Front Public Health 2022; 10:960913. [PMID: 36324474 PMCID: PMC9618952 DOI: 10.3389/fpubh.2022.960913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 10/03/2022] [Indexed: 01/24/2023] Open
Abstract
Background The information on medication literacy among Chinese caregivers of discharged children with Kawasaki disease (KD) is unknown. We aimed to investigate the status of medication literacy among caregivers of discharged children with KD and evaluate the influencing factors of medication literacy. Methods From March 2020 to February 2021, 106 caregivers with a KD child were recruited for the present study. We collected the sociodemographic characteristics of the KD caregivers using structured interviews. The medication literacy of the KD caregivers was assessed by the Chinese version of Medication Literacy Assessment. KD patients' demographic and clinical data were obtained from the medical records. The multiple logistic regression was performed to identify factors associated with medication literacy. Results (1) The average medication literacy score was 4.91 ± 1.51. (2) Most of the Chinese KD caregivers had insufficient medication literacy (≤ 5 scores), and only 39.2% of the caregivers had adequate medication literacy (>5 scores). (3) The multiple logistic regression shows that education level, monthly income, and duration of hospitalization are the independent influencing factors on the medication literacy of KD caregivers. Conclusion There is preliminary evidence that medication literacy among KD caregivers is low and needs improvement. A higher level of education, higher income, and longer duration of hospitalization were influencing factors of adequate medication literacy.
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Affiliation(s)
- Yingzi Zhang
- Department of Pediatric Cardiology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xiuqiong Wang
- Department of Pediatric Cardiology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Jianghui Cai
- Department of Pharmacy, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yanfeng Yang
- Department of Pediatric Cardiology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China,*Correspondence: Yanfeng Yang
| | - Yiling Liu
- Department of Pediatric Cardiology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yeling Liao
- Department of Pediatric Cardiology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yanhong Zhou
- Department of Pediatric Cardiology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Baoqin He
- Department of Pediatric Cardiology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Wen Wen
- Department of Pediatric Cardiology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Qian Zhuang
- Department of Pediatric Cardiology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yonghong Lin
- Department of Obstetrics and Gynecology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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Lee EKP, Poon P, Yip BHK, Bo Y, Zhu MT, Yu CP, Ngai ACH, Wong MCS, Wong SYS. Global Burden, Regional Differences, Trends, and Health Consequences of Medication Nonadherence for Hypertension During 2010 to 2020: A Meta-Analysis Involving 27 Million Patients. J Am Heart Assoc 2022; 11:e026582. [PMID: 36056737 PMCID: PMC9496433 DOI: 10.1161/jaha.122.026582] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Background Nonadherence to antihypertensive medications is the leading cause of poor blood pressure control and thereby cardiovascular diseases and mortality worldwide. Methods and Results We investigated the global epidemiology, regional differences, and trend of antihypertensive medication nonadherence via a systematic review and meta‐analyses of data from 2010 to 2020. Multiple medical databases and clinicaltrials.gov were searched for articles. Observational studies reporting the proportion of patients with anti‐hypertensive medication nonadherence were included. The proportion of nonadherence, publication year, year of first recruitment, country, and health outcomes attributable to antihypertensive medication nonadherence were extracted. Two reviewers screened abstracts and full texts, classified countries according to levels of income and locations, and extracted data. The Joanna Briggs Institute prevalence critical appraisal tool was used to rate the included studies. Prevalence meta‐analyses were conducted using a fixed‐effects model, and trends in prevalence were analyzed using meta‐regression. The certainty of evidence concerning the effect of health consequences of nonadherence was rated according to Grading of Recommendations, Assessment, Development and Evaluations. A total of 161 studies were included. Subject to different detection methods, the global prevalence of anti‐hypertensive medication nonadherence was 27% to 40%. Nonadherence was more prevalent in low‐ to middle‐income countries than in high‐income countries, and in non‐Western countries than in Western countries. No significant trend in prevalence was detected between 2010 and 2020. Patients with antihypertensive medication nonadherence had suboptimal blood pressure control, complications from hypertension, all‐cause hospitalization, and all‐cause mortality. Conclusions While high prevalence of anti‐hypertensive medication nonadherence was detected worldwide, higher prevalence was detected in low‐ to middle‐income and non‐Western countries. Interventions are urgently required, especially in these regions. Current evidence is limited by high heterogeneity. Registration URL: www.crd.york.ac.uk/prospero/; Unique identifier: CRD42021259860.
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Affiliation(s)
- Eric K P Lee
- Jockey Club School of Public Health and Primary Care The Chinese University of Hong Kong Shatin Hong Kong
| | - Paul Poon
- Jockey Club School of Public Health and Primary Care The Chinese University of Hong Kong Shatin Hong Kong
| | - Benjamin H K Yip
- Jockey Club School of Public Health and Primary Care The Chinese University of Hong Kong Shatin Hong Kong
| | - Yacong Bo
- Jockey Club School of Public Health and Primary Care The Chinese University of Hong Kong Shatin Hong Kong
| | - Meng-Ting Zhu
- Jockey Club School of Public Health and Primary Care The Chinese University of Hong Kong Shatin Hong Kong
| | - Chun-Pong Yu
- Li Ping Medical Library The Chinese University of Hong Kong Shatin Hong Kong
| | - Alfonse C H Ngai
- Jockey Club School of Public Health and Primary Care The Chinese University of Hong Kong Shatin Hong Kong
| | - Martin C S Wong
- Jockey Club School of Public Health and Primary Care The Chinese University of Hong Kong Shatin Hong Kong
| | - Samuel Y S Wong
- Jockey Club School of Public Health and Primary Care The Chinese University of Hong Kong Shatin Hong Kong
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22
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Qin N, Duan Y, Yao Z, Shi S, Liu H, Li X, Zheng F, Zhong Z. Psychometric properties and validation of the revised Chinese Medication Literacy Scale for Hypertensive Patients (C-MLSHP-R). Front Cardiovasc Med 2022; 9:976691. [PMID: 36148050 PMCID: PMC9486212 DOI: 10.3389/fcvm.2022.976691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/02/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundMedication literacy is one of the key indicators that can affect the self-management of medications and medication safety. This study aimed to revise the Chinese Medication Literacy Scale for hypertensive patients (C-MLSHP) and test the reliability and validity of the revised scale.MethodsWe revised the C-MLSHP by several methods, i.e., focus group discussion, expert consultation, patient interview, and pilot study, based on the established evaluation index system of medication literacy for hypertensive patients. Then, a formal survey using the revised Chinese Medication Literacy Scale for hypertensive patients (C-MLSHP-R) was carried out on hypertensive patients from hospitals and community healthcare centers in Changsha city of China to test its reliability and validity. The reliability was evaluated with Cronbach's α coefficient, split-half reliability, and test–retest reliability. The validity was evaluated with content validity, construct validity, convergent validity, discriminant validity, and criterion-related validity.ResultsThe C-MLSHP-R contained 18 items within four domains, i.e., the knowledge domain included four items, the attitude domain had three items, the skill domain involved seven items, and the practice domain included four items. A total of 339 hypertensive patients participated in the formal survey. The results showed that the Cronbach's α coefficient of C-MLSHP-R was 0.802, and for each domain ranged from 0.639 to 0.815. The split-half reliability coefficient of C-MLSHP-R was 0.709, and for each domain ranged from 0.648 to 0.792. The test–retest reliability coefficient of C-MLSHP-R was 0.851, and for each domain ranged from 0.655 to 0.857. The I-CVI of each item ranged from 0.833 to 1.000, the S-CVI/Ave of C-MLSHP-R was 0.981, the S-CVI/UA was 0.889, and for each domain ranged from 0.958 to 1.000. Confirmatory factor analysis results showed that the model fitted well. The convergent validity of C-MLSHP-R was acceptable, and the discriminant validity was good. The criterion coefficient between C-MLSHP-R and C-MLSHP was 0.797, and for each domain ranged from 0.609 to 0.755.ConclusionCompared with C-MLSHP, the C-MLSHP-R with 18 items was much shorter for measuring, and had decreased reliability within the acceptable range and better validity, which was more appropriate and time-saving to assess the medication literacy level for hypertensive patients scientifically and conveniently.
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Affiliation(s)
- Ning Qin
- Nursing Department, The Third Xiangya Hospital, Central South University, Changsha, China
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Yinglong Duan
- Emergency Department, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Ziqiang Yao
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Shuangjiao Shi
- Cardiology Department, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Haoqi Liu
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Xiao Li
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Feng Zheng
- Cardiology Department, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Zhuqing Zhong
- Nursing Department, The Third Xiangya Hospital, Central South University, Changsha, China
- Xiangya School of Nursing, Central South University, Changsha, China
- Key Laboratory of Medical Information Research, College of Hunan Province, Central South University, Changsha, China
- *Correspondence: Zhuqing Zhong
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23
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Gentizon J, Bovet E, Rapp E, Mabire C. Medication Literacy in Hospitalized Older Adults: Concept Development. Health Lit Res Pract 2022; 6:e70-e83. [PMID: 35389270 PMCID: PMC8973764 DOI: 10.3928/24748307-20220309-02] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Jenny Gentizon
- Address correspondence to Jenny Gentizon, MSc, Lausanne University Hospital, Rue du Bugnon 46, Lausanne, Vaud, 1011, Switzerland; jenny.
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Ni H, Lin Y, Peng Y, Li S, Huang X, Chen L. Relationship Between Family Functioning and Medication Adherence in Chinese Patients With Mechanical Heart Valve Replacement: A Moderated Mediation Model. Front Pharmacol 2022; 13:817406. [PMID: 35273498 PMCID: PMC8902640 DOI: 10.3389/fphar.2022.817406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 01/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Medication adherence is crucial for patients with mechanical heart valve replacement. Although families functioning is positively associated with medication adherence, little is known about the underlying mechanisms. Objective: To test whether family functioning affects medication adherence through illness perceptions and whether this mediating effect was moderated by medication literacy. Methods: 319 patients after mechanical heart valve replacement were included in this cross-sectional study from June 2021 to October 2021. Data regarding family functioning, illness perceptions, medication adherence, and medication literacy were collected through questionnaires. The moderated mediation model was examined by Hayes's PROCESS macro, based on the bootstrapping method. Results: The results revealed illness perceptions partially mediated the association of family functioning on medication adherence [β = 0.08, 95% confidence intervals: (0.04, 0.12)], and this effect was stronger for patients with low medication literacy than those with high literacy [β = -0.36, 95% CI: (-0.50, -0.22)]. Furthermore, the relationship between family functioning and medication adherence was only significant in patients with low medication literacy [β = 0.36, 95% CI: (0.23, 0.50)]. Conclusion: The mediating effect of illness perceptions between family functioning and medication adherence was moderated by medication literacy. Efforts to improve medication adherence by targeting at improving family functioning may be more effective when considering illness perceptions, especially for patients with limited medication literacy.
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Affiliation(s)
- Hong Ni
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Yanjuan Lin
- Department of Nursing, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Yanchun Peng
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Sailan Li
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Xizhen Huang
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Liangwan Chen
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
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Wan J, Wu Y, Ma Y, Tao X, Wang A. Predictors of poor medication adherence of older people with hypertension. Nurs Open 2022; 9:1370-1378. [PMID: 35094495 PMCID: PMC8859025 DOI: 10.1002/nop2.1183] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 12/12/2021] [Accepted: 01/09/2022] [Indexed: 11/16/2022] Open
Abstract
Aims To explore the risk factors for poor medication adherence in older people with hypertension. Design A cross‐sectional study. Methods Participants were administered with a self‐report questionnaire about their demographic characteristics; additionally, their four‐item Morisky Medication Adherence Scale scores were calculated. The STROBE checklist was applied as the reporting guideline for this study (File S1). Results Univariate analysis indicated that the following five factors were statistically significantly associated with medication adherence: education level (χ2 = 8.073, p = .045), co‐living (χ2 = 11.364, p = .010), hypertension complications (χ2 = 10.968, p = .001), admission blood pressure (χ2 = 8.876, p = .003), and falls (χ2 = 6.703, p = .010). Multivariable binary logistic regression analysis showed that there were four statistically significant predictors, such as people who lived with spouses and offspring (OR = 3.004, p = .017), and those who had high admission blood pressure (OR = 1.910, p = .003) had a greater risk of poor medication adherence, whereas those without hypertension complications (OR = 0.591, p = .026) and those without falls (OR = 0.530, p = .046) had a lower risk. Relevance to clinical practice We believe that these findings contribute to the identification of high‐risk people with poor adherence, allowing nurses to identify people with poor adherence in a timely manner, and pay attention to the people's medication.
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Affiliation(s)
- Jingjing Wan
- Department of Graduate School Wannan Medical College Wuhu China
| | - Yinyin Wu
- Department of Graduate School Wannan Medical College Wuhu China
| | - Yuan Ma
- Department of Graduate School Wannan Medical College Wuhu China
| | - Xiubin Tao
- Nursing Department at First Affiliated Hospital of Wannan Medical College Wuhu China
| | - Anshi Wang
- Department of Public Health Wannan Medical College Wuhu China
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26
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Li Y, Liu G, Liu C, Wang X, Chu Y, Li X, Yang W, Shen Y, Wu F, Zhang W. Effects of Pharmacist Intervention on Community Control of Hypertension: A Randomized Controlled Trial in Zunyi, China. GLOBAL HEALTH, SCIENCE AND PRACTICE 2021; 9:890-904. [PMID: 34933984 PMCID: PMC8691874 DOI: 10.9745/ghsp-d-20-00505] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/15/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE We aimed to test the effects of pharmacist intervention on the community control of hypertension through a comparative randomized controlled trial. METHODS We recruited adult hypertensive patients with comorbidity or confusion with medication (n=636) from 2 community health centers in Zunyi, China. They were randomly and equally divided into 2 groups. Both groups received the usual care and participated in the community systematic management program of hypertension. Participants in the intervention group were given interventions from pharmacists, including a monthly review of medications, patient education, and medication adjustment advice to medical doctors over 6 months. Participants' blood pressure was assessed at baseline, 3 months, and 6 months. Participants' knowledge and medication adherence were measured using a questionnaire before and after the trial. RESULTS Compared to the control group (n=298), a significantly higher percentage of participants in the intervention group (n=290) had their blood pressure under control 3 months (46.9% vs. 38.3%, P=.034) and 6 months (60.7% vs. 40.9%, P<.001) after the interventions. Difference-in-differences analyses showed that the pharmacist intervention resulted in an increase in knowledge scores by 12.55 points (P<.001), a decrease in systolic blood pressure by 6.65 mmHg (P=.001), and a decrease in diastolic blood pressure by 7.26 mmHg (P<.001) compared to the controls after adjustment for variations in potential confounding factors. The odds of participants passing the hypertension knowledge tests in the intervention group was 4.45 times those in the control group (P<.001). Similarly, it was found that the intervention group had higher odds of not needing any medication adjustments (adjusted odds ratio [AOR]=2.75, P<.001) and having their blood pressure under control (AOR=2.18, P=.002) compared to the control group. CONCLUSION It is evident that pharmacist intervention has significant short-term effects on improving the knowledge and medication adherence of hypertensive patients, as well as timely medication adjustments from medical doctors, resulting in lowered blood pressure and an increased control rate. Further studies should explore the long-term sustainability of the effects of community pharmacist intervention.
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Affiliation(s)
- Ying Li
- School of Management, Zunyi Medical University, Zunyi, People's Republic of China
- The Second Affiliated Hospital of Zunyi Medical University, Zunyi, People's Republic of China
| | - Guoqin Liu
- School of Management, Zunyi Medical University, Zunyi, People's Republic of China.
| | - Chaojie Liu
- School of Psychology and Public Health, La Trobe University, Melbourne VIC 3086, Australia.
| | - Xianhong Wang
- School of Management, Zunyi Medical University, Zunyi, People's Republic of China
| | - Yalin Chu
- School of Management, Zunyi Medical University, Zunyi, People's Republic of China
| | - Xiaoqin Li
- School of Management, Zunyi Medical University, Zunyi, People's Republic of China
| | - Wenhao Yang
- School of Management, Zunyi Medical University, Zunyi, People's Republic of China
| | - Yewei Shen
- School of Management, Zunyi Medical University, Zunyi, People's Republic of China
| | - Fang Wu
- School of Management, Zunyi Medical University, Zunyi, People's Republic of China
| | - Wenzhi Zhang
- Department of Pharmacy, Affiliated Hospital of Zunyi Medical University, Zunyi, People's Republic of China
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27
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Effect of health literacy towards medication compliance on elderly with hypertension: An updated literature review. ENFERMERIA CLINICA 2021. [DOI: 10.1016/j.enfcli.2021.07.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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28
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Abu Khudair S, Khader YS, Morrissey H, El-Khatib Z, Sandor J. Factors Associated with Suboptimal Adherence to Hypertensive Medications Among Syrian Refugees - Cross-Sectional Study at the Zaatari Camp, Jordan. Patient Prefer Adherence 2021; 15:2125-2135. [PMID: 34584406 PMCID: PMC8464360 DOI: 10.2147/ppa.s327903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 08/25/2021] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE This study aimed to assess the level of medication adherence and associated factors among Syrian refugees with hypertension in Jordan. METHODS This cross-sectional study included 180 randomly selected Syrian refugees diagnosed with hypertension residing in Zaatari camp, Jordan. The Adherence to Refills and Medications Scale (ARMS) was used to assess adherence to antihypertensive medications. Additional data were collected on sociodemographics, therapy-related factors, patients' behaviors and knowledge of hypertension disease and therapy, and health system-related factors. Multivariate linear regression was used to assess the association between adherence scores and other variables. RESULTS The mean (SD) of ARMS scores was 15.7 (2.9). Based on ARMS scores, 22.8% of patients were adherents and 77.2% were non-adherents. Multivariate analysis showed that newly initiated therapy (≤2 years) and illiteracy were both strong predictors of lower adherence with p < 0.001 and p = 0.012, respectively. Other variables that were significantly associated with lower adherence included discontinuation of antihypertensive medications due to side effects (p = 0.032), reporting irregular availability of free antihypertensive medications dispensed by non-governmental organizations (NGOs) (p = 0.024), and dissatisfaction with health services (p = 0.022). CONCLUSION Suboptimal adherence to antihypertensive medications remains a substantial unmet need among Syrian refugees with hypertension. As illiteracy appears to have a negative impact on adherence levels, educational interventions that promote medication adherence and favorable health behaviors through auditory and visual aids are needed to better reach and engage people with limited literacy skills. Strengthening the pharmaceutical supply chain at various levels is strongly recommended to respond quickly to changes in demand and prevent an indirect negative impact on adherence levels.
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Affiliation(s)
- Sara Abu Khudair
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Yousef S Khader
- Department of Community Medicine, Public Health and Family Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Hana Morrissey
- Faculty of Science and Engineering, School of Pharmacy, University of Wolverhampton, Wolverhampton, UK
| | - Ziad El-Khatib
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Janos Sandor
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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Adherence Level to Arterial Hypertension Treatment: A Cross-Sectional Patient Survey and Retrospective Analysis of the NHS Prescription Database. Healthcare (Basel) 2021; 9:healthcare9081085. [PMID: 34442222 PMCID: PMC8392655 DOI: 10.3390/healthcare9081085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 08/12/2021] [Accepted: 08/19/2021] [Indexed: 12/02/2022] Open
Abstract
One of the major problems in cardiology practice is poor adherence to antihypertensive medication. This study aimed to evaluate medication adherence; we also aim to investigate the predictors of intentional and unintentional non-adherence. We issued a survey containing questions about patient demographics, blood pressure control, pharmaceutical care, and adherence level to medication. Retrospective analysis of the prescription database of the National Health Service of the Republic of Latvia was performed. The prevalence of non-adherence was 45.9%. The lowest adherence rate (38.2%) was found among patients taking medication for 2–4.9 years. Even though 84.7% of respondents had a blood pressure monitor at home, only 25.3% of them reported measuring blood pressure regularly. There were differences between the groups of adherent patients in terms of the patients’ net income (p = 0.004), medication co-payments (p = 0.007), and whether the pharmacist offered to reduce the costs of drug therapy (p = 0.002). Roughly half of the prescriptions (50.4%) containing perindopril were purchased by patients from pharmacies. The medication adherence level and blood pressure control at home were assessed as low. Intentionally non-adherent respondents discontinued their medication because of fear of getting used to medicines. The pharmacists’ behaviour in terms of offering to reduce the costs of medications used was influenced by socio-economic factors.
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Peimani M, Garmaroudi G, Stewart AL, Yekaninejad M, Shakibazadeh E, Nasli-Esfahani E. Patient-physician interpersonal processes of care at the time of diabetes treatment intensification and their links to patient outcomes. PATIENT EDUCATION AND COUNSELING 2021; 104:1659-1667. [PMID: 33431242 DOI: 10.1016/j.pec.2020.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 12/05/2020] [Accepted: 12/13/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To investigate how patient-physician interpersonal processes of care are related to levels of diabetes-related distress, diabetes medication-taking behavior, and HbA1c during conversations with patients about intensifying medication. METHODS We randomly recruited 1270 patients from diabetes specialty clinics in Tehran, Iran who were taking an additional oral diabetes medication or starting insulin during the prior 3 months. This interviewer-administered cross-sectional survey assessed multiple aspects of patient-physician interpersonal processes, diabetes-related distress, and diabetes medication-taking. Clinical history and HbA1c were collected from electronic medical records. Regression estimates and Structural Equation Modeling were used to test associations. RESULTS Some communication scales indicated a significant relationship with total diabetes distress (P < 0.001). Diabetes medication-taking was associated with less diabetes distress (adjusted odds ratio [aOR]=0.45, P < 0.001), lower Hurried Communication (aOR=0.72, P = 0.013), higher Elicited Concerns (aOR=1.30, P = 0.012), and higher Explained Results (aOR=1.41, P < 0.001) scores. SEM analyses showed medication-taking behavior was associated with a 0.68 decrease in HbA1c. Hurried Communication and diabetes distress were directly associated with HbA1c. CONCLUSION Aspects of patient-physician interpersonal processes at the time of intensifying diabetes treatment may be related to experiencing less distress, effective medication-taking, and improved HbA1c. PRACTICE IMPLICATIONS The results are intended to inform communication strategies that physicians might incorporate into practice.
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Affiliation(s)
- Maryam Peimani
- Department of Health Education & Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Gholamreza Garmaroudi
- Department of Health Education & Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Anita L Stewart
- Center for Aging in Diverse Communities, University of California San Francisco, San Francisco, CA, USA; Institute for Health & Aging, University of California San Francisco, San Francisco, CA, USA.
| | - MirSaeed Yekaninejad
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Elham Shakibazadeh
- Department of Health Education & Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Ensieh Nasli-Esfahani
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
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Abstract
Health literacy is defined as the ability to obtain, evaluate, and scrutinize health information and make appropriate decisions and actions. The spread of the Internet means that medical and drug information is becoming increasingly accessible to patients. However, there is also a large amount of inappropriate and biased medical- and drug-related information on the Internet. Therefore, patients require a high level of health literacy to ensure the effectiveness and safety of pharmacotherapy. In particular, outpatients need a high level of health literacy because they use their own medications without the supervision of healthcare professionals. In this article, I discuss the situation of health literacy and access to pharmaceutical information on the Internet in Japan. Furthermore, issues related to providing drug information to specific populations are explained using the example of chronic kidney disease. It is essential for all pharmaceutical information stakeholders to work together to solve these problems.
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Affiliation(s)
- Yuki Kondo
- Graduate School of Pharmaceutical Sciences, Kumamoto University
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32
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Shen Z, Shi S, Ding S, Zhong Z. Mediating Effect of Self-Efficacy on the Relationship Between Medication Literacy and Medication Adherence Among Patients With Hypertension. Front Pharmacol 2020; 11:569092. [PMID: 33364943 PMCID: PMC7750474 DOI: 10.3389/fphar.2020.569092] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 10/27/2020] [Indexed: 12/31/2022] Open
Abstract
Background: Studies have reported that medication literacy had a positive effect on medication adherence in patients with hypertension. However, little is known about the mechanism underlying this relationship in patients with hypertension. Objective: The purpose of this study was to investigate the mediating effect of self-efficacy between medication literacy and medication adherence. Methods: A total of 790 patients with hypertension were investigated using the Chinese Medication Literacy Scale for Hypertensive Patients (C-MLSHP), the Morisky Medication Adherence Scale-8 (MMAS-8) and the Medication Adherence Self-efficacy Scale-Revision (MASES-R). Hierarchical regression and the bootstrap approach were used to analyze the mediating effect of self-efficacy on the relationship between medication literacy and medication adherence. Results: A total of 60.9% of hypertensive patients were low adherent to their antihypertensive drug regimens. Self-efficacy had a significant positive correlation with medication literacy (r= 0.408, p < 0.001) and medication adherence (r = 0.591, p < 0.001). Self-efficacy accounts for 28.7% of the total mediating effect on the relationship between medication literacy and adherence to antihypertensive regimens for hypertensive patients. Conclusion: More than half of the hypertensive patients in the study were low adherent to antihypertensive regimens. Self-efficacy had a partial significant mediating effect on the relationship between medication literacy and medication adherence. Therefore, it was suggested that hypertensive patients' medication adherence might be improved and driven by increasing self-efficacy. Targeted interventions to improve patients' self-efficacy should be developed and implemented. In addition, health care providers should also be aware of the importance of medication literacy assessment and promotion in patients with hypertension.
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Affiliation(s)
- Zhiying Shen
- Department of Hematology, Third Xiangya Hospital, Central South University, Changsha, China
- Department of Nursing, Third Xiangya Hospital, Central South University, Changsha, China
- Clinical Nursing Safety Management Reasearch Center of Central South University, Third Xiangya Hospital, Central South University, Changsha, China
| | - Shuangjiao Shi
- Department of Nursing, Third Xiangya Hospital, Central South University, Changsha, China
- Clinical Nursing Safety Management Reasearch Center of Central South University, Third Xiangya Hospital, Central South University, Changsha, China
| | - Siqing Ding
- Department of Nursing, Third Xiangya Hospital, Central South University, Changsha, China
- Clinical Nursing Safety Management Reasearch Center of Central South University, Third Xiangya Hospital, Central South University, Changsha, China
| | - Zhuqing Zhong
- Department of Nursing, Third Xiangya Hospital, Central South University, Changsha, China
- Clinical Nursing Safety Management Reasearch Center of Central South University, Third Xiangya Hospital, Central South University, Changsha, China
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Gönderen Çakmak HS, Uncu D. Relationship between Health Literacy and Medication Adherence of Turkish Cancer Patients Receiving Oral Chemotherapy. Asia Pac J Oncol Nurs 2020; 7:365-369. [PMID: 33062832 PMCID: PMC7529023 DOI: 10.4103/apjon.apjon_30_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 06/06/2020] [Indexed: 11/30/2022] Open
Abstract
Objective: The aim of this study was to explore the relationship between health literacy and self-report medication adherence of Turkish cancer patients receiving oral chemotherapy. Methods: The present research was a descriptive and cross-sectional study and conducted with 100 voluntary cancer patients who were admitted to the medical oncology outpatient clinic and received oral chemotherapy. The data were collected through a questionnaire form consisting of the Oral Chemotherapy Adherence Scale and the Turkish Health Literacy Scale (TSOY-32). The collected data were analyzed using descriptive statistics, one-way ANOVA, and Pearson's correlation coefficient. Results: The results revealed that 57% of the patients were female, 35% were primary school graduates, 51% were breast cancer, and 36% took capecitabine. The mean index scores of the participants on both scales were calculated as 12.39 ± 1.51 and 73.25 ± 6.18, respectively. Overall, a positive and strong correlation was found between oral chemotherapy adherence and health literacy of the participants (r = 0.707, P = 0.000). Conclusions: Medication adherence and health literacy levels among the cancer patients in Turkey are alarming so that patient-centered interventions and training are required to overcome the barriers to medication adherence.
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Affiliation(s)
| | - Doğan Uncu
- Department of Medical Oncology, T. C. Ministry of Health Ankara City Hospital, Ankara, Turkey
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Gentizon J, Hirt J, Jaques C, Lang PO, Mabire C. Instruments assessing medication literacy in adult recipients of care: A systematic review of measurement properties. Int J Nurs Stud 2020; 113:103785. [PMID: 33080478 DOI: 10.1016/j.ijnurstu.2020.103785] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 08/06/2020] [Accepted: 09/27/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The assessment of medication literacy in patients is an important step in assisting clinicians to plan for education, prescription simplification, assistance and/or medication aids. There have been several attempts to develop a standardised, objective measure of medication literacy. The objectives of this systematic review were to critically appraise, compare and summarise the measurement properties of existing instruments that assess medication literacy in adult recipients of care. DESIGN A systematic review was performed. SEARCH METHODS Structured searches were conducted in Embase, MEDLINE PubMed, CINAHL, APA PsycINFO and Web of Science Core Collection in March 2020. Additional searches were performed in ProQuest Dissertations and Theses, DART Europe, and Google Scholar, followed by citation tracking of included studies. REVIEW METHODS Two researchers independently identified eligible studies. Two researchers then assessed the methodological quality of the studies and quality of measurement properties, using the Consensus-based Standards for selection of health Measurement Instruments (COSMIN) guidelines. A best-evidence synthesis for each instrument was performed. RESULTS From the 5035 citations, 17 studies were included that concerned 13 instruments using different administration methods (i.e., performancebased or self-report), medication type (i.e., prescribed or nonprescribed) and context of use (i.e., clinical or community settings). Very low- to moderate-quality evidence supported satisfactory content validity regarding relevance and comprehensibility, while comprehensiveness remained inconsistent. Other measurement properties were less frequently examined and were supported by moderate-quality evidence (i.e., structural validity) to low- or very low-quality evidence (i.e., internal consistency, reliability, construct validity). The bestvalidated instrument is the unidimensional 14-item Medication Literacy in Spanish and English assessment tool (MedLitRxSE), based on direct testing of participant performance regarding four hypothetical scenarios on medication use. Nine instruments have the potential to be recommended but require additional research, while for others, their psychometric soundness is too limited and they require content revisions. CONCLUSION This is the first systematic review to identify instruments for medication literacy. None of the identified instruments had all measurement properties properly assessed and none reported measurement invariance, measurement error and responsiveness of the instrument. Further research is necessary for a better theoretical understanding of medication literacy in order to assist health professionals in identifying patient needs for education, regimen simplification, assistance and/or medication aids. Such research will help conceptualise new instruments that not only cover relevant domains dedicated to specific populations (e.g., polymorbid and/or older individuals), but also exhibit satisfactory measurement properties.
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Affiliation(s)
- Jenny Gentizon
- Institute of Higher Education and Research in Healthcare, Lausanne University Hospital and University of Lausanne, Switzerland; Lausanne University Hospital, Switzerland.
| | - Julian Hirt
- International Graduate Academy, Institute for Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany; Institute for Applied Nursing Sciences, Department of Health, FHS St. Gallen, Switzerland
| | - Cécile Jaques
- Medical Library, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | - Cedric Mabire
- Institute of Higher Education and Research in Healthcare, Lausanne University Hospital and University of Lausanne, Switzerland
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Toolabi M, Khoramjouy M, Aghcheli A, Ayati A, Moghimi S, Firoozpour L, Shahhosseini S, Shojaei R, Asadipour A, Divsalar K, Faizi M, Foroumadi A. Synthesis and radioligand‐binding assay of 2,5‐disubstituted thiadiazoles and evaluation of their anticonvulsant activities. Arch Pharm (Weinheim) 2020; 353:e2000066. [DOI: 10.1002/ardp.202000066] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 08/03/2020] [Accepted: 08/10/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Mahsa Toolabi
- Department of Medicinal Chemistry, School of Pharmacy Ahvaz Jundishapur University of Medical Sciences Ahvaz Iran
| | - Mona Khoramjouy
- Department of Pharmacology and Toxicology, School of Pharmacy Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Ayoub Aghcheli
- Drug Design and Development Research Center, The Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences Tehran Iran
| | - Adileh Ayati
- Drug Design and Development Research Center, The Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences Tehran Iran
| | - Setareh Moghimi
- Drug Design and Development Research Center, The Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences Tehran Iran
| | - Loghman Firoozpour
- Drug Design and Development Research Center, The Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences Tehran Iran
| | - Soraya Shahhosseini
- Department of Pharmaceutical Chemistry and Radiopharmacy, School of Pharmacy Shahid Beheshti University of Medical Sciences Tehran Iran
| | | | - Ali Asadipour
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences Kerman Iran
| | - Kouros Divsalar
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences Kerman Iran
| | - Mehrdad Faizi
- Department of Pharmacology and Toxicology, School of Pharmacy Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Alireza Foroumadi
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences Kerman Iran
- Department of Medicinal Chemistry, Faculty of Pharmacy Tehran University of Medical Sciences Tehran Iran
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Pantuzza LLN, Nascimento E, Botelho SF, Martins MAP, Souza Groia Veloso RC, Nascimento MMG, Vieira LB, Reis AMM. Mapping the construct and measurement of medication literacy: A scoping review. Br J Clin Pharmacol 2020. [DOI: 10.1111/bcp.14490] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Laís Lessa Neiva Pantuzza
- Programa de Pós‐Graduação em Medicamentos e Assistência Farmacêutica, Faculdade de Farmácia Universidade Federal de Minas Gerais 6627 Presidente Antônio Carlos Ave., Pampulha Belo Horizonte Minas Gerais Brazil
| | - Elizabeth Nascimento
- Faculdade de Filosofia e Ciências Humanas, Departamento de Psicologia Universidade Federal de Minas Gerais 6627 Presidente Antônio Carlos Ave., Pampulha Belo Horizonte Minas Gerais Brazil
| | - Stephanie Ferreira Botelho
- Programa de Pós‐Graduação em Medicamentos e Assistência Farmacêutica, Faculdade de Farmácia Universidade Federal de Minas Gerais 6627 Presidente Antônio Carlos Ave., Pampulha Belo Horizonte Minas Gerais Brazil
| | | | - Ronara Camila Souza Groia Veloso
- Hospital das Clínicas Universidade Federal de Minas Gerais 110 Professor Alfredo Balena Ave., Santa Efigênia Belo Horizonte Minas Gerais Brazil
| | - Mariana Martins Gonzaga Nascimento
- Faculdade de Farmácia Universidade Federal de Minas Gerais 6627 Presidente Antônio Carlos Ave., Pampulha Belo Horizonte Minas Gerais Brazil
| | - Liliana Batista Vieira
- Faculdade de Ciências Farmacêuticas Universidade Federal de Alfenas 700 Gabriel Monteiro da Silva St., Centro Alfenas Minas Gerais Brazil
| | - Adriano Max Moreira Reis
- Faculdade de Farmácia Universidade Federal de Minas Gerais 6627 Presidente Antônio Carlos Ave., Pampulha Belo Horizonte Minas Gerais Brazil
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Zhong Z, Shi S, Duan Y, Shen Z, Zheng F, Ding S, Luo A. The Development and Psychometric Assessment of Chinese Medication Literacy Scale for Hypertensive Patients (C-MLSHP). Front Pharmacol 2020; 11:490. [PMID: 32425773 PMCID: PMC7203424 DOI: 10.3389/fphar.2020.00490] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 03/27/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To develop the medication literacy scale for patients with hypertension, and to test the reliability and validity of the scale. METHODS The initial draft of the scale was formulated based on the operationalization of medication literacy with four core elements of knowledge, attitude, skill, and practice, and was developed through procedures of literature review, interviews to hypertensive patients, and research group discussion. Expert panel meeting, interviews, and pre-test on the initial draft of the scale to 10 hypertensive patients, as well as a two iterations of expert feedback were used to form a primary medication literacy scale for pilot investigation and item selection. In this study, 260 patients with hypertension in Changsha city of China were purposively selected to conduct a pilot survey using the primary medication literacy scale. After item selection by a series of statistical analysis method and item re-wording according to patients' feedback, the scale was revised to form a formal investigation scale with four domains and 37 items. A formal investigation was carried out on 650 patients with hypertension selected purposively in a tertiary general hospital and two community health service centers in Changsha city of China. The reliability and validity of the scale were analyzed. RESULTS Finally, the formal scale consists of four domains on knowledge, attitude, practice and skills, 11 sub-factors and 37 items in total. The scale-level content validity index (S-CVI/Ave) of this scale was 0.968, and the I-CVI for each item ranged from 0.833 to 1.000, indicating a good and acceptable content and face validity. The Cronbach's α coefficient was 0.849 for the overall scale and ranged from 0.744 to 0.783 for domains. The Pearson's correlation coefficients between domains and the total scale were ranging from 0.530 to 0.799. Besides, the Pearson's correlation coefficient among domains of the scale ranged from 0.157 to 0.439. The Spearman-Brown split-half reliability coefficient was 0.893 for the total scale and ranged from 0.793 to 0.872 for domains. The test-retest reliability coefficient of the total scale was 0.968 and ranged from 0.880 to 0.959 for domains. Four domains of knowledge, attitude, skill, and practice were identified through the exploratory factor analysis and confirmatory factor analysis from each domain. The total explained variation of domains for the overall scale was 51.420%. Eleven sub-factors for domains were extracted through respective exploratory factor analysis from each domain, and the total explained variation of sub-factors for its belonging domain were ranging from 56.111 to 64.419%. The confirmatory factor analysis showed the fit indices of the four-domain model were as follows (χ2/df=2.629, GFI=0.804, AGFI=0.777, RMR=0.012, IFI=0.746, RMSEA=0.066, PNFI=0.599, PCFI=0.689), which indicated an acceptable model fit. CONCLUSIONS The medication literacy scale for hypertensive patients has good reliability and acceptable validity, which is suitable and acceptable for evaluating the medication literacy level of hypertension patients in China. In the future, further construct and model fit validation and English translation with appropriate adaptation of this whole scale are required, so that this scale can be further validated and applied worldwide.
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Affiliation(s)
- Zhuqing Zhong
- Nursing Department, Third Xiangya Hospital, Central South University, Changsha, China
- Xiangya Nursing School, Central South University, Changsha, China
| | - Shuangjiao Shi
- Nursing Department, Third Xiangya Hospital, Central South University, Changsha, China
- Xiangya Nursing School, Central South University, Changsha, China
| | - Yinglong Duan
- Nursing Department, Third Xiangya Hospital, Central South University, Changsha, China
| | - Zhiying Shen
- Nursing Department, Third Xiangya Hospital, Central South University, Changsha, China
| | - Feng Zheng
- Department of Cardiology and Cardiovascular, Third Xiangya Hospital, Central South University, Changsha, China
| | - Siqing Ding
- Nursing Department, Third Xiangya Hospital, Central South University, Changsha, China
- Xiangya Nursing School, Central South University, Changsha, China
| | - Aijing Luo
- Key Laboratory of Medical Informatics Research, Central South University, College of Hunan Province, Changsha, China
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