Adherence to Long-Term Therapies - Evidence for Action
(2003; 211 pages) View the PDF document
Table of Contents
View the documentPreface
View the documentAcknowledgements
View the documentScientific writers
View the documentIntroduction
View the documentTake-home messages
Open this folder and view contentsSection I - Setting the scene
Open this folder and view contentsSection II - Improving adherence rates: guidance for countries
Close this folderSection III - Disease-Specific Reviews
Open this folder and view contentsChapter VII - Asthma
Open this folder and view contentsChapter VIII - Cancer (Palliative care)
Open this folder and view contentsChapter IX - Depression
Open this folder and view contentsChapter X - Diabetes
Open this folder and view contentsChapter XI - Epilepsy
Open this folder and view contentsChapter XII - Human immunodeficiency virus and acquired immunodeficiency syndrome
Open this folder and view contentsChapter XIII - Hypertension
Close this folderChapter XIV - Tobacco smoking cessation
View the document1. The burden of tobacco smoking
View the document2. Clinical guidelines and therapies available for tobacco smoking cessation
View the document3. Definitions
View the document4. Epidemiology of adherence
View the document5. Factors affecting adherence
View the document6. Interventions for improving adherence
View the document7. Cost, effectiveness and cost-effectiveness of adherence
View the document8. Conclusions
View the document9. References
Open this folder and view contentsChapter XV - Tuberculosis
Open this folder and view contentsAnnexes
Open this folder and view contentsWhere to find a copy of this book
 

5. Factors affecting adherence

Some baseline variables apparently influence adherence to therapy. In one study, mean daily cigarette consumption, expired carbon monoxide, plasma nicotine and cotinine, and Fagerstrom Tolerance Questionnaire (FTQ) scores (44) were significantly higher in the dropout group than in the adherent group (1). Alterman et al. (25) concluded that greater dependence on tobacco was associated with less patch use, indicating that patients who smoked more cigarettes were less adherent to treatment with patches.

Depression is an important psychological factor associated with cessation of smoking. A higher prevalence of depressive symptoms would theoretically increase the risk of nonadherence to treatment (45). Differing results of studies of this association have been reported. Some studies showed that smokers with a history of major depression who were not depressed at the time of a 4-week treatment programme had a lower abstinence rate than did smokers without a history of depression. In another study, smokers with a history of major depression in an 8-week multicomponent cognitive behavioural group plus nicotine-gum programme, had a significantly higher abstinence rate than smokers with a history of depression who were treated with nicotine plus a standard programme of information (3,45). Ginsberg et al. suggested that cognitive - behavioural sessions emphasizing group cohesion and social support among smokers with a history of depression maintains adherence in this population (45). A satisfactory explanation of this link will require further research (3,24,31).

Other variables, such as gender, racial or ethnic background, history of psychiatric pathology (25), weight gain (29,30), craving and withdrawal symptoms are reported as being potential predictors of patch adherence. However, because there are no validated measures of these variables, the available data are insufficient to assess their effects on adherence.

During an NRT programme, investigators observed some factors that had a positive effect on adherence. These included motivation (25), attendance at cessation classes, access to free NRT, higher education levels, older age, advice from physicians (26), and more frequent contact with physicians and pharmacists

(35). These factors were also reported as predictive of success in stopping smoking. The analysis of the studies showed that these factors have proven to be statistically significant in increasing abstinence rates, but there is no measure proving their association with adherence.

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