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1.
Medicine (Baltimore) ; 99(51): e23308, 2020 Dec 18.
Artículo en Inglés | MEDLINE | ID: mdl-33371064

RESUMEN

ABSTRACT: Immigrants in Korea are relatively vulnerable in terms of medication self-management and have low levels of medication adherence. We aimed to evaluate antidepressant adherence and its patterns in immigrants and to identify predictors of nonadherence.In this matched cohort study using the National Health Insurance claims database, immigrants who were newly prescribed antidepressants were identified (n = 2,398). The immigrants were matched with native-born Koreans in a 1:1 ratio. Antidepressant adherence was measured by the medication possession ratio at monthly intervals. Logistic regression was performed to compare antidepressant nonadherence between immigrants and native-born Koreans, and to identify factors affecting immigrants' nonadherence.The average medication possession ratio of immigrants was 27.1%, which was lower than that of native-born Koreans (30.9%) (P = .038). Immigrants had a lower likelihood of adherence than native-born Koreans (odds ratio [OR] 0.76, 95% confidence interval [CI] 0.3-0.92). Older age, visiting a psychiatrist for the first diagnosis of depression (OR 2.24, 95% CI 1.60-3.13), achieving appropriateness of care (OR 3.54, 95% CI 2.51-4.98), and having a usual source of care (OR 1.69, 95% CI 1.25-2.27) were associated with a higher likelihood of adherence in immigrants.This study showed that antidepressant adherence of immigrants was lower than that of native-born Koreans. However, it appears that visiting a psychiatrist, achieving appropriateness of care, and having a usual source of care might increase antidepressant adherence among immigrants. Further research that focuses on cultural and/or linguistic factors affecting immigrants' adherence and healthcare utilization is suggested as a way to increase adherence.


Asunto(s)
Antidepresivos/uso terapéutico , Depresión/tratamiento farmacológico , Depresión/etnología , Emigrantes e Inmigrantes/estadística & datos numéricos , Cumplimiento de la Medicación/etnología , Adulto , Factores de Edad , Anciano , Antidepresivos/administración & dosificación , Comorbilidad , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , República de Corea/epidemiología , Características de la Residencia , Factores Sexuales , Factores Socioeconómicos , Inmigrantes Indocumentados/estadística & datos numéricos , Adulto Joven
2.
MMWR Morb Mortal Wkly Rep ; 69(40): 1437-1442, 2020 Oct 09.
Artículo en Inglés | MEDLINE | ID: mdl-33031362

RESUMEN

During 2018, estimated incidence of human immunodeficiency virus (HIV) infection among Hispanic and Latino (Hispanic/Latino) persons in the United States was four times that of non-Hispanic White persons (1). Hispanic/Latino men who have sex with men (MSM) accounted for 24% (138,023) of U.S. MSM living with diagnosed HIV infection at the end of 2018 (1). Antiretroviral therapy (ART) adherence is crucial for viral suppression, which improves health outcomes and prevents HIV transmission (2). Barriers to ART adherence among Hispanic/Latino MSM have been explored in limited contexts (3); however, nationally representative analyses are lacking. The Medical Monitoring Project reports nationally representative estimates of behavioral and clinical experiences of U.S. adults with diagnosed HIV infection. This analysis used Medical Monitoring Project data collected during 2015-2019 to examine ART adherence and reasons for missing ART doses among HIV-positive Hispanic/Latino MSM (1,673). On a three-item ART adherence scale with 100 being perfect adherence, 77.3% had a score of ≥85. Younger age, poverty, recent drug use, depression, and unmet needs for ancillary services were predictors of lower ART adherence. The most common reason for missing an ART dose was forgetting; 63.9% of persons who missed ≥1 dose reported more than one reason. Interventions that support ART adherence and access to ancillary services among Hispanic/Latino MSM might help improve clinical outcomes and reduce transmission.


Asunto(s)
Antirretrovirales/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/etnología , Accesibilidad a los Servicios de Salud , Hispanoamericanos/psicología , Homosexualidad Masculina/etnología , Cumplimiento de la Medicación/etnología , Adolescente , Adulto , Hispanoamericanos/estadística & datos numéricos , Homosexualidad Masculina/estadística & datos numéricos , Humanos , Masculino , Cumplimiento de la Medicación/estadística & datos numéricos , Persona de Mediana Edad , Factores Socioeconómicos , Estados Unidos , Adulto Joven
3.
Vasc Health Risk Manag ; 16: 299-305, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32764950

RESUMEN

Objective: The main aim of this study was to investigate predictive factors of adherence to the hypertension control therapeutic and lifestyle recommendations in a sample of Iranian patients based on the constructs of Pender's health promotion model. Patients and Methods: The cross-sectional study was performed on the 380 hypertensive patients who were referred to the health centers, the emergency and internal diseases departments of the Bagheralolom Hospital, and the cardiologists' offices in the city of Ahar, North West of Iran. Data were collected using a researcher designed questionnaire based on the Pender's health promotion model. The Pearson correlation test, multivariate linear regression, and independent t-test were used for data analysis. Results: Mean age of the recruited patients was 52.94 (SD=12.8). Perceived benefits, perceived barriers, situational influences, and interpersonal influences (adjusted R2= 0.525) explained 52.5% of the observed variation in adherence to hypertension control recommendations. Conclusion: Successful hypertension control in patients with chronic morbidity need to be based on sound data about major determinants of the relevant health/illness behaviors. The study findings revealed that the Pender's health promotion model could be applicable as a theoretical framework to identify major determinants of adherence to hypertension control recommendations. Future cross-cultural validation of the study findings in more representative and larger sample sizes could add to the legitimacy of the evidence surrounding self-care practices in hypertensive patients.


Asunto(s)
Antihipertensivos/uso terapéutico , Presión Sanguínea/efectos de los fármacos , Conocimientos, Actitudes y Práctica en Salud , Promoción de la Salud , Hipertensión/terapia , Cumplimiento de la Medicación , Modelos Teóricos , Conducta de Reducción del Riesgo , Adulto , Anciano , Antihipertensivos/efectos adversos , Estudios Transversales , Características Culturales , Femenino , Conocimientos, Actitudes y Práctica en Salud/etnología , Humanos , Hipertensión/etnología , Hipertensión/fisiopatología , Hipertensión/psicología , Irán/epidemiología , Masculino , Cumplimiento de la Medicación/etnología , Persona de Mediana Edad , Resultado del Tratamiento
4.
Artículo en Inglés | MEDLINE | ID: mdl-32748853

RESUMEN

Medication non-adherence is a concern in chronic disease management. Currently, there is no scale that characterizes sufficient non-adherent reasons for practical use in the Chinese population. This study developed and validated the Chinese version of the Medication Adherence Reasons Scale (ChMAR-Scale) and described non-adherence reasons in adult patients taking blood pressure medicine in Taiwan. A forward-backward procedure was used to translate the original MAR-Scale, and new items pertinent to cultural differences were added. Patients aged above 20 years old who were taking blood pressure medicine were recruited from a regional hospital and eight community pharmacies in the Taipei metropolitan area. Data analyses were conducted with IBM SPSS 19 (Armonk, NY, USA). Exploratory factor analysis revealed six domains, including belief, self-perception, forgetfulness, management, availability, and miscellaneous issues, with Cronbach's alphas ranging from 0.649 to 0.852, item-total correlations ranging from 0.362 to 0.719, and factor loadings ranging from 0.365 to 0.775. Criterion-related validity with the visual analog scale and two global items were 0.525, 0.436, and 0.502. Forgetfulness, belief issues, and self-perception issues were the most common non-adherence reasons. In conclusion, the ChMAR-Scale showed good psychometric properties and identified more reasons for medication non-adherence than other existing scales. Healthcare providers should be vigilant of these problems while consulting patients.


Asunto(s)
Cumplimiento de la Medicación/etnología , Encuestas y Cuestionarios/normas , Adulto , Análisis Factorial , Humanos , Masculino , Cumplimiento de la Medicación/psicología , Persona de Mediana Edad , Psicometría , Reproducibilidad de los Resultados , Taiwán
5.
AIDS Patient Care STDS ; 34(8): 344-355, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32757979

RESUMEN

Antiretroviral therapy (ART) adherence is vital for optimal HIV treatment. However, there is limited ART adherence research on the US Latinx population, who are at increased risk for HIV infection and worse HIV health outcomes. This study examined electronically measured ART adherence (Medication Event Monitoring System) and its association with demographic, clinical, neurocognitive, and sociocultural variables in Latinx and non-Latinx white (NLW) persons living with HIV [PLWH (N = 128)]. Latinx participants demonstrated worse adherence than NLW participants (p = 0.04). Linear regressions revealed different predictors of adherence. Among Latinx participants, recent cocaine use, stress, and, unexpectedly, higher US acculturation predicted worse adherence (ps < 0.05). Among NLW participants, recent cocaine use predicted worse adherence (p < 0.05). Intergroup comparisons within the Latinx group were not conducted due to subsample size. Thus, ethnicity, sociocultural variables, and cocaine use are important considerations for ART adherence, and poor ART adherence may be one pathway explaining worse outcomes in Latinx PLWH. Culturally tailored adherence interventions incorporating substance use treatment, acculturation, and stress management are warranted to improve health outcomes.


Asunto(s)
Antirretrovirales/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Disparidades en Atención de Salud/etnología , Hispanoamericanos/psicología , Cumplimiento de la Medicación/etnología , Trastornos Relacionados con Sustancias/complicaciones , Aculturación , Adulto , Grupo de Ascendencia Continental Europea/psicología , Femenino , Infecciones por VIH/psicología , Humanos , Masculino , Cumplimiento de la Medicación/estadística & datos numéricos , Factores Socioeconómicos , Estrés Psicológico , Trastornos Relacionados con Sustancias/epidemiología
6.
Rev Assoc Med Bras (1992) ; 66(3): 290-295, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32520147

RESUMEN

The objective of this study was to verify the level of adherence to antiretroviral treatment and its associated factors. This is a descriptive cross-sectional study based on data retrieved from medical records. To achieve this, we used a questionnaire composed of sociodemographic and clinical information recorded from patients aged between thirteen and fifty-nine years who attended a specialized service from 2007 to 2014. The chi-square test was performed to verify the association of the outcome with the categorical variables. Continuous variables were compared through the Student t-test. Thirteen variables were analyzed in the bivariate model, resulting in the selection of the following variables to the multivariate model (p<0.20) age of discovery (p=0.12), age (p=0.14), skin color (p=0.12), level of education (p=0.03), time since HIV diagnosis (p<0.001) and AIDS case (p<0.001). Among the six variables selected for the multivariate model, cases of aids (p<0.001) remained significant. We concluded that having aids decreases the probability of non-adherence to antiretroviral treatment by 92%. These results indicate that symptomatic patients have better adherence to therapy.


Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Terapia Antirretroviral Altamente Activa/estadística & datos numéricos , Infecciones por VIH/tratamiento farmacológico , Cumplimiento de la Medicación/estadística & datos numéricos , Adolescente , Adulto , Brasil , Estudios Transversales , Femenino , Humanos , Masculino , Cumplimiento de la Medicación/etnología , Persona de Mediana Edad , Cooperación del Paciente , Factores de Riesgo , Factores Socioeconómicos , Encuestas y Cuestionarios , Adulto Joven
7.
Arch Cardiovasc Dis ; 113(6-7): 433-442, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32434710

RESUMEN

BACKGROUND: Sub-Saharan Africa is experiencing a rising burden of hypertension. Antihypertensive medications and diet are the cornerstone of effective hypertension control. AIMS: To assess adherence to medication and salt restriction in 12 sub-Saharan countries, and to study the relationship between adherence and blood pressure control in patients with hypertension. METHODS: We conducted a cross-sectional survey in urban clinics in twelve sub-Saharan countries. Data were collected on demographics, treatment and adequacy of blood pressure control in patients with hypertension attending the clinics. Adherence was assessed by questionnaires completed by the patients. Hypertension grades were defined according to European Society of Cardiology guidelines. Association between adherence and blood pressure control was investigated using multilevel logistic regression analysis, adjusting for age, sex and country. RESULTS: Among the 2198 patients, 77.4% had uncontrolled blood pressure, 34.0% were poorly adherent to salt restriction, 64.4% were poorly adherent to medication and 24.6% were poorly adherent to both. Poor adherence to salt restriction (odds ratio [OR] 1.33, 95% confidence interval [CI] 1.03-1.72), medication (OR 1.56, 95% CI 1.25-1.93) or both (OR 1.91 1.39-2.66) was related to uncontrolled blood pressure. Moreover, poor adherence to both medication and salt restriction was related to a 1.52-fold (95% CI 1.04-2.22), 1.8-fold (95% CI 1.22-2.65) and 3.08-fold (95% CI 2.02-4.69) increased likelihood of hypertension grade 1, 2 and 3, respectively. CONCLUSIONS: High levels of poor adherence to salt restriction and medication were noted in this urban sub-Saharan study; both were significantly associated with uncontrolled blood pressure, representing major opportunities for intervention to improve hypertension control in sub-Saharan Africa.


Asunto(s)
Antihipertensivos/uso terapéutico , Presión Sanguínea/efectos de los fármacos , Dieta Hiposódica , Hipertensión/terapia , Cumplimiento de la Medicación/etnología , Conducta de Reducción del Riesgo , África del Sur del Sahara/epidemiología , Grupo de Ascendencia Continental Africana , Anciano , Estudios Transversales , Dieta Hiposódica/etnología , Femenino , Encuestas de Atención de la Salud , Conocimientos, Actitudes y Práctica en Salud/etnología , Humanos , Hipertensión/diagnóstico , Hipertensión/etnología , Hipertensión/fisiopatología , Masculino , Persona de Mediana Edad , Factores de Riesgo , Resultado del Tratamiento
8.
Womens Health Issues ; 30(3): 191-199, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32340896

RESUMEN

BACKGROUND: Diabetes is increasingly prevalent among women of reproductive age, yet little is known about quality of diabetes care for this population at increased risk of diabetes complications and poor maternal and infant health outcomes. Previous studies have identified racial/ethnic disparities in diabetes care, but patterns among women of reproductive age have not been examined. METHODS: This retrospective cohort study analyzed 2016 data from Kaiser Permanente Northern California, a large integrated delivery system. Outcomes were quality of diabetes care measures-glycemic testing, glycemic control, and medication adherence-among women ages 18 to 44 with type 1 or type 2 diabetes (N = 9,923). Poisson regression was used to estimate the association between patient race/ethnicity and each outcome, adjusting for other patient characteristics and health care use. RESULTS: In this cohort, 83% of participants had type 2 diabetes; 31% and 36% of women with type 2 and type 1 diabetes, respectively, had poor glycemic control (hemoglobin A1c of ≥9%), and approximately one-third of women with type 2 diabetes exhibited nonadherence to diabetes medications. Compared with non-Hispanic White women with type 2 diabetes, non-Hispanic Black women (adjusted risk ratio, 1.2; 95% confidence interval, 1.1-1.3) and Hispanic women (adjusted risk ratio, 1.2; 95% confidence interval, 1.1-1.3) were more likely to have poor control. Findings among women with type 1 diabetes were similar. CONCLUSIONS: Our findings indicate opportunities to decrease disparities and improve quality of diabetes care for reproductive-aged women. Elucidating the contributing factors to poor glycemic control and medication adherence in this population, particularly among Black, Hispanic, and Asian women, should be a high research and practice priority.


Asunto(s)
Prestación Integrada de Atención de Salud/normas , Diabetes Mellitus Tipo 1/etnología , Diabetes Mellitus Tipo 2/etnología , Disparidades en Atención de Salud/estadística & datos numéricos , Calidad de la Atención de Salud , Adolescente , Adulto , Afroamericanos/estadística & datos numéricos , Grupo de Ascendencia Continental Asiática/estadística & datos numéricos , Glucemia , Estudios de Cohortes , Grupos Étnicos/estadística & datos numéricos , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Femenino , Hemoglobina A Glucada , Hispanoamericanos/estadística & datos numéricos , Humanos , Cumplimiento de la Medicación/etnología , Prevalencia , Estudios Retrospectivos , Riesgo , Estados Unidos , Adulto Joven
9.
Am J Clin Oncol ; 43(7): 504-509, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-32251120

RESUMEN

OBJECTIVES: African American (AA) women with breast cancer (BrCA) have higher mortality than any other race. Differential mortality has been attributed to nonadherence to endocrine therapy (ET). ET can lower the risk of dying by one third; yet 50% to 75% of all women are nonadherent to ET. Despite the wealth of research examining adherence to ET, understanding which groups of women at risk for poor adherence is not well established. The aim of this investigation was to describe ET adherence by race and geographic location among a cohort of younger BrCA survivors. MATERIALS AND METHODS: Cancer registry records were linked to administrative data from Medicaid and a private insurance plan in South Carolina. Inclusion criteria included: European American (EA) or AA race, 3 years of continuous enrollment in the insurance plan after diagnosis, and BrCA diagnosis between 2002 and 2010. Adherence was measured by computing a medication possession ratio (MPR) based upon refill service dates and the number of pills dispensed. Adjusted least squared means were calculated by racial and geographic group using analysis of covariance methods. RESULTS: The average MPR for EA women was significantly higher at 96% compared with 92% for AA women (P<0.01). After adjustment for years on hormone therapy, age, and number of pharmacies utilized, rural AA women had an average MPR of 90% compared with 95% for EA women (P<0.01). CONCLUSIONS: AA women residing in rural areas demonstrate significantly lower adherence compared with their EA counterparts. Interventions are needed to improve adherence that may ameliorate AA mortality disparities.


Asunto(s)
Antineoplásicos Hormonales/uso terapéutico , Neoplasias de la Mama/tratamiento farmacológico , Supervivientes de Cáncer/estadística & datos numéricos , Cumplimiento de la Medicación/etnología , Afroamericanos , Estudios de Cohortes , Grupo de Ascendencia Continental Europea , Femenino , Humanos , Persona de Mediana Edad , Estudios Retrospectivos , South Carolina
10.
Nurs Res ; 69(3): 197-209, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31972851

RESUMEN

BACKGROUND: Maintaining adherence to antiretroviral therapy (ART) is a significant challenge for human immunodeficiency virus (HIV)-infected racial and ethnic minority adolescents and young adults (youth). Given the consequences of suboptimal ART adherence, there is a pressing need for an expanded understanding of adherence behavior in this cohort. OBJECTIVES: As part of an exploratory sequential, mixed-methods study, we used qualitative inquiry to explore adherence information, motivation, and behavioral skills among HIV-infected racial and ethnic minority youth. Our secondary aim was to gain an understanding of the contextual factors surrounding adherence behavior. METHODS: The information-motivation-behavioral skills model (IMB model) was applied to identify the conceptual determinants of adherence behavior in our target population, along with attention to emergent themes. In-depth, individual, semistructured interviews, including open-ended questions with probes, were conducted with a convenience sample of HIV-infected racial and ethnic minority youth (ages 16-29 years), receiving ART and with evidence of virologic failure (i.e., detectable HIV viral load). New participants were interviewed until information redundancy was reached. Qualitative interviews were digitally recorded, transcribed verbatim, and analyzed using Atlas.ti (v8). Directed content analysis was performed to generate categories and broad themes. Coding was initially conceptually driven (IMB model) and shifted to a data-driven approach, allowing for the discovery of key contextual factors that influence adherence behavior in this population. Methodological rigor was ensured by member checks, an audit trail, thick descriptive data, and triangulation of data sources. RESULTS: Twenty racial and ethnic minority participants (mean age = 24.3 years, 55.0% male) completed interviews. We found adherence information was understood in relation to HIV biomarkers; adherence motivation and behavioral skills were influenced by stigma and social context. We identified five primary themes regarding ART self-management: (a) emerging adulthood with a chronic illness, (b) stigma and disclosure concerns, (c) support systems and support deficits, (d) mental and behavioral health risks and challenges, and (e) mode of HIV transmission and perceptions of power and control. DISCUSSION: Key constructs of the IMB model were applicable to participating HIV-infected youth yet did not fully explain the essence of adherence behavior. As such, we recommend expansion of current adherence models and frameworks to include known contextual factors associated with ART self-management among HIV-infected racial and ethnic minority youth.


Asunto(s)
Antirretrovirales/uso terapéutico , Grupos Étnicos/psicología , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/etnología , Cumplimiento de la Medicación/etnología , Grupos Minoritarios/psicología , Automanejo/psicología , Adolescente , Adulto , Grupos Étnicos/estadística & datos numéricos , Femenino , Infecciones por VIH/psicología , Conocimientos, Actitudes y Práctica en Salud/etnología , Humanos , Masculino , Grupos Minoritarios/estadística & datos numéricos , Modelos Psicológicos , Motivación , Investigación Cualitativa , Estigma Social , Adulto Joven
11.
Postgrad Med ; 132(2): 132-140, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31900018

RESUMEN

Aims: Prevention and control of hypertension can be achieved by improving patient adherence to long-term treatment regimens. Non-adherence is an obstacle to chronic disease management. We studied the impact of value reference point and risk preference on patient adherence and influencing factors from the perspective of behavioral economics so as to offer targeted recommendations to improving patient adherence in low-income areas.Methods: A representative impoverished area, Qianjiang District in Chongqing was selected as the sample district. A cross-sectional survey using questionnaire augmented with an interview was conducted to collect information with 321 patients previously diagnosed with hypertension stage 3. Preference experiments conducted through scenario simulation were used to elicit and measure patients' value and risk preferences. We constructed a structural equation model to verify the impact of value reference points and risk preference on adherence behavior decision-making. Logistic regression models were constructed to analyze other factors that may influence adherence.Results: Adherence was determined by patients' value reference points (path coefficient = 0.876, p < 0.01) and risk preference (path coefficient = 0.715, p < 0.01). The factor loadings of all indicators on the latent variables were significant (p < 0.01). Hypertensive patients in our cohort adhered poorly to health management and were heavily influenced by knowledge of hypertension, expectation, health literacy and opportunity costs. Certainty effect, overconfidence and optimism significantly affected patients' risk preference in decision-making progress. In the face of the uncertain benefits of adherence, patients preferred to delay treatment until condition affected their quality of life, resulting in poor adherence. Satisfaction with current services and relationship with physicians, as well as type of drugs also influenced adherence.Conclusions: Adherence may be improved by changing patients' value reference points and perceptions through health education and better health service resources. One of the key to increasing adherence is through identifying and eliminating bias.


Asunto(s)
Antihipertensivos/uso terapéutico , Conocimientos, Actitudes y Práctica en Salud , Hipertensión/tratamiento farmacológico , Cumplimiento de la Medicación/etnología , Pobreza , Adulto , Factores de Edad , Anciano , Antihipertensivos/administración & dosificación , Antihipertensivos/economía , China , Enfermedad Crónica , Estudios Transversales , Economía del Comportamiento , Femenino , Humanos , Hipertensión/economía , Masculino , Persona de Mediana Edad , Prioridad del Paciente , Satisfacción del Paciente , Calidad de Vida , Factores de Riesgo , Automanejo , Índice de Severidad de la Enfermedad , Factores Sexuales , Factores Socioeconómicos
12.
PLoS One ; 15(1): e0227326, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31923264

RESUMEN

BACKGROUND: Illness perceptions may vary between different populations. This raises the question as to whether refugees and migrants of the same ethnic background have different perceptions. Understanding differences may have a significant impact on enhancing medication adherence in these groups. OBJECTIVE: The study examined the associations and differences between illness perceptions, and medication adherence in hypertensive Middle Eastern migrants and refugees. METHODS: Middle Eastern refugees and migrants (≥30 years old), with hypertension were recruited from Arabic community groups in Australia and asked to complete a cross-sectional survey. The survey consisted of basic socio-demographic and clinical profile, self-reported illness perceptions, and self-reported medication adherence. The outcome measure was the Medication Adherence Questionnaire. Simple mediation modelling was applied to examine the role of illness perceptions as a mediator between different migration statuses, and medication adherence. RESULTS: A total of 320 participants were recruited; 168 refugees, and 152 migrants. Educational level was found to be positively significantly associated with medication adherence in refugees, p = 0.003, while employed migrants were more likely to report higher adherence to hypertensive medication, p = 0.005. In both groups, there was a significant association between illness perceptions and medication adherence p = 0.0001. Significant differences were found between both groups regarding adherence and illness perceptions variables. Refugees had more negative illness perceptions and were less adherent than migrants. Illness perception was a mediator in the relationship between migration status and medication adherence; the unstandardized indirect effect was 0.24, and the 95% confidence interval ranged from (0.21-0.36). CONCLUSIONS: To achieve better adherence to medications in vulnerable populations such as refugees, illness perceptions need to be understood, and differentiated from other populations, such as migrants from similar backgrounds. Patients' education about illnesses and medications should be specific and targeted to each population. Interventional studies are recommended to modify refugees' and migrants' illness perceptions, to enhance medication adherence and wellbeing.


Asunto(s)
Cumplimiento de la Medicación/etnología , Percepción , Refugiados/psicología , Migrantes/psicología , Adulto , Árabes/psicología , Australia/epidemiología , Estudios Transversales , Humanos , Hipertensión/tratamiento farmacológico , Hipertensión/psicología , Cumplimiento de la Medicación/psicología , Persona de Mediana Edad , Refugiados/educación , Encuestas y Cuestionarios , Migrantes/educación
14.
Prog Cardiovasc Dis ; 63(1): 40-45, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31863786

RESUMEN

While there have been significant advances made towards controlling cardiovascular disease (CVD) morbidity and mortality in recent decades, African- Americans continue to experience a markedly elevated burden of CVD. Multiple factors have contributed to this major public health crisis, including medication adherence, racial inequities in diagnosis and treatment, lack of culturally competent care, and disparities in healthcare access. Historical approaches to reduce this burden are targeted towards community outreach by recruiting community partners and healthcare providers to disseminate health information on CVD awareness and prevention. Current community-based approaches, such as the barbershop and faith-based programs, have built upon previous approaches and incorporated novel ideas to increase community engagement in risk factor and disease reduction. Based on these models, future directions point to an increased usage of community partners, alongside health information technology and healthy behavior patient education, to reduce risk factors and prevalence of CVD in an ethnically vulnerable community.


Asunto(s)
Afroamericanos , Antihipertensivos/uso terapéutico , Presión Sanguínea/efectos de los fármacos , Relaciones Comunidad-Institución , Asistencia Sanitaria Culturalmente Competente/etnología , Hipertensión/etnología , Hipertensión/terapia , Salud Pública , Conducta de Reducción del Riesgo , Afroamericanos/psicología , Conocimientos, Actitudes y Práctica en Salud/etnología , Disparidades en el Estado de Salud , Disparidades en Atención de Salud , Humanos , Hipertensión/diagnóstico , Hipertensión/fisiopatología , Cumplimiento de la Medicación/etnología , Factores de Riesgo , Determinantes Sociales de la Salud/etnología , Resultado del Tratamiento
15.
Prog Cardiovasc Dis ; 63(1): 33-39, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31825799

RESUMEN

Uncontrolled hypertension (HTN) in the U.S. is particularly prevalent and devastating among black individuals, who disproportionately suffer the consequences of this condition to a greater extent compared with persons in other racial/ethnic groups. Furthermore, African Americans are often underrepresented in cardiovascular clinical trials, limiting the ability to reliably apply the results from many outcome studies in this specific population. In this review, we summarize and analyze the currently available evidence, specifically related to the risk factors, manifestations, complications and management of HTN in this often difficult-to-treat population. The aim of the review is to improve understanding of the underlying pathophysiologic mechanisms and identify the optimal approach to deliver the best care for African American patients.


Asunto(s)
Afroamericanos , Antihipertensivos/uso terapéutico , Presión Sanguínea/efectos de los fármacos , Hipertensión/etnología , Hipertensión/terapia , Conducta de Reducción del Riesgo , Afroamericanos/psicología , Comorbilidad , Asistencia Sanitaria Culturalmente Competente , Conocimientos, Actitudes y Práctica en Salud/etnología , Disparidades en el Estado de Salud , Disparidades en Atención de Salud , Humanos , Hipertensión/diagnóstico , Hipertensión/fisiopatología , Cumplimiento de la Medicación/etnología , Factores de Riesgo , Resultado del Tratamiento , Estados Unidos/epidemiología
16.
Anthropol Med ; 27(1): 1-16, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31385715

RESUMEN

During the 2013-2016 West African Ebola epidemic, medical emergency response teams negotiated a context marked by public hysteria and fear to prevent the spread of the virus and treat those already infected. However, the presence and work of Ebola response teams added to suspicions provoked by the rapid increase in numbers of dead and dying and by locally unintelligible emergency measures. Based on data collected from 40 young adult 'survivors' between 16 and 29 years of age who were hospitalized for Ebola during the epidemic, this article examines how pharmaceutical treatments were accepted (or not) by patients in ebola treatment units (ETU). Three key questions guide this analysis: (1) Did hospitalized individuals adhere with or refuse treatments offered at ETUs? (2) Did their attitudes change over the course of their hospitalization? (3) Which factors influenced refusal of treatment or compliance? To the authors' knowledge, no previous studies have explored the resistance of hospitalized patients to treatment in Ebola centers. This article, in addition to exploring patients' practices and related perceptions of treatment with evolving meanings in this outbreak crisis situation, also presents practical recommendations for future Ebola interventions as well as theoretical knowledge about the circulation and transformation of socially constructed representations of medications.


Asunto(s)
Fiebre Hemorrágica Ebola , Cumplimiento de la Medicación , Adolescente , Adulto , Antropología Médica , Antivirales/administración & dosificación , Antivirales/uso terapéutico , Epidemias , Guinea/etnología , Fiebre Hemorrágica Ebola/tratamiento farmacológico , Fiebre Hemorrágica Ebola/etnología , Fiebre Hemorrágica Ebola/psicología , Humanos , Cumplimiento de la Medicación/etnología , Cumplimiento de la Medicación/psicología , Opinión Pública , Adulto Joven
17.
AIDS Care ; 32(2): 249-254, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31159584

RESUMEN

The HPTN 067/ADAPT Study evaluated the feasibility, acceptability, patterns of adherence and coverage for three randomly assigned oral FTC/TDF pre-exposure prophylaxis (PrEP) dosing regimens to prevent HIV infection. Using qualitative methods, we explored facilitators and barriers among a subset of men who have sex with men (MSM) participants in Bangkok, Thailand. Between August 2013 and March 2014, 32 HPTN 067/ADAPT participants joined in 6 focus group discussions, and 6 attended key informant interviews. Facilitators of PrEP adherence included use of strategies to have PrEP available when needed, simplicity in regimen requirements with recognition that more complex regimens may take some time to master, ability to plan for sex, receipt of social and technology support, ability to use a PrEP regimen that best matches to one's own patterns of sex, and experiences with PrEP as a part of health and well-being. Challenges to PrEP adherence included perceptions of no or low HIV risk, difficulties following regimens when intoxicated, concerns about side effects, experience of HIV stigma, and affordability of PrEP outside of study context influencing uptake and use in the community. Preferences for regimens varied, suggesting that multiple PrEP effective regimen options should be available to fit those with different needs.


Asunto(s)
Fármacos Anti-VIH/administración & dosificación , Infecciones por VIH/prevención & control , Homosexualidad Masculina/psicología , Cumplimiento de la Medicación/psicología , Profilaxis Pre-Exposición/métodos , Estigma Social , Apoyo Social , Adulto , Alcoholismo/complicaciones , Grupos Focales , Infecciones por VIH/etnología , Infecciones por VIH/psicología , Homosexualidad Masculina/etnología , Humanos , Masculino , Cumplimiento de la Medicación/etnología , Persona de Mediana Edad , Investigación Cualitativa , Tailandia/epidemiología
18.
AIDS Behav ; 23(9): 2514-2521, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31520239

RESUMEN

To inform the development of interventions to increase uptake and adherence to antiretroviral therapy (ART), we explored perceptions of ART in semi-structured interviews with 52 men and women from UK black African and black Caribbean communities. Verbatim transcripts were analyzed using framework analysis. Perceptions of ART could be grouped into two categories: doubts about the personal necessity for ART and concerns about potential adverse effects. Doubts about necessity stemmed from feeling well, doubts about the efficacy of ART, religious beliefs and the belief that treatment was futile because it could not cure HIV. Concerns about adverse effects included the fear that attending HIV services and taking treatment would lead to disclosure of HIV, feeling overwhelmed at the prospect of starting treatment soon after diagnosis, fears about side effects and potential long-term effects, and physical repulsion. The findings will facilitate the development of interventions to increase uptake and adherence to ART.


Asunto(s)
Grupo de Ascendencia Continental Africana/psicología , Miedo , Infecciones por VIH/tratamiento farmacológico , Cumplimiento de la Medicación/psicología , Adulto , África del Sur del Sahara/etnología , Grupo de Ascendencia Continental Africana/etnología , Región del Caribe/etnología , Estudios Transversales , Revelación , Femenino , Infecciones por VIH/psicología , Humanos , Entrevistas como Asunto , Masculino , Cumplimiento de la Medicación/etnología , Persona de Mediana Edad , Percepción , Investigación Cualitativa , Religión , Estigma Social , Reino Unido/epidemiología
19.
AIDS Behav ; 23(9): 2610-2617, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31377894

RESUMEN

Adherence to antiretroviral therapy (ART) during pregnancy and the postpartum period is necessary to prevent vertical HIV transmission and to secure the long-term health of an HIV-infected woman. Health behavior theory suggests that patients' attitudes towards medication can predict their medication-taking behaviour. This study sought to understand how women's attitudes towards ART changes between the pregnancy and postpartum periods, and the factors associated with these attitudes. The study enrolled 200 pregnant women living with HIV. Structured surveys were administered during pregnancy and at three and 6 months postpartum. Overall, attitudes towards ART were stable over time. More positive attitudes towards ART were associated with HIV acceptance, lower levels of depression, and lower levels of shame. Counselling interventions are needed to help HIV-infected women accept their status and reduce shameful emotions. Depression screening and treatment should be integrated into PMTCT services. This study emphasizes the importance of early attention to attitudes towards ART, in order to establish a trajectory of sustained care engagement.


Asunto(s)
Antirretrovirales/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/psicología , Conductas Relacionadas con la Salud , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Cumplimiento de la Medicación/psicología , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Mujeres Embarazadas/psicología , Adulto , Consejo , Femenino , Infecciones por VIH/etnología , Conductas Relacionadas con la Salud/etnología , Humanos , Estudios Longitudinales , Cumplimiento de la Medicación/etnología , Cumplimiento de la Medicación/estadística & datos numéricos , Periodo Posparto/psicología , Embarazo , Mujeres Embarazadas/etnología , Tanzanía/epidemiología , Adulto Joven
20.
Sex Reprod Healthc ; 22: 100459, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31442747

RESUMEN

BACKGROUND: Anti-retroviral therapy has led to a significant reduction in morbidity and mortality related to HIV/AIDS. However, this cannot be fully realized without addressing the barriers related to retention in care and medication adherence. METHODS: A cross-sectional study design was implemented to select 293 pregnant women on option B+ anti-retroviral treatment (ART). The collected data was cleaned and entered into Epidata version 3.1 and exported to SPSS Version 21 for analysis. Multiple logistic regression models were used to indicate the association between variables. RESULTS: The overall drug adherence of pregnant women on ART medications was 82.6%. The study showed that participants educational status, AOR 4.54(95% CI; 1.72-11.95), participants status disclosure 2.61(95% CI; 1.01-6.71), social and financial support to the participants AOR 2.76(95% CI; 1.17-6.51), counseling on the benefit AOR 2.9(95% CI; 1.27-6.63), were all positive and significantly associated with adherence to option B + treatment, while experience of drug side effect AOR 0.24(95% CI; 0.1-0.6), and fear of stigma and discrimination AOR 15.79(95% CI; 4.64-53.67), were negatively associated with adherence to option B+ treatment. CONCLUSION: Educational status, counseling on the health benefit of treatment for the fetus and the mothers, social and financial support favors adherence while fear of stigma and discrimination and drug side effects negatively affect adherence to option B+. The study calls for collaborative work among patients, healthcare professionals, and the public to enhance ART adherence.


Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/prevención & control , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Cumplimiento de la Medicación/estadística & datos numéricos , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Mujeres Embarazadas/psicología , Adolescente , Adulto , Consejo , Estudios Transversales , Etiopía/epidemiología , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/transmisión , Seropositividad para VIH/epidemiología , Humanos , Cumplimiento de la Medicación/etnología , Madres/psicología , Embarazo , Encuestas y Cuestionarios , Adulto Joven
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