MPH, Faculty of Health Sciences, University of the Witwatersrand, 2009. / Introduction Patient retention and loss to follow-up in the antiretroviral programmes in South Africa and indeed the world is important as failures to reduce these lead to higher drug resistances and treatment failures. In the light of the few drugs available to treat HIV and AIDS it is imperative that patients lost to follow-up be traced and brought back into the programme. The objectives of the study were to quantify the number of patients enrolled in the programme between 01st June 2004 and 31st December 2004; determine the demographic profile of enrolled patients with regard to age; sex; education; employment and area of residence; to determine compliance and defaulter rates at every monthly appointment up to 6 months of follow-up and to describe follow-up systems in place for tracking patients on ARVs; identifying those who fail to comply with scheduled appointments; and ensuring complianceand finally to identify challenges faced by the hospitals in tracking patients on ARV therapy. Material and Methods The two hospital chosen were the first public hospitals to rollout antiretroviral treatment in Ekurhuleni in 2004. This was a descriptive study involving review of health facility records and primary data collection through key informant interviews at two district hospitals in Ekurhuleni. The study reviewed mechanisms employed by the two hospitals in tracking those patients who started on the programme during the first six months of the ARV programme (June 2004 to December 2004). Results The two hospitals had after six months of starting with the rollout a combined number of 378 patients on treatment. Far East Rand Hospital (FERH) had registered 208 5 patients and Natalspruit (NSH) had 170 patients on their register. Most of the patients started on treatment were from Townships (82%), and 81% of all patients started on treatment were unemployed. The male(33.7%) to female (62.7) ratio was 1:2. Even though on average 90% of patients at both hospitals kept their first six appointment, defaulter rates at FERH was 23,2% and NSH was sitting at 33,1%. Discussion Our results show tha the two hospitals fall short on achieving the requierements by the Departmentof Health’s HIV plan that states under Priority Area 2, point 6.2, that accredited facilities must have the capacity to increase the retention of children and adults on ART – actively trace people on ART who are more than a month late for clinic/pharmacy appointment. The hospitals do not have proper tracking mechanisms in place, they lack important resources like transport, telephones and get wrong addresses. Based on the evidence we have gathered the hospitals’ defaulter rates and loss to follow-up are a concern but they are also not far off when compared to other places and countries whose defaulter rates are 20% on average. Conclusion and Recommendation Retention of patients in the programmes is an essential health imperative. It is therefore necessary that we make the following improvements to our hospital programmes: Make resources like telephone and transport available to healthcare workers; employ a dedicated team of workers doing only patient tracing and followup; invest in technology that would alert health care workers immediately a patient misses an appointment and finally educate the patients themselves of the importance of adherence to treatment and follow-up.

Abstract The goals in diabetes care are good metabolic control, minimisation of complications due to diabetes and a good quality of life. In order to achieve these goals, it is important that persons with diabetes adhere to self-care. Internationally, there are numerous studies available about adherence to self-care among adults with diabetes, but in Finland there are hardly any, especially in nursing science. The purpose of this study was to examine adherence to self-care and also how metabolic control, social support and health locus of control beliefs are related to patient adherence. The data were gathered by questionnaires from 213 working-aged adults with insulin-treated diabetes from the Oulu Health Center or the Central Hospital of Lapland. The response rate was 76%. In order to verify the reliability and the validity of the instruments, we used correlation coefficients, factor analysis and item-total analysis. Internal consistency was checked by Cronbach's alfa. Cross-tabulations with the chi-square test of independence, correlations, One- and Two-Way ANOVA and covariate analysis were used for data analysis. Our multivariate statistical methods consisted of logistic and multiple linear regression analysis and cluster analysis. The subjects who were adherent to self-care had better metabolic control than those who neglected self-care. A fifth of the respondents were neglecting their self-care. The others undertook flexible, regimen-adherent or self-planned self-care. Poor metabolic control, smoking and living alone explained neglect of self-care. If the diabetic got support from her/his family and friends, living alone was not a predictor of neglect of self-care. Those who were adherent to self-care perceived themselves as getting more support from their family and friends than the group who neglected self-care. Those who had poor metabolic control perceived themselves as getting peer support from other persons with diabetes. Those who were adherent to self-care were responsible internals who believed both in their own action and in health care team action. Those who mainly believed in health care team action (powerful other externals) were more adherent to self-care than those with an internal or chance external health locus of control. We got evidence about the importance of adherence to self-care, and its relationship with metabolic control, social support anf HLOC beliefs. The results can be used when developing the individual patient education of persons with diabetes.

No description available.

Background: Lifestyle changes and drug treatment can improve the prognosis and quality of life for patients with coronary heart disease (CHD), but their co-operation with suggested treatment is often limited. The aim of this thesis was to study how patients and their spouses conceive CHD and its treatment. Material and Methods: The research design used was inductive and descriptive. The studies were based on three complementary sets of data. Patients with CHD (n=23) and spouses (n=25) were interviewed one year after an episode of the disease. Consecutive patients with CHD derived from another investigation were interviewed within six weeks or one year after the coronary event (n=113). All semi-structured interviews, tape-recorded or from notes taken by hand, were subjected to analysis within the phenomenographic framework. Findings: The patients’ conceptions of CHD varied and were vague, even as judged on a lay level. They were associated with symptoms rather than with the disease. Co-operation with drug treatment was rarely linked to improved prognosis. The patients’ descriptions of benefits from lifestyle changes and treatment did not give the impression of being based on a solid understanding of the importance of such changes. Incentives for lifestyle changes were classified into four categories, all of which contained both facilitating and constraining incentives. Somatic incentives featured direct and indirect physical signals. Social/practical incentives involved shared concerns, changed conditions, and factors connected with external environment. Cognitive incentives were characterised by active decisions and appropriated knowledge, but also by passive compliance with limited insights, and by the creating of routines. Affective incentives comprised fear and reluctance related to lifestyle changes and disease and also lessened self-esteem. All incentives mostly functioned facilitatively. The cognitive and the social/practical incentives were the most prevalent. Spouses’ understanding about the causes of CHD involved both appropriate conceptions and misconceptions. Drug treatment was considered necessary for the heart, but harmful to other organs. Spouses’ support to partners was categorised, and found to be contextually bound. The participative role was co-operative and empathetic. The regulative role controlled and demanded certain behaviours. The observational role was passive, compliant, and empathetic. The incapacitated role was empathetic, unable to support, and positive to changes. The dissociative role was negative to changes and reluctant to be involved in lifestyle changes. Conclusions: These results could be useful in the planning of care and education for CHD patients. The findings also emphasise the importance of adopting a family perspective to meet the complex needs of these patients and their spouses in order to facilitate appropriate lifestyle changes. / On the day of the public defence of the doctoral thesis the status of article V was Submitted.

Imperfect patient adherence to treatment leads to adverse individual and social outcomes: it has negative effect on patient health and, consequently, it increases health care costs. The adherence is low particularly in chronically ill patients with complex regimen, such as hemodialysis. This thesis provides an in-depth study of the phenomenon and presents a survey targeted at hemodialysis patients in the Czech Republic. The survey assesses prevalence of nonadherence, identifies predictors of nonadherence, and analyzes patients' attitude to a hypothetical incentive program to promote adherence. Then, an optimal design of an intervention to promote adherence is discussed. Results show that 72% of patients do not adhere to one or more areas of hemodialysis treatment. Prevalence of nonadherence is highest for following fluid restrictions (62.8%) and diet guidelines (55.7%). On the contrary, medication and appointment nonadherence is not frequent. Strongest predictors for nonadherence are: young age, male sex, treatment for depression, number of prescribed pills, and length of dialysis treatment. Most of patients (83%) indicated that they would change their behavior when involved in an incentive program to promote adherence. With regard to broad prevalence of nonadherence, an intervention targeted at...

Bakgrund Diabetes är en av de sjukdomar som ökar mest i hela världen, detta medför att även följdsjukdomar förknippade med diabetes ökar. Diabetesretinopati [DRP] är en av dessa följdsjukdomar. Regelbunden ögonbottenfotografering gör att förändringar upptäcks i tid. Följsamheten till ögonbottenfotografering bland patienter med diabetes är dock inte optimal.   Syfte Syftet med studien var att identifiera faktorer som bidrar till att patienter med diabetes har låg följsamhet till ögonbottenfotografering.   Metod Studien utfördes som en systematisk litteraturstudie, med kvalitativa och kvantitativa artiklar för att sammanställa tidigare forskning.    Resultat Studien resulterade i tre huvudkategorier Faktorer relaterade till interaktionen med sjukvården, faktorer relaterade till patientens livssituation och personlighet och faktorer relaterade till det omgivande samhället samt åtta underkategorier. De huvudsakliga faktorer som framkom var brist på information, ekonomiska aspekter samt känslor relaterade till undersökningarna.   Slutsats Genom att identifiera försvårande faktorer kan denna studies resultat användas som utgångspunkt för att utveckla hälsofrämjande åtgärder för en ökad följsamhet. Även annan vårdpersonal, till exempel diabetessjuksköterskan kan få nytta av kunskapen som framkommer. Vidare forskning behövs som behandlar nordiska förhållanden. / Background Diabetes is an increasing health problem all around the world. This means that health problems associated with diabetes are also increasing. Diabetic retinopathy [DRP] is one of these problems. To detect DRP at an early stage, regular fundus examinations are recommended. However, compliance among diabetic patients is not optimal. Purpose The purpose of the study was to identify factors that contribute to patients' with diabetes low compliance to fundus examinations. Method The study was a systematic literature review, including both qualitative and quantitative research in order for a comprehensive compilation of previous studies. Results The result showed three main categories. Factors related to the interaction with the healthcare system, factors related to the patient's life situation and personality and factors related to the surrounding society. There were also eight subcategories. The main factors that emerged were lack on information, economic aspects and emotions related to the examinations. Conclusions By identifying aggravating factors, the result in this study may be useful as a starting point to develop health-promoting actions to increase compliance. Other healthcare professionals, such as the diabetic nurse, may also benefit from the knowledge that emerges. Further research about the conditions in Scandinavia is required.

Submitted by Fabio Sobreira Campos da Costa (fabio.sobreira@ufpe.br) on 2017-07-14T15:57:43Z No. of bitstreams: 2 license_rdf: 811 bytes, checksum: e39d27027a6cc9cb039ad269a5db8e34 (MD5) disertaçãomestradoalexbernardoposneuro2016.pdf: 1482621 bytes, checksum: 6077c9780a49008fbef291d8e14c99fb (MD5) / Made available in DSpace on 2017-07-14T15:57:43Z (GMT). No. of bitstreams: 2 license_rdf: 811 bytes, checksum: e39d27027a6cc9cb039ad269a5db8e34 (MD5) disertaçãomestradoalexbernardoposneuro2016.pdf: 1482621 bytes, checksum: 6077c9780a49008fbef291d8e14c99fb (MD5) Previous issue date: 2016-05-30 / Um aspecto crucial na gestão do cuidado para pacientes com Esclerose Múltipla está na identificação, manutenção e inclusão dos pacientes quanto a aderência ao tratamento. Objetivo: O objetivo desta dissertação foi investigar quais fatores sociodemográficos, clínicos e relacionados à terapêutica medicamentosa influenciam na adoção da prática da autoadministração de imunomoduladores em pacientes de EM e se tal prática resulta em maior adesão ao tratamento. Métodos: trata-se de estudo prospectivo, descritivo e exploratório com abordagem quantitativa. A amostra foi composta por 82 pacientes de EM atendidos em um Centro de Referência do Estado de Pernambuco. Os dados foram coletados através de entrevistas realizadas nos meses de março e abril de 2016. Os dados foram armazenados e analisados no SPSS -21. Para a análise de associação foram utilizados testes estatísticos que considerou significância estatística quando o valor de p< 0,05. Resultados: Apresentaram significância estatística positiva para adoção da prática da autoadministração foram: menor idade (p=0,021), maior escolaridade (p=0,006), permanecia na atividades acadêmicas e/ou profissionais (0,001), realizavam todas as doses prescritas do medicamento (p=0,001). Quanto a adesão ao tratamento as variáveis que apresentaram significância estatística positiva foram: permanecia na atividades acadêmicas e/ou profissionais (p=0,001), menor impacto da doença na qualidade de vida (p=0,042). Os paciente aderentes ao tratamento mudaram menos de imunomodulador (p=0,001). Conclusão: idade, escolaridade e ocupação podem torna-se barreiras para adoção da prática da autoadministração de imunomoduladores em pacientes de Esclerose Múltipla. A prática da autoadministração melhora a aderência ao tratamento, resultado em menor taxa de migração do immunomoduador e menor índice de falha terapêutica. / A crucial aspect of care management for patients with Multiple Sclerosis is the identification, maintenance and inclusion of patients and adherence to treatment. Objective: The aim of this work was to investigate which sociodemographic, clinical factors and related to drug therapy influence the adoption of the practice of selfadministration of immunomodulators in MS patients and the practice results in better treatment adherence.Methods: It is a prospective, descriptive study with a quantitative approach. The sample consisted of 82 patients with MS treated at a State of Pernambuco Reference Cente. Data were collected through interviews conducted in March and April 2016. Data were stored and analyzed using the SPSS -21. For association analysis statistical tests were used which considered statistically significant when the p value <0.05.Results: Showed positive statistical significance for adoption of the practice of self-administration were younger age (p = 0.021), higher education (p = 0.006) remained in academic activities and / or professionals (0,001), performed all prescribed doses of the drug (p = 0.001). The adherence to treatment variables that showed positive statistical significance were remained in academic and / or professional activities (p = 0.001), lower impact of disease on quality of life (p = 0.042). The adherent to treatment immunomodulator changed less (p = 0.001). Conclusion: age, education and occupation can become barriers to adoption of the practice of selfadministration of immunomodulators in multiple sclerosis patients. The practice of self management improves adherence to treatment, results in lower immunomoduador migration rate and lower treatment failure rate.

The current study empirically tested four models of type II diabetic patient adherence, including wellness, screening, medication, and treatment adherence. Four mediators were proposed patient understanding, agreement, trust, and motivation were tested for each model. The current study is grounded in patient-centered communication, responding to Street’s (2013) call to model pathways between communication and patient health outcomes. Moreover, the study argues that adherence, for type II diabetic patients should be conceptualized as four distinct clusters of behavior (wellness, screening, medication, and treatment). A sample of (n=817) type II diabetes patients from the U.S. under the care of a medical provider and taking medication for their type II diabetes were surveyed. Findings from the present study indicate that the relationship between patient-centered communication and patient-health outcomes is mediated by proximal outcomes. The results contribute to our understanding or patient-centered communication, patient understanding, agreement, trust, and motivation, and adherence behaviors. Resulted indicated that while three of the four proposed hypotheses were supported, the most commonly studied type of adherence (medication), the relationship between patient-centered communication and medication adherence was not mediated. The current study ends with a discussion and implication of the findings as well as directions for future research

No description available.

Bakgrunn: Frisklivssentralen, eller fysisk aktivitet på resept,er en kommunal forebyggende helsetjeneste i Norge med tilbud om hjelp til endring og mestring av levevaner.Forskning som dokumenterer langtidseffekten av deltagelse i tilbudeter begrenset. Formål: Denne studien undersøker om Frisklivssentralenoppnår målsettingen om varig endring av fysisk aktivitetsnivå og helserelatert livskvalitet,målt tre år etter deltagelse. Metode: Tre år etter deltagelse i Frisklivssentralen (04.2010-03.2011) ble en spørreundersøkelse besvart av 33 tidligere deltagere for å utforske deres nåværende fysisk aktivitetsnivå, opprettholdelse av aktivitetsnivå, faktorer som påvirker opprettholdelse av aktivitet, helserelatert livskvalitet og erfaringer fra oppfølgingen i Frisklivssentralen. Resultatene ble sammenlignet med data innsamlet ved baseline og tre måneders oppfølging. Deskriptive statistikker ble brukt for å beskrive utvalget og fordelingav svarene. Ikke-parametriske tester ble brukt for å se på endring over tid og for å sammenligne subgrupper. Resultater: Resultateneviserat denpositiv endringeni aktivitetsnivå fra baselinetil tre måneder vedvarte til tre år etter(P=0.001). Fra baseline til tre år hadde 39,4% av respondentene økt aktivitetsnivået. De som ikke økte aktivitetsnivået hadde et høyere aktivitetsnivå ved baseline. Etter tre år var medianen for hele utvalget etaktivitetsnivå på &gt; 4 timer per uke. Uavhengig av endring i aktivitetsnivå fra baseline til tre år,rapporterte deltagerne positiveendring i helserelatert livskvalitet(P≤0.001). Konklusjon: Frisklivssentralen øker fysisk aktivitetsnivå og helserelatert livskvalitet. Deltagere som i utgangspunktet var mindre aktive (f.eks. 1-2timer per uke)økte sitt aktivitetsnivå til &gt; 4 timer per uke og opprettholdt det i tre år. Respondentene oppnådde bedring i helserelatert livskvalitet uavhengig av endring i aktivitetsnivå. / Background:Frisklivssentralen, or physical activity on prescription, is an intervention used by Norwegian municipalities for preventive health services. This approach helps individuals change lifestyle habits and increase physical activity. Research documenting thelong-termeffects of participation in Frisklivssentralen is sparse. Objective:This study aimed to evaluate whether Frisklivssentralen achieves its goal of permanently changing individuals’ activity level and health-related quality of life, as measured three years after participation. Method: Three years after the Frisklivssentralen intervention (04.2010–03.2011) concluded, 33 former participants answered a questionnaire exploring their current level of physical activity, adherence to physical activity, factors affecting such adherence, health-related quality of life, and experiences from participation at Frisklivssentralen. We compared their answers to data collected at baseline and the 3-month follow up. We used descriptive statistics to assess the range and is tribution of participants and their answers. Non-parametric tests explored changes over time and compared subgroups. Results: Our results revealed that the positive change in activity level achieved from baseline to 3-month follow upp ersisted three years later(P=0.001). From baseline to three years, 39.4% of participants increased their activitylevel. Interestingly, participants in the current study who reported no increase in activity were more activeat baseline. After three years, the median activity level for the total sample was&gt; 4 hours per week. Regardless of changes in activitylevels from baseline to three years, participants reported positive changes in health-related quality of life (P≤0.001). Conclusion: Frisklivssentralen increases physical activity levels and health-related quality of life. Participants who initially were less active (i.e., 1–2 hours/week) increased their activity level to &gt; 4 hours per week and maintained it for 3 years. Respondents improved their health-related quality of liferegardless of changes in activitylevel / <p>ISBN 978-91-86739-85-0</p>