The role of psychological science in efforts to improve cardiovascular medication adherence.

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Date

2018-11

Authors

Bosworth, Hayden B
Blalock, Dan V
Hoyle, Rick H
Czajkowski, Susan M
Voils, Corrine I

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Abstract

Poor adherence to cardiovascular disease medications carries significant psychological, physical, and economic costs, including failure to achieve therapeutic goals, high rates of hospitalization and health care costs, and incidence of death. Despite much effort to design and evaluate adherence interventions, rates of adherence to cardiovascular-related medications have remained relatively stagnant. We identify two major reasons for this: First, interventions have not addressed the time-varying reasons for nonadherence, and 2nd, interventions have not explicitly targeted the self-regulatory processes involved in adherence behavior. Inclusion of basic and applied psychological science in intervention development may improve the efficacy and effectiveness of behavioral interventions to improve adherence. In this article, we use a taxonomy of time-based phases of adherence-including initiation, implementation, and discontinuation-as context within which to review illustrative studies of barriers to adherence, interventions to improve adherence, and self-regulatory processes involved in adherence. Finally, we suggest a framework to translate basic psychological science regarding self-regulation into multicomponent interventions that can address multiple and time-varying barriers to nonadherence across the three adherence phases. The field of psychology is essential to improving medication adherence and associated health outcomes, and concrete steps need to be taken to implement this knowledge in future interventions. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

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10.1037/amp0000316

Publication Info

Bosworth, Hayden B, Dan V Blalock, Rick H Hoyle, Susan M Czajkowski and Corrine I Voils (2018). The role of psychological science in efforts to improve cardiovascular medication adherence. The American psychologist, 73(8). pp. 968–980. 10.1037/amp0000316 Retrieved from https://hdl.handle.net/10161/28705.

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Scholars@Duke

Bosworth

Hayden Barry Bosworth

Professor in Population Health Sciences

Dr. Bosworth is a health services researcher and Deputy Director of the Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT)  at the Durham VA Medical Center. He is also Vice Chair of Education and Professor of Population Health Sciences. He is also a Professor of Medicine, Psychiatry, and Nursing at Duke University Medical Center and Adjunct Professor in Health Policy and Administration at the School of Public Health at the University of North Carolina at Chapel Hill. His research interests comprise three overarching areas of research: 1) clinical research that provides knowledge for improving patients’ treatment adherence and self-management in chronic care; 2) translation research to improve access to quality of care; and 3) eliminate health care disparities. 

Dr. Bosworth is the recipient of an American Heart Association established investigator award, the 2013 VA Undersecretary Award for Outstanding Achievement in Health Services Research (The annual award is the highest honor for VA health services researchers), and a VA Senior Career Scientist Award. In terms of self-management, Dr. Bosworth has expertise developing interventions to improve health behaviors related to hypertension, coronary artery disease, and depression, and has been developing and implementing tailored patient interventions to reduce the burden of other chronic diseases. These trials focus on motivating individuals to initiate health behaviors and sustaining them long term and use members of the healthcare team, particularly pharmacists and nurses. He has been the Principal Investigator of over 30 trials resulting in over 400 peer reviewed publications and four books. This work has been or is being implemented in multiple arenas including Medicaid of North Carolina, private payers, The United Kingdom National Health System Direct, Kaiser Health care system, and the Veterans Affairs.

Areas of Expertise: Health Behavior, Health Services Research, Implementation Science, Health Measurement, and Health Policy

Blalock

Daniel Blalock

Associate Consulting Professor in the Department of Psychiatry and Behavioral Sciences

I am a behavioral health researcher with a background in Clinical Psychology and Experimental Psychology.  My research interests include broad processes of behavior change and self-regulation as well as psychometric measurement and research methods/statistics.  My specific research endeavors include 1) the measurement and behavior change applicability of constructs related to self-control, 2) measurement and interventions to improve self-regulatory health behaviors including medication adherence and substance use, and 3) measure development and psychometrics as related to self-reported and patient-reported outcomes.

Hoyle

Rick Hoyle

Professor of Psychology and Neuroscience

Research in my lab concerns the means by which adolescents and emerging adults manage pursuit of their goals through self-regulation. We take a broad view of self-regulation, accounting for the separate and interactive influences of personality, environment (e.g., home, school, neighborhood), cognition and emotion, and social influences on the many facets of goal management. Although we occasionally study these influences in controlled laboratory experiments, our preference is to study the pursuit of longer-term, personally meaningful goals “in the wild.” Much of our work is longitudinal and involves repeated assessments focused on the pursuit of specific goals over time. Some studies span years and involve data collection once or twice per year. Others span weeks and involve intensive repeated assessments, sometimes several times per day. We use these rich data to model the means by which people manage real goals in the course of everyday life.

In conjunction with this work, we spend considerable time and effort on developing and refining means of measuring or observing the many factors at play in self-regulation. In addition to developing self-report measures of self-control and grit and measures of the processes we expect to wax and wane over time in the course of goal pursuit, we are working on unobtrusive approaches to tracking goal pursuit and progress through mobile phones and wearable devices.


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