scholarly journals Protocol for partnering with peers intervention to improve medication adherence among African Americans with Type 2 Diabetes

2020 ◽  
Author(s):  
Olayinka O Shiyanbola ◽  
Martha Maurer ◽  
Earlise C Ward ◽  
Lisa Sharp ◽  
Jonas Lee ◽  
...  
Keyword(s):  
Medication Adherence ◽  
African Americans ◽  
Clinical Outcomes ◽  
Health Beliefs ◽  
Self Efficacy ◽  
Group Intervention ◽  
Controlled Trial ◽  
Phase 1 ◽  
Improve Medication Adherence ◽  
Management Interventions

AbstractAfrican Americans (AAs) with diabetes are more likely to develop diabetes-related complications and have the highest diabetes-related mortality rates, than all other racial/ethnic groups. These health disparities are primarily due to poor medication adherence (defined as not taking medications as prescribed). AAs have substantially lower adherence to diabetes medications than whites, which contributes to higher rates of diabetes-related complications, such as amputations and strokes. There is a critical need to develop diabetes self-management interventions that improve medication adherence, clinical outcomes and in turn reduce morbidity and mortality among AAs with diabetes. Focusing on psychosocial factors such as health beliefs, self-efficacy and patient-provider communication is instrumental to improving AAs medication adherence. To address this need, we developed, the Peers Supporting Health Literacy, Self-Efficacy, Self-Advocacy, and Adherence (Peers LEAD) intervention, which provides AAs with culturally adapted diabetes and medication beliefs information, one-on-one peer support from AAs with diabetes, and communication and self-efficacy skill development to enhance medication adherence. This pilot research is a pre-post single group intervention study design which will be conducted in two phases using a community engaged approach. The objective is to test the Peers LEAD intervention in Phase 1, and then examine specific intervention elements for refinement in Phase 2. We will employ both quantitative and qualitative methods to assess the feasibility, acceptability, and outcomes of Peers LEAD. Building on established community partnerships, we plan to recruit and enroll 30 Peer Buddies and 20 Peer Ambassadors to participate in the intervention. By utilizing patient feedback to refine Peers LEAD and piloting it to examine its feasibility, we will generate evidence regarding its real world use and provide support for a randomized controlled trial of its impact on AAs diabetes medication adherence and clinical outcomes.

Community Participation for People with Trauma Injuries: A Study Protocol of a Crossover Randomised Controlled Trial of the Effectiveness of a Community Mobility Group Intervention (CarFreeMe TI)

2019 ◽  
Vol 20 (1) ◽  
pp. 96-103
Author(s):  
Stacey George ◽  
Christopher Barr ◽  
Angela Berndt ◽  
Maria Crotty ◽  
Rachel Milte ◽  
...  
Keyword(s):  
Community Participation ◽  
Self Efficacy ◽  
Group Intervention ◽  
Complex Trauma ◽  
Spinal Cord Injuries ◽  
Controlled Trial ◽  
Phase 1 ◽  
Exclusion Criterion ◽  
Secondary Outcome ◽  
Community Mobility

Background: Following traumatic brain and spinal cord injuries, maximising community participation leads to better physical and mental health outcomes.Objectives: To determine the effectiveness and health system resource use of a group intervention (CarFreeMe TI) on community participation in people with complex trauma injuries.Method: Randomised crossover trial of 54 participants, recruited from rehabilitation services in Adelaide, Australia. Inclusion criteria is a trauma injury, unable to return to full driving, aged over 18 years of age, adequate cognition/behavioural/communication abilities to participate in sessions and mobile. Exclusion criterion is living in setting where alternative transport is provided. Participants will be randomly assigned on a 1:1 allocation basis, to receiving Phase 1 CarFreeMe TI-group-based intervention or Phase 2 information related to transport options. Then, crossover to Phase 1 or 2 will occur. Primary outcome measure is community participation using a Global Positioning System. Secondary outcome measures include Community Mobility Self-efficacy Scale; CarFreeMe TI Transport Questionnaire, AQOL, EQ-5D-5L; Carer's Community Mobility Self-efficacy Scale and Modified Carer Strain Index for carers of participants. Outcome assessors will be blinded to group allocation. All analyses will be on an intention to treat basis with difference in community participation between the groups determined via a GLM ANOVA and the significance between groups on other measures using independent sample t-tests. It is hypothesised that the community mobility intervention (CarFreeMeTI) will result in increased community participation.Discussion: The results will provide proof of concept information on the feasibility and inform allocation of resources for people with complex trauma injuries.Trial registration: Australian and New Zealand Clinical Trials Register (ANZCTR): ACTRN12616001254482.

Translational Research Principles of an Effectiveness Trial for Diabetes Care in an Urban African American Population

2005 ◽  
Vol 31 (6) ◽  
pp. 880-889 ◽  
Author(s):  
Tiffany L. Gary ◽  
Felicia Hill-Briggs ◽  
Marian Batts-Turner ◽  
Frederick L. Brancati
Keyword(s):  
African American ◽  
African Americans ◽  
Diabetes Care ◽  
Large Scale ◽  
Health Workers ◽  
Controlled Trial ◽  
Phase 1 ◽  
Community Setting ◽  
Minority Community ◽  
Effectiveness Trials

Purpose Large-scale effectiveness trials designed to translate evidence-based diabetes care to community settings are few. Studies describing these methods among high-risk minority populations are particularly limited. Methods The authors describe Project Sugar, a randomized controlled trial conducted in 2 phases: Project Sugar 1 (1994-1999), which piloted a 4-arm clinic and homebased intervention using nurse case management and community health workers in 186 urban African Americans with type 2 diabetes, and Project Sugar 2 (2000-2005), which examined effectiveness of this intervention among 542 diabetic, urban African Americans. Results and Conclusions Project Sugar had success with regard to recruitment and retention, both in phase 1 (80% rate at 24 months) and phase 2 (>90% at 24 months). Using the RE-AIM framework, planning and research design for Project Sugar 2 is described in detail for elements that contributed to the reach, effectiveness, adoption, implementation, and maintenance of this study within a minority community setting. In addition to successful strategies, challenges to conducting effectiveness trials in an inner-city African American community are identified.

scholarly journals Mixed methods pilot evaluation of interpersonal psychotherapy for body image for adolescents

2020 ◽  
pp. 135910452096337
Author(s):  
Fiona Duffy ◽  
Helen Sharpe ◽  
Emily Beveridge ◽  
Kate Osborne ◽  
Cathy Richards
Keyword(s):  
Body Image ◽  
Young People ◽  
Body Dissatisfaction ◽  
Clinical Outcomes ◽  
Group Intervention ◽  
Treatment Satisfaction ◽  
Controlled Trial ◽  
Interpersonal Psychotherapy ◽  
Post Intervention ◽  
Randomised Controlled

Body dissatisfaction is common in adolescence and associated with poor outcomes. The aim of this mixed method pilot evaluation was to determine acceptability, feasibility and preliminary efficacy of Interpersonal Psychotherapy for Body Image (IPT-BI), a school-based group intervention for young people with high levels of body dissatisfaction. Eighteen participants (11–13 years, 78% female) took part in two IPT-BI groups ( n = 10; n = 8). Feasibility was measured by recruitment and attrition rates; acceptability using a treatment satisfaction questionnaire and focus groups; and clinical outcomes at baseline, each session and post intervention. The majority of young people (72%, n = 18/25) who were referred or expressed interest went on to take part. Average session attendance was 100% and 89%. Participants expressed high levels of treatment satisfaction with 94% ( n = 16/17) rating IPT-BI as ‘quite helpful’ or ‘very helpful’ and 94% ( n = 16/17) stating they would recommend it to others. Preliminary exploration of efficacy showed significant improvements in body image and significant reductions in interpersonal difficulties and appearance-based conversations. Young people valued specific IPT-BI skills (role play, communication strategies), alongside generic therapeutic factors (therapeutic alliance, group cohesion). IPT-BI is feasible and acceptable with promising provisional clinical outcomes indicating the need for a fully powered randomised controlled trial.

scholarly journals Effective Engagement of Adolescent Asthma Patients With Mobile Health–Supporting Medication Adherence (Preprint)

2018 ◽  
Author(s):  
Richelle C Kosse ◽  
Marcel L Bouvy ◽  
Svetlana V Belitser ◽  
Tjalling W de Vries ◽  
Piet S van der Wal ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Mobile Health ◽  
Controlled Trial ◽  
Study Data ◽  
Improve Medication Adherence ◽  
Actual Use ◽  
Asthma Patients ◽  
Log File ◽  
Cluster Randomized ◽  
Mhealth Apps

BACKGROUND Mobile health (mHealth) apps have the potential to support patients’ medication use and are therefore increasingly used. Apps with broad functionality are suggested to be more effective; however, not much is known about the actual use of different functionalities and the effective engagement. OBJECTIVE The aim of this study was to explore the use and the effective engagement of adolescents (aged 12 to 18 years) with the Adolescent Adherence Patient Tool (ADAPT). METHODS The ADAPT intervention consisted of an app for patients, which was connected to a management system for their pharmacist. The aim of the ADAPT intervention was to improve medication adherence and, therefore, the app contained multiple functionalities: questionnaires to monitor symptoms and adherence, medication reminders, short movies, pharmacist chat, and peer chat. For this study, data of the ADAPT study and a cluster randomized controlled trial were used. Adolescents with asthma had 6 months’ access to the ADAPT intervention, and all app usage was securely registered in a log file. RESULTS In total, 86 adolescents (mean age 15.0, SD 2.0 years) used the ADAPT app 17 times (range 1-113) per person. Females used the app more often than males (P=.01) and for a longer period of time (P=.03). On average, 3 different functionalities were used, and 13% of the adolescents used all functionalities of the app. The questionnaires to monitor symptoms and adherence were used by most adolescents. The total app use did not affect adherence; however, activity in the pharmacist chat positively affected medication adherence (P=.03), in particular, if patients sent messages to their pharmacist (P=.01). CONCLUSIONS mHealth apps for adolescents with asthma should contain different functionalities to serve the diverging needs and preferences of individual patients. Suggested key functionalities to promote use and effectiveness in adolescents with asthma are questionnaires to monitor symptoms and a health care provider chat.

scholarly journals Randomised controlled trial of a video intervention and behaviour contract to improve medication adherence after renal transplantation: the VECTOR study protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. e025495 ◽  
Author(s):  
Holly Mansell ◽  
Nicola Rosaasen ◽  
Patricia West-Thielke ◽  
Jenny Wichart ◽  
Christopher Daley ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Medication Adherence ◽  
Randomised Controlled Trial ◽  
Usual Care ◽  
Self Efficacy ◽  
Controlled Trial ◽  
Transplant Recipients ◽  
Post Transplant ◽  
Video Intervention ◽  
Randomised Controlled

IntroductionNon-adherence after kidney transplantation contributes to increased rejections, hospitalisations and healthcare expenditures. Although effective adherence interventions are sorely needed, increasing education and support to transplant recipients demands greater use of care providers’ time and resources in a healthcare system that is stretched. The objective of this clinical trial is to determine the effectiveness of an electronically delivered video series and adherence behaviour contract on improving medication adherence to immunosuppressant medications.Methods and analysisA multicentre, parallel arm, randomised controlled trial will be conducted with four sites across North America (Saskatoon, Calgary, Halifax, Chicago). Adult patients will be randomised (1:1) to either the intervention (ie, home-based video education +behaviour contract plus usual care) or usual care alone. De novo transplant recipients will be enrolled prior to their hospital discharge and will be provided with electronic access to the video intervention (immediately) and adherence contract (1 month post-transplant). Follow-up electronic surveys will be provided at 3 and 12 months postenrolment. The primary outcome will be adherence at 12 months post-transplant, as measured by self-report Basel Assessment of Adherence to Immunosuppressive medications and immunosuppressant levels. Secondary outcomes include the difference in knowledge score between the intervention and control in groups (measured by the Kidney Transplant Understanding Tool); differences in self-efficacy (Generalised Self-efficacy Scale), Beliefs of Medicine Questionnaire (BMQ), quality of life (Short Form-12), patient satisfaction and cost utilisation. The study aims to recruit at least 200 participants across participating sites.Ethics and disseminationEthical approval was obtained from the University of Saskatchewan Behavioural Ethics Committee (Beh 18–63), and all patients provide informed consent prior to participating. This educational intervention aims to improve information retention and self-efficacy, leading to improved medication adherence after kidney transplantation, at low cost, with little impact to existing healthcare personnel. If proven beneficial, delivery can be easily implemented into standard of care.Trial registration numberNCT03540121; Pre-results.

scholarly journals Current State and Future Trends to Optimize the Care of Chronic Kidney Disease in African Americans

2017 ◽  
Vol 46 (2) ◽  
pp. 176-186 ◽  
Author(s):  
Kimberly Harding ◽  
Tesfaye B. Mersha ◽  
Joseph A. Vassalotti ◽  
Fern J. Webb ◽  
Susanne B. Nicholas
Keyword(s):  
Chronic Kidney Disease ◽  
Medication Adherence ◽  
African Americans ◽  
Kidney Disease ◽  
Kidney Failure ◽  
Social Determinant ◽  
Assessment Tools ◽  
Improve Medication Adherence ◽  
Outreach Programs ◽  
Caucasian Americans

Background: African Americans (AAs) suffer the widest gaps in chronic kidney disease (CKD) outcomes compared to Caucasian Americans (CAs) and this is because of the disparities that exist in both health and healthcare. In fact, the prevalence of CKD is 3.5 times higher in AAs compared to CAs. The disparities exist at all stages of CKD. Importantly, AAs are 10 times more likely to develop hypertension-related kidney failure and 3 times more likely to progress to kidney failure compared to CAs. Summary: Several factors contribute to these disparities including genetic and social determinants, late referrals, poor care coordination, medication adherence, and low recruitment in clinical trials. Key Messages: The development and implementation of CKD-related evidence-based approaches, such as clinical and social determinant assessment tools for medical interventions, more widespread outreach programs, strategies to improve medication adherence, safe and effective pharmacological treatments to control or eliminate CKD, as well as the use of health information technology, and patient-engagement programs for improved CKD outcomes may help to positively impact these disparities among AAs

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