Author ORCID Identifier

https://orcid.org/0000-0002-8210-6057

Year of Publication

2020

Degree Name

Doctor of Philosophy (PhD)

Document Type

Doctoral Dissertation

College

Nursing

Department/School/Program

Nursing

First Advisor

Dr. Terry A. Lennie

Abstract

Medication adherence is an ongoing challenge for patients with heart failure (HF) that can adversely affect mortality, morbidity, and quality of life. Living with a spouse has been associated with better adherence while living alone has been associated with poor adherence. Other factors demonstrated to affect adherence include medication complexity, perceived barriers to adherence, and depressive symptoms. Interestingly, the effect of these latter factors on adherence has not been examined in the context of the patient’s living arrangement. The purpose of this dissertation was to investigate the relationships among medication complexity, perceived barriers, and depressive symptoms with medication adherence across living arrangements of patients with HF using secondary analyses of data from an HF data registry.

The first study was a secondary data analysis of 130 patients with HF and examined the association between medication complexity and medication adherence across living arrangements. Exploratory nonlinear regression with gamma log link was used to determine if there was an association between medication complexity and medication adherence, ANOVA, and Chi-square to test differences across living arrangements. There was no association between medication complexity and medication adherence; however, patients with HF that lived with spouses had better medication adherence than patients that lived with non-spousal family and friends. There was a higher number than expected participants in the group that lives with non-spousal family or friends in the financial category that doesn’t have enough to make ends meet.

The second study was a secondary data analysis of 209 patients with HF to determine the association between perceived barriers and medication adherence using an exploratory nonlinear regression with gamma log link. ANOVA and Chi-square were used to determine differences across living arrangements. There was no association between perceived barriers and medication adherence; however, patients with HF that lived with spouses had better medication adherence than patients that lived with non-spousal family and friends. The group that lived with non-spousal family or friends had significantly higher mean depressive scores than the other two groups. There were also a higher than expected number of participants in the group that lives with non-spousal family or friends in the financial category that didn’t have enough to make ends meet.

The third study was a secondary data analysis using the same registry to determine whether perceived social support moderates the moderation effect of living arrangements on the association between depressive symptoms and medication adherence. The model was significant in that depressive symptoms and two moderators (i.e., living arrangement and perceived social support) explained 13.2% of the variance of medication adherence. Among the predictors, the only interaction among depressive symptoms, the living alone group, and perceived social support, significantly predicted medication adherence. We found that a three-way interaction (X*W*Z: depressive symptom X living arrangement X perceived social support) was significant. This indicated that the effect of depressive symptoms on medication adherence was significantly moderated by the living arrangement moderated by perceived social support.

This dissertation has fulfilled an essential first step in examining the living arrangements of patients with heart failure and medication adherence. These results suggest that living arrangements and social support should be considered in medication adherence when planning care for patients with depressive symptoms. Future research is needed to further examine the relationship of the group that lives with non-spousal family and friends, and explore whether the combined intervention of improving depressive symptoms and social support interventions focus on instrumental social support effectively increases medication adherence.

Digital Object Identifier (DOI)

https://doi.org/10.13023/etd.2020.504

Available for download on Thursday, December 15, 2022

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