Patient preference and adherence最新文献

Background: Despite proven benefits, intelligent personalized exercise prescription (IPEP) adherence remains low in middle-aged and older adults with chronic diseases (MOACD). Research evidence suggests that mobile health (mHealth)-based gamification interventions can improve participation in physical activity; however, their effects on adherence to IPEP remain unclear. Moreover, most studies report that adherence often declines rapidly once gamification interventions end, and no effective strategies have been proposed to address this issue. This study embeds the Octalysis gamification framework into a smartphone-based app to investigate the effects of an mHealth-based gamification intervention on adherence to IPEP among MOACD, as well as on related physical and psychological outcomes. Additionally, the study examines whether combining gamification interventions with health education can help sustain adherence after the intervention concludes.

Methods: We propose a double-center, single-blind, three-arm randomized controlled trial. We will recruit 132 MOACD who will participate in dyads (66 pairs). Participants will be randomly assigned to three groups: a non-gamification group, a gamification group, or a health education plus gamification group. The intervention will last for 12 weeks, followed by a 12-week follow-up period. The primary outcome is adherence to IPEP, defined as the proportion of days on which participants completed their prescribed exercise tasks at 12 and 24 weeks. Secondary outcomes include biomedical risk factors, sedentary behavior, sleep quality, self-efficacy, intrinsic motivation, patient satisfaction, and the acceptability of the intervention.

Conclusion: This trial employs the Octalysis gamification framework to design an intervention aimed at enhancing adherence to the IPEP. The findings may inform the development of scalable digital interventions to promote physical activity and long-term adherence among MOACD.

With aging populations worldwide, informal caregivers (ICs) play an essential role in transitional hospital-to-home care for older people, providing essential first-line support, clinical assistance, emotional care, and crucial coordination of care. However, their involvement in discharge planning remains insufficiently recognized, potentially compromising patient safety and continuity of care. Despite their vital contributions and growing policy initiatives, ICs' involvement in hospital discharge planning remains insufficiently recognized. This lack of structured integration leads to significant gaps in communication, education, and collaborative care planning-factors that can compromise patient safety, disrupt continuity of care, and increase caregiver burden. ICs often report feeling unheard and excluded from key decisions, which contributes to adverse outcomes for both patients and ICs. Addressing these gaps requires comprehensive systemic changes aimed at formalizing the role of ICs in professional training, hospital discharge protocols, and integrating ICs meaningfully into care decision-making processes. This perspectives article provides an overview of the current state of IC involvement in transitional care, reflects on its relevance among healthcare professionals, policymakers, and researchers, and explores the implications for patient safety and health outcomes. Drawing on evidence-based models such as the Transitional Care Model and Better Outcomes for Older people through Safe Transitions, the article discusses key strategies to enhance IC participation. These include raising awareness among professional caregivers, improving communication and information transfer, formally recognizing and integrating ICs as care partners, and leveraging technology and support systems tailored to their needs. By fostering structured partnerships and collaborative approaches with ICs, healthcare systems can improve the quality and safety of transitional care while alleviating caregiver burden and promoting better long-term health trajectories for older people.

Introduction: Spinal cord injury (SCI) individuals undergoing home-based rehabilitation face multiple challenges, including functional impairments, bladder dysfunction, and employment barriers. Poor bladder management impacts autonomy, health, and quality of life, while limited mobility and environmental inaccessibility hinder return-to-work.

Objective: To assess rehabilitation priorities and unmet needs among home-based individuals with SCI, focusing on bladder management, functional limitations, and employment reintegration. The study aims to identify personal, medical, and environmental factors affecting rehabilitation outcomes.

Methods: A cross-sectional survey was conducted from May to September 2023 by West China Hospital, Sichuan University. A total of 3,055 SCI individuals across mainland China completed an online questionnaire assessing demographics, functional status, rehabilitation goals, and employment challenges. Descriptive statistics, t-tests, ANOVA, Chi-square, and multivariate regression were used for data analysis.

Results: Challenges: Most participants (80.88%) had traumatic SCI. Significant daily life barriers included financial burden (46.0%), unemployment (44.1%), accessibility issues (34.3%), health concerns (29.5% frequent medical visits; 25.7% persistent issues), and stigma (26.8%). Only 2.7% could walk ≥1 km independently. Rehabilitation Goals: Bladder function improvement (49%) was the top priority, followed by restoring mobility (standing 17%; walking 16%) and preventing complications (10%). Notably, 63.3% did not define specific bladder management targets. Predictors: Multivariate analysis showed that thoracic/cervical injury, complete paralysis, and limited mobility were predictors of prioritizing bladder management (p<0.001). Employment reintegration was significantly influenced by mobility level, environmental accessibility, and social factors such as stigma and recurrent illness.

Conclusion: SCI individuals face intertwined challenges that impact rehabilitation and social participation. Bladder care, mobility, psychosocial stressors, and environmental access are key factors shaping rehabilitation priorities and employment outcomes. Individualized, biopsychosocial approaches are essential to promote recovery and community reintegration.

Purpose: Patient decision aid (PDA) can help inform appropriate selection of laser peripheral iridotomy for primary angle closure suspect (PACS) or primary angle closure (PAC). This study assesses the impact of a PDA on the decision-making process of patients diagnosed with PACS or PAC when evaluating LPI treatment options.

Patients and methods: All participants were randomly assigned 1:1 to either the control group (n = 53), with an informed consent form, or to the intervention group with a PDA (n = 54). The primary outcome investigated was decisional conflict, which was assessed at baseline and again immediately following the intervention. The secondary outcomes included knowledge scores, patient satisfaction with their participation in the decision making, and decision regret.

Results: A total of 107 participants with PACS or PAC were involved in this study. The post-intervention decisional conflict score of the intervention group was lower than that of the control group, and the difference in their scores was statistically significant (P < 0.001). Patients in the intervention group scored higher on the knowledge questionnaire than those in the control group after the intervention, showing a statistically significant difference (P < 0.001). Furthermore, no statistically significant differences were identified in the scores between the groups for patient satisfaction with participation in medical decision making (P = 0.721) or in decision regret (P = 0.104).

Conclusion: In comparison to the control group, the application of the PDA enabled patients with PACS or PAC to be more informed, to experience reduced decisional conflict.

Background: Medication adherence is a key factor in the management of Diabetes Mellitus (DM). Various interventions have been proposed to improve adherence.

Objective: The objective of this systematic review is to evaluate and summarize the effectiveness of different interventions aimed at improving medication adherence among people living with diabetes.

Methods: A comprehensive search was conducted across five databases (PubMed, Scopus, Embase, Cochrane Library, and ProQuest) to identify studies published between January 2015 and 1st April 2025. Studies were included if they focused on people living with diabetes and interventions targeting medication adherence, with an emphasis on randomized controlled trials (RCTs) published in English. Inclusion and exclusion criteria were independently reviewed for quality by three researchers.

Results: A total of 38 studies were included in this review, with 18 studies as low risk of bias, and the remaining studies exhibiting either some concerns risk of bias. Most studies were conducted in developing countries, with face-to-face education being the most commonly used intervention. Multi-component interventions were also frequently employed. The Morisky Medication Adherence Scale (MMAS) was the most widely used tool for measuring medication adherence. Additionally, eight studies incorporated theoretical models into their interventions.

Conclusion: Both traditional and modern interventions have demonstrated potential in improving medication adherence among people living with diabetes, with multi-component strategies showing the most promising results. Future research should focus on integrating appropriate theoretical models into intervention designs and assessing the long-term effectiveness of these interventions across different populations.

Purpose: Poor medication adherence for children receiving hematopoietic stem cell transplant (HCT) leads to increased risk for infection and fatal complications. Mobile health (mHealth) interventions improve adherence across multiple chronic diseases, yet only 20% of medication apps offer alternative languages. Therefore, it is imperative mHealth interventions are expanded for diverse populations; thus, we aimed to trans-create BMT4me©, an mHealth adherence app, for Spanish-speaking families undergoing HCT.

Patients and methods: Community Advisory Board focus group members were recruited from Nationwide Children's Hospital Hispanic employee resource group. Purposive sampling was used to select six interested members (age: M=38.83 years; SD=9.39) representing diverse backgrounds: Puerto Rican, Peruvian, Venezuelan, Costa Rican, Colombian, and Mexican. Three focus groups were conducted using an iterative app revision process. Upon study completion, members completed the System Usability Scale (SUS) and Reaction Card for app evaluation.

Results: Focus group feedback revealed 4 major qualitative themes: 1) user interface strengths (eg, visuals, legibility); 2) usability improvements (eg, navigation issues, confusing elements); 3) clinical implications (eg, client/provider communication); 4) evaluating content pertinence (eg, socio-cultural appropriateness, comprehension). Notably, members identified mistranslated words and made suggestions to make essential aspects align with Spanish-speaking countries: "There's not a Spanish word for reset, pero es reiniciar [but it is restart]".

Conclusion: Overall, the focus groups provided essential feedback regarding visual appeal, usability, clinical relevance, and socio-cultural appropriateness to trans-create the app, leading to an intuitive and useful Spanish version of the mHealth tool. This work underscores the importance of including community partners in transcreation to achieve culturally appropriate digital interventions.

Background: The medication self-management at home among older adults with coronary artery disease is found suboptimal, leading to discrepancies from the prescriptions. More support is expected to meet their needs in medication self-management. This study aims to understand medication self-management at home of older adults with coronary artery disease.

Methods: From June to August 2024, a descriptive qualitative study was conducted among 28 older adults with coronary artery disease and six healthcare professionals. Older adults participated in interviews before and one month after hospital discharge. The healthcare professionals were interviewed once. The semi-structured interviews were conducted face-to-face or through a virtual platform. Thematic analysis was used in data analysis.

Findings: Two themes with five sub-themes emerged: 1. Dealing with unknown when starting new regimens: seeking support from healthcare professionals when starting medication self-management, self-information seeking is far from satisfactory. 2. Exploring strategies to support adherence to medications: difficulties in integrating medication taking into daily routine, aids as reminders for medication taking, and requesting help from caregivers.

Conclusion: Older adults with coronary artery disease struggled with seeking information to adapt to the new regimens and exploring different strategies to improve their adherence. Future interventions could improve their medication self-efficacy through patient-centred communication and peer education. Offering reliable information resources and improving the capacity to identify the accuracy of online information were important for self-information seeking. Besides, support in medication management aids and involving caregivers in medication management according to their needs were also warranted.

Purpose: To investigate the reasons for discontinuation of subcutaneous immunotherapy (SCIT) in patients with allergic rhinitis (AR) and to inform strategies for improving treatment adherence.

Materials and methods: In this single-center retrospective cross-sectional study, 794 AR patients (age 1-60 years) who initiated standardized SCIT with house dust mite extracts at Shenzhen University General Hospital between December 2019 and July 2023 were included. SCIT followed a structured dose-escalation and maintenance protocol: weeks 1-4, 0.1-0.8 mL (50 TU/mL); weeks 5-8, 0.1-0.8 mL (500 TU/mL); weeks 9-14, 0.1-1.0 mL (5000 TU/mL); weeks 14-152, monthly 1.0 mL (5000 TU/mL). Symptom severity was assessed using a visual analogue scale (VAS) at baseline and at 6 months, 1, 2, and 3 years; <20% VAS reduction and/or patient-reported insufficient improvement after ≥12 months defined "unsatisfactory efficacy". Structured telephone follow-up was used, with caregivers interviewed for pediatric patients. All patients provided detailed contact information; no loss to follow-up occurred.

Results: Fifty-eight patients (7.30%) discontinued SCIT (27 males, 31 females; mean age 14.71 ± 10.76 years). Leading reasons were relocation for education, work, or travel (53.45%), perceived lack of efficacy (17.24%), limited time (8.62%), and pregnancy/gynecological conditions (6.90%). Females were more likely to discontinue due to relocation, males due to unsatisfactory efficacy; age and comorbidities were not significantly associated with dropout.

Conclusion: SCIT discontinuation was mainly driven by relocation, treatment expectations, and logistical factors, with gender-specific patterns. Tailored pre-treatment counseling, assessment of lifestyle and reproductive plans, and strategies to maintain continuity of care may reduce dropout and improve long-term adherence.

Background: Understanding the determinants of self-care self-efficacy (SS) is essential to improving health outcomes in patients facing advanced disease. This study contributes to the field by examining the direct and indirect effects of quality of care (QC), patient-centered communication (PCC), perceived health (PH), and emotional well-being (EW) on SS in American adults with knowledge of palliative care.

Methods: A predictive-crossover design study was conducted. Data from N = 1154 adult respondents to the 2018 Health Information National Trends Survey (HINTS) 5, cycle 2 were used. Structural Equation Modeling (SEM) was used to report the direct and indirect effects for the proposed mediation model.

Results: QC had a strong, significant association with PCC (β =0.930, p <0.001). PCC was significantly associated with PH (β =0.104, p <0.01) and EW (β =0.098, p <0.01), but not directly with SS (β =0.030, p >0.05). SS was significantly predicted by PH (β =0.659, p <0.001) and EW (β =0.178, p <0.001). Indirect effects of PCC on SS via PH and EW were confirmed.

Conclusion: These findings highlight the importance of promoting perceived health and emotional well-being as key mechanisms by which care quality and communication impact self-efficacy. This study underscores the need to prioritize patient perceptions in palliative care interventions aimed at enhancing self-care capacity.