Background: The RS01X is a digital dry powder inhaler (DPI) that records inhalation parameters such as technique or adherence. This offers patients and health care providers a way to have a feedback on inhalation treatments. This study used real-life data gained from 28 healthy volunteers for adherence assessment, technique evaluation, and in vitro testing. Methods: The study enrolled 28 healthy volunteers. Participants were shown how to use an inhaler and provided with empty capsules. The inhalers record several inhalation parameters such as peak inspiratory flow (PIF), volume, duration, and orientation. Half of the participants were selected to be in an "intervention" group with access to their inhalation data as well as feedback to improve their inhalation. The other half were a "control" group without access to their data nor any feedback. The data were then used for in vitro testing. Results: Overall, 28 participants were enrolled, and inhalation data were available for 13 interventions and 15 controls. Average adherence was 82.0% and 69.5% for intervention and control, respectively. The technique of inhalation was 65.58% good, 19.89% fair, and 14.53% poor for the intervention group and 36.73% good, 26.99% fair, and 36.28% poor for the control group. The variability of PIF was 9% for intervention and 30% for control. In vitro simulations showed the importance of proper angle orientation in inhalation, which was supported by in vivo data. The fine particle fraction of active pharmaceutical ingredients was similar to the inhalation profile of the intervention in comparison with a theoretical perfect inhalation. Conclusion: This study results showed clear improvement in inhalation technique and adherence for patients using digital DPI. In addition, in vitro testing provided concrete data illustrating the measurable advancements digitalization offers in enhancing patient adherence and inhalation technique.

Non-adherence in advanced rectal cancer therapy is common and severely impairs clinical outcomes. Although behavioral research suggests emotional factors influence adherence, limited evidence links pretreatment emotional distress (PED) to treatment adherence in rectal cancer patients.

This post hoc analysis of a phase 3 randomized clinical trial was conducted from June 9, 2010, to February 15, 2015, involving 219 patients (assigned to receive neoadjuvant therapy with fluorouracil plus radiotherapy [group A, 67 patients], modified fluorouracil, leucovorin, and oxaliplatin [mFOLFOX6] plus radiotherapy [group B, 66 patients], or mFOLFOX6 alone [group C, 86 patients] followed by TME resection and postoperative adjuvant chemotherapy) with locally advanced rectal cancer from the main center. The PED of patients was measured through the emotional dimension items in the Quality of Life Questionnaire-Core Questionnaire (QLQ-C30). The primary outcome was adherence to therapy, with non-adherence defined as patients in groups A and B receiving fewer than ten cycles of chemotherapy or less than 37 Gy of radiotherapy, and patients in group C receiving fewer than ten cycles of chemotherapy. Multivariable logistic regression models were used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for adherence by PED levels. Additionally, the structural equation model (SEM) was utilized to analyze the impact pathways of PED on adherence.

Among the 219 patients (142 men; mean age, 53.4 years) who completed the QLQ-C30 scale, 27.8% (61/219) demonstrated non-adherence to the treatment regimen. Multivariable analyses showed that each 1-point increase in PED score raised non-adherence risk by 4.37 times (OR: 4.37, 95% CI: 1.92-9.96, P < 0.001). The SEM analysis revealed that PED score was positively correlated with the risk of non-adherence (standardized regression coefficients [β] = 0.25, 95% CI: 0.11 to 0.28), while economic burden was positively correlated with PED (β = 0.17, 95% CI: 0.11 to 0.28), and could indirectly affect adherence through PED (β = 0.04, 95% CI: 0.01 to 0.09).

Higher levels of pretreatment emotional distress were associated with an increased risk of treatment non-adherence, thereby highlighting the potential significance of addressing emotional distress in cancer management.

ClinicalTrials.gov identifier: NCT01211210.

Chronic obstructive pulmonary disease (COPD) is a progressive respiratory condition with debilitating manifestations that adversely affect patients' health-related quality of life (HRQoL). The clinical course is complicated by patients' low medication adherence level. Low adherence and poor HRQoL are linked to unfavorable disease outcomes. Although many factors affect adherence and HRQoL in COPD, the impact of adherence on HRQoL remain controversial. This study aimed to measure medication adherence and its impact on HRQoL in patients with COPD.

This cross-sectional observational study included patients with COPD from two health centers in Riyadh, Saudi Arabia. Patients were identified using the medical database and only those fulfilling the GOLD 2020 criteria for COPD diagnosis were recruited. Data were collected via phone interviews and included sociodemographic information, the level of medication adherence assessed using the 5-item Medication Adherence Report Scale (MARS-5), and the HRQoL measured using the St. George Respiratory Questionnaire for COPD (SGRQ-C). Simple and multiple-regression analysis was used to study the factors affecting both parameters and the relation between adherence and HRQoL.

The mean MARS-5 score was 21.17± 4.8 (mean ± SD) with only 56.4% of patients with COPD reporting high adherence to their medications. The average total SGRQ score was 51.35 ± 23.82 indicating low HRQoL. Using multiple-regression analysis, comorbidity and intermediate disease duration were associated with lower adherence, while older age, female gender, polypharmacy, and concomitant hypertension predicted lower HRQoL. Moreover, higher adherence to medications was associated with higher overall HRQoL in patients with COPD.

Patients with COPD have low medication adherence and low HRQoL. Several patient-, disease-, and therapy-related factors were shown to affect both outcomes; however, higher adherence to medication per se was associated with higher HRQoL in patients with COPD.

To investigate the prevalence and potential determinants of cost-related non-adherence (CRNA) in US adults with heart failure (HF).

A serial cross-sectional analysis using nationally representative data from 2012 to 2021 of the US Medical Expenditure Panel Survey.

Population-based.

Adult participants with HF diagnosis.

Self-report of never getting or delaying getting prescription medicine because of costs.

We included 1753 patients with HF (mean age 69.36 [95% CI, 68.23 to 70.48]) years, 47.85% men and 17.09% non-Hispanic Black. The overall weighted prevalence of CRNA was 7.94% (6.40-9.81), increasing from 3.09% (1.29-7.24) in 2012 to 13.69% (8.99-20.32) in 2018 and decreasing to 8.71% (3.82-18.67) in 2021. The prevalence of CRNA was higher among patients <65 years than those ≥65 years (11.78% vs 6.04%), and was more prevalent among patients with lower family income, with no insurance or public insurance, and with a greater comorbidity burden. The highest prevalence of CRNA was found among uninsured patients (18.54 [8.01-37.30]). Among patients <65 years, patients with CRNA had significantly lower utilisation of sodium glucose cotransporter-2 inhibitors and slightly lower use of beta blockers and ACEi/ARBs. The out-of-pocket cost for medication was higher among those with CRNA, especially cost on central nervous system medicines.

CRNA was prevalent among patients with HF, disproportionately affecting those younger than 65 years, with lower socioeconomic status, and higher comorbidity burden. Interventions are needed to reduce financial burden and enhance medication adherence.

NCDs arise from complex interactions of modifiable factors such as unhealthy lifestyles, poor diet, and psychosocial challenges, along with non-modifiable factors like age and genetics. Notably, medication non-adherence is a widespread and growing concern, significantly contributing to disease progression and poor outcomes globally.

This scoping review aims to synthesize evidence on medication adherence scales used for selected non communicable diseases. It examines their development methods, psychometric properties, and assessed domains, while identifying gaps or limitations in their design and application.

The Joanna Briggs Institute methodological framework guided this scoping review and the protocol was registered prospectively to ensure methodological transparency and rigor. Electronic databases, the reference list of included articles, and grey literature were searched. Studies published in English from January 1950 to June 2024 were included. Two reviewers independently screened all articles, and a third reviewer settled any conflicts between the reviewers. Critical appraisal of the screened-in articles was done using JBI critical appraisal scales. The data was compiled into tables and a narrative summary that is consistent with the review's goal.

Our study included 140 articles, identifying 57 medication adherence scales. These scales, developed using qualitative methods (10.8%), literature review (32.4%), and mixed methods (45.9%), primarily focus on behavior, often neglecting cost-related non-adherence, self-efficacy, and systemic barriers. Psychometric findings varied widely, reflecting heterogeneity in study designs and scale development approaches. Many scales lack validation in diverse settings, underscoring the need for comprehensive, context-sensitive tools.

This scoping review highlights gaps in existing medication adherence scales for NCDs, particularly their limited consideration of socioeconomic and cultural factors and incomplete adherence assessment. Future research should focus on developing more holistic, contextually relevant adherence scales that integrate these dimensions. Strengthening adherence measurement methodologies can enhance patient-centered care, inform policy interventions, and improve health outcomes.

Dynamic treatment regimes (DTRs) are sequences of functions that formalize the process of precision medicine. DTRs take as input patient information and output treatment recommendations. A major focus of the DTR literature has been on the estimation of optimal DTRs, the sequences of decision rules that result in the best outcome in expectation, across the complete population if they were to be applied. While there is a rich literature on optimal DTR estimation, to date, there has been minimal consideration of the impacts of nonadherence on these estimation procedures. Nonadherence refers to any process through which an individual's prescribed treatment does not match their true treatment. We explore the impacts of nonadherence and demonstrate that, generally, when nonadherence is ignored, suboptimal regimes will be estimated. In light of these findings, we propose a method for estimating optimal DTRs in the presence of nonadherence. The resulting estimators are consistent and asymptotically normal, with a double robustness property. Using simulations, we demonstrate the reliability of these results, and illustrate comparable performance between the proposed estimation procedure adjusting for the impacts of nonadherence and estimators that are computed on data without nonadherence.

If used properly, contact lenses (CLs) provide a safe and effective alternative to eyeglasses for refractive error correction. However, often due to patient noncompliance, CL-related complications may occur, such as discomfort, dry eye, as well as serious conditions like infectious keratitis. Our study aimed to assess the perceived knowledge and behavior of CL wearers in Switzerland regarding the handling of CLs and associated ocular health risks.

This investigator-initiated, cross-sectional, qualitative, multicenter study was conducted in Switzerland from August 2023 to August 2024. After verbal consent, CL wearers were interviewed using a structured survey. The questionnaire explored participants' demographics, their perceived knowledge of the overall handling of CLs and associated health risks, as well as their behavior in two emergency scenarios involving monocular redness or pain. The descriptive statistical analysis was performed using Microsoft Excel (Microsoft Corp., Redmond, WA, USA). Figures were created with Prism version 10.2.3 (GraphPad Software, San Francisco, CA, USA).

A total of 172 participants with a median (IQR [range]) age of 39 (27 to 54 [10 to 82]) years were interviewed, whereby 81 (47.1%) were female. Myopia (61.0%) and keratoconus (30.2%) were the most reported indications for CL use. In terms of overall CL handling, 91.3% of participants felt well or sufficiently informed, whereas this was the case of 66.3% regarding CL-related health risks. In the scenario involving eye redness during CL use, 135 of 175 (77.1%) responses did not mention seeking professional advice, while 25 (14.3%) indicated visiting an ophthalmologist within 1 day of symptom onset. In the event of monocular pain, 67 of 179 (37.4%) responses did not consider seeking professional care, whereas 86 (48.0%) included consulting an ophthalmologist.

This study provides insight into the unmet educational need of CL wearers, especially regarding CL-related complications. Participants generally felt better informed about overall CL handling than about the potential health risks. This information discrepancy is reflected by their responses to scenarios involving monocular redness or pain, where a considerable number of participants failed to react adequately. Further studies are warranted to explore effective, practical strategies for improving patient awareness and behavior.

Transjugular intrahepatic portosystemic shunt (TIPS) is an established procedure for managing portal hypertension in cirrhotic patients, but the impact of post-TIPS overt hepatic encephalopathy (OHE) on survival remains controversial. While its effect on short-term survival is well-documented, its long-term implications remain unclear.

This study aims to investigate the long-term impact of post-TIPS OHE on mortality in cirrhotic patients for variceal bleeding, focusing on the timing and predictive value of OHE beyond the first year post-TIPS.

A multicenter, retrospective cohort study was conducted involving 3262 cirrhotic patients who underwent TIPS for variceal bleeding at seven Chinese tertiary centers between January 2010 and June 2020. Clinical data, including demographics, procedure details, post-TIPS complications and survival outcomes, were collected. The primary endpoints were all-cause mortality and OHE, with follow-up until death, liver transplantation or 60 months. Propensity score matching minimised confounding effects, and multivariate Fine-Grey competing risk models identified independent mortality predictors.

During a median follow-up of 1077 days, 33.2% developed post-TIPS OHE, associated with higher MELD and Child-Pugh scores. Among these, 19.3% died, with a median time from OHE onset to death of 947 days. Post-TIPS OHE was not linked to early survival (within 12 months) but emerged as an independent predictor of long-term mortality beyond 24 months, consistent across various clinical scenarios.

Post-TIPS OHE does not affect short-term survival but significantly increases long-term mortality risk. These findings highlight the need for continuous monitoring and tailored interventions to improve long-term outcomes in post-TIPS patients.

(1) To estimate adherence to brace wearing for medial collateral ligament (MCL) injuries across 3 phases of conventional treatment and (2) to explore predictors of adherence for each phase.

Exploratory cohort study.

Primary care center.

Fifty-nine patients aged 18 to 65 (27 men, 32 women) from a randomized clinical trial examined the effectiveness of 2 bracing techniques (0-90 degrees or 30-90 degrees) for acute isolated MCL or combined anterior cruciate ligament injuries. Patients were prescribed a 6-week bracing protocol and were followed for 12 weeks.

Patients were prescribed constant brace wearing for 4 weeks (∼23 h/d), then daytime wear only (∼15 h/d) until brace discontinuation at 6 weeks. Rehabilitation exercises were prescribed from 2 weeks onward. Adherence to the protocol was assessed through daily self-reported logs. Clinical and patient-reported outcomes were collected throughout the randomized clinical trial (baseline, 2, 4, and 6 weeks). This study interpreted them as predictor variables of treatment adherence alongside patient and treatment characteristics.

Adherence to each 2-week phase, interpreted dichotomously (adherer or nonadherer). Adherers were identified as those who wore their brace according to the protocol.

Adherence and pain decreased, while overall knee ratings improved throughout the treatment. Pain, affected knee, and brace range-of-motion settings were significant predictors of adherence in the exploratory logistic regressions.

Pain, affected knee, and brace range-of-motion settings were the primary predictors of brace wearing in the first 4 weeks of treatment. This study is the first to provide insight into MCL bracing adherence, potentially aiding clinicians in treatment management.

Organizational variables as perceived organizational justice can influence patients' behaviors. After analyzing the three tenants of patient-centered care (i.e., communication, relationships and health promotion), we identified a gap regarding how patients' attitudes and organizational perceptions contribute to enhancing the effectiveness of patient-centered care. This study aims to improve the understanding of patients' experiences with health care organizations to enable health care service management to enhance patient-centered care quality. Given the structural differences in healthcare systems in Spain and the U.S., we examined both contexts to strengthen our analysis of patient perceptions that are critical for improving patient-centered care across different systems.

We conducted a cross-sectional survey study using two data samples from Spain and the U.S. We tested the role of patients perceived interactional and informational organizational justice in health service performance with respect to patients' behaviors of adhering to professional advice and loyalty to the service. The final sample comprised 473 health care users from Spain (male 59.2%) and 406 from the U.S. (male 52.0%), all aged 18 or older. In Spain, we developed a random sample selection from patients that visited their primary care service onsite. In the U.S., patients were invited to participate though an online survey platform that randomly selected participants from their panel database of the general population. In both samples the participants had visited a healthcare service within the past six months. We assessed perceived organizational justice (interactional and informational), adherence to professional advice, and loyalty to the service, and the mediating role of trust in healthcare providers and satisfaction with services.

Significant correlations were found in both samples for each justice dimension with both behaviors: adherence to advise (interactional, r = 0.15/0.18, p < 0.01; informational, r = 0.19/0.19, p < 0.01) and loyalty to the service (interactional, r = 0.45/0.79, p < 0.01; informational, r = 0.45/0.70, p < 0.01). When we tested the model that included mediating patients' attitudes of trust and satisfaction, we found that the direct relationship between informational justice and adherence still held (standardized trajectory coefficient = 0.13, p < 0.01) showing their consolidated relationship. For interactional fairness, trust and satisfaction significantly mediated the relationship with adherence. On the other hand, the relationships between both justices and patient loyalty to the service were always partially mediated by patient trust and satisfaction (model fit for interactional justice perceptions RMSEA = 0.101, CFI = 0.959, GFI = 0.959; model fit for informational justice perceptions RMSEA = 0.136, CFI = 0.937, GFI = 0.946).

Patients' perceptions of interactional and informational justice play an essential role in their adherence to professional advice, their loyalty to the service, and their ability to develop trust and satisfaction in health services. Communication and relationship-building in patient-centered care should incorporate fairness considerations to enhance healthcare outcomes. Policies and programs should integrate these justice perceptions into patient-centered care strategies. We outline specific implications for improving healthcare quality and patient-centered care.

Because of their high prevalence, chronic respiratory diseases, like asthma and chronic obstructive pulmonary disease, represent main public health problems. They are mainly treated through inhaled therapy. There is low adherence to such therapy, resulting in poor control of chronic respiratory diseases. However, more research is needed on the association of several factors with low adherence. The purpose of this study was to estimate the association of age, sex, type of drug, and frequency of administration with low adherence to inhaled therapy. In order to do this, we performed a cross-sectional study.

We selected all patients treated with long-acting anticholinergics (LAMA), long-acting β2-adrenergics (LABA), LAMA/LABA, or inhaled corticosteroid (ICS)/LABA in the Health Area of Lleida on 16 March 2017. For each treatment, we determined the percentage of patients showing low adherence to therapy (less than 50%), calculated as drug boxes collected from the pharmacy with respect to the prescribed ones. Then, we analysed the association of age, sex, type of drug, and frequency of administration, with low adherence to therapy through a multivariate linear model.

11,128 people had electronic prescriptions for one of the inhaled therapy; of them, 24.6% (2,741) showed low adherence. The highest percentage of people with low adherence was found among young patients and women. Women 25-34 years of age included the highest percentage of patients with low adherence. As for drugs, the highest percentage of patients with low adherence was found among the ones treated with LABA and ICS/LABA. Finally, a higher percentage of patients with an administration frequency of 12 h presented low adherence, in comparison with patients treated every 24 h, in general and in the LABA and ICS/LABA groups.

The differences that we observed in adherence to inhaled therapy according to the different factors analysed should be considered when managing chronic respiratory diseases and their impact on patients' clinical burden, quality of life, and costs for the health system.

Achieving glycaemic control is essential to avoid disease progression and diabetes-related complications. Non-adherence and discontinuity in diabetic therapy are major barriers to optimal glycaemic control. The aim of this study was to evaluate adherence, persistence and therapy switching over 1 year in real-life conditions in patients with type 2 diabetes within an Italian region.

A retrospective, observational, non-interventional study was conducted, analysing patients treated with Anatomical Therapeutic Chemical (ATC) Classification A10B drugs dispensed by pharmacies under the local health authority (ASL) of the Umbria region from 1 January 2022 to 31 December 2023. Adherence was measured using the Proportion of Days Covered (PDC), while persistence was calculated as the duration between the start and end of therapy.

A total of 6928 patients with type 2 diabetes were analysed. After 1 year, the overall adherence rate was 0.78, with 58% (4017/6928) of patients having adherence greater than 0.80. The lowest adherence was observed in patients treated with metformin +dipeptidyl peptidase 4 (DPP4) inhibitors, with a mean adherence of 0.71 and 36% (142/395) of patients achieving adherence greater than 0.80. Conversely, the highest adherence was seen in patients on sodium-glucose co-transporter 2 (SGLT2) inhibitors, with a mean adherence of 0.91 and 97% (473/487) of patients achieving adherence greater than 0.80. Persistence data showed concerning results, with less than 10% of patients remaining on treatment for 1 year across all drug classes. Among patients initially treated with metformin (n=4427), there was a substantial loss to follow-up, with 3582 patients (81%) discontinuing treatment within the first year.

The 1 year data on adherence and persistence for antidiabetic drugs revealed concerning trends. These findings underscore the need for targeted interventions, involving clinicians and pharmacists, to improve adherence and persistence in patients with type 2 diabetes, ultimately ensuring better disease management and reducing long-term healthcare costs.

To investigate medication non-adherence and its determinants in diabetes, hypertension, and hyperlipidemia.

In a multicenter, cross-sectional, non-interventional study, 518 diabetic, 721 hypertensive, and 463 hyperlipidemic patients were recruited, using consecutive sampling, in Greece during the COVID-19 pandemic. Medication adherence was measured with the Adherence to Refills and Medications Scale (ARMS). Multiple linear regressions with robust standard errors investigated the predictors of the ARMS summary score.

Perfect adherence was estimated at 16%, 12%, and 11%, and low adherence at 38.8%, 61.3%, and 66.7% in diabetes, hypertension, and hyperlipidemia, respectively. The factors that significantly increased the likelihood of non-adherence were the following: (a) lower age, female gender, no public health insurance, high perceived threat of illness, low satisfaction with physician consultations, shorter consultations, bad general health, fewer comorbidities, and type 2 diabetes; (b) male gender, not being married, low education, no public insurance, smoking, frequent drinking, shorter consultations, self-perceived inadequacy of knowledge, negative views of medication, presence of comorbidities, fewer medicines being used, and high blood pressure in hypertension; and (c) lower age, not being employed, smoking, frequent drinking, no public insurance, low satisfaction with consultations, negative views of medication, taking 3-4 medicines, high LDL, and low HDL and triglyceride levels in hyperlipidemia. Different curvilinear associations of adherence with BMI and exercise were also found.

Medication non-adherence is very common in diabetes, hypertension, and hyperlipidemia. Strategies to improve adherence should consider the different determinants of non-adherence among patient groups.

Smoking, obesity, and insufficient physical activity are modifiable health risk behaviors. Self-regulation is one fundamental behavior change mechanism often incorporated within digital therapeutics as it varies momentarily across time and contexts and may play a causal role in improving these health behaviors. However, the role of momentary self-regulation in achieving behavior change has been infrequently examined. Using a novel momentary self-regulation scale, this study examined how targeting self-regulation through a digital therapeutic impacts adherence to the therapeutic and two different health risk behavioral outcomes.

This prospective interventional study included momentary data for 28 days from 50 participants with obesity and binge eating disorder and 50 participants who smoked regularly. An evidence-based digital therapeutic, called Laddr™, provided self-regulation behavior change tools. Participants reported on their momentary self-regulation via ecological momentary assessments and health risk behaviors were measured as steps taken from a physical activity tracker and breathalyzed carbon monoxide. Medical regimen adherence was assessed as daily Laddr usage. Bayesian dynamic mediation models were used to examine moment-to-moment mediation effects between momentary self-regulation subscales, medical regimen adherence, and behavioral outcomes.

In the binge eating disorder sample, the perseverance [β 1 = 0.17, 95% CI = (0.06, 0.45)] and emotion regulation [β 1 = 0.12, 95% CI = (0.03, 0.27)] targets of momentary self-regulation positively predicted Laddr adherence on the following day, and higher Laddr adherence was subsequently a positive predictor of steps taken the same day for both perseverance [β 2 = 0.335, 95% CI = (0.030, 0.717)] and emotion regulation [β 2 = 0.389, 95% CI = (0.080, 0.738)]. In the smoking sample, the perseverance target of momentary self-regulation positively predicted Laddr adherence on the following day [β = 0.91, 95% CI = (0.60, 1.24)]. However, higher Laddr adherence was not a predictor of CO values on the same day [β 2 = -0.09, 95% CI = (-0.24, 0.09)].

This study provides evidence that a digital therapeutic targeting self-regulation can modify the relationships between momentary self-regulation, medical regimen adherence, and behavioral health outcomes. Together, this work demonstrated the ability to digitally assess the transdiagnostic mediating effect of momentary self-regulation on medical regimen adherence and pro-health behavioral outcomes.

ClinicalTrials.gov, identifier (NCT03774433).

This study aims to culturally adapt the 'Motivation and Attitudes Towards Changing Health (MATCH)' scale into Turkish and assess its reliability and validity within the Turkish population.

The Turkish version of the MATCH questionnaire, designed to gauge patient motivation for initiating or sustaining behaviour changes, was created through translation and adaptation. A total of 305 patients diagnosed with chronic illnesses completed the questionnaire and scale to evaluate its validity and reliability.

The Turkish version of MATCH demonstrated strong internal consistency and reliability. The Cronbach's alpha coefficient for the entire scale was 0.737, with subdimensions ranging between 0.69 and 0.75. Notably, no item displayed a total correlation value below 0.40. Furthermore, test-retest analysis indicated high intraclass correlation coefficients. Consequently, no items were removed due to their consistently high reliability values among all nine items.

The Turkish-adapted MATCH scale proves to be a valid and reliable instrument for assessing motivational status within the Turkish population.

The use of herbal or traditional medicines has survived the proliferation of modern medicine. The phenomenon has been labeled as the 'herbal medicines paradox' (HMP). We study whether such HMP hypothesis can be explained by the persistence of attitudes across cultural boundaries. We undertake a secondary analysis of individual-level migration data to test the persistence of the use of herbal medicines in relation to norms in the person's country of birth (or home country). We study the association between attitudes towards herbal medicine treatments of both first (N = 3630) and second-generation (N = 1618) immigrants in 30 European countries, and the average attitudes of their sending country origins. We find robust evidence of an association that is stronger for the second-generation migrants. We document a stronger effect among maternal than paternal lineages, as well as significant heterogeneity based on migrants' country of origin. Our estimates are robust to different sample analysis. Our estimates are consistent with a cultural explanation for the HMP.

Background: Sexual and gender minority (SGM) individuals are at increased risk for an array of chronic illness due to minority stress. Up to 70% of SGM individuals report healthcare discrimination, which may cause additional challenges for SGM people living with chronic illness including avoiding necessary healthcare. The extant literature highlights how healthcare discrimination is associated with depressive symptoms and treatment nonadherence. However, there is limited evidence on the underlying mechanisms between healthcare discrimination and treatment adherence among SGM people living with chronic illness.Methods: Among a sample of SGM individuals living with chronic illness (n = 149) recruited from social media, the current study examined the mediating roles of anticipated discrimination and depressive symptoms on the relation between healthcare discrimination and treatment adherence in a serial mediation model.Results: We found that healthcare discrimination was associated with greater anticipated discrimination, increased depressive symptoms, and, in turn, poorer treatment adherence. Conclusion: These findings highlight the association between minority stress and both depressive symptoms and treatment adherence among SGM individuals living with chronic illness. Addressing institutional discrimination and the consequences of minority stress may improve treatment adherence among SGM individuals living with chronic illness.

Patients with gastrointestinal tract cancer reported suboptimal adherence to oral anticancer agents (OAAs), reducing their therapeutic benefit and increasing mortality risk. A scoping review can comprehensively map available evidence on adherence to OAAs and inform appropriate support to improve treatment outcomes.

The aim of this study was to comprehensively map studies on adherence to OAAs among adults with gastrointestinal tract cancer, including the adherence rate, nonadherence reasons, influential factors, management strategies, and theories that guide these studies.

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews Checklist and the 5-stage methodological framework of scoping review were followed. According to the 5 research questions, 7 databases were systematically searched for peer-reviewed original studies, and a narrative synthesis was performed.

Fifty-two studies were included. Adherence ranged from 16.7% to 100%, giving a median rate of 68% by self-report. Seven categories of nonadherence reasons were identified, with adverse effects, cancer progression, patient refusal, and forgetfulness being most frequently reported. Furthermore, more than 40 influential factors were identified. They are related to patient, disease condition, therapy, socioeconomic, and healthcare-system dimensions. Education and follow-up care were the main components of management strategies, but the effectiveness was inconsistent. Currently, only 3 of 52 studies adopted theoretical frameworks.

Adherence to OAAs among adults with gastrointestinal tract cancer is suboptimal. Future studies with rigorous designs and theoretical frameworks are needed to develop adherence-enhancing strategies and explain theoretical mechanisms.

Routine assessments and preventive actions are suggested to delay modifiable nonadherence.

Social support (SS) and social isolation (SI) are social determinants of health (SDOH) associated with psychiatric outcomes. In electronic health records (EHRs), individual-level SS/SI is typically documented in narrative clinical notes rather than as structured coded data. Natural language processing (NLP) algorithms can automate the otherwise labor-intensive process of extraction of such information.

Psychiatric encounter notes from Mount Sinai Health System (MSHS, n = 300) and Weill Cornell Medicine (WCM, n = 225) were annotated to create a gold-standard corpus. A rule-based system (RBS) involving lexicons and a large language model (LLM) using FLAN-T5-XL were developed to identify mentions of SS and SI and their subcategories (eg, social network, instrumental support, and loneliness).

For extracting SS/SI, the RBS obtained higher macroaveraged F1-scores than the LLM at both MSHS (0.89 versus 0.65) and WCM (0.85 versus 0.82). For extracting the subcategories, the RBS also outperformed the LLM at both MSHS (0.90 versus 0.62) and WCM (0.82 versus 0.81).

Unexpectedly, the RBS outperformed the LLMs across all metrics. An intensive review demonstrates that this finding is due to the divergent approach taken by the RBS and LLM. The RBS was designed and refined to follow the same specific rules as the gold-standard annotations. Conversely, the LLM was more inclusive with categorization and conformed to common English-language understanding. Both approaches offer advantages, although additional replication studies are warranted.

This review aims to provide a comprehensive overview of sensor technologies employed in interventions to enhance patient adherence to inhalation therapy for chronic respiratory diseases, with a particular emphasis on human factors. Sensor-based interventions offer opportunities to improve adherence through monitoring and feedback; however, a deeper understanding of how these technologies interact with patients is essential.

We conducted a systematic review by searching online databases, including PubMed, Scopus, Web of Science, Science Direct, and ACM Digital Library, spanning the timeframe from January 2014 to December 2023. Our inclusion criteria focused on studies that employed sensor-based technologies to enhance patient adherence to inhalation therapy.

The initial search yielded 1563 results. After a thorough screening process, we selected 37 relevant studies. These sensor-based interventions were organized within a comprehensive HFE framework, including data collection, data processing, system feedback, and system feasibility. The data collection phase comprised person-related, task-related, and physical environment-related data. Various approaches to data processing were employed, encompassing applications for assessing intervention effectiveness, monitoring patient behaviour, and identifying disease risks, while system feedback included reminders and alerts, data visualization, and persuasive features. System feasibility was evaluated based on patient acceptance, usability, and device cost considerations.

Sensor-based interventions hold significant promise for improving adherence to inhalation therapy. This review highlights the necessity of an integrated "person-task-physical environment" system to advance future sensor technologies. By capturing comprehensive data on patient health, device usage patterns, and environmental conditions, this approach enables more personalized and effective adherence support. Key recommendations include standardizing data integration protocols, employing advanced algorithms for insights generation, enhancing interactive visual features for accessibility, integrating persuasive design elements to boost engagement, exploring the advantages of conversational agents, and optimizing experience to increase patient acceptance.

The increasing use of genomic sequencing in research means secondary findings (SF) is more frequently detected and becoming a more pressing issue for researchers. This is reflected by the recent publication of multiple guidelines on this issue, calling for researchers to have a plan for managing SF prior to commencing their research. A deeper understanding of participants' experiences and outcomes from receiving SF is needed to ensure that the return of SF is conducted ethically and with adequate support. This review focuses on the uptake and outcomes of receiving actionable SF for research participants. This review included studies from January 2010 to January 2023. Databases searched included Medline, Embase, PsycINFO, and Scopus. Of the 3903 studies identified, 29 were included in the analysis. The uptake of SF ranged between 20% and 97%, and outcomes were categorized into psychological, clinical, lifestyle and behavioral, and family outcomes. The results indicate there is minimal psychological impact from receiving SF. Almost all participants greatly valued receiving SF. These findings highlight considerations for researchers when returning results, including the importance of involving genetic health professionals in consenting, results return process, and ensuring continuity of care by engaging healthcare providers.

To date, there is no adherence estimator to identify risk of nonadherence prior to initiating oral oncolytics.

A workgroup was assembled through the National Community Oncology Dispensing Association and tasked with creating a tool to meet this need. Tool constructs were defined after a review of the literature identifying top barriers to adherence. A second literature search was conducted to identify questions targeting specific barriers from validated adherence questionnaires. Once a finalized draft was complete, the risk assessment tool was built into an electronic survey where a risk category can be automatically calculated for the patient.

The six most impactful factors affecting compliance to oral oncolytics were identified as patient's confidence, health literacy, perception of treatment, quality of life, social support, and complexity of chemotherapy regimen. A six-item questionnaire was created with five patient-directed questions and one clinician-directed question. Examples and descriptions were provided for clinicians to consider when categorizing complexity of a regimen. The tool was designed for responses to each question to be indexed into categories through a 10-point system. Results will be stratified into low, moderate, or high risk for nonadherence.

The creation of a tool to predict nonadherence prior to starting therapy is an unmet need for patients initiating oral oncolytics. The aim of this tool is to meet those needs and better guide clinicians to provide patients with strategies to better manage nonadherence. Next steps include tool validation and piloting in clinical practice.

The objective of this study was to investigate the factors influencing adherence with tuberculosis medication therapy. Non-adherence can result in treatment failure, ongoing infectiousness, and the development of drug resistance. Therefore, understanding the reasons behind non-adherence is crucial for achieving the World Health Organization's target of 90% treatment success.

Data were collected prospectively from a cohort at three different tuberculosis dispensaries (TBDs), with participants being followed up with at face-to-face visits every two months for a total of three visits.

In this study, the adherence rates among participants were the highest during the intensive treatment phase (81.0% at the first follow-up) but declined during the continuation phase, reaching 69.4% at the second follow-up (at the end of the fourth month of treatment) and 71.1% at the third follow-up (at the end of the sixth month of treatment) according to self-reports for the past 30 days. According to the generalised estimating equations method, factors significantly associated with better adherence included knowledge of infectiousness, daily access to medication, workplace permissions, high household income, regular sleep patterns, extrapulmonary TB, secondary education, and no alcohol consumption.

Non-adherence with anti-TB medication has been observed in patients with TB, particularly during the continuation phase of treatment. Interventions targeting patients who experience frequent forgetfulness, adverse drug reactions, or a lack of workplace flexibility may help to improve adherence. In addition, providing personalised health education that highlights the risks of non-adherence and emphasises the infectious nature of TB could improve understanding and commitment to treatment. Ensuring regular follow-ups and support, particularly for those with lower socioeconomic status or limited social support, can further reinforce the importance of adherence in TB treatment outcomes.

In-home remote foot temperature monitoring (RTM) holds promise as a method to reduce foot ulceration in high-risk patients with diabetes. Few studies have evaluated adherence to this method or evaluated the factors associated with noncompliance.

The aims of this study were to estimate noncompliance in patients who were enrolled in RTM nationwide across Department of Veterans Affairs (VA) and to evaluate characteristics associated with noncompliance.

We conducted an observational study including 1137 patients in the VA who were enrolled in RTM between January 2019 and June 2021, with follow-up through October 2021. Patient information was obtained from the VA's electronic health record and RTM use was obtained from the company. Noncompliance was defined as using the mat <2 days per week for ≥4 of the 12 months of follow-up. Using a multivariable model, we calculated odds ratios (ORs) and 95% CIs for associations between various factors and noncompliance and compared using Akaike information criterion statistics, a measure of model fit.

The sample was predominantly male (n=1125, 98.94%) ; 21.1% (n=230) were Black and 75.7% (n=825) were White. Overall, 37.6% (428/1137) of patients were classified as noncompliant. In the multivariable model, an intermediate area deprivation index was statistically significantly and inversely associated with noncompliance (area deprivation index 50-74 vs 1-24; OR 0.56, 95% CI 0.35-0.89); factors significantly and positively associated with noncompliance included recent history of osteomyelitis (OR 1.44, 95% CI 1.06-1.97), Gagne comorbidity index score ≥4 (vs ≤0; OR 1.81, 95% CI 1.15-2.83), telehealth encounters (28+ vs <6; OR 1.70, 95% CI 1.02-2.84), hemoglobin A1c≥10 (vs <5.7; OR 2.67, 95% CI 1.27-5.58), and current smoking (OR 2.06, 95% CI 1.32-3.20). Based on Akaike information criterion differences, the strongest factors associated with noncompliance were behavioral factors (poor glucose control [as measured by hemoglobin A1c] and smoking), and to a lesser extent, factors such as a recent history of osteomyelitis and an elevated Gagne comorbidity index, indicating a high comorbidity burden.

To reduce the risk of ulcer recurrence and amputation, proactively providing additional support for self-monitoring to patients with characteristics identified in this study (poor glucose control, current smoking, high comorbidity burden) may be helpful. Furthermore, research is needed to better understand barriers to use, and whether the addition of design features, reminders, or incentives may reduce noncompliance and the risk of foot ulcers.

Medical large language models are being introduced to the public in collaboration with governments, medical institutions, and artificial intelligence (AI) researchers. However, a crucial question remains: Will patients follow the medical advice provided by AI doctors? The lack of user research makes it difficult to provide definitive answers. Based on the clinician-patient communication pathway model, this study conducted a factorial experiment with a 2 (medical provider, AI vs. human) × 2 (information support, low vs. high) × 2 (response latency, slow vs. fast) between-subjects design (n = 535). The results showed that participants exhibited significantly lower adherence to AI doctors' advice than to human doctors. In addition, the interaction effect suggested that, under the slow-response latency condition, subjects perceived greater health benefits and patient-centeredness from human doctors, while the opposite was observed for AI doctors.

The prevalence of hypertension and uncontrolled hypertension may differ by age and sex.

We included participants in the Atherosclerosis Risk in Communities study at seven study visits over 33 years (visit 1: 15 636 participants; mean age, 54 years; 55% women), estimating sex differences in prevalence of hypertension (systolic blood pressure ≥130 mm Hg; diastolic blood pressure ≥80 mm Hg; or self-reported antihypertension medication use) and uncontrolled hypertension (systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg) using unadjusted and comorbidity-adjusted models.

The prevalence of hypertension increased with age from 40% (ages, 43-46 years) to 93% (ages, 91-94 years). Within hypertensive individuals, the prevalence of uncontrolled hypertension was higher in men (33%) than women (23%) at ages 43 to 46 years but became higher in women than men starting at ages 61 to 64, with 56% of women and 40% men having uncontrolled hypertension at ages 91 to 94. This sex difference was not explained by differences in coronary heart disease, diabetes, body mass index, estimated glomerular filtration rate, number of antihypertension medications, classes of medications, or adherence to medications. In both sexes, uncontrolled hypertension was associated with a higher risk for chronic kidney disease progression (hazard ratio, 1.5 [1.2-1.9]; P=4.5×10-4), heart failure (hazard ratio, 1.6 [1.4-2.0]; P=8.1×10-7), stroke (hazard ratio, 2.1 [1.6-2.8]; P=1.8×10-8), and mortality (hazard ratio, 1.5 [1.3-1.6]; P=6.2×10-19).

Sex differences in the prevalence of hypertension and uncontrolled hypertension vary by age, with the latter having implications for health throughout the life course.

Pediatric gender-affirming medical care has strong research evidence and support, and transition-related regret is uncommon. Misinformation about regret has nonetheless been used to limit adolescents from accessing this care. This study is the first of a 3-part initiative to clarify long-term satisfaction and regret related to pediatric gender-affirming care (GAC).

An anonymous survey was distributed to individuals of age 15 and older who participated in at least one prior appointment at a large pediatric gender clinic. The survey questions included (1) demographics; (2) use of gender-affirming interventions; (3) barriers to accessing medical interventions; (4) reasons for any discontinuation of medical interventions; (5) emotions associated with GAC; and (6) intervention-related regret.

Participants (N = 150; Mage = 18.6) were predominantly transmasculine-identified and/or assigned female at birth (86%). The most common emotions associated with GAC were satisfaction (88.0%) and confidence (86.7%). A total of 141 participants reported taking hormones, 30 of whom reported ever discontinuing (21.3%). Among these, 11 have already resumed hormones, and 16 might resume. Of the three with no plan to resume hormones, one is fully satisfied with the results, and the remaining two no longer identify as transgender. Only one participant (0.7% of those who ever took hormones) wishes they had never started testosterone or had top surgery, both of which occurred in adulthood.

Individuals who accessed GAC as adolescents are largely satisfied with this care. Care-related satisfaction and regret are more nuanced than sometimes portrayed and should not be used to limit access.

The COVID-19 pandemic is a major public health challenge. The US Centers for Disease Control published guidelines early in the pandemic emphasizing practicing good hygiene and staying at home, which were later modified.

Using a community sample of 2152 participants in the state of Florida who responded to a series of online surveys, we tested a prediction model of adherence to guidelines and intent to vaccinate during the COVID-19 pandemic.

Participants were assessed in May 2020, June 2020, and January 2021. Predictors included sociodemographic and psychological variables.

A slight decrease in adherence was reported over time. In multivariate models, older age, female sex, having health insurance, greater knowledge about COVID-19, more worry, less loneliness, and greater confidence and trust in COVID-19 information were all significantly and consistently associated with greater adherence to guidelines. Significant predictors of intent to vaccinate were male sex, greater knowledge, higher socioeconomic status, identifying as White, and greater guideline adherence (p's < 0.05).

Our findings highlight a number of significant predictors, including knowledge, loneliness, and confidence/trust. Critically these variables are modifiable and could therefore serve as targets in public health interventions to improve adherence to pandemic guidelines in the general population, as well as certain demographic characteristics that may influence intent to vaccinate. COVID-19 knowledge appears to play a central role in both adherence to guidelines and intent to vaccinate suggesting that having accurate information is critical for appropriate behavior.

Low drug adherence is a major obstacle to the benefits of pharmacotherapies and it is therefore important to identify factors associated with discontinuing or being poorly adherent to a prescribed treatment regimen. Using high-quality nationwide health registry data and genome-wide genotyping, we evaluate the impact of socio-demographic and genetic risk factors on adherence and persistence for 5 common medication classes that require long-term, regular therapy (N = 1,814,591 individuals from Finnish nationwide registries, 217,005 with genetic data from Finland and Estonia). Need for social assistance and immigration status show a notable negative effect on persistence and adherence across the examined medications (odd ratios between 0.48 and 0.82 for persistence and between 1.1% to 4.3% decrease in adherence) while demographic and health factors show comparably modest or inconsistent effects. A genome-wide scan does not identify genetic variants associated with the two phenotypes, while some pharmacogenes (i.e. CYP2C9 and SLCO1B1) are modestly associated with persistence, but not with adherence. We observe significant genetic correlations between medication adherence and participation in research studies. Overall, our findings suggest that socio-economically disadvantaged groups would benefit from targeted interventions to improve the dispensing and uptake of pharmacological treatments.

Treatment non-adherence is common in young people with inflammatory bowel disease (IBD), yet support is lacking. A self-led self-management intervention supporting teens with IBD (ASSIST-IBD) is a new theory-based digital treatment adherence intervention, co-developed by young people living with IBD. ASSIST-IBD includes 10 short modules supporting adolescents to feel confident to follow their treatment plan, develop skills to overcome adherence obstacles, feel confident when talking to others about IBD and feel positive about the future. This research aims to determine the feasibility of implementing and measuring the effectiveness of ASSIST-IBD, using a single-arm mixed-methods feasibility trial.

24 young people (aged 13-17) with IBD identified as being ≤80% adherent, and their parents, will use ASSIST-IBD for 6-12 weeks. For the primary endpoint of progression to randomised controlled trial, qualitative and quantitative data will be collected on; number of eligible members of the target population; number of recruited participants; reasons for non-participation and ineligibility; retention and follow-up rates; reasons for early withdrawal; completeness and utility of outcome measures; as well as further data on intervention acceptability, user experiences and user engagement. Secondary outcomes of preliminary effectiveness will include pre-intervention and post-intervention measures of treatment adherence (MARS-5), quality-of-life (IMPACT-III) and well-being (WEMWBS), and self-reported behaviour change success. Quantitative data will be analysed using descriptive statistics; qualitative data will be analysed thematically. An active patient and public involvement and engagement group will advise on the research throughout, including the development of the protocol.

The study has been granted ethical approval by Aston University's Health and Life Sciences Research Ethics Committee (ref:#HLS2112) and NHS Research Ethics Committee, Nottingham 1 Board (IRAS:#344918). Findings will be disseminated via peer-reviewed publications and lay summaries.

This protocol is registered on the Open Science Framework (https://doi.org/10.17605/OSF.IO/KC649).

Medication non-adherence is a common issue in chronic illness. The World Health Organization has recognized a need for a valid and reliable method of measuring adherence to understand and mitigate non-adherence. This study aimed to psychometrically evaluate the English version of the Adelphi Adherence Questionnaire (ADAQ©), a questionnaire designed to assess patient-reported medication adherence across multiple therapy areas, in patients with Osteoarthritis (OA).

Data from the Adelphi OA Disease Specific Programme™, a survey of physicians and their consulting adult patients with OA conducted in the United States, November 2020 to March 2021, was used to assess the psychometric properties of the ADAQ. Patients completed the ADAQ, Adherence to Refills and Medication Scale (ARMS), Western Ontario and McMaster Universities Arthritis Index (WOMAC), and EQ-5D-3L. The measurement model of the 13-item ADAQ was assessed and refined using latent variable modelling (Multiple Indicator Multiple Cause, confirmatory and exploratory factor analyses, item response theory, Mokken scaling, and bifactor analyses). Correlational analyses (Spearman's rank and polyserial as appropriate) with ARMS, WOMAC, and EQ-5D-3L scores assessed construct validity. Anchor- and distribution-based analyses were performed to estimate between-group clinically important differences (CID).

Overall, 723 patients were included in this analysis (54.5% female, 69.0% aged ≥ 60). Latent variable modelling indicated a unidimensional reflective model was appropriate, with a bifactor model confirming an 11-item essentially unidimensional score. Items 12 and 13 were excluded from scoring as they measured a different concept. The ADAQ had high internal reliability with omega hierarchical and Cronbach's alpha coefficients of 0.89 and 0.97, respectively. Convergent validity was supported by moderate correlations with items of the ARMS, and physician-reported adherence and compliance. Mean differences in ADAQ score between high and low adherence groups yielded CID estimates between 0.49 and 1.05 points, with a correlation-weighted average of 0.81 points.

This scoring model showed strong construct validity and internal consistency reliability when assessing medication adherence in OA. Future work should focus on confirming validity across a range of disease areas.

Despite recent advances in the management of asthma and chronic obstructive pulmonary disease (COPD), patients still experience suboptimal disease control largely due to medication non-adherence and inappropriate use of inhaler. This study evaluates the impact of pharmacist-led intervention in medication adherence and inhaler usage on asthma and COPD control among out-patients attending the premier tertiary hospital in Nigeria.

A quasi-experimental study carried-out among eligible out-patients attending pulmonology clinic of University College Hospital, Ibadan. Baseline questionnaire explored medication adherence using a comprehensive-medication-adherence-assessment-scale (CMAAS-12) developed by the study co-investigators, use of pressurized-metered-dose (pMDI) and Diskus inhalers, as well as asthma/COPD control using validated asthma control test (ACT) and COPD assessment test (CAT). Subsequently, patients were allocated into control (n = 65) or intervention group (n = 65) using odd or even number. Intervention group received 2-month follow-up educational and/or cognitive-behavioural interventions to resolve identified adherence barriers, while control group continued with traditional care. Descriptive statistics, Chi-square and Wilcoxon-signed-ranked tests were used for analysis at p < 0.05.

Overall, patients with optimal adherence were 11(18.6%) and 16(27.1%), p = 0.132 (control), but 20(33.3%) and 38(63.3%), p < 0.001 (intervention) at baseline and post-baseline, respectively. Specifically, in the intervention group, the identified adherence barriers at baseline were summarized into knowledge (120;40.4%), practical (115;38.7%) and attitudinal (62;20.9%). Patients with correct use of pMDI were 11(21.6%) baseline and 19(36.5%) post-baseline, p = 0.011 (control), but 13(22.8%) and 46(80.7%) respectively, p < 0.001 (intervention). Correct use of Diskus inhaler were 5(50.0%) and 4(40.0%), p = 0.157 (control), but 7(35.0%) and 14(70.0%), p = 0.025 (intervention) at baseline and post-baseline, respectively. Patients with 'well-controlled asthma' were 25(44.6%) and 26 (47.3%), p = 0.025 (control), but 18(35.3%) and 32(60.4%), p < 0.001 (intervention) at baseline and post-baseline, respectively. The COPD-specific health status indicated that 0(0.0%) and 1(14.3%), p = 0.059 (control), but 0(0.0%) and 7(50.0%), p < 0.001 (intervention) at baseline and post-baseline, respectively, belonged to 'low COPD impact'.

Pharmacist-led intervention significantly enhanced medication adherence and appropriate use of inhaler among the intervention cohort, with subsequent significant improvement in asthma control and reduced COPD impact compared with the control group. This underscores the need for active involvement of pharmacists in collaborative management of patients with chronic respiratory diseases in clinical practice.

ClinicalTrials.gov identifier: NCT06417931. Retrospectively-registered.

To develop and validate the Mobile Adherence Satisfaction Scale (MASS) for assessing user satisfaction with mobile health applications aimed to improve medication adherence.

The study involved patients over 18 with asthma, hypertension, heart failure, or diabetes, who used the CareAide® app for six months. Scale development included a literature review, expert consultations, and patient interviews, initially identifying 129 items. These were refined to 27 using a two-round Delphi technique and grouped into six dimensions: user interface, perceived usability, system quality, service quality, feature satisfaction, and general satisfaction. A pilot study with 30 participants further refined the model, which was then validated with 135 participants using exploratory and confirmatory factor analyses in SPSS 29 and SmartPLS 4. Data were collected via self-administered questionnaires.

A total of 135 complete questionnaires were analysed. Respondents had an average age of 66.7 years (SD = 11.6) with 42.2 % male (n = 57) and 57.8 % female (n = 78). After removal of an item due to cross loading, exploratory factor analysis resulted six dimensions and 26 items with Kaiser-Meyer-Olkin measure of 0.837 and Bartlett's Test of Sphericity (χ2(n = 325) = 2085.673, P < 0.001). The confirmatory factor analysis confirmed high reliability and validity: Cronbach's alpha values > 0.70 for each dimension and an overall alpha of 0.89, with Composite Reliability and Average Variance Extracted both >0.70 and >0.50, respectively, for each dimension. Structural model indicated a significant positive impact of user interface (β = 0.226, P = 0.006) and feature satisfaction (β = 0.230, P = 0.002) on general satisfaction, explaining 23.1 % of the variance (R2 = 0.231).

The study developed and validated the MASS, a reliable tool for assessing user satisfaction with mHealth apps. User interface design and feature satisfaction are key for long-term engagement and consistent medication adherence.

The objective of this study is to assess disparities in adherence to swallowing therapy for clinically diagnosed oropharyngeal dysphagia (OD) patients.

Analysis was conducted on data from 600 patients with OD and confirmed impairments in swallowing safety and/or efficiency on a videofluoroscopic swallow study. Patients were classified based on their adherence to treatment sessions, defined as the number of swallow treatment sessions attended. The outcome of treatment adherence was categorized into two groups: those who attended fewer than 50% of the prescribed treatment sessions and those who attended 50% or more of the sessions. Continuous variables were presented as mean ± standard deviation or median ± interquartile range. Categorical variables were compared using Pearson chi-square tests and Fisher's exact test when appropriate. Univariable and multivariable binary logistic regression models were employed to identify factors associated with successful adherence.

Approximately 79% adhered to swallowing treatment. We found no significant relationship between adherence and age, sex, race, ethnicity, primary language, marital status, insurance status, occupation, median income, distance, education, OD severity, and diagnosis year (p > 0.05). We found no covariables to be significant predictors to swallowing treatment nonadherence in both univariable and multivariable binary regression models (p > 0.05).

The variables analyzed in this study were not significantly associated with nonadherence to swallow therapy. Nevertheless, our study still addressed an important knowledge gap and future studies would benefit from exploring other relevant socioeconomic and disease-related factors.

Level 4.

Surgical decision making in the context of pilonidal disease (PD) can be challenging. Current evidence for the management of PD is inadequate and optimum treatment is not clear. This paper reports on patient experience of shared decision making (SDM) and decision regret following surgical management of PD.

The Pilonidal Trial. Studying the Treatment Options (PITSTOP) study (ISRCTN95551898) is a prospective cohort study of patients with PD treated between May 2019 and March 2022. This subanalysis reports the results of quantitative data capture between baseline and 6 months post-procedure. Baseline data consisted of patient and disease characteristics, surgical procedure and impression of SDM. Post-procedure data consisted of operative outcomes and decision regret. Multiple linear regression analysis was used to analyse the relationship between clinical outcomes and decision regret.

Overall, 677 patients were included, and follow-up data to 6 months were available for 476 (71%). Most (59.5%) patients underwent major excisional surgery; 45.1% of patients experienced a postoperative complication. Participant impression of SDM was positive, with a median CollaboRATE mean-score response of 3 (interquartile range: 3-4). Of the patients who underwent a 'leave open' approach, 20.6% were dissatisfied or very dissatisfied with their treatment. Postoperative complications (β = 3.21, 95% CI: -12.75 to 7.25, p < 0.001) and disease recurrence (β = 11.5, 95% CI: -10.6 to 9.4, p < 0.001) were both associated with higher rates of decision regret.

The clinical outcomes, postoperative complications and recurrence, were associated with higher levels of decision regret. Surgeons treating patients with PD should practice SDM and ensure that patient priorities inform treatment approach.

A subgroup analysis of a randomized clinical trial established the efficacy of selexipag plus background therapy (monotherapy or double oral therapy [DOT]) vs placebo plus background therapy and found that the addition of selexipag within 6 months had an added benefit. However, the timing of selexipag addition to DOT and the incremental benefit in clinical practice is not well studied.

To compare triple oral therapy (TOT) consisting of selexipag, endothelin receptor antagonist (ERA), and phosphodiesterase type 5 inhibitor (PDE5i) vs DOT consisting of ERA and PDE5i.

This comparative effectiveness study was conducted using data from the US Komodo claims database to emulate a randomized trial. Patients aged 18 years or older with pulmonary arterial hypertension (PAH) treated with ERA plus PDE5i with records from July 2015 through June 2022 were duplicated to TOT and DOT and artificially censored when observed treatment deviated from assigned treatment. Hypothetical randomization was emulated using inverse probability of treatment weighting, and the study accounted for censoring-induced selection bias using inverse probability of censoring weighting. A pooled logistic model estimated the per-protocol difference between treatment groups. Data were analyzed from November 2022 through July 2023.

TOT (addition of selexipag within 3, 6, and 12 months of initiating DOT) vs DOT.

Adjusted risk of all-cause hospitalization, PAH-related hospitalization, and PAH-related disease progression over a 2-year follow-up.

A total of 2966 patients with PAH (mean [SD] age, 54.3 [14.0] years; 2125 female [71.6%]) met eligibility criteria. Adding selexipag within 6 months of ongoing DOT was associated with a reduction in risk for all-cause hospitalization (adjusted hazard ratio [aHR], 0.82; 95% CI, 0.72-0.94), PAH-related hospitalization (aHR, 0.81; 95% CI, 0.70-0.95), and PAH-related progression (aHR, 0.82; 95% CI, 0.70-0.95) vs DOT alone. There were no associations if selexipag was initiated within 12 months for all-cause hospitalization, PAH-related hospitalization, or PAH-related disease progression. The association remained with a greater decrease in risk for disease progression vs DOT for selexipag initiation within 3 months (aHR, 0.74; 95% CI, 0.61-0.90).

This study found that early selexipag addition to ERA plus PDE5i was associated with a reduction in risk of hospitalization and disease progression. These findings suggest that delays in selexipag initiation likely contribute to suboptimal patient and health system outcomes.

Suboptimal medication adherence is common among patients with cardiovascular diseases. We sought evidence on non-pharmacological interventions used to support adherence for patients with hypertension and/or dyslipidemia.

We searched MEDLINE, EMBASE, MEDLINE In-Process, ClinicalTrials.gov, EUCTR, and conference proceedings from July 2011 to July 2021 to identify trials evaluating effects of health education, phone reminders, or digital interventions on medication adherence or persistence of adult patients with hypertension and/or dyslipidemia. Risk of bias was assessed using the Cochrane Risk of Bias Assessment Tool v2.

Of 64 studies, 62 used health education approaches (e.g. educational interviews, motivational meetings, advice from physicians, and mobile health content), 16 phone reminders (e.g. text reminders, electronic pill-box linked reminders, bi-directional text messaging), and 10 digital applications as interventions (e.g., various self-management applications). All studies assessed medication adherence; only two persistence. Overall, 30 studies (83%) assessing health education approaches alone and 25 (78%) combined with other strategies, 12 (75%) phone reminders and eight studies (80%) digital applications combined with other strategies reported improved medication adherence. Two studies assessing health education approaches reported improved persistence.

Our findings indicate non-pharmacological interventions may positively impact adherence. Therefore, 'beyond the pill' approaches could play a role in preventing cardiovascular diseases.