PSYCHOLOGICAL AND BEHAVIORAL CORRELATES OF MEDICAL ADHERENCE AMONG ADULT BONE MARROW TRANSPLANT RECIPIENTS.
Contributors: Wayne State University.
Published: 1993
Number of pages: 181
Subjects: Psychology, Clinical.; Health Sciences, Medicine and Surgery.; Health Sciences, Nursing.
Description: Bone Marrow Transplant (BMT) recipients are required to adhere to a complex outpatient regimen including immunosuppressant medications, strict personal hygiene, and environmental restrictions for the first 100 days post-transplant due to their immunocompromised condition. Non-adherence can be life-threatening and BMT patients are at risk for non-adherence due to the regimen complexity, duration, degree of lifestyle change and medication side-effects.

This study is a prospective correlational investigation of adult outpatient post-BMT adherence to medication, personal hygiene, and environmental restrictions. Of the 88 patients aged 18-60 years initially enrolled, 56 completed a battery of psychological questionnaires four times: prior to admission to the hospital, day of admission, 14 days post-BMT, and 84-100 days post-BMT. Attrition was due to death (n = 15), hospitalization 100 days post-BMT (n = 12), refusal (n = 3), and relapse (n = 2). The psychological assessment included the MMPI and measures of health locus of control, self-rated prior adherence, illness distress, depression, anxiety, hopelessness, and optimism. At 84-100 days post-BMT, medication and hygiene adherence were measured using self-reported 24-hour recall and adherence to environmental restrictions was measured using seven-day recall.

Multivariate analysis of variance revealed that rate of hygiene adherence (M = 65.2%, SD = 16.6) was significantly worse than adherence to medication (M = 94.7%, SD = 7.8) or environmental restrictions (M = 93.7%, SD = 6.9) (p $<$.001), with autologous transplant patients committing significantly more infractions than allogeneic patients despite their simpler medication regimen (p =.02). Hierarchical multiple regression revealed none of the demographic or psychological variables predicted medication or hygiene adherence. However, total inpatient days predicted hygiene adherence (p $<$.01). MMPI scale K (p $<$.05) and total inpatient days (p $<$.01) were positively associated with adherence to environmental restrictions.

These findings indicate that although adherence is quite high to complex medication regimens and environmental restrictions, hygiene adherence is a significant problem, particularly for autologous patients. Interventions should be developed to target this issue.
Notes: Source: Dissertation Abstracts International, Volume: 55-02, Section: B, page: 0594.

Thesis (PH.D.)--WAYNE STATE UNIVERSITY, 1993.

School code: 0254.