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Appendix 1
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Zwikker H, Bart van den Bemt, Cornelia van den Ende, Wim van Lankveld , Alfons den Broeder, Frank van den
Hoogen, Birgit van de Mosselaar, Sandra van Dulmen (2012) Development and content of a group-based
intervention to improve medication adherence in non-adherent patients with rheumatoid arthritis. Patient
Education and Counseling Vol. 89 pp143-151.
Study
Purpose
& Type
To describe
the
systematic
development
and content
of a short
intervention to
improve
medication
adherence to
diseasemodifying
antirheumatic
Sample
Characteristics
Intervention/Method
Outcome /
Measures
Results
Limitations
Inclusions:
consecutive RA
pts on DMARD
therapy treated at
a specialized
clinic in the
Netherlands.
The intervention
mapping (IM)
framework was used
to develop the
intervention.
Outcomes:
improved
medication
adherence
1. Adherent
patients
had higher
mean
2. necessity
scores than
nonadherent
patients p =
0.02.
3. Patients
with recent
onset RA
were more
Use of a manual
during the
intervention, as
manual-guided MI
might be associated
with smaller effect
sizes.
n = 228
Questionnaires
distributed to 228
consecutive RA
patients.
Literature study
Focus groups led by 2
Measures:
Compliance
Questionnaire
Rheumatology
The Medication
Adherence
Report Scale.
Recommendations
The content of this
paper could serve
as guideline for the
development of
other interventions.
1
drugs in nonadherent
patients with
RA.
Cross
sectional
study
Pilot
psychologists
Intervention pilot
consisting of 2
motivational guided
group sessions led by
a pharmacologist.
Pharmacy refill
rates
4. adherent
than
patients
with a
longer RA
duration p =
0.05.
Adherent
patients
reported
fewer
adverse
medication
effects than
nonadherent
5. patients.
2
Nielsen D, Ryg J, Nielsen W, Knold B, Nissen N. Brixen K (2010) Patient education in groups increases
knowledge of osteoporosis and adherence to treatment: A two-year randomized controlled trial. Patient
Education and Counseling Vol. 81 pp155-160.
Study
Purpose &
Type
To
investigate if
a groupbased
educational
programme
would
increase
patients’
knowledge
and
level of
adherence
with medical
treatment.
RCT
Sample
Intervention/Method Outcome /
Characteristics
Measures
Results
Limitations
Exclusions: pts
unable to
participate in
mild exercise,
pts suffering
from psychiatric
illness.
Inclusions:
diagnosis of
osteoporosis
and who had
started on
specific pharm.
therapy within
previous year.
At 2 year followup,
improvement in
knowledge
score was (p <
0.001) and selfreported
adherence to
pharmacological
therapy was
significantly
higher in the
school group
(92%)
compared to the
control group
(80%), p <
0.001.
Adherence
questionnaire was
not validated.
n=300
Patients randomised
to either an
osteoporosis school
programme (four
classes of
8–12 participants
over four weeks) or a
control group.
Increased
knowledge and
adherence to
medication
Measures:
Participants’
knowledge
about
Teaching was
osteoporosis
multidisciplinary
was tested
(physicians,
before
dieticians,
randomization
physiotherapists
and at 3, 12
nurses) based on
and 24 months
patients’ experiences using a
and background and validated, selfdesigned to
administered,
The MCQ revealed
patients’ factual
knowledge about the
physical and clinical
aspects of
osteoporosis, but not
what they might
have gained from
participating in the
programme.
Dropout rate was
higher in the control
group
3
encourage
empowerment.
multiple-choice
questionnaire
(PAVIOS)
The score
range on the
PAVIOS
questionnaire
is 0–28, where
a higher score
reflects greater
knowledge.
Recommendations
Group-based patient
educational
programmes can not
be a substitute for
individual face-toface discussions
with physicians and
nurses, they can
however be a
valuable
supplement.
4
Lacey, J, Cate H, Broadway DC, (2009) Barriers to adherence with glaucoma medications: a qualitative research
study. Eye23 924-932
Study Purpose
& Type
To gain a better
understanding of
the obstacles to,
and motivations
for adherence
with glaucoma
medication and
explore potential
methods to
improve
adherence
Sample
Characteristics
Recruited from 2
NHS ophthalmic
departments
(Norfolk and
Norwich University
hospital, serving
urban and rural pts
and Cromer and
district hospital
serving rural pts.)
Intervention/Method
2 focus groups
conducted, one at
each hospital, Pts
attended focus group
at own hospital.
Following focus
group, 10 one-to-one
home based, semistructured, in-depth
interviews of 40-90
mins, Interviews were
39 pts approached conducted and taped
Qualitative
24 recruited, 8
by (JL) psychologist
research using a participants aged
working in isolation
phenomenological between 52-60yrs from clinic staff.
approach
and 16 over 60yrs.
12 male/female
Written transcripts
8 employed >
sent to all participants
60yrs
for 'member checking'
23 White
. final data consisted
British/mixed
of interview audio
Outcome /
Measures
Outcomes:
Creation of 6
themes
directly
reflecting
participant
opinion.
Measures:
'Framework'
analysis and
qualitative
methodology
successfully
'unearthed'
pts opinion
Results
Limitations
Multiple
obstacles to
adherence
identified:
poor
education,
lack of
motivation,
forgetfulness
, drop
application.
Homogeneity of
participating
participants.
Recommendations
The need for
individually tailored
approaches with
initial education
about the
consequences of
non-adherence and
longer -term
feedback about drop
efficacy may
improve patients'
motivations for
adherence
5
British, 1 White
other.
Inclusion: prev
diagnosis of
mod/sev. POAG,
VA <6/12 ,
prescribed > 2
topical antiglaucoma
medications.
Exclusions:
inability to speak
English, desire to
withhold dem.
details, clinically
significant medical
or psychiatric
condition,
signif.nonglaucomatous comorbidity i.e
ARMD
Intervention
tapes and transcripts
(81 463 words),
researcher notes and
member checking
correspondence
n = 24
6
Chen X, Chen Y (2009) Notable role of glaucoma club on patients’ knowledge of glaucoma. Clinical and
Experimental Ophthalmology Vol.37 pp.590-594.
Study
Purpose
& Type
To assess
how general
glaucoma
patients
understand
their disease
compared
with patients
from the
Shanghai
Glaucoma
Club
Sample
Characteristic
s
Est. 1999
Glaucoma
club mean age
67yrs
Male 144
Female 157
General pts
Mean age
57yrs
Male 147
Female 167
n = 301
Intervention
Outcome /
Measures
Results
Limitations
Activities every
2 months
Outcomes
Medication
adherence
Shanghai Glaucoma
Club understood the
nature and course of
glaucoma
significantly better
than the general
glaucoma patients (P
< 0.01) and also
lived healthier lives
(P < 0.01)
None discussed
Lectures:
characteristics
of glaucoma,
diets, circadian
rhythms
Communication
skills
Traditional
Chinese
medicine &
glaucoma
Improved
knowledge
Measure
20 question
questionnaire
Recommendations
Providing ‘patientcentered care’ that
better meets the
needs of patients
can control the
progression of
glaucoma.
No significant
difference between
groups for
medication
adherence.
7
Okeke CO, Quigley, Jampel HD, Ying G, Plyer RJ, Jiang Y, Friedman DS (2009) Interventions Improve Poor
Adherence with Once Daily Glaucoma Medications in Electronically Monitored Patients. Ophthalmology: Journal
of The American Academy of Ophthalmology Vol.116, No.12 2286-2293
Study
Purpose
& Type
To
investigate
the impact of
an
intervention
programme
to improve
adherence
with topical,
once daily
therapy for
glaucoma.
RCT
Sample
Characteristics
Intervention
Outcome
Measures
Results
Limitations
Recruited from
Glaucoma
services Wilmer
Eye Inst.
Multifaceted
intervention
administered by
study staff,
involving: 10
min. education
video stressing
the importance
of regular drop
taking, structured
discussion with
study
coordinator, use
of a diary,
reminder phone
calls and admin.
of questionnaire
about drop
taking behaviour
Outcomes
Change in
drop use
adherence
determined by
a electronic
dosing aid.
Significantly
increased
adherence
with
glaucoma
medications
(p < 0.001)
Despite randomised
process intervention
group were more
experienced using eye
drops and had low
adherence rates at
baseline
n = 35
intervention
n = 31 control
Measures
Dosing Aid
Travoprost
Patient's informed they
were being monitored
and provided with
drugs at no cost
Recommendations
Further research is
needed to determine
which components of
this intervention are
most effective
8
Blondeau P, Esper P, Mazerolle E (2007) An information session for glaucoma patients. Canadian Journal of
Ophthalmology Vol.42 pp 816-820.
Study
Purpose &
Type
To investigate
the impact of
an information
session to
improve
understanding
and
compliance
with glaucoma
medication.
Sample
Characteristics
Intervention
Outcome /
Measures
Results
Limitations
Promotion of
clinic through
newspaper
articles and
meetings with
ophthalmologists,
clinic personnel,
optometrists,
and pharmacists
2 hour session
presented by a
nurse, with the aid of
a Microsoft
PowerPoint
presentation and
video segments in
which all aspects of
glaucoma are
covered, to a small
group of 15 patients
and family members.
During a pause for
refreshments, the
nurse observes each
of the participants as
they instill practice
drops. A 25-page
document is
distributed to the
Outcomes:
Improved
understandi
ng and
compliance
.
Following session
19% of
respondents
reported improved
adherence at 1
and 4 months but
increased to 37%
after 10 months
None discussed
n= 100
participants
Measure:
Questionna
ire admin.
at 1,4,10
months
Recommendations
It was important
to know who, among
the patients, are
interested and
willing to participate
in the clinic.
Information session
has the potential to
improve compliance
and persistency.
9
participants
at the end of the
session. Follow up
by telephone at 1, 4,
and 10 months after
the session.
10
Jiang Yi-Der , Chuang Lee-Ming, Wu Huey-Peir, Shiau Shu-Jen, Wang Chao-Hung, Lee Yann-Jin, Juang JyuhnHuarng, Lin BJ, Tai Tong-Yuan (1999) Assessment of the function and effect of diabetes education programs in
Taiwan. Diabetes Research and Clinical Practice Vol.46 pp 177–182.
Study
Purpose &
Type
To investigate
the function
and impact of
diabetic
education
programmes
on diabetic
control.
Multi centre
prospective
study
Sample
Intervention
Characteristics
Outcome /
Measures
Results
Limitations
208 subjects
with type 2
diabetes were
recruited from
three medical
centers located
in the northern
part of Taiwan.
Outcomes:
Improved
understanding
and
compliance.
Diabetes self-care
techniques were
significantly
improved in the
experimental
group.
None discussed
Diabetes
education based
on the American
Diabetes
Association is
provided by a
team of diabetes
physicians,
dieticians, and
Inclusion: aged nurse educators.
between 35 and
70 years old,
able to read,
had a
HbA1c level
]8.0% and with
stable metabolic
control, or the
HbA1c levels
Measure:
Questionnaire The overall score
developed by for diabetes selfHsiao
care techniques
improved in both
groups at 4
months over
baseline values.
The change was
significant with
the controls (P
=0.001)
Recommendations
Despite study
findings, education
may not be the
major determinant
in improving
diabetic control.
Other elements,
such as behaviour
modification in
comprehensive
diabetic care
programs, may be
of greater
importance in
producing
improved outcomes
11
less of than 1%,
within 3 months
of initiation of
study.
n-208
12
Windsor RA, Bailey WC, Richards JM, Manzella B, SEN-JAW Soong SJ, Brooks M (1990) Evaluation of the
Efficacy and Cost Effectiveness of Health Education Methods to Increase Medication Adherence among Adults
with Asthma. American Journal of Public Health Vol. 80 pp 1519-1521.
Study
Purpose &
Type
To investigate
the efficacy
and cost
effectiveness
of health
education
methods to
increase
medication
and adherence
among adults
with asthma
RCT
Sample
Intervention
Characteristics
Outcome /
Measures
Results
Limitations
Inclusion:
Patients who
had a primary
diagnosis of
asthma, used
medications
daily, and met
the following
criteria :
recurrent
episodes of
wheezing or
dyspnea;
bjective
evidence of
significantly
increased
airway
resistance
Outcomes:
4 behavioural
outcomes:
1) correct
inhaler use
2) inhaler
adherence
3) medication
adherence
4) total
adherence
rating.
Experimental
group patients
exhibited a
significantly
higher level of
improvement in
adherence (44 %)
than control group
patients (2%)
Patient self-reports
of adherence may
represent a "social
desirability"
response.
Pts received a
peak flow meter
and a
standardized
program from a
health education
specialist:
* A 30-minute
one-to-one
session with
instruction on
peak flow meter
use, inhaler use
skills, and use of
A
Self-Help Guide
to Asthma
Control;'8
* A 60-minute
Measure:
Medication
adherence (MA)
and inhaler
adherence
(IA) were
assessed using
Recommendations
From an
administrative and
programmatic
perspective this type
of intervention has
potential for
adaptation by
other asthma
programmes.
13
during episodes;
and
improvement in
the airway when
symptom-free.
n-135 control
n = 132 exp.
asthma support
group session of
four to
six patients and
asthma control
partners, and
* 2 brief
telephone
reinforcement
calls within one
month of the
group
instruments
adapted from
literature.
14
Dunn SM, Beeney LJ, Hoskins PL, Turtle JR (1990) Knowledge and Attitude Change as Predictors of Metabolic
Improvement in Diabetes Education. Social Science & Medicine Vol.10 pp1135-1141.
Study
Purpose &
Type
To examine
the impact of a
formal
diabetes
education
programme on
diabetesspecific
knowledge
and attitude,
and the
relationship
between these
characteristics
and metabolic
control of the
disease over a
15month
period.
Sample
Intervention
Characteristics
Outcome /
Measures
Results
Limitations
The study
sample
consisted of 309
consecutive
patients
attending a
diabetes
education
programme
over a period of
18 months. The
mean age of
patients was 49
(range 11-84)
52% were
males.
Approximately
two-thirds were
insulin-treated
and the mean
Outcomes:
Improved
understanding
and control of
diabetes.
Diabetes
knowledge did not
predict
improvement in
the
control of
diabetes.
None discussed
2 day
programmes
approx. 40
programmes
being run each
year. Day 1
information on
the causes,
symptoms,
treatment and
complications of
diabetes, general
management
and dietary
principles, . Day
2 information on
hypoglycaemia,
hyperglycaemia
and
management
Measure:
Diabetes
knowledge
scales (DKN)
Recommendations
Health beliefs may
escape awareness
unless they are
directly challenged.
Feelings and beliefs
about diabetes,
which are born of
necessity, may be
more tangible, more
specific and more
predictive of
subsequent
behaviour.
15
RCT
duration of
diabetes was 68 years.
n-309
of sick days,
exercise,
leisure/travel,
insulin types,
renal
thresholds,
interpretation of
blood and urine
results,
use of alchol,
and diabetes in
pregnancy. Each
topic was
introduced with a
brief videotape
segment
(8-IOmin) and
mutual
discussion was
encouraged.
16