Relationship Between Family Functioning and Medication Adherence in Chinese Patients With Mechanical Heart Valve Replacement: A Moderated Mediation Model

Determinants of Medication Non-Adherence among Productive-Aged Hypertensive Patients in Indonesia: A Secondary Data Analysis of Basic Health Research Database 2018

Background

Medication non-adherence in hypertensive patients induced disease progressivity. Several factors contribute to non-adherence to treatment, such as multidrug prescription, the relationship between doctors and patients, and barriers in health services. We aimed to analyze determinants of medication non-adherence in productive-aged hypertensive patients in Indonesia.

Methods

A cross-sectional study was conducted among 58,148 respondents across Indonesia. Covariates are gender, age, education, occupation, residence, smoking status, family member, and history of stroke, cardiovascular and diabetes mellitus. Chi-square and Binary Logistic were performed using SPSS version 21.

Results

More than half of the 58,148 hypertension patients in Indonesia (53.9%) are not taking their medication regularly. Chi-square analysis found that male gender, age groups (25 to 34, 35 to 44, 45 to 55, 56 to 64), graduated senior high school, employed workers, living in urban, smokers, four family members, and disease history correlated with non-adherence to treatment. However, Binary Logistic is obtained that age groups age groups (25 to 34, 35 to 44, 45 to 55 and 56 to 64; AOR=1.251, 1.609, 2.179, 2.424, respectively), employed workers (AOR=0.912), urban lived (AOR=1.085), smokers (AOR=0.853), more than four family members (AOR=1.146), stroke history (AOR=1.793), cardiovascular history (AOR=1.623), and diabetes mellitus history (AOR=1.489) found their significance level at 0.00. Two variables, gender and education, are not of significant.

Conclusion

Medication non-adherence in hypertensive patients has multifactorial aspects, such as in this study, including age, employed workers, living in urban areas, smokers, more prominent family members, and the history of the disease.

Family function and depression in older adults with chronic comorbidities: the chain-mediated role of cognitive fusion and coping styles

BACKGROUND

This study explores the influence of family function on depression in older adults with chronic comorbidities and the mediating roles of cognitive fusion and coping styles.

METHODS

The Family Adaptation Partnership Growth Affection and Resolve Index, Patient Health Questionnaire-9, Cognitive Fusion Questionnaire-Fusion, and Trait Coping Style Questionnaire were used to survey 448 community-dwelling older adults with chronic comorbidities. A mediation test was conducted using the Process 4.0 macro program.

RESULTS

Family function was found to be significantly and negatively correlated with cognitive fusion, maladaptive coping style, and depression. Cognitive fusion and maladaptive coping style were positively correlated with depression. Cognitive fusion was positively correlated with maladaptive coping styles. Family function affected depression directly; it also affected older adults' depression through two indirect paths: through the mediating role of cognitive fusion and the chain-mediating role of both cognitive fusion and maladaptive coping style.

CONCLUSIONS

Family function in older adults can influence their levels of depression, which is mediated by cognitive fusion and maladaptive coping styles. Based on these findings, interventions to prevent and alleviate depression in older adults with chronic disease comorbidities can be offered to improve their well-being.

The influence of family health on self-efficacy in patients with chronic diseases: the mediating role of perceived social support and the moderating role of health literacy

BACKGROUND

Chronic diseases are a global health challenge, and therefore, more attention should be paid to improving self-efficacy in people with chronic diseases. This study examined the relationship between family health and self-efficacy, and explored the mediating role of perceived social support and the moderating role of health literacy. The aim is to enhance the self-efficacy of chronic patients by improving family health, social support, and health literacy, thereby improving their physical and mental state.

METHODS

A cross-sectional study based on psychological and behavioural factors was conducted, namely, the 2022 China Residents Survey, which included 5150 Chinese patients with chronic diseases. The General Self-Efficacy Scale-Short Form was used to assess self-efficacy, the Health Literacy Questionnaire-short form was used to assess health literacy, the Perceived Social Support Scale-Short Form was used to evaluate perceived social support, and the Chinese version of the Family Health Scale-Short Form was used to assess family health status.

RESULTS

Family health of patients with chronic diseases had a significant positive effect on self-efficacy. Perceived social support was identified as a partial mediator between family health and self-efficacy, accounting for 59.39% of the total effect. Health literacy moderated the impact of family health on perceived social support and self-efficacy.

CONCLUSIONS

Chronic diseases have become a global health challenge, and more attention should be paid to improving the self-efficacy of the chronically ill population. Our results not only facilitate the understanding of the relationship mechanisms between family health and self-efficacy in chronic patients but can also serve as a guide for healthcare workers and policymakers who wish to provide better care for patients.

[Adaptation of the 12-item medication adherence scale ( the Questionnaire for assessment of adherence to Medication) on a Russian-speaking sample of patients with type 1 and type 2 diabetes mellitus]

BACKGROUND

Poor adherence to treatment among patients with type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) hinders the effective use of antidiabetic agents and the achievement of optimal glycemic control, reducing their quality of life and outcomes. Assessing adherence to treatment using a questionnaire can help identify and eliminate factors and barriers that negatively affect adherence to medical recommendations and satisfaction with treatment.

AIM

To conduct linguistic and cultural adaptation of the 12-item Medication Adherence Scale (MAS-12) questionnaire and evaluate the psychometric properties of the Russian version of the MAS-12 questionnaire among patients suffering from T1DM and T2DM.

MATERIALS AND METHODS

A survey of 198 patients with T1DM and T2DM was carried out, including self-completion of the MAS-12 questionnaire in Russian. Average age: 47.1±18.62 years, proportion of women - 76%. Average duration of the disease: 13.08±10.05 years. The construct validity of the MAS-12 questionnaire was assessed using confirmatory factor analysis. As an external criterion for assessing convergent validity, the KOP-25 method was used - the Russian Questionnaire for Quantitative Assessment of Treatment Adherence (KOP-25). Reliability of the MAS-12 was assessed using Cronbach's α internal consistency and participant retest after 1 to 4 months.

RESULTS

The factor structure of the MAS-12 questionnaire is reproduced for the first time on a Russian sample of patients with diabetes. Recommended fit indicators for the measurement model (CFI=0.983, RMSEA=0.049, TLI=0.968) were achieved by excluding two items (9 and 12) that did not demonstrate statistically significant contributions to their respective subscales. The internal consistency of the subscales (α ϵ [0.522; 0.857]) and the questionnaire as a whole (α=0.766) was assessed as sufficient. Significant correlations of the adapted methodology and its subscales with the scales of the KOP-25 questionnaire were obtained. The closest connections (r ϵ [0.333; 0.431], p<0.010) are observed with the COP-25 scales related to drug therapy, which indicates good external validity of the adapted methodology.

CONCLUSION

The Russian version of the MAS-12 questionnaire "Questionnaire for assessing adherence to medication treatment" (PML-10), consisting of 10 questions, has good psychometric properties, is a valid and reliable tool for assessing medication adherence among patients with T1DM and T2DM and can be recommended for use in clinical practice, including for monitoring treatment adherence in Russia.

Warfarin Adherence and Its Associated Factors in Thai Older Adults with Atrial Fibrillation

Introduction

Older people mostly found unable to adhere with warfarin treatment guidelines. The health service system is challenged in order to improve medication adherence in older population under limited health resources. The purpose of this study was to explore health systems factors on warfarin adherence in older population, particularly in resources constraint setting.

Methods

This study was a cross-sectional predictive study that enrolled older people who experienced atrial fibrillation (AF) and treated by warfarin, aged 60 years and over, and followed up at the warfarin clinic.

Results

A total of 197 participants with the mean age of 72.03 years (SD = 8.84) was recruited. Almost of them (85.8%) reported adhered to warfarin prescription. More than a half (60.5%) were able to report their targeted INR. Participants who stayed with the family had 5.54 times (95% CI 1.79-19.33), took regular daily dose warfarin had 5.07 times (95% CI 1.05-24.49), perceived targeted INR had 2.94 times (95% CI 1.04-8.29), and received family support had 1.33 times (95% CI 1.11-1.60) increased odds of warfarin adherence than those who did not. Participants who perceived a barrier to taking medication had 0.93 times decreased odds of warfarin adherence than those who did not (95% CI 0.86-0.99).

Conclusion

Healthcare system should encourage family to support the older population with AF in order to increase warfarin adherence. Future research should develop intervention combining family support to promote warfarin adherence.

Pre-stroke anticoagulation for atrial fibrillation in primary English speakers and non-primary English speakers: a multicentre retrospective cohort study

BACKGROUND

Anticoagulation can prevent most strokes in individuals with atrial fibrillation (AF); however, many people presenting with stroke and known AF are not anticoagulated. Language barriers and poor health literacy have previously been associated with decreased patient medication adherence. The association between language barriers and initiation of anticoagulation therapy for AF is uncertain.

AIMS

The aims of this study were to determine whether demographic factors, including non-English primary language, were (1) associated with not being initiated on anticoagulation for known AF prior to admission with stroke, and (2) associated with non-adherence to anticoagulation in the setting of known AF prior to admission with stroke.

METHODS

A multicentre retrospective cohort study was conducted for consecutive individuals admitted to the three South Australian tertiary hospitals with stroke units over a 5-year period.

RESULTS

There were 6829 individuals admitted with stroke. These cases included 5835 ischaemic stroke patients, 1333 of whom had pre-existing AF. Only 40.0% presenting with ischaemic stroke in the setting of known pre-existing AF were anticoagulated. When controlling for demographics, socioeconomic status and past medical history (including the components of the CHADS2VASC score and anticoagulation contraindications), having a primary language other than English was associated with a lower likelihood of having been commenced on anticoagulant for known pre-stroke AF (odds ratio: 0.52, 95% confidence interval: 0.36-0.77, P = 0.001), but was not associated with a differing likelihood of anticoagulation adherence.

CONCLUSIONS

A significant proportion of patients with stroke have pre-existing unanticoagulated AF; these rates are substantially higher if the primary language is other than English. Targeted research and interventions to minimise evidence-treatment gaps in this cohort may significantly reduce stroke burden.

Effective health management strategies for patients undergoing valve replacement: a bibliometric analysis of the current research status and future directions

Background

Valvular heart disease is a major health concern worldwide. The effective management of patients undergoing valve replacement determines their prognosis. Bibliometric analysis of studies on managing patients with artificial heart valves has not been previously performed.

Methods

This study analyzed 2,771 publications related to patient management after valve replacement published in the Web of Science Core Collection database between January 1, 2013, and December 31, 2022. Bibliometric analysis was performed using CiteSpace and VOSviewer considering countries, institutions, authors, journals, references, and keywords.

Results

The countries with the most significant contributions in this field were the United States of America (USA), Germany, and Italy. Leon MB from Columbia University, USA was the most influential author. Transcatheter aortic valve replacement was a current research hotspot, while anticoagulation management was a key area of interest. Combining anticoagulation therapy with internet-linked tools and portable health devices may offer new research avenues. Frailty assessment and intervention were potential future research areas.

Conclusions

This bibliometric analysis provides clinicians and researchers with useful insights for developing novel ideas and directions to manage the health of patients undergoing valve replacement.

Effect of teaching health-promoting behaviors on the care burden of family caregivers of hemodialysis patients: a four-group clinical trial

INTRODUCTION

Chronic kidney disease could have a profound effect on the life of patients and family caregivers. The caregivers' care burden increases as the disease progresses. Interventions reducing care burden should be investigated. Educational interventions could affect family caregivers' care burden among hemodialysis patients. However, most studies and interventions have focused on caregivers. Therefore, this study aims to compare the effect of teaching Health-promoting behaviors on the care burden of family caregivers of hemodialysis patients.

MATERIALS AND METHODS

This trial was conducted using a pretest-posttest design and follow-up after one month. Hemodialysis patients and their family caregivers were selected using convenience sampling method. In total, 124 patient-caregiver pairs were divided into four groups of patient-centered education, caregiver-centered education, Patient and caregiver education and control by block randomization (15 blocks of 8 members and 1 block of 4 members) (n = 31 pairs per group). The intervention (teaching health-promoting behaviors) was performed in 8 sessions using the teach-back method, except for the control. The data were collected by patient and caregiver demographic forms and Novak and Guest care burden inventory as well as following the treatment regimen in three stages (before, immediately after and one month after the intervention). Demographic variables were compared among the four groups using ANOVA, Kruskal-Wallis and Chi-square test. The intragroup comparison of the main variables was made using the repeated measures ANOVA with modified LSD post hoc test. The intergroup comparison was made by one-way ANOVA with LSD post hoc test.

RESULTS

Out of 124 caregivers participating in the study, 68 (54.8%) were female. Also, out of 124 patients participating in the study, 86 (69.4%) were male. The mean age of the caregivers and patients was 39.2 ± 11.31 and 54.23 ± 14.20 years old, respectively. There was a statistically significant difference in the mean total care burden scores of the pre-test and post-test between the four groups (p < 0.001). The total care burden decreased in patient-centered, caregiver-centered and Patient and caregiver education groups. However, this reduction in the caregiver-centered and Patient and caregiver education groups was significantly higher than the patient-centered education group (p < 0.001).

CONCLUSION

The results revealed teaching health-promoting behaviors reduced care burden. Moreover, caregiver-centered approach could reduce care burden more than patient-centered approach. Therefore, this could be used as a supportive method to improve the health of patients and caregivers.

TRIAL REGISTRATION NUMBER (TRN)

IRCT20090522001930N4.

DATE OF REGISTRATION

2021-11-12.

Family Functioning, Illness-Related Self-Regulation Processes, and Clinical Outcomes in Major Depression: A Prospective Study in Greece

Major depressive disorder (MDD) is a common, seriously impairing, and often recurrent mental disorder. Based on the predictions of the Circumplex Model of Marital and Family Systems and the Common-Sense Self-Regulation Model, the aim of the present prospective study is to examine the predictive value of clinical outcomes of a process model in which associations between perceived family functioning and patient's clinical outcomes (i.e., symptom severity and suicide risk) are mediated by illness representations and coping strategies. A total of 113 patients with a clinical diagnosis of MDD (16.8% males and 83.2% females) aged 47.25 ± 13.98 years and recruited from the outpatient department and the mobile mental health unit of the Psychiatric Clinic of the University Hospital of Heraklion in Crete, Greece, and from a Greek online depression peer-support group participated in the study. Family functioning was assessed in terms of cohesion and flexibility (Family Adaptability and Cohesion Evaluation Scales IV) at baseline. Illness representations (Illness Perception Questionnaire-Mental Health) and coping strategies (Brief Cope Orientation to Problems Experienced) were measured about five months later (5.04 ± 1.16 months). Symptom severity (Beck Depression Inventory) and suicidality (Risk Assessment Suicidality Scale) were measured about 10 months after the baseline assessment (9.56 ± 2.52 months). The results indicated that representations about MDD impact and symptom severity serially mediated the association between family cohesion and suicide risk in MDD. Furthermore, family cohesion was found to be linked with maladaptive coping through MDD impact representations. Family-based psychotherapeutic interventions specifically designed to target unhealthy family functioning, along with negative illness perceptions and dysfunctional coping, could be further developed and explored as adjunctive therapy to standard treatment in MDD.

Exploring Patient Beliefs and Medication Adherence in the Mediterranean Context: A Cross-Sectional Study in Patients with Cardiovascular Diseases and Cardiometabolic Disorders in Greece-The IACT-Study

BACKGROUND

Evidence has shown that poor adherence to vascular medications contributes to a considerable proportion of all cardiovascular disease (CVD) events and mortality. The aim of the present work was to examine patients' beliefs/views that affect their level of adherence to the assigned medical treatment in the context of a multi-center study in Greece.

METHODS

Between July 2022 and April 2023, 1988 patients (1180 females) with established cardiovascular disease or relevant cardiometabolic disorders were chosen from seven medical centers in Greece. The 4-item Morisky Medication Adherence Questionnaire gauged medication adherence and investigated patients' beliefs/views regarding treatment.

RESULTS

Among participants, 51.2% showed perfect medication adherence, contrasting with 48.8% displaying poor adherence. Patients with negative medication beliefs were around three times more likely to be non-adherent (OR = 2.73; 95% CI = 2.28-3.28). Non-adherers held concerns about drug efficacy (OR = 2.34; 95% CI = 1.10-4.97) and favored alternative therapies (OR = 2.25; 95% CI = 1.75-2.91).

CONCLUSION

The findings highlight the significance of addressing patient beliefs/views to improve medication adherence. The distinct Mediterranean context, influenced by cultural, socioeconomic, and clinical factors, emphasizes the need for tailored interventions. This underscores the call for contextually sensitive strategies to boost medication adherence and improve health outcomes in this unique region.

Adherence, belief, and knowledge about oral anticoagulants in patients with bioprosthetic heart valve replacement: a cross-sectional study

Aims: To investigate adherence to oral anticoagulants among patients after mechanical heart valve (BHV) replacement and further examine the mediating role of medication belief in the relationship between knowledge and medication adherence. Background: The number of patients who undergo BHV replacement has increased in recent years. Short-term anticoagulant therapy is recommended for patients after BHV replacement. However, little is known about adherence to oral anticoagulant therapy and the underlying mechanisms among patients with BHV replacement. Methods: A cross-sectional study was conducted between September 2022 and November 2022. A convenience sample of 323 patients who underwent BHV replacement was recruited from a tertiary public hospital in Southwest China. Data were collected by using the 8-item Morisky Medication Adherence Scale, Beliefs about Medicines Questionnaire-specific, and the Knowledge of Anticoagulation Questionnaire. The mediation model was tested by Hayes's PROCESS macro. The STROBE checklist was used. Results: Approximately 17.3% of participants had low adherence, 47.1% had medium adherence, and only 35.6% reported high adherence to oral anticoagulants. Knowledge and necessity beliefs were positively related to medication adherence, while concern beliefs were negatively correlated with medication adherence. Medication belief mediated the relationship between knowledge and adherence to oral anticoagulants. Conclusion: Patients with BHV replacement demonstrated relatively low adherence to oral anticoagulant therapy. Efforts to enhance medication adherence should consider improving patients' knowledge and medication beliefs.

Relationship Between Family Caregiver Burden and Medication Adherence in Patients with Mechanical Valve Replacement: A Structural Equation Model

BACKGROUND

Oral anticoagulant is a necessary long-term treatment after mechanical valve replacement (MVR), and medication adherence has a great impact on patients with MVR. Although family caregiver burden is negatively correlated with medication adherence, little is known about the underlying mechanism.

PURPOSE

To test whether family caregiver burden influences medication adherence through post-traumatic growth or medication literacy in patients with MVR.

PATIENTS AND METHODS

A total of 206 patients after MVR were included in this cross-sectional study from July 2021 to December 2021. Data regarding medication adherence, family caregiver burden, post-traumatic growth, and medication literacy were collected by questionnaires. Data were analyzed through SPSS, and pathway analysis was conducted by using AMOS, based on the bootstrapping method.

RESULTS

Post-traumatic growth was positively associated with medication adherence (r = 0.284, P < 0.05). Post-traumatic growth independently mediated the association of family caregiver burden on medication adherence [β = 0.32, 95% confidence intervals: (-0.016, -0.008)]. The mediated effect value for post-traumatic growth was 0.07, accounting for 24.14% of the total effect. The model's fit indices were adequate.

CONCLUSION

The mediating effect of post-traumatic growth between family caregiver burden and medication adherence existed in patients with MVR. Interventions considering post-traumatic growth may be useful to increase medication adherence and improve patient rehabilitation.