Failure to comply with prescribed regimens is a major reason for the failure of treatment programs. This study investigated factors which are related to compliance with prescribed diet revision therapy for food allergies in school-aged children. Forty-five children, aged 6 to 12 years, who were under a physician's care for food allergies, formed the sample. The Health Belief Model was used as the basis for a questionnaire devised to measure these factors. The development of the Diet Revision Therapy Parent Questionnaire involved a pilot test and revisions; the resulting instrument consists of 38 items organized into 4 subtests, of which one 7-item subtest is to be considered optional. The 38-item DRTPQ has a full scale internal consistency reliability of .87, and a composite reliability of .61 for the four subscales. The canonical correlation between 3 types of subjective ratings of compliance and the 4 subtests is .80, with 64% shared variance between these sets of variables. A discriminant function of 3 subtests of the DRTPQ proved capable of discriminating diet therapy dropouts from continuing subjects with 88.9% accuracy. These three subtests measured: 1. Parent and family life factors, such as the amount of perceived interference in normal routines, 2. Child's attitudes to the treatment and his/her normal behavior with respect to cooperation with parental demands, and 3. Belief in the benefits to be derived from the treatment. A fourth category of items measured perceived severity of the condition and perceived susceptibility to illness but proved not to predict compliance in this sample, although it may be useful in clinical practice. Suggestions for interventions to aid compliance are outlined. / Education, Faculty of / Educational and Counselling Psychology, and Special Education (ECPS), Department of / Graduate

The control of communicable diseases in children is an important public health role. With the availability of effective vaccines, the conquest of many childhood diseases is possible. However, the success of the present immunization programs rests ultimately with the parents, who are responsible for ensuring that their children's immunization status is complete. Many factors can influence this parental compliance. The parents of kindergarten students in two suburban communities completed a questionnaire on immunizations and family characteristics. The questionnaire was constructed using items submitted from a panel of public health nurses and from the literature. A pretest was conducted.. The total' number of questionnaires returned by the deadline was 376. Data on preschool children's immunization status were also collected from health unit records. Analyses of the data included frequency distributions, contingency table analyses, factor analysis, and discriminant analysis. The major findings of the study were: 1. There was a difference between preschool children's recorded immunization status according to health unit statistics and the national standard. 2. There was a discrepancy between preschool children's immunization status as reported by parents and as recorded in health unit statistics. There was not a significant relationship between parental education level, family mobility, family socio-economic level, family composition, or parental knowledge of immunizations and preschool children's reported immunization status. 4. There was a significant relationship between a positive parental attitude toward immunization and completed preschool children's reported immunization status. 5. There was a significant relationship amongst the variables. High family mobility, a low educational level for the father, an incomplete parental immunization status, and a feeling of lack of knowledge about immunizations were discriminatory for a reported incomplete immunization status. As well mobility, education-income, family composition and attitude best accounted for the relationship amongst the variables on factor analysis Implications for nursing practise are discussed and recommendations for further research are suggested. / Applied Science, Faculty of / Nursing, School of / Graduate

Two studies were performed to provide insight into the causes and effects of client noncompliance to behavioral treatments. An Analogue Study was performed in which undergraduate participants were taught about progressive muscle relaxation. Participants were randomly assigned to either a directive condition (which placed an emphasis on describing relaxation as an expert would) or a supportive condition (which emphasized incorporating relaxation into the person's daily life). Results indicated that participants in the supportive condition reported higher levels of enjoyment, satisfaction, and homework compliance than participants in the directive condition, but did not display significantly different levels of intrasession noncompliance. As well, a Clinical Study served as a naturalistic study involving six therapist-mother pairs where the mother was presenting with parenting difficulty and worked with the therapist during six sessions of behavioral parent training. This study surprisingly found that mothers were more likely to show noncompliance immediately following therapist supportive behavior than after directive behavior, but that overall levels of directive behavior resulted in less homework completion, and that overall levels of supportive therapist behavior corresponded with higher client satisfaction and lower overall levels of intra-session noncompliance. As well, therapists were more likely to respond to client noncompliance with supportive rather than directive behavior. Reconciliation of these results with previous research was discussed, along with limitations to these studies and potential areas for future research. / Arts, Faculty of / Psychology, Department of / Graduate

Thesis (M.Sc. in Epidemiology)--University of the Witwatersrand, Faculty of Health Sciences, 2014. / Introduction: The prevalence of the Human Immunodeficiency Virus (HIV) in South Africa was 17.8% among 15 to 49 year olds in 2010. Antiretroviral therapy (ART) has thus played a crucial role in mitigating the impact of the HIV epidemic. Themba Lethu Clinic is one of the largest single clinics providing ART in South Africa. One of the challenges of ART provision is ensuring adherence to taking the medication. To date there has been no clear consensus on the ideal way to measure adherence in resource limited settings (RLS). Viral load is perhaps the best and most reliable indicator of poor adherence but is expensive and not easily accessible or available in many RLS. Surrogate markers such as mean cell volume (MCV), CD4 cell count, self-reported adherence and missed visits have been shown to be useful to measure adherence but their reliability remains unclear. The aim of the study was to identify other markers that can be used to measure adherence using viral load as the gold standard. Materials and methods: The study was a retrospective analysis of HIV-positive ART-naïve adults (≥ 18 years) initiating standard first-line ART at the Themba Lethu Clinic in Johannesburg, South Africa between April 2004 and January 2012. The association between the last self-reported adherence, change in MCV calculated from baseline to 6 months, change in CD4 count calculated from baseline to 6 months (≥ or < the expected increase of 50 cells/mm3 at 6 months) and missed visits (defined as a scheduled appointment that had been missed by ≥ 7 days but not by more than 3 months) and poor adherence (defined as a viral load ≥ 400copies/ml after 6 months on ART) was tested using Poisson regression models with robust error variance to estimate incidence rate ratio (IRR) and 95% confidence interval (CI). The IRR was used to approximate the relative risk (RR) of poor adherence. Interacting variables were stratified by each other, to create a new variable. The diagnostic accuracy of each identified marker of adherence was also tested using sensitivity, specificity, positive predictive values and negative predictive values. Results: 7160 patients were eligible for the study and of these 63.2% were female. The median age was 36.7 years. The median CD4 count was 101 cells/mm3 at baseline and 18.9% of the patients had poor adherence at 6 months. Variables associated with poor adherence at 6 months were change in CD4 count stratified by change in MCV at 6 months (change in CD4 count ≥ expected and change in MCV ≥ 14.5fL; adjusted relative risk (aRR) 1, change in CD4 count ≥ expected and change in MCV < 14.5fL; aRR 3.11 95% CI 2.41 – 4.02, change in CD4 < expected and change in MCV ≥ 14.5fL; aRR 1.23 95% CI 0.76 – 2.00 and change in CD4 count < expected and change in MCV < 14.5fL; aRR 6.98 95% CI 5.35 – 9.09), CD4 count at baseline (> 200 cells/mm3; aRR 1, 101 – 200 cells/mm3; aRR 1.05 95% CI 0.80 – 1.38, 51 – 100 cells/mm3; aRR 1.08 95% CI 0.80 – 1.47 and ≤ 50cells/mm3; aRR 1.34 95% CI 1.02 – 1.76) , WHO stage at baseline (stage I; aRR 1, stage II; aRR 1.16 95% CI 0.90 – 1.48, stage III; aRR 1.27 95% CI 1.04 – 1.55 and stage IV; aRR 1.44 95% CI 1.12 – 1.84) and MCV at baseline (< 80fL; aRR 1, 80 – 100fL; aRR 1.33 95% CI 1.01 – 1.75 and > 100fL aRR 0.98 95% CI 0.62 – 1.55). Sensitivity and specificity of the change in CD4 stratified by change in MCV at 6 months to predict poor adherence were 86.5% and 37.3% respectively for all eligible patients. For patients on AZT-based regimens the variables associated with poor adherence at 6 months were change in CD4 count at 6 months (≥ expected; aRR 1 and < expected; aRR 7.66 95% CI 0.98 – 59.91) and pregnancy during the first 6 months on ART (Never pregnant; aRR 1 and pregnant during follow up; aRR 9.11 95% CI 2.17 – 38.25). Sensitivity and specificity of the change in CD4 count at 6 months to predict poor adherence were 64.7% and 75.2% respectively for all eligible patients on AZT-based regimens. Sensitivity and specificity of pregnancy during the first 6 months on ART to predict poor adherence were 20% and 97.6% respectively for all eligible patients on AZT-based regimens. Discussion: Change in CD4 count stratified by change in MCV at 6 months was an expected marker of adherence as CD4 count is expected to rise in adherent patients on ART and since most patients (62.9%) were on d4T or AZT-based regimens. Pregnancy during the first 6 months on ART appeared as a marker of adherence for patients on AZT-based regimens before multiple imputation possibly due to missing data hence results for this variable should be interpreted with caution. Contrary to previous studies, self-reported adherence was not associated with poor adherence at 6 months before multiple imputation. This could have been due to the fact that that > 50% of patients had missing data for this variable. The variable is also vulnerable to recall and reporting bias so even after multiple imputation, the area under the receiver operating characteristic (ROC) curve remained < 0.55. The number of missed medical visits and regimen change were also markers of adherence in a few of the models after multiple imputation and require further investigation. In conclusion, the markers of adherence to ART are change in CD4 count stratified by change in MCV at 6 months and pregnancy during the first 6 months on ART for patients on AZT-based regimens. These could help health workers identify poor adherence in the absence of viral load testing and target patients for adherence interventions to prevent virological failure.

The patient's failure to cooperate effectively in the patient/physician (patient and physician) interaction has been shown to be a problem of significant magnitude. In the present study, an attempt was made to identify specific, patient behaviors which might be related to physician judgment of a good patient and progress of treatment. A checklist of 37 behaviors was compiled. A series of 100 patients was observed during their interaction with physicians and occurrences of behaviors from the checklist were noted by an experimenter. Physicians also indicated whether the patient was considered to be a good patient and whether treatment was progressing as expected. For every third patient, physicians noted the occurrence of behaviors from the checklist. An association was found between some behaviors from the checklist and the physicians' judgment. There was also shown to be a difference in the ability of the experimenter and the physicians involved to detect these behaviors.

Thesis (M.S.)--University of Michigan, 1993.

Thesis (M.S.)--University of Michigan, 1991. / eContent provider-neutral record in process. Description based on print version record.

Thesis (M.S.)--University of Michigan, 1991. / eContent provider-neutral record in process. Description based on print version record.

Thesis (M.Sc.)--Memorial University of Newfoundland, Faculty of Medicine, 1997. / Typescript. Bibliography: leaves 154-161.

Source: Dissertation Abstracts International, Volume: 70-07, Section: B, page: 4116. Adviser: Patricia D. Mullen. Includes bibliographical references.