A systematic review of interventions using health behavioral theories to improve medication adherence among patients with hypertension.

Medication adherence is a major problem in the treatment of hypertension. Approximately half of the patients who use antihypertensive medications are not adherent. Several interventions have endeavored to improve medication adherence among patients with hypertension, and some have used health behavioral models/theories. However, the quality and effectiveness of using health behavioral models/theories in improving medication adherence among patients with hypertension remain unknown. The main aim of this systematic review was to describe study characteristics and types of health behavioral models/theories used in interventions for improving medication adherence among adults with hypertension. PubMed, Scopus, Ovid MEDLINE, CINAHL, and PsycINFO databases were searched for randomized clinical trial interventions using any health behavioral models/theories published in English from 1979 to 2019. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, two independent reviewers searched, screened abstracts and articles, extracted data, and assessed the risk of bias and the use of the model/theory using the Theory Coding Scheme. A total of 11 articles were included in this systematic review. Two studies reported significant improvement in medication adherence. The Self-Regulation Model and Social Cognitive Theory were the most common types of models/theories. Nine studies used a single model/theory, and four studies measured the constructs of a model/theory. Risk of bias was good (n = 4) and fair (n = 5) in interventions. Using health behavioral models/theories may be an efficient way for health care professionals to improve adherence to medications among patients with hypertension. More interventions with rigorous designs are needed that appropriately utilize health behavioral models/theories for improving medication adherence among adults with hypertension.

Health behavioral theories used to explain dietary behaviors in adolescents: a systematic review

Background: Health behavior theories are useful to interpret adolescents'dietary behaviors. Evidences show that theories are influenced by social and psychological determinants. So, the purpose of this study is to systematically review studies that tested social cognitive theories (non-integrated) that predict adolescents 'dietary behaviors. METHODS: A structured electronic search of all publication years (through April 2016) was conducted to identify studies in MEDLINE, SciELO, PsycINFO, Scopus, and LILACS with full text. Included publications were cross-sectional and longitudinal (non-intervention) studies involving adolescents (10 to 18 years) that examined the associations between constructs of social-cognitive theories and dietary behaviors. Related strings in titles, abstracts, and indexing fields were searched. RESULTS: Theories used to explain dietary intake were the planned behavior and the social cognitive. It wasobserved evidences of positive associations between the social cognitive constructs and the fruits, the vegetables, the milk groups, and the whole-wheat foods (e.g., bread rich in fiber) and negative associations with sugar- sweetened beverages, soft drinks, snacks high in fat, sugar, and/or sodium, and sweet treats. Theories explained greater proportion of variance for intention to dietary intake. The variance for intention ranged from 3% for pizzas, candy bars, candies, and sugar-sweetened beverages to 68% for whole-wheat food (i.e., bread rich in fiber). CONCLUSION:Longitudinal designs are necessary to comprehend the theories and evaluate the behavioral changes. Finally, the use of food groups should be employed in the studies to help the comparisons and present higher reproducibility. Studies always based on objective, systematic, and rigorous evidences