Judith A. Erlen

Health-related quality of life in chronic disorders: a comparison across studies using the MOS SF-36.

The purpose of this report is to examine health-related quality of life (HRQoL) as measured by the Medical Outcomes Study Short Form-36, across patient populations with chronic disorders and to compare quality of life (QoL) in these subjects with normative data on healthy persons. Six studies, within the Center for Research in Chronic Disorders at the University of Pittsburgh School of Nursing, in patients with urinary incontinence, prostate cancer, chronic obstructive pulmonary disease (COPD), acquired immune deficiency syndrome (AIDS), fibromyalgia and hyperlipidaemia provided the data for analysis. The results demonstrated that not only did the prostate cancer and hyperlipidaemia patients have the highest QoL across the chronic disorders, but their QoL was comparable to normative data on healthy persons. Homebound, elderly, incontinent patients had the lowest QoL for physical functioning, whereas patients hospitalized with AIDS had the lowest QoL in general health and social functioning. Patients with COPD had the lowest QoL in role-physical, role-emotional and mental health. Patients with fibromyalgia had the lowest QoL in bodily pain and vitality. Compared to normative data, patients with urinary incontinence, COPD, AIDS and fibromyalgia generally had lower QoL. Prostate cancer and hyperlipidaemia patients had QoL comparable to normative data. Compared to normative data, patients with urinary incontinence, COPD, AIDS and fibromyalgia had more variability for role-emotional. AIDS patients had more variability on physical functioning, bodily pain and social functioning compared to the normative data. These data suggest that patients with various chronic disorders may have QoL that is lower in most domains compared to a healthy population. However, there may be differences in the domains affected as well as the extent of variation across specific chronic disorders.

Adherence in chronic disease.

Nonadherence to treatmeot regimen is a prevalent problem of patients with chronic disorders. Approximately half of the patients with a chronic disease have problems following their prescribed regimen to the extent that they are unable to obtain optimum clinical benefit. This chapter reviews the state of knowledge regarding adherence to chronic disease regimens across the life span and demonstrates that the extent and nature of the adherence problems are similar across diseases, across regimens, and across age groups. Adherence to the commonly prescribed regimens is addressed, including pharmacological therapies, therapeutic diets, and therapeutic exercise. Randomized, controlled studies focusing on various educational, behavioral, cognitive, and affective interventions to improve adherence are included. Based on this review, further work is needed to better understand and improve adherence. New strategies for analysis and measurement will support these needed advances in the field of adherence.

Problem Drinking and Medication Adherence Among Persons with HIV Infection

AbstractOBJECTIVE: To examine the relation between problem drinking and medication adherence among persons with HIV infection. DESIGN: Cross-sectional survey. SETTING/PARTICIPANTS: Two hundred twelve persons with HIV infection who visited 2 outpatient clinics between December 1997 and February 1998. MEASUREMENTS AND MAIN RESULTS: Nineteen percent of subjects reported problem drinking during the previous month, 14% missed at least 1 dose of medication within the previous 24 hours, and 30% did not take their medications as scheduled during the previous week. Problem drinkers were slightly more likely to report a missed dose (17% vs 12 %, P=.38) and significantly more likely to report taking medicines off schedule (45% vs 26%, P=.02). Among drinking subtypes, taking medications off schedule was significantly associated with both heavy drinking (high quantity/frequency) (adjusted odds ratio [OR], 4.70; 95% confidence interval [95% CI], 1.49 to 14.84; P<.05) and hazardous drinking (adjusted OR, 2.64; 95% CI, 1.07 to 6.53; P<.05). Problem drinkers were more likely to report missing medications because of forgetting (48% vs 35%, P=.10), running out of medications (15% vs 8%, P=.16), and consuming alcohol or drugs (26 % vs 3 %, P<.001). CONCLUSION: Problem drinking is associated with decreased medication adherence, particularly with taking medications off schedule during the previous week. Clinicians should assess for alcohol problems, link alcohol use severity to potential adherence problems, and monitor outcomes in both alcohol consumption and medication adherence.

Barriers and facilitators to medication adherence in a southern minority population with HIV disease.

Adherence to HIV medications has been an important focus over the past decade, but little is known about adherence barriers and facilitators specifically in that part of the United States known as the Deep South. Characteristics of the region may affect factors associated with adherence related to the patient, the patient-provider relationship, and the environment. A total of 20 HIV-infected clients of a large public infectious diseases clinic in the Deep South participated in one of three focus groups; themes were identified by content analysis. Barriers included the perceived burden of extra planning, denial, life stress, difficult characteristics of the medicines, social stigma, and shame. Facilitators included acceptance of the diagnosis, thinking about the consequences of not taking the medicines, prayer and spirituality, improvements in the medicines, and support from family and friends. In the South, faith and prayer may be strong facilitators that need to be considered when adapting existing adherence interventions.

Moral distress: a pervasive problem.

The shortage of nurses and the flaws within the structure of the current health care system are compromising the nurses ability to provide competent, compassionate care. Nurses are increasingly disturbed because they see themselves as ineffective advocates for their patients. Nurses, unable to take the appropriate ethical actions, feel paralyzed by their situation. The authors recent conversations with staff nurses about their clinical practice suggest that moral distress has become a very pervasive problem. The purpose of this article is to describe ethical practice, moral distress, the imbalance of power, and the nature of an ethical environment. There is a discussion of potential strategies that will help to create and maintain an ethical environment thereby reducing moral distress such as facilitating dialogue, developing a support system, providing opportunities for professional development, and developing and revising institutional policies.

A qualitative study of persons who are 100% adherent to antiretroviral therapy

Abstract This qualitative study examined the medication-taking behaviors and attitudes of participants determined to be 100% adherers to antiretroviral therapy from a NIH-funded study testing a 12-week telephone adherence intervention. Using open-ended questions, interviewers collected data on a sample of 13 informants, whose medication adherence to a randomly selected antiretroviral medication was 100%, based on a 30-day data collection using electronic event monitoring (EEM). The analysis revealed ‘successful medication management’ as the core category or main theme. The participants achieved success with medication adherence through managing specific areas (regimen, self and environment). By adopting realistic expectations and pragmatic attitudes, adherence is fostered when medication taking is a priority, when patients believe in the efficacy of their medications and when there is a strong patient/provider relationship. Future research is needed to develop tailored interventions using strategies identified by this population. Further in-depth examination of medication-taking behaviors in 100% adherers may be useful in developing individualized programs to maximize adherence to antiretroviral therapy in the clinical setting.

Exemplars of mixed methods data combination and analysis

Background: Mixed methods research approaches can be applied to nursing and healthcare. Multiple perspectives and different types of data (e.g., social-behavioral data, numerical outcome measures, or clinical variables) often are needed to examine complex clinical problems and health behaviors fully. Although qualitative and quantitative methods are recognized widely as complementary for studying and explaining human phenomena, methodological techniques for combining and analyzing mixed methods data have received less attention. Objectives: To describe techniques for mixed methods data combination and analyses using three different design approaches. Methods: Data combination and analysis techniques are presented using the following approaches: (a) mixed methods event analysis, (b) concurrent-mixed analysis for complementarity and completeness, and (c) concurrent nested analysis to provide a broader understanding of phenomena and enrich the description of participants. Results: Research exemplars from topical areas such as weaning from long-term mechanical ventilation, medication-taking among community-dwelling persons with dementia, health control beliefs after lung transplantation, and recovery from subarachnoid hemorrhage are presented. Simple and complex matrix construction and a variety of graphical displays are used to illustrate data combination and analysis techniques for mixed methods research. Discussion: The techniques for mixed methods data combination and analysis presented have the potential to advance the use and refinement of mixed methods research, thereby expanding the repertoire of methodologies to study complex phenomena of interest to nurses.

An Examination of the Relationships Among Gender, Health Status, Social Support, and HIV-Related Stigma

&NA; This secondary analysis used E. Goffmans (1963) model of stigma to examine how social support and health status are related to HIV stigma, after controlling for specific sociodemographic factors, and how these relationships differed between men and women living with HIV. Baseline data from 183 subjects in a behavioral randomized clinical trial were analyzed using multigroup structural equation modeling. Women reported significantly higher levels of stigma than men after controlling for race, history of injection drug use, and exposure category. HIV‐related stigma was negatively predicted by social support regardless of gender. The theorized model explained a significant amount of the variance in stigma for men and women (24.4% and 44%, respectively) and may provide novel and individualized intervention points for health care providers to effect positive change in perceived stigma for the person living with HIV. The study offers insight into understanding the relationships among gender, health status, social support, and HIV‐related stigma.

Multiple authorship: Issues and recommendations

The increase in multidisciplinary research has led to a subsequent expansion of multiple authored articles in nursing as well as other disciplines. Although there are benefits to multiple authorship, there also are areas of possible conflict. The lack of adequate guidelines to address issues that may arise from multiple authorship heightens the possibility of disputes. Developing a blueprint for the preparation and presentation of papers emanating from a research teams work early in the project can avoid conflicts and ensure that the efforts of the appropriate individuals are reflected in the publications. This article discusses several issues related to authorship, including the assignment of authorship credit, the increased pressures to publish, and the complexity of authorship issues associated with multisite studies. The authors offer recommendations to reduce problems that may arise among members of a research team because of authorship issues. In addition, they include the guidelines that their multidisciplinary research team developed early in their project.

Functional health literacy, medication‐taking self‐efficacy and adherence to antiretroviral therapy

AIMS To report a study of the relationship between functional health literacy and medication adherence, as mediated by medication-taking self-efficacy, while controlling for the effect of key demographic variables (such as race, income and level of education). BACKGROUND Medication adherence is critical to successful HIV/AIDS self-management. Despite simplified regimens and the availability of tools to assist with medication-taking, adherence remains a challenge for many people living with HIV/AIDS. DESIGN Cross-sectional, secondary analysis. METHODS Data for this study of 302 adults living with HIV/AIDS who were taking antiretroviral medications were collected from January 2004-December 2007. Medication adherence was measured using electronic event monitors. Bivariate analyses and stepwise regression were conducted to examine the associations among functional health literacy, medication-taking self-efficacy and HIV medication adherence. RESULTS Overall, functional health literacy was much higher than expected; however, adherence in this sample was sub-optimal. Higher medication-taking self-efficacy was associated with higher medication adherence; however, functional health literacy was not significantly related to either medication adherence or self-efficacy beliefs. Hence, medication-taking self-efficacy did not mediate the relationship between functional health literacy and medication adherence. CONCLUSIONS Medication adherence continues to be an issue for people living with HIV/AIDS. Additional research is needed to understand the disparate findings related to functional health literacy and medication adherence in this and other studies examining this association.