Measuring empowerment among people living with HIV: a systematic review of available measures and their properties.

A systematic review was conducted to identify and appraise measures of empowerment used in peer-reviewed research with people living with HIV. Thirty articles reporting on 12 scales were identified via keyword and citation searches of electronic databases and hand searching of reference lists. The instruments captured a wide range of constructs, including self-efficacy, perceived knowledge/information seeking, self-management behaviours, belief in an active patient role and tolerance of uncertainty. While the majority of instruments were focused exclusively on self-efficacy to manage HIV, the Patient Activation Measure (PAM-13 and PAM-22) and the Health Empowerment Inventory were broader in scope. Most of the identified measures had acceptable construct validity, however there were insufficient data to determine the reliability or responsiveness of many of the scales. The findings highlight the need for a more concrete definition of empowerment and for further validation of existing measures with people living with HIV.

Measuring quality of life among people living with HIV: a systematic review of reviews.

AIM: A systematic review of reviews was conducted to identify and appraise brief measures of health-related quality of life (HRQoL) that have been used in peer-reviewed research with people living with HIV. METHODS: The review was conducted in two stages: 1) search of electronic databases to identify systematic reviews of tools used to measure HRQoL in adults living with HIV, published since the year 2000; 2) selection of HRQol scales from those identified in the reviews. Inclusion criteria included scales that could be self-administered in 10 min or less, covering at least 3 domains of quality of life (physical function, social/role function and mental/emotional function). For generic scales, inclusion criteria included the availability of normative data while for HIV-specific scales, patient input into the development of the scale was required. RESULTS: Ten reviews met the inclusion criteria. Nine generic scales met the inclusion criteria: the EuroQol five dimensions questionnaire (EQ-5D); Health Utilities Index; McGill Quality of Life questionnaire; Medical Outcomes Study (MOS) Short Form (SF)-12; SF-36; World Health Organisation Quality of Life (WHOQOL- BREF), Questions of Life Satisfaction (FLZM) and SF-20. Available psychometric data supported the EQ-5D and SF-36. Seven HIV-specific scales met the inclusion criteria: the AIDS Clinical Trials Group (ACTG)-21; HIV-QL-31; MOS-HIV; Multidimensional Quality of Life Questionnaire for Persons with HIV/AIDS (MQOL-HIV), PROQOL-HIV, Symptom Quality of Life Adherence (HIV-SQUAD) and the WHOQOL-HIV BREF. Of the HIV -specific measures, the MOS-HIV was considered to have the most well-established psychometric properties, however limitations identified in the reviews included insufficient input from people living with HIV in the development of the scale, cross-cultural relevance and continued applicability. Two relatively new measures, the WHOQOL-HIV BREF and PROQOL-HIV, were considered to have promising psychometric properties and may have more relevance to people living with HIV. CONCLUSION: The findings highlight the need for further validation of HRQoL measures in people living with HIV. The choice of one measure over another is likely to be influenced by the purpose of the quality of life assessment and the domains of HRQoL that are most relevant to the specific research or clinical question.

mHealth Interventions To Support Self-Management In HIV: A Systematic Review.

BACKGROUND: Self-management is an important aspect of long-term HIV treatment. Mobile technologies offer the potential to efficiently deliver interventions to facilitate HIV self-management. The last comprehensive review of such mHealth interventions was conducted in 2011. Given the rapidly evolving field, a need was identified for an updated review of the literature. OBJECTIVE: The study aimed to describe and evaluate current evidence-based mHealth interventions to support self-management in HIV. METHOD: Eight online databases (Medline, Scopus, Embase, PsycINFO, Cochrane, Global Health CAB, IEEE explore, Web of Science) were systematically searched for papers describing and evaluating mHealth HIV self-management interventions. Reference lists of relevant papers were also searched. Data on intervention content and evaluation methodology were extracted and appraised by two researchers. RESULTS: 41 papers were identified evaluating 28 interventions. The majority of these interventions (n=20, 71%) had a single focus of either improving adherence (n=16), increasing engagement in care (n=3) or supporting smoking cessation (n=1), while just 8 (29%) were more complex self-management interventions, targeting a range of health-related behaviours. Interventions were predominantly delivered through SMS messaging. They significantly impacted on a range of outcomes including adherence, viral load, mental health and social support. CONCLUSION: Since the last major review of mHealth interventions in HIV, there has been a shift from exploratory acceptability/feasibility studies to impact evaluations. While overall the interventions impacted on a range of outcomes, they were generally limited in scope, failing to encompass many functions identified as desirable by people living with HIV. Participant incentives may limit the generalizability of findings.

Innovations in Practice: Grow2Grow - engaging hard-to-reach adolescents through combined mental health and vocational support outside the clinic setting.

BACKGROUND: Based on an organic farm and education centre, Grow2Grow offers young people with complex mental health needs both clinical mental health support and vocational opportunities. METHODS: Change in functioning (CGAS), vocational outcomes and client satisfaction were assessed for all young people completing Grow2Grow placements between June 2010 and July 2014. RESULTS: Twenty-one young people completed Grow2Grow placements, achieving increased CGAS scores (p < .001) and reporting high levels of satisfaction with the project. Eighty-one per cent achieved educational and/or employment outcomes. CONCLUSION: This innovative approach to working with hard-to-reach young people is achieving high levels of engagement and positive vocational and mental health outcomes.

The effectiveness of antenatal interventions to prevent postnatal depression in high-risk women.

BACKGROUND: Postnatal depression can have a major impact on the lives of women affected and on those around them. While effective treatments are available, it would be preferable to prevent the condition. The aim of this review was to examine the effectiveness of antenatal interventions designed to prevent postnatal depression in high-risk women. METHODS: Randomised controlled trials of interventions to prevent postnatal depression delivered to high-risk women in pregnancy were identified through an electronic database search and a reference list search. Information regarding the selection criteria, content and delivery of the interventions was extracted and synthesised. RESULTS: Eleven studies met the review inclusion criteria. Six described interventions that were significantly more effective in reducing the incidence and/or symptoms of postnatal depression than a control condition. Interventions were most likely to be effective when delivered to women who were depressed during pregnancy and when incorporating evidence-based psychological treatments for depression and addressing interpersonal difficulties. LIMITATIONS: It is possible that unpublished trials of antenatal interventions to prevent postnatal depression exist that were not detected. Due to the recognised publication bias, these studies may have been less likely to find a significant effect of antenatal interventions on postnatal depression. CONCLUSIONS: There is evidence to suggest that interventions delivered in pregnancy can be effective in preventing postnatal depression. However, these interventions may be better conceptualised as treatment than prevention as they were delivered to women experiencing antenatal depression. There is a need to identify pregnant women experiencing depression and deliver evidence-based psychological interventions.

Development and validation of the Medication-Related Consultation Framework (MRCF).

OBJECTIVES: To develop and test a framework for evaluating the consultation skills of practitioners undertaking medication-related consultations. METHODS: Key components of medication-related consultations were identified through a literature review and compiled to form an initial consultation skills framework. This was iteratively refined through consultation with experts (n=21) to form the Medication-Related Consultation Framework (MRCF). Psychometric testing was undertaken by analyzing pharmacists' (n=10) assessment of fifteen pre-recorded simulated consultations. RESULTS: The MRCF consisted of 46 consultation behaviors, grouped into five sections. Performance was rated at individual behavior, framework section and global consultation levels. The MRCF discriminated between good, satisfactory and poor consultations at the global rating level (p<0.01) with good test-retest reliability (rho=0.59-0.95) and moderate inter-assessor reliability (Kendall's W=0.67). There was also good internal consistency for the five sections (Cronbach's alphas=0.58-0.97). CONCLUSIONS: The MRCF demonstrated good psychometric properties at the global and section rating levels. Some inconsistencies in assessors' ratings of individual consultation behaviors were indentified, which may represent a future training need. PRACTICE IMPLICATIONS: The MRCF provides healthcare professionals with a patient-centered consultation structure, serving to identify medication-related needs and potentially support adherence. It also allows the quality of a practitioner's consultation to be evaluated.

High adherence and concordance within a clinical trial of antihypertensives.

OBJECTIVES: To explore hypertensive patients' beliefs about their condition and its treatment and their adherence within the context of a clinical trial. To assess the degree of concordance between patients' beliefs about hypertension and the medical model of the condition. METHODS: This was a questionnaire-based study, involving 230 patients participating in the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT), a randomized controlled trial comparing two pharmaceutical approaches to the management of hypertension. A comparison group of 106 hypertensive patients who were screened for ASCOT but did not meet the entry criteria was also recruited. Outcome measures were beliefs about hypertension and antihypertensive medication, and adherence to medication (self-report and tablet count). RESULTS: Adherence to medication was higher than anticipated, with 45% participants reporting complete adherence over the 18-month study and a further 40% only rare non-adherence. Patients' beliefs about their condition and treatment were generally concordant with the medical model of hypertension. High concordance was associated with high medication adherence (p<0.001). DISCUSSION: Clinical trial volunteers may have beliefs that are unusually concordant with the medical model of hypertension and may demonstrate atypically high adherence. This has implications for the transferability of trial findings to the general hypertensive population.

The value of self-report assessment of adherence, rhinitis and smoking in relation to asthma control.

AIMS: To explore the utility of self-report measures of inhaled corticosteroid (ICS) adherence, degree of rhinitis and smoking status and their association with asthma control. METHODS: Patients prescribed ICS for asthma at 85 UK practices were sent validated questionnaire measures of control (Asthma Control Questionnaire; ACQ) and adherence (Medication Adherence Report Scale), a two-item measure of smoking status, and a single-item measure of rhinitis. RESULTS: Complete anonymised questionnaires were available for 3916 participants. Poor asthma control (ACQ >1.5) was associated with reported rhinitis (OR = 4.62; 95% CI: 3.71-5.77), smoking (OR = 4.33; 95% CI: 3.58-5.23) and low adherence to ICS (OR = 1.35; 95% CI: 1.18-1.55). The degree of rhinitis was important, with those reporting severe rhinitis exhibiting the worst asthma control, followed by those reporting mild rhinitis and then those reporting no rhinitis symptoms (F(2, 3913)=128.7, p<.001). There was a relationship between the number of cigarettes smoked each day and asthma control (F(5,655)=6.08, p<.001). CONCLUSIONS: Poor asthma control is associated with self-reported rhinitis, smoking and low medication adherence. These potentially modifiable predictors of poor asthma control can be identified through a brief self-report questionnaire, used routinely as part of an asthma review.

The utility of the Necessity--Concerns Framework in explaining treatment non-adherence in four chronic illness groups in Italy.

OBJECTIVE: To translate the Beliefs about Medicines Questionnaire (BMQ) into Italian and explore the utility of the Necessity-Concerns Framework in explaining treatment non-adherence in four chronic illness groups in Italy. METHODS: 449 patients with chronic illness (depression, asthma, diabetes and cardiac disease) were approached at outpatient clinics in Turin and asked to complete Italian translations of the BMQ and the Medication Adherence Report Scale. RESULTS: 427 patients consented to participate in the study. The BMQ demonstrated good internal consistency, with Cronbach's alphas of 0.78 (Necessity subscale) and 0.72 (Concerns subscale). Participants were divided into four attitudinal groups based on their responses to the BMQ: 59% Accepting (high Necessity, low Concerns), 29% ambivalent (high Necessity, high Concerns), 8% Indifferent (low Necessity, low Concerns) and 4% Skeptical (low Necessity, high Concerns). Those in the Accepting group reported the highest adherence to medication and those in the Skeptical group the lowest (p50.01). DISCUSSION: The BMQ has been successfully translated and validated in Italian. This study provides support for the Necessity-Concerns Framework in explaining medication non-adherence in chronic illness. Interventions that address low perceived need for treatment and concerns about potential adverse effects of treatment are likely to facilitate optimal use of medicines.

Understanding medication non-adherence in bipolar disorders using a Necessity-Concerns Framework.

BACKGROUND: Medication non-adherence is a major problem in patients with severe mental disorders and is associated with poor clinical outcomes and high resource utilization. This study examined the utility of the Necessity-Concerns Framework for understanding patient attitudes towards and levels of adherence with medications prescribed for bipolar disorders. METHOD: A convenience sample of 223 individuals currently prescribed medication for bipolar disorders, recruited by advertisement in a Manic Depression Fellowship newsletter, completed the Beliefs about Medication Questionnaire and the Medication Adherence Report Scale. RESULTS: Low adherence was reported by 30% (n=64) and was predicted by greater doubts about personal need for treatment (OR=.50; 95% CI: .31-.82) and stronger concerns about potential negative effects (OR=2.00; 95% CI: 1.20-3.34). These predictors were independent of current mood state, illness and demographic characteristics. LIMITATIONS: Participants were a potentially biased sample of volunteers who had been recruited through a patient organisation newsletter. However, clinical characteristics and adherence rates in this study were similar to those reported in other studies conducted in Europe and the USA. CONCLUSIONS: The Necessity-Concerns Framework is a useful theoretical model for understanding key attitudes towards medication in bipolar disorders. Interventions to facilitate adherence should elicit and address patients' beliefs about medication.

A systematic review of the prevalence and determinants of nonadherence to phosphate binding medication in patients with end-stage renal disease.

BACKGROUND: Cardiovascular events are the leading cause of death in end stage renal disease (ESRD). Adherence to phosphate binding medication plays a vital role in reducing serum phosphorus and associated cardiovascular risk. This poses a challenge for patients as the regimen is often complex and there may be no noticeable impact of adherence on symptoms. There is a need to establish the level of nonadherence to phosphate binding medication in renal dialysis patients and identify the factors associated with it. METHODS: The online databases PsycINFO, Medline, Embase and CINAHL were searched for quantitative studies exploring predictors of nonadherence to phosphate binding medication in ESRD. Rates and predictors of nonadherence were extracted from the papers. RESULTS: Thirty four studies met the inclusion criteria. There was wide variation in reported rates of non-adherence (22-74% patients nonadherent, mean 51%). This can be partially attributed to differences in the way adherence has been defined and measured. Demographic and clinical predictors of nonadherence were most frequently assessed but only younger age was consistently associated with nonadherence. In contrast psychosocial variables (e.g. patients' beliefs about medication, social support, personality characteristics) were less frequently assessed but were more likely to be associated with nonadherence. CONCLUSION: Nonadherence to phosphate binding medication appears to be prevalent in ESRD. Several potentially modifiable psychosocial factors were identified as predictors of nonadherence. There is a need for further, high-quality research to explore these factors in more detail, with the aim of informing the design of an intervention to facilitate adherence.

Adherence to medication in bipolar disorder: a qualitative study exploring the role of patients' beliefs about the condition and its treatment.

OBJECTIVES: Patients' perceptions of illness and treatment have been found to predict adherence to medication in many chronic conditions. This has not yet been fully explored in bipolar disorder (BD). The aim was to use a qualitative methodology to explore in depth the beliefs about BD and its treatment that are associated with adherence to medication prescribed for BD. METHODS: Sixteen adults prescribed prophylactic treatment for BD completed semi-structured interviews about their perceptions of BD and its treatment and their adherence to medication. Interviews were recorded and transcribed verbatim. Two researchers identified perceptions associated with non-adherence in the transcripts. RESULTS: Thirteen participants (81%) reported some degree of intentional or unintentional medication non-adherence. Intentional non-adherence was associated with patients' concerns about the prescribed medication, arising from the experience of side effects, but also from beliefs that regular use could lead to adverse effects in the future. Intentional non-adherence was also associated with doubts about the personal need for medication, which were related to perceptions of BD (e.g., not accepting diagnosis, believing the condition is not controllable, believing it is not a chronic condition). CONCLUSIONS: This study has identified some of the salient beliefs about BD and its treatment that should be elicited and addressed in interventions to facilitate adherence to medication. Further quantitative work is justified to explore the utility of this approach in the development of interventions.

Patients' perceptions of information received about medication prescribed for bipolar disorder: implications for informed choice.

BACKGROUND: Previous research suggests that patients are dissatisfied with information provided about medication prescribed for mental illness, but has not identified which aspects of information provision are unsatisfactory. METHODS: 223 members of the Manic Depression Fellowship (MDF) completed the Satisfaction with Information about Medicines Scale (SIMS), a validated measure of patients' satisfaction with various aspects of information provision. RESULTS: Patients reported highest dissatisfaction with information about potential problems associated with medication; over 60% of participants reported dissatisfaction with information about the risks of side effects and whether the medication would affect their sex lives. Participants were significantly less satisfied with information about potential problems associated with their medication than people prescribed medication for HIV in a previously reported study (p<.01). Those reporting low adherence to medication had significantly lower satisfaction with information scores than those reporting high adherence (p<.05). LIMITATIONS: The sample could be prone to selection bias; participants were members of an organisation for people affected by bipolar disorder, whilst the comparator group was a NHS HIV clinic sample. Furthermore, the objective amount and type of information provided was not assessed, therefore the cause of patients' dissatisfaction is not known. CONCLUSIONS: Perceived satisfaction with information is low, particularly in relation to possible drug side-effects. Health practitioners need to elicit individuals' information requirements and tailor information to meet their needs, in order to facilitate informed choice and adherence to treatment. Moreover, they need to provide information in a manner appropriate for a patient's cognitive functioning at different illness phases.

The use and reporting of cluster analysis in health psychology: a review.

PURPOSE: Cluster analysis is a collection of relatively simple descriptive statistical techniques with potential value in health psychology, addressing both theoretical and practical problems. There are many methods of cluster analysis from which to choose, with no clear guidelines to aid researchers. In the absence of guidelines it is likely that methods already reported by published researchers will be adopted, and so clear reporting of statistical methodology, while always important, is particularly crucial with cluster analysis. The aim of this review is to describe and evaluate the reporting of cluster analysis in health psychology publications. METHODS: Electronic searches of 18 health psychology journals identified 59 articles using cluster analysis published between 1984 and 2002. Articles were submitted to systematic evaluation against published criteria for the reporting of cluster analysis. RESULTS: Just 27% of the papers reviewed met all five criteria, although 61% met at least four. Details of the similarity measure and the computer program used were most frequently omitted. Furthermore, while researchers usually reported the procedures employed to determine the number of clusters and to validate the clusters, these procedures were often lacking in rigour, and were reported in insufficient detail for replication. CONCLUSIONS: The reporting of cluster analysis was found to be generally unsatisfactory, with many studies failing to provide enough information to allow replication or the evaluation of the quality of the research. Clear guidelines for conducting and reporting cluster analyses in health psychology are needed.

Patients' use of GPs and community pharmacists in minor illness: a cross-sectional questionnaire-based study.

BACKGROUND: Despite pharmacists having increased involvement in managing minor illness, many patients continue to attend their GP with problems that could be managed by community pharmacists. OBJECTIVE: Our aim was to investigate the prevalence of visits to the GP that GPs felt could be managed by a pharmacist, and to explore patients' reasons for such visits. METHODS: This cross-sectional questionnaire study was conducted at 13 general practices in West Sussex, UK. A questionnaire was given to all patients attending appointments with their GP in these practices over a 1-week period, asking what the presenting problem was and whether the advice of a pharmacist had been sought. If patients had not sought the advice of a pharmacist, they were asked why not. The GP was then asked to indicate whether, in their opinion, the patient's problem could have been managed by a community pharmacist. RESULTS: The response rate was 94% (3984), representing 87% of all patients consulting their doctor during the week of the study. GPs felt that only 7% (260) of these visits could have been managed by a community pharmacist. The proportion of 'unnecessary' visits was significantly higher (P < 0.001) amongst young adults, those presenting with new medical problems and those consulting about a child's health. Skin and musculoskeletal problems were the most common causes of 'unnecessary' visits to the GP. The majority of patients making 'unnecessary' visits (59%) disagreed with the GP and felt that the pharmacist would not have been appropriate for their problem. CONCLUSIONS: GPs and patients were, on the whole, in agreement over which conditions were appropriate for GP attention. There is, however, a need for education to increase awareness of the roles of pharmacists, aimed particularly at young adults and at those with children.