Impact of gender on adherence to therapy

Non-adherence to prescribed medications has been the focus of much interest in the literature owing to the poor treatment outcomes and increased healthcare burden which ensue as a consequence. In order to develop targeted interventions to address treatment non-adherence, it is necessary to first understand the factors which may influence patients’ medication taking behaviour. It has been suggested that patient gender may be one such factor, where knowledge of its impact can have the potential to assist researchers and clinicians in pre-empting instances of non-adherence and allowing them to monitor patients more closely and intervene in a timely fashion if required. In this article, we explore the issue of gender and nonadherence by examining the findings of studies related to three key disease states. It is apparent that there are variations in research evidence on this topic and that it is likely that other factors such as regimen complexity and patient knowledge interplay and may also demonstrate a larger role in impacting adherence to therapy.peer-reviewe

Gender differences in health and medicine information seeking behaviour : a review

Consumers periodically seek information about their health and medicines to increase their knowledge and understanding, and to support self-management. Gender has an impact on people’s attitudes and behaviour; gaining a better understanding of how males and females differ in the way in which they find and use health and medicine information may help to enhance patient-health care provider communication and the information that they receive. Based on a review of the literature, women overall are more active information seekers than men. A number of differences do exist, notably in: sources of information consulted, information desired and degree of engagement in information seeking.peer-reviewe

Exploring factors influencing initiation, implementation and discontinuation of medications in adults with ADHD

Background: Adherence to ADHD medication is a complex phenomenon as the decision to adhere is influenced by a range of factors. To design tailored interventions to promote adherence, it is important to understand the factors that influence adherence in the context of its three phases: initiation, implementation and discontinuation. Objective: The objective of this study was to explore the phase-specific factors that influence adherence to medication in adults who have a diagnosis of ADHD. Methods: Three focus groups (FGs) were conducted with twenty adults with ADHD in different metropolitan areas of Sydney, Australia. FGs were transcribed verbatim and thematically analysed. Results: Participants’ decision to initiate medication (the initiation phase) was influenced by their perceived needs (desire to improve academic and social functioning) and concerns (fear of side-effects) about medication following a similar process as defined by the Necessity-Concerns Framework (NCF). The balance between benefits of medication (needs) and side-effects (concerns) continued to determine participants’ daily medication-taking (the implementation phase) and persistence (or discontinuation) with their medication. Forgetfulness and stigma were reported as concerns negatively impacting the implementation phase, while medication cost and dependence influenced the discontinuation phase of adherence. Conclusions: Adults’ decision to initiate, continue or discontinue medication is influenced by a range of factors; some are unique to each phase while some are common across the phases. Participants balanced the needs for the medication against their concerns in determining whether to adhere to medication at each phase. It appears that the NCF has applicability when decision making about medication is explored at the three phases of adherence

Moving the needle—what does RSAP look for and what does it aim to do?

Peer reviewe

A Qualitative Study on Medication Taking Behaviour Among People With Diabetes in Australia

Background: Australia has a high proportion of migrants with an increasing migration rate from India. Type II diabetes is a long-term condition common amongst the Indian population. Aims: To investigate patients’ medication-taking behaviour and factors that influence adherence at the three phases of adherence. Methods: Semi-structured interviews were conducted with a convenience sample of 23 Indian migrants living in Sydney. All interviews were audio-recorded, transcribed verbatim and thematically analysed. Results: 1) Initiation: The majority of participants were initially prescribed oral antidiabetic medicine and only two were started on insulin. Most started taking their medicine immediately while some delayed initiating therapy due to fear of side-effects. 2) Implementation: Most participants reported taking their medicine as prescribed. However, some reported forgetting their medicine especially when they were in a hurry for work or were out for social events. 3) Discontinuation: A few participants discontinued taking their medicine. Those who discontinued did so to try Ayurvedic medicine. Their trial continued for a few weeks to a few years. Those who did not receive expected results from the Ayurvedic medicine restarted their prescribed conventional medicine. Conclusion: A range of medication-taking behaviours were observed, ranging from delays in initiation to long-term discontinuation, and swapping of prescribed medicine with Ayurvedic medicine. This study highlights the need for tailored interventions, including education, that focus on factors that impact medication adherence from initiation to discontinuation of therapy

A Qualitative Study

Background: Social media is frequently used by consumers and health care professionals; however, our knowledge about its use in a professional capacity by pharmacists is limited. Objective: Our aim was to investigate the professional use of social media by pharmacists. Methods: In-depth semistructured interviews were conducted with practicing pharmacists (N=31) from nine countries. Interviews were recorded, transcribed verbatim, and thematically analyzed. Results: Wikipedia, YouTube, and Facebook were the main social media platforms used. Professional use of social media included networking with peers, discussion of health and professional topics, accessing and sharing health and professional information, job searching, and professional promotion. Wikipedia was the participants’ first choice when seeking information about unfamiliar topics, or topics that were difficult to search for. Very few pharmacy-related contributions to Wikipedia were reported. YouTube, a video-sharing platform, was used for self-education. University lectures, “how-to” footage, and professionally made videos were commonly watched. No professional contribution was made to YouTube. Facebook, a general social networking site, was used for professional networking, promotion of achievements, and job advertisements. It also afforded engagement in professional discussions and information sharing among peers. Conclusions: Participants used social media in a professional capacity, specifically for accessing and sharing health and professional information among peers. Pharmacists, as medicines experts, should take a leading role in contributing to health information dissemination in these user-friendly virtual environments, to reach not only other health care professionals but also health consumers. J Med Internet Res 2016;18(9):e258 doi:10.2196/jmir.570

Eliciting preferences for continuing medication among adult patients and parents of children with attention‐deficit hyperactivity disorder

Background: Adherence to medication for attention‐deficit hyperactivity disorder (ADHD) is less than optimal. Previous studies have primarily focused on qualitative assessment of factors that influence medication adherence. Objective: This study aimed to quantify the factors that influence patient and parent preferences for continuing ADHD medication. Method: A discrete‐choice experiment was conducted to investigate preferences. Adults, and parents of children, with ADHD were presented with eight hypothetical choice tasks of three options (Medication A, Medication B, No Medication) described by six attributes related to medication outcomes. Preferences were estimated using a mixed multinomial logit model. Results: Overall, respondents' preferences (n = 216) for continuing medication were negative (mean [β] = −1.426, p < .001); however, a significant heterogeneity in preferences was observed amongst respondents (standard deviation = 0.805, p < .001). Improvements in education, aggressive behaviour, social behaviour and family functioning, and side effects and stigma, influenced respondents' decision to continue taking medication. The respondents were willing to continue medication if they experienced positive effects, but side effects (even moderate) were the strongest concern for not continuing medication. While side effects were the most important factor for both adult patients and parents of children with ADHD, improvement in education was relatively more important for adults and improvement in aggressive behaviour, social behaviour and family functioning was relatively more important for parents of children with ADHD. Parents were more likely to not continue a medication with severe side effects even at the highest level of improvement in education. Conclusions: Side effects are the most important factor that influenced preferences for continuing medication for both adults with ADHD, as well as parents of children with ADHD. While overall the respondents preferred not to take/give medication, discrete‐choice experiment showed that the relative importance of factors that influenced continuation of medications was different for the two groups. Patient and Public Involvement: Adults, and parents of children, with ADHD participated in this study by completing the online questionnaire. The questionnaire was based on findings of research in the literature, as well as earlier focus groups conducted with adults, and parents of children, with ADHD. The face validity of the questionnaire was determined by asking parents of children, and adults, with ADHD (n = 3) to complete the survey and participate in a short discussion on their understanding of the questions and their recommendations on improving the clarity of the survey

Community health literacy outcome measurement practices: A scoping review of recent interventions

Introduction: Evidence suggests that, while a preference for functional Health Literacy (HL) outcome measurement exists, researchers are converging towards more all‐encompassing instruments. While this claim is present in the HL field, minimal research has comprehensively explored the state of community HL measurement practices at the direct and proxy level. The almost exclusive focus on direct, as opposed to proxy, community HL measurement indicates a review of progress is needed. Objective: To identify HL outcome measurement practices for community HL interventions at the direct and proxy level of measurement. Search Strategy: Medline, PsycINFO, Web of Science, ERIC, Embase, Scopus, CINAHL, ProQuest Dissertations and Theses, Google Scholar and targeted websites were searched. Inclusion Criteria: Studies were sampled from the general population, included HL as an outcome of interest, involved an intervention aiming to improve HL, were English‐text publications and were published ≥2010. Data Extraction and Synthesis: Study author(s) and publication years, sample characteristics, intervention profiles and direct and proxy instrument and outcome measurement information were extracted. Full‐text review retrieved 25 eligible studies. Main Results: In total, 21 unique direct and 38 unique proxy instruments were extracted. The majority of interventions assessed functional compared to communicative, critical, and other HL domains, with objective instruments more frequently used than subjective or combined objective‐subjective types, though more unique subjective HL instruments were extracted overall. The Test of Functional HL in Adults was the most popular instrument, and perceived health, knowledge, behaviors and health intentions were the most frequent proxy outcome measures, with only the Healthy Lifestyle Behavior Scale‐II and Patient Activation Measure used across multiple interventions. Discussion and Conclusions: Direct HL outcome practices endured a unidimensional profile, despite previous suggestions of a convergence towards holistic instruments. This review provides the first overview of proxy HL measurement across community HL interventions, identifying substantial variation in proxy outcome practices. Patient or Public Contribution: A University‐based senior librarian contributed to the development of the search strategy, and reviewed iterations of the strategy until refinement was complete. No further public or patient contribution was made given the review‐based nature of the research