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Paper-based sleep diaries play an important role in the diagnosis and treatment of insomnia disorder. Accurate self-report data help to guide therapy and track progress, both in the clinic and during research trials. Previous research with paper diaries suggests that timely adherence with self-report diaries may be an issue, which can result in biased event recall. University students (N = 31) were asked to track their bedtime and wake time within 30 min of these events on paper-based sleep diaries. Specially designed binders covertly timestamped when participants actually wrote on their sleep diary. We assessed adherence by comparing timestamped diary usage with what participants documented in their sleep diary. Participants self-reported they were adherent with sleep diary instructions 97.9% of the time. However, timestamped data revealed that only 37.1% of diary entries were completed within the instructed timeframe. More than half of participants backfilled diary data, and three participants (9.7%) provided data that completely did not match their actual time of completion. When naïve to the objective tracking of their sleep diary usage, participants greatly over-reported the extent of their adherence. Non-adherence with sleep diary protocols poses a challenge for researchers utilizing this tool as a study outcome in clinical trials and for clinicians attempting to implement behavioral therapies for insomnia. • Paper sleep diaries are commonly used for insomnia diagnosis and treatment. • There is limited research evaluating adherence with this self-report tool. • We designed a special binder to covertly timestamp when data entry occurred. • Reported sleep diary adherence greatly exceeded what timestamped data suggested. • Non-adherence with paper sleep diary protocols is an issue for researchers and clinicians. [ABSTRACT FROM AUTHOR]

Most adolescents with type 1 diabetes (T1D) do not achieve a glycated hemoglobin (HbA1c) <7.0%, which is the current clinical target. mHealth can offer a scalable and age-appropriate delivery method for behavioral interventions to lower adolescents' HbA1c levels, while applying established behavior change and behavioral economics theories can enhance scientific rigor. We aim to conduct a pilot randomized clinical trial of a novel mHealth intervention called Coin2Dose (C ash- O nly IN centives To promote insulin DOSE engagement), in a sample of youth with T1D: 1) to obtain measures of feasibility and acceptability and 2) to examine preliminary efficacy versus a standard care control group based on differences in youth's daily BOLUS scores, HbA1c levels, and Time in Range (TIR) at post-intervention and 3-month post-intervention follow-up. This pilot RCT is already registered in http://ClinicalTrials.gov (NCT#05280184). Our pilot will recruit youth with T1D 11–17 years-old who use an insulin pump or Bluetooth connected insulin pen and have an average daily BOLUS score ≤2.5. Youth randomized to Coin2Dose will receive the intervention for 12 weeks followed by a 12-week maintenance period. The pilot is scheduled to start July 2022 and to conclude in 2025. At the conclusion of the pilot, we will have information about the feasibility and acceptability of two different behavioral economic incentive structures for improving BOLUS scores. The work is anticipated to progress to final efficacy trial. We will disseminate study results through presentations at local, national, and international conferences and through peer-reviewed diabetes and psychology journals. [ABSTRACT FROM AUTHOR]

Effective treatments for familial hypercholesterolaemia (FH) offer patients the opportunity of normal life expectancy, but lifelong adherence to both lipid-lowering therapies and lifestyle measures is challenging, and thus, this is rarely achieved. The aim of this systematic review is to identify attributes of educational interventions that promote adherence to treatment in FH. A systematic literature search was undertaken using Medline, CINAHL, HMIC and Embase. Papers were included based upon pre-defined inclusion and exclusion criteria; the quality of each included paper was assessed using the MERSQI scoring system. Relevant data were extracted, and a narrative synthesis was created. Six relevant studies of varying methodological quality were found amongst 2963 papers identified during the search. In total, there were 619 patients with FH in the intervention arm of the relevant studies. All six studies showed a positive effect of education on adherence to FH treatment; however, only two papers observed a statistically significant effect. Assessment was limited to the short-term. Four themes were identified as important when using education to improve treatment adherence: involving family, patient empowerment, practical problem solving and use of information leaflets. Educational interventions improve short term treatment adherence in patients with FH. Successful interventions are those that involve the whole family, set practical problem solving tasks, and that use techniques to increase the patients self-efficacy. This should all be supported by contemporaneous provision of written, age-appropriate information. There were no studies looking at education and long-term adherence in FH patients, and more research is needed in this area. [ABSTRACT FROM AUTHOR]

Aims: Adherence to therapeutic footwear is vital for effective diabetic foot ulcer prevention and treatment. Understanding the key adherence factors and potential barriers is important for footwear design and implementation. Our team is creating intelligent offloading footwear to prevent lower extremity amputations in people living with diabetes (PLwD). This exploratory study assessed the ability of the established Unified Theory of Acceptance and Use of Technology (UTAUT) model to predict behavioral intention to use or recommend this intelligent offloading footwear by PLwD, caregivers of PLwD, or medical professionals treating PLwD. Methods: Online and paper questionnaires were implemented to assess the impact of the UTAUT model factors (performance expectancy, effort expectancy, social influence, facilitating conditions) and psychosocial factors (attitude, anxiety, self-efficacy) on the overall behavioral intention to use the footwear. Furthermore, factors influencing potential acceptance and rejection of the footwear were explored. Results: Patients (4.0/5) and medical professionals (4.1/5) showed a behavioral intention to "agree" to use or recommend the footwear when it becomes available. Structural equation modeling showed that the UTAUT constructed model may not be the best indicator for behavioral intention here based on a lack of statistical significance. However, the logistic regression modeling showed that the social influence for PLwD (p=0.004) and the attitude toward the footwear for medical professionals (p=0.001) may be the most important when designing and implementing the footwear, though several other factors (performance expectancy, effort expectancy, facilitating conditions, and self-efficacy) were also important for one or both of these populations. Additionally, cost and clinician support were shown to be important factors influencing potential acceptance of the footwear. Conclusions: The study found promising intention to use the intelligent footwear in the future. This highlights the need to continue future development and implementation of the footwear to incorporate these results, thus improving the likelihood of high adherence of the footwear. [ABSTRACT FROM AUTHOR]

Background: In oestrogen‐receptor positive breast cancer, daily oral adjuvant endocrine therapy (ET) for at least 5 years significantly reduces risks of recurrence and breast cancer‐specific mortality. However, many women are poorly adherent to ET. Development of effective adherence support requires comprehensive understanding of influences on adherence. We undertook an umbrella review to identify determinants of ET adherence. Methods: We searched PubMed, Embase, CINAHL, PsycINFO, Cochrane and PROSPERO (inception to 08/2022) to identify systematic reviews on factors influencing ET adherence. Abstracted determinants were mapped to the World Health Organization's dimensions of adherence. Reviews were quality appraised and overlap assessed. Results: Of 5732 citations screened, 17 reviews were eligible (9 quantitative primary studies; 4 qualitative primary studies; 4 qualitative or quantitative studies) including 215 primary papers. All five WHO dimensions influenced ET non‐adherence: The most consistently identified non‐adherence determinants were patient‐related factors (e.g. lower perceived ET necessity, more treatment concerns, perceptions of ET 'cons' vs. 'pros'). Healthcare system/healthcare professional‐related factors (e.g. perceived lower quality health professional interaction/relationship) were also important and, to a somewhat lesser extent, socio‐economic factors (e.g. lower levels of social/economic/material support). Evidence was more mixed for medication‐related and condition‐related factors, but several may be relevant (e.g. experiencing side‐effects, cost). Potentially modifiable factors are more influential than non‐modifiable/fixed factors (e.g. patient characteristics). Conclusions: The evidence‐base on ET adherence determinants is extensive. Future empirical studies should focus on less well‐researched areas and settings. The determinants themselves are numerous and complex in indicating that adherence support should be multifaceted, addressing multiple determinants. [ABSTRACT FROM AUTHOR]

Background: A lifelong gluten‐free (GF) diet to manage coeliac disease is recognised to be challenging. This paper comprises two studies: study one aimed to report the opinions of adults with coeliac disease on review provision and explore factors influencing dietary adherence. Study two aimed to report dietetic provision for adults with coeliac disease. Methods: A cross‐sectional online survey was completed by 722 adults with coeliac disease, including validated dietary adherence, health literacy and quality‐of‐life questionnaires. An online and paper survey designed to capture the provision of dietetic services to adults with coeliac disease was completed by 88 dietetic departments within the United Kingdom. Results: Only 26% of adults with coeliac disease were offered annual reviews. In contrast, 85% considered reviews important, with 62% preferring dietetic provision. Those who considered reviews important had lower health literacy, greater dietary burden, poorer GF dietary adherence and lower GF food knowledge (all p < 0.05) compared with those who did not consider reviews important. GF dietary adherence was associated with health literacy, self‐regulatory behaviours, dietary burden and GF food knowledge; 53% agreed with the 'cost of GF food restricts what I eat'; they had poorer GF dietary adherence compared with those who disagreed (p < 0.001). More than 72% of dietetic coeliac review provision provided content on improving access to GF foods and eating out of the home. Conclusions: A subpopulation of adults with coeliac disease have a greater need for support and guidance, which supports the viewpoint that limited resources should be targeted towards patients with the most need for support to enable successful disease management. Key points: The majority of adults with coeliac disease were not receiving healthcare reviews for coeliac disease, whereas 85% would like to have reviews.Adults living with coeliac disease who had lower health literacy, poorer gluten‐free (GF) food knowledge and poorer GF dietary adherence score rated healthcare reviews as important.A varied provision of dietetic services for coeliac disease reviews was evident across the United Kingdom. [ABSTRACT FROM AUTHOR]

Background: Prophylactic swallowing exercises (PSE) during radiotherapy can significantly reduce dysphagia after radiotherapy in head and neck cancer (HNC). However, its positive effects are hampered by low adherence rates during the burdensome therapy period. Hence, the main goal of this multicenter randomized controlled trial (RCT) was to investigate the effect of 3 different service-delivery modes on actual patients' adherence. Methods: A total of 148 oropharyngeal cancer patients treated with primary (chemo)radiotherapy were randomly assigned to a 4 weeks PSE program, either diary-supported (paper group; n = 49), app-supported (app group; n = 49) or therapist-supported (therapist group; n = 50). Participants practiced 5 days/week, daily alternating tongue strengthening exercises with chin tuck against resistance exercises. Adherence was measured as the percentage of completed exercise repetitions per week (%reps). Statistical analysis was performed by means of SPSSv27, using Linear Mixed-effects Models with post hoc pairwise testing and Bonferroni-Holm correction. Results: Adherence and evolution of adherence over time was significantly different between the three groups (p <.001). Adherence rates decreased in all three groups during the 4 training weeks (p <.001). During all 4 weeks, the therapist group achieved the highest adherence rates, whilst the app group showed the lowest adherence rates. Conclusions: PSE adherence decreased during the first 4 radiotherapy weeks regardless of group, but with a significant difference between groups. The therapist group achieved the highest adherence rates with a rather limited decline, therefore, increasing the face-to-face contact with a speech-language therapist can overcome the well-known problem of low adherence to PSE in this population. Trial Registration: Trial registration: ISRCTN, ISRCTN98243550. Registered December 21, 2018 – retrospectively registered, https://www.isrctn.com/ISRCTN98243550?q=gwen%20van%20nuffelen&filters=&sort=&offset=1&totalResults=2&page=1&pageSize=10&searchType=basic-search. [ABSTRACT FROM AUTHOR]

Purpose: Mindfulness‐Based Cognitive Therapy (MBCT) can improve the lives of those with a chronic condition and psychological distress, however, high drop‐out rates limit benefits. MBCT might be a candidate treatment for this population if nonadherence can be overcome. This review explores the existing literature on the barriers and facilitators to adherence to MBCT for those with chronic conditions. Method: Databases MEDLINE, PsycINFO, CINAHL and Scopus were searched between 28th May and 11th June 2021. We included empirical papers that identified barriers and/or facilitators to MBCT adherence in patients with chronic conditions—excluding non‐English and grey literature. Papers were screened and duplicates removed. Extracted data included: setting, design, aim, sample‐size, population and identified barriers/facilitators to MBCT adherence. The Mixed Methods Appraisal Tool (MMAT) was adapted and used to appraise the quality of studies Results: Twenty papers were eligible for review. Synthesis identified six themes (in prevalence order): (1) Practical Factors (e.g., time and other commitments), (2) Motivation (e.g., change‐readiness), (3) Patient clinical and demographic characteristics (e.g., current physical health), (4) Connection with Others (facilitators and group members), (5) Credibility (perception of the intervention) and (6) Content difficulty (intervention accessibility). Findings highlight potential adaptations to implementation (e.g., clear treatment rationale, preference matching, and eliciting and responding to individual concerns or obstructive assumptions) that could address barriers and harness facilitators. Conclusion: This review contributes a higher order understanding of factors that may support/obstruct client adherence to MBCT with implications for future implementation in research and practice. Future research should prioritize open exploration of barriers/facilitators. [ABSTRACT FROM AUTHOR]

Purpose: An interplay of clinical and psychosocial variables affects breast cancer patients' experiences and clinical trajectories. Several studies investigated the role of socio-demographic, clinical, and psychosocial factors in predicting relevant outcomes in breast cancer care, thus developing predictive models. Our aim is to summarize predictive models for specific psychological and behavioral outcomes: psychological distress, quality of life, and medication adherence. Specifically, we aim to map the determinants of the outcomes of interest, offering a thorough overview of these models.Methods: Databases (PubMed, Scopus, Embase) have been searched to identify studies meeting the inclusion criteria: a breast cancer patients' sample, development/validation of a predictive model for selected psychological/behavioral outcomes (ie, psychological distress, quality of life, and medication adherence), and availability of English full-text.Results: Twenty-one papers describing predictive models for psychological distress, quality of life, and adherence to medication in breast cancer were included. The models were developed using different statistical approaches. It has been shown that treatment-related factors (eg, side-effects, type of surgery or treatment received), socio-demographic (eg, younger age, lower income, and inactive occupational status), clinical (eg, advanced stage of disease, comorbidities, physical symptoms such as fatigue, insomnia, and pain) and psychological variables (eg, anxiety, depression, body image dissatisfaction) might predict poorer outcomes.Conclusion: Predictive models of distress, quality of life, and adherence, although heterogeneous, showed good predictive values, as indicated by the reported performance measures and metrics. Many of the predictors are easily available in patients' health records, whereas others (eg, coping strategies, perceived social support, illness perceptions) might be introduced in routine assessment practices. The possibility to assess such factors is a relevant resource for clinicians and researchers involved in developing and implementing psychological interventions for breast cancer patients. [ABSTRACT FROM AUTHOR]

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Delivering Dialectical Behavior Therapy (DBT) with adherence to the manual is a critical aspect of quality assurance and leads to better outcomes for clients. However, DBT is a challenging treatment to deliver adherently as it requires therapists to learn many strategies and to know when and how to apply them effectively. To date, little is known about the degree to which therapists in routine care deliver DBT adherently or what adherence challenges may be most common in these settings. This paper presents data from two studies in which the DBT Adherence Coding Scale (Linehan, M. M., & Korslund, K. E. (2003). Dialectical behavior therapy adherence coding scale manual. University of Washington.) was used to evaluate 158 DBT individual therapy sessions delivered by 63 therapists to 78 clients in routine practice (non-academic or research) settings. Nearly all therapists (98.4%) had read the DBT manual and attended DBT workshops (M = 17.9 days). Across studies, therapists delivered DBT individual therapy slightly below adherence on average (M = 3.96, SD = 0.18; cut-off for adherence = 4.00). Overall, 54.4% of sessions were adherent and 45.6% of sessions were non-adherent. On average, therapists exhibited highest adherence for acceptance-oriented strategies, moderate adherence for structural strategies, and lowest adherence for change-oriented and dialectical strategies. Informed by these results, we provide recommendations for how to improve adherence for the strategies most frequently delivered non-adherently as well as how to increase use of underutilized strategies. [ABSTRACT FROM AUTHOR]

Cardiovascular disease (CVD) is the primary cause of death and disability worldwide. Although age-standardized CVD mortality rates decreased globally by 14.5% between 2006 and 2016, the burden of CVD remains disproportionately higher in low- and middle-income countries compared to high-income countries. Even though proven, effective approaches based on multiple-drug intake aimed at the prevention and treatment of CVD are currently available, poor adherence, early discontinuation of treatment, and suboptimal daily execution of the prescribed therapeutic regimes give rise to shortfalls in drug exposure, leading to high variability in the responses to the prescribed medications. Wald and Law, in their landmark paper published in BMJ 2003, hypothesized that the use of a fixed-dose combination of statins, β-blockers, angiotensin receptor blockers, angiotensin-converting enzyme inhibitors, and aspirin (classic Polypill composition) may increase adherence and decrease CVD by up to 80% when prescribed as primary prevention or in substitution of traditional protocols. Since then, many clinical trials have tested this hypothesis, with comparable results. This review aims to describe the available clinical trials performed to assess the impact of fixed-dose combinations on adherence, cost-effectiveness, and the risk factors critical to the onset of CVD. [ABSTRACT FROM AUTHOR]

Fidelity of implementation (FOI) is employed to probe into the implementation of the curriculum by English teachers as intended by developers through the curriculum guide. This explanatory-sequential paper sought to probe into the fidelity of implementation practice of high school English teachers using the dimensions of adherence, duration and quality of delivery. Data were gathered using the Curriculum Fidelity of Implementation Survey-Questionnaire, focus group discussion and document analysis. Data analyses were conducted using quantitative and qualitative approaches. Findings revealed that teachers mostly implement the curriculum with average adherence but cited several reasons for not accomplishing the learning competencies. Overall, high quality of delivery was observed and the required time allotment for the Grade 10 English subject was implemented; however, these did not translate to the full implementation of the curriculum. Reasons such as lack of orientation on the learning competencies, intervening and other-teaching related activities, professional development programs during class days, among others resort to teachers' backlogged discussion of the competencies. Implications of and recommendation for the study were provided for future researchers and empirical discussion. [ABSTRACT FROM AUTHOR]

There has been a paradigm shift in the treatment of chronic lymphocytic leukemia (CLL) over the past decade. With the advent of self-administered targeted oral anticancer agents (OAAs), the treatment of CLL has begun to shift from the infusion clinic to the patient's home. This introduced new challenges including patient non-adherence, class-specific adverse effects, and financial toxicity to treatment. In this paper, we discuss a structured approach to identifying and addressing barriers to optimal patient outcomes. We will ground our discussion using the five dimensions of adherence as defined by the World Health Organization (WHO): therapy factors, health-system factors, condition-related factors, social/economic factors, and patient factors. We discuss how each of these domains present in patients with CLL. We will also discuss how we can prevent and address these barriers in through the various phases of treatment. A multidisciplinary program to support patients on OAAs is critical for patients with CLL. This team should involve pharmacists and social workers in addition to nursing, advanced practitioner and physician colleagues. The program should aim to identify, prevent, and address patient-specific barriers by offering individualized solutions. We describe how such a program can be designed and implemented. [ABSTRACT FROM AUTHOR]

This paper explores experiences of PrEP, a HIV-prevention intervention, among bugchasers, gay men who eroticize HIV. While PrEP has been hailed as a "game changer" in HIV-prevention, little attention has been paid to why and how some people may discontinue it in the face of HIV risk, such as bugchasers do. This paper relies on interview data with bugchasers themselves to discuss the process of discontinuation and its effects. The paper argues that, for these men, discontinuation is a fluid, complex, and sometimes contradictory process. It also describes how participants perceived themselves as being at different stages of discontinuation. The paper also analyzes how these men see PrEP as a barrier to intimacy, risk, and a tool to negotiate their desires and identity: through discontinuing PrEP, these men are able to reflect on and build their identities as bugchasers. [ABSTRACT FROM AUTHOR]

Stroke survivors receive considerable rehabilitation efforts as inpatients, but one-on-one therapy decreases after discharge. The gap between the amount of required therapy and the lack of its availability in this phase of care may be partly overcome by self-practice. However, patient's adherence to prescribed programs is often low. While single studies have examined factors affecting adherence in this specific case, they have not been reviewed and synthesised previously. A thematic synthesis of qualitative studies explored factors affecting stroke survivors' adherence to prescribed, recovery-oriented self-practice. Five databases were systematically searched for references: Medline, Psycinfo, CINAHL, Embase, and ASSIA. Quality assessment was undertaken using the CASP tool. From 1308 references, 68 potential papers were read in full, and 12 were included in the review. An overarching theme was identified as: "Tailoring and personalization rather than standardization." It was informed by the following three analytical themes: "The meaning of 'self' in self-practice," "Identifying self-practice as a team effort," and "Self-practice that is grounded in one's reality." To have a positive effect on adherence to self-practice, clinicians are advised to spend time learning about each individual's life circumstances, so they can tailor proposed exercise programs to patients' personal situations, preferences, and needs. The topic of patient's adherence to self-practice of prescribed exercise is a common concern, often voiced by frustrated rehabilitation health professionals. Bridging the gap between the patient's needs for post-discharge intensive therapy and the inability of healthcare systems to provide it could be filled partly by self-practice. Adherence to self-practice has become even more essential since the COVID 19 pandemic and the decrease in face-to-face delivery of rehabilitation due to social distancing requirements. Adherence to exercise is a broad topic. Reasons for poor adherence differ between patient populations and the exercises they are prescribed. This study focuses on post-discharge stroke survivors' adherence to recovery targeted exercise that could be described as repetitive and less physically demanding movements and functions. Reviewed studies were qualitative and usually included a relatively small number of participants within a specific context. Using thematic synthesis, we combined these small pieces of the puzzle into a larger picture, to produce recommendations that could be drawn on by clinicians to improve self-practice adherence. [ABSTRACT FROM AUTHOR]

In the realm of antenatal care, vaccinations serve as a cornerstone, crucial for safeguarding the health of both the mother and the fetus, while also extending protection to the newborn against communicable diseases. Nevertheless, vaccine adherence among pregnant women remains very low. The aim of our study was to evaluate the uptake of vaccines (influence, pertussis, and COVID-19) among women during pregnancy and to understand pregnant women's knowledge of vaccines and the diseases they protect against. The purpose was to investigate the reasons why pregnant women chose not to be vaccinated and to develop effective strategies for informing them about the importance of vaccination for both maternal and fetal safety. A prospective observational study was conducted in the Department of Obstetrics and Gynaecology, "Ospedale Santa Maria della Misericordia" in Udine, from 1 December 2021 to 30 June 2022. During this period, a self-completed paper questionnaire was administered to women at the end of pregnancy or during the puerperium. A total of 161 questionnaires were collected. Higher educational level was found to be significantly associated with influenza vaccination uptake (p = 0.037, OR = 2.18, 95% CI 1.05–4.51). Similarly, for pertussis vaccination, adherence was mainly associated with higher educational level (p = 0.014, OR = 2.83, 95% CI 1.24–6.47), but also with Italian nationality (p = 0.003, OR = 3.36, 95% CI 1.56–8.43) and pregnancy attended by a midwife or private gynecologist (p = 0.028, OR = 0.39, 95% CI 0.17–0.90). Regarding the COVID-19 vaccine, the only factor positively influencing uptake was Italian nationality (p = 0.044, OR = 2.66, 95% CI 1.03–6.91). Women's fear that vaccines would endanger the fetus appeared to be the most important reason for refusing vaccinations. Simultaneously, patients also exhibited a desire to receive more information about maternal vaccination, particularly from their general physician or gynecologist. For this reason, it is imperative to enhance maternal vaccination counselling, making it a routine step in prenatal care from the first antenatal visit until the postpartum period. [ABSTRACT FROM AUTHOR]

Prophylactic swallowing exercises (PSE) during head-and-neck cancer (HNC) (chemo)radiotherapy (CRT) have a positive effect on swallowing function and muscle strength. Adherence rates to PSE are, however, moderate to low, undermining these effects. PRESTO already showed that the service-delivery mode (SDM), the way the exercises are offered, can influence adherence. The aim of this study was to investigate the effect of SDM on swallowing function and muscle strength during and post-CRT. In addition, the effect of overall adherence (OA), independent of SDM, was also investigated. A total of 148 HNC patients, treated with CRT, were randomly assigned to one of the three SDM's (paper-supported, app-supported, or therapist-supported PSE) and performed a 4-week PSE program. OA was calculated based on the percentage of completed exercises. Patients were divided into OA levels: the OA75+ and OA75− group performed respectively ≥ 75 and < 75% of the exercises. Swallowing function based on Mann Assessment of Swallowing Ability-Cancer (MASA-C), tongue and suprahyoid muscle strength during and up to 3 months after CRT were compared between the SDM's and OA levels. Linear Mixed-effects Models with post hoc pairwise testing and Bonferroni–Holm correction was used. No significant differences were found between the three SDMs. Significant time effects were found: MASA-C scores decreased and muscle strength increased significantly during CRT. By the end of CRT, the OA75+ showed significantly better swallowing function compared to OA75−. Muscle strength gain was significantly higher in the OA75+ group. SDM had no impact on swallowing function and muscle strength; however, significant effects were shown for OA level. Performing a high level of exercise repetitions is essential to benefit from PSE. Trial registration ISRCTN, ISRCTN98243550. Registered December 21, 2018—retrospectively registered, https://www.isrctn.com/ISRCTN98243550?q=gwen%20van%20nuffelen&filters=&sort=&offset=1&totalResults=2&page=1&pageSize=10&searchType=basic-search [ABSTRACT FROM AUTHOR]

Background: When parents bring their child to appointments and then adhere to agreed speech and language therapy (SLT) recommendations, there is the potential to increase the intensity of the intervention, support generalization and improve outcomes. In SLT, however, little is known about factors that may promote attendance or adherence. Studies in other clinical areas such in medicine, psychology and physiotherapy have identified risk factors for non‐attendance or non‐adherence that are multifactorial and variable dependent on, for example, population and intervention. Aims: To identify rates of non‐attendance and non‐adherence, and to identify parent or child factors associated with parent involvement in intervention for children under 5 years of age receiving SLT. Methods: Parents completed questionnaires at two time points assessing the domains of parents' beliefs (problem perceptions, self‐efficacy), personal circumstances (socio‐demographics, family functioning), treatment experience and child factors. Predictors of parent attendance and adherence were identified through multiple regression analyses. Non‐attendance rates were identified via local health records and non‐adherence ascertained using a specific parent‐reported measure within the treatment experience domain. Results: Participants (N = 199) were predominantly mothers, and were ethnically and socio‐economically diverse, speaking a wide range of languages. Their children presented with a range of speech, language communication needs (SLCN). The rate of non‐attendance was 25% and the main predictors of non‐attendance were maternal age, education level and two factors within the parent beliefs domain. This model explained 40% of the variance in attendance. The rate of non‐adherence in this cohort was 26% with parental rating of the importance of a recommendation and self‐efficacy beliefs predicting adherence; this explained 56% of the variance in adherence to SLT recommendations at home. Conclusions & Implications: Our research has provided preliminary evidence of the influence of parents' beliefs, personal circumstances and treatment experiences on their involvement in their child's therapy. Speech and language therapists should consider factors impacting attendance and adherence to treatment and explore parental perceptions of their child's SLCN before embarking on an intervention, a foundation for collaborative practice. A possible limitation of this study is that the levels of attrition in our sample led to generally high measured rates of participation, which should be considered in future studies. Future research should explore adherence in treatments with varying doses, with different types of SLCN or interventions and in different settings. WHAT THIS PAPER ADDS: What is already known on the subject: It is acknowledged that parent involvement in their child's therapy, such as attending and adhering to recommendations, is important but little is known about the rates of involvement and what factors may be associated with attendance and adherence in SLT. Qualitative research has explored parental involvement suggesting that beliefs about an intervention may be pertinent. Extensive research in other clinical areas suggest multiple and varied factors are influential and further exploration of particular populations and interventions is necessary. What this paper adds to the existing knowledge: This study identified rates of parental non‐attendance and non‐adherence in a cohort of predominantly mothers of children under the age of 5 years. It is the first study to measure parent adherence in SLT and identify factors that are associated parental adherence to SLT recommendations. It adds to the small body of SLT specific research in understanding risk factors for non‐attendance. What are the potential or actual clinical implications of this work?: This study highlights the need for a speech and language therapist to consider and explore parents' perspectives of their child's SLCN as a part of achieving collaboration with a parent in order to achieve the best outcomes. It provides a foundation for further systematic research into parent involvement with the ultimate aim of enhancing outcomes for children with SLCN. [ABSTRACT FROM AUTHOR]

Introduction: Current evidence reveals concerning rates of non-adherence to antidepressant treatment, possibly influenced by various relevant determinants such as sociodemographic factors or those related to the health system and their professionals. The aim of this paper is to review the scientific evidence on sociodemographic and clinical predictors of adherence to pharmacological treatment in patients diagnosed with a depressive disorder. Methods: a systematic review (SR) was conducted. The search for a previous SR was updated and de novo searches were performed in Medline, EMBASE, Web of Science (WoS) and PsycInfo (last 10 years). The risk of bias was assessed using the Cochrane tool for non-randomized studies-of Exposure (ROBINS-E). Meta-analyses were conducted. Results: Thirty-nine studies (n = 2,778,313) were included, 24 of them in the meta-analyses. In the initiation phase, no association of adherence was found with any of the predictors studied. In the implementation and discontinuation phases, middle-aged and older patients had better adherence rates and lower discontinuation rates than younger ones. White patients adhered to treatment better than African-American patients. Discussion: Age and ethnicity are presented as the predictive factors of pharmacological adherence. However, more research is needed in this field to obtain more conclusive results on other possible factors. [ABSTRACT FROM AUTHOR]

Objective: This manuscript aims to provide a review and synthesis of contemporary advancements in footwear, sensor technology for remote monitoring, and digital health, with a focus on improving offloading and measuring and enhancing adherence to offloading in diabetic foot care. Methods: A narrative literature review was conducted by sourcing peer‐reviewed articles, clinical studies, and technological innovations. This paper includes a review of various strategies, from specifically designed footwear, smart insoles and boots to using digital health interventions, which aim to offload plantar pressure and help prevent and manage wounds more effectively by improving the adherence to such offloading. Results: In‐house specially made footwear, sensor technologies remotely measuring pressure and weight‐bearing activity, exemplified for example, through applications like smart insoles and SmartBoot, and other digital health technologies, show promise in improving offloading and changing patient behaviour towards improving adherence to offloading and facilitating personalised care. This paper introduces the concept of gamification and emotive visual indicators as novel methods to enhance patient engagement. It further discusses the transformative role of digital health technologies in the modern era. Conclusions: The integration of technology with footwear and offloading devices offers unparallelled opportunities for improving diabetic foot disease management not only through better offloading but also through improved adherence to offloading. These advancements allow healthcare providers to personalise treatment plans more effectively, thereby promising a major improvement in patient outcomes in diabetic foot ulcer healing and prevention. [ABSTRACT FROM AUTHOR]

Objective: Self-monitoring of blood glucose (SMBG) plays a vital role in the maintenance of blood glucose with type 2 diabetes mellitus(T2DM) and prediabetes patients. The study was intended to describe the current status of SMBG with T2DM and pre-diabetes patients in grassroots communities, explore the relationship between SMBG frequency and blood glucose level and apply information-motivation-behavior(IMB) model to analyze the potential influencing factors of SMBG compliance based on electronic questionnaires. Methods: A cross-sectional study was conducted with 1388 T2DM and prediabetes patients who completed electronic questionnaires composed of demographics and IMB model content. Chi-square test, Mann-Whitney U test and multivariable logistic regression model analysis were utilized to explore deeply causes of SMBG compliance. Results: The results of this study showed that among 1388 T2DM patients, only 26.2% (363/1388) patients reached SMBG standard, indicating low compliance with SMBG. Given that SMBG is one of the individual predictors of type 2 risk in prediabetes patients, this result suggests that the SMBG compliance rate needs to be improved. Patients with fixed occupation (OR=1.989, P=0.035), BMI in normal range (OR=1.336, P=0.049), smoking habit(OR=1.492, P=0.019), understanding SMBG frequency (OR=1.825, P<0.001), understanding control goal of blood glucose (OR=1.414, P<0.001), knowing all the functions of the blood glucose meter (OR=1.923, P<0.001), buying a blood glucose meter/test paper conveniently(OR=2.329, P=0.047), taking supplementary measurement when forgetting blood glucose test(OR=2.044, P=0.005), rotating all the fingers when measuring blood glucose (OR=1.616, P<0.001) and less pain at the needling site(OR=2.114, P<0.001)were independently promoting factors of adherence to SMBG. However, the lack of accessibility and convenience of blood glucose meter or heavy financial burden were blocking factors of adherence to SMBG. Moreover, there were still bottlenecks such as lack of health care knowledge and needle pricking pain. Conclusion: This study verified the practicability of applying IMB model to SMBG with T2DM and pre-diabetes patients. Adherence to SMBG still remained to improved, and putting more emphasis in improvement of individual information, motivation and behavioral skills with patients might be beneficial to maintain better adherence to SMBG in long-term routine of diabetes self-management. [ABSTRACT FROM AUTHOR]

Dysphagia is a common consequence of head and neck radiation and may be mitigated by performance of swallowing exercises during radiation treatment. Given historically poor adherence to such exercise protocols, we created a mobile health application, HNC Virtual Coach as an adjunct to standard clinical care. This randomized control trial investigated the impact of HNC Virtual Coach on adherence as well as swallowing outcomes by comparing those using the mobile app to those receiving only standard clinical care and paper logs. Both treatment groups were provided with the same exercise protocol as well as the same baseline educational information. Outcome measures included adherence rates, physiologic measures obtained during a Modified Barium Swallow Study (PAS, MBS-ImP, DIGEST), patient-reported outcomes (MDADI), diet levels (FOIS, PSS-HN), and quality of information received (INFO-25). Patients using the HNC Virtual Coach tended to have better adherence to treatment recommendations during radiation therapy. Increased adherence was associated with better patient-reported quality of life, but not physiologic function 2–3 months following completion of radiation. Results suggest that a mobile health application may provide benefit for some patients undergoing head and neck radiation. [ABSTRACT FROM AUTHOR]

Objective of this paper was to describe the various definitions for engagement used in HIV clinical trials. Methods: Articles were retrieved from CASCADE, a database of 298 clinical trials conducted to improve the HIV care cascade (https://hivcarecascade.com/), curated by income level, vulnerable population, who delivered the intervention, the setting in which it was delivered, the intervention type, and the level of pragmatism of the intervention. Studies with engagement listed as an outcome were selected from this database. Results: 13 studies were eligible, of which five did not provide an explicit definition for engagement. The remaining studies used one or more of the following: appointment adherence (n=6), laboratory testing (n=2), adherence to antiretroviral therapy (n=2), time specification (n=5), intervention adherence (n=5), and quality of interaction (n=1). Conclusion: This paper highlights the existing diversity in definitions for engagement in the HIV care cascade and categorize these definitions into appointment adherence, laboratory testing, adherence to antiretroviral therapy, time specification, intervention adherence, and quality of interaction. We recommend consensus on how to describe and measure engagement. [ABSTRACT FROM AUTHOR]

This systematic review assessed four measurement properties of measures (instruments) used by researchers to assess adherence to caregiver facilitated therapeutic activities (CFTA) for children in published research. The measurement properties considered in this systematic review were dyadic considerations, interpretability, reliability, and validity of the instruments used to assess adherence or compliance. Two databases ( and EMBASE) were searched for studies that reported adherence or compliance to CFTA prescribed by physiotherapists or occupational therapists or speech and language therapists. Papers included in this review were those that studied children less than 18 years old and or their primary caregivers. Data were extracted by the authors using a data extraction table adapted from the work of Bollen and colleagues (2014) and by rating the measurement properties of the adherence measures identified based on predefined rating criteria (see supplementary file and Table 1 respectively). The authors relied only on the published research articles and any associated published supplementary files/data. None of the 40 adherence instruments identified wholly fulfilled all the criteria of the four measurement properties assessed. The results of this systematic review show that the measures used by researchers for assessing adherence to CFTA generally lack validity, reliability, and dyadic considerations. [ABSTRACT FROM AUTHOR]

Purpose: Most people living with HIV (PLH) in the United States are over age 50 and this sector of PLH continues to grow. Aging with HIV can be challenging due to comorbid medical conditions, mental health disorders, substance use, and lack of social and practical support. Additional challenges are faced by older PLH living in the rural United States, such as longer distances to health care, concerns over privacy and stigma, and social isolation. PLH in rural areas have higher mortality rates than urban PLH. We aimed to understand factors associated with HIV care engagement and quality of life in rural US adults over age 50. Methods: We conducted a cross‐sectional study to evaluate the association between patient‐level factors and a combined outcome variable encompassing multiple aspects of care engagement. Findings: Either online or on paper, 446 participants completed our survey. One‐third of the participants (33%) were from the southern United States; one‐third were women; one‐third were non‐White; and 24% completed the survey on paper. In multiple regression analysis, lower income, residing in the southern United States, lacking internet access at home, not having an HIV specialist provider, higher levels of stress, living alone, and longer distance to an HIV provider were all associated with lower engagement in HIV care. Conclusions: Our findings demonstrated multiple potential options for interventions that could improve care engagement, such as providing and enhancing access to technology for health care engagement and remotely delivering social support and mental health services. Research on such potential interventions is needed for older, rural PLH. [ABSTRACT FROM AUTHOR]

Background: Human papillomavirus (HPV) infection is the most common sexually transmitted viral infection in the world. HPV vaccination adherence rates in men are generally lower than in women. The aim of this systematic review and meta-analysis was to assess adherence to HPV vaccination in young working-age males (18–30 years old). Methods: A systematic review was performed using three databases: PubMed, Scopus, and Web of Science, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Results: After duplicate removal, the initial search resulted in 478 eligible papers. With the exclusion of 425 papers after screening the abstracts, full texts of 53 articles were reviewed. Subsequently, 45 were excluded. Among the eight studies included, four (50%) examined the vaccination adherence in young adults through data registered in nationwide insurance or private companies' databases, three (37.5%) in young adults in different settings through data collected from surveys and questionnaires, and one (12.5%) an HPV vaccination campaign in a family medicine residency practice. Conclusion: Adherence to HPV vaccination in men of working age (18–30 years) does not appear to be adequate (pooled prevalence 11%). In order to achieve a higher level of compliance, it is important to place an emphasis on vaccination campaigns in schools as well as in the workplace, after consultation with and approval from local, regional, and federal public health agencies. [ABSTRACT FROM AUTHOR]

Background: Interest in research on the topic of nursing interventions and medication adherence in tuberculosis (TB) patients has increased. In future research, researchers need information about trends and new things for the topic of nursing intervention research and medication adherence in tuberculosis patients in the future. Purpose: The purpose of this research is to explore the trend of the number of publications, the trend of the number of citations, the journal with the highest number of publications, network visualisation, overlay visualisation, and density visualisation on the topic of nursing interventions and medication adherence in tuberculosis patients through bibliometric analysis. Research method: Bibliometric analysis was used in this study. The data is identified through the https://app.dimensions.ai/ database, which is then selected using the PRISMA flowchart. Papers are limited to publication in 2018- 2023, focusing on the fields of health sciences, nursing, public health, the science of services and health systems, information science, and types of publications are articles. Data were analysed using VOSviewer, and then the analysis results were reviewed by co-occurrence. Results: A search for publications on nursing interventions to improve medication adherence in TB patients resulted in 60,204 articles. After being filtered through the specified criteria, the number of articles obtained was 3,237. The peak of publications on nursing interventions to improve medication adherence in TB patients occurred in 2018. Meanwhile, the lowest number of publications occurred in 2023. The health sector and other fields such as Human society, Information and computing science, and Psychology carry out research on nursing interventions to improve medication adherence in TB patients. In addition, health trends in nursing interventions to improve medication adherence in TB patients currently focus on using digital technology-based interventions such as mobile health applications, health education, and family support. The density visualisation shows that the topics not widely researched related to nursing interventions to improve medication adherence in TB patients are application, mobile health, health education, family, social support, stigma, and attitude. Conclusion: The topic of nursing interventions to improve medication adherence in TB patients is a topic that needs to be further developed in various countries. Suggestions for other researchers: please choose a theme included in the visualisation category that has not been widely researched to find novelty for future studies. [ABSTRACT FROM AUTHOR]

The risk of vitamin D deficiency is high in infants. Therefore, potential vitamin D deficiency should be prophylactically treated with vitamin D supplementation. Achieving good adherence to recommended prophylactic regimens is the goal of every primary pediatrician. The aim of this paper was to establish whether Croatian infants receive recommended prophylactic doses of vitamin D regularly. We analyzed the prescription rate of vitamin D preparation during the first year of life in one pediatric primary practice. Our research has shown, for the first time in Croatia, that there is low treatment adherence. Only 7.6% of infants received the recommended doses of vitamin D. The percentage of infants in the moderately irregular adherence group was 19.3%. There was no statistical difference regarding urban or rural place of living or parents' educational level. Based on these findings, a comprehensive public health campaign is needed to improve adherence to vitamin D supplementation during infancy. Also, further studies on larger samples and on a national level are warranted. [ABSTRACT FROM AUTHOR]

We know very little about exercise adherence, compliance and sustainability in multiple sclerosis (MS), yet adherence is seemingly important for yielding immediate and sustained health benefits. This paper is focused on exercise adherence, compliance and sustainability in the context of informing research and practice involving MS. This focus is critical for clarifying terminology for future research and providing a roadmap guiding clinical research and practice. Our objective was accomplished through a narrative summary of the literature by a panel of experts on exercise adherence from the Moving Exercise Research in Multiple Sclerosis Forward (MoXFo) initiative and a concluding summary of the state of the literature and future research directions. The panel of experts identified three overall themes (Background and Importance; Understanding and Promoting Exercise Adherence, Compliance and Sustainability and Challenges to Exercise Adherence, Compliance and Sustainability) that represented a categorization of nine subthemes. These overall themes and subthemes formed the basis of our recommendations regarding future research broadly involving exercise adherence in MS. Overall, there is limited evidence on rates and determinants of exercise adherence and compliance in MS, and little is known about techniques and interventions for immediate and long-term exercise behaviour change. [ABSTRACT FROM AUTHOR]

Introduction: The CDC (2020) revealed that the age-adjusted prevalence of diabetes mellitus in the United States among the Black, non-Hispanic population is 16.8%. A study conducted by Bivins et al. (2021) revealed a 39% prevalence of type 2 diabetes mellitus (T2DM) among Haitian Americans (HAs) living in several states. In the literature, HAs are often grouped with Black Americans, yet Haitian American women (HAW) have unique struggles with treatment and management of T2DM. No prior study used the empowerment theory to improve the management of T2DM in HAW. Purpose: To improve the understanding of T2DM in HAW using empowerment theory. This article is the second installment of a two-part series discussing findings from a 2017 hermeneutic phenomenological study conducted with 25 HAW living with T2DM in South Florida. Methods: This phenomenological study used Van Manen's six research techniques to guide this qualitative inquiry involving 25 HAW. Results: Several themes emerged from the data analysis. This paper discusses two themes that can be addressed through empowerment theory to improve health outcomes: (a) challenges to adhering to treatment regimen, with the subthemes of health beliefs, mistrust, and perceived powerlessness, and (b) recognizing the enemy--stress. Discussion: This paper will demonstrate how nurses are well positioned to educate HAW with T2DM to manage their condition better and increase adherence to treatment by using the empowerment theory. [ABSTRACT FROM AUTHOR]

Aim: Cognitive assessment services were found to be beneficial to older people with cognitive complaints but information is limited on adherence to the recommendations provided. This study aimed to identify predictors of clients' adherence to nursing recommendations after attending a community‐based nurse‐led cognitive assessment service in Hong Kong. Methods: A cross‐sectional design was adopted. We analysed a dataset routinely collected from clients attending the services between January 2012 and January 2018. Multiple regression analyses were conducted to identify predictors (demographics, functional health status and cognitive performance) of the clients' adherence. Their satisfaction with the services was also examined. Results: Two hundred and twenty‐three clients attended the clinic. Of the 133 who completed the telephone follow‐up at the 6 months postconsultation, 44.1% did not adhere to the recommendations. Clients with a higher Clinical Dementia Rating (OR = 4.17), lower Clock Drawing Test score (OR = 1.13) and lower education level (OR = 0.91) were found to be less likely to adhere to the nursing recommendations. Ninety‐six percent (190/198) were satisfied with the overall services. Conclusion: Cognitive assessment services in nurse‐led clinics could provide a self‐referred service for older people with cognitive complaints. However, low adherence to nursing recommendations was found among clients with poorer cognitive functions and lower education levels. Summary statement: What is already known about this topic: Community‐based nurse‐led cognitive assessment services were found to be beneficial to older people with cognitive complaints by providing clients with timely screening, assessment, education and advice.Nonadherence to the recommendations of health‐care professionals could pose significant risks to the clients' health.There has been limited research on clients' adherence to the recommendations of nurses at community‐based cognitive assessment services. What this paper adds: About 44.1% of clients receiving a cognitive assessment did not adhere to the nursing recommendations. Those with poorer cognitive functions and lower education levels were found to be less likely to be adherent.About 96% of clients attending the community‐based cognitive assessment services in a nurse‐led clinic expressed satisfaction with them. The implications of this paper: Community‐based cognitive assessment clinics should develop appropriate strategies to improve clients' adherence, especially those with poor cognitive functions and lower education levels.Future research should investigate why clients with poor cognitive functions and lower education levels are less likely to adhere to nursing recommendations. [ABSTRACT FROM AUTHOR]

This scoping review maps recent research into peer navigation programs for people living with HIV. Four databases were systematically searched in June 2020. Results were screened according to defined criteria and were not restricted to any design, outcome or country. Six papers drew from randomised control trials, five from quasi-experimental or pragmatic trials, and four panel, eight qualitative, three mixed method and one cross-sectional designs were included for review. Programs incorporated health systems navigation and social support. Authors provided strong theoretical bases for peers to enhance program effects. Studies primarily reported program effects on continuum of care outcomes. Further research is required to capture the role HIV peer navigators play in preventing disease and promoting quality of life, mental health, and disease self-management in diverse settings and populations. Peer programs are complex, social interventions. Future work should evaluate detailed information about peer navigators, their activities, the quality of peer engagement as well as employee and community support structures to improve quality and impact. [ABSTRACT FROM AUTHOR]