Psychosocial and Socioeconomic Barriers to Treatment Adherence in Pediatric Atopic Dermatitis

Research Background: Atopic dermatitis (AD) is a chronic inflammatory skin condition in children that significantly impacts physical health and quality of life. Adherence to treatment regimens is crucial for effective disease management but is often hindered by various psychosocial and socioeconomic barriers. Parental mental health issues, family dynamics, financial constraints, and limited access to specialized care contribute to inconsistent treatment adherence, exacerbating the condition. Purpose/Aim: The aim of this study is to explore the multifaceted barriers to treatment adherence in children with AD and evaluate the effectiveness of current interventions targeting these challenges. The study seeks to identify strategies that can improve adherence and health outcomes by addressing psychosocial and socioeconomic factors. Method: The method involves a comprehensive review of existing literature on the impact of psychosocial and socioeconomic factors on treatment adherence in children with AD. The study also examines various interventions designed to address these barriers, including community support programs, family-centered interventions, financial aid, integrated care models, and telehealth solutions. Results: Results indicate that psychosocial barriers, such as parental anxiety and depression, significantly hinder effective disease management. Family dynamics, including poor communication and single-parent households, complicate adherence efforts. Socioeconomic factors, such as financial constraints and limited healthcare access, further impede adherence. Interventions that address these barriers show promise in improving treatment adherence and health outcomes. Community support programs and family-centered interventions enhance parental mental health and family communication. Financial aid programs and integrated care models help mitigate economic and logistical challenges. Telehealth solutions improve access to specialized care, particularly in underserved areas. Conclusion: The study concludes that a holistic approach integrating medical treatment with psychosocial and socioeconomic support is essential for managing pediatric AD effectively. Policy recommendations include increased funding for community support programs, expanded telehealth services, and the integration of social services with medical care. Addressing these barriers comprehensively can enhance treatment adherence and improve the quality of life for children with AD. Further research should focus on long-term outcomes and diverse populations to refine these interventions and ensure they meet the needs of all affected children.

Assessment of Factors Contributing to TB Treatment Adherence among Patients on TB Treatment in Kano State, Nigeria: A Case Study

Background: The WHO recommended DOTS has been proven to be very effective in the treatment of tuberculosis (TB) patients. However, despite its effectiveness, non-adherence to the treatment regimen remains a major concern in TB management. This has great consequences which include persistent infectiousness, higher rates of treatment failure, continued transmission, drug resistance, and untimely death. The aim of this study is to examine the factors and behavioural patterns that contribute to treatment adherence among TB patients in Kano State, Nigeria. Methods: A qualitative study design which included two focus group discussions (FGDs) and four key informant interviews (KIIs) were adopted for this study. In total, 20 participants were interviewed comprising 16 focus group discussion participants (8 patients on treatment and 8 individuals who have been cured) divided into two groups and four key informant interviews with 4 health workers in the selected treatment facilities. Data analysis was done by translating and transcribing the responses from the FGDs and KIIs. The transcribed data was analysed using a thematic framework procedure. Results: It was observed that having a good treatment supporter who was effective and very supportive was the most important factor contributing to treatment adherence. Other identified factors that contributed to treatment adherence included: good communication by health personnel, social support from relatives and communities, little or no side effects from drug usage, low cost of transportation to the health facilities, a positive mind set towards drug usage and treatment, support and motivation from health workers, feelings of wellness during treatment, and a balanced diet. All the respondents agreed that treatment adherence had far reaching effects on positive treatment outcomes. Conclusion: For better treatment adherence, a competent treatment supporter should be available for TB patients. Health care workers should ensure that effective communication and a cordial relationship do exist with TB patients. Also, TB patients should be properly counselled before the commencement of their treatment regimen to help them maintain a positive mind-set towards treatment. Finally, TB interventions should provide adequate social support for patients.

Healthcare Worker-Related Factors Contributing to Tuberculosis Treatment Non-Adherence among Patients in Kisumu East Sub-County

Background: Treatment non-adherence poses significant risks to health outcomes and impedes the health system’s efficiency, hence curtailing progress towards the end Tuberculosis (TB) strategy under SDG 3.3. Despite interventions to address TB treatment non-adherence, Kenya still reports high TB treatment non-adherence rates of 35% and consequently poor treatment outcome rates. Health Care Workers (HCWs) play a critical role in linking the population to health services, yet little is known of their influence on patients’ TB treatment non-adherence in Kenya. Objective: To analyze HCW-related factors associated with TB treatment non-adherence among patients in Kisumu East Sub-County. Methods: Health facility-based analytical cross-sectional mixed-method study. A Semi-structured questionnaire on treatment adherence and patients’ perceptions of HCWs during the clinic visit was administered to 102 consenting adult (out of a total census of 107 adults) drug-susceptible TB patients. 12 purposively selected HCWs by rank from 6 health facilities participated in Key Informant Interview sessions. Medication adherence was measured using the Morisky Medication Adherence Scale and then expressed as a dichotomous variable. Quantitative analysis utilized STATA version 15.1 while qualitative deductive thematic analysis was done using NVIVO version 14. Results: TB treatment non-adherence rate of 26% (CI: 18% - 36%) was recorded. Overall, patients who felt supported in dealing with the illness were 8 times more likely to adhere to treatment compared to those who were not (aOR = 7.947, 95% CI: 2.214 - 28.527, p = 0.001). Key HCW related factors influencing adherence to treatment included: friendliness (cOR = 4.31, 95% CI: 1.514 - 12.284, p = 0.006), respect (cOR = 6.679, 95% CI: 2.239 - 19.923, p = 0.001) and non-discriminatory service (cOR = 0.1478, 95% CI: 0.047 - 0.464, p = 0.001), communication [adequacy of consultation time (cOR = 6.563, 95% CI: 2.467 - 17.458, p = 0.001) and patients’ involvement in their health decisions (cOR = 3.02 95% CI: 1.061 - 8.592, p = 0.038)] and education and counselling (cOR = 4.371, 95% CI: 1.725 - 11.075, p = 0.002). Conclusion: The study results underline importance of patient-centered consultation for TB patients and targeted education and counselling for improved treatment adherence.

Effects of sociodemographic characteristics and patients’health beliefs on tuberculosis treatment adherence in Ethiopia:a structural equation modelling approach

Background:Patients’beliefs are a major factor affecting tuberculosis(TB)treatment adherence.However,there has been little use of Health Belief Model(HBM)in determining the pathway effect of patients’sociodemographic characteristics and beliefs on TB treatment adherence.Therefore,this study was aimed at determining the effect of sociodemographic characteristics and patients’health beliefs on TB treatment adherence based on the HBM concept in Ethiopia.Methods:A cross-sectional study was conducted in Addis Ababa,Ethiopia among TB patients undertaking treatment.Thirty health centres were randomly selected and one hospital was purposely chosen.Six hundred and ninety-eight TB patients who had been on treatment for 1-2 month,were aged 18 years or above,and had the mental capability to provide consent were enrolled consecutively with non-probability sampling technique from the TB registration book until required sample size achieved.Structured questionnaires were used to collect data.Structural equation modelling was employed to assess the pathway relationship between sociodemographic characteristics,patients’beliefs,and treatment adherence.Results:Of the 698 enrolled participants,401(57.4%)were male and 490(70.2%)were aged 35 years and below.The mean age of participants was 32(±11.7)and the age range was 18-90 years.Perceived barrier/benefit was shown to be a significant direct negative effect on TB treatment adherence(ß=−0.124,P=0.032).In addition,cue to action(ß=−0.68,P≤0.001)and psychological distress(ß=0.08,P<0.001)were shown significant indirect effects on TB treatment adherence through perceived barrier/benefit.Conclusions:Interventions intended to decrease perceived barriers and maximize perceived benefits should be implemented to enhance TB treatment adherence.In addition,it is crucial that counselling is incorporated with the regular directly observed therapy program.Motivators(cue to actions)such as friends,family,healthcare workers,and the media could be used to promote TB treatment adherence.

Symptom severity,quality of sleep,and treatment adherence among patients suffering from schizophrenia and depression

Aim:Treatment non-adherence is a common problem in patients suffering from schizophrenia and depression.This study investigated the possible relationships between symptom severity,quality of sleep,and treatment adherence.Methods:Thirty outpatients with schizophrenia and 58 outpatients with depression were enrolled in this study.The beck depression Inventory-II,the positive and negative syndrome scale,and the pittsburgh sleep quality index were used to assess symptom severity and quality of sleep,and sleep log data were used to measure treatment adherence.Results:The preliminary results showed no significant relationship between symptom severity and treatment adherence or between quality of sleep and treatment adherence in patients with depression.However,a significant positive relationship was found between negative symptoms and treatment adherence and a significant negative relationship between quality of sleep and treatment adherence in patients with schizophrenia.Conclusion:The present exploratory study revealed a positive relationship between symptom severity and treatment adherence and a negative relationship between quality of sleep and treatment adherence in patients with schizophrenia,but no significant relationships in patients with depression were found.Future studies are needed in order to gain a better understanding of possible risk factors related to treatment non-adherence.

Double-Blind, Parallel Group Study to Compare the Clinical Effectiveness of Calcium Dobesilate 500 mg BID vs. Calcium Dobesilate LP 1 g OD, in Patients with Chronic Venous Insufficiency of the Lower Limbs

Background: Chronic venous insufficiency (CVI) describes a condition that affects the venous system of the lower extremities due to venous hypertension (VH. The prevalence is between 5% - 30%. CVI is associated with older age, smoking, lower extremity trauma, presence of an arteriovenous shunt, and elevated estrogen levels. All patients should be initially treated with conservative management. Venoactive drugs like calcium dobesilate are useful. Objectives: The primary objective compared the clinical improvement in patients with CVI, grades 0 - 3 of the CEAP classification of chronic venous disease, produced by two formulations of calcium dobesilate: calcium dobesilate LP 1 g OD vs calcium dobesilate 500 mg BID, immediate release. The secondary objective assessed the side effects of both formulations. Method: All patients took one tablet and one capsule at 7 am, and one capsule at 7 pm, for 8 weeks. One group received dobesilate 1 g OD and the other group received dobesilate 500 md BID. They were evaluated after 15, 30 and 60 days of treatment, using the symptom evaluation scale. Results: In both groups, there was a significant decrease in the symptom score after 15 days. Four patients in the Dobesilate OD group: had adverse effects, which did not require suspension of treatment. In the BID dobesilate group, there was one therapeutic failure, and one case of gastric discomfort. Conclusions: Prolonged-release Calcium dobesilate 1 g OD is as effective as calcium dobesilate 500 mg BID for the treatment of patients with chronic venous insufficiency.

Extension of the theory of adherence to treatment in patients with coronary heart disease

Background: Increased knowledge of the concept of adherence is needed for development patient-centered care, nursing interventions, and guidelines for patients with coronary heart disease (CHD). The aim of this study was to test and extend the Theory of Adherence to Treatment regarding informational support in patients with CHD.Methods: The study utilized an explanatory and descriptive survey. The study was conducted in 2013 and involved 416 patients in five hospitals in Finland. The Adherence of Patients with Chronic Disease instrument and the Social Support for People with CHD instrument were used. The model was tested using structural equation modeling (SEM).Results: SEM confirmed direct associations between motivation (β = 0.49,p < 0.001) and results of care (β = 0.29,p < 0.01), and indirect associations between sense of normality, fear of complications, support from nurses and next of kin, and informational support to adherence to a healthy lifestyle and medication. Informational support included information and advice on CHD risk factors, physical exercise, chest pain, medication, continuum of care, and rehabilitation. Indirect standardized path coefficients varied between 0.14 and 0.45. The model explained 45% of adherence to a healthy lifestyle and medication.Conclusion: The results of this study showed that informational support is a justified extension to the original Theory of Adherence to Treatment in Patients with CHD. Informational support seems to offer a new perspective that can be used to develop patient-centered nursing interventions and thus support adherence to treatment by patients with a lifelong disease such as CHD.

Impact of specialized nursing outpatient case management on postcoronary artery bypass grafting patients

BACKGROUND Some patients with coronary atherosclerotic heart disease experience major adverse cardiac events(MACE)and require readmission after Coronary Artery Bypass Grafting(CABG)surgery.This is often attributed to patients'unhealthy lifestyles and dietary habits,inadequate understanding of the disease,and poor disease management compliance.Thus,searching for more targeted nursing intervention models that can enhance patients'self-management abilities and reduce the risk of readmission after CABG surgery is significant.AIM To observe the impact of specialized nursing outpatient case management on patients after CABG surgery.METHODS A total of 103 patients who underwent CABG surgery in our hospital between April 2021 and April 2022 comprised the study sample.The patients were divided into two groups using an odd-even number grouping method.The control group received routine nursing care,while the case management group received specialized nursing outpatient case management.The differences in psychological status,adherence to medical treatment,self-care ability,knowledge mastery,quality of life scores,and the occurrence rate of MACE were compared between the two groups.RESULTS After the intervention,the case management group had lower scores on the selfrating depression scale and self-rating anxiety scale and lower MACE rate,as well as higher scores for adherence to a healthy diet,medication adherence,good lifestyle habits,regular exercise,and timely follow-up,higher scores on the Coronary Heart Disease Self-Management Scale,higher scores for managing adverse habits,symptoms,emotional cognition,emergency response,disease knowledge,general lifestyle,and treatment adherence,higher scores for understanding coronary heart disease,recognizing the importance of medication adherence,understanding selfcare points after CABG surgery,and being aware of post-CABG precautions,higher scores for physical well-being,disease condition,general health,social-psychological well-being,and work-related aspects(P<0.05).CONCLUSION Specialized nursing outpatient case management can enhance patient adherence to medical treatment,knowledge mastery,psychological well-being,and overall quality of life in patients after CABG surgery.

Inflammatory bowel disease:Efficient remission maintenance is crucial for cost containment

The inflammatory bowel diseases(IBD) are chronicincurable inflammatory disorders of the gut. Some 10% run a downhill course, requiring emergency medical support and often surgery; another small subset are monogenic, and, threatening pediatric patients, are the challenge of these days. The majority of the IBDs, however, are polygenic low-penetrance diseases, running a lifetime waxing-and-waning course. The prevalent trend is towards a slow worsening and steady cost increase. Each and all drugs of the available arsenal exhibit strengths and weaknesses: Mesalamines are chiefly effectively for mildmoderate colitis, and do not work in Crohn's; steroids do not control some 40% of the ulcerative colitis cases, and are not indicated for Crohn's; thiopurines are effective in the maintenance of the IBDs but do not prevent relapses on withdrawal; biologics are still being used empirically(not monitored) causing further increase of their cost over that of hospitalization. Against all these caveats, two simple rules still hold true: Strict adherence maintenance and avoidance of colitogenic drugs. This matter is expanded in this minireview.

Monitoring Adverse Events during Seasonal Malaria Chemoprevention Campaigns for Children Aged 3 - 59 Months in Benin in 2023

Background: Seasonal malaria chemoprevention (SMC) is crucial for reducing the burden of malaria in children. However, adverse events (AEs) can affect treatment adherence and efficacy. This study assesses the prevalence of AEs associated with SMC and identifies factors associated with treatment discontinuation. Methods: A cross-sectional study of 3115 children receiving SMC was conducted. The study was conducted in two departments in northern Benin. The prevalence of AEs and factors associated with discontinuation of treatment were analyzed. Results: Among the children, 578 (18.6%, 95% CI: 17.2 - 19.9) reported AEs, mainly vomiting (63.5%), fever (43.8%) and diarrhea (23.0%). Boys (51.9%) had slightly more AEs than girls (48.1%). The prevalence of AEs was higher in rural areas (64.0%) than in urban areas (36.0%). Only 2.8% of children stopped taking SMC because of AEs. There was no significant association between AEs and discontinuation of SMC (p = 0.608). Children referred to health centers for management of AEs were less likely to discontinue treatment (p = 0.015). Conclusion: AEs were common, but the rate of discontinuation of SMC due to AEs was low, indicating good treatment tolerance. Effective management of AEs in health centers reduces treatment interruptions.