This study tested the effectiveness of special packaging in increasing the medication compliance of hypertensive patients in the outpatient clinic at San Joaquin General Hospital. Seventy patients were randomly assigned to an experimental and control group. After a 6 week treatment period, the mean compliance estimates for the experimental and control groups (xl = 68.59%, x2 = 48.67%) were compared and found to be significantly different (t = 2.46, df = 33, p < .05). In addition, a statistically significant negative correlation was found between compliance and blood pressure (r = -0.51, p ~ .01).

While much research has examined factors thought to affect patient compliance with therapeutic regimen, relatively little is known about the relationship between psychiatric patients' attitudes toward treatment regimen and their adherence to the treatment regimen. Compliance rates for psychiatric patients remain the lowest of the medical patient population, probably due to psychological and social characteristics of psychiatric patients. Because of a trend in the United States toward self-medication for an increasingly ambulatory psychiatric patient population, the ability to predict patient compliance with medication regimen has become more important than ever before. Before potential noncompliers can be identified and patient compliance predicted through the use of attitudes, an examination of the nature of these attitudes is needed. Scientific literature and theory suggest that attitude is one of several variables which corresponds to behavior. Specific attitudes are thought to develop as a result of 2 real or vicarious experience with the attitude referent. In addition, research has shown that attitudes toward specific objects correlate highly with beliefs, behavioral intentions, and behavior. Therefore, it is hypothesized that psychiatric patients with prior medicine-taking experience will have developed different patterns of attitudes toward pharmacological treatment than will medicine-naive patients. The hypothesis implies that knowing these attitudes will permit prediction of compliance of experienced and naive patients with therapeutic regimen. As the first step of investigating using attitudes to predict compliance, a 20-item Likert-type rating scale, the Psychiatric Medicine Attitude Scale (PMAS), was developed. An alternate forms reliability coefficient of .93 was obtained. Mean score for Form A for the psychiatric medicineexperienced subjects was 2.85, for the medicine-naive subjects, 3.40. Form B scores were 3.17 for the experienced subjects and 3.51 for the naive subjects. These scores show that on both Forms A and B, individuals without prior experience with psychiatric medicine tended tb express more negative attitudes toward the referent object than did the subjects who had previous medicine experience. The next steps, outside the range of this project, will be to develop norms and to ascertain if compliance behaviors will be a function of PMAS scores.

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The present study evaluated the effectiveness of a behavioral family intervention on adherence and metabolic control in insulin dependent diabetic children (IODM). Specifically, assumption of regimen responsibilities between the parent and child were manipulated to facilitate regimen adherence. The intervention delivered was a target-specific behavioral contract extended sequentially across four target behaviors (Le., blood glucose testing, insulin injections, diet, and exercise). Regimen components were targeted in a within subjects, multiple baseline design across behaviors to assess the relationship between adherence and metabolic control. Metabolic control was assessed with a measure of glycosylated hemoglobin (e.g., HbA1C.) Five IDDM children (3 female,2 male), who met study criteria (Le., nonadherence to blood glucose testing defined as oS. 2 tests daily and metabolic status outside the optimal range using standard laboratory reference values) were recruited from physician referrals and media announcements. Subjects were between the ages of 10 and 15 years (M = 12.6); four were Caucasian and one was African-American. Mean duration of diabetes upon entry into the study was 4.3 years. Results revealed that four subjects responded to the intervention and three of those four evidenced clinically significant improvements in metabolic control at mid - and/ or post-study. One subject demonstrated only moderate intervention effects and no improvement in metabolic control while another increased adherence, but decrements in metabolic control were noted. These results suggest that adherence may mediate the relationship between family variables and metabolic status. Two additional subjects demonstrating consistently good metabolic were employed to assess the validity of target behaviors. The results were related to various family and diabetes-specific psychosocial indices. / Master of Science

The present study evaluated a commitment-based intervention to improve adherence with a 10-day antibiotic regimen. Subjects were 48 undergraduate students receiving treatment from the Student Health Services at Virginia Polytechnic Institute and State University. Adherence was assessed by pill counts obtained in unannounced home visits 7 to 10 days after the regimen was prescribed and by subjects’ self-reports. Pre- and posttest measures of self- efficacy and outcome expectancy were completed by subjects. Significantly more subjects in the intervention group were adherent (85%) than in the control group (64%) when adherence was defined as at least 80% of medication taken and nonadherence defined as less than 80% or more than 110% of medication taken. Self-efficacy and outcome expectancy scores, when multiplied together for a predictive index, were significantly correlated with self-reported adherence at pre- and posttest, but were not correlated with pill count adherence. Self-efficacy at pre- and posttest and outcome expectancy at pretest were significantly correlated with self-reported adherence. Self-efficacy at posttest was significantly correlated with pill count adherence. An intervention designed to increase commitment to medical regimen resulted in greater adherence with a short-term regimen. Self-efficacy and outcome expectancy predicted self-reports of adherence behavior, but were poor predictors of objective measures of adherence. At best, self-efficacy appeared to reflect recent behavior. / Master of Science

Thesis (Dr. P.H.)--University of Texas Health Science Center at Houston, School of Public Health, 2008. / "May 2008." Source: Dissertation Abstracts International, Volume: 69-02, Section: B, page: 0911. Adviser: Lu-Yu Hwang. Includes bibliographical references (leaves 54-62).

Thesis (M.S.)--University of Michigan, 1991.

Thesis (M.S.)--University of Michigan, 1991.

Indiana University-Purdue University Indianapolis (IUPUI) / Medication adherence remains a problem among Type-2 diabetes (T2D) patients despite availability of effective treatments. Three analyses of extant data sets were conducted to examine barriers to using medication as prescribed as an alternate method to assess medication adherence: 1) development and psychometric evaluation of the Murage-Marrero-Monahan-Medication barriers (4M) scale to assess patients’ perceived barriers; 2) patient demographic factors associated with barriers to using medication as prescribed, and 3) the association between patients’ perceived barriers to medication use and cardiovascular disease (CVD) risk factor control.Twelve focus groups and a cross-sectional study of 362 T2D patients contributed to develop and evaluate psychometric properties of the 4M scale. A cross-sectional survey of 964 T2D patients was used for the other two studies. Analysis of covariance identified demographic factors associated with reported barriers. Multivariable logistic regression was used to identify barriers associated with CVD risk factors (glucose, blood pressure and lipids) categorized as either poor or good control. Exploratory factor analysis with Varimax rotation resulted in a 19-item 4M scale with acceptable psychometric properties. As a five-domain (or single-domain) structure, coefficient alpha ranged from 0.70 to 0.83 (0.92). Both structures demonstrated discriminant validity and known-group validity. Age was inversely associated with all identified barriers while income was inversely associated with poor communication with providers and side effects. A unit increase in the overall barrier mean score on the 4M scale was associated with 92% increase in the odds of having poor control of two or more CVD risk factors compared to good control of all three risk factors (adjusted OR=1.92, 95% CI: 1.16–3.17; p<0.05). The 4M scale demonstrated acceptable psychometric properties in assessing barriers to using medication among T2D patients. Poor medication adherence has been previously associated with CVD risk. In this study, greater barriers were associated with poorer control of CVD risk factors making barriers a potential alternative to medication adherence, whose current assessment methods are limited. The 4M scale has the advantage to identify specific barriers inhibiting medication use that can facilitate patient-provider discussions and the development of targeted interventions. / Some parts of this dissertation work were jointly funded by Program Announcement 04005 from the Centers for Disease Control and Prevention (Division of Diabetes Translation) and the National Institute of Diabetes and Digestive and Kidney Diseases. The findings and conclusions in this report are those of the author(s) and do not necessarily represent the views of the funding agency(s).

The use of the Minnesota Multiphasic Personality Inventory (MMPI) and the Health Attribution Test (HAT) for predicting referral compliance to a state vocational rehabilitation program was evaluated. Subjects included 53 patients (26 males, 27 females) who were chosen at random three to 18 months following discharge from an inpatient chronic and spinal pain center. Subjects were administered the MMPI and HAT upon hospital admission and seven outcome measures of referral compliance were obtained. A discriminant analysis was performed to test the hypothesis that certain items would best discriminate compliance. Most discriminative of compliance was the MMPI validity scale K (Wilks Lambda = .751, p ≤ .033). A regrouping of data into two groups, active and inactive, yielded ego strength (MMPI, ES) and ability to trust others (PA) as significant differentiating variables.