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A screening instrument to identify ulcerative colitis patients with the high possibility of current non-adherence to aminosalicylate medication based on the Health Belief Model: a cross-sectional study.

Kawakami A, Tanaka M, Nishigaki M, Yoshimura N, Suzuki R, Maeda S, Kunisaki R, Yamamoto-Mitani N - BMC Gastroenterol (2014)

Bottom Line: We hypothesized that there was a significant relationship between current aminosalicylate non-adherence and five components of the HBM: beliefs about taking aminosalicylates, disease characteristics, medication characteristics, abdominal symptoms, and sociodemographic characteristics.The instrument appeared to be reliable for identifying patients with a high possibility of current non-adherence to aminosalicylates.On the other hand, we need to evaluate disease activity more strictly and examine whether it is included in the screening instrument in the future.

View Article: PubMed Central - PubMed

Affiliation: Inflammatory Bowel Disease Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan. akikawakami-tky@umin.ac.jp.

ABSTRACT

Background: Non-adherence to aminosalicylates is observed among 30% to 45% of patients with ulcerative colitis and increases the risk of relapse. The Health Belief Model is a theoretical model that could offer a broader perspective to improve patients' self-medication adherence. This study aimed to develop a screening instrument based on the Health Belief Model to screen patients with ulcerative colitis who had a high possibility of current non-adherence to aminosalicylates. The study was also designed to allow examination of factors of non-adherence.

Methods: A multicenter, cross-sectional study was conducted in outpatients diagnosed with ulcerative colitis and prescribed aminosalicylates. Non-adherence was defined as taking less than 80% of the prescribed dose. We hypothesized that there was a significant relationship between current aminosalicylate non-adherence and five components of the HBM: beliefs about taking aminosalicylates, disease characteristics, medication characteristics, abdominal symptoms, and sociodemographic characteristics. A logistic regression model was applied and the coefficients converted to a numeric scores in order to develop a screening instrument which could reliably discriminate non-adherent and adherent subjects.

Results: Non-adherence was observed in 127 (29.6%) of the 429 enrolled subjects. Lower perceptions of belief in taking aminosalicylates, absence of visible bleeding, eight daily tablets or less taken, and no concomitant use of thiopurines were related to non-adherence. We then developed a screening instrument comprising 22 items. When the cut-off point was set at 60, the instrument showed 85.0% sensitivity and 69.2% specificity with an area under the curve of 0.84 (95% confidence interval = 0.79-0.91).

Conclusions: The instrument appeared to be reliable for identifying patients with a high possibility of current non-adherence to aminosalicylates. Further, the instrument may provide useful information for detecting patients with a high possibility of current non-adherence and for assessing factors of non-adherence. On the other hand, we need to evaluate disease activity more strictly and examine whether it is included in the screening instrument in the future.

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Receiver operating characteristic curve for the screening instrument for non-adherence. This is the Receiver Operating Characteristic curve we applied to assess current non-adherence. The area under the curve was 0.84 (95% confidence interval = 0.79 to 0.91). Sensitivity was 85.0% and specificity was 69.2% when a cut-off value of 60 was applied. N = 426.
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Fig2: Receiver operating characteristic curve for the screening instrument for non-adherence. This is the Receiver Operating Characteristic curve we applied to assess current non-adherence. The area under the curve was 0.84 (95% confidence interval = 0.79 to 0.91). Sensitivity was 85.0% and specificity was 69.2% when a cut-off value of 60 was applied. N = 426.

Mentions: The risk score weights based on each factor’s coefficient in the final multivariate logistic regression model are shown in Table 2. Each coefficient was divided by the smallest coefficient, which was “perceived barrier”, and each quotient was rounded to the nearest whole number. The screening instrument consists of 22 variables and the range of the overall score was 0 to 153, with a higher score indicating a higher possibility of current non-adherence. The mean score and SD were 61.5 and 18.9 (range: 7–109). The ROC curve of the total score is shown in Figure 2 (AUC = 0.84, 95% CI = 0.79–0.91). The instrument showed a sensitivity of 85.0 and specificity of 69.2 when a cut-off point of 60 was used. When subjects were grouped into fours by quartile score, the current non-adherence rate increased significantly with score strata (p < 0.01) (Figure 3). The final screening instrument is shown in the Additional file 1.Figure 2


A screening instrument to identify ulcerative colitis patients with the high possibility of current non-adherence to aminosalicylate medication based on the Health Belief Model: a cross-sectional study.

Kawakami A, Tanaka M, Nishigaki M, Yoshimura N, Suzuki R, Maeda S, Kunisaki R, Yamamoto-Mitani N - BMC Gastroenterol (2014)

Receiver operating characteristic curve for the screening instrument for non-adherence. This is the Receiver Operating Characteristic curve we applied to assess current non-adherence. The area under the curve was 0.84 (95% confidence interval = 0.79 to 0.91). Sensitivity was 85.0% and specificity was 69.2% when a cut-off value of 60 was applied. N = 426.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4279902&req=5

Fig2: Receiver operating characteristic curve for the screening instrument for non-adherence. This is the Receiver Operating Characteristic curve we applied to assess current non-adherence. The area under the curve was 0.84 (95% confidence interval = 0.79 to 0.91). Sensitivity was 85.0% and specificity was 69.2% when a cut-off value of 60 was applied. N = 426.
Mentions: The risk score weights based on each factor’s coefficient in the final multivariate logistic regression model are shown in Table 2. Each coefficient was divided by the smallest coefficient, which was “perceived barrier”, and each quotient was rounded to the nearest whole number. The screening instrument consists of 22 variables and the range of the overall score was 0 to 153, with a higher score indicating a higher possibility of current non-adherence. The mean score and SD were 61.5 and 18.9 (range: 7–109). The ROC curve of the total score is shown in Figure 2 (AUC = 0.84, 95% CI = 0.79–0.91). The instrument showed a sensitivity of 85.0 and specificity of 69.2 when a cut-off point of 60 was used. When subjects were grouped into fours by quartile score, the current non-adherence rate increased significantly with score strata (p < 0.01) (Figure 3). The final screening instrument is shown in the Additional file 1.Figure 2

Bottom Line: We hypothesized that there was a significant relationship between current aminosalicylate non-adherence and five components of the HBM: beliefs about taking aminosalicylates, disease characteristics, medication characteristics, abdominal symptoms, and sociodemographic characteristics.The instrument appeared to be reliable for identifying patients with a high possibility of current non-adherence to aminosalicylates.On the other hand, we need to evaluate disease activity more strictly and examine whether it is included in the screening instrument in the future.

View Article: PubMed Central - PubMed

Affiliation: Inflammatory Bowel Disease Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan. akikawakami-tky@umin.ac.jp.

ABSTRACT

Background: Non-adherence to aminosalicylates is observed among 30% to 45% of patients with ulcerative colitis and increases the risk of relapse. The Health Belief Model is a theoretical model that could offer a broader perspective to improve patients' self-medication adherence. This study aimed to develop a screening instrument based on the Health Belief Model to screen patients with ulcerative colitis who had a high possibility of current non-adherence to aminosalicylates. The study was also designed to allow examination of factors of non-adherence.

Methods: A multicenter, cross-sectional study was conducted in outpatients diagnosed with ulcerative colitis and prescribed aminosalicylates. Non-adherence was defined as taking less than 80% of the prescribed dose. We hypothesized that there was a significant relationship between current aminosalicylate non-adherence and five components of the HBM: beliefs about taking aminosalicylates, disease characteristics, medication characteristics, abdominal symptoms, and sociodemographic characteristics. A logistic regression model was applied and the coefficients converted to a numeric scores in order to develop a screening instrument which could reliably discriminate non-adherent and adherent subjects.

Results: Non-adherence was observed in 127 (29.6%) of the 429 enrolled subjects. Lower perceptions of belief in taking aminosalicylates, absence of visible bleeding, eight daily tablets or less taken, and no concomitant use of thiopurines were related to non-adherence. We then developed a screening instrument comprising 22 items. When the cut-off point was set at 60, the instrument showed 85.0% sensitivity and 69.2% specificity with an area under the curve of 0.84 (95% confidence interval = 0.79-0.91).

Conclusions: The instrument appeared to be reliable for identifying patients with a high possibility of current non-adherence to aminosalicylates. Further, the instrument may provide useful information for detecting patients with a high possibility of current non-adherence and for assessing factors of non-adherence. On the other hand, we need to evaluate disease activity more strictly and examine whether it is included in the screening instrument in the future.

Show MeSH
Related in: MedlinePlus