Research Methods for Health and Social care

Research Methods for Health and Social care 17000554
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and AIs (50%) (Murphy et al., 2012). According to the National Institute for Health
and Care Excellence (NICE) (2009, p.2), the notion of adherence is defined as “ the
extent to which a patient’s action matches the agreed recommendations” while nonadherence to long term therapy can be classified as unintentional or intentional.
Unintentional nonadherence to long term therapy occurs due to barriers such as not
remembering, not understanding therapy instruction or their inability to pay for
therapy despite the will to follow the recommended therapy (NICE, 2009).
Conversely, intentional nonadherence occurs due to the individual’s perception and
beliefs about the treatment and decides to stop treatment (NICE, 2009).
The Necessity-Concerns Framework (NCF) can be utilised to understand a patient’s
decision to adhere / not adhere to long term ET (Horne et al., 2013). Thus,
adherence to therapy depends on the individual’s belief about the necessity of the
treatment and their belief about the adverse outcome associated with taking the
treatment (Horne et al., 2013). Furthermore, both quantitative and qualitative studies
have found that factors such as severe side effects, lower quality of life and poor
patient-provider communication are associated with nonadherence to ET
(Bluethmann et al., 2017; Chlebowski, Kim and Haque, 2014; Chalela et al., 2018;
Pan et al., 2018). What is more, adherence is greater in clinical trials compared to
clinical practice due to the increased clinical contacts which indicates that regular
follow-up and support with management of side effects increases adherence to
endocrine therapy (Chlebowski, Kim and Haque, 2014). Thus, highlights the
importance of access to regular follow-up care and effective patient-physician
communication.
Sociodemographic and socioeconomic factors have also been reported to
independently predict nonadherence to ET among women in the US (Bender et al.,
2014). Evidence suggests that there is a strong association between
sociodemographic factors such as age and ethnicity and non-adherence to ET
among women in the US (Spencer, 2020). What is more, minority population who
are also on a low income are less likely to integrate into the health care system thus,
have poor access to health care providers resulting in suboptimal ET use (Roberts,
Wheeler and Reeder-Hayes, 2015). Additionally, a retrospective cohort study of
women under the age of 65 and Medicare insured, conducted by Farias and Du SH7008 Research Methods for Health and Social care 17000554
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(2017) found that the cost of therapy was significantly associated with nonadherence
to ET. Similarly, in a recent quantitative study conducted by Spencer et al. (2020)
lack of resources and being public insured were identified as barriers to adherence
to endocrine therapy. Thus, privately insured women were less likely to report tradeoff and resource barriers compared to Medicare insured women (Spencer et al.,
2020).
Economic and insurance issues have been identified as barriers to access to health
care among cancer survivors in the National Action Plan for Cancer Survivorship
(NAPCS) (2004) Advancing Public Health Strategies. The Action Plan recommends
that survivorship advocates should educate decision-makers about the financial
barriers that cancer patients face to access quality follow-up care (NAPCS, 2004). A
descriptive assessment of the implementation of NAPCS’s and its applicability at five
national organisations conducted by Smith et al. (2013) found that insurance issues
such as ineligibility to public health programmes and advocacy regarding insurance
issues were being addressed by educating policymakers through a variety of
methods such as briefing materials and white papers.