Predictors of Adherence to Glaucoma Treatment in a Multisite Study

Abstract

Background Poor adherence hinders glaucoma treatment. Studies have identified demographic and clinical predictors of adherence but fewer psychological variables. Purpose We examined predictors from four health behavior theories and past research. Methods In the baseline phase of a 3-site adherence study, before any intervention, 201 participants used electronic Medication Event Monitoring System (MEMS) bottles to monitor eyedrop use for 2 months, and completed questionnaires including self-reported adherence. Results MEMS showed 79% adherence and self-report 94% (0.5–1.5 missed weekly doses), but correlated only rs = .31. Self-efficacy, motivation, dose frequency, and non-minority race/ethnicity predicted 35% of variance in MEMS. Cues to action, self-efficacy, and intention predicted 20% of variance in self-reported adherence. Conclusions Self-efficacy, motivation, intention, cues to action, dose frequency, and race/ethnicity each independently predicted adherence. Other predictors from all theories were supported in bivariate analyses, but additional study is needed. Researchers and clinicians should consider psychological predictors of adherence.

Clinical Correlates of Computationally Derived Visual Field Defect Archetypes in Patients from a Glaucoma Clinic

“…[81][82][83][84][85] The association of AT6 with elevated current IOP in our study may reflect some combination of physiological barriers to IOP control and socioeconomic barriers to glaucoma treatment adherence. [86][87][88][89][90] Fuller characterization of patients with the AT6 (central island) pattern of VF loss may aid development of targeted glaucoma screening and management protocols for those most at risk for advanced glaucomatous VF loss.…”

Accuracy of Patient-reported Adherence to Glaucoma Medications on a Visual Analog Scale Compared With Electronic Monitors

“…Pharmacy refill methods 10–12 , electronic monitoring 13–19 , and self-report measures 15,18,20 have all been used to assess the medication adherence of glaucoma patients. Estimates of adherence vary based on the method being used; pharmacy refill records have produced the lowest estimates of glaucoma medication adherence while self-report measures have yielded the highest adherence estimates.…”

“…Estimates of adherence vary based on the method being used; pharmacy refill records have produced the lowest estimates of glaucoma medication adherence while self-report measures have yielded the highest adherence estimates. 15 Refill records are limited in that they may contain missing information 21 , are restricted in the types of adherence that can be assessed (e.g., interdose intervals cannot be calculated), and may be too cumbersome for providers to incorporate into practice. Although electronic monitors have been referred to as the “gold standard” for adherence measurement 22–24 , their cost makes them impractical for monitoring adherence in clinical settings.…”

“…A few studies have examined the validity of self-reported measures against objective measures (e.g., pharmacy records or electronic monitors) in glaucoma patients. 15,18 Both studies found that patients with glaucoma tended to over-estimate their adherence to glaucoma medications. 15,18 Furthermore, Cook et al 15 found that the correlation between MEMS and self-report was only 0.31.…”

“…15,18 Both studies found that patients with glaucoma tended to over-estimate their adherence to glaucoma medications. 15,18 Furthermore, Cook et al 15 found that the correlation between MEMS and self-report was only 0.31. These previous examinations of self-report versus objective measures have been limited in several respects.…”