Search

Older adults with memory loss often require assistance from caregivers to manage their medications. This study examined the efficacy of a problem-solving-based intervention focused on caregiver medication management, problem solving, self-efficacy, and daily hassles. Caregiver health-related quality of life (HRQoL) and patient health care utilization were secondary outcomes. Totally, 83 patients (age 79.9±8.8 years) and their informal caregivers (age 66.9±12 years, female 69.9%, White 85.5%) were randomized; data collection occurred at baseline, 8, 16, and 24 weeks. Linear mixed modeling showed significant decreases in medication deficiencies which were sustained over time. No significant changes in caregiver problem solving, daily hassles, or patient health care utilization occurred between groups or over time. In addition, caregiver self-efficacy and mental HRQoL decreased in both groups. Physical HRQoL decreased in the intervention group, yet increased in the usual care group. Future research should investigate these outcomes in larger and more diverse samples. [ABSTRACT FROM AUTHOR]

The high prevalence of chronic illnesses in South Asian Indian immigrant women underscores the need for identifying factors that could influence their PA. The purpose of this qualitative study was to examine the perspectives of South Asian Indian immigrant women related to barriers to and motives for lifestyle PA within the PA Framework for South Asian Indian Immigrants. Forty women participated in focus groups that were conducted in English and Hindi. Focus group questions were open-ended and semistructured. Transcribed and de-identified audiotaped sessions were coded and analyzed using Atlas.ti software. Role expectation was a core theme for barriers with four subthemes: lack of time, loss of interest, diminished social support, and environmental constraints. Self-motivation was a core theme for motives with three subthemes: optimal physical and psychological health, emphasis on external beauty, and strong social support. Future PA interventions need to target these culturally sensitive factors. [ABSTRACT FROM AUTHOR]

Limited research exists assessing problem-solving capabilities among caregivers of individuals with memory loss using a validated instrument. To address this gap, the current study evaluated the psychometric properties of the Problem Solving Inventory (PSI) using data at baseline and 8 weeks from a randomized controlled trial among caregivers (N = 78) of community-dwelling individuals with memory loss. Participants were mainly White (85.9%), female (71.8%), and on average age 66.5. Cronbach's alphas ranged from 0.84 to 0.92 for the subscales and overall PSI. Test-retest reliability over 8 weeks ranged from 0.44 to 0.56. Five factors were retained through exploratory factor analysis. Spearman's correlations showed convergent validity and discriminant validity between scores on the PSI and Beck Depression Inventory®-II (r = 0.32, p < 0.01), the Self-Efficacy for Managing Chronic Disease Scale (r = -0.44, p < 0.001), and the Newest Vital Sign questionnaire (r = -0.07, p > 0.05). Findings show that the PSI is reliable and valid in assessing problemsolving capabilities among caregivers of individuals with memory loss. [ABSTRACT FROM AUTHOR]

Aim To examine the mediating role of social support on the relationship of depressive symptoms to medication adherence and self-care activities in Korean adults. Background Recent evidence suggests that higher levels of social support are associated with improved medication adherence and self-care activities; however, the role of social support on the relationship of depressive symptoms to medication adherence and self-care activities is less well understood. Design A cross-sectional survey. Methods The data were collected from 311 Korean adults with type 2 diabetes who were taking hypoglycaemic agents in the period 2012-2013. Depressive symptoms, social support, medication adherence and self-care activities were assessed using structured questionnaires. Multiple regression analysis with adjustment for covariates and the Sobel test were used to examine the mediating effect of social support on the relationship of depressive symptoms to medication adherence and self-care activities. Results There were statistically significant differences by subgroups with and without depressive symptoms in social support, medication adherence and self-care activities of diet, physical activity and stress management. The Sobel test confirmed that social support mediated the effect of depressive symptoms on medication adherence and self-care activities of diet, physical activity and stress management. Conclusion The evidence from this study suggests that social support-enhancing interventions that also manage depressive symptoms may be more timely and effective than interventions that target depressive symptoms alone in promoting adherence to medication adherence and self-care activities in this population. [ABSTRACT FROM AUTHOR]

Increasingly, family members are assisting with the complex task of medication management when patients are experiencing cognitive decline. To date, limited published research addresses caregiver-mediated medication management of patients with impaired cognition. Thus, the purpose of this study was to describe the characteristics and correlates of caregiver-mediated medication management in community-dwelling patients with memory loss. We used baseline data from the 91 patient-caregiver dyads participating in a randomized controlled trial designed to assist caregivers of patients with memory loss with medication management. The patient's level of cognitive impairment was not related to medication errors; however, the number of medications that patients were prescribed and taking was related to medication errors. Important factors to consider when discussing medication management with caregivers of patients with memory loss include the caregiver's age, cognitive ability, and depressive symptoms, as well as the caregiver's perception of the impact of the patient's behavioral problems. [ABSTRACT FROM AUTHOR]

colbert a.m., sereika s.m. & erlen j.a. (2012) Functional health literacy, medication-taking self-efficacy and adherence to antiretroviral therapy. Journal of Advanced Nursing 69(2), 295-304. doi: 10.1111/j.1365-2648.2012.06007.x Abstract 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. [ABSTRACT FROM AUTHOR]

Background and Purpose: This study examined the psychometric properties of a 9-item Morisky Medication Adherence Scale (MMAS-9) adapted specifically for patients with HIV/AIDS. Methods: We used data from two randomized controlled trials investigating telephone-delivered interventions for improving adherence to antiretroviral therapy to assess reliability (Cronbach’s α and Pearson’s product correlation) and validity (convergent and concurrent) of the MMAS-9. Results: The internal consistency (Cronbach’s α) of the MMAS-9 was.66 (study 1) and.69 (study 2); 3-month test–retest reliability (Pearson’s correlation) ranged from.50 to.74. Validity was supported by associations with electronic event monitored adherence, social support, depressive symptoms, self-efficacy, stigma, regimen complexity, and impact of side effects in the hypothesized direction. Conclusions: The adapted MMAS-9 demonstrated good convergent validity but somewhat lower internal consistency reliability than other reports. [ABSTRACT FROM AUTHOR]

Supplemental digital content is available in the text. Background: Diabetes self-management and glycemic control are suboptimal among Chinese patients with Type 2 diabetes with a large proportion of patients identified with metabolic syndrome. Objectives: Based on social cognitive theory, this study examines the effect of selected personal, behavioral, and environmental factors on self-management behaviors, glycemic control, metabolic syndrome and Type 2 diabetes. Methods: A cross-sectional study was conducted among 207 Chinese with Type 2 diabetes living in a suburban area of Beijing, China. Regression models were applied to examine the effect of selected personal, behavioral, and environmental factors on self-management behaviors, glycemic control, and metabolic syndrome. The relationship among individual self-management behaviors, glycemic control, and metabolic syndrome was also examined. Results: Self-efficacy was significantly associated with all self-management behaviors. Social support was related to overall self-management, diabetes knowledge was related to diet, and depressive symptoms was related to self-monitoring. Problem-solving and self-management behaviors related to medication adherence and diet were significant correlates of glycemic control. Health literacy and self-management behaviors related to physical activity were correlates of metabolic syndrome. Discussion: Findings suggest that a multifactorial approach may be beneficial when providing care for Chinese with Type 2 diabetes. In addition, these findings provide support for developing and testing tailored interventions that address problem-solving, health literacy, and self-efficacy, among other factors, to help patients achieve optimal glycemic control and thereby reduce their risk for metabolic syndrome and related complications. [ABSTRACT FROM AUTHOR]

Background: Understanding caregiver's perceptions of their family member's memory loss is a necessary step in planning nursing interventions to detect and address caregiver burden. Objective: The purpose of this study was to characterize caregivers' perceptions of their family members' memory loss and identify potential correlates within Leventhal's common sense model (CSM). Methods: This secondary analysis used baseline data from a larger randomized controlled trial. Patients with memory loss and their caregivers (N = 83 dyads) from the community were included. The adapted Brief Illness Perception Questionnaire (BIPQ) assessed caregivers' illness perceptions. Eight additional instruments measured correlates within the CSM. Responses were described; multiple linear regression was used to predict BIPQ dimension scores, and logistic regression was used to predict dichotomized BIPQ scores. Results: Most caregivers were female, White, and spouses of the patients; they reported a range of perceptions on the nine BIPQ dimensions. Patients' cognitive function consistently emerged as a significant correlate of caregivers' illness perceptions, explaining the most variance in caregivers' perceived consequences, identity, and treatment control (p < .01). Caregivers' reactions to patients' behavioral symptoms and caregivers' trait anxiety were associated with perceived illness coherence (p < .01). Caregivers with higher severity of daily hassles and White caregivers perceived that their family members' memory loss would last longer (p < .001). Discussion: Caregivers' perceptionsof family members' memory loss varied; distinct dimensions of caregivers' illness perception were associated with a range of clinical and psychosocial factors. This exploratory study demonstrates the complexity of applying the CSM to caregivers of persons with memory loss. [ABSTRACT FROM AUTHOR]

The article discusses a study to describe the assessment of fidelity to the structured intervention protocol in an examination of a nurse-delivered telephone intervention designed to improve medication adherence for individuals with HIV/AIDS. It offers details related to fidelity assessment that involved random selection and review of the audiorecorded intervention sessions, stratified by interventionist, and the use of visual analog scales. Also discussed is the result of the study.