Adherence is a complex concept, with multiple definitions, over 200 possible predictors, and inconsistent measurement. This has had a detrimental impact on producing interventions to promote treatment adherence. Promoting and maintaining treatment adherence can decrease the likelihood of poor health outcomes and decrease healthcare costs for patients. This study created a conceptual model that was utilized in a secondary analysis to determine if patient factors (Income, Depression, Perceived Threat of Illness Severity, Social Support, and Treatment Beliefs) in the model predict adherence to Transcutaneous Electrical Nerve Stimulation (TENS) when used for pain control post-Total Knee Replacement (TKR). The sample included 97 patients who were randomized to TENS treatment. A higher level of Perceived Threat of Illness Severity, measured with the Pain Catastrophizing Scale, was significantly related to a Moderate level of Adherence (60-79%) versus Non-Adherence (0-59%) (OR= .260, 95% CI= .073-.992, p= .037). The other patient factors of income, depression, social support and treatment beliefs did not significantly predict adherence. This finding is clinically important, as clinicians can assess how patients are interpreting or perceiving actual (or potential) threats of illness severity, then provide education and support to help patients adhere to treatment. The effect of Daily Pain [measured with an 11-point Numeric Rating Scale (0-10)] on Daily Adherence was also investigated in this study. Daily Pain and Daily Adherence did not show a significant association in this sample. This could be attributed to the fact that Daily Adherence was maintained consistently around 70% throughout the 2-week period.
Dissertation
Adherence to treatment: development and testing of the Fiala treatment adherence model with transcutaneous electrical nerve stimulation for acute postoperative pain after total knee replacement as an exemplar
University of Iowa
Doctor of Philosophy (PhD), University of Iowa
Autumn 2018
DOI: 10.17077/etd.pu5x-7pjo
Abstract
Details
- Title: Subtitle
- Adherence to treatment: development and testing of the Fiala treatment adherence model with transcutaneous electrical nerve stimulation for acute postoperative pain after total knee replacement as an exemplar
- Creators
- Catherine Anne Fiala - University of Iowa
- Contributors
- Barbara A. Rakel (Advisor)Sue Gardner (Committee Member)Keela Herr (Committee Member)M. Kathleen Clark (Committee Member)Jacob Oleson (Committee Member)
- Resource Type
- Dissertation
- Degree Awarded
- Doctor of Philosophy (PhD), University of Iowa
- Degree in
- Nursing
- Date degree season
- Autumn 2018
- DOI
- 10.17077/etd.pu5x-7pjo
- Publisher
- University of Iowa
- Number of pages
- xiii, 163 pages
- Copyright
- Copyright © 2018 Catherine Anne Fiala
- Language
- English
- Date submitted
- 03/01/2019
- Description illustrations
- illustrations (some color)
- Description bibliographic
- Includes bibliographical references (pages 112-152).
- Public Abstract (ETD)
Trouble sticking with a treatment that a care provider (like a doctor or nurse practitioner) has prescribed is a common problem. Current tools to measure how well people adhere to their prescribed treatment have not provided much information about what factors contribute to poor adherence.
Poor adherence can result in poor health and increased healthcare costs. This study examined how well patients adhered to Transcutaneous Electrical Nerve Stimulation (TENS) for pain control after Total Knee Replacement surgery. The results showed that patients who perceived the threat of their pain severity as high, were more likely to adhere moderately than not adhere at all when using TENS as prescribed for their pain control. When patients do not perceive their pain to be a severe threat, other ways to promote adherence may be needed.
This study also investigated the effect of daily pain ratings (as rated on a 0-10 numeric pain scale) on daily adherence to the TENS treatment. In this study, the results indicated that there was not a significant association between daily pain ratings and adherence to TENS. This could have been related to the fact that over the 2-week period, patients consistently maintained a moderate level of adherence (60-79%) to the TENS treatment.
- Academic Unit
- Nursing
- Record Identifier
- 9983776621602771
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