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Chebly KO, Shen M, Schoenthaler AM. Frequency and nature of discussing social influences on health in urban safety-net clinics: A qualitative analysis. Patient Educ Couns 2023; 117:107974. [PMID: 37729818 PMCID: PMC10872873 DOI: 10.1016/j.pec.2023.107974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 08/07/2023] [Accepted: 09/07/2023] [Indexed: 09/22/2023]
Abstract
OBJECTIVE Chronic social isolation is a risk factor for all-cause mortality and disease progression, but is not routinely screened for in clinical settings. This study analyzed provider-patient communication patterns about social influences during primary care encounters, to identify opportunities to screen for objective or perceived social isolation. METHODS Content analysis was conducted on transcripts of 97 audiotaped, English-speaking patient encounters with 27 primary care providers at 3 safety-net primary care centers in New York City. Conversations were first coded for specific social isolation screening, then more broadly to quantify and qualify how social influences were discussed in relation to health. RESULTS Transcripts included no explicit examples of social isolation screening. Social influences on health were discussed meaningfully in only 28 % of transcripts, compared to medication adherence (93 %) and diet (64 %). Patients initiated conversations about social influences on health twice as often as providers, however providers did not acknowledge 67% of these prompts. CONCLUSION Social influences on health, including social isolation, were uncommonly discussed in this sample of primary care visits. When social influences were discussed meaningfully, providers utilized relationship-centered communication strategies. PRACTICE IMPLICATIONS Strategic conversations about social influences, even when brief and informal, can effectively screen patients for social isolation.
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Affiliation(s)
- Katherine Otto Chebly
- NYU Langone Medical Center, Department of Medicine, 550 First Avenue - NBV 16N30, New York, NY 10016, USA.
| | - Michael Shen
- NYC Health & Hospitals/Woodhull, Department of Medicine, 760 Broadway, Brooklyn, NY 11206, USA
| | - Antoinette M Schoenthaler
- NYU Langone Medical Center, Department of Medicine, 550 First Avenue - NBV 16N30, New York, NY 10016, USA
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Kharmats AY, Martinez TR, Belli H, Zhao Y, Mann DM, Schoenthaler AM, Voils CI, Blecker S. Self-reported adherence and reasons for nonadherence among patients with low proportion of days covered for antihypertension medications. J Manag Care Spec Pharm 2023; 29:557-563. [PMID: 37121253 PMCID: PMC10387969 DOI: 10.18553/jmcp.2023.29.5.557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BACKGROUND: Incorporation of pharmacy fill data into the electronic health record has enabled calculations of medication adherence, as measured by proportion of days covered (PDC), to be displayed to clinicians. Although PDC values help identify patients who may be nonadherent to their medications, it does not provide information on the reasons for medication-taking behaviors. OBJECTIVE: To characterize self-reported adherence status to antihypertensive medications among patients with low refill medication adherence. Our secondary objective was to identify the most common reasons for nonadherence and examine the patient sociodemographic characteristics associated with these barriers. METHODS: Participants were adult patients seen in primary care clinics of a large, urban health system and on antihypertensive therapy with a PDC of less than 80% based on 6-month linked electronic health record-pharmacy fill data. We administered a validated medication adherence screener and a survey assessing reasons for antihypertensive medication nonadherence. We used descriptive statistics to characterize these data and logistic and Poisson regression models to assess the relationship between sociodemographic characteristics and adherence barriers. RESULTS: The survey was completed by 242 patients (57% female; 61.2% White; 79.8% not Latino/a or Hispanic). Of these patients, 45% reported missing doses of their medications in the last 7 days. In addition, 48% endorsed having at least 1 barrier to adherence and 38.4% endorsed 2 or more barriers. The most common barriers were being busy and having difficulty remembering to take medications. Compared with White participants, Black participants (incident rate ratio = 2.49; 95% CI = 1.93-3.22) and participants of other races (incident rate ratio = 2.16; 95% CI = 1.62-2.89) experienced a greater number of barriers. CONCLUSIONS: Nearly half of patients with low PDC reported nonadherence in the prior week, suggesting PDC can be used as a screening tool. Augmenting PDC with brief self-report tools can provide insights into the reasons for nonadherence. DISCLOSURES: Dr Kharmats, Ms Martinez, Dr Belli, Ms Zhao, Dr Mann, Dr Schoenthaler, and Dr Blecker received grants from the National Institute of Health/National Heart, Lung, Blood Institute. Dr Voils holds a license by Duke University for the DOSE-Nonadherence measure and is a consultant for New York University Grossman School of Medicine. This research was supported by the NIH (R01HL156355). Dr Kharmats received a postdoctoral training grant from the National Institutes of Health (5T32HL129953-04). Dr Voils was supported by a Research Career Scientist award from the Health Services Research & Development Service of the Department of Veterans Affairs (RCS 14-443). The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the United States Government.
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Affiliation(s)
- Anna Y Kharmats
- Departments of Population Health, Grossman School of Medicine, New York University
- Institute for Excellence in Health Equity, NYU Langone Health, NY
- Office of Disease Prevention, National Institute of Health, Bethesda, MD
| | - Tiffany R Martinez
- Departments of Population Health, Grossman School of Medicine, New York University
| | - Hayley Belli
- Departments of Population Health, Grossman School of Medicine, New York University
| | - Yunan Zhao
- Departments of Population Health, Grossman School of Medicine, New York University
| | - Devin M Mann
- Departments of Population Health, Grossman School of Medicine, New York University
- Departments of Population Health and Medicine, Grossman School of Medicine, New York University
- Institute for Excellence in Health Equity and Medical Center Information Technology, NYU Langone Health, NY
| | - Antoinette M Schoenthaler
- Departments of Population Health, Grossman School of Medicine, New York University
- Departments of Population Health and Medicine, Grossman School of Medicine, New York University
- Institute for Excellence in Health Equity, NYU Langone Health, NY
| | - Corrine I Voils
- William S. Middleton Memorial Veterans Hospital, Madison, WI, and Department of Surgery, School of Medicine and Public Health, University of Wisconsin, Madison
| | - Saul Blecker
- Departments of Population Health, Grossman School of Medicine, New York University
- Departments of Population Health and Medicine, Grossman School of Medicine, New York University
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Schoenthaler AM, Gallager RP, Kaplan SA, Hopkins KA. From Screening to the Receipt of Services: A Qualitative Examination. Am J Prev Med 2022; 63:S144-S151. [PMID: 35987526 DOI: 10.1016/j.amepre.2022.03.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/01/2022] [Accepted: 03/14/2022] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Research has focused on developing methods to facilitate screening and tracking data on social risk factors in healthcare settings. Less is known about the multiple factors that shape patients' acceptance of healthcare-based social risk programs. This qualitative study sought to elucidate the multilevel (individual, interpersonal, family/community, system, policy) factors that influence patients' acceptance of a healthcare-based social risk program within a Federally Qualified Health Center in New York City. METHODS Participants included 5 patients receiving care at the Federally Qualified Health Center who screened positive for social risks, 4 nurses who are responsible for conducting social risk screenings, and 5 Family Support Services counselors who conduct outreach to patients who screened positive. Interviews were conducted from March to June 2021 and analyzed from July to September 2021 using the constant comparative method. RESULTS Analyses of the transcripts identified the following 3 themes: (1) Patients appreciated being asked about social risk factors, but there was a mismatch between their understanding of the screening process, their desire for assistance, and the support received. Although nurses and counselors described relationship-centered approaches to involve patients in the process, patients reported feeling initial discomfort and confusion; (2) Multilevel barriers inhibit patients' acceptance of assistance; and (3) Patient trust in the physician and healthcare organization serves as facilitators to acceptance. CONCLUSIONS Patients' views about the purpose of a healthcare-based social risk program differed from nurses' and counselors' perspectives of the process. Although patients face multilevel challenges, strong trust in the physician and Family Health Centers served as facilitators to accepting healthcare-based assistance.
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Affiliation(s)
- Antoinette M Schoenthaler
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, NYU Grossman School of Medicine, New York, New York.
| | - Rebecca P Gallager
- Family Support Services, Family Health Centers at NYU Langone Health, New York, New York
| | - Sue A Kaplan
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
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4
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Blecker S, Adhikari S, Zhang H, Dodson JA, Desai SM, Anzisi L, Pazand L, Schoenthaler AM, Mann DM. Validation of EHR medication fill data obtained through electronic linkage with pharmacies. J Manag Care Spec Pharm 2021; 27:1482-1487. [PMID: 34595945 PMCID: PMC8759289 DOI: 10.18553/jmcp.2021.27.10.1482] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND: Recent linkages between electronic health records (EHRs) and pharmacy data hold opportunity for up-to-date assessment of medication adherence at the point of care. OBJECTIVE: To validate linked EHR-pharmacy data, which can be used for point-of-care interventions for concordance with insurance claims data for patients in a large health care delivery system. METHODS: We performed a retrospective cohort study of adult patients with an active antihypertensive medication order and seen as outpatients between August 25, 2019, and August 31, 2019. Pharmacy fill information was obtained from the EHR via linkages with Surescripts pharmacy and pharmacy benefit manager data, as well as from insurance claims available at our institution. We matched antihypertensive medication fills observed in the linked EHR-pharmacy database with available fills in the insurance claims database and calculated the percentage of medication fills that were available in each database. We estimated medication adherence using proportion of days covered in the linked EHR-pharmacy database and in the insurance claims database. RESULTS: Of 26,679 patients with hypertension, 23,348 (87.5%) had at least 1 antihypertensive medication fill recorded in the linked EHR-pharmacy database. Of 1,501 patients matched with the insurance database and with a documented medication fill, a fill was present for 1,484 (98.9%) and 1,259 (83.9%) patients in the linked EHR-pharmacy and insurance databases, respectively. Of 12,109 medication fills recorded in the insurance data, we found an overlap of 11,060 (91.3%) fills with the linked EHR-pharmacy database. The linked EHR-pharmacy database also contained 18,232 of 19,281 (94.6%) medication fills present in either database. Measured medication adherence was higher for patients when based on linked EHR-pharmacy data compared with insurance claims data (42% vs 30%, P < 0.001). CONCLUSIONS: Linked EHR-pharmacy data captured medication fills for the vast majority of patients and resulted in higher estimates of adherence than insurance claims. Our results suggest that pharmacy fill data available in the EHR have sufficient reliability to be used for point-of-care assessment of medication adherence. DISCLOSURES: This study was supported by grant R01HL155149 from the National Heart, Lung, and Blood Institute. Allen Thorpe provided funding for the NYU Langone Health Learning Health System Program, which helped fund this project. The authors have nothing to disclose.
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Affiliation(s)
- Saul Blecker
- Department of Population Health and Department of Medicine, NYU School of Medicine, New York, NY
| | | | - Hanchao Zhang
- Department of Population Health, NYU School of Medicine, New York, NY
| | - John A Dodson
- Department of Population Health and Department of Medicine, NYU School of Medicine, New York, NY
| | - Sunita M Desai
- Department of Population Health, NYU School of Medicine, New York, NY
| | - Lisa Anzisi
- NYU Network Integration, NYU Langone Health, New York, NY
| | - Lily Pazand
- Department of Managed Care, NYU Langone Health, New York, NY
| | | | - Devin M Mann
- Department of Population Health and Department of Medicine, NYU School of Medicine, New York, NY
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Biran N, Anthony Kouyaté R, Yucel E, McGovern GE, Schoenthaler AM, Durling OG, Unawane R, Schutt A, Panjabi S. Adaptation and Evaluation of a Symptom-Monitoring Digital Health Intervention for Patients With Relapsed and Refractory Multiple Myeloma: Pilot Mixed-Methods Implementation Study. JMIR Form Res 2020; 4:e18982. [PMID: 33200997 PMCID: PMC7709004 DOI: 10.2196/18982] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 09/10/2020] [Accepted: 09/30/2020] [Indexed: 01/09/2023] Open
Abstract
Background Relapsed and refractory multiple myeloma (RRMM) is a bone marrow cancer that requires systemic treatment, which often results in severe symptom burden. Recent studies have found that electronic patient-reported outcome (ePRO) interventions implemented in the clinic setting have had positive outcomes for other oncology populations. Evidence of the efficacy of a similar approach is lacking for patients with RRMM. Objective Recent recommendations for digital health interventions call for the publication of descriptions of iterative development processes in order to improve reproducibility and comparability. This study is an implementation pilot aiming to evaluate the acceptability and appropriateness of an ePRO intervention for patients with RRMM and to explore its impact on clinic workflow. Methods A total of 11 patients with RRMM were recruited from the John Theurer Cancer Center in Hackensack, New Jersey. Patients used a mobile app to report on 17 symptoms at 4 sessions, each a week apart. Patients could also report symptoms ad hoc. When reports met predefined thresholds, the clinic was alerted and patients received automated guidance. Study end points were assessed using qualitative and quantitative methods. Results A total of 9 patients (mean age 69.7 years) completed the study. Overall, 83% (30/36) of weekly sessions were completed. Patients found the frequency and time required to complete reporting acceptable. All patients agreed that the app was easy to use and understand. Providers felt the alerts they received required refinement. Patients and providers agreed it would be beneficial for patients to report for longer than 4 weeks. Patients felt that the training they received was adequate but contained too much information for a single session. All patients found the symptoms tracked to be appropriate; providers suggested shortening the list. All patients understood how to use the app for weekly reporting but had confusion about using it ad hoc. Providers felt the ad hoc feature could be removed. Neither patients nor providers viewed the in-app data reports but agreed on their potential value. Patients reported benefitting from symptom reporting through increased awareness of their symptoms. Clinic staff reported that app alerts were too numerous and redundant. They had difficulty responding to alerts within their existing workflow, partially because the data were not integrated into the electronic medical record system. Conclusions Overall, the intervention was found to be acceptable and appropriate for patients with RRMM. Points of friction integrating the intervention into the clinic workflow were identified. Clinic staff provided recommendations for addressing these issues. Once such modifications are implemented, ePRO data from patients with RRMM could be used to inform and improve clinical research and care. This study underlines the importance of an iterative approach to implementation that includes all stakeholders in order to ensure successful adoption.
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Affiliation(s)
- Noa Biran
- Division of Multiple Myeloma, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, United States
| | | | - Emre Yucel
- Amgen Inc, Thousand Oaks, CA, United States
| | | | | | | | - Rashmi Unawane
- Division of Multiple Myeloma, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, United States
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Schoenthaler AM, Lancaster KJ, Chaplin W, Butler M, Forsyth J, Ogedegbe G. Cluster Randomized Clinical Trial of FAITH (Faith-Based Approaches in the Treatment of Hypertension) in Blacks. Circ Cardiovasc Qual Outcomes 2018; 11:e004691. [DOI: 10.1161/circoutcomes.118.004691] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Antoinette M. Schoenthaler
- Department of Population Health, Center for Healthful Behavior Change, New York University School of Medicine (A.M.S., M.B., J.F., G.O.)
| | - Kristie J. Lancaster
- Department of Nutrition and Food Studies, Steinhardt School of Culture, Education, and Human Development, New York University (K.J.L.)
| | - William Chaplin
- Department of Psychology, St. John’s University College of Liberal Arts and Sciences, Queens, NY (W.C.)
| | - Mark Butler
- Department of Population Health, Center for Healthful Behavior Change, New York University School of Medicine (A.M.S., M.B., J.F., G.O.)
| | - Jessica Forsyth
- Department of Population Health, Center for Healthful Behavior Change, New York University School of Medicine (A.M.S., M.B., J.F., G.O.)
| | - Gbenga Ogedegbe
- Department of Population Health, Center for Healthful Behavior Change, New York University School of Medicine (A.M.S., M.B., J.F., G.O.)
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7
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Schoenthaler AM, Butler M, Chaplin W, Tobin J, Ogedegbe G. Predictors of Changes in Medication Adherence in Blacks with Hypertension: Moving Beyond Cross-Sectional Data. Ann Behav Med 2017; 50:642-652. [PMID: 26944584 DOI: 10.1007/s12160-016-9791-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Many studies have examined the multiple correlates of non-adherence in Blacks. However, they are largely cross-sectional; thus, these studies are unable to examine their predictive value on long-term medication adherence. PURPOSE The purpose of this study is to examine the predictive role of key psychosocial and interpersonal factors on changes in medication adherence over a 1-year period. METHODS Data were collected from 815 Black patients with hypertension followed in community health centers. Hypothesized predictor variables included self-efficacy, depressive symptoms, social support, and patient-provider communication measured at baseline, 6, and 12 months. The dependent variable, medication adherence was assessed at baseline, 6, and 12 months. Latent Growth Modeling was used to evaluate the pathways between the latent predictor variables and medication adherence. RESULTS Participants were mostly female, low-income, with high school education or less, and mean age of 57 years. At baseline, high self-efficacy was associated with low depressive symptoms (β = -0.22, p = 0.05), collaborative patient-provider communication (β = 0.17, p = 0.006), and better medication adherence (β = 1.04, p < 0.001). More social support and collaborative patient-provider communication were associated with low depressive symptoms (β = -0.08, p = 0.02; β = -0.18, p = 0.01). More social support was positively associated with collaborative patient-provider communication (β = 0.32, p < 0.001). In the longitudinal model, increasing self-efficacy over time predicted improvements in medication adherence 1 year later (β = 1.76, p < 0.001; CFI = 0.95; RMSEA = 0.04; SRMR = 0.04; Chi-Squared Index of Model Fit = 1128.54). CONCLUSIONS Self-efficacy is a key predictor of medication adherence over time in Black patients with hypertension. Initial levels of self-efficacy are influenced by the presence of depressive symptoms as well as the perceived quality of patient-provider communication.
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Affiliation(s)
- Antoinette M Schoenthaler
- Center for Healthful Behavior Change, Division of Health & Behavior, Department of Population Health, New York University School of Medicine, 227 East 30th Street, 634, New York, NY, 10016, USA.
| | - Mark Butler
- Center for Healthful Behavior Change, Division of Health & Behavior, Department of Population Health, New York University School of Medicine, 227 East 30th Street, New York, NY, 10016, USA
| | - William Chaplin
- Department of Psychology, St. John's University, Queens, NY, 11439, USA
| | - Jonathan Tobin
- Clinical Directors Network, Inc. (CDN), New York, NY, USA
- The Rockefeller University, New York, NY, USA
| | - Gbenga Ogedegbe
- Center for Healthful Behavior Change, Division of Health & Behavior, Department of Population Health, New York University School of Medicine, 227 East 30th Street, 633, New York, NY, 10016, USA
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Schoenthaler AM. Reexamining medication adherence in black patients with hypertension through the lens of the social determinants of health. J Clin Hypertens (Greenwich) 2017; 19:1025-1027. [PMID: 28942605 PMCID: PMC8031128 DOI: 10.1111/jch.13071] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Antoinette M. Schoenthaler
- Center for Healthful Behavior ChangeDivision of Health & BehaviorDepartment of Population HealthNew York UniversityNew YorkNYUSA
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9
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Affiliation(s)
- Antoinette M Schoenthaler
- Division of Health & Behavior, Department of Population Health, Center for Healthful Behavior Change, New York University, School of Medicine, New York, NY, USA
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Lancaster KJ, Carter-Edwards L, Grilo S, Shen C, Schoenthaler AM. Obesity interventions in African American faith-based organizations: a systematic review. Obes Rev 2014; 15 Suppl 4:159-76. [PMID: 25196412 DOI: 10.1111/obr.12207] [Citation(s) in RCA: 117] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Revised: 06/09/2014] [Accepted: 06/10/2014] [Indexed: 01/14/2023]
Abstract
African Americans, especially women, have higher obesity rates than the general US population. Because of the importance of faith to many African Americans, faith-based organizations (FBOs) may be effective venues for delivering health messages and promoting adoption of healthy behaviours. This article systematically reviews interventions targeting weight and related behaviours in faith settings. We searched literature published through July 2012 for interventions in FBOs targeting weight loss, diet and/or physical activity (PA) in African Americans. Of 27 relevant articles identified, 12 were randomized controlled trials; seven of these reported a statistically significant change in an outcome. Four of the five quasi-experimental and single-group design studies reported a statistically significant outcome. All 10 pilot studies reported improvement in at least one outcome, but most did not have a comparison group. Overall, 70% of interventions reported success in reducing weight, 60% reported increased fruit and vegetable intake and 38% reported increased PA. These results suggest that interventions in African American FBOs can successfully improve weight and related behaviours. However, not all of the findings about the success of certain approaches were as expected. This review identifies gaps in knowledge and recommends more rigorous studies be conducted to strengthen the comparative methodology and evidence.
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Affiliation(s)
- K J Lancaster
- Steinhardt School of Culture, Education, and Human Development, Department of Nutrition, Food Studies and Public Health, New York University, New York, NY, USA
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Lancaster KJ, Schoenthaler AM, Midberry SA, Watts SO, Nulty MR, Cole HV, Ige E, Chaplin W, Ogedegbe G. Rationale and design of Faith-based Approaches in the Treatment of Hypertension (FAITH), a lifestyle intervention targeting blood pressure control among black church members. Am Heart J 2014; 167:301-7. [PMID: 24576512 DOI: 10.1016/j.ahj.2013.10.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 10/28/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND Uncontrolled hypertension (HTN) is a significant public health problem among blacks in the United States. Despite the proven efficacy of therapeutic lifestyle change (TLC) on blood pressure (BP) reduction in clinical trials, few studies have examined their effectiveness in church-based settings-an influential institution for health promotion in black communities. METHODS Using a cluster-randomized, 2-arm trial design, this study evaluates the effectiveness of a faith-based TLC intervention vs health education (HE) control on BP reduction among hypertensive black adults. The intervention is delivered by trained lay health advisors through group TLC sessions plus motivational interviewing in 32 black churches. Participants in the intervention group receive 11 weekly TLC sessions targeting weight loss, increasing physical activity, fruit, vegetable and low-fat dairy intake, and decreasing fat and sodium intake, plus 3 monthly individual motivational interviewing sessions. Participants in the control group attend 11 weekly classes on HTN and other health topics delivered by health care experts. The primary outcome is change in BP from baseline to 6 months. Secondary outcomes include level of physical activity, percent change in weight, and fruit and vegetable consumption at 6 months, and BP control at 9 months. CONCLUSION If successful, this trial will provide an alternative and culturally appropriate model for HTN control through evidence-based lifestyle modification delivered in churches by lay health advisors.
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12
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Schoenthaler AM, Schwartz BS, Wood C, Stewart WF. Patient and Physician Factors Associated With Adherence to Diabetes Medications. Diabetes Educ 2012; 38:397-408. [DOI: 10.1177/0145721712440333] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose The purpose of this study was to examine the influence of patient and physician psychosocial, sociodemographic, and disease-related factors on diabetes medication adherence. These factors were also examined as effect modifiers of the association between quality of the patient-physician relationship and medication adherence. Methods Data were collected from 41 Geisinger Clinic primary care physicians and 608 of their patients with type 2 diabetes. Adherence to oral hypoglycemic medications was calculated using a medication possession ratio based on physician orders in electronic health records (MPREHR). MPREHR was defined as the proportion of total time in the 2 years prior to study enrollment that the patient was in possession of oral hypoglycemic medications. Linear regression was used to examine the influence of patient- and physician-level factors on adherence. Effect modification of the patient-physician relationship-adherence association was evaluated by adding the main effects of the individual-level factors and their cross-products to the models. Results In adjusted analyses, satisfaction with the physician’s patient education skills, patient beliefs about the need for their medications, and lower diabetes-related knowledge were associated with better adherence to oral hypoglycemic medications. Shorter duration of time with diabetes and taking only oral hypoglycemic medications were also associated with better adherence. Finally, the association between shared decision making and medication adherence was significantly modified by patients’ level of social support. Conclusions This study identified several patient-, physician-, and disease-related factors that should be targeted to maximize the potential for developing tailored adherence-enhancing interventions within the context of a collaborative patient-physician relationship.
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Affiliation(s)
- Antoinette M. Schoenthaler
- Department of Medicine, New York University School of Medicine, New York, New York (Dr Schoenthaler)
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland (Dr Schwartz)
- Geisinger Center for Health Research, Danville, Pennsylvania (Mr Wood, Dr Stewart)
| | - Brian S. Schwartz
- Department of Medicine, New York University School of Medicine, New York, New York (Dr Schoenthaler)
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland (Dr Schwartz)
- Geisinger Center for Health Research, Danville, Pennsylvania (Mr Wood, Dr Stewart)
| | - Craig Wood
- Department of Medicine, New York University School of Medicine, New York, New York (Dr Schoenthaler)
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland (Dr Schwartz)
- Geisinger Center for Health Research, Danville, Pennsylvania (Mr Wood, Dr Stewart)
| | - Walter F. Stewart
- Department of Medicine, New York University School of Medicine, New York, New York (Dr Schoenthaler)
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland (Dr Schwartz)
- Geisinger Center for Health Research, Danville, Pennsylvania (Mr Wood, Dr Stewart)
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Lewis LM, Schoenthaler AM, Ogedegbe G. Patient factors, but not provider and health care system factors, predict medication adherence in hypertensive black men. J Clin Hypertens (Greenwich) 2012; 14:250-5. [PMID: 22458747 DOI: 10.1111/j.1751-7176.2012.00591.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The problem of medication adherence is pronounced in hypertensive black men. However, factors influencing their adherence are not well understood. This secondary analysis of the ongoing Counseling African Americans to Control Hypertension (CAATCH) randomized clinical trial investigated the patient, provider, and health care system factors associated with medication adherence among hypertensive black men. Participants (N=253) were aged 56.6±11.6 years, earned <$20,000 yearly (72.7%), and almost one half were on Medicaid (44%). Mean systolic blood pressure was 148.7±15.8 mm Hg and mean diastolic blood pressure was 92.7±9.8 mm Hg. Over one half of participants (54.9%) were nonadherent. In a hierarchical regression analysis, the patient factors that predicted medication adherence were age, self-efficacy, and depression. The final model accounted for 32.1% of the variance (F=7.80, df 10, 165, P<.001). In conclusion, age, self-efficacy, and depression were associated with antihypertensive medication adherence in black men followed in Community/Migrant Health Centers. Age is a characteristic that may allow clinicians to predict who may be at risk for poor medication adherence. Depression can be screened for and treated. Self-efficacy is modifiable and its implications for practice would be the development of interventions to increase self-efficacy in black men with hypertension.
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Affiliation(s)
- Lisa M Lewis
- School of Nursing, University of Pennsylvania, Philadelphia, PA 19104-4217, USA.
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Lancaster KJ, Midberry SA, Watts SO, Cole HV, Schoenthaler AM, Ogedegbe G. Lifestyle barriers to managing hypertension in people of African descent. FASEB J 2011. [DOI: 10.1096/fasebj.25.1_supplement.974.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - Sheldon O Watts
- Nutrition, Food Studies & Public HealthNew York UniversityNew YorkNY
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Fernandez S, Scales KL, Pineiro JM, Schoenthaler AM, Ogedegbe G. A Senior CenterâBased Pilot Trial of the Effect of Lifestyle Intervention on Blood Pressure in Minority Elderly People with Hypertension. J Am Geriatr Soc 2008; 56:1860-6. [DOI: 10.1111/j.1532-5415.2008.01863.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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