Aim The aim of this qualitative study was to explore Indonesian nurses’ experiences of patient education and patients’ adherence to TB treatment. Background Tuberculosis (TB) is an infectious disease that 9.6 million people in the world suffer from. Indonesia is one of the world’s 22 high-burden countries with over 320.000 cases of TB in 2014. The UN’s (United Nation) goal is to have ended the TB epidemics by the year 2030. Nurses play a central role in accomplishing adherence to treatment and prevention of TB. Method To fulfil the aim a qualitative method using semi-structured interviews was used. The interviews were recorded and transcribed. The transcribed data was analysed by using a qualitative content analysis with a manifest approach. Findings The findings, based on the result of nine interviews, showed four themes: “Strategies for patient education”, “Factors affecting patient education and adherence to treatment”, ”Outcomes of patient education” and ”Feelings and opinions about patient education”. Conclusion This study showed that the nurses use different strategies when practicing patient education. It was also shown that the nurses are well aware about patient-related factors and how they affect patient education and adherence to TB treatment. Keywords Tuberculosis, nursing care, patient education, adherence

Background: A low adherence is one of the reasons for the development of drug resistant Tuberculosis. One of the identified factors connected to adherence is the relations between health care personal and patient. Nurses all over the world daily work close to the patient supporting them to achieve a high adherence to their treatment plan. Still there is an underrepresentation in a scientific view of exploring and evaluating this preformed work. Aim: The aim of this study wad to explore how the Namibian nurses experienced adherence to treatment in patients diagnosed with multidrug-resistant tuberculosis. Method: A qualitative research technic was used to collect data. The interview questions were constructed in a semi-structure with partly opened questions. The data was analysed with Graneheim and Lundman (2004) analysis model. Result: Strategies that was used by the nurses to enable a high adherence was providing information, counselling and education to the patient together with a practical support of delegating DOTS and providing the patient with medicine. There was a divided opinion on how to communicate with the patient depending on the nurse fundamental view of adherence. A doctor centred view resulted in a one way communication by informing the patient. A patient centred view of adherence resulted in a two way communication when the nurse aimed to learn about the patient own point of views. Conclusion: To enable a high adherence there has to be a two way communication which demands high communicational skills from the nurse.

Background: Diabetes is an increasing global health problem and this puts high demands on the health care system. Patients with diabetes demand continuous treatment and monitoring in order to control the disease and avoid complications. Adherence to recommended treatment was important in order for the treatment to give positive effect. In this context adherence was defined as the extent to which the patients follow medical instructions.Aim: The aim of this study was to identify factors that can affect the adherence to recommended treatment among patients with type 1 and type 2 diabetes. Method: The study was a cross-sectional study with a quantitative method. A questionnaire was administered to 150 respondents at the diabetes clinic of Mulago hospital in Kampala, Uganda. Patients diagnosed with both type 1 and type 2 diabetes were included in the study. Result: Out of 150 participants 48 (32%) did not take their drugs as prescribed and 80 (53.3%) did not follow any recommended diet. Main reason for non-adherence to the treatment was reported as financial problems. 118 (78.7%) of the respondents had participated in some kind of diabetes education, still 67 patients (44.7%) reported that they did not have enough knowledge about their diabetes diagnosis. The results show that those with knowledge about their diabetes diagnosis also take their medication to a higher extent (46%) than those who reported lack of knowledge (22%). Conclusion: Factors that affect the adherence was identified as poverty, lack of knowledge, non-access to medications, the use of alternative medicines and non-access to health care. Further studies about adherence to treatment among diabetes patients are of importance in order to improve the diabetes care and come up with solutions to a growing global health problem.

The purpose of this investigation was to explore how adherence to a positional therapy intervention affected therapeutic outcome in participants with positional-related obstructive sleep apnea syndrome. Eighteen adult participants identified as having positional-related obstructive sleep apnea by an initial overnight polysomnography study were recruited. Participants were instructed to use a “tennis ball technique” positional device for three weeks at home and record their sleep habits and adherence before a final post-treatment polysomnography evaluation. A repeated measures MANOVA found significant effects of treatment between pre- and post-test on the objective polysomnography variables of Total Recording Time [F(1,17) = 5.21, p<.05, η²=.24], Total Sleep Time [F(1,17) = 8.59, p<.01, η²=.34], Sleep Efficiency [F(1,17) = 5.42, p<.05, η²=.24], Total REM sleep time [F(1,17) = 9.91, p<.01, η²=.37], and the Apnea- Hypopnea Index [F(1,17) = 14.28, p<.001, η²=.46]. Sleep onset latency was not statistically significant. There were significant effects of treatment on the subjective measures of the Functional Outcome of Sleep Quality [F(1,17) = 8.92, p<.01, η²=.35], Pittsburgh Sleep Quality Index [F(1,17) = 11.2, p<.01, η²=..39], Epworth Sleepiness Scale [F(1,17) = 6.69, p<.05, η²=.28], and the Brief Symptom Inventory [F(1,17) = 5.14, p<.05, η²=.23]. No significant interaction effects were found between treatment and adherence when participants were grouped post-hoc into an adherent or non-adherent categories based on their self-reported daily log data. In summary, the results of this study indicated that the positional device was efficacious for significantly improving both objective polysomnography variables and subjective variables of sleep. The results also indicated even partially adherent participants reported significant improvements in nighttime sleep quality and quality of life after the three week treatment period. Mixed Linear Modeling demonstrated that significant improvements in sleep quality, time to sleep onset, and total sleep time were not seen until the last weeks of treatment. This study found very acceptable adherence rates with this positional device design; all participants were able to utilize the therapeutic device on at least a portion of every night during the three-week intervention.

In light of the current global prevalence of overweight and obesity, the associated health risks, and the continuing adoption of sedentary lifestyle, this thesis investigated some of the factors that contribute to exercise adherence, directly comparing high-intensity whole body interval training and continuous endurance training. 68 inactive university aged adults (Age: 21.4±3.4 yrs, BMI: 25.6±4.6 kg/m2, VO2peak 40.1±5.7 ml/kg/min) were randomized into one of three groups; a non-exercise control, whole body high intensity training, or continuous endurance training. Aerobic capacity measurements, time to completion trials, muscular endurance, and core strength measures were taken at pre, post and follow up testing sessions. Psychological questionnaires were also administered during exercise as well as throughout the study. Following the intervention both exercise groups demonstrated equivalent improvements in aerobic performance, with only the interval group experiencing improved muscular and core endurance. After the 2-month follow up testing sessions the interval group lost all aerobic and core adaptation, with endurance only experiencing a partial loss. This finding indicates that the interval group did not adhere to exercise at a level that was high enough to preserve the adaptations associated with training. This finding is further supported by the psychological factors measured throughout this study, including acute affect, enjoyment and intentions to engage in future exercise. / Thesis (Master, Kinesiology & Health Studies) -- Queen's University, 2013-10-31 15:08:15.524

Background: Improving adherence to medication is a persistent challenge within the health system. Adherence is influenced by many factors at the patient, provider, treatment and health system levels. Adherence may also be affected by continuity of care; defined as the consistent professional relationship between a health provider or source of care and a patient. Objective: To estimate the strength of association between continuity of community pharmacy care and adherence to statin medication among persons initiating statin therapy in Nova Scotia between 1998 and 2008.  Methods: This was a retrospective cohort study using administrative data from the Nova Scotia Seniors’ Pharmacare program. Subjects were included if they were dispensed at least one prescription for a statin medication between 1998 and 2008. Continuity of care was calculated via two methods: the Usual Provider of Care (UPC) index and the Continuity of Care Index (COCI), which measure the density and dispersion of relational continuity of care, respectively. Adherence was calculated using the medication possession ratio. The strength of association between continuity of care and adherence was analyzed using hierarchical regression. Results: During the study period, 31 592 individual subjects received a first statin dispensation. Adjusted hierarchical regression showed that for each 0.10 increase in continuity of care, the odds of adherence increase by 3% (95% CI: 1.01-1.05). Continuity of care measured by the UPC is highly correlated with continuity of care measured by the COCI (r=0.98). Conclusions: Continuity of community pharmacy care is positively associated with adherence to statins among Nova Scotian seniors who initiated statin therapy between 1998 and 2008.

PRΕLIMINARY ANALYSIS OF DRUG ADHERENCE OF PATIENTS WITH ULCERATIVE COLITIS Author: Konstantina Tsianou Tutor: Prof. Jiri Vlcek Department of Social and Clinical Pharmacy, Faculty of Hradec Kralove, Charles University in Prague, Czech Republic Aim of diploma thesis: To investigate the role of the beliefs of patients suffering with Ulcerative Colitis about medicines according to age group (group 1: age between 20-45 years old versus group 2: age between 46-65 years old). The study employs the Belief about Medicine Questionnaire to measure the adherence of patients with Ulcerative Colitis in Greece. Method: This study was conducted using the Greek version of the BMQ that has been translated from English into Greek language by a professional bilingual translator and then translated back into English by a native English speaker in a previous study. Results: Our study is resulted to the lowest accepting belief group ratio (12.8%) along with the highest results for ambivalent and indifferent belief group ratios (31.2% and 40%, respectively). Conclusion: The Greek version of the Beliefs about Medicines Questionnaire presented satisfactory psychometric/measurement properties indicating its reliability for use in patients with IBD who receive care in an outpatient hospital clinic. The BMQ is a useful tool...

Class of 2007 Abstract / Objectives: A prescription claims database from COPE Behavioral Services in Tucson, Arizona was used to retrospectively assess the differences between patients receiving <4 and those receiving > 4 psychotropic medications over a 12-month period in adult patients with schizophrenia. Methods: Medication groups (i.e., < 4 versus > 4 concomitant psychotropic agents) were compared for differences in gender, age, duplication of antipsychotic therapy, adherence rates, court order treatment status, psychiatric hospitalization rates and length of stay, cost of services provided, and concomitant psychotropic medications. Results: A total of 506 adult patients with schizophrenia (F=214 and M=292) met the inclusion criteria for receiving psychotropic medications during the 12-month study. Of those, 388 patients (76.7%) were found to have an average of < 4 medications, while 118 patients (23.3%) were found to have > 4 medications. Duplication of antipsychotic therapy was more common in the > 4 group (29.7%) compared to the < 4 group (3.1%), p < 0.001. Psychotropic adherence rates were significantly higher in the > 4 group based on month’s supply of prescriptions. Demographic differences between groups included: increased age, more women, fewer court order status, and higher cost of care in the > 4 compared to the < 4 medication group. No differences in hospitalizations, length of stay, and hospital costs were found between groups. Conclusions: Our findings suggest that patients with schizophrenia with increased rates of polypharmacy have higher adherence rates, more duplication of antipsychotics, and a higher cost of care (i.e., case management, laboratory, other services, total prescription costs) compared to patients receiving < 4 psychotropic medications.

Magister Curationis - MCur / HIV stigma is still affecting People Living with HIV (PLHIV) despite biomedical and structural interventions to reduce this phenomenon. Stigma, particularly health facility related stigma, experienced by PLHIV is reported to fuel poor access to services. As a result, considerable interventions to reduce the stigma among PLHIV have been proposed. However, poor HIV indicators are still reported. Little is reported about PLHIV’s lived experiences of stigma, especially at health facilities, which might be the contributor to poor health outcomes. Hence, this study sought to explore and describe the stigma experienced by PLHIV at a health facility in Khayelitsha Sub-District, Cape Town, South Africa. A qualitative approach, using an exploratory design was followed. Participants were purposively selected, and unstructured interviews were conducted. In total, 15 participants were anticipated to be interviewed. However, saturation occurred after 12 participants were interviewed, but the researcher went further to interview 14 participants. Audiotaped interviews were transcribed verbatim by the researcher (those in English) and assistant researchers (isiXhosa and Afrikaans). Data were then organised and entered into ATLAS.Ti version 8, a Computer Assisted Qualitative Data Analysis Software (CAQDAS) used for analysis of large sets of data. An independent coder was given raw data, and the two outcomes were discussed to reach a consensus on generated themes. The supervisor reviewed the analysed data. Rigour was ensured through the criteria of credibility, dependability, transferability and conformability. The ethical clearance for this study was obtained from the Biomedical Research Ethics Committee (BMREC) at the University of the Western Cape and the City of Cape Town. Six themes emerged from the data because of participants’ experience of stigma at the facility. These include: existence of stigma triggers, participants’ experience of stigma at the clinic, direct stigmatising behaviour, and PLHIV’s characterisation of stigma types, PLHIV’s directed health outcomes, and activism as a secondary health outcome. The results of the study revealed that stigma was perpetuated in the health facility in numerous forms. These were: physical demarcation of the facility, negative behaviour of nurses towards People living with HIV and incompetence of the nurses. This gave rise to recommendations in nursing practice, to policymakers and a need for further research on the topic.

Magister Public Health - MPH / Background: Hypertension (HTN) complications are one of the leading causes of disability and mortality worldwide, with increasing trends noted in Africa. The most neglected causes of uncontrolled HTN and its complications are unhealthy diets, excess alcohol consumption and physical inactivity. Adherence to recommended lifestyle modifications remains low in Zimbabwe. This study seeks to explore the factors influencing adherence to World Health Organisation (WHO) lifestyle modification recommendations in patients with hypertension at Parirenyatwa Hospital, Harare. Methodology: An analytic cross-sectional study design was utilized. 328 hypertensive patients aged at least 18, receiving care at Parirenyatwa Hospital were recruited into the study. A self-administered questionnaire was used to collect information on demographics, knowledge and adherence to WHO recommended lifestyle modifications from participants. Statistical Package for Social Scientists (SPSS) version 20 was used for data analysis. The Spearman test was used to test for linear correlation among variables and the 5-point Likert Scale was utilized to categorize the extent of practice of dietary and physical activity recommendations by WHO.