No abstract

BackgroundNon-adherence impacts negatively on patient health outcomes and has associated economic costs. Understanding drivers of treatment adherence in immune-mediated inflammatory diseases is key for the development of effective strategies to tackle non-adherence.ObjectiveTo identify factors associated with treatment non-adherence across diseases in three clinical areas: rheumatology, gastroenterology, and dermatology.DesignSystematic review.Data SourcesArticles published in PubMed, Science Direct, PsychINFO and the Cochrane Library from January 1, 1980 to February 14, 2014.Study SelectionStudies were eligible if they included patients with a diagnosis of rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, inflammatory bowel disease, or psoriasis and included statistics to examine associations of factors with non-adherence.Data ExtractionData were extracted by the first reviewer using a standardized 23-item form and verified by a second/third reviewer. Quality assessment was carried out for each study using a 16-item quality checklist.Results73 studies were identified for inclusion in the review. Demographic or clinical factors were not consistently associated with non-adherence. Limited evidence was found for an association between non-adherence and treatment factors such as dosing frequency. Consistent associations with adherence were found for psychosocial factors, with the strongest evidence for the impact of the healthcare professional–patient relationship, perceptions of treatment concerns and depression, lower treatment self-efficacy and necessity beliefs, and practical barriers to treatment.ConclusionsWhile examined in only a minority of studies, the strongest evidence found for non-adherence were psychosocial factors. Interventions designed to address these factors may be most effective in tackling treatment non-adherence.Electronic supplementary materialThe online version of this article (doi:10.1007/s12325-015-0256-7) contains supplementary material, which is available to authorized users.

The needs of carers have become more visible since the Carers Recognition & Service Act (1995). Although the demand for respite care is apparent it has proven much harder to establish its precise benefits using quantitative analysis. Some studies have shown no benefit at all to carers and the only clear benefit to emerge from more elaborate randomized controlled trials is a modest reduction in caregiver distress. Quantitative instruments may miss some of the benefits. We embarked on a qualitative study to determine what carers themselves said about the benefits or otherwise of respite care. Twenty-three carers were interviewed about their experiences of respite care and qualitative themes were derived from the transcripts of these semi-structured interviews. Caring was conceptualized in terms of costs (physical exhaustion, feelings of despair, lack of recognition and financial losses) and benefits (a sense of closeness to the dependant and enhanced self-esteem). Respite care emerged as a service that offered 'normality' and 'freedom' to the carer. Conversely, it was also perceived in critical terms if there was any shortfall between the quality of professional care compared to their own informal care. However high the quality of respite care, there was the uncomfortable realization by many that this care might be viewed as a signal to the patient, the family and the local community that they were no longer able to cope. Respite care was perceived as a service which, on balance, facilitated informal care and enabled care to continue at home for longer than would otherwise have been possible. The particular component of this service that was most valued was the option of a home-sitting service.

Objective: To evaluate the effectiveness of a computer-generated tailored intervention leaflet compared with a generic leaflet aimed at increasing brown bread, wholegrain cereal, fruit and vegetable intakes in adolescent girls. Design: Clustered randomised controlled trial. Dietary intake was assessed via three 24 h dietary recalls. Setting: Eight secondary schools in areas of low income and/or high ethnic diversity, five in London and three in the West Midlands, UK. Subjects: Girls aged 12-16 years participated (n 823) and were randomised by school class to receive either the tailored intervention (n 406) or a generic leaflet (n 417). Results: At follow-up 637 (77 %) participants completed both baseline and follow-up dietary recalls. The tailored intervention leaflet had a statistically significant effect on brown bread intake (increasing from 0?39 to 0?51 servings/d) with a smaller but significant increase in the control group also (increasing from 0?28 to 0?35 servings/ d). The intervention group achieved 0?05 more servings of brown bread daily than the control group (P , 0?05), which is equivalent to 0?35 servings/week. For the other foods there were no significant effects of the tailored intervention. Conclusions: The intervention group consumed approximately 0?35 more servings of brown bread weekly than the control group from baseline. Although this change between groups was statistically significant the magnitude was small. Evaluation of the intervention was disappointing but the tailored leaflet was received more positively in some respects than the control leaflet. More needs to be done to increase motivation to change dietary intake in adolescent girls.