Thesis (M.S.)--University of Wisconsin-Madison. / Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 56-61).

Thesis (Ph. D.)--University of Chicago, School of Social Service Administration. / Includes bibliographical references. Also available on the Internet.

Thesis (M. A ) - - University of the Western Cape, 2008. / Summary in English. Includes bibliographical references.

Thesis (Ph. D.)--University of Wisconsin-Madison, 2002. / eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (p. 240-252).

Thesis (M.S.)--University of Wisconsin-Madison, 1988. / eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves: 28-32).

Thesis (Ph. D.)--Georgia State University, 2007. / Title from title page. Lindsey L. Cohen, committee chair; Lisa Armistead, Erin B. McClure, Mary K. Morris, committee members. Electronic text (113 p. : ill. (some col.)) : digital, PDF file. Description based on contents viewed Oct. 11, 2007. Includes bibliographical references (p. 73-80).

Diabetes has been labelled as one of the largest crises in the twenty-first century. Saudi Arabia is one of the top 10 countries for prevalence of diabetes and one in five people has the condition. Medication adherence assessment is vital to help clinicians reach therapy outcomes and identify gaps in patient management. The aim of this PhD was to explore oral hypoglycaemic medication (OHM) adherence in patients with Type 2 diabetes patients in Saudi Arabia and to identify factors associated with OHM adherence. The aim was addressed by: 1) Conducting a systematic review to identify which tools could be used to measure adherence to OHM as well as to quantify adherence levels across different countries; 2) Undertaking a cross-sectional study to quantify the prevalence of adherence to OHM in a group of patients in Saudi Arabia using a validated measure of adherence. An interview study on a subset of these patients then explored in detail Type 2 diabetic patients' beliefs and attitudes towards their OHM regimen, including factors which helped or hindered their medication taking behaviour. The systematic review included 37 studies. It showed that the level of OHM adherence varied widely across all measures: 36% to 95% when dispensing records were used, 37% to 98% with self-report, and 17% to 97% with pill counts. The term 'adherence' was most commonly used. There was no identified studies assessing OHM adherence in Saudi Arabia. The cross-sectional study showed that the level of OHM adherence was 40%, Lower adherence was associated with patients of younger age (OR, 1.084; 95% CI, 1.056-1.112), individual taking a higher number of non-OHM (OR, 0.848; 95% CI, 0.728-0.986) and having a higher HbA1c level (OR, 0.808; 95% CI, 0.691-0.943). The interview study identified several factors affecting OHM adherence using a validated theoretical framework. Facilitators of OHM adherence were OHM scheduling, knowledge about OHM, knowledge on other relevant behaviours such as diet and physical activity, knowing how to take OHM appropriately and how to manage hypoglycaemia. In addition, OHM adherence was facilitated by beliefs of preventing diabetic complications, avoiding insulin injections, achieving an improved quality of life, accepting diabetes, being optimistic about the future, and having high self-confidence. Conversely, barriers to OHM adherence were forgetfulness, cognitive overload, lack of knowledge of sexual health implications of OHM, and knowledge of OHM side effects or drug-drug interactions. Furthermore, side effects of OHM such as weight gain or hypoglycaemia, knowing how to measure blood sugar, feeling no symptoms, and having many medications to take were additional barriers to OHM adherence. The MASA study also showed that there are several social- and physical-related factors affecting OHM adherence such as the patient-physician relationship and perceived family support. The work in this PhD suggests that targeting suboptimal OHM adherence behaviour needs to be done in a comprehensive manner. The key benefit is to provide future researchers with a comprehensive range of factors that can be targeted when defining targets for an intervention(s). Further systematic intervention development and testing is required to choose and prioritise the most promising interventions to improve OHM adherence.

It has been well-documented in the literature that there are many physical and psychological benefits to be derived from regular aerobic exercise. It has also been noted that adherence/compliance to aerobic exercise regimens tends to be quite low. Investigators have found that a number of factors tend to correlate with adherence, but it has been difficult thus far to determine a mechanism which underlies a tendency to adhere versus a tendency to drop-out. This study examined the problem of non-adherence from the perspective of Self-Efficacy Theory (Bandura, 1977). Subjects for this investigation included all patients seen during a four week period in the Cooper Clinic at the Aerobics Center in Dallas, Texas. Patients at the clinic receive a complete physical examination and health prescriptions based upon the results of their examination. During this four week period, half were administered a Self-Efficacy Questionnaire. Approximately three months later all patients seen during this four week period received a followup (adherence questionnaire in the mail). It was hypothesized that there would be a positive relationship between responses on the Self-Efficacy Questionnaire and responses on the Adherence Questionnaire. A second hypothesis stated that there would be a positive relationship between items which specifically pertained to exercise on each of the questionnaires. In addition, it was expected that there would be no difference in adherence rates between those who made self-efficacy judgments and those who did not. Results of a t-test conducted between the group which made self-efficacy judgments and the group that was not asked to make such an evaluation demonstrated no significant difference in adherence rates. A correlational analysis revealed that there was not a statistically significant relationship between total self-efficacy scores and total adherence scores. There was, however, a statistically significant relationship between levels of exercise self-efficacy and levels of exercise adherence. In addition to these main variables of interest, correlations between other variables (sex, age, percent bodyfat, etc.) were examined and discussed.

Myocardial Infarction: A Study of the Effects On Patient Compliance of Structured Education and Participation of the Significant Other This study was designed to explore the effects of the independent variables of patient education and the significant other on compliance. The purpose of the study was to test three hypotheses predicting that subjects who receive structured education with their significant other would have higher compliance rates with health care recommendations than would subjects who receive structured and unstructured education without their significant other. The study was conducted with a convenience sample of 12 male patients who had a significant other and had not experienced a previous myocardial infarction within five years. The convenience sample was then randomly and equally allocated into three groups. The control group received unstructured education as currently practiced by nursing staff. One experimental group received structured education from the investigator and the other experimental group of subjects and their significant other received structured education from the investigator. Using a semi-structured interview guide, the investigator interviewed each subject at one month and at three to four months postdischarge from hospital to determine compliance rates with physical activity, dietary, and medication health care recommendations as prescribed by the subject's physician. Open-ended questions were used to determine recommendations and difficulties encountered by noncompliers. More specific questions were used to allow subjects to rate their compliance. Results were subjected to the Kruskal-Wallis rank-sum test with one-way analysis of variance. Statistically significant differences (p < .05) were not found suggesting that method of patient education was not a valid prediction of compliant behaviour. The insignificant findings of this study need to be interpreted with caution because of the small sample size and between group differences of the demographic variables of age and employment. From general observations of the total sample, personal definitions of health, simultaneous demands and the extent of behavioural changes required, and the demographic variables of education and employment appear to influence compliance. These findings suggest that individual differences have an impact on compliant behaviour. Findings also suggest that the significant others of patients with myocardial infarctions are actively involved with the therapeutic regimen prescribed for their mates. The study discusses implications and recommendations for nurse practitioners and researchers who wish to improve their care of myocardial infarction patients and their significant others. / Applied Science, Faculty of / Nursing, School of / Graduate

The primary objective of this study was to examine the association between the theory of planned behavior (TBP) and adherence to a multidisciplinary pain center (MPC) treatment program for chronic pain. While the results of several studies have provided support for the efficacy of MPC treatment in chronic pain, the problems of adherence and attrition are important. TPB is a cognitive/social model of behavior that has been used to predict a variety of behaviors, although it has never been used to predict adherence to a multidisciplinary chronic pain treatment program. It was predicted that Adherence would be predicted by Intentions and that Intentions would be predicted by 1) Perceived Social Norms, 2) Perceived Behavioral Control, 3) Attitudes Toward New Behavior (completing the treatment program), and 4) Attitude Toward Current Behavior (maintaining current treatment and coping strategies). It was found that the total Intentions scores did not predict the total Adherence scores. However, Intentions was predicted by 1) Perceived Behavioral Control, 2) Attitudes Toward New Behavior (completing the treatment program), and 3) Attitude Toward Current Behavior (maintaining current treatment and coping strategies). The finding that Perceived Social Norms did not predict Intentions was consistent with results of previous studies with the TBP. The secondary objective was to examine the extent to which MPC treatment affects patients' attitudes towards behaviors that are associated with successful pain management. The majority of the patients (82%) developed a more favorable attitude toward the program and their average report of the importance of the program was 6.78 on a 10-point scale. The majority of patients (74%) reported experiencing a greater decrease in pain than expected, and the average amount of pain decrease was 5.39 on a 10-point scale.