Negative affect and self-agency's association with immunosuppressant adherence in organ transplant: A meta-analysis.

Objective: In organ transplant, prevalence estimates of negative affect (e.g., depressive symptoms) are higher than in the general population and self-agency is required for successful regimen self-management. Nonetheless, the roles of these psychological factors for immunosuppressant adherence in this population remain unclear. Method: Meta-analytic techniques were used to determine the associations between negative affect and self-agency with adherence and to identify moderators of these associational effect sizes (ES). Results: Across 50 studies and 46,106 adult organ recipients, there is a small negative association between negative affect and adherence (mean weighted ES: r = -.14, p < .001; 95% confidence interval, CI [-.175, -.096]) and a small positive association between self-agency and adherence (ES: r = .17, p < .001; 95% CI [.094, .251]). Studies conducted outside of Europe and North America, assessing illness-specific negative affect and utilizing questionnaire adherence measures, and studies of better quality were associated with a larger ES, explaining 54% of the heterogeneity in the negative affect and adherence association. For the association between self-agency and adherence, a higher percentage of females and medication-specific self-agency were associated with a larger ES, explaining 34% of the heterogeneity. Conclusions: By elucidating overlooked trends in the existing literature for the associations between negative affect and self-agency with adherence, the current meta-analyses clarify previously contradicting findings in organ transplant. The findings also shed light on factors contributing to the existing variability and highlight the importance of careful consideration of methodology in studies of adherence postorgan transplant. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Opportunities for Engaging Patients in Kidney Research.

PURPOSE: The purpose of this review is to provide a summary of the rationale for engaging patients in research as well as to review the established and envisioned advantages and strategies for patient-researcher partnerships. The authors of this article, which include a patient and 4 researchers in kidney disease, discuss the expected benefits and opportunities for patient engagement in their respective research programs. The 4 research programs span the spectrum of kidney disease and focus on enhancing bone health, increasing living donor kidney transplants, improving medication adherence, and preventing kidney transplant rejection. SOURCES OF INFORMATION: The sources of information for this review include published studies on the topics of patient engagement and the 4 research programs of the new investigators. KEY FINDINGS: (1) Patient, health care provider, and researcher partnerships can contribute useful insights capable of enhancing research in kidney disease. (2) Regardless of the research program, there are various strategies and opportunities for engagement of patients with lived experience across the various stages of research in kidney disease. (3) Envisioned advantages of patient-researcher partnerships include: targeting patient-identified research priorities, integrating patients' experiential knowledge, improving study design and feasibility through patient-researcher input, facilitating dissemination of research findings to other patients, effectively responding to patient concerns about studies, and inspiring researchers to conduct their research. LIMITATIONS: The limitations of the current review include the relative scarcity of literature on patient engagement within the field of kidney disease. IMPLICATIONS: The findings of the current review suggest that it will be important for future studies to identify optimal strategies for patient engagement in setting research priorities, study design, participant recruitment, execution of research projects, and knowledge dissemination and translation.

OBJET: Le but de cet article synthèse est de fournir un résumé des raisons justifiant de faire participer les patients à la recherche. On veut également examiner les avantages établis et envisagés, de même que les stratégies de partenariats patients-chercheurs. Les auteurs de cet article, un patient et quatre chercheurs dans le domaine des maladies rénales, discutent des bénéfices espérés et des débouchés attendus de l'implication des patients dans leurs programmes de recherche respectifs. Les quatre programmes de recherche étudiés couvrent un spectre étendu dans le domaine des maladies du rein, et se concentrent sur l'amélioration de la santé osseuse, l'augmentation du nombre de greffes provenant de donneurs vivants, l'amélioration de l'observance à la médication et la prévention du rejet de la greffe. SOURCES: Les sources consultées comprennent les recherches publiées sur le thème de la participation des patients en recherche et sur les quatre programmes de recherche des chercheurs participants (amélioration de la santé osseuse, augmentation du nombre de greffes provenant de donneurs vivants, amélioration de l'observance à la médication et prévention du rejet de greffe). PRINCIPALES CONCLUSIONS: (1) Les partenariats entre les patients, les professionnels de la santé et les chercheurs peuvent apporter de précieuses informations susceptibles de faire avancer la recherche sur les maladies rénales. (2) Peu importe le programme de recherche, il existe plusieurs stratégies et possibilités pour encourager la participation de patients et le partage de leur expérience lors des différentes étapes de la recherche sur les maladies rénales. (3) On discute des nombreux avantages attendus des partenariats patients-chercheurs, notamment le ciblage des priorités de recherche établies par les patients, l'intégration des connaissances tirées de l'expérience des patients, l'amélioration de la conception et de la faisabilité des études par les apports des patients et des chercheurs, la diffusion facilitée des résultats de la recherche auprès des autres patients, la réponse efficace aux soucis des patients en regard des études, et la source de motivation fournie aux chercheurs pour la poursuite de leurs études. LIMITES DE L'ÉTUDE: Les résultats sont limités par le fait qu'il existe peu de recherches ayant porté sur la participation des patients à la recherche sur les maladies rénales. IMPLICATIONS: Les résultats de cette étude suggèrent qu'il sera important pour les études ultérieures de définir les stratégies optimales favorisant la participation des patients lors de l'établissement des priorités de recherche, de la conception de l'étude, du recrutement des participants, de l'exécution des projets de recherche et au moment de la diffusion et du transfert des connaissances.

An observational study of health literacy and medication adherence in adult kidney transplant recipients.

BACKGROUND: There is a high prevalence of non-adherence to immunosuppressants in kidney transplant recipients. Although limited health literacy is common in kidney recipients and is linked to adverse outcomes in other medical populations, its effect on medication adherence in kidney transplant recipients remains poorly understood. The objective was to investigate the effect of lower health literacy on immunosuppressant adherence. METHODS: Kidney recipients who were at least 6 months post-transplant and outpatients of Vancouver General Hospital in B.C., Canada were recruited through invitation letters. A total of 96 recipients completed the Health Literacy Questionnaire, which provides a multifactorial profile of self-reported health literacy and the Transplant Effects Questionnaire-Adherence subscale measuring self-reported immunosuppressant adherence. Hierarchical linear regression was used to analyze the association between health literacy and adherence after controlling for identified risk factors of non-adherence. RESULTS: Our sample was on average 53 years old, 56% male and 9 years post-transplant. Kidney recipients reported low levels of health literacy on scales measuring active health management and critical appraisal of information and 75% reported non-perfect adherence. Worse adherence was associated with poorer overall health literacy (ΔR2 = 0.08, P = 0.004) and lower scores on six of nine of the health literacy factors. CONCLUSIONS: Poorer health literacy is associated with lower immunosuppressant adherence in adult kidney transplant recipients suggesting the importance of considering a recipient's level of health literacy in research and clinical contexts. Medication adherence interventions can target the six factors of health literacy identified as being risk factors for lower medication adherence.