Non-adherence to treatment is a major problem faced by professionals in mental health-care. Non-adherence to treatment increases the costs of service, in financial terms, as well as in the investment of time and effort. In addition, research has shown that outcomes of service may be negatively affected as a result of non-adherence. One factor that has been found to increase adherence to treatment programs is commitment. The purpose of the present study is to examine the efficacy of an intervention designed to increase adherence to treatment by increasing client commitment to therapy. This intervention is based on Rusbult's Investment Model of commitment. The participants in this study were 6 clients being seen at a university psychological services center. A multiple baseline across subjects design was used to analyze the efficacy of this treatment. It was found that only two of the six subjects met criteria for success in this intervention. However, in five of the six subjects, adherence to treatment increased when seen from a more long-term perspective. No difference in satisfaction with therapy was found between the subjects who successfully completed the treatment and those who did not successfully complete the treatment. Other elements of the treatment, such as participant demographics, treatment outcome, and presenting problems were analyzed descriptively. The results indicate that this intervention is insufficient to address the problem of non-adherence to therapy. Explanations regarding the failure of this intervention are discussed. / Master of Science

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No description available.

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.

MA, School of Human and Community Development, Faculty of Humanities, University of the Witwatersrand / HIV/AIDS remains a global pandemic that is affecting millions of people. The advent of antiretroviral medication in the late 1980s has led to major advances in clinical treatment that has turned the deadly disease into a chronic condition for those who are infected. However, adherence to antiretroviral medication remains problematic. Whilst extensive international research has been done to identify various variables that contribute to rates of non-adherence, there is not much research being done in South Africa that provides a reliable prediction of non-adherence or generates a theoretical understanding of the issue. The main aim of this study was to ascertain the barriers and facilitators that contribute to the level of adherence to antiretroviral treatment. This was done from a biopsychosocial perspective that takes into account not only the biomedical factors that may have an impact on antiretroviral treatment levels but also includes the various psychological and socio-political factors that contribute to non-adherence. The qualitative research methodology was used. Data was collected from 14 participants using semi-structured interviews. The participants included 3 medical practitioners, 1 nutritionist, 2 counsellors, 2 treatment activist, 2 caregivers to PLWHA and 4 people on treatment. Interviews were audio-recorded and transcribed. Thematic content analysis was used to generate themes. Themes were categorised under individual, interpersonal level and systemic level barriers and facilitators to ARV treatment which included biomedical, psychological as well as social-political factors that facilitate non-adherence. The main findings in this study suggest that there is a complex web of interaction between the various biomedical, psychological and socio-political factors that impact on adherence levels. Additionally, the response by PLWHA to their illness and subsequently to ARV treatment is more complex than a mere conforming to a set of medical standards and instructions. As such intervention that looks to increase adherence levels cannot be a one-dimensional or onesided endeavour and requires a multifaceted approach.

<p>Begreppen ”compliance, adherence och concordance” används inom många delar av omvårdnadsforskningen. Dessa begrepp används frekvent inom det njurmedicinska forskningsfältet eftersom njurmedicin är ett område med komplexa behandlingar som ställer stora krav på både vårdpersonal och patienter. Syftet med denna litteraturstudie var att beskriva vad dessa begrepp egentligen betyder och hur de används. För att uppnå dessa mål har artiklar sökts i flera databaser och därefter noga lästs igenom och analyserats metodiskt. Resultatet visar att det saknas entydiga definitioner av begreppen. Dessutom råder det en viss begreppsförvirring då man i vissa studier använder begreppen som synonymer trots att de enligt de flesta definitioner inte är det. Sammantaget gör detta att det blir svårvärderat hur man skall använda resultaten i utförda studier med dessa begrepp som mätpunkter och det leder dessutom till svårigheter i jämförelser mellan olika studier. En annan slutsats i denna litteraturstudie är att compliance anses en aning förlegat och att adherence är det man framförallt använder idag medans concordance tycks vara på frammarsch. Sammanfattningsvis kan man säga att det krävs mer forskning på området för att finna konsensus i nomenklaturen så att studier som utförs kan värderas och jämföras mot varandra.</p> / <p>The terms ”compliance, adherence and concordance” are used in several areas of nursing research. These terms are often used in research covering the field of nephrology since renal medicine is an area with complex treatments that demand much from both health care providers and patients. The aim of this literature review was to clarify these terms actual meaning and how they are used. To reach these goals, articles have been sought in several databases, and articles included have thereafter been read thoroughly and methodically analyzed. The results show that there is no unambiguous definition of the terms. Furthermore there are some confusion regarding how to use the terms and in some studies they are even used as synonyms even though this is wrong according to most definitions. Taken together these points makes it hard to evaluate how to use results from studies with these terms as points of measure it also leads to difficulties in comparing studies with each other. Another conclusion in this study is that compliance is considered a bit obsolete and adherence is what is generally used today while concordance is upcoming. More research is warranted to reach agreement on defining these terms to enhance comparability between studies.</p>

This dissertation had three specific aims: to estimate the prevalence of adherence among drug users, to determine whether drug use was directly associated with adherence, and to assess whether factors drawn from the Behavioral Model of Health Care Utilization (BMHCU) are associated with adherence. The self-reported prevalence of adherence to prescribed health care recommendations in the past 12 months among the community sample of drug users and non-drug users from similar low-income areas in the study sample ranged from 53%-74%. Non-drug users consistently had higher rates of adherence than drug users, except for adherence to female health care recommendations, yet this difference was insignificant at the bivariate level. In the multivariate analysis, when controlling for all other variables within the BMHCU, only non-injection drug use was significantly associated with adherence to mental health care recommendations. In exploring its predictive utility, the BMHCU accounted for a range of 17% to 54% of the variance for the adherence measures. Although percentages accounted for by the BMHCU were substantial the fact that very few predictor variables were significant may indicate multicollinearity and other severe limitations with the data, such as small sample size, and the conceptualization of the adherence measure. The conceptualization of adherence remains an issue in need of further delineation. Further studies are needed in order to develop appropriate measures of adherence. Qualitative studies may be needed to further understand adherence among drug users.

Begreppen ”compliance, adherence och concordance” används inom många delar av omvårdnadsforskningen. Dessa begrepp används frekvent inom det njurmedicinska forskningsfältet eftersom njurmedicin är ett område med komplexa behandlingar som ställer stora krav på både vårdpersonal och patienter. Syftet med denna litteraturstudie var att beskriva vad dessa begrepp egentligen betyder och hur de används. För att uppnå dessa mål har artiklar sökts i flera databaser och därefter noga lästs igenom och analyserats metodiskt. Resultatet visar att det saknas entydiga definitioner av begreppen. Dessutom råder det en viss begreppsförvirring då man i vissa studier använder begreppen som synonymer trots att de enligt de flesta definitioner inte är det. Sammantaget gör detta att det blir svårvärderat hur man skall använda resultaten i utförda studier med dessa begrepp som mätpunkter och det leder dessutom till svårigheter i jämförelser mellan olika studier. En annan slutsats i denna litteraturstudie är att compliance anses en aning förlegat och att adherence är det man framförallt använder idag medans concordance tycks vara på frammarsch. Sammanfattningsvis kan man säga att det krävs mer forskning på området för att finna konsensus i nomenklaturen så att studier som utförs kan värderas och jämföras mot varandra. / The terms ”compliance, adherence and concordance” are used in several areas of nursing research. These terms are often used in research covering the field of nephrology since renal medicine is an area with complex treatments that demand much from both health care providers and patients. The aim of this literature review was to clarify these terms actual meaning and how they are used. To reach these goals, articles have been sought in several databases, and articles included have thereafter been read thoroughly and methodically analyzed. The results show that there is no unambiguous definition of the terms. Furthermore there are some confusion regarding how to use the terms and in some studies they are even used as synonyms even though this is wrong according to most definitions. Taken together these points makes it hard to evaluate how to use results from studies with these terms as points of measure it also leads to difficulties in comparing studies with each other. Another conclusion in this study is that compliance is considered a bit obsolete and adherence is what is generally used today while concordance is upcoming. More research is warranted to reach agreement on defining these terms to enhance comparability between studies.

No description available.

Background: The foods people choose to eat can determine their health status because inadequate or excessive amounts of certain food components are associated with risk of disease. A number of factors influence the foods people choose and the amounts of these foods, such as social situations, habits, advertising and the cost of food (Delormier, et al., 2009). The aim of this study is to identify the perceptions and environmental factors that are associated with food choices and the extent of perceptions to adherence to dietary advice among women with type 2 diabetes. Objectives: 1) To describe food behaviours of women who have diabetes, within their own daily food patterns; 2) To describe the perceptions of women who have diabetes about their social, economic and environmental situations that influence their food choice;, and 3) To identify the perceptions that are associated with the intent or ability to adhere to recommended health and nutrition behaviours. Methodology: Semi-structural individual interviews were used to collect data from 20 women with type 2 diabetes. The Food Choice Map was used to generate the food patterns and food perceptions, Interviews were recorded and transcripts were analyzed by using principles of the Theory of Planned Behavior, constant comparison method to extract themes, and coded by Nvivo software. In addition, the women completed a demographic questionnaire. Results: Of the major factors that the women perceived as influencing their food behaviours, four major factors enabled women to follow nutritional advice, while three factors acted as barriers to following the advice. Groups of women were identified: those who wanted to follow advice and did, those who did not want to follow advice and did not, those who wanted to follow advice but could not, and those who wanted to follow advice but experienced psychological conflict in doing so. Conclusion: Results showed that food behaviours could be better understood through multi-dimensional factors. The four groups of women with diabetes according to perceived intent or ability to adhere to health and nutrition advice was possible in this study, but further studies are needed to justify the use of these groupings in interventions that enhance adherence to dietary advice in the context of type 2 diabetes. Background: The foods people choose to eat can determine their health status because inadequate or excessive amounts of certain food components are associated with risk of disease. A number of factors influence the foods people choose and the amounts of these foods, such as social situations, habits, advertising and the cost of food (Delormier, et al., 2009). The aim of this study is to identify the perceptions and environmental factors that are associated with food choices and the extent of perceptions to adherence to dietary advice among women with type 2 diabetes. Objectives: 1) To describe food behaviours of women who have diabetes, within their own daily food patterns; 2) To describe the perceptions of women who have diabetes about their social, economic and environmental situations that influence their food choice;, and 3) To identify the perceptions that are associated with the intent or ability to adhere to recommended health and nutrition behaviours. Methodology: Semi-structural individual interviews were used to collect data from 20 women with type 2 diabetes. The Food Choice Map was used to generate the food patterns and food perceptions, Interviews were recorded and transcripts were analyzed by using principles of the Theory of Planned Behavior, constant comparison method to extract themes, and coded by Nvivo software. In addition, the women completed a demographic questionnaire. Results: Of the major factors that the women perceived as influencing their food behaviours, four major factors enabled women to follow nutritional advice, while three factors acted as barriers to following the advice. Groups of women were identified: those who wanted to follow advice and did, those who did not want to follow advice and did not, those who wanted to follow advice but could not, and those who wanted to follow advice but experienced psychological conflict in doing so. Conclusion: Results showed that food behaviours could be better understood through multi-dimensional factors. The four groups of women with diabetes according to perceived intent or ability to adhere to health and nutrition advice was possible in this study, but further studies are needed to justify the use of these groupings in interventions that enhance adherence to dietary advice in the context of type 2 diabetes.