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Appendix 1 Below are 9 tables. Each consist of six columns and 2 rows. Each new table with explanations are found after a page break. 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