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    Social support, automatic thought processes and coping style as predictors of compliance with treatment among adult diabetes patients in Northland : a dissertation presented to the School of Psychology in partial fulfilment of the requirements for the Masters Degree of Psychology
    (Massey University, 2004) Goosen, Tanya
    Little research has examined the relationship of automatic negative thought patterns, coping styles and depression to compliance with treatment for diabetes. A questionnaire consisting of demographic questions, the Ways of Coping Checklist, the Automatic Thoughts Questionnaire, a depression inventory and a compliance rating scale was completed by 114 adult diabetes patients attending the Northland Health retinopathy clinic. There were equal numbers of men and women, whose median age was 59 years (M = 59.2, SD = 14.9). Clinicians who were responsible for one or more of the patients independently completed a separate compliance rating scale for their respective patient(s). Multivariate analysis of variance revealed that there were no significant overall difference for gender and ethnic identity on any of the variables. Automatic negative thoughts, avoidance and blaming coping styles were positively related to depression, and negatively related to patients' ratings of compliance. A problem focus coping style correlated positively with patients' ratings of compliance. Patients tended to rate their own compliance as better than the staff ratings. According to staff ratings, Maori patients who identified less strongly with their culture, were also less likely to comply with treatment than the other ethnic groups. Staff and patients seemed to differ on what 'compliance' meant. Staff appeared to see compliance as how well the patients followed the treatment instructions. Patients were concerned about their thought content (i.e. positive or negative thinking) and their ability to act or decide for themselves. Hierarchical regression analysis showed that negative thought patterns and problem focused coping were significant predictors of patients' compliance ratings, while negative thought patterns and depression were significant predictors of staff's compliance ratings. The findings were discussed in terms of risk factors for lack of compliance and psychosocial treatment options for diabetes patients.
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    What people think about medicines : the relationship between medication beliefs and adherence to antidepressant therapy : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Psychology at Massey University
    (Massey University, 2006) Russell, Judith Catherine
    Major depressive disorder is a common mental disorder seen in primary care and treatment with antidepressant medication has been shown to be an effective treatment. Non-adherence to treatment regimens is considered by many to be the most serious challenge facing medical practice today. Research on medication adherence has more recently shifted its focus to the cognitive factors (i.e., patient beliefs) that determine adherence. Prior research has shown that pre-treatment perception of benefits and barriers to medication predict initial medication adherence. To contribute to this emerging literature, the present study assessed 85 depressed primary care patients about their beliefs in the necessity for and concerns about antidepressant therapy, and reported adherence using validated questionnaires (BMQ, Home, Weinman, & Hankins, 1999; MARS. Home & Weinman, 2002). The results of the present study showed no relationship between patient beliefs about the necessity of antidepressant therapy for their health and reported adherence. As predicted, participants holding stronger concerns about the potential adverse effects of the medication and stronger necessity beliefs, compared to concerns beliefs, reported increased rates of adherence. Depression severity was found to be associated with reported adherence, but was independent of the relationship between medication concerns and adherence. The present study replicated previous research and added further support for the theoretical basis of medication adherence by showing that there are similar theoretically based, determinants of adherence among patients with chronic physical health issues and those with mental health issues.
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    Conditional expertise in chronic illness : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy in Social Sciences at Massey University
    (Massey University, 2000) Casey, Georgina
    The incidence of chronic illness is increasing in the developed world. This means that there is an increased utilisation of acute health care services by people with chronic illnesses, either for treatment of exacerbations or for unrelated health problems. Acute health care services are based on the notion of finite, curable episodes of ill-health, and as such they do not always meet the needs of people with chronic illnesses. This study uses a grounded theory approach to examine the issues surrounding hospitalisation in acute care facilities for a group of eight people with chronic illness. Participants were interviewed within two months of an admission to hospital. Analysis of data, further interviews and other data collection, and generation of theoretical concepts were performed in accordance with the grounded theory method. The key finding from the research was a state of conditional expertise for the chronically ill. While living at home, and in a state of relative well-being, participants were acting as experts in the management of their illnesses. During encounters with health providers in the primary care setting, particularly those whom participants knew, a process of negotiation occurred, engendered by mutual trust in each other's expertise. However, once the acute care setting was entered, participants discovered that their expertise was neither valued nor acknowledged. In response, they went through the processes of informing health carers, by repeatedly telling their stories to different health professionals they encountered, and finally withdrawing from participation in care. This withdrawal could be either physical, where the participants sought early discharge, or emotional in terms of becoming passive recipients of care. The implications of this study, given its limitations, are numerous. In order to provide satisfactory care for people with chronic illnesses, health professionals working in acute care settings must move beyond the dominant model and seek to establish trust relationships which acknowledge and value patient expertise. This requires, first, that education programmes for health carers encourage the recognition of important data patients that do not relate to biological and disease states. Second, a system of care needs to be developed within the acute care setting that allows ongoing relationships to be established between individual patients and carers. This in turn would generate trust between patient and carer, which would enhance the abilities of each to acknowledge expertise. The Partnership model of nursing care is proposed as a possible solution to this problem.
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    Patients' treatment requests, psychiatrists' understanding of patient requests, and adherence to treatment : a thesis presented ... for the degree of Master of Science in Clinical Psychology at Massey University
    (Massey University, 1982) Deane, Frank Patrick
    This study aimed to determine the treatment requests of patients in the initial psychiatric interview and to compare the relative preference or these requests to those of other patient samples. It also aimed to determine psychiatrists accuracy in estimating the importance their patients placed on their requests, and to explore the relationship between psychiatrist understanding of patient requests to patient adherence to treatment. The study was carried out on 269 consecutive new patients to a psychiatric unit attached to a public hospital of whom 85 completed a 14 item Patient Request Form before their initial interview, and their psychiatrists completed an equivalent form at the conclusion of the interview. Patients adhered if they returned for their next appointment. Generally it was found that patients wanted psychologically based treatments most and medical oriented treatment least, and that the rank orders of the requests provided significant positive correlations with all other samples. It was found that psychiatrists significantly underestimated six request categories and overestimated one, supporting nine of the 14 differences hypothesised. No significant relationship was found between adherence and psychiatrists understanding of patients requests. Results are discussed in terms of their implications for helping therapists understand their patients requests.
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    Compliance from the perspective of tuberculosis patients : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Nursing Studies at Massey University
    (Massey University, 1983) North, Nicola
    Using a phenomenological approach, a study was undertaken designed to extend understanding of patient compliance by interpreting subjective experiences of people following treatment for tuberculosis in their own homes. The progress of patients from the beginning of the illness until treatment is completed was conceptualised by using a patient career model, covering four main stages: onset of illness, period of hospitalisation, ambulatory care, and cure. The study focused on the ambulatory stage, during which the patient manages the regimen at home. Compliance with the regimen is critical if the end-point, cure, is to be achieved. In-depth, unstructured interviews were recorded in their own homes from twenty-two patients resident in one metropolitan area. Men and women of varying age, ethnic origin, and socio-economic status were included. Supplementary data were obtained from family members, health care practitioners, and records. A modified form of comparative analysis yielded a rich pattern of themes in four main areas of concern. These were compliance with medication regimens in contrast to compliance with lifestyle recommendations; compliance in home environments and the role of family members; patient education and preparation for compliance; and the subjective experience of being ill with tuberculosis. Although overall rates of compliance with medication regimens were found to be high, findings of the study highlighted the difficulties in measuring a multidimensional phenomenon as it appears from the outside without also interpreting the inner perspective. Taking the patients' perspective on compliance, findings of this study suggest that present practices to encourage compliance under-estimate the ability and motivation of patients to be actively involved in promoting their own recovery, and that of other family members to assist them. Patients recognised the period of hospitalisation as a time when they learned to manage their own medication regimens. However, they perceived themselves as being inadequately prepared for the contingency decision-making which was often required after discharge, Patients' explanations suggested further that opportunities for patient education in self-care were underutilised by health care practitioners. Patients also perceived a failure by practitioners to recognise and deal with their subjective experiences of having what they saw as a serious and stigmatising illness. Patients were left with unresolved anxieties and uncertainties which, though not directly interfering with compliance or recovery, are not conducive to developing self-care capacities within holistic health care. In conclusion, the simple patient career model is elaborated to take account of contextual influences and patient perceptions. The importance of the hospitalisation period for preparing ambulatory patients to continue the course of treatment highlights the need for health care practices to better facilitate the transition of the person from one stage to the next. Specific recommendations for practice and for further research are included when the implications of the study are summarised.