Association of medication attitudes with non-persistence and non-compliance with medication to prevent fractures.

UNLABELLED: Our objective was to assess the association of self-reported non-persistence (stopping fracture-prevention medication for more than 1 month) and self-reported non-compliance (missing doses of prescribed medication) with perceived need for fracture-prevention medication, concerns regarding long-term harm from and/or dependence upon medications, and medication-use self-efficacy (confidence in one's ability to successfully take medication in the context of their daily life). INTRODUCTION: Non-persistence (stopping medication prematurely) and non-compliance (not taking medications at the prescribed times) with oral medications to prevent osteoporotic fractures is widespread and attenuates their fracture reduction benefit. METHODS: Cross-sectional survey and medical record review of 729 patients at a large multispecialty clinic in the United States prescribed an oral bisphosphonate between January 1, 2006 and March 31, 2007. RESULTS: Low perceived necessity for fracture-prevention medication was strongly associated with non-persistence independent of other predictors, but not with non-compliance. Concerns about medications were associated with non-persistence, but not with non-compliance. Low medication-use self-efficacy was associated with non-persistence and non-compliance. CONCLUSIONS: Non-persistence and non-compliance with oral bisphosphonate medication have different, albeit overlapping, sets of predictors. Low perceived necessity of fracture-prevention medication, high concerns about long-term safety of and dependence upon medication , and low medication-use self-efficacy all predict non-persistence with oral bisphosphonates, whereas low medication-use self-efficacy strongly predicts non-compliance with oral bisphosphonate medication. Assessment of and influence of these medication attitudes among patients at high risk of fracture are likely necessary to achieve better persistence and compliance with fracture-prevention therapies.

Development of a Brief, Multidimensional, Self-Report Instrument for Treatment Outcomes Assessment in Psychiatric Settings: Preliminary Findings.

Preliminary reliability and validity data are reported on a new, brief measure of psychiatric symptomatology. The Symptom Assessment-45 Questionnaire (SA-45) is a 45-item, patient self-report symptom inventory derived from the original Symptom Checklist-90-R (SCL-90), using cluster analytic methods. The SA-45 consists of nine 5-item scales assessing each of the same symptom domains as its parent instrument with no item overlap across domains. The vast majority of the internal consistency reliabilities for the SA-45's nine scales were in the .70s and .80s across different age and patient status samples. As expected, both adolescent and adult patient samples generally differed significantly from nonpatient control samples, and patients at treatment follow-up differed significantly from patients at intake. Moreover, depressed patients with and without psychotic features differed significantly on three scales. A cluster analysis generally supported the nine-scale structure of the inventory, but it failed to consistently support the distinction between the Paranoid Ideation and Interpersonal Sensitivity scales. Limitations to the study are noted, but overall, the initial findings support the use of the SA-45 in clinical settings. Suggestions for needed future research are presented.

Describing and testing a moderator of the moral judgment and action relationship.

The relationship between moral judgment development and action for Ss who differ in the degree to which justice-based moral judgments influence moral decision making was investigated. First, a method for quantifying Ss' use of justice-based moral judgments in moral decision making (the utilizer variable) is described. Second, 5 moral judgment and action studies are reanalyzed to assess the moderating effect of the utilizer variable information. Results indicate that the relationship between moral judgment scores and action intensifies as utilization increases. Moreover, the utilizer effect appears uniform across different age and educational levels and behavioral domains. These findings support the validity of the utilizer variable and are consistent with recent multiprocess models of moral action that suggest that moral judgements are a necessary, but insufficient, factor in the production of moral action.

A longitudinal study of moral and ego development in young adults.

The purpose of this study was to investigate the longitudinal changes in moral judgment and ego development in a young adult sample when a concurrent measure of verbal ability was used as a statistical control. Sixty-one late adolescents and young adults, representing three educational groups, were tested in 1977 and 1979 on the Defining Issues Tests, a measure of moral judgment (Rest), the Sentence Completion Test of Ego Development (Loevinger and Wessler) and Terman's Concept Mastery Test, a measure of verbal ability. No group or time differences were found in ego development. A significant increase was found between the 1977 and 1979 moral judgment scores,p<0.05, and between groups at both testing,p<0.001. Sex differences were found,p<0.01, with females scoring higher than males, which were statistically accounted for by verbal ability. These findings suggest that moral development continues into the young adult years and that verbal ability may moderate sex differences in moral judgment.

Some considerations in the measurement of change.

When conducting a study to assess the "gains in ability" or the "shifts in attitudes" of a group of subjects, the researcher must be aware of the presence of measurement error and regression toward the mean and must attempt to minimize and allow for these phenomena. Also of concern are whether the study can be generalized to a larger population and what statistical techniques are appropriate for the conditions of the study and the type of data collected. Educational and psychologic measurement is subject to particular types of error and must be analyzed and interpreted accordingly. The authors discuss and make recommendations regarding these most important considerations.