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      Designing and Testing a Treatment Adherence Model Based on the Roy Adaptation Model in Patients With Heart Failure: Protocol for a Mixed Methods Study

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          Abstract

          Background

          Adherence to treatment is an important factor to decrease repeated and costly hospitalization owing to heart failure (HF). The explanation and prediction of medication adherence and other lifestyle recommendations in chronic diseases, including HF, are complex. Theories lead to a better understanding of complex situations as well as the process of changing behavior and explain the reasons for the existence of a problem.

          Objective

          The aim of this study is to report a protocol for a mixed methods study setting out to investigate the empirical validity of the Roy Adaptation Model as a conceptual framework for explaining and predicting adherence to treatment in patients with HF in Iran.

          Methods

          This mixed methods study consists of an exploratory sequential design to be conducted in 2 phases. The first phase involves identifying the factors associated with treatment adherence in patients with HF through content analysis of the literature and elucidating the perception of participants in the context of Iranian health care where the model of adherence to treatment is designed based on the Roy Adaptation Model. The second phase addresses the interrelationships among variables in the model through a descriptive study using structural equation modeling. Finally, following the summarization and separate interpretation of the qualitative findings and quantitative results, a decision is made about the extent to and ways in which the results of the quantitative stage can be generalized or tested for the qualitative findings.

          Results

          Content analysis of the literature in part 1 of the first phase was completed in 2017. Collection and analysis of qualitative data in part 2 of the first phase will be completed soon. The results are expected to be submitted for publication in 2019. Then, the second phase—the quantitative study—will be conducted.

          Conclusions

          The results of this study will provide valuable information about the empirical validity of the Roy Adaptation Model as a conceptual framework for explaining and predicting adherence to treatment in patients with HF, which, to date, have received little attention. The results can be used as a guide for nursing practice and care provision to patients with HF and also to design and implement effective interventions to improve treatment adherence in these patients.

          International Registered Report Identifier (IRRID)

          DERR1-10.2196/13317

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          Most cited references28

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          Epidemiology of heart failure and scope of the problem.

          Heart failure (HF) is typically a chronic disease, with progressive deterioration occurring over a period of years or even decades. HF poses an especially large public health burden. It represents a new epidemic of cardiovascular disease, affecting nearly 5.8 million people in the United States, and over 23 million worldwide. In the present article, our goal is to describe the most up-to-date epidemiology of HF in the United States and worldwide, and challenges facing HF prevention and treatment. Copyright © 2014 Elsevier Inc. All rights reserved.
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            Predictors of medication adherence using a multidimensional adherence model in patients with heart failure.

            Medication adherence in heart failure (HF) is a crucial but poorly understood phenomenon. The purpose of this study was to explore factors contributing to medication adherence in patients with HF by using the World Health Organization's multidimensional adherence model. Patients (N = 134) with HF (70% were male, aged 61 +/- 12 years, 61% with New York Heart Association III/IV) were studied to determine the predictors of medication adherence derived from the multidimensional adherence model. Medication adherence was measured objectively using the medication event monitoring system for 3 months. Three indicators of adherence were assessed by the medication event monitoring system: 1) dose-count, the percentage of prescribed doses taken; 2) dose-days, the percentage of days the correct number of doses were taken; and 3) dose-time, the percentage of doses that were taken on schedule. Barriers to medication adherence, ethnicity, and perceived social support predicted dose-count (P < .001). New York Heart Association functional class, barriers to medication adherence, financial status, and perceived social support predicted dose-day (P < .001). Barriers to medication adherence and financial status predicted dose-time (P = .005). A number of modifiable factors predicted medication adherence in patients with HF, providing specific targets for intervention.
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              Barriers and facilitators to self-care in chronic heart failure: a meta-synthesis of qualitative studies

              Chronic heart failure (CHF) is a costly condition that places large demands on self-care. Failure to adhere with self-care recommendations is common and associated with frequent hospitalization. Understanding the factors that enable or inhibit self-care is essential in developing effective health care interventions. This qualitative review was conducted to address the research question, "What are the barriers and facilitators to self-care among patients with CHF?” Electronic databases including Medline, EMBASE, CINAHL, Web of Science, Scopus and Google scholar were searched. Articles were included if they were peer reviewed (1995 to 2012), in English language and investigated at least one contextual or individual factor impacting on self-care in CHF patients > 18years. The criteria defined by Kuper et al. including clarity and appropriateness of sampling, data collection and data analysis were used to appraise the quality of articles. Twenty-three articles met the inclusion criteria. Factors impacting on self-care were included factors related to symptoms of CHF and the self-care process; factors related to personal characteristics; and factors related to environment and self-care system. Important factors such as socioeconomic situation and education level have not been explored extensively and there were minimal data on the influence of age, gender, self-confidence and duration of disease. Although there is an emerging literature, further research is required to address the barriers and facilitators to self-care in patients with CHF in order to provide an appropriate guide for intervention strategies to improve self-care in CHF.
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                Author and article information

                Contributors
                Journal
                JMIR Res Protoc
                JMIR Res Protoc
                ResProt
                JMIR Research Protocols
                JMIR Publications (Toronto, Canada )
                1929-0748
                July 2019
                26 July 2019
                : 8
                : 7
                : e13317
                Affiliations
                [1 ] Nursing Care Research Center School of Nursing and Midwifery Iran University of Medical Sciences Tehran Islamic Republic of Iran
                [2 ] Cancer Research Center, Shahid Beheshti University of Medical Sciences Tehran Islamic Republic of Iran
                [3 ] Workplace Health Promotion Research Center and Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences Tehran Islamic Republic of Iran
                Author notes
                Corresponding Author: Mansoureh Ashghali Farahani m_negar110@ 123456yahoo.com
                Author information
                http://orcid.org/0000-0003-2997-1823
                http://orcid.org/0000-0001-9361-9707
                http://orcid.org/0000-0002-4310-4796
                http://orcid.org/0000-0002-5607-8064
                http://orcid.org/0000-0003-3922-0564
                Article
                v8i7e13317
                10.2196/13317
                6688435
                31350842
                b8f70180-b1cf-4d06-a327-50c5a4d2c467
                ©Shabnam Shariatpanahi, Mansoureh Ashghali Farahani, Forough Rafii, Maryam Rassouli, Amir Kavousi. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 26.07.2019.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Research Protocols, is properly cited. The complete bibliographic information, a link to the original publication on http://www.researchprotocols.org.as well as this copyright and license information must be included.

                History
                : 5 January 2019
                : 3 February 2019
                : 7 April 2019
                : 6 May 2019
                Categories
                Protocol
                Protocol

                adaptation,treatment adherence and compliance,heart failure

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