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Total knee arthroplasty (TKA) places a large burden on the Canadian Health care system with over 700 million dollars spent on this procedure annually. Exercise has been shown to be effective in improving pain, physical function, mobility and quality of life post-operatively. There is very limited research on adherence to rehabilitation and exercise after TKA. The aim of this thesis was to increase understanding of exercise adherence in this population. The first manuscript in this thesis was a scoping review that evaluated exercise adherence and the quality of reporting of exercise interventions within post-operative TKA rehabilitation trials. A systematic search of scientific databases was conducted for randomized controlled trials (RCT) with an exercise intervention for post-operative TKA. In total, 112 articles were included in this review. This study found that the vast majority of articles (85%) were of poor quality having either high/unclear risk of bias. The majority of RCTs (63%, N=71) on post-operative TKA rehabilitation did not adequately report exercise adherence (e.g., definition, outcome measure used and results), while only 23% (N=15) provided a definition of adherence in the context of their study. Overall reporting of the exercise intervention was poor, with 15 items (of 19) of the Consensus on Exercise Reporting Template (CERT) reported less than 60% of the time. Inadequate reporting of exercise interventions and adherence to exercises leads to decreased reproducibility and translation into clinical practice. Proper reporting of rehabilitation exercises after TKA will ensure standardization for future studies and clinical replication. The second manuscript in this thesis was a qualitative study that aimed to understand the patient- related barriers and facilitators to exercise adherence in patients immediately after undergoing TKA. Using an interpretive description approach, semi-structured qualitative interviews were conducted. Seven participants were interviewed at 8-weeks post-operatively in order to better capture physical, psychological, social and contextual factors linked to exercise adherence. Interview questions explored participants’ experience with physical activity and exercise, motivation to perform physical activity, beliefs that exercise will reduce pain, the factors that limit their ability to engage in exercise, and the importance of using self-regulation to improve exercise adherence. Emergent themes were mapped onto the domains of the WHO adherence framework. This study identified 4 themes that fit within the WHO adherence framework: patient-related factors, condition-related factors, health care system, and social support. In particular, self-regulation, previous knowledge of exercise, post-operative complications, comorbidities, social support, and lack of guidance from health care providers were identified as personal and environmental characteristics that affect exercise adherence. The overall findings of this study suggest exercise adherence is a multifaceted construct with interconnected concepts. / Thesis / Master of Health Sciences (MSc) / Total knee replacement (TKR) surgery costs the Canadian Health care system millions of dollars per year. Exercise is an effective method for improving function and decreasing pain after surgery. However, it is unclear how much patients perform exercise as recommended by health care providers. The purpose of this study was to understand exercise behaviour after knee surgery. The first study was a scoping review that looked at exercise adherence and the characteristics of exercise treatments delivered after knee surgery in previously published clinical trials. The study found that most studies did not report enough information for replication of exercise treatment protocols (e.g. description of provided exercises/progression, who implemented the intervention, etc.). Similarly, exercise adherence was also poorly reported (e.g., definition, how adherence was measured). Poor reporting of exercise treatment methods, and how well participants complete exercises decreases the ability of researchers and therapists to apply the results of these trials. In the second study, patients were interviewed after knee surgery to understand why patients do or do not exercise after surgery. There were several factors, both positive and negative, that patients identified that affected their ability to exercise (e.g. self-regulation (referring to the ability to control thoughts, emotions and behaviour to pursue long-term goals), prior knowledge of exercise, having social support from family and friends, as well as lack of support from health care providers). The overall findings suggest that how well participants exercise after surgery is a complex issue. In order to improve exercise adherence, we need to have a better understanding of the individual factors that may influence adherence.

The purpose of the current study was threefold: 1) to assess youths' and parents' perceptions of their competency in managing diabetes, 2) to assess family flexibility and cohesiveness, and 3) to assess the utility of self-efficacy and family factors as predictors of adherence and metabolic control. Participants included 62 youths with insulin-dependent diabetes mellitus (IDDM) and their parents. Parents' and youths' perceptions of their abilities in diabetes and related situations, family cohesion and adaptability, and perceptions of the family's ability to integrate the demands of the diabetes regimen into general family routines were assessed. Results suggested that both social learning factors and general family relations were important in the prediction of youths' adherence to the treatment regimen for diabetes and metabolic control. Moreover, family efficacy and family cohesion were related, suggesting the need for models of assessment and intervention that include both social learning and general family functioning variables. / Ph. D.

Gydytojo nurodymų nesilaikymas ir netinkamas vaistų vartojimas vis dar yra aktuali problema, skatinanti rezistentiškų bakterijų padermių atsiradimą. Tikslas ir uždaviniai. Palyginti nedaug atliktų tyrimų siekė pagerinti gydytojo nurodymų laikymąsi ir tik nedaugelis jų buvo sėkmingi.Todėl siekėme ištirti paprastos vaistininko intervencijos veiksmingumą gerinant gydytojo nurodymų laikymąsi, taip pat, išsiaiškinti veiksnius, siejamus su gydytojo nurodymų laikymusi ir nesilaikymo paplitimą, pacientų drausmingumo proporcijas. Tyrimo metodika ir metodai. Tyrime dalyvavo 66 pilnamečiai pacientai, kuriems buvo paskirtas trumpalaikis gydymas antibiotikais. 32 iš jų atsitiktine tvarka buvo įvykdyta vaistininko intervencija, po 48-72 val. laikotarpio nuo vaistų paskyrimo buvo skambinama pacientams ir informuojama apie galimas gydytojo nurodymų nesilaikymo pasekmes bei skatinama tinkamai vartoti vaistus. Rezultatai. Nustatyta, kad trečdalis pacientų (n=22, 33,3 proc.) nesilaikė gydytojo nurodymų vartojant antibiotikus ambulatoriškai (n=66). Atlikta paprasta intervencija reikšmingai pagerino gydytojo nurodymų laikymąsi (p=0,001): 28 (87,5 proc.) intervencinėje grupėje ir tik 16 (47,2 proc.) kontrolinėje grupėje laikėsi gydytojo nurodymų. Nustatyta (p≤0,01), jog žinantys kaip vartoti vaistus, savo ligą vertinantys kaip rimtą bei priimantys sprendimus susijusius su gydymu kartu su gydytoju buvo drausmingesni; nustatyta tendencija jog žinantys apie savo ligą pacientai taip pat yra... [toliau žr. visą tekstą] / Purpose and objectives of the research. Failure to follow prescribed antibiotic regimen may lead to the emergency of resistant to antibiotic drug therapy bacteria strains. Relatively small number of studies tried to enhance medication adherence in case of antibiotic use, and only few of them resulted in better adherence. Therefore we aimed to explore efficacy of simple pharmacist’s intervention (3-5 min telephone call) in enhancing outpatients' adherence, and also to determine risk factors of non-adherence in our sample. Methods. A total of 66 adult outpatients who received short-term treatment with antibiotics took part in our survey. Almost half of them (n=32, 48.5%) were randomized to intervention group, and were called in 48-72 hours after antibiotic prescribing to inform about possible consequences of non-adherence and to encourage to take antibiotics as prescribed. Results. It was found that one-third of patients (n=22, 33%) were non-adherent to the prescribed antibiotic regimen. Simple pharmacists’ intervention significantly improved adherence (p = 0.001): 28 (87.5%) and only 16 (47.2%) patients in the intervention group and in the control group followed physician instructions, respectively. It was found (p <0.01) that patients who knew how to take their medication, who perceived severity of their condition, as well as those who make decisions related to the treatment together with the physician reported better adherence. Also, there was found a trend (p = 0.128) that... [to full text]

Magister Public Health - MPH / Background: HIV and AIDS is one of the major public health problems facing South Africa today. In 2005, it was estimated that 5.54 million people were living with HIV in South Africa, which means that 18.8% of the population between the ages of 15 – 49 years are infected with HIV. This makes South Africa the developing country worst affected by the HIV pandemic. The severity of the HIV epidemic is closely linked to poverty and other socio-economic factors. The National Department of Health of South Africa launched the National Operational Plan for Comprehensive HIV and AIDS management, treatment, care, and support in 2007 to ensure that ART is freely available in the public health sector. It is estimated that by mid-2008 approximately 568, 000 HIV infected patients were receiving ART at South African hospitals. Suboptimal adherence to ART is pervasive despite specific protocols to prepare patients for long-term adherence prior to treatment initiation. Known barriers to ART adherence have been categorized as patient, socio-economic, service, therapy/regimen and communityrelated factors. Effective delivery of ART services requires an understanding of patients’ knowledge, attitudes, and beliefs about ART and how these influence their adherence. Aim: The aim of the study was to assess adherence to antiretroviral therapy and knowledge, attitudes and beliefs about ART among people on ART at Shongwe hospital in Nkomazi region in Mpumalanga province, South Africa. Methodology: A descriptive, cross-sectional survey was conducted among 184 patients receiving ART at Shongwe hospital in Mpumalanga. Data was collected through selfiv administration and face-to-face interviews. Quantitative data was analysed using the SPSS version 16.0 and for stratification Epi-Info version 3.4.1 was used. Results: All participants were on first line regimens: lamivudine/stavudine/stocrine or efivarenz (65.6%); and lamivudine/stavudine/nevirapine (34%). Self-reported adherence was high - 92.4% and 84.2% of participants reported optimal adherence over the previous two days and seven days, respectively. Disclosure of HIV status and being on ART was high among the respondents (97% and 97.3%) respectively. The most common barriers to missing doses were problems travelling to the clinic (22.3%), forgetting (19.6%), and sleeping away from home (18.5%). There was significant association between participants knowing that “missing doses of ART leads to disease progression”, and ART adherence on two day recall (p=0.00) and seven day recall (p=0.02). There was a significant association between disclosure of HIV status and ART adherence on two day recall (p=0.01). Significantly more participants who disclosed being on ART (98.2%) reported optimal adherence over the previous two days (p = 0.00) and seven days (p = 0.00) compared to those who did not disclose being on ART. Participants who reported forgetfulness were 76% less likely (95% CI: 0.09-0.65) and 92% less likely (95% CI: 0.04 – 0.17) to have optimal adherence over two and seven days, respectively, than participants who did not report forgetfulness to be a barrier. Conclusion: Adherence levels in Nkomazi region are to be comparable with those in other regions in South Africa, despite the fact that participants were facing financial constraints and high unemployment rates. These study findings emphasize the need for strengthening communication between patients and health care providers, and the need for overcoming access barriers related to the services, forgetfulness and sleeping away from home.

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<p><font face="Times New Roman"> <p align="left"><font face="Times New Roman"><b><font face="Times New Roman">Aim</font><font face="Times New Roman">: To obtain baseline data on adherence levels and the major determinants of adherence among patients on HAART at Rundu Hospital, Namibia.</font></b></font></p> </font></p>

<p><font face="Times New Roman"> <p align="left"><font face="Times New Roman"><b><font face="Times New Roman">Aim</font><font face="Times New Roman">: To obtain baseline data on adherence levels and the major determinants of adherence among patients on HAART at Rundu Hospital, Namibia.</font></b></font></p> </font></p>

Magister Public Health - MPH / Aim: To obtain baseline data on adherence levels and the major determinants of adherence among patients on HAART at Rundu Hospital, Namibia. Results: Seventy-eight percent of the 97 participants included in the study were female, resulting in a female to male ratio of 4 :1. The mean age of the participants was 36.7 (SD: 9.00) years with 80% of the participants being in the 20-44 age group. The mean duration on ART treatment was 20 (SD: 10.3) months with 76% of the participants being on ART for 24 or less months. The average adherence rate reported by mean composite of the three measures was 95.1%, while the proportion of patients who achieved adherence levels of 95% and above was 64%. The main barriers to adherence to HAART reported by participants were forgetfulness (28%), lack of food (13%) and being away from the pills (11%): facilitators reported included counselling (19%) and treatment supporters (11%). Having knowledge of the consequences of failing to take HAART as prescribed was significantly associated with adherence (p = 0.03), as was being female (p = 0.04) while living further than 6 km from the hospital was significantly associated with non adherence (p = 0.018).