Adherence to the post-transplant medical regimen in lung transplant recipients
Lu Hu · D-Scholarship@Pitt (University of Pittsburgh) · 2016
Adherence to the post-transplant medical regimen could maximize outcomes in lung transplant recipients (LTRs). This dissertation addresses three major gaps in the LTR adherence literature: 1) the need to synthesize evidence on adherence to medical regimen, 2) a lack of evidence concerning longitudinal patterns and correlates of adherence to self-monitoring, a challenging issue for LTRs, and 3) the need to understand longitudinal patterns and correlates of self-care agency (SCA, one’s willingness and ability to perform self-care), a potentially important theoretical construct for adherence. Study 1. To synthesize the current state of science on adherence in LTRs, a systematic review was conducted. Findings indicated that nonadherence rates varied greatly across the elements of the regimen and between studies, and could not be consistently attributed to any single factor. Effect sizes of interventions designed to promote adherence ranged from .05 to .45. There was a weak correlation between nonadherence to home spirometry and patient mortality. Study 2. To better understand longitudinal patterns and correlates of SCA, a trajectory analysis was conducted. Findings revealed 3 patterns for SCA: persistently low, persistently moderate, and persistently high. Requiring re-intubation post-transplant (p=.043), discharged to a facility rather than home (p=.048), and endorsing a higher baseline anxiety level (p=.001) were associated with membership in the persistently low SCA group. Higher anxiety and depression levels were associated with memberships in the persistently moderate and persistently low SCA groups over 12-months (ps<.05). Study 3. To advance the field’s understanding of patterns and correlates of adherence to self-monitoring, a trajectory analysis was performed. Findings revealed two patterns of adherence to self-monitoring: moderately adherent with slow decline and persistently nonadherent. Baseline correlates for being persistently nonadherent included female gender (p=.035), higher anxiety (p=.008), and lower sense of personal control over health (p=.005). Lower physical component scores of quality of life over 12 months were associated with membership in the persistently nonadherent group (p=.004). This dissertation points to the need for more strategies to promote and sustain adherence over time in LTRs. Future interventions should target reducing psychological distress and reinforcing the sense of control over one’s health in LTRs.