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.

Many registered nurses (RNs) are not achieving the recommended daily levels of physical activity. This study collected data from 623 RNs about their personal health behaviours and their professional, physical activity-related health-promotion practices. The findings showed that 75% of the sample reported engaging in personal physical activity, 25% were at risk of hazardous drinking or active alcohol use disorders, 17% were past smokers and 11% were current smokers, 47% reported having a normal body weight-size, and 73% desired to be a normal body weight-size. Nearly half of the sample reported that they were promoting physical activity within their clinical practice. Personal physical activity behaviour, perceived health status, length of clinical practice, clinical specialty, and actual body weight-size were significantly related to the RNs' professional, physical activity-related practices. This study highlights a need for training on physical activity-related counselling, including awareness of the latest recommendations and strategies to promote physical activity. Health-care employers should also consider addressing nurses' barriers to the promotion of physical activity within their clinical practice so that all health-care contacts are able to maximise opportunities to promote active ageing.

BackgroundDuring the 2009–10 influenza (flu) pandemic, surveys to assess behaviour among the general public were designed quickly and suffered from methodological deficits as a result. To facilitate survey work in a future pandemic we (1) identified variables relating to behaviour, perceptions and presence of symptoms that were of relevance to policy-makers and other public health experts; (2) tested and refined the wording of questions to measure these variables; (3) assessed the reliability of responses to these questions; and (4) tested whether non-response bias due to attrition might prevent the use of a longitudinal design for future pandemic-related surveys.ObjectiveTo design, test and refine a set of questions to assess perceptions and behaviours in relation to a pandemic flu outbreak.MethodWe identified variables via existing systematic reviews and through consultation with pandemic flu planners from Public Health England, the English Department of Health, their advisory groups and academic colleagues. We adapted questions from existing scales or developed them afresh, and tested their clarity in three rounds of qualitative interviews with members of the public (totaln = 78). We used a random-digit dial telephone survey of adults from Great Britain (n = 1080) to assess the internal reliability of scales. We used a follow-up survey 1–2 weeks later to assess the test–retest reliability of responses and the differences between responders (n = 621) and non-responders (n = 459).ResultsWe identified seven core sets of outcome variables relating to the presence of flu-like illness and to various protective behaviours, as well as a set of likely predictor variables for the behaviours. Qualitative interviews identified multiple issues with our questions, most of which we resolved. Reliability of the items was largely satisfactory. Evidence of non-response bias was found, with non-responders being younger and less well educated than responders, and differing on several flu-related variables.ConclusionsIt would be ill-advised for public health bodies to enter the next pandemic without a plan for how to measure the public’s behaviours and perceptions. The extensive set of items that we compiled as part of this work has the benefit of being evidence based, policy relevant and readily understood. Although choosing how to gather data still requires consideration, these items can be used with confidence as soon as the next pandemic begins. Future work should consider the most appropriate method for conducting surveys using these items.Study registrationCurrent Controlled Trials ISRCTN40930724.FundingThis project was funded by The National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full inHealth Services and Delivery Research; Vol. 2, No. 41. See the NIHR Journals Library website for further project information.