Julie A. Chambers

Adherence to medication in stroke survivors: A qualitative comparison of low and high adherers

OBJECTIVES The aim of this study was to investigate factors that may explain variance in adherence to medication in stroke patients. Design. A qualitative comparison of high and low adherers to medication. METHODS Thirteen participants, selected from a sample of 180 stroke survivors because they self-reported the lowest adherence to medication regimes, were matched with 13 reporting maximal adherence. All took part in semi-structured qualitative interviews. RESULTS Thematic analysis revealed that those with poor adherence to medication reported both intentional and non-intentional non-adherence. Two main themes emerged: the importance of stability of a medication routine and beliefs about medication and treatment. High adherers reported remembering to take their medication and seeking support from both family and health professionals. They also had a realistic understanding of the consequences of non-adherence, and believed their medicine did them more good than harm. Low adherers reported forgetting their medication, sometimes intentionally not taking their medication and receiving poor support from medical staff. They disliked taking their medication, had limited knowledge about the medication rationale or intentions, and often disputed its benefits. CONCLUSIONS Our findings suggest that appropriate medication and illness beliefs coupled with a stable medication routine are helpful in achieving optimal medication adherence in stroke patients. Interventions designed to target both intentional and non-intentional adherence may help maximize medication adherence in stroke patients.

Stories of weight management: Factors associated with successful and unsuccessful weight maintenance

OBJECTIVE Although behavioural interventions are successful in achieving short-term weight loss, most individuals regain most or all of their weight within a few years. Our aim was to investigate factors that can help in long-term weight maintenance. DESIGN Qualitative interviews were conducted in order to elicit experiences, successes, and difficulties associated with weight control over the lifespan. METHODS Participants were 20 adult volunteers (aged 30-67) including lifelong weight maintainers, active weight maintainers who have maintained weight loss, and weight gainers. Thematic analysis was used to highlight differences between weight groups. RESULTS Successful weight maintainers adopt a staged approach to weight management, including monitoring weight fluctuations and having a clear alarm signal for weight gain that triggers immediate action. They have several behavioural strategies for weight control, comprising relatively small adjustments to diet and/or exercise behaviour and also have clear strategies for coping with lifestyle interruptions. In contrast, unsuccessful weight maintainers display negative cognitive factors, including erratic or inconsistent weight vigilance, failure to respond to warning signs of weight gain, and failure to restrict weight unless in a positive mindset. Further, their coping strategies for weight gain or failed actions are poor. CONCLUSIONS The results suggest that successful weight maintainers, irrespective of current weight band, adopt a staged behavioural approach to weight management that allows them to maintain a fairly stable weight. Encouraging the use of such strategies in those who typically regain weight after dieting may aid them in maintaining weight loss.

Psychometric properties of the Parental Bonding Instrument and its association with psychological distress in a group of incarcerated young offenders in Scotland.

Abstract  Background: The Parental Bonding Instrument (PBI) was developed in order to help quantify the parental contribution to psychological distress. It has subsequently been shown to be of value in examining the influence of parents in many diverse areas including delinquency. Method: A shortened form of the PBI and the Hospital Anxiety and Depression Scale (HADS) were administered to a group of young offenders held in custody in Scotland. Results: High levels of psychological distress were linked with low parental care, but there were no associations between psychological distress and parental control. However, an analysis of the factor structure found that, although the care factor of the PBI showed good internal reliability, the control factor was less well defined in this group. Conclusions: It is suggested that a three-factor solution representing care, control with regard to independence and protective control may be more appropriate.

The Quality of Perceived Parenting and Its Association with Peer Relationships and Psychological Distress in a Group of Incarcerated Young Offenders

An investigation was carried out to examine the association of perceived parenting as measured by a shortened form of the Parental Bonding Instrument with self-esteem, relationships with peers and staff, and psychological distress levels in a group of young offenders held in custody. There were strong associations between low parental care with both low self-esteem and increased psychological distress as well as between low maternal care and poorer peer relationships. In addition, poor-quality peer relationships with other inmates and low self-esteem showed strong associations with increased levels of psychological distress in prison, suggesting that peer relations and self-esteem may both act as mediator variables in the association between parental care and anxiety and depression. There were, however, no associations between self-esteem and either the quality or number of peer relationships.

Anticipated regret to increase uptake of colorectal cancer screening (ARTICS): A randomised controlled trial

Screening is important for early detection of colorectal cancer. Our aim was to determine whether a simple anticipated regret (AR) intervention could increase uptake of colorectal cancer screening. A randomised controlled trial of a simple, questionnaire-based AR intervention, delivered alongside existing pre-notification letters, was conducted. A total of 60,000 adults aged 50–74 years from the Scottish National Screening programme were randomised into the following groups: (1) no questionnaire (control), (2) Health Locus of Control questionnaire (HLOC) or (3) HLOC plus AR questionnaire. The primary outcome was return of the guaiac faecal occult blood test (FOBT). The secondary outcomes included intention to return test kit and perceived disgust (ICK). A total of 59,366 people were analysed as allocated (intention-to-treat (ITT)); no overall differences were seen between the treatment groups on FOBT uptake (control: 57.3%, HLOC: 56.9%, AR: 57.4%). In total, 13,645 (34.2%) individuals returned the questionnaires. Analysis of the secondary questionnaire measures showed that AR indirectly affected FOBT uptake via intention, whilst ICK directly affected FOBT uptake over and above intention. The effect of AR on FOBT uptake was also moderated by intention strength: for less-than-strong intenders only, uptake was 4.2% higher in the AR (84.6%) versus the HLOC group (80.4%) (95% CI for difference (2.0, 6.5)). The findings show that psychological concepts including AR and perceived disgust (ICK) are important factors in determining FOBT uptake. However, the AR intervention had no simple effect in the ITT analysis. It can be concluded that, in those with low intentions, exposure to AR may be required to increase FOBT uptake. The current controlled trials are presented at the website www.controlled-trials.com (number: ISRCTN74986452).

Improving medication adherence in stroke survivors: Mediators and moderators of treatment effects

OBJECTIVE The purpose of the current study was to test theory-based predictions of mediators and moderators of treatment effects of a pilot randomized controlled trial, which aimed to increase adherence to preventive medication in stroke survivors via addressing both automatic (i.e., habitual responses) and reflective (i.e., beliefs and value systems) aspects of medication-taking behavior. METHOD Sixty-two stroke survivors were randomly allocated to either an intervention or control group. Intervention participants received a brief 2-session intervention aimed at increasing adherence via (a) helping patients establish better medication-taking routines using implementation intentions plans (automatic), and (b) eliciting and modifying any mistaken patient beliefs regarding medication and/or stroke (reflective). The control group received similar levels of non-medication-related contact. Primary outcome was adherence to antihypertensive medicine measured objectively over 3 months using an electronic pill bottle. Secondary outcome measures included self-reported adherence (including forgetting) and beliefs about medication. RESULTS Intervention participants had 10% greater adherence on doses taken on schedule (intervention, 97%; control, 87%; 95% CI [0.2, 16.2], p = .048), as well as significantly greater increases in self-reported adherence and reductions in concerns about medication. Treatment effects were mediated by reductions in both forgetting and concerns about medication, and moderated by the presence of preexisting medication-taking routines. CONCLUSIONS Addressing both automatic and reflective aspects of behavior via helping stroke survivors develop planned regular routines for medication-taking, and addressing any concerns or misconceptions about their medication, can improve adherence and thus potentially patient outcomes.

A health assessment tool for multiple risk factors for obesity: age and sex differences in the prediction of body mass index

The aim was to establish the relative importance of multiple dietary, activity and other risk factors in determining BMI. A cross-sectional survey was conducted with 322 adults (71 % female; aged 18-79 years; BMI 16.5-40.9 kg/m2) using a previously developed, psychometrically tested, seventy-three-item questionnaire covering a wide range of obesity risk factors (consisting of five dietary, five activity and seven other risk factor subscales). Outcome was self-reported weight and height for BMI, cross-validated with items on clothes size and perceived need to lose weight. Stepwise regression analysis predicted 25-55 % of the variance in BMI with physical activity participation, current and past dieting behaviour, amount eaten, and age being the most important predictors. The association of lower BMI and younger age appeared to be due to higher activity levels, as younger participants reported much less healthy eating behaviour than the older age group. Amount eaten and physical activity participation were stronger predictors of BMI than other factors including healthy eating and use of mechanised transport. Results showed that the relationship between various risk factors and obesity may differ by both sex and age group, suggesting that different interventions may need to be targeted at different groups. The higher-risk eating behaviour observed in younger participants is of concern and needs to be addressed, if the current trend of rising obesity levels is to be halted.

A Health Assessment Tool for Multiple Risk Factors for Obesity: Psychometric Testing and Age Differences in UK Adults

Background: Although many individual health behaviours (e.g. diet/activity) have been implicated in the current rise in obesity levels, their confounding or cumulative effects have yet to be established. This study psychometrically tested a previously piloted comprehensive measure of obesity risk factors, designed to assess their relative importance at individual and population levels. Material and Methods: A user-friendly, self-report questionnaire, completed by 359 adult volunteers (71% female, age range 18–81 years), was subjected to exploratory factor analysis and related to body mass index (BMI) and age. Results: The final solution had 74 items and showed a clear factor structure, with 5 dietary and 5 activity factors, plus 8 unrelated factors covering dieting behaviour, alcohol consumption, sleep, and varied developmental influences. Younger respondents generally reported unhealthier behaviours. Once age was controlled for, less healthy eating, more emotional eating, higher amounts eaten, less physical activity, more use of mechanised transport, and more/less successful dieting behaviour were all strongly related to higher BMI, with lesser associations for more TV watching and less parental encouragement to be active. Conclusion: This easy-touse self-report measure of multiple risk factors showed good psychometric properties and has merit in determining the contribution of varied factors in the tendency to overweight and obesity. The finding that younger adults generally reported less healthy dietary and activity behaviour indicates a pressing need for early intervention.

A pilot randomized controlled trial of telephone intervention to increase Breast Cancer Screening uptake in socially deprived areas in Scotland (TELBRECS)

Objectives To determine whether a brief telephone support intervention could increase breast cancer screening uptake among lower socio-demographic women in Scotland, via eliciting and addressing barriers to screening attendance. Methods In a pilot randomized controlled trial, participants receiving a reminder letter for a missed screening appointment (February-June 2014) were randomized to four arms: No telephone call (control), Simple telephone reminder (TEL), Telephone support (TEL-SUPP), or Telephone support plus anticipated regret (TEL-SUPP-AR). Primary outcomes were making an appointment and attending breast screening. Results Of 856 women randomized and analysed on intention-to-treat basis, compared with controls, more women in the telephone intervention groups made an appointment (control: 8.8%, TEL: 20.3%, TEL-SUPP: 14.1%; TEL-SUPP-AR: 16.8%, χ2(3) = 12.0, p = .007) and attended breast screening (control: 6.9%, TEL: 16.5%, TEL-SUPP: 11.3%; TEL-SUPP-AR: 13.1%, χ2(3) = 9.8, p = .020). Of 559 women randomized to the three telephone groups, 404 were successfully contacted and 247 participated in the intervention. Intervention participants (ie. per protocol analysis) were more likely to make (17% versus 10%, χ2(1) = 7.0, p = .008) and attend (13% versus 7%, χ2(1) = 5.5, p = .019) an appointment than non-participants, but there were no differences in attendance between the three telephone groups. Conclusions A simple telephone reminder doubled attendance at breast screening in women from lower socio-demographic areas who had not attended their initial appointment, compared with a reminder letter only (odds ratio 2.12, 95% CI (1.2, 3.8)). However, contacting women proved problematic and there was no additional effect of telephone support or anticipated regret.