Hypertension, or high blood pressure, is a major risk factor for heart disease and stroke. Elevated blood pressure is often a silent process affecting multiple organ systems. Risk for heart disease is associated with poorly treated or unrecognized hypertension that is more common among women than men. Non-adherence to prescribed treatment regimens has been identified as a major reason for inadequate hypertension management. This exploratory descriptive qualitative study using narrative inquiry investigated adherence practices among Caucasian women with diagnoses of hypertension from a rural area of Florida. The purpose of this study was to gain an understanding from women who had been diagnosed with hypertension about the challenges of living with and managing this chronic condition in their daily lives. Participants included Caucasian women (n = 11) recruited from a Federally Qualified Rural Health Center in Florida. Semi-structured interviews were used to collect data. Content analysis procedures were used to analyze the interviews. Emergent themes included: work stress affecting health and leading to high blood pressure; silent ―sneaky, gradual‖ onset of mild to moderate symptoms leading to high blood pressure; and strong influence of family members with high blood pressure and related complications that instilled fear in participants to adhere to their prescribed treatment plan in some, or in others to non-adherence. Social support from friends and coworkers was a repeated theme supporting adherence. Minor themes associated with non-adherence included fear of potential side effects of medications, challenges of daily living caring for family, fatigue from high blood pressure and medications affecting daily work, poor food choices due to finances and availability of high sodium and fatty foods at work and home, stress and time demands affecting iv ability to exercise to control high blood pressure, and focus on family forgetting self-needs. Limitations of the study included a small convenience sample with findings that may not be applicable to a population of hypertensive women from different rural settings. Future nursing studies in similar populations may contribute to improved adherence practices, leading to reduced complications from poorly controlled hypertension.

Problem: A Major challenge for healthcare providers is the non-adherence of patients to prescrip- tions. One important area is hypertension treatment through medication. A treatment often starts with multiple adjustment cycles of medication type or dosage, which are based on regular at-home blood pressure measurements. Patients therefore need to adhere to regular medication intake and blood pressure measurements. Research Aim: The project first explored whether or not it is possible to develop a medication reminder system that checks patient adherence based on vital parameters. The project goal was adapted to the design and development of a reminder and data logging system for hypertension patients, based on the following research questions: 1) What are functional and non- functional requirements for the proposed artefact? 2) How can these requirements be implemented? Method: The project makes use of Design Science Research to create the system. The problem and requirement explication for the new artefact was achieved by working closely with a general prac- titioner who deals with hypertension patients. The artefact was evaluated by presenting it ex-post to a focus group of a hypertension patient, developers and founders in digital health. Results: The results of expert interviews concluded that the initial project aim is not feasible due to continuous vital monitoring being invasive and intrusive, lack of applicability for health conditions and medica- tions and other potential negative consequences. These insights led to the new research aim. The results address the question: ”What are functional and non-functional requirements for the proposed artefact?”. The envisioned product is a cross-platform application, illustrating the frequent medica- tion adjustments for hypertension patients. The treating doctor should configure all patient-specific parameters and the app should guide patients through daily tasks like measurements and medication intake. The patient should also be reminded of their tasks. The app should record, display, and export data for the doctor’s review, and ensure easy input of measurements. Future remote data exchange capabilities via servers were also considered. To address the research question ”How can these requirements be implemented?”, the researcher developed a cross-platform mobile application for iOS and Android with .NET Multi-Platform App UI (MAUI) that implements the desired features. A concept for remote data exchange and a system for scanning measured values of blood pressure devices were developed. The evaluation partially validated the problem area and discussed future implementations, such as remote data exchange, usage of patient data for research and adoption to other medication. The perceived high usability of the application was emphasized. Conclusions: The researcher concludes that the developed artefact addresses a relevant problem and extends existing solutions in the problem space. It is acknowledged that future research has to be conducted to prove the effectiveness of the tool as well as assess its usability and accuracy. Difficulties for accepting the artefact in real life settings are discussed.

Background Non-adherence to evidence based secondary prevention medicines (SPM) by coronary heart disease (CHD) patients limits their expected benefits and may result in a lack of improvement or significant deterioration in health. This study explored self-reported non-adherence to SPM, barriers to adherence, and the perception that patients in West Yorkshire have about their medicines in order to inform practice and improve adherence. Methods In this cross-sectional study a specially designed postal survey (The Heart Medicines Survey) assessed medicines-taking behaviour using the Morisky Medicines Adherence 8 items Scale (MMAS-8), a modified version of the Single Question Scale (SQ), the Adherence Estimator (AE), Beliefs about Medicines Questionnaire(BMQ) and additional questions to explore practical barriers to adherence. Patients were also asked to make any additional comments about their medicines-taking experience. A purposive sample of 696 patients with long established CHD and who were on SPM for at least 3 months was surveyed. Ethical approval was granted by the local ethics committee. Results 503 (72%) patients participated in the survey. 52%, 34% and 11% of patients were prescribed at least four, three and two SPMs respectively. The level of non-adherence to collective SPM was 44%. The AE predicted that 39% of those had an element of intentional non-adherence. The contribution of aspirin, statins, clopidogrel, beta blockers, angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARBs) to overall non-adherence as identified by the SQ scale was 62%, 67%, 7%, 30%, 22% and 5%, respectively. A logistic regression model for overall non-adherence revealed that older age and female gender were associated with less non-adherence (OR = 0.96, 95% CI: 0.94, 0.98; OR = 0.56, 95% CI: 0.34, 0.93; respectively). Specific concern about SPM, having issues with repeat prescriptions and aspirin were associated with more non-adherence (OR = 1.12, 95% CI: 1.07, 1.18; OR = 2.48, 95% CI: 1.26, 4.90, OR = 2.22, 95% CI: 1.18, 4.17). Other variables were associated with intentional and non-intentional non-adherence. 221 (44%) patients elaborated on their medicines-taking behaviour by providing additional comments about the need for patient tailored information and better structured medicines reviews. Conclusions The Medicines Heart Survey was successful in revealing the prevalence of self-reported non-adherence and barriers to adherence in our population. Healthcare professionals should examine specific modifiable barriers to adherence in their population before developing interventions to improve adherence. Conducting frequent structured medicines-reviews, which explore and address patients' concerns about their medicines and healthcare services, and enable them to make suggestions, will better inform practice and may improve adherence.

This study was conducted using a quantitative design and statistical analysis to determine the extent to which social support will influence an individual's decision to seek treatment for a medical illness. Main findings include significant correlations between measures of perceived and tangible social support and treatment compliance.

The relationship between health beliefs, based on the Health Beliefs Model, and compliance with a sodium-restricted diet was investigated. Significant predictors of compliance and the relationships among compliance measures were also investigated. The Health Beliefs Questionnaire was administered to a convenience sample of 30 hypertensive elderly subjects. Overnight urine chloride, questionnaire (added salt and salty foods), blood pressure, and dietary recall operationalized compliance. No significant relationship was found between a total health beliefs score, perceived resusceptibility to hypertension, and perceived severity of hypertension and compliance. Perceived benefits of antihypertension treatment had significant relationships with urine chloride (r = 0.41) and blood pressure (r = 0.35). Age, a significant predictor, accounted for 12% of compliance. Urine chloride significantly correlated with added salt (r = 0.44), salty foods (r = 0.44), and blood pressure (r = 0.45). Barriers to a sodium-restricted diet were categorized as no control of salt in prepared foods, desire for salt, addictive behavior, and beliefs about salt.

Diabetes mellitus is a complex disease that requires constant patient compliance to diet, life style, glucose level monitoring and medication. Non-compliance to medication can be associated with the development of complications, avoidable hospitalization, disease progression, premature disability and death. Noncompliance is also very costly and therefore compliance to medication regimens is very important. A promising, yet under-explored approach to compliance is self-regulation. Selfregulation refers to the process of goal setting and striving. Self-regulation has specifically been associated with success in reaching one’s goals. The key selfregulation processes include goal establishment, planning, striving towards a goal and revising it. Although a large number of studies have been conducted on compliance related to diabetes, there is a lack of research findings from a selfregulation perspective. The aim of this study is to investigate the relationship between self-regulation and patient compliance to type I and type II medication. Specific aims are (a) to determine whether there is a significant difference in the mean self-regulation scores for participants high and low in compliance and (b) to determine whether there are significant differences in the mean self-regulation scores between compliant and non-compliant participants within different gender and age groups. The participants consisted of an availability sample of 50 (31 female and 19 male) type I and type II diabetes patients collecting their medication at the Clicks Pharmacy in Potchefstroom and Trans 50 retirement villages in Pretoria, Bloemfontein and Kimberley. The ages of the participants ranged between 20 and 87 years. Compliance was measured by investigating the participants’ repeat scripts as well as the Clicks Medication Therapy Management Questionnaire (MTM-Q), developed in 2009 by pharmacists at Clicks to measure patients’ self-report of compliance. Selfregulation was measured with the Shortened Self-Regulation Questionnaire (SSRQ) (Carey, Neal, & Collins, 2004). The study used the factor structure proposed by Potgieter and Botha (2009), based on a factor analysis of the SSRQ in the South- African context. Data capturing and analysis was done in consultation with the Statistical Consultation Services of the North-West University. A total number of 28 (56%) participants in this study were classified as compliant, which is lower than compliance figures reported in most international studies. Differences between compliant and non-compliant participants were primarily noted with regard to Mindful Awareness, Monitoring and Decision making. No differences were noted between any of the groups regarding Learning from mistakes, Perseverance, or Self-evaluation. Compliant participants in the total, female and older groups scored higher on Mindful Awareness than non-compliant participants. For older participants, this difference was practically significant. Compliant participants in the female and older group also obtained higher scores on Monitoring, with the difference in the female group practically significant. Surprisingly, noncompliant female participants scored higher on Decision Making than compliant female participants. Compliant and non-compliant male and younger participants, however, did not differ on any of the self-regulation factors. The study emphasizes the fact that diabetes is perceived as a significant challenge to the current goals of the patient. Subsequently, this study confirms, to a large extent, the importance of self-regulation in compliance to type I and type II diabetes medication, providing support for international studies that emphasise the importance of behavioural factors in diabetes. Mindfulness and Monitoring emerged as important factors in this study, and was explained in relation to compliance as a challenge to one’s perceptual awareness and ability to continuously generate feedback regarding one’s health status. The reason for gender and age related differences in the relationship between compliance and self-regulation, however, is not totally clear and needs to be explored in further research. An important limitation of the study is the small sample size that was used. Future research should explore the trends emerging from this study in larger, random samples. / MA (Research Psychology), North-West University, Potchefstroom Campus, 2014

Diabetes mellitus is a complex disease that requires constant patient compliance to diet, life style, glucose level monitoring and medication. Non-compliance to medication can be associated with the development of complications, avoidable hospitalization, disease progression, premature disability and death. Noncompliance is also very costly and therefore compliance to medication regimens is very important. A promising, yet under-explored approach to compliance is self-regulation. Selfregulation refers to the process of goal setting and striving. Self-regulation has specifically been associated with success in reaching one’s goals. The key selfregulation processes include goal establishment, planning, striving towards a goal and revising it. Although a large number of studies have been conducted on compliance related to diabetes, there is a lack of research findings from a selfregulation perspective. The aim of this study is to investigate the relationship between self-regulation and patient compliance to type I and type II medication. Specific aims are (a) to determine whether there is a significant difference in the mean self-regulation scores for participants high and low in compliance and (b) to determine whether there are significant differences in the mean self-regulation scores between compliant and non-compliant participants within different gender and age groups. The participants consisted of an availability sample of 50 (31 female and 19 male) type I and type II diabetes patients collecting their medication at the Clicks Pharmacy in Potchefstroom and Trans 50 retirement villages in Pretoria, Bloemfontein and Kimberley. The ages of the participants ranged between 20 and 87 years. Compliance was measured by investigating the participants’ repeat scripts as well as the Clicks Medication Therapy Management Questionnaire (MTM-Q), developed in 2009 by pharmacists at Clicks to measure patients’ self-report of compliance. Selfregulation was measured with the Shortened Self-Regulation Questionnaire (SSRQ) (Carey, Neal, & Collins, 2004). The study used the factor structure proposed by Potgieter and Botha (2009), based on a factor analysis of the SSRQ in the South- African context. Data capturing and analysis was done in consultation with the Statistical Consultation Services of the North-West University. A total number of 28 (56%) participants in this study were classified as compliant, which is lower than compliance figures reported in most international studies. Differences between compliant and non-compliant participants were primarily noted with regard to Mindful Awareness, Monitoring and Decision making. No differences were noted between any of the groups regarding Learning from mistakes, Perseverance, or Self-evaluation. Compliant participants in the total, female and older groups scored higher on Mindful Awareness than non-compliant participants. For older participants, this difference was practically significant. Compliant participants in the female and older group also obtained higher scores on Monitoring, with the difference in the female group practically significant. Surprisingly, noncompliant female participants scored higher on Decision Making than compliant female participants. Compliant and non-compliant male and younger participants, however, did not differ on any of the self-regulation factors. The study emphasizes the fact that diabetes is perceived as a significant challenge to the current goals of the patient. Subsequently, this study confirms, to a large extent, the importance of self-regulation in compliance to type I and type II diabetes medication, providing support for international studies that emphasise the importance of behavioural factors in diabetes. Mindfulness and Monitoring emerged as important factors in this study, and was explained in relation to compliance as a challenge to one’s perceptual awareness and ability to continuously generate feedback regarding one’s health status. The reason for gender and age related differences in the relationship between compliance and self-regulation, however, is not totally clear and needs to be explored in further research. An important limitation of the study is the small sample size that was used. Future research should explore the trends emerging from this study in larger, random samples. / MA (Research Psychology), North-West University, Potchefstroom Campus, 2014

The purpose of this study was to identify factors contributing to non-compliance to TB treatment amongst pulmonary TB patients in Waterberg district, Limpopo. The health-belief model was the conceptual framework which guided this study. A quantitative, cross-sectional, descriptive study design was used. Data was collected using a structured questionnaire administered by trained data collectors. Data was collected from 215 respondents. Informed consent was obtained from each respondent prior to data collection. MS Excel and SPSS were used to analyse data. Findings on significant factors contributing to noncompliance to TB treatment include; non-availability of food whilst taking TB treatment, disbelief in the fact that TB can result in death if not treated, belief in traditional medicine for curing TB, bad healthcare worker attitudes, long distance to the clinic for treatment, belief that TB treatment takes very long and the pill burden / Health Studies / M.A. (Public Health)

Assignment (MA)--University of Stellenbosch, 2005. / ENGLISH ABSTRACT: Adherence to medical regimes and the difficulties associated with patient adherence are well documented. Furthermore, non-adherence with prescribed medication is ubiquitous. Regarding HIV, strict adherence to combination highly active antiretroviral therapy regimes is a prerequisite for immunological reconstitution. Certain factors have been identified as predicting non-adherence. However, the role of personality variables on adherence has been neglected, specifically with regards to personality pathology. Moreover, there is a high rate of comorbidity between HIV and Axis II disorders, including BPD. Despite controversy, the DSM-IV-TR identifies nine fundamental criteria required for the diagnosis of BPD to be made. These criteria are considered separately in an attempt to elucidate their potential role on non-adherence. Clinically, it is likely that the criteria interact to create a gestalt effect, further complicating adherence. / AFRIKAANSE OPSOMMING: Patient voldoening ter mediese aanbevele en die probleme geassosier daarmee is goed gedokumenteer. En verder is dit allerdags dat patlente nie met hul voorgeskrewe medikasie voldoen nie. In verband met MIV, streng voldoening tot HAART is a voorvereiste vir immunologiese hersamestelling. Sekere faktore is geidentifiseer wat voldoening en die teenoorgestelde daarvan voorspel. Alhoewel, die rei van persoonlikheid veranderlikes op voldoening is nie in ag geneem nie, spesifiek in verband met persoonlikheid patologie. Bowenal, is daar n hoe frekwensie van komorbiditeit tussen MIV en As II steurings, insluitend BPO. Ten spyte van kontroversie, die OSM-IV-TR identifiseer nege fundementele kriteria, waarvan vyf teenwoordig moet wees vir n diagnose van BPO. Hierdie kriteria word individueel bespreek in n poging om hulle impak op patiente voldoening te illustreer. Klinies is dit heel moontlik dat daar interaksie is tussen die kriteria wat n gestalt effek sal skep, wat voldoening weer verder sal kompliseer.

Descriptive research was conducted to describe the relationships among host and environmental factors and immunization compliance in two year old children. Secondary data was collected from a sample of 306 well baby clinic records in a public health department in a Southwestern state. Results revealed statistically significant differences between the compliant and noncompliant groups for income and number of children living at home. Higher income, higher maternal age, fewer number of children, and races other than of Spanish origin were significantly correlated with children who received all immunizations at the appropriate age. Significant relationships were found between children who received all immunizations at the public health department versus children who received immunizations from both a public and private provider. Compliant children made more visits for immunizations and fewer other visits than noncompliant children. These factors can assist in identifying children at highest risk for failure to receive immunization on time.