Exploring challenges to nutrition intervention adherence using COM-B model among patients with wet age-related macular degeneration: a qualitative study

Abstract

ObjectivesTo explore challenges to nutrition intervention adherence using the Capability, Opportunity and Motivation-Behaviour (COM-B) model among wet age-related macular degeneration (AMD) patients. These factors should be considered in the development of potential support and intervention programmes to address these problems.DesignA qualitative study was conducted with one-to-one and face-to-face interviews with wet AMD patients using a semi-structured question guide. Data were analysed based on COM-B model: capability (physical and psychological), opportunity (physical and social) and motivation (reflective and automatic).SettingSouthwest Hospital of Chongqing Province in China.ParticipantsA convenient and purposive sample of 24 wet AMD patients were recruited.ResultsThe themes and subthemes were identified: psychological capability: (1) insufficient knowledge of nutrition; (2) misconceptions about the disease and treatment; (3) knowledge conflict; physical capability: (1) physical restriction; (2) limited access to nutrition knowledge; physical opportunity: (1) communication between providers and patients; (2) health insurance and extra charges; (3) food environment; social opportunity: (1) stigma of disease; (2) family influence; reflective motivation: (1) self-efficacy; (2) attitude; (3) outcome expectancies; (4) lack of professional support; automatic motivation: (1) difficulties in changing eating habits; (2) mindset.ConclusionMedical staff should pay much attention to the process of patients’ nutrition intervention. In addition, it is also necessary to develop professional and internet-based intervention to modify the dietary behaviour and improve the management skills of the patients.

Exploring factors affected timely receiving intravitreal anti-VEGF treatment in patients with Diabetic Macular Edema: a qualitative interview study analyzed with COM-B model

“…Some participants mentioned that it was difficult to communicate with doctors. Communication was identified as one of the most significant obstacles in terms of the subtheme “physical opportunity”[20]. Most patients in China went directly to tertiary hospitals regardless of the severity or type of disease, leading to an excessive clinical workload for doctors in tertiary hospitals[21], the accumulation of patients also leads to long waiting time and short reception time, and make doctors have no much time to give detailed explanation, the feeling of rushed by doctors made it difficult for patients to raise all their concerns or ask questions, which was consistent with other research where patients expressed a desire for longer consultations with their clinicians[22,23].…”

Adesão ao tratamento medicamentoso e não medicamentoso de pessoas com hipertensão arterial e diabetes mellitus

“…Neste estudo também houve relatos de pessoas que acreditavam que os medicamentos eram a única maneira de controlar a doença, sendo uma fala encontrada em outras pesquisas semelhantes. Isso mostra um fraco entendimento sobre o próprio tratamento e evidencia o nível de medicamentalização presente na população, que pode ser justificada pela baixa oferta de informações e condições precisas por parte de serviços de saúde que são baseados, em grande parte, no modelo biomédico, o qual negligencia a promoção da saúde (19) .…”

“…Diversos fatores relacionados à falta de aderência ao tratamento se devem principalmente à falha de comunicação entre profissional de saúde e usuário, como indicado em vários relatos neste estudo. Na pesquisa de Bian et al (19) , conclui-se que fatores relacionados à abordagem do diálogo e ao nível de confiança no profissional podem impactar de forma profunda na aderência ao tratamento. Em grande parte, atendimentos insatisfatórios em saúde se deram pelo tempo insuficiente para acolher os pacientes e oferecer orientações sobre medicamentos, dieta e exercícios físicos, resultando em consultas rápidas e pouco proveitosas.…”

A Narrative Review of Non-Pharmacological Strategies for Managing Sarcopenia in Older Adults with Cardiovascular and Metabolic Diseases

“…For example, physical activity interventions may be ineffective in older populations simply because older adults might not be able to adhere to these interventions due to a host of factors that may include physical limitations, chronic illnesses, obesity, a lack of social support and low socioeconomic status [19]. Similarly, the effectiveness of nutritional interventions may be negatively influenced by further factors, including underdeveloped professional support, physical restrictions, unhelpful family influences and difficulties in changing eating habits [20]. Therefore, it is important that bespoke interventions, designed to cater to the specific needs of any older population, integrate powerful elements of behavioural modification and implementation aspects to enhance intervention effectiveness.…”