We describe a new estimator (labeled Morris) for meta-analysis. The Morris estimator combines elements of both the Schmidt-Hunter and Hedges estimators. The new estimator is compared to (a) the Schmidt-Hunter estimator, (b) the Schmidt-Hunter estimator with variance correction for the number of studies (“k correction”), (c) the Hedges random-effects estimator, and (d) the Bonett unit weights estimator in a Monte Carlo simulation. The simulation was designed to represent realistic conditions faced by researchers, including population random-effects distributions, numbers of studies, and skewed sample size distributions. The simulation was used to evaluate the estimators with respect to bias, coverage of the 95% confidence interval of the mean, and root mean square error of estimates of the population mean. We also evaluated the quality of credibility intervals. Overall, the new estimator provides better coverage and slightly better credibility values than other commonly used methods. Thus it has advantages of both commonly used approaches without the apparent disadvantages. The new estimator can be implemented easily with existing software; software used in the study is available online, and an example is included in the appendix in the Supplemental Material available online.
Background Consistent self-care slows the progression of heart failure (HF). Gratitude, the practice of appreciating the positive aspects of life, may influence self-efficacy, which in turn is known to improve self-care. However, little is known about the relationships among gratitude, self-efficacy, and medication adherence in HF. Objective The aim of this study was to test a model to determine if self-efficacy mediates the relationship between gratitude and medication adherence in asymptomatic patients with HF. Method This is a secondary analysis of data from a prospective observational study. Data were analyzed using a structural equation model to examine associations between gratitude, cardiac-specific self-efficacy, and medication adherence in 153 patients with HF. Gratitude, self-efficacy, and medication adherence were assessed using the Gratitude Questionnaire-6, Cardiac Self-efficacy Scale–Maintain Function Subscale, and the Morisky Medication Adherence Scale, respectively. Results Patient mean (SD) age was 66 (11) years, and 95% of the participants were men. Patients were primarily white (79%), black (12%), or Asian (6%). Gratitude exerted an indirect effect on medication adherence through self-efficacy (b = 0.16; P < .05). Gratitude was positively related to self-efficacy (b = 0.50; P < .05), and self-efficacy was positively related to medication adherence (b = 0.31; P < .05). The model fit was acceptable (comparative fit index = 0.92, Tucker-Lewis index = 0.90, root-mean-square error of approximation = 0.08). Conclusion In this study, we found evidence that self-efficacy was a mechanism through which gratitude was associated with medication adherence in asymptomatic patients with HF, suggesting a way to improve self-care nonpharmacologically. Future work will examine whether gratitude intervention results in improved self-care.
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