Associations between Modifiable Health-Risk Behaviors and Personality Types

Objectives: The first objective for this study was to explore if characteristics of personality type (using the Preferred Communication Style Questionnaire) are associated with the following modifiable health-risk behaviors: smoking, exercise, alcohol consumption, nutrition, sleep, depression-related stress, anxiety-related stress, healthcare professional usage, and self-discipline. The second objective for this study was to explore if characteristics of personality type are associated with (1) the quality of patient-physician relationships, (2) patient-physician communication, and (3) preferred method for receiving information. Methods: Data were collected from 10,500 adult individuals residing in the United States via an on-line, self-administered survey coordinated by Qualtrics Panels from March 14-30, 2016. Chi-square analysis was used for making comparisons between categories of personality types and items related to health-risk behaviors. Statistical significance was set at p \u3c 0.05. However, chi-square analysis with large sample sizes (e.g. 10,500 in this study) readily yields statistical significance. Practical significance was set at four or more percentage points above or below the overall mean. Results: Regarding objective 1, personality type was associated with all nine health-risk behaviors studied. Personality types within the Experiencer temperament (17% of the U.S. population) accounted for 46% of the undesirable scores we computed for health-risk behaviors. The Idealist temperament (17% of population) accounted for 32% of the undesirable scores. Conceptualizers (10% of population) accounted for 17% of the undesirable scores and Traditionalists (46% of population) accounted for 5% of the undesirable scores. Regarding objective 2, the findings showed that personality type was associated with (1) the importance people place on the patient-physician relationship, (2) which characteristics of that relationship are most desirable, (3) desire for more communication with their physician, and (4) the preferred method for receiving information. Discussion and Conclusions: Precision medicine has been proposed as a way to create a new taxonomy of disease that uses individual specific data to develop accurate diagnosis, targeted treatment, and improved health outcomes. Based on the findings of this study, we propose that inclusion of personality type is an important component of these efforts so that the health care system can conform more to the individual patient in order to increase engagement and adherence, reduce errors, minimize ineffective treatment and waste, and can be cost effective

Use of the Jung/Myers Model of Personality Types to Identify and Engage with Individuals at Greatest Risk of Experiencing Depression and Anxiety

Depression is the leading cause of ill health and disability worldwide. Objectives were (1) to determine the strength of the association between personality type with depression and anxiety using the Preferred Communication Style Questionnaire (PCSQ©) and the Four-Item Patient Health Questionnaire for Depression and Anxiety (PHQ-4) and (2) evaluate the extent to which severity of depression and anxiety is associated with personality type. Data were collected via a self-administered online survey of 10,500. Chi-square analysis compared personality types and depression and anxiety. Practical significance was determined by calculating the percentage-from-expected score based on established statistics reflecting each personality type’s percentage in the US population. Personality type was strongly associated with both depression and anxiety with certain types at significantly greater risk than others. Findings can improve the research and clinical community’s understanding of the specific risk factors and triggers for depression and anxiety, and result in more efficacious, tailored treatment options

Financial Hardship from Purchasing Prescription Drugs Among Older Adults in the United States Before, During, and After the Medicare Part D “Donut Hole”: Findings from 1998, 2001, 2015, and 2021

BACKGROUND: Cost-related nonadherence compromises successful and effective management of chronic disease. The Medicare Modernization Act of 2003 (MMA) and Patient Protection and Affordable Care Act of 2010 (ACA) aimed to increase the affordability of outpatient prescription drugs for older adults (older than age 64 years). The Medicare Part D prescription drug insurance coverage gap (“donut hole”) created by the MMA was fully closed in 2020 by the ACA. OBJECTIVES: To (1) describe prescription drug coverage and financial hardship from purchasing prescription drugs among older American adults for 2021, (2) compare these results with findings from data collected before the MMA and during the progressive elimination of the Medicare Part D coverage gap, and (3) compute the likelihood for financial hardship from purchasing prescription drugs using variables for year, prescription drug insurance coverage, health-related information, and demographics. METHODS: Data were obtained from 4 nationally distributed, crosssectional surveys of older adults to track coverage for and financial hardship from purchasing prescription drugs. Surveys in 1998 and 2001 were mailed to national random samples of US seniors. Of 2,434 deliverable surveys, 700 (29%) provided useable data. Data were collected in 2015 and 2021 via online surveys sent to samples of US adults. Of 27,694 usable responses, 4,445 were from older adults. Descriptive statistics and logistic regression analyses described relationships among financial hardship and demographics, diagnoses, and daily prescription drug use. RESULTS: Five percent of older adults lacked prescription drug coverage in 2021, continuing a downward trend from 32% in 1998, 29% in 2001, and 9% in 2015. Contrastingly, 20% of older adults reported financial hardship from prescription drug purchases in 2021, bending an upward trend from 19% in 1998, 31% in 2001, and 36% in 2015. Financial hardship from purchasing prescription drugs was more likely to be reported by older adults lacking prescription drug insurance, taking multiple medications daily, and having a low annual household income across all survey years. The latter 2 of these 3 factors were still predictive of financial hardship from purchasing prescription drugs among older adults with prescription drug insurance. CONCLUSIONS: Financial hardship from purchasing prescription drugs is still experienced by many older adults after the full implementation of the MMA and ACA. Lacking prescription drug coverage, taking more than 5 prescription drugs daily, and a low annual household income may increase the likelihood of experiencing this financial hardship. Pharmacists can be a resource for older adults making choices about their prescription drug coverages and purchases. DISCLOSURES: Funding was provided by the American Association of Colleges of Pharmacy New Investigator Program, the University of Minnesota Grant-in-Aid of Research Program, the Peters Endowment for Pharmacy Practice Innovation, the Chapman University Research Program, and the University Minnesota Research Program. Plain language summary Almost all older adults in the United States have prescription drug insurance, but many still cannot afford them. This is most true for those who take many daily prescriptions, do not have prescription insurance, and have a low income

Development of the Adherence Predictive Index (API) for Medication Taking

The objective for this study was to explore if characteristics of personality type using the Preferred Communication Style Questionnaire, in concert with the demographic characteristics of age, education, and race/ethnicity, are associated with, and help predict, individuals’ medication adherence behavior. Data were collected via an on-line survey, sent to a sample of adults residing in the United States, between April 28 and June 22, 2015. Out of 26,173 responses to the survey, 16,736 reported taking one or more medications and were eligible for inclusion in this study. The development of the Adherence Predictive Index (API) used mean Morisky Medication Adherence Scale (MMAS-8) scores for each of eight personality types as a starting point. API scores were calculated by adding or subtracting specific values to each group’s mean MMAS-8 score based on personality type, age, education and race/ethnicity characteristics which were demonstrated to have significant effects on adherence. The weighting system was informed by linear regression, logistic regression, personality type literature, researcher experience, and previous qualitative and quantitative research. The resultant score was converted to an API score that ranged from 1 to 5 so that it would be feasible for health care providers to understand and use. The findings showed that an Adherence Predictive Index (API) could be developed based upon a relatively small number of questions that focus on personality type and generational, educational, and cultural experiences. It was developed in order to be a component of a comprehensive program that has the goals of (1) identifying and describing specific behavioral strategies individuals are most likely to successfully employ, (2) motivating patients by using their preferred communication style, and (3) predicting each patient’s propensity to adhere. Future research is needed to evaluate the index’s validity, sensitivity, and effectiveness in actual practice compared with other risk indices

Development of the Adherence Predictive Index (API) for Medication Taking

The objective for this study was to explore if characteristics of personality type using the Preferred Communication Style Questionnaire, in concert with the demographic characteristics of age, education, and race/ethnicity, are associated with, and help predict, individuals’ medication adherence behavior. Data were collected via an on-line survey, sent to a sample of adults residing in the United States, between April 28 and June 22, 2015. Out of 26,173 responses to the survey, 16,736 reported taking one or more medications and were eligible for inclusion in this study. The development of the Adherence Predictive Index (API) used mean Morisky Medication Adherence Scale (MMAS-8) scores for each of eight personality types as a starting point. API scores were calculated by adding or subtracting specific values to each group’s mean MMAS-8 score based on personality type, age, education and race/ethnicity characteristics which were demonstrated to have significant effects on adherence. The weighting system was informed by linear regression, logistic regression, personality type literature, researcher experience, and previous qualitative and quantitative research. The resultant score was converted to an API score that ranged from 1 to 5 so that it would be feasible for health care providers to understand and use. The findings showed that an Adherence Predictive Index (API) could be developed based upon a relatively small number of questions that focus on personality type and generational, educational, and cultural experiences. It was developed in order to be a component of a comprehensive program that has the goals of (1) identifying and describing specific behavioral strategies individuals are most likely to successfully employ, (2) motivating patients by using their preferred communication style, and (3) predicting each patient’s propensity to adhere. Future research is needed to evaluate the index’s validity, sensitivity, and effectiveness in actual practice compared with other risk indices.   Type: Original Researc

An Evaluation of the Distribution, Scope, and Impact of Community Pharmacy Foundation Grants Completed by Academic Principal Investigators between 2002 and 2014

Objective: From a total of 107 grants, a subset evaluation of 58 grants awarded to and completed by pharmacy faculty by the Community Pharmacy Foundation (CPF) from 2002 through 2014 was conducted to: (a) evaluate the representativeness across principal investigator (PI) academic institutions, (b) compare the scope of CPF grants completed by academic PIs across time, and (c) compare the impact of CPF grants completed by academic PIs across time. Methods: Quantitative data for all 107 CPF grants awarded between 2002 and 2014 were obtained from the CPF website and CPF personnel. Qualitative ethnographic data was generated from principal investigator (PI) interviews by email communications. All 107 grants, including a subset of 58 grants awarded to pharmacy faculty, were analyzed and compared between ‘Initial Years’ (2002-2008) and ‘Recent Years’ (2009-2014) using descriptive statistics for quantitative data and an extraction of dominant themes from PI reflections for qualitative data. Results: In the initial years (2002-2008), 54% of grants awarded to pharmacy faculty were from public academic institutions. This proportion increased to 80% in recent years (2009-2014). In recent years, pharmacy faculty projects were increasingly focused on higher AHRQ Impact Categories, such as changing policies and programs, clinical care and practice patterns, and health outcomes (AHRQ Impact Levels 2-4), rather than simply adding to the knowledge base (Impact Level 1). Academic investigators reported that funding positively influenced practice development (59%), promotion & advancement (59%), and expanded collaborations (38%). Diverse geographic representation of funding recipients was achieved. Conclusions: CPF funding has been invaluable for investigators seeking experience securing grant funding. And the impact of CPF funding has transitioned from studies that add to the knowledge base only, toward studies that effect actual health outcomes or that profoundly change practice. Conflict of Interest Anne Marie Kondic is Executive Director and Grants Administrator for the Community Pharmacy Foundation.   Type: Original Researc

Comparing the Research Contributions of Community Pharmacy Foundation Funding on Practice Innovation Between Non-Academics and Academics

Objective: Evaluate and compare the research contributions of Community Pharmacy Foundation (CPF) funding on community pharmacy practice innovation between non-academic and academic principal investigators (PIs) with respect to the following measurements: 1) “Pharmacy Practice Activity Classifications” (PPAC); 2) CPF “Coordinated Use of Medications”; and 3) CPF Investigator Impact. Methods: Quantitative data for all 124 CPF-funded grants awarded from 2002-2016 were obtained from the CPF website and personnel, while ethnographic qualitative data was generated from queries of PIs. Grant categorization was conducted by researchers serving as judges trained on the rules and procedures for coding. A threshold level of 90% agreement in scores of independent judging was established a priori. Findings were summarized and groups were compared using descriptive statistics for quantitative data and a thematic analysis of PI ethnographic reflections for qualitative data. Results: There were no differences between non-academic and academic PI groups for Coordinated Use of Medications and PPAC domains, but non-academics contributed more to two dispensing-related PPAC subclasses: ‘Preparing the Product’ (10% vs. 2%) and ‘Delivering the Medication or Device’ (13% vs. 2%). Analysis of investigator reflections revealed similarities between groups regarding impact on practice innovations, expanded collaborations, new practice tools, and patient-care financing models. Conclusions: CPF funding contributed new knowledge and resources for expanding and enhancing practice innovations as shown by quantitative (PPAC & Coordinated Use of Medications) and qualitative (PI impact) measures. Similarities between PI groups suggest that the CPF has established a funding niche with unique diversity of practice innovation opportunities. This investigation’s findings may be useful to the CPF’s continuous quality improvement efforts, as well as future grant applicants to assess research gaps in the medication use process and develop sustainable, transferable, and replicable patient-care innovations in community pharmacy practice. Conflict of Interest This program evaluation analysis was funded by the Community Pharmacy Foundation (CPF). Co-author Anne Marie Kondic is Executive Director and Grants Administrator for the Community Pharmacy Foundation. The ideas articulated in the manuscript are those of the authors to characterize historical CPF grant funding and do not necessarily indicate or impact future funding priorities.   Type: Original Researc

Associations between Modifiable Health-Risk Behaviors and Personality Types

Objectives: The first objective for this study was to explore if characteristics of personality type (using the Preferred Communication Style Questionnaire) are associated with the following modifiable health-risk behaviors: smoking, exercise, alcohol consumption, nutrition, sleep, depression-related stress, anxiety-related stress, healthcare professional usage, and self-discipline. The second objective for this study was to explore if characteristics of personality type are associated with (1) the quality of patient-physician relationships, (2) patient-physician communication, and (3) preferred method for receiving information. Methods: Data were collected from 10,500 adult individuals residing in the United States via an on-line, self-administered survey coordinated by Qualtrics Panels from March 14-30, 2016. Chi-square analysis was used for making comparisons between categories of personality types and items related to health-risk behaviors. Statistical significance was set at p < 0.05. However, chi-square analysis with large sample sizes (e.g. 10,500 in this study) readily yields statistical significance. Practical significance was set at four or more percentage points above or below the overall mean. Results: Regarding objective 1, personality type was associated with all nine health-risk behaviors studied. Personality types within the Experiencer temperament (17% of the U.S. population) accounted for 46% of the undesirable scores we computed for health-risk behaviors. The Idealist temperament (17% of population) accounted for 32% of the undesirable scores. Conceptualizers (10% of population) accounted for 17% of the undesirable scores and Traditionalists (46% of population) accounted for 5% of the undesirable scores. Regarding objective 2, the findings showed that personality type was associated with (1) the importance people place on the patient-physician relationship, (2) which characteristics of that relationship are most desirable, (3) desire for more communication with their physician, and (4) the preferred method for receiving information. Discussion and Conclusions: Precision medicine has been proposed as a way to create a new taxonomy of disease that uses individual specific data to develop accurate diagnosis, targeted treatment, and improved health outcomes. Based on the findings of this study, we propose that inclusion of personality type is an important component of these efforts so that the health care system can conform more to the individual patient in order to increase engagement and adherence, reduce errors, minimize ineffective treatment and waste, and can be cost effective. Conflict of Interest Co-author, Paul Tieger is CEO of SpeedReading People, LLC which holds copyright for the Individual Wellness Plan and Adherence Predictive Index tools that are mentioned in this manuscript.   Type: Original Researc

Applying Personality Type Theory to Develop Individualized Wellness Plans for Reducing Chronic Diseases

Objective: The objective of this study was to explore if characteristics of personality type (using the Preferred Communication Style Questionnaire) are associated with activities people prefer for getting adequate exercise, losing weight, managing stress, quitting smoking, reducing alcohol consumption, and taking medications as prescribed. Methods: The data source for this study was the 2016 National Consumer Survey of the Medication Experience and Pharmacists’ Roles. Data were collected via an on-line, self-administered survey conducted from March 14-30, 2016. Data were obtained from 10,500 adults residing in the United States. Chi-square analysis was used for making comparisons between categories of personality types and how respondents believed they could best reach their personal goals. Statistical significance was set at p < 0.05. Practical significance was set at five or more percentage points above or below the overall mean. Results: Findings showed that (1) there are key differences between individuals that impact their behavior and (2) these differences can be easily and accurately identified using the Preferred Communication Style Questionnaire. The findings supported the notion that individuals are more likely to experience success in changing health-risk behaviors if they engage in activities that are consistent with (i) how they are energized, (ii) the kind of information they naturally notice, (iii) how they prefer to make decisions, and (iv) their preferences to live in a more structured way or in a more spontaneous way. Conclusions: Personality type characteristics can be used to develop and implement successful change strategies and intervention tools, such as individualized wellness plans (IWPTM) that help promote intention stability, create implementation intention, resist situational pressure, reduce the impact of past habits on future performances, and improve change maintenance. Conflict of Interest We declare no conflicts of interest or financial interests that the authors or members of their immediate families have in any product or service discussed in the manuscript, including grants (pending or received), employment, gifts, stock holdings or options, honoraria, consultancies, expert testimony, patents and royalties.   Type: Original Researc

The Crystal Structure of CHIR-AB1: A Primordial Avian Classical Fc Receptor

CHIR-AB1 is a newly identified avian immunoglobulin (Ig) receptor that includes both activating and inhibitory motifs and was therefore classified as a potentially bifunctional receptor. Recently, CHIR-AB1 was shown to bind the Fc region of chicken IgY and to induce calcium mobilization via association with the common γ-chain, a subunit that transmits signals upon ligation of many different immunoreceptors. Here we describe the 1.8-Å-resolution crystal structure of the CHIR-AB1 ectodomain. The receptor ectodomain consists of a single C2-type Ig domain resembling the Ig-like domains found in mammalian Fc receptors such as FcγRs and FcαRI. Unlike these receptors and other monomeric Ig superfamily members, CHIR-AB1 crystallized as a 2-fold symmetrical homodimer that bears no resemblance to variable or constant region dimers in an antibody. Analytical ultracentrifugation demonstrated that CHIR-AB1 exists as a mixture of monomers and dimers in solution, and equilibrium gel filtration revealed a 2:1 receptor/ligand binding stoichiometry. Measurement of the 1:1 CHIR-AB1/IgY interaction affinity indicates a relatively low affinity complex, but a 2:1 CHIR-AB1/IgY interaction allows an increase in apparent affinity due to avidity effects when the receptor is tethered to a surface. Taken together, these results add to the structural understanding of Fc receptors and their functional mechanisms