Submitted by Claudia Cristina de Góes null (claudia_crgoes@hotmail.com) on 2016-10-25T00:07:10Z No. of bitstreams: 1 Dissertação versão final_claudia_c_goes.pdf: 2050683 bytes, checksum: 70e8dfcecbdd00db785d6e0d61886ba7 (MD5) / Approved for entry into archive by Juliano Benedito Ferreira (julianoferreira@reitoria.unesp.br) on 2016-10-31T13:53:47Z (GMT) No. of bitstreams: 1 goes_cc_me_bauru.pdf: 2050683 bytes, checksum: 70e8dfcecbdd00db785d6e0d61886ba7 (MD5) / Made available in DSpace on 2016-10-31T13:53:47Z (GMT). No. of bitstreams: 1 goes_cc_me_bauru.pdf: 2050683 bytes, checksum: 70e8dfcecbdd00db785d6e0d61886ba7 (MD5) Previous issue date: 2016-06-03 / A estimativa de pessoas vivendo com HIV/AIDS é de 734mil, a maior concentração de casos é na população com idade entre 25 e 39 anos desde 1980 até junho de 2014. Devido à supressão do sistema imune e queda do número de células de defesa CD4, o paciente pode ser acometido por alterações no funcionamento fisiológico e por doenças oportunistas, incluindo as manifestações neurológicas, como os transtornos neurocognitivos associados ao HIV (HAND; HIV-associated neurocognitive disorders). Pessoas com HAND geralmente apresentam comprometimento da aprendizagem e das habilidades motoras, alterações de humor e déficits nos domínios cognitivos, os quais são classificados conforme a gravidade como leve, moderada ou grave e podem comprometer a adesão ao tratamento com antirretrovirais e à qualidade de vida. Contudo, a relação entre estas variáveis, cruciais para a sobrevivência do paciente, não se encontra estabelecida, sendo o envelhecimento uma das variáveis a esclarecer. Objetivou-se traduzir e adaptar o instrumento Simplified Medication Adherence Questionnaire (SMAQ); avaliar e comparar diferenças do desempenho cognitivo entre dois grupos em função da idade e identificar relações entre Qualidade de Vida e adesão à Terapia Antirretroviral combinada. Foram avaliados 50 voluntários com idades entre 21 e 58 anos e divididos em dois grupos (jovens e maduros) que participaram do protocolo completo, composto por testes cognitivos (domínios cognitivos: atenção, memória, linguagem e inteligência) e escalas de rastreio de depressão, ansiedade, uso de drogas psicoativas, adesão ao tratamento e qualidade de vida e situação socioeconômica. Como resultados, foram encontradas diferenças significativas entre os grupos nos seguintes domínios cognitivos: memória episódica, memória operacional, linguagem, processamento visuoespacial e função sensório-motora, tornando possível observar a influência da idade sobre o comprometimento cognitivo em pessoas vivendo com HIV. / In Brazil, 734,000 people are currently estimated to live with HIV / AIDS, and most cases concentrate in the 25 to 39 year-old population born from 1980 to June 2014. Due to suppression of immune system and fall in the number of CD4 T immune cells, a patient may be affected by changes in physiologic functioning and opportunistic diseases, including neurological manifestations such as HIV-associated neurocognitive disorders (HAND). People with HAND usually present learning and motor skills impairments, mood changes, and deficits in cognitive domains, which are classified according to gravity as mild, moderate or severe and may compromise adherence to antiretroviral therapy and quality of life. However, the relation between those variables, which are critical to a patient’s survival, has not been established yet, and aging is a variable to be clarified. The objective of this study was to translate and to adapt the Simplified Medication Adherence Questionnaire (SMAQ) to Brazilian Portuguese; to evaluate and to compare differences in cognitive performance between two groups according to age; and to identify and to compare relations between quality of life and adherence to cART (Combination Antiretroviral Therapy) In this study, 50 volunteers, aged from 21 to 58 years old, were assessed and divided into two groups (young adults and mature). Both groups took part of the full protocol, composed by cognitive tests (cognitive domains: attention, memory, language, and intelligence) and screening scales for depression, anxiety, use of psychoactive drugs, treatment adherence and quality of life, and socioeconomic status. As a result, significant differences between the groups were found in the following cognitive domains: episodic memory, working memory, language, visuospatial processing and sensory-motor function, which made it possible to observe age influence on the cognitive impairment of people living with HIV.

Introdução: A glicogenose hepática tipo 1 (GSD I) é um erro inato do metabolismo (EIM), ocasionada pela presença de mutações patogênicas em genes que codificam enzimas envolvidas no catabolismo do glicogênio, levando ao acúmulo desse substrato e de gordura no fígado, rins e mucosa intestinal, ocasionando alterações metabólicas importantes que comprometem significativamente a qualidade de vida do indivíduo. O tratamento da GSD I é essencialmente dietético, e objetiva proporcionar uma fonte contínua de glicose para evitar a hipoglicemia e prevenir distúrbios metabólicos secundários, através da administração frequente de amido de milho cru (AMC) e/ou dieta contínua noturna administrada por sonda nasogástrica ou gastrostomia, além da restrição de frutose, sacarose e lactose, bem como suplementação de vitaminas e minerais. Em pacientes com complicações graves, o transplante hepático pode ser indicado. A não adesão aos tratamentos é um problema de saúde pública de magnitude mundial e sabe-se que a baixa adesão às intervenções prescritas é um problema complexo e presente especialmente em pacientes com doenças crônicas. Não foram encontrados estudos sobre adesão ao tratamento em glicogenoses hepáticas. Estudos realizados sobre adesão relacionada à fenilcetonúria (EIM com tratamento com restrição alimentar semelhante, sob alguns aspectos, às glicogenoses) indicaram, para essa doença, que o nível de adesão depende de múltiplos fatores e também foi evidenciado um alto nível de não adesão. Objetivo: Caracterizar a adesão ao tratamento de pacientes com GSD I e identificar os fatores que influenciam a adesão desses pacientes. Métodos: Estudo transversal cuja amostra foi selecionada por conveniência, incluindo indivíduos com diagnóstico de GSD Ia e GSD Ib acompanhados no ambulatório de EIM do Serviço de Genética Médica do Hospital de Clínicas de Porto Alegre. Os dados foram coletados através de revisão de prontuário e entrevista com pacientes ou familiares. Dois questionários foram aplicados a eles contendo questões sobre hábitos de vida, suporte social, percepção da dieta e conhecimento sobre a doença. A adesão foi avaliada por meio dos marcadores biológicos de tratamento e as variáveis foram analisadas estatisticamente para verificar possíveis associações. Resultados: Dezoito pacientes foram incluídos. A mediana de idade foi de 6,5 anos (IQ = 9 a 34 anos). Onze pacientes foram classificados como aderentes ao tratamento. A totalidade dos pacientes de GSD subtipo Ib foi aderente. O convívio com o pai e a mãe foi um dos fatores associados à adesão (p=0,049). Três pacientes tiveram um ótimo nível de 6 adesão. A maioria apresentou conhecimento satisfatório sobre a doença. Restrição dietética, acordar durante a madrugada, palatabilidade do AMC, custo da dieta e a distância da residência do paciente ao ambulatório foram as dificuldades mais relatadas. Conclusão: O estudo teve um índice maior de adesão do que o referenciado pela literatura para doenças crônicas. A adesão ao tratamento em GSD I é um tema complexo e que necessita de mais estudos. Compreender os fatores associados à adesão é necessário para a efetividade do tratamento. Nesse estudo, obtiveram-se informações importantes que possibilitam melhor compreensão sobre possíveis fatores que podem contribuir para não adesão ao tratamento das GSD I. Estratégias devem ser elaboradas pelo sistema de saúde e pelos profissionais com o intuito de que as dificuldades associadas ao tratamento sejam trabalhadas e minimizadas em conjunto com os pacientes ou familiares. / Introduction: Glycogen Storage Disease type I (GSDI) is an inborn error of metabolism (IEM) due to the presence of pathological mutations on genes that code enzymes involved in glycogen’s metabolism that leads to the accumulation of this substrate and fat in the liver, kidneys and intestinal mucosa and causes important metabolic alterations that significantly compromise the individual's quality of life. The treatment for GSDI is essentially dietetic and aims to provide a continuous source of glucose to avoid hypoglycemia and also to prevent secondary metabolic disorders, through the frequent administration of uncooked cornstarch (UCCS) and/or continuous nocturnal nasogastric feeding or gastrostomy, restricting fructose, saccharose and lactose besides supplementation of vitamins and minerals. Liver transplant may be indicated for more severely acute patients. Non-adherence to treatments is a world-wide public health matter and it is known that low adherence to prescribed interventions is a complex problem that is present especially in chronic disease patients. To date, no studies were found on adherence to treatment on hepatic glycogen storage disease. Studies on adherence to treatment related to phenylketonuria (EIM with dietetic restriction) indicate that, for this disease, the adherence level depends on multiple factors and a high level of non-adherence has been evidenced. Objective: To characterize adherence to treatment of GSDI patients and identify the factors that influence those patients' adherence. Methods: Convenience sampled in cross-sectional study, including individuals diagnosed with GSDIa and GSDIb followed by the IEM Ambulatory of the Medical Genetics Service of the Hospital de Clínicas de Porto Alegre. The data was collected through medical records review and interviews with patients and/or family members. Two questionnaires were administered with questions about life habits, social support, diet perception and knowledge about the disease. Adherence was evaluated by biochemical biomarkers and the variables were statistically analysed to verify possible associations. Results: 18 patients were included. The median age was 6,5 years. Eleven patients were classified as adherents to treatment. All the GSD patients with subtype Ib were adherent. Living with both parents was one of the factors associated to adherence. Three patients had an optimal level of adherence. Most patients showed satisfying knowledge about the disease. The most reported difficulties were dietetic restriction, waking up in the middle of the night, UCCS 8 palatability, diet cost and distance from the patient’s residence to the ambulatory clinic. Conclusions: The study had a higher index of adherence than referenced by the literature for chronic diseases. Adherence to treatment in GSDI is a complex theme that needs more research. It is necessary to understand the factors associated with adherence to result in effect treatment. In this study, important data was obtained that provides better comprehension of the possible factors that can contribute to non-adherence for the treatment of the GSDI types. Strategies must be considered and incorporated into standards of care by the Health Care System and health professionals to insure that patients and their families understand requirements needed to improve and minimize the difficulties associated with the treatment.

In the treatment of the mental disorders (MD), the not adhesion to the pharmacotherapy is observed in about 50% of people and is responsible for countless damage, besides being the main cause of psychiatric morbidity and rehospitalization. In this work, among other objectives, it sought to determine the psychoactive medicinal product utilization profile, as well as to evaluate the adhesion degree to the medical treatment in patients attended in an Ambulatory of Mental Health in Aracaju s Municipal district SE. For that, it was accomplished an exploratory, descriptive observational study with transversal delineation, within the period from August 2011 to November 2011 and conceived in two distinct stages medical records and interviews analysis. In the study first stage were evaluated medical records of 244 patient, of which 69.67% belonged to the feminine gender; 79.10% owned age superior to 35 years (average = 47,4 }13,8 years), and 36.64% of the patients used antidepressant; 27.22% anticonvulsants; 26.30% antipsychotics and 10.40% anxiolytics. In the second research stage, it was possible to infer that more than 55% of the sample owned low education; 41.4% were single and 42.8% presented other health problems, besides MD. Regarding to the knowledge level on the used medications, this variable presented good results, since 60% of the patients were classified in the category know well. However, when the analyzed variable was the adhesion, the results revealed that 49,3 % of the investigated patients did not adhere to the treatment, having as main causes of not adhesion the forgetfulness (53%), the medication lack in the units of health (47%) or the lack of financial resources for the acquisition of the same (45%) all these considered not intentional causes of not adhesion. By the case it is an unpublished study in the outpatient attention context in Mental Health in the State, it expects that the results contribute for the evaluation and planning actions in the component specialized of the Pharmaceutical Assistance and in the precepts invigoration perspective of the psychiatric reform, having as focus the integral approach of the attention to the mental health and the rational use of psychotropic pharmacons. / No tratamento dos transtornos mentais (TM), a não adesão à farmacoterapia é observada em cerca de 50% das pessoas e é responsável por inúmeros prejuízos, além de ser a principal causa de morbidade psiquiátrica e reinternações. Neste trabalho, dentre outros objetivos, buscou-se determinar o perfil de utilização de psicofármacos, bem como avaliar o grau de adesão ao tratamento medicamentoso em pacientes atendidos num Ambulatório de Saúde Mental no município de Aracaju SE. Para tanto, foi realizado um estudo do tipo observacional exploratório, descritivo com delineamento do tipo transversal, no período de agosto de 2011 a novembro de 2011 e concebida em duas etapas distintas análise de prontuários e entrevistas. Na primeira etapa do estudo foram avaliados os prontuários de 244 pacientes, dos quais 69,67% eram do gênero feminino; 79,10% possuíam idade superior a 35 anos (média = 47,4±13,8 anos), sendo que 36,64% dos pacientes faziam uso de antidepressivos; 27,22% de antiepiléticos; 26,30% de antipsicóticos e 10,40% de ansiolíticos. Na segunda etapa da pesquisa, foi possível inferir que mais de 55% da amostra possuíam baixa escolaridade; 41,4% eram solteiros e 42,8% apresentavam outros problemas de saúde, além dos TM. No que se refere ao nível de conhecimento sobre os medicamentos usados, esta variável apresentou bons resultados, já que 60% dos pacientes foram classificados na categoria conhece muito . Entretanto, quando a variável analisada foi a adesão, os resultados revelaram que 49,3 % dos pacientes investigados não aderiam ao tratamento, tendo como principais causas de não adesão o esquecimento (53%), a falta de medicamento nas unidades de saúde (47%) ou a falta de recursos financeiros para a aquisição dos mesmos (45%) todas estas consideradas causas não intencionais de não adesão. Por se tratar de um estudo inédito no contexto da atenção ambulatorial em Saúde Mental no Estado, espera-se que os resultados contribuam para as ações de avaliação e planejamento no componente especializado da Assistência Farmacêutica e na perspectiva do fortalecimento dos preceitos da reforma psiquiátrica, tendo como foco a abordagem integral da atenção à saúde mental e o uso racional de fármacos psicotrópicos.

Introdução: A falta de adesão ao tratamento é fator limitante para o sucesso dos transplantes de coração, pois contribui para o aumento da morbidade e mortalidade, reduz a qualidade de vida e aumenta os custos referentes ao uso de serviços de saúde. Objetivo: Sintetizar as melhores evidências sobre as intervenções para o manejo da adesão ao tratamento farmacológico e não farmacológico no transplante cardíaco. Método: Revisão sistemática de literatura por meio de busca de estudos publicados e não publicados nas seguintes bases: CINAHL, EMBASE, ProQuest dissertations and theses, PsycINFO, MEDLINE/Pubmed, SCOPUS, Web of Science e banco de Teses da Capes. Foram critérios de inclusão: estudos clínicos com pacientes adultos depois de transplante cardíaco, que tivessem testado o impacto de qualquer intervenção na adesão ao tratamento, avaliada objetivamente ou por auto-relato, usando instrumentos válidos e confiáveis, comparada ao cuidado usual. A qualidade metodológica dos estudos elegíveis foi realizada por dois revisores independentes e as discordâncias foram resolvidas por consenso. Os resultados foram integrados de forma narrativa. Resultados: Foram identificadas 2.519 citações potencialmente relevantes. Excluídos 1.336 por repetição, restaram 1.183 citações que tiveram seus resumos lidos e, após a aplicação de critérios de inclusão, restaram sete publicações para análise da qualidade metodológica. Quatro estudos foram excluídos e os principais motivos foram a falta de avaliação de intervenção (dois estudos), estudo teórico (um estudo) e a adesão ao tratamento não ter sido o foco da intervenção estudada (um estudo). Um dos estudos mantidos não detectou diferença entre intervenção educativa realizada em laboratório de ensino comparada a cuidado usual; outro estudo também não detectou diferença entre uma intervenção multifacetada, composta por oficinas interativas, oferecida pela internet comparada a cuidado usual; e o terceiro detectou impacto positivo da diminuição na dose diária do imunossupressor, de duas vezes ao dia para uma vez. Com relação ao método, dois estudos utilizaram ensaio clínico controlado não randomizado e um foi descritivo / observacional. Conclusões: As evidências disponíveis para orientar decisões sobre intervenções para controlar a adesão do paciente submetido ao transplante de coração ainda são escassas. A realização de ensaios clínicos randomizados, com alta qualidade metodológica, é fundamental para fornecer evidencias mais robustas sobre o manejo da adesão no transplante cardíaco. / Introduction: Treatment adherence failure is a limiting factor for effective heart transplants, as it contributes with increased morbidity and mortality and a reduced quality of life in addition to increasing health service costs. Objective: To synthesize the best available evidence regarding interventions for managing adherence to pharmacological and non-pharmacological treatments in heart transplant patients. Method: Systematic literature review by searching published and unpublished studies on the following databases: CINAHL, EMBASE, ProQuest dissertations and theses, PsycINFO, MEDLINE/Pubmed, SCOPUS, Web of Science and the Capes Thesis database. The inclusion criteria were: clinical studies with adult heart transplant patients, which tested the impact of any intervention over treatment adherence, evaluated objectively or through self-reports, using validated and reliable instruments, compared to common care. Two independent raters assessed the methodological quality of the eligible studies and any disagreements were solved by consensus. The results were integrated in a narrative form. Results: A total of 2.519 potentially relevant statements were identified. Of the total, 1.336 were repeated, and, therefore, excluded. The abstracts of the remaining 1.183 statements were read and, after considering the inclusion criteria, seven publications were analyzed in terms of their methodological quality. Four studies were excluded mainly because they did not present an evaluation of the intervention (two studies), one was a theoretical study, and one study was not center the investigation on treatment adherence. On of the selected studies did not find any difference between the educational intervention performed in a teaching laboratory compared to common care; another study also did not find any difference between one multiple intervention, comprised of online interactive workshops, compared to common care; and the third study found a positive impact from reducing the immunosuppressant dose from twice to once a day. Regarding the method, there were two non-randomized clinical trials and one descriptive/observational study. Conclusions: The current best evidence to guide decisions regarding interventions to manage treatment adherence of heart transplant patients remain scant. Randomized clinical trials with high methodological rigor are key to obtain more robust evidence regarding treatment adherence management in heart transplants.

Magister Public Health - MPH / Background: The incidence of tuberculosis in South Africa last measured at 834 in 2015 as reported by the World Bank. Out of these cases, only 54% cured and 13% of patients stop taking treatment. In Pretoria, Gauteng, comprehensive TB services are available in 87% of clinics and all these clinics offer the Directly Observed Treatment Short-course (DOTS) programme and help to diagnose TB and trace contacts. However, the average Pretoria district DOTS coverage has decreased from 88.8% to 84.7% in the last few years. The health district's cure rate as at 2012 is 61%, and its average rate of successful treatment of all new smear positive cases is 66% since 2005. Certain factors that determine patients' adherence towards TB treatment have been identified to include demographic, psychosocial and health system related factors. However, the WHO identified factors responsible for or predisposing patients to discontinue the DOTS programme have not been investigated in the study setting. Aim: The aim of this study was to assess the determinants of adherence to DOTS therapy amongst TB patients who commenced TB treatment at the TB clinic of a district hospital during April – June 2014. Methodology: A quantitative study was conducted using a descriptive cross-sectional design. An inclusive sample was drawn from adults in the DOTS programme receiving first line treatment during the 6-month period prior to commencement of the research. The calculated sample size was 234 individuals. The data collection tools included a questionnaire, 2-day recall and 30-day recall instruments and pill counts. Data were analysed using EPI info version 7 which included descriptive statistics to measure level of adherence. Associations between identified factors and adherence to TB treatment were also determined. Results: The final sample size was 80 participants of which 76% were male. The mean composite adherence rate was found to be 94% while the proportion of the patients who achieved adherence of 95% and above was 75%. Identified barriers to adherence include forgetfulness, lack of transport fare on clinic appointment days, patients not feeling well and so were not strong enough to attend clinic appointments. On the other hand, the role of treatment supporters and counseling were found to have a positive impact on adherence to DOT in this setting. The use of reminders such as cell phones and alarm-radios were also identified as facilitators to adherence. Patients' knowledge of consequences for not taking medications as prescribed, which is closely linked with counseling, was found to be significantly associated with adherence in this study. Education status of participants was found to be significantly associated with adherence to DOTS (p = 0.01), when considering the pharmacy refill pill count as the adherence measure. Significant association was found between DOTS treatment regimens and 30-day recall adherence measures (p = 0.002). Significant association was also found for medication side effects and the adherence measures of 2-day recall, 30-day recall and pill count with p = 0.04; p = 0.03; p = 0.05 respectively There were significant associations between age and adherence with two of the adherence measures (30-day recall and pill count) at p = 0.002 and p = 0.003 level of significance respectively. Significant association was observed between duration of DOTS treatment when dichotomised using the mean treatment period (17 weeks) as the cut-off point and any of the adherence measures. Conclusion: The factors identified in this study can be classified into patient related factors, economic factors, social factors and health care workers and health system related factors. Furthermore, the factors at these different levels impact on one another and their improvements need to be made at all these levels to address the challenges facing TB patients to achieve optimal treatment adherence. This study is the first study of its kind in the study location and the findings have provided useful baseline data on the adherence rates and some insights into the major factors that affect adherence among patients on DOTS at a Pretoria West District Hospital. However further qualitative and quantitative studies are required to explore the factors influencing adherence further.

Magister Public Health - MPH / According to the Demographic and Health Survey in Zambia the national HIV prevalence among population aged 15-49 years was 14%. In 2002 the Government of Zambia introduced Antiretroviral Therapy (ART) in two of the largest hospitals in Zambia: Lusaka and Ndola hospitals. As many people begin accessing ART in rural areas in Zambia, one of the major challenges is ensuring that those receiving ART adhere to treatment to avoid the emergence of drug resistance and treatment failure. The research therefore set to identify the potential barriers and facilitators to antiretroviral treatment adherence among people living with HIV and AIDS in the rural district of Chongwe,Zambia.A descriptive qualitative study was conducted over a period of three weeks from 11th December to 29th December 2008. The perceptions, opinions and experiences of PLHIV on ART and those of the health workers and treatment supporters were explored through in-depth interviews and focus group discussions. In-depth interviews were conducted with nine persons living with HIV (PLHIV): 5 females and 4 males. Two focus group discussions were conducted with members of 2 different PLHIV support groups from Refunsa and Chimusanya villages served by the ART clinic of St Luke Mission Hospital and another with a group of ART treatment supporters. In addition, interviews were held with five key informants, who were health workers from the ART clinic in St Luke Mission Hospital in Mpanshaya.Reported barriers to adherence among PLHIV in rural areas included experiencing side effects to ART drugs, stopping medication due to improvement in wellbeing, a lack of understanding of the importance of adherence, and forgetting to take their medication due to alcohol consumption. Other barriers included stigma and discrimination, inadequate food to support ART uptake and non disclosure of one’s status for fear of being rejected especially for women who feared rejection in relationships. Another key barrier to adherence was the religious belief held by some PLHIV that one would get healed after being prayed for and therefore discontinued treatment.Key facilitators to adherence identified in the study included getting into a regular routine of taking antiretroviral drugs (ARVs), knowledge of and belief in the efficacy of ART, disclosure of HIV status, access to social support and nutritional support. Other facilitators identified were use of treatment supporters who provided support to PLHIV by providing them with on-going adherence counseling, and making referrals to the ART facility for further support, mobile ART clinics that have brought ART services closer to the rural communities and the adaptation of strategies such as clocks and use of alarms by PLHIV to remind them to take their medication. Although better health resulting from taking ARVs was citied as a barrier to adherence it also acted as a facilitator to adherence as better health motivated PLHIV to continue taking their medication.In conclusion, based on the findings from the study a series of recommendations were made to inform the current ART adherence information and counseling strategies used by the ART facility at St Luke Mission Hospital in Mpanshaya - and other ART programmes being implemented in similar rural health facilities in Zambia. The recommendations included the need for the ART facility to address alcohol abuse among PLHIV taking ART, addressing perceptions on ARVs in the community, reviewing of the counseling programme, caring for treatment supporters, strengthening food security and livelihood opportunities for PLHIV and their families and increasing collaboration between the ART facility and the churches.

Among the 14 million persons living in the United States with current or remitted cancer, poor physical health-related quality of life (HRQL) is a significant concern. However, self-compassion (i.e., common humanity, mindfulness, self-kindness) may be a protective factor, either directly or indirectly, by allowing for a sense of empowerment and control over illness, and in turn, facilitating engagement in treatment and positive perceptions of health. Serial mediation analyses among persons living with current (n = 67) or remitted (n = 168) cancer lend support for a positive, direct association between self-compassion and physical HRQL, as well as indirect effects via internal perceived control and, to a lesser degree, treatment adherence. Mixed findings, especially among cancer patients, highlight limitations of resiliency traits while also supporting the notion that self-compassion interventions (e.g., Mindful Self-Compassion Training) may have positive implications for health-related control beliefs, behaviors, and quality of life in the cancer population.

Background: Untreated patients and discontinuity in treatments are problems that mental health care is facing. Even though people seek care, there is still a pattern of patients who do not attend their scheduled appointments, referred to as No-shows. Noshows result in prolonged waiting times for patients and decreased efficiency and workflow for healthcare professionals. Moreover, causing great financial costs and losses for the healthcare sector. Using machine learning to predict potential No-shows beforehand could be a possible solution to minimize No-shows, while enhancing treatment adherence. Aim: The aim is to explore the best-performing algorithm for No-show predictions in digital psychotherapy. Furthermore, gaining a deeper knowledge of common behaviors in patient demographic and appointment data that may explain the reasons behind No-shows in digital mental health care services. Methods: A quantitative experimental research methodology and design with an inductive approach were utilized, incorporating computational methods, tools, and techniques. The Knowledge Discovery in Databases process was used as a guidance in the data mining process. Results: An observational relationship was found between No-shows and the following features age, day of the week of the appointment, date in a month of the appointment, month of the appointment, and waiting time. The best-performing algorithms to predict No-shows were Gradient Boosting Decision Tree and Random Forest. The date in a month was the most impactful feature for both classifiers, followed by the appointment month, the day of the week, and the number of waiting days. Conclusion: Machine learning has the potential to predict No-shows in digital psychotherapy and can be used to identify the underlying factors and patterns behind Noshows while providing useful information to support and improve digital mental health care delivery, treatment adherence, and patient outcomes. Thus, predicting No-shows beforehand is highly relevant for enhancing treatment adherence in digital psychotherapy and mental health care.

Introduktion: Tidigare forskning visar att det finns flera olika faktorer som bidrar till följsamhet vid läkemedelsbehandling av psykisk sjukdom, både möjligheter och svårigheter. En viktig uppgift som psykiatrisjuksköterskan har i mötet med patienter som lider av psykisk sjukdom är att psykiatrisjuksköterskan ska motivera patienten till att ta emot rekommenderad läkemedelsbehandling. Det är av värde att göra en översikt gällande aktuell forskning kring omvårdnadsmetoder och åtgärder som kan vidtas av psykiatrisjuksköterskan för att motivera patienter med psykisk sjukdom till följsamhet vid läkemedelsbehandling. Syfte: Syfte med denna studie är att undersöka hur sjuksköterskor inom psykiatrisk vård kan motivera personer med psykisk sjukdom till följsamhet vid läkemedelsbehandling. Metod: Metoden för detta examensarbete var litteraturöversikt bestående av 21 vetenskapliga artiklar, varav 14 kvantitativa, 5 kvalitativa och två med mixad metod. Vid litteratursökningenanvändes databaserna Pubmed och CINAHL. Resultat: Analysen av data resulterade i fyra kategorier (figur 3) vilket beskriver hur en sjuksköterska inom psykiatrisk vård kan motivera patienter med psykisk sjukdom tillföljsamhet vid läkemedelsbehandling. Dom fyra kategorierna blev: Den terapeutiska relationen och stöd från anhöriga vid följsamhet till läkemedelsbehandling, Psykoedukation för följsamhet till läkemedelsbehandling, Följsamhetsterapi för läkemedelsbehandling och Andra interventioner för att motivera till följsamhet vid läkemedelsbehandling. Slutsats: Det finns flera olika omvårdnadsinterventioner som specialistsjuksköterskan i psykiatrisk vård kan använda sig av för att motivera patienten att ta emot läkemedel och följa rekommenderad läkemedelsbehandling. Dessa omvårdnadsinterventioner överensstämmer med Roys anpassningsteori där Roy beskriver sjuksköterskans roll i patientens anpassningsförmåga och hur sjuksköterskan hjälper individer att hitta strategier för att hantera olika situationer samt ger individer möjligheter och stöd om behovet finns / Introduction: Previous research has shown that there are several different factors that contributes to adherence to drug treatment of mental illness, both opportunities and difficulties. An important task that the psychiatric nurse has in the meeting with patients suffering from mental illness is that the psychiatric nurse should motivate the patient to accept recommended drug treatment. It is of value to make an overview of current research on the different methods and measures that can be used by the psychiatric nurse to motivate patients with mental illness to adherence to drug treatment. Aim: The aim of this study is to investigate on how nurses in psychiatric care can motivate people with mental illness to adherence to drug treatment. Method: The method for this thesis was a literature review consisting of 21 scientific articles, of which 14 quantitative, 5 Qualitative and two with mixed method. The databases Pubmed and CINAHL were used in the literature search. Results: The analysis of the data resulted in four categories (figure 3), which describes how a nurse in psychiatric care can motivate patients with mental illness to adherence to drug treatment. The four categories were: The therapeutic relationship and support from relatives to motivate adherence to drugtreatment, Psychoeducation for adherence to drug treatment, Adherence therapy for drug treatment and Other interventions to motivate adherence to drug treatment. Conclusion: There are several different nursing interventions that the specialist nurse in psychiatric care can use to motivate a patient to receive medication and follow recommended drug treatment. These nursing interventions are consistent with Roy's adaptation theory where Roy describes the nurse's role in the patient's adaptation capability and how the nurse helps individuals find strategies to handle different situations and gives individuals opportunities and support if needed.

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