Qualitative evaluation of adherence therapy in Parkinson’s disease: a multidirectional model

Abstract

Background: Medication can control the symptoms of Parkinson's disease (PD). Despite this, non-adherence with medication is prevalent in PD. Treatments for improving adherence with medication have been investigated in many chronic conditions, including PD. However, few researchers have evaluated their interventions qualitatively. We investigated the acceptability and potential mechanism of action of adherence therapy (AT) in PD patients and their spouse/ carers who received the intervention as part of a randomized controlled trial. Methods: Sixteen participants (ten patients and six spouses/carers) who had recently completed the trial were purposely selected in order to cover a range of ages and disease severity. Semi-structured interviews were conducted in the participants' homes. Data were transcribed and analyzed using a thematic approach. A second researcher, naïve to PD and AT, analyzed the data independently to limit bias. Results: The trial showed that AT significantly improved both medication adherence and quality of life in people with PD. Specifically, patients who received AT reported improvements in mobility, activities of daily living, emotional wellbeing, cognition, communication, and body discomfort. General beliefs about medication also significantly improved in those who received AT compared with controls. In the current qualitative evaluation, a total of 175 codes were generated, which formed eleven subthemes. These could be grouped under three overarching themes, ie, perceptions prior to AT, positive effects of AT, and attributes of AT. Conclusion: This randomized controlled trial is the first to investigate AT in PD. The acceptability and underlying mechanism of the intervention suggest a new multidirectional model of AT in PD which future research should seek to confirm. The findings provide a deeper understanding of AT and will allow clinicians to modify the delivery of the intervention by acknowledging various pathways to improved outcomes.

Shifting mindsets: a realist synthesis of evidence from self-management support training

“…Twenty of the included articles provided data for this theory . This theory describes how HCPs attempt to integrate SMS into clinical practice, influenced by the reasoning processes described in the earlier theories.…”

“…The impact of PNCs on cognition could make it challenging for patients to identify meaningful goals and to plan or perform SM activities (C). HCPs responded to these challenges (M) by providing more time, involving family members and delivering interventions in the home environment where patients with cognitive impairment may be more at ease(O) …”

“…Twenty of the included articles provided data for this theory. 29,30,34,37,39,[41][42][43][44]48,53,55,57,58,60,64,[67][68][69][70] This theory describes how HCPs attempt to integrate SMS into clinical practice, influenced by the reasoning processes described in the earlier theories. Health care professionals (HCPs) reasoned that some of their patients were not able to self-manage, meaning that supporting self-management was not worthwhile (M).…”

“…HCPs responded to these challenges (M) by providing more time, involving family members and delivering interventions in the home environment where patients with cognitive impairment may be more at ease(O). 67,68 In settings where there was continuity of care (C), it was easier for HCPs to identify when they felt was the 'right time' for SMS (M) and so effective support could be provided when the patient needed it, increasing job satisfaction (O). Smith et al 64 describe in their paper how they found that:…”

Barriers to and Facilitators of Older Adult's Adherence to Health Recommendations

“…Accessing the later may allow tailoring communications to people's actual and perceived information needs, rather than to the information the health professionals perceive that people need. There are examples in the literature concerning tailored interventions that aim for this, such as for example the Adherence Therapy (Daley, Deane, Gray, Hill, & Myint, 2015). Although there are examples, these are more often found in the scientific literature rather than in practice.…”