scholarly journals Researchers’ perspectives on methodological challenges and outcomes selection in interventional studies targeting medication adherence in rheumatic diseases: an OMERACT-adherence study

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Shahrzad Salmasi ◽  
Ayano Kelly ◽  
Susan J. Bartlett ◽  
Maarten de Wit ◽  
Lyn March ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Intervention Studies ◽  
Structured Interviews ◽  
Services Research ◽  
Core Domain ◽  
The Past ◽  
Core Outcomes ◽  
Adherence Intervention ◽  
Adherence Interventions ◽  
Core Domain Set

Abstract Background Research on adherence interventions in rheumatology is limited by methodological issues, particularly heterogeneous outcomes. We aimed to describe researchers’ experiences with conducting interventional studies targeting medication adherence in rheumatology and their perspectives on establishing core outcomes. Methods Semi-structured interviews using audio conference were conducted with researchers who had conducted an adherence study of any design in the past 10 years. Data collection and thematic analysis were performed iteratively, until saturation. Results We interviewed 13 researchers, most of whom worked in academia and specialized in epidemiology and/or health services research. We identified three themes: 1) improving measurement of adherence (considering all phases of adherence, using appropriate and relevant measures, and establishing clinically meaningful thresholds); 2) challenges in designing and appraising adherence intervention studies (considering the confusion over a plethora of outcomes, difficulties with powering studies to demonstrate meaningful changes, and suboptimal descriptions of adherence interventions in published studies); and 3) advancing outcome assessment in adherence intervention studies (capturing rationale for developing a core domain set as well as recommendations and anticipated challenges by participants). Conclusions Uniquely gathering perspectives from international adherence researchers, our findings led to researcher-informed recommendations for improving adherence research including specifying the targeted adherence phase in designing interventions and studies and providing a glossary of terms to promote consistency in reporting. We also identified recommendations for developing a core domain set for interventional studies targeting medication adherence including involvement of patients, clinicians, and other stakeholders and methodological and practical considerations to establish rigor and support uptake.

scholarly journals THU0565 RESEARCHERS’ PERSPECTIVES ON ADHERENCE INTERVENTION RESEARCH AND OUTCOMES IN RHEUMATOLOGY: AN INTERNATIONAL QUALITATIVE STUDY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 524.2-524
Author(s):  
S. Salmasi ◽  
A. Kelly ◽  
S. J. Bartlett ◽  
M. De Wit ◽  
L. March ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Intervention Studies ◽  
Intervention Research ◽  
Research Support ◽  
Core Domain ◽  
The Past ◽  
The People ◽  
Outcome Selection ◽  
Adherence Intervention ◽  
Core Domain Set

Background:Medication non-adherence is a significant problem among patients with rheumatic diseases. Research on adherence interventions in rheumatology is limited and disappointing, with studies using heterogeneous outcomes. Understanding these limitations is needed to inform the design of better interventions and research studies.Objectives:To describe researchers’ perspectives and experiences on adherence intervention research and outcomes in rheumatology.Methods:Semi-structured interviews using video conference were conducted with researchers who had been an investigator on an adherence study of any design in the past 10 years. Interviews were recorded and transcribed verbatim. Participants were asked about their experiences with conducting adherence research and perspectives on introduction of a core domain set of outcomes for adherence intervention trials in rheumatology. Data collection and thematic analysis were conducted iteratively, until saturation.Results:We interviewed 13 researchers from seven countries (Australia, Belgium, Canada, Netherland, Thailand, UK, and USA). A majority worked in academia (75%), specialized in epidemiology and/or health services research (62%) and had led between 2-5 adherence studies in the past five years (62%).Three themes were identified:1) challenges in designing, conducting and evaluating adherence studies;2) current outcomes in adherence intervention studies and their relevance; and3) implementing a core domain set of outcomes for adherence intervention studies.Major challenges in conducting adherence research included inconsistent adherence terminology and measurement. Participants noted a lack of guidance on outcome selection and measurement when evaluating the effectiveness of an adherence intervention and indicated their preference for research to report adherence, intervention-specific, and health-related outcomes. Finally, implementing a core domain set of outcomes was thought to be challenging but valuable in strengthening the evidence (by facilitating meta-analysis), and improving clinical outcomes (by informing clinicians about the effectiveness of interventions).Conclusion:Adherence research in rheumatology has been hindered by lack of standardization and guidance on terminology, measurement and outcome selection. Our findings form the basis for recommendations for improving the design, conduct and evaluation of adherence intervention studies in rheumatology, particularly for developing a core domain set of outcomes to improve consistency and facilitate comparisons.Table 1.Themes and representative quotations.Theme 1: Challenges in designing, conducting and evaluating studies of adherence interventions“…the people you often most want in your sample are the people who are non-adherent and often the people who are non-adherent are the people who are hardest to recruit.”“Long term the issue has been about measurements because people confuse and conflate various aspects of medication adherence.Theme 2: Current outcomes in adherence intervention studies and their relevance“you have a whole range of outcomes…psychological outcomes…there’s measures of health care utilization and things like attendance at hospital, nurse appointments and duration, things like times off work,, and also all the relevant clinical outcomes.”Theme 3: Implementing a core domain set of outcomes for adherence intervention studies“…will make trials more comparable and increase the likelihood that you’d be able to combine efforts internationally”Disclosure of Interests:Shahrzad Salmasi: None declared, Ayano Kelly: None declared, Susan J. Bartlett Consultant of: Pfizer, UCB, Lilly, Novartis, Merck, Janssen, Abbvie, Speakers bureau: Pfizer, UCB, Lilly, Novartis, Merck, Janssen, Abbvie, Maarten de Wit Grant/research support from: Dr. de Wit reports personal fees from Ely Lilly, 2019, personal fees from Celgene, 2019, personal fees from Pfizer, 2019, personal fees from Janssen-Cilag, 2017, outside the submitted work., Consultant of: Dr. de Wit reports personal fees from Ely Lilly, 2019, personal fees from Celgene, 2019, personal fees from Pfizer, 2019, personal fees from Janssen-Cilag, 2017, outside the submitted work., Speakers bureau: Dr. de Wit reports personal fees from Ely Lilly, 2019, personal fees from Celgene, 2019, personal fees from Pfizer, 2019, personal fees from Janssen-Cilag, 2017, outside the submitted work., Lyn March: None declared, Allison Tong: None declared, Peter Tugwell: None declared, Kathleen Tymms: None declared, Suzanne Verstappen Grant/research support from: BMS, Consultant of: Celltrion, Speakers bureau: Pfizer, Mary De Vera: None declared

scholarly journals Addressing Challenges in Developing a Core Domain Set in Adherence Interventions in Rheumatology: A Report from the OMERACT-Adherence Group

2019 ◽  
Vol 46 (9) ◽  
pp. 1202-1206
Author(s):  
Ayano Kelly ◽  
Susan J. Bartlett ◽  
Maarten P. de Wit ◽  
Dorcas E. Beaton ◽  
Therese Dawson ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Contextual Factors ◽  
Critical Factor ◽  
Drug Trials ◽  
Core Domain ◽  
Methodological Challenges ◽  
Adherence Interventions ◽  
Core Domain Set ◽  
Adherence Group

Objective.The OMERACT-Adherence meeting was convened to discuss the conceptual and methodological challenges in developing a core domain set (Adherence-CDS) for trials of interventions for medication adherence in rheumatology.Methods.Forty participants from nine countries participated.Results.Four ideas emerged: for adherence trials, the Adherence-CDS could include adherence and the condition-specific CDS; many factors affect adherence and are intervention targets, contextual factors, or outcome domains; adherence is a critical factor in drug trials; and standardized adherence measures are needed.Conclusion.Despite the challenges, the meeting clarified an approach to developing an Adherence-CDS that complements existing OMERACT work and methodology.

scholarly journals Planning for a neighborhood and city-scale green network system in Qatar: the case of MIA Park

2021 ◽  
Author(s):  
Raffaello Furlan ◽  
Brian R. Sinclair
Keyword(s):  
Urban Landscape ◽  
Single Case ◽  
Landscape Fragmentation ◽  
The State ◽  
Network System ◽  
Design Strategies ◽  
Structured Interviews ◽  
Main Mode ◽  
The Past ◽  
Neighborhood Scale

AbstractIn the past decade, Doha has witnessed fast-urban growth, an increased population rate, and an over-reliance on the automobile as the main mode of urban transportation. These factors caused social and environmental problems related to (1) the loss of a compact urban pattern, (2) an increased level of air pollution (3) high traffic congestions and (4) increasing landscape fragmentation. In consideration of such concerns, The State of Qatar invested large funds into the urban landscape development of Doha, as envisioned by Qatar National Vision 2030. As a result, in the past five years various parks and/or green areas, such MIA Park, a major public green space located around the Museum of Islamic Art (MIA), were planned and developed within metropolitan Doha. The authors argue that this park is currently facing issues and challenges related to (1) accessibility to/from the neighboring districts, and (2) connectivity to/from the neighboring parks. Therefore, this research study aims at assessing the existing conditions of MIA Park, at considering the broader city context and, at recommending strategies for implementing MIA Park’s green network system. It approached the investigative challenge using a multi-pronged comprehensive methodology, that deployed focus groups, semi-structured interviews and a comprehensive network analysis based on graph theory. The findings, revealed through these hybrid research tactics, allowed the researchers to generate a framework to enhance accessibility and connectivity of MIA Park through a green network system, planned at inter-related neighborhood-scale and city-scale levels. While the research examines most notably a single case, it is advocated that the proposed framework represents not just an optional feature pertaining to the case in Doha, but a valuable reference for the sustainable master planning of future cities in the State of Qatar and across the GCC. The paper proffers numerous key contributions, including the critical exploration of manufactured landscapes in Doha Qatar and the delineation of broadly applicable environmental design strategies to improve the fabric and livability of cities.

Sicker and Poorer—The Consequences of Being Uninsured: A Review of the Research on the Relationship between Health Insurance, Medical Care Use, Health, Work, and Income

2003 ◽  
Vol 60 (2_suppl) ◽  
pp. 3S-75S ◽  
Author(s):  
Jack Hadley
Keyword(s):  
Health Insurance ◽  
Medical Care ◽  
Data Sets ◽  
Work Effort ◽  
Services Research ◽  
The Past ◽  
Medical Care Use ◽  
Process Studies ◽  
Annual Earnings ◽  
The Relationship

Health services research conducted over the past 25 years makes a compelling case that having health insurance or using more medical care would improve the health of the uninsured. The literature's broad range of conditions, populations, and methods makes it difficult to derive a precise quantitative estimate of the effect of having health insurance on the uninsured's health. Some mortality studies imply that a 4% to 5% reduction in the uninsured's mortality is a lower bound; other studies suggest that the reductions could be as high as 20% to 25%. Although all of the studies reviewed suffer from methodological flaws of varying degrees, there is substantial qualitative consistency across studies of different medical conditions conducted at different times and using different data sets and statistical methods. Corroborating process studies find that the uninsured receive fewer preventive and diagnostic services, tend to be more severely ill when diagnosed, and receive less therapeutic care. Other literature suggests that improving health status from fair or poor to very good or excellent would increase both work effort and annual earnings by approximately 15% to 20%.

scholarly journals Multilateral Naval Exercise Komodo: Enhancing Indonesia’s Multilateral Defence Diplomacy?

2021 ◽  
pp. 186810342110089
Author(s):  
Frega Wenas Inkiriwang
Keyword(s):  
Structured Interviews ◽  
The Past ◽  
Documentary Analysis

Defence diplomacy has gained attention in the past decades. Hence, Indonesia has also developed its defence diplomacy for achieving its strategic interests. In Indonesia’s defence diplomacy, bilateral forms have dominated the practice of joint exercises with its defence partners. However, under the Yudhoyono administration in 2014, Indonesia hosted its first multilateral joint exercise, the Multilateral Naval Exercise Komodo (MNEK), which aimed at facilitating multilateral engagement with greater international partners. This exercise was continued by the Widodo administration as a biannual event in the following years. Since this multilateral exercise has rarely been studied, this article attempts to qualitatively examine how this exercise has developed and contributed to Indonesia’s multilateral defence diplomacy. To support the analysis, this article relies on a combination of documentary analysis and semi-structured interviews, including with numerous participants of past MNEK exercises in 2014, 2016, and 2018.

scholarly journals Homegarden agroecosystems managed by Salar people on Qinghai-Tibet Plateau

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Mingjing Zhu ◽  
Binsheng Luo ◽  
Ben La ◽  
Ruijie Chen ◽  
Fenggui Liu ◽  
...  
Keyword(s):  
Plant Species ◽  
Rural Areas ◽  
Production Systems ◽  
Farming Systems ◽  
Field Investigation ◽  
Tibet Plateau ◽  
Ecosystem Functions ◽  
Structured Interviews ◽  
Services Research ◽  
Qinghai Tibet Plateau

Abstract Background Salar is a Turkic-speaking Islamic ethnic group in China living mainly in Xunhua Salar Autonomous County (Xunhua or Xunhua County), Qinghai-Tibet Plateau. Salar people are skilled in horticulture and their homegarden (HG) management. They are regarded as the first people on the Qinghai-Tibet Plateau to practice horticulture, especially manage their HGs, traditional farming systems, and supplementary food production systems. Traditional knowledge of Salar people associated with their HGs always contributes significantly to the local livelihood, food security, ornamental value, and biodiversity conservation. The cultivation of different plants in HGs for self-sufficiency has a long tradition in China’s rural areas, especially in some mountainous areas. However, Salar traditional HGs have not been described. The present paper aims to report the features of Salar HGs mostly based on agrobiodiversity and its ecosystem services. Methods The methods used in this work included semi-structured interviews and participatory observation. A total of 60 households in three townships, 9 villages were surveyed. There are 4–12 family members in each household, aged from 20 to 86 years old. The homestead size is between 200 and 1200 m2. Plant species cultivated in Salar HGs were identified according to Flora of China. Based on a comprehensive survey of Salar HGs and related to background data, we identified and characterized the most important services and functions provided by Salar HGs. Results According to primary production systems, there are 4 different types of Salar HGs, including ornamental focus, product focus, dual-purpose and multi-purpose. In total, 108 (excluding weeds and bonsai) plant species were recorded in Salar HGs, within 43 plant families. The most important and frequently used plants are Rosa chinensis, Armeniaca vulgar, Prunus salicina, and Ziziphus jujuba. About 4 to 32 plant species were recorded in each homegarden. We found that the Salar HGs, as a typical agroecosyste, prossess multiple servcices and functions that directly benefit households according to the field investigation. Conclusion This paper reveals the floristic diversity of Salar HGs. It presents useful information in the homegarden agroecosystem of Salar people, such as HG types and species diversity in Salar HGs. Ecosystem functions and services research suggested that the Salar HG agroecosystem provides agroecosystem services mainly related to supply and culture services. Salar HGs are important as food supplement resources, aesthetics symbol, and cultural spaces.

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