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Paula Anne Newman-Casey, Leslie M. Niziol, Paul P Lee, Kenneth Resnicow, Michele Heisler; Perceived autonomy support from the healthcare team is associated with glaucoma medication adherence. Invest. Ophthalmol. Vis. Sci. 2018;59(9):5227.
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© ARVO (1962-2015); The Authors (2016-present)
Self-determination theory posits that autonomy, motivation and perceived competence are all significant mediators of initiating and sustaining health behavior changes. This study assesses whether the autonomy supportiveness of health care providers and patients’ reported levels of autonomous motivation and perceived competence are associated with glaucoma medication adherence.
Glaucoma patients ≥40 years and taking ≥1 medication who self-reported poor medication adherence were included. Medication adherence was monitored electronically for three months and calculated as the proportion of doses taken on time by the total doses prescribed. Proportions <0.8 were considered non-adherent. Prior to monitoring, participants completed a survey that included validated instruments to measure the autonomy supportiveness of their ophthalmologist (15 item Health Care Climate Questionnaire, HCCQ), motivational state (19 item Treatment Self-Regulation Questionnaire, TSRQ), and perceived competence (4 item Perceived Competence Scale, PCS) to adhere to glaucoma medications. Items for all instruments were scored on a 7-point Likert scale with higher scores indicating better outcomes. The score for each instrument was calculated as the mean of item scores. Two-sample t-tests were used to investigate differences in ophthalmologist autonomy supportiveness, autonomous motivation and perceived competence between adherent and non-adherent glaucoma patients.
45 participants completed medication monitoring, and 32 (71%) were non-adherent. Adherent patients reported significantly higher scores for HCCQ items relating feeling understood by their provider (p=0.02), feeling like their provider has confidence in their ability to make a change (p=0.04), feeling accepted by their provider (p=0.01), and feeling that their provider listens (p=0.02). There was no difference in autonomous motivation and perceived competence between adherent and non-adherent participants (TSRQ: 5.4±0.8 vs 5.5±0.9, p=0.59; PCS: 5.7±1.3 vs 5.6±1.2, p=0.70).
Creating programs that support patients’ glaucoma self-management in a way that promotes their autonomy will be important in improving medication adherence among glaucoma patients.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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