<p>Bakgrund: Bristande följsamhet till behandling leder till sämre behandlingsresultat och står för en stor kostnad för samhället. Individens egen kunskap, erfarenhet och tro på området har betydelse för de beslut denne fattar rörande sin behandling. Syfte: Litteraturstudiens syfte var att belysa patientens syn på mediciner, medicinering och livsstilsförändringar. Metod: Studien baserades på 17 vetenskapliga artiklar som analyserades med hjälp av kvalitativ innehållsanalys. Resultat: Patienternas syn på sina mediciner berodde på faktorer som sjukdomsacceptans, bedömning av medicinerna samt tillgång till och syn på information. När det gäller synen på livsstilsförändringar så var motivation till förändring den avgörande faktorn. Diskussion: Sjukdomsacceptans var en viktig faktor när patienterna fattade beslut om följsamhet till behandling och frånvaron av symtom kunde leda till sjukdomsförnekelse. Rädsla för negativa effekter hade stor betydelse för bedömningen av medicinerna. Livsstilsförändringar påverkade identiteten kraftigare än medicinering och upplevdes därför svårare att vara adherent till. Slutsats: Att få tillgång till patienternas åsikter på området är en grundläggande faktor för att kunna få till stånd en dialog om behandlingen.</p>

<p>Background Nightingale attention that hygiene was an important task to prevent health- related infection. Today there are guidelines how hand hygiene should be followed, to prevent health- related infection. Good knowledge and education in hand hygiene and its consequences if it’s not followed is of great importance. Hand hygiene should be performed before and after the clean and the unclean work with patients and materials. Health- related infection is an infection which can affect both employees and patients as a result of care, regardless of care service. Good compliance is when hand hygiene is carried out at an appropriate time, but several studies show that this is not followed. Aim The aim with the study was to describe nurse’s knowledge and compliance to hand hygiene. Method A literature review was used to analyze scientific articles related to the topic. Results The result showed that knowledge and education was an important factor to retain compliance to hand hygiene. Hand hygiene was performed as a routine, but this could be lacking when nurses where interrupted in their working moment. Another reason why hand hygiene was not performed was that some nurses experienced skin irritation as a result. Nurses used soap and water instead of hand disinfection. Compliance was better after than before patient contact. Conclusion The authors have noted that after the hygiene education increases compliance to hand hygiene. Regular education is seen as an important part to create and maintain procedures for hand hygiene.</p>

<p>Antiretroviral therapy places extraordinarily high demands on adherence, since non-adherence affects both individuals and society due to the spread of resistant viral strains. The aims of the thesis were to investigate the prevalence of adherence in Swedish HIV-infected patients, changes in adherence over time, and factors associated with adherence, including patients’ readiness to adhere. Further, to investigate the collaboration between nurses, doctors and pharmacists after the introduction of a HIV-clinic satellite pharmacy. Data were collected via two cross-sectional patient surveys in 1998 and 2002, qualitative interviews with health care personnel at a major HIV clinic, and a nation-wide, cross-sectional patient survey in 2003-2004. </p><p>The level of adherence improved from 28% in 1998 to 57% in 2002, possibly due to simplified treatment and a new multi-professional treatment model at the clinic. The proportion of adherent patients was 63% in the nationwide survey. Factors associated with adherence were high age, high quality patient-provider relationships, no drug or alcohol problems and shorter time on treatment. </p><p>A hypothesized structural equational model, using readiness and adherence as separate latent concepts, was tested and found to support readiness as a distinct factor influencing adherence. </p><p>The health care personnel believed that conventional pharmacies had several disadvantages in serving the HIV infected population. They found the HIV-clinic satellite pharmacy valuable, since it contributed to increased communication and trust between the health care professions, and improved teamwork in medication management.</p><p>In conclusion, the level of adherence increased over time, and several factors associated with adherence were identified. Improved collaboration between health care professionals may enhance treatment support, and increased attention should be given to interventions that focus on the individual’s readiness for behavioural change in order to optimize treatment outcomes.</p>

Antiretroviral therapy places extraordinarily high demands on adherence, since non-adherence affects both individuals and society due to the spread of resistant viral strains. The aims of the thesis were to investigate the prevalence of adherence in Swedish HIV-infected patients, changes in adherence over time, and factors associated with adherence, including patients’ readiness to adhere. Further, to investigate the collaboration between nurses, doctors and pharmacists after the introduction of a HIV-clinic satellite pharmacy. Data were collected via two cross-sectional patient surveys in 1998 and 2002, qualitative interviews with health care personnel at a major HIV clinic, and a nation-wide, cross-sectional patient survey in 2003-2004. The level of adherence improved from 28% in 1998 to 57% in 2002, possibly due to simplified treatment and a new multi-professional treatment model at the clinic. The proportion of adherent patients was 63% in the nationwide survey. Factors associated with adherence were high age, high quality patient-provider relationships, no drug or alcohol problems and shorter time on treatment. A hypothesized structural equational model, using readiness and adherence as separate latent concepts, was tested and found to support readiness as a distinct factor influencing adherence. The health care personnel believed that conventional pharmacies had several disadvantages in serving the HIV infected population. They found the HIV-clinic satellite pharmacy valuable, since it contributed to increased communication and trust between the health care professions, and improved teamwork in medication management. In conclusion, the level of adherence increased over time, and several factors associated with adherence were identified. Improved collaboration between health care professionals may enhance treatment support, and increased attention should be given to interventions that focus on the individual’s readiness for behavioural change in order to optimize treatment outcomes.

Background Nightingale attention that hygiene was an important task to prevent health- related infection. Today there are guidelines how hand hygiene should be followed, to prevent health- related infection. Good knowledge and education in hand hygiene and its consequences if it’s not followed is of great importance. Hand hygiene should be performed before and after the clean and the unclean work with patients and materials. Health- related infection is an infection which can affect both employees and patients as a result of care, regardless of care service. Good compliance is when hand hygiene is carried out at an appropriate time, but several studies show that this is not followed. Aim The aim with the study was to describe nurse’s knowledge and compliance to hand hygiene. Method A literature review was used to analyze scientific articles related to the topic. Results The result showed that knowledge and education was an important factor to retain compliance to hand hygiene. Hand hygiene was performed as a routine, but this could be lacking when nurses where interrupted in their working moment. Another reason why hand hygiene was not performed was that some nurses experienced skin irritation as a result. Nurses used soap and water instead of hand disinfection. Compliance was better after than before patient contact. Conclusion The authors have noted that after the hygiene education increases compliance to hand hygiene. Regular education is seen as an important part to create and maintain procedures for hand hygiene.

Regular exercise is challenging and lapses in activity may lead to non-adherence. Adherence may be particularly challenging for symptomatic individuals with disease-related symptoms that may impede exercise. The combined use of cognitive-behavioural strategies including problem-solving has been strongly encouraged for promoting exercise adherence. However, evidence supporting the link between the use of the independent strategy of problem-solving and exercise adherence is limited. The overall purpose of this dissertation was to examine problem-solving relative to exercise-lapse related problems. Using two theoretical frameworks that offer insight into problem-solving (Model of Social Problem-Solving and Social Cognitive Theory), three studies were conducted to examine proposed relationships in various asymptomatic and symptomatic exercising samples. In Study 1A, relationships between self-regulatory efficacy (SRE) for exercise and problem-solving approach (task-diagnostic and self-diagnostic) were explored in a sample of exercising university students (n = 79). Results indicated that SRE beliefs were significantly and (1) positively related to task-diagnostic problem-solving approach and (2) negatively related to self-diagnostic problem-solving approach. In Study 1B, relationships between problem-solving effectiveness and exercise-related social cognitions were examined in the same sample. Findings demonstrated that problem-solving effectiveness was positively associated with social cognitive correlates of exercise adherence linked to adaptation. Relationships demonstrated in Study 1 provide preliminary support for previously unexamined problem-solving research questions relative to exercise. In Study 2, relationships between problem-solving effectiveness and exercise-related social cognitions (self-efficacy and persistence) were examined in a sample of exercising cardiac rehabilitation initiates (n = 52). These relationships were considered relative to two distinct components of the problem-solving process (seeking solutions to problems and carrying out solutions), which have not previously been examined relative to exercise lapses. Findings indicated significant relationships between problem-solving effectiveness and (a) self-efficacy for problem-solving (seeking solutions to problems), (b) persistence with problem-solving, (c) self-efficacy for solution implementation (carrying out solutions) and (d) persistence with solution implementation. In Study 3, problem-solving was examined among exercising cancer survivors (n = 35) with cancer-related fatigue, a problematic exercise barrier. Partial support was demonstrated for differences between more and less effective problem-solvers on fatigue-related variables. An under-examined area in problem-solving research was also examined in this study; the relationship between problem-solving and positive psychological functioning. Findings indicated significant differences for positive psychological functioning between individuals with higher and lower positive problem orientation. Taken together, the three studies represent an initial attempt to advance exercise and problem-solving literature by illustrating important theoretical relationships in three samples of exercisers, and addressing important gaps in the exercise and problem-solving literature. In regard to the latter point, the research was the first to examine (a) variables that may link problem-solving to exercise adherence, (b) two distinct components of the problem-solving process relative to an exercise lapse situation, and (c) potential links between problem-solving and selected positive psychological outcomes. Future research directions relative to problem-solving and exercise are suggested as possible next steps to advance this preliminary research.

Effective antiretroviral therapy (ART) is essential for viral suppression (VS) in HIV-infected patients. However, there is a lack of nationally representative data on types of ART regimens used and their impact on VS. This thesis used self-reported interview and abstracted medical record from 2009 Medical Monitoring Project (MMP) to study ART regimen type and related health outcomes. Results showed that 88.6% of HIV-infected adults in care was prescribed ART, and about half took regimens designated as ‘preferred’ according to U.S ART guidelines. Among MMP participants prescribed ART, 62.7% achieved durable VS, 77.8% achieved recent VS, 83.5% were 100% dose-adherent, and 17.1% reported side effects. Multivariate regression analyses revealed that although ART was critical for VS, there were minor differences in health outcomes among the major ART classes in the U.S. ART guidelines or six most-commonly used regimens. This study could be potentially useful for future strategic planning of HIV care.

The implementation of automatic transit data collection via Automatic Vehicle Location (AVL) and Automatic Passenger Counting (APC) systems provides an opportunity to create large, detailed datasets of transit operations. These datasets are valuable because they provide an opportunity to evaluate and optimize transit operations using methods that were previously infeasible and without the need for expensive manual data collection. This thesis develops a methodology to utilize data collected by typical AVL/APC system installations in order to (a) develop advanced performance measures to quantify schedule adherence and (b) automatically determine the causes of poor schedule adherence. The methodology addresses the difficulty that many small to medium sized transit agencies have in utilizing the data being collected by proposing a methodology that can be automated, thereby reducing resource and expertise requirements and allowing the data to be more effectively utilized. The ultimate output of the proposed methodology includes the following: 1. A ranked list of routes by direction (for a given time period) that identifies routes with the poorest schedule adherence performance. 2. Performance measures within any given route, direction, and time period that identify which timepoints are contributing most to poor schedule adherence. 3. Statistics indicating identified causes of poor schedule adherence at individual timepoints. 4. A visualization aid to be used in conjunction with the cause statistics generated in Step 3 in order to develop an effective strategy for improving schedule adherence issues. With this information, transit agencies will be able to act proactively to improve their transit system, rather than wait until they discover problems on their own or hear complaints from passengers and drivers. The methodology is tested and demonstrated through application to AVL/APC system data from Grand River Transit, a public transit agency serving Waterloo Region in Ontario, Canada.

Problem and significance: Adherence to health-promoting behaviors in a diabetes self-care regimen is essential for individuals with diabetes and can assist providers and individuals with diabetes management. The purpose of this research was to explore the relationship between personal factors (age, length of diabetes diagnosis, perceived health status, weight), perceived barriers to action (number of barrier days), interpersonal influences (social support), situational influences (depressive symptoms), and patient adherence to health-promoting behaviors (blood glucose monitoring, diet, and exercise) and health outcomes ( A1c and body mass index) in a diabetes self-care regimen. Methods: A descriptive correlational analysis was performed using baseline data from the National Health and Nutrition Examination Survey (NHANES) [2007-2008]. Constructs from the Health Promotion Model were used to predict health-promoting behaviors and health outcomes in diabetes self-management. The 713 participants with diabetes were primarily Black or Hispanic (57.5%), older ( M 62.2 years, SD 12.9), and married or living with a partner (56.2%). Approximately half of the participants were female (50.8%); 59% were obese. Results: The longer the time since diagnosis and the more barrier days experienced per month, the more frequently blood glucose monitoring was performed (R2 = .076, R2adj = .060, F (6, 363) = 4.875, p < .001). The greater the body weight, the more likely participants were to implement diet management behaviors (R2 = .097, R2adj = .081, F (7, 413) = 6.209, p < .001). The younger the age and the higher perceived health status, the more minutes per week were spent in exercise (R2 = .054, R2adj = .038, F (7, 412) = 3.307, p < .01). The older the age and the shorter time since diagnosis, the lower the A1c levels (R2 = .054, R2adj = .044, F (6, 568) = 5.391, p < .001). The younger the age, the more barrier days per month and the more diet management behaviors reported, the higher the BMI (R2 = .149, R2adj = .140, F (6, 581) = 16.764, p < .001). Findings indicate that treatment measures, not preventative, are being practiced, and that predictors of behaviors and outcomes are multifaceted and require further investigation.

Background: Recently across the United States, chronic diseases have been becoming more prevalent and compliance rates to recommendations have been declining. Non-adherence to health professionals recommendations creates a greater risk of complications for the patient. Objective: The objective of this study is to discover which populations have the highest prevalence of chronic disease and compare adherence to physicians’ recommendations throughout those populations. If a physician tells a patient to complete a certain behavioral change to improve health, a physician would assume that the adherence level should be nearly 100%, but it is clear adherence levels do not reach those levels. Different demographic factors play a role in adherence: gender, age, race, socioeconomic status, education status, marital status, medical insurance coverage, and comorbidity of chronic diseases. Methods: The 2007-2008 National Health and Nutrition Examination Survey (NHANES), a secondary data source, was used for data collection. The total number of people who participated in the 2007-2008 NHANES study was 5,687. Data analysis was performed with the statistical software program SPSS 19.0. A number of descriptive analyses, cross tabulations, correlations, and binary logistic regression were used to conduct a univariate and multivariate analysis of the subjects. The chronic diseases chosen to assess were hypercholesterolemia, hypertension, and diabetes. The different recommendations were made to all the patients included: eating less fat, control weight, increase exercise, and take a prescription medication for each specific condition Results: The 5,687 participants were included in the study. The prevalence of hypertension was 21.2%, hypercholesterolemia was 19.3%, and diabetes was 8.7% among those who were surveyed. Among those who were told to eat less fat, control weight, increase exercise and take prescription to control their chronic disease condition, adherence levels ranged greatly. The significance of a physician recommending a behavioral change had the biggest impact on whether a patient would adhere. No significance was seen between any of the demographic variables except for marital status for those who were told to take a prescription to control hypercholesterolemia. Discussion: The study has proven physician recommendations to control chronic disease are usually to take a medication. An individual’s demographics have a small impact on whether he or she will adhere to the advice of the physician. Additional research needs to be completed to understand the patient to physician relationship, which seems to have the biggest impact on behavioral change. Furthermore, new interventions are needed to increase adherence to 100%. Increasing chronic disease adherence across the United States will result in decrease spending in health care costs in the United States.