A Scoping Review of International Barriers to Asthma Medication Adherence Mapped to the Theoretical Domains Framework.

BACKGROUND: Internationally, adult asthma medication adherence rates are low. Studies characterizing variations in barriers by country are lacking. OBJECTIVE: To conduct a scoping review to characterize international variations in barriers to asthma medication adherence among adults. METHODS: MEDLINE, EMBASE, Web of Science (WOS), and CINAHL were searched from inception to February 2017. English-language studies employing qualitative methods (eg, focus groups, interviews) were selected to assess adult patient- and/or caregiver-reported barriers to asthma medication adherence. Two investigators independently identified, extracted data, and collected study characteristics, methodologic approach, and barriers. Barriers were mapped using the Theoretical Domains Framework and findings categorized according to participants' country of residence, countries' gross national income, and the presence of universal health care (World Health Organization definitions). RESULTS: Among 2942 unique abstracts, we reviewed 809 full texts. Among these, we identified 47 studies, conducted in 12 countries, meeting eligibility. Studies included a total of 2614 subjects, predominately female (67%), with the mean age of 19.1 to 70 years. Most commonly reported barriers were beliefs about consequences (eg, medications not needed for asthma control, N = 29, 61.7%) and knowledge (eg, not knowing when to take medication, N = 27, 57.4%); least common was goals (eg, asthma not a priority, N = 1, 2.1%). In 27 studies conducted in countries classified as high income (HIC) with universal health care (UHC), the most reported barrier was participants' beliefs about consequences (N = 17, 63.3%). However, environmental context and resources (N = 12, 66.7%) were more common in HIC without UHC. CONCLUSION: International adherence barriers are diverse and may vary with a country's sociopolitical context. Future adherence interventions should account for trends.

Does Baseline Heart Rate Variability Reflect Stable Positive Emotionality?

Several recent studies have found significant correlations, medium in effect size, between baseline heart rate variability (HRV) and measures of positive functioning, such as extraversion, agreeableness, and trait positive affectivity. Other research, however, has suggested an optimal level of HRV and found nonlinear effects. In the present study, a diverse sample of 239 young adults completed a wide range of measures that reflect positive psychological functioning, including personality traits, an array of positive emotions (measured with the Dispositional Positive Emotions Scale), and depression, anxiety, and stress symptoms (measured with the DASS and CESD). HRV was measured with a 6-minute baseline period and quantified using many common HRV metrics (e.g., respiratory sinus arrhythmia, root mean square of successive differences, and others), and potentially confounding behavioral and lifestyle variables (e.g., BMI, caffeine and nicotine use, sleep quality) were assessed. Neither linear nor non-linear effects were found, and the effect sizes were small and near zero. The findings suggest that the cross-sectional relationship between HRV and positive experience deserves more attention and meta-analytic synthesis.