Browsing by Author "Bartlett Ellis, Rebecca"

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    A Cost-Effectiveness Analysis: Personal Systems Approach in Improving Medication Adherence in Adult Kidney Transplant Patients
    (Wolters Kluwer, 2022) Whittington, Melanie; Goggin, Kathy; Glasscock, Ernest L.; Noel-MacDonnell, Janelle; Hathaway, Donna; Remy, Laura; Aholt, Dana; Clark, Debra; Miller, Courtney; Ashbaugh, Catherine; Wakefield, Mark; Bartlett Ellis, Rebecca; Russell, Cynthia; School of Nursing
    Interventions to improve medication non-adherence in transplantation have recently moved from a focus on motivation and intention, to a focus on person-level quality improvement strategies. These strategies link adherence to established daily routines, environmental cues and supportive people. The objective of this evaluation was to estimate the cost of implementation and the cost-effectiveness of a person-level intervention shown to increase medication adherence. To estimate the intervention costs, a direct measure micro-costing approach was used following key informant interviews with project champions and a review of implementation expenditures. Cost-effectiveness was calculated by comparing the incremental implementation costs and healthcare costs associated with non-adherence to the incremental percent adherent, defined as the percent of patients who took greater or equal to 85% of their medication doses, for each pairwise comparison. The intervention was low-resource to implement, costing approximately $520 to implement per patient, and was associated with significant improvements in medication adherence. These implementation costs were more than outweighed by the expected healthcare savings associated with improvements in adherence. This person-level intervention is a low cost, efficacious intervention associated with significant statistical and clinical improvements in medication adherence in adult kidney transplant recipients.
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    Lessons Learned: Beta-Testing the Digital Health Checklist for Researchers Prompts a Call to Action by Behavioral Scientists
    (JMIR, 2021-12-22) Bartlett Ellis, Rebecca; Wright, Julie; Soederberg Miller, Lisa; Jake-Schoffman, Danielle; Hekler, Eric B.; Goldstein, Carly M.; Arigo, Danielle; Nebeker, Camille; School of Nursing
    Digital technologies offer unique opportunities for health research. For example, Twitter posts can support public health surveillance to identify outbreaks (eg, influenza and COVID-19), and a wearable fitness tracker can provide real-time data collection to assess the effectiveness of a behavior change intervention. With these opportunities, it is necessary to consider the potential risks and benefits to research participants when using digital tools or strategies. Researchers need to be involved in the risk assessment process, as many tools in the marketplace (eg, wellness apps, fitness sensors) are underregulated. However, there is little guidance to assist researchers and institutional review boards in their evaluation of digital tools for research purposes. To address this gap, the Digital Health Checklist for Researchers (DHC-R) was developed as a decision support tool. A participatory research approach involving a group of behavioral scientists was used to inform DHC-R development. Scientists beta-tested the checklist by retrospectively evaluating the technologies they had chosen for use in their research. This paper describes the lessons learned because of their involvement in the beta-testing process and concludes with recommendations for how the DHC-R could be useful for a variety of digital health stakeholders. Recommendations focus on future research and policy development to support research ethics, including the development of best practices to advance safe and responsible digital health research.
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    Receptiveness to Social Support: Understanding the Conflicting Relationship Between Social Support and Medication Adherence in Adults with Type 2 Diabetes Mellitus
    (2024-12) Elomba, Charles Donald; Bartlett Ellis, Rebecca; Carpenter, Janet S.; Knopf, Amelia; Staten, Lisa K.
    Out of the 38 million Americans living with diabetes, about 34 million have Type 2 diabetes mellitus (T2DM). The chronicity of T2DM, the progression of the disease as pancreatic beta cells continue to decline in function, the propensity of the disease to affect multiple aspects of life, and the complex management strategies required to reduce the risk of diabetes-related complications highlight the significance of diabetes management. Antidiabetic medications are utilized in diabetes management to enhance glycemic control. Although adherence to antidiabetic medications is crucial, non-adherence is common and attributed to a variety of factors, such as social support. While social support is a promising approach for improving medication adherence, research on its influence has produced conflicting results, with some studies reporting significant relationships and others not. Receptiveness to social support might explain the conflicting findings between social support and medication adherence. Thus, a qualitative descriptive study involving 14 adults with T2DM was conducted to describe (a) factors that motivate them to take medications as prescribed, (b) their perceptions of the role of social support in T2DM medication management, and (c) their receptiveness to current or future social support for medication taking. Thematic analysis identified five themes: receiving the diagnosis and taking medications for T2DM (motivational factors), receiving support (perceptions of social support), envisioning the future, and advising others (receptiveness to social support). Participants described internal and external motivators for taking their medications and how social support from their support system, including their family, positively influenced their medication management by providing emotional encouragement, practical advice, and increased confidence. Privacy, trust, perceived need, and reluctance to ask for help were identified as factors influencing receptiveness to social support. The findings provide crucial insights into social support’s influence on T2DM medication management. They suggest that individuals’ openness to social support influences its effectiveness in enhancing medication adherence. These insights can guide future studies to incorporate receptiveness to social support, providing a more comprehensive understanding and enabling the development of instruments to measure it and theories that account for its influence, thereby enhancing the use of social support-related resources to improve medication adherence.