A behavioral medicine perspective on adherence to long-term medical regimens.

Adherence is a major problem in pharmacological intervention, with approximately half of all patients with chronic diseases not adhering to their medical regimens. Studies have demonstrated that feedback of drug levels and reinforcement for medication intake are effective behavioral measures, whereas self-monitoring of medication or symptoms is so far only a promising method. Methodological concerns of compliance research are addressed, including setting goals for compliant behavior, measurement of compliance, and the interpretation of adherence as a correlated and independent factor in outcome. Areas for future research include long-term follow-up, better integration of behavioral theory to treatment development, and better understanding of the compliance and health outcome relationship. (63 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Physicians'' refusal to provide life-prolonging medical interventions

Phantom scatter factors, for square fields of various sizes, have been determined at a fixed reference depth of 10 cm, separately in different institutes, for a large number of linear accelerators under the auspices of the Netherlands Commission on Radiation Dosimetry. The method used for these measurements has been described in a previous paper. The present article describes the conversion of the measured values into a comprehensive and consistent data set, that gives the phantom scatter factor as a function of field size (from 4 cm up to 40 cm) and quality index (from 0.600 up to 0.800).     

Factor affecting adherence to rehabilitation interventions for individuals with fibromyalgia.

Examined treatment adherence of 87 Ss (mean age 43.96 yrs) with fibromyalgia syndrome enrolled in a rehabilitation clinical trial study and randomly assigned to 1 of 3 treatment groups: (1) biofeedback, (2) exercise, (3) combination (biofeedback and exercise) or to an attention control condition. Ss completed a 6-wk training program, questionnaires, and a physical exam. Between-group differences on an adherence measure were examined, and multiple regression analyses were used to determine the best model for predicting adherence. Results show that adherence among people with fibromyalgia is multidetermined. Those in the biofeedback intervention were more adherent, suggesting that treatment factors impact adherence. Furthermore, the best model for predicting adherence suggests that subject characteristics like age and education also influence adherence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patient adherence to cancer control regimens: Scale development and initial validation.

Describes the development of a 38-item self-report Adherence Determinants Questionnaire (ADQ) to assess 7 elements of patients' adherence to medical treatment and prevention: (1) perceptions of interpersonal care, (2) beliefs about susceptibility to disease, (3) beliefs about severity of disease, (4) assessments of perceived utility of adhering (efficacy and benefits vs costs of adhering), (5) perceptions of subjective social norms for adhering, (6) intentions to adhere, and (7) perceptions of supports available for and absence of barriers to adherence. Past adherence and health value were also assessed. In 4 diverse field settings, intentions to adhere were most highly correlated with the perceived utility of adhering. Adherence (self-reported and objectively measured) was related most strongly to the presence of supports for and the absence of barriers to adherence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Enhancing commitment improves adherence to a medical regimen.

A commitment-based intervention was evaluated for improvement of adherence to a 10-day antibiotic regimen. Experimental Ss made verbal and written commitments for adherence and completed tasks designed to increase their investment in a medication regimen. Control Ss performed similarly structured tasks unrelated to the medical regimen. Adherence, measured by unannounced pill counts, was significantly higher for experimental Ss than for control Ss. Self-reported adherence was significantly correlated with posttest self-efficacy but not with pretest self-efficacy. Adherence to a medical regimen may be improved by strategies conceptually based on the investment model of commitment, which provides a useful framework for further study of adherence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavioral interventions to increase HPV vaccination acceptability among mothers of young girls.

Objective: To determine the most effective ways to present human papillomavirus (HPV) vaccine risk and benefit information to mothers in Hispanic, African American, and White communities, to increase mothers’ intentions to vaccinate their daughters against HPV. Design: The study used a 3 × 2 between-subjects factorial design, involving 3 different risk presentation formats (graphical HPV statistics, nongraphical HPV statistics, or no-statistics control) and the presence or absence of rhetorical questions (RQ). Data were collected from a national sample of 471 mothers of girls ages 11–16. Main Outcome Variables: The primary outcome variable was mothers’ intention to vaccinate their daughters against HPV. Secondary outcomes included mothers’ self-reported message comprehension and perceptions of daughters’ vulnerability to HPV infection, infection severity, vaccine efficacy, and obstacles to immunization. Results and Conclusion: Results showed that both risk presentation format and RQs had an overall positive effect on mothers’ intention to vaccinate their daughters. However, the interventions appear to be more effective when used separately than when used in combination. Each of these interventions is brief and could easily be implemented by health care providers as well as in patient health communication literature. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluating three theory-based interventions to increase physicians' recommendations of smoking cessation services.

Objective: To evaluate three theory-based interventions aimed at increasing the rate at which primary care physicians recommend smoking cessation services to smokers. Design: Primary care physicians (n = 251) were randomized to one of four conditions: (a) information based on social cognitive theory (SCT) targeting outcome expectations, (b) information based on SCT + elaboration likelihood model, (c) feedback based on self-perception theory, or (d) control. Main Outcome Measures: Intentions to recommend and self-reported recommendations of smoking cessation services 1 week postintervention. Results: Data were analyzed using covariance and mean structure analysis. Compared with the control group, only the SCT group reported more frequently recommending services (mean difference = 1.1 recommendations per week, Cohen's d = 0.46) and higher intentions. Mediation analysis was consistent with increased intentions resulting from changes in outcome expectations. There was no evidence that changes in intentions explained self-reported behavior change. Conclusion: The study provides preliminary “proof of principle” for further studies incorporating more robust outcome measures. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Unnecessary medical interventions. A questionnaire study among physicians and laymen

The aim of the study was to survey attitudes among medical doctors and lay people to unsolicited medical intervention. The design of the study was an anonymous questionnaire study including three scenarios implying ethical considerations. A total of 445 medical doctors working within different areas received the questionnaire, as did 75 medical students and 600 lay people. The results showed a response rate of 67%, highest among medical doctors and students. The lay people had significantly higher expectations concerning the medical intervention in two out of three scenarios compared to medical doctors and students. The participants were offered the opportunity to comment on the questionnaire. The conclusion of the Danish survey is that there is a significantly different approach to unsolicited medical intervention among lay people compared to medical doctors and students. Medical doctors are less disposed to perform unsolicited intervention compared with the wishes/expectations of the lay people. More open attitudes and information as well as better communication is recommended.     

Patient-oriented interventions to improve communication in a medical office visit.

Examined an intervention to improve the patient's contribution to communication in a medical office visit. In Study 1, 53 women awaiting a medical appointment were assigned either to a group that was asked to list 3 questions to ask their physician or to a control group. Ss who listed questions asked more questions in the visit and reported being less anxious. In Study 2, with 49 women, a 3rd group received a message from their physician encouraging question asking. Both experimental groups asked more of the questions they had wished to, had greater feelings of control, and were more satisfied with the visit and with the information they received. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Adapting to the change in medical models to increase the quality of nursing care

OBJECTIVES: To evaluate the effects of insulin-like growth factor-I (IGF-I) on the maturation, fertilization, and cleavage of murine oocytes. METHODS: Immature and mature murine oocytes were cultured alone or together with murine spermatozoa in vitro. Various concentrations of IGF-I were added to the media as experimental groups, and was not added as controls. Then the rates of maturation, fertilization and cleavage of murine oocytes were observed, and compared between the 2 groups. RESULTS: The rates of maturation, fertilization and cleavage of murine oocytes in experimental groups were significantly higher than those in the controls (P < 0.01 or P < 0.05). Unequal blastomeres and cell fragments were observed in both groups, but the differences during the same cultured period were not statistically significant (P > 0.05). CONCLUSIONS: IGF-I could induce murine oocyte maturation, promote its fertilization and cleavage in vitro, and do no harm to the fertilized oocytes and embryos.     

Assessment of irrational health beliefs: Relation to health practices and medical regimen adherence.

The purpose of the present research was to provide initial validation of the 20-item Irrational Health Belief Scale (IHBS). Study 1 included 392 undergraduate psychology students. Results from Study 1 suggested that the IHBS total score is internally consistent and stable over an 18-month time period. Greater health-related cognitive distortion (higher IHBS scores) was associated with weaker internal health locus of control beliefs, lower positive affectivity, stronger chance health locus of control beliefs, and greater negative affectivity. Most important, greater cognitive distortion was uniquely and significantly associated with a less positive pattern of health practices. Study 2 involved 107 individuals with Type I diabetes mellitus. Results indicated that higher IHBS scores were significantly associated with both objective (hemoglobin HbA?) and self-reported diabetic regimen adherence independent of trait neuroticism and conscientiousness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparison of lifestyle and structured interventions to increase physical activity and cardiorespiratory fitness: a randomized trial

CONTEXT: Even though the strong association between physical inactivity and ill health is well documented, 60% of the population is inadequately active or completely inactive. Traditional methods of prescribing exercise have not proven effective for increasing and maintaining a program of regular physical activity. OBJECTIVE: To compare the 24-month intervention effects of a lifestyle physical activity program with traditional structured exercise on improving physical activity, cardiorespiratory fitness, and cardiovascular disease risk factors. DESIGN: Randomized clinical trial conducted from August 1, 1993, through July 31, 1997. PARTICIPANTS: Sedentary men (n = 116) and women (n = 119) with self-reported physical activity of less than 36 and 34 kcal/kg per day, respectively. INTERVENTIONS: Six months of intensive and 18 months of maintenance intervention on either a lifestyle physical activity or a traditional structured exercise program. MAIN OUTCOME MEASURES: Primary outcomes were physical activity assessed by the 7-Day Physical Activity Recall and peak oxygen consumption (VO2peak) by a maximal exercise treadmill test. Secondary outcomes were plasma lipid and lipoprotein cholesterol concentrations, blood pressure, and body composition. All measures were obtained at baseline and at 6 and 24 months. RESULTS: Both the lifestyle and structured activity groups had significant and comparable improvements in physical activity and cardiorespiratory fitness from baseline to 24 months. Adjusted mean changes (95% confidence intervals [CIs]) were 0.84 (95% CI, 0.42-1.25 kcal/kg per day; P<.001) and 0.69 (95% CI, 0.25-1.12 kcal/kg day; P = .002) for activity, and 0.77 (95% CI, 0.18-1.36 mL/kg per minute; P = .01) and 1.34 (95% CI, 0.72-1.96 mL/kg per minute; P<.001) for VO2peak for the lifestyle and structured activity groups, respectively. There were significant and comparable reductions in systolic blood pressure (-3.63 [95% CI, -5.54 to -1.72 mm Hg; P<.001] and -3.26 [95% CI, -5.26 to -1.25 mm Hg; P = .002]) and diastolic blood pressure (-5.38 [95% CI, -6.90 to -3.86 mm Hg; P<.001] and -5.14 [95% CI, -6.73 to -3.54 mm Hg; P<.001) for the lifestyle and structured activity groups, respectively. Neither group significantly changed their weight (-0.05 [95% CI, -1.05 to 0.96 kg; P = .93] and 0.69 [95% CI, -0.37 to 1.74 kg; P = .20]), but each group significantly reduced their percentage of body fat (-2.39% [95% CI, -2.92% to -1.85%; P<.001] and -1.85% [95% CI, -2.41 % to -1.28%; P<.001]) in the lifestyle and structured activity groups, respectively. CONCLUSIONS: In previously sedentary healthy adults, a lifestyle physical activity intervention is as effective as a structured exercise program in improving physical activity, cardiorespiratory fitness, and blood pressure.     

A feasibility test of a brief educational intervention to increase fruit and vegetable consumption among callers to the Cancer Information Service

BACKGROUND: In this paper, results are reported from a pilot study designed to test the feasibility of a proactive educational intervention delivered to callers of the Cancer Information Service (CIS). METHODS: The study used a randomized two-group design (intervention vs control). Callers assigned to the intervention condition received a brief educational intervention at the end of usual service to increase fruit and vegetable consumption. As part of the intervention, key education messages and materials drawn from the 5 A Day for Better Health program of the National Cancer Institute were provided to CIS callers over the telephone and then reinforced with two follow-up mailings. RESULTS: Results from this pilot study indicated high levels of adherence to protocol by CIS Information Specialists who delivered the intervention to eligible CIS callers. Results obtained from the 4-week telephone follow-up interviews indicated that intervention subjects (n = 142) reported higher consumption of fruits and vegetables, averaging approximately 0.75 servings more per day (P < 0.01) than control subjects (n = 134). CONCLUSION: Nearly 80% of CIS callers endorsed the strategy of providing 5 A Day information at the end of usual service, even if such information was not specifically requested by the caller (i.e., the information was provided to CIS callers proactively.     

Spouses' use of pressure and persuasion to promote osteoarthritis patients' medical adherence after orthopedic surgery.

Objective: The authors investigated health-related effects of social control (influence) that spouses exert in relation to osteoarthritis patients' medical adherence after total knee replacement surgery. Patients' behavioral and emotional responses to control were examined as mediators of associations between spouses' use of two control strategies (pressure, persuasion) and patients' physical and psychological recovery. Design: The authors used a three-wave panel design with assessments at one month before surgery, 1 month and 3 months after surgery. Data were collected during in-person interviews with 70 married, older adult patients. Main Outcome Measures: Recovery outcomes were assessed as improvement in knee limitations and depressive symptoms at the 3 month follow-up. Results: Spousal pressure and persuasion at one month postsurgery were indirectly associated with patients' recovery outcomes through patients' positive emotional responses to control. Conclusion: Although there are often immediate behavioral benefits in response to partners' use of both pressure and persuasion, the long-term health effects of these strategies seem to be accounted for by their opposing links to positive emotions. Findings further refine theory on health-related social control in marriage. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A social problem-solving model of adherence to HIV medications.

HIV medication adherence remains a challenge and limits the degree to which treatment benefit can be maximized. This study tested an explanatory model of HIV medication adherence using a social problem-solving (SPS) framework. Associations of SPS with adherence are hypothesized to be direct and/or indirect via psychological health. HIV+ adults were interviewed using validated measures of SPS, psychological health, and antiretroviral therapy (ART) medication adherence. Structural equation modeling (SEM) techniques were used to test hypothesized relationships and to evaluate overall fit of the model to the data. SEM supported an indirect association (but not direct) of SPS on adherence via psychological health among the 545 HIV+ adults included in the analyses. Overall, the findings resulted in a model of adherence that offered very good fit to the data and correctly classified 97% of the cases as adherent versus nonadherent. Results support the use of SPS as a conceptual framework for understanding adherence to ART. Findings offer rationale and direction for SPS interventions to enhance adherence by improving psychological health. Such approaches, if effective, have the potential to positively impact psychological well being and adherence, thereby maximizing clinical benefit from treatment, which is linked to lower mortality from AIDS. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Physicians' characteristics influence patients' adherence to medical treatment: Results from the Medical Outcomes Study.

Examined the influence of physicians' attributes and practice style on patients' adherence to treatment in a 2-yr longitudinal study of 186 physicians and their diabetes, hypertension, and heart disease patients. A physician-level analysis was conducted, controlling for baseline patient adherence rates and for patient characteristics predictive of adherence in previous analyses. General adherence and adherence to medication, exercise, and diet recommendations were examined. Baseline adherence rates were associated with adherence rates 2 yrs later. Other predictors were physician job satisfaction (general adherence), number of patients seen per week (medication), scheduling a follow-up appointment (medication), tendency to answer patients' questions (exercise), number of tests ordered (diet), seriousness of illness (diet), physician specialty (medication, diet), and patient health distress (medication, exercise). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A method for studying adherence of oral streptococci to solid surfaces

The LDH isoenzyme pattern of the uninvolved mucosa of gastric cancer patients differs as regards the LDH isoenzyme pattern from that of similar tissue of patients with benign gastric disease; the former tissue is characterised by a high M/H ratio of the LDH isoenzymes (M and H sub-units). A high M/H ratio characterises antral mucosa when the latter is compared with fundic mucosa. Mucosa showing superficial and atrophic gastritis also has a higher M/H ratio, whereas the presence of intestinal metaplasia does not appear to influence the M/H ratio. These observations are consistent with the concept that the tissue from which the cancer arose may possess a pre-malignant biochemical lesion.     

Hypothesis: interventions that increase the response to stress offer the potential for effective life prolongation and increased health

In the last decade it has become evident that many laboratory manipulations, both genetic and environmental, can lead to significant life extension. All or almost all of the observed life-extension phenotypes are associated with increased resistance and/or ability to respond to environmental stress. These observations show dramatically that life span is not maximized. We suggest that latent within many species-perhaps even humans-is the ability for large increases of life expectancy. The striking correlation between the increased stress resistance of all long-lived mutants in C. elegans and other species and the increased resistance of dietary restricted rodents to environmental toxins is consistent with an evolutionary conservation of a life-span maintenance/environmental stress resistance program. We suggest that it may be possible to develop methods for life extension in mammals, including humans, using relatively straightforward manipulations, such as drug treatments. It should be obvious that these findings have tremendous implications for human society at large, and we suggest that the implications of these findings should be explored.