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Adherence to the post-transplant medical regimen in lung transplant recipients

Hu, Lu (2016) Adherence to the post-transplant medical regimen in lung transplant recipients. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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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.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Hu, Luluh16@pitt.eduLUH16
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairLingler, Jennifer Hlinglerj@pitt.eduLINGLERJ
Committee MemberDeVito Dabbs, Annette Jajdst42@pitt.eduAJDST420000-0003-3325-435X
Committee MemberSereika, Susan Mssereika@pitt.eduSSEREIKA
Committee MemberDew, Mary Amandadewma@upmc.eduDEW10000-0002-4666-1870
Date: 17 March 2016
Date Type: Publication
Defense Date: 22 February 2016
Approval Date: 17 March 2016
Submission Date: 3 March 2016
Access Restriction: 2 year -- Restrict access to University of Pittsburgh for a period of 2 years.
Number of Pages: 101
Institution: University of Pittsburgh
Schools and Programs: School of Nursing > Nursing
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: Adherence, Lung transplantation, self-management, self-monitoring, self-care agency
Date Deposited: 17 Mar 2016 20:25
Last Modified: 17 Mar 2018 05:15


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