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Berglund, E. (2019). Adherence to drug treatment and interpretation of treatment effects. (Doctoral dissertation). Uppsala: Acta Universitatis Upsaliensis
Open this publication in new window or tab >>Adherence to drug treatment and interpretation of treatment effects
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Suboptimal adherence to medical treatments is prevalent across several clinical conditions and can lead to treatment failure. Adherence is a far from fully explored phenomenon and there is little knowledge about how patients interpret treatment effects. Commonly used treatment evaluation measures are often relative measures, which may be difficult for lay people and patients to understand.

The overall aim of this thesis was to investigate factors with relevance to adherence, to estimate treatment effects with the time-based Delay of Event (DoE) measure in anticoagulant preventive treatments, and to explore how lay people responded to the DoE measure, as compared with established measures, regarding treatment decisions and effect interpretation.

A quantitative population-based cross-sectional design was used for Study I. Study II used data from the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) clinical trial and estimated effects as DoEs. Studies III and IV were carried out as randomised survey experiments.

The results showed that general adherence behaviour was associated with both environmental and social factors. Estimations of DoE showed that stroke or systemic embolism was delayed 181 (95% CI 76 to 287) days through twenty-two months of apixaban use, as compared with  warfarin use. The delay of major and intracranial bleeding was 206 (95% CI 130 to 281) and 392 (95% CI 249 to 535) days, respectively, due to apixaban use for twenty-two months, as compared with  warfarin use. Presenting preventive treatment effects as DoEs to lay people was associated with high willingness to initiate treatment and positive views on treatment benefits and willingness to pay for treatment.

Non-optimal adherence was partly associated with modifiable factors and it might be possible to increase adherence by managing these factors. Estimations of DoEs in preventive treatments gave information on effects regarding delay of different outcomes; the estimation also provides tools that might be useful for interpreting and communicating treatment effects in clinical decision-making. Lay people seemed to react rationally to variations in DoE magnitude; a higher proportion accepted treatment when the magnitude was greater.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2019. p. 91
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1549
Keywords
Medication adherence, Health-seeking behaviour, Chronic treatment, Cardiovascular treatments, Anticoagulants/therapeutic use, Treatment outcome, Effect measure, Quality of care, Medical decision-making, Necessity-concern framework, Choice behaviour, Risk communication, Risk perception, Health communication
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Social Medicine
Identifiers
urn:nbn:se:uu:diva-379077 (URN)978-91-513-0592-9 (ISBN)
Public defence
2019-04-26, Sal X, Universitetshuset, Biskopsgatan 3, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2019-04-05 Created: 2019-03-11 Last updated: 2019-05-07
Berglund, E., Westerling, R., Sundström, J. & Lytsy, P. (2018). Length of time periods in treatment effect descriptions and willingness to initiate preventive therapy: a randomised survey experiment. BMC Medical Informatics and Decision Making, 18, Article ID 106.
Open this publication in new window or tab >>Length of time periods in treatment effect descriptions and willingness to initiate preventive therapy: a randomised survey experiment
2018 (English)In: BMC Medical Informatics and Decision Making, ISSN 1472-6947, E-ISSN 1472-6947, Vol. 18, article id 106Article in journal (Refereed) Published
Abstract [en]

Background Common measures used to describe preventive treatment effects today are proportional, i.e. they compare the proportions of events in relative or absolute terms, however they are not easily interpreted from the patient's perspective and different magnitudes do not seem to clearly discriminate between levels of effect presented to people. Methods In this randomised cross-sectional survey experiment, performed in a Swedish population-based sample (n=1041, response rate 58.6%), the respondents, aged between 40 and 75years were given information on a hypothetical preventive cardiovascular treatment. Respondents were randomised into groups in which the treatment was described as having the effect of delaying a heart attack for different periods of time (Delay of Event,DoE): 1month, 6months or 18months. Respondents were thereafter asked about their willingness to initiate such therapy, as well as questions about how they valued the proposed therapy. ResultsLonger DoE:s were associated with comparatively greater willingness to initiate treatment. The proportions accepting treatment were 81, 71 and 46% when postponement was 18months, 6months and 1month respectively. In adjusted binary logistic regression models the odds ratio for being willing to take therapy was 4.45 (95% CI 2.72-7.30) for a DoE of 6months, and 6.08 (95% CI 3.61-10.23) for a DoE of 18months compared with a DoE of 1month. Greater belief in the necessity of medical treatment increased the odds of being willing to initiate therapy. ConclusionsLay people's willingness to initiate preventive therapy was sensitive to the magnitude of the effect presented as DoE. The results indicate that DoE is a comprehensible effect measure, of potential value in shared clinical decision-making.

Place, publisher, year, edition, pages
BMC, 2018
Keywords
Medical decision-making, Risk communication, Risk perception, Necessity-concern framework
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:uu:diva-371868 (URN)10.1186/s12911-018-0662-2 (DOI)000450786000002 ()30458757 (PubMedID)
Available from: 2019-01-07 Created: 2019-01-07 Last updated: 2019-03-11Bibliographically approved
Berglund, E., Anderzén, I., Andersén, Å., Carlsson, L., Gustavsson, C., Wallman, T. & Lytsy, P. (2018). Multidisciplinary Intervention and Acceptance and Commitment Therapy for Return-to-Work and Increased Employability among Patients with Mental Illness and/or Chronic Pain: A Randomized Controlled Trial. International Journal of Environmental Research and Public Health, 15(11), Article ID 2424.
Open this publication in new window or tab >>Multidisciplinary Intervention and Acceptance and Commitment Therapy for Return-to-Work and Increased Employability among Patients with Mental Illness and/or Chronic Pain: A Randomized Controlled Trial
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2018 (English)In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 15, no 11, article id 2424Article in journal (Refereed) Published
Abstract [en]

Background: People on long-term sick leave often have a long-lasting process back to work, where the individuals may be in multiple and recurrent states; i.e., receiving different social security benefits or working, and over time they may shift between these states. The purpose of this study was to evaluate the effects of two vocational rehabilitation programs, compared to a control, on return-to-work (RTW) or increased employability in patients on long-term sick leave due to mental illness and/or chronic pain. Methods: In this randomized controlled study, 427 women and men were allocated to either (1) multidisciplinary team management, i.e., multidisciplinary assessments and individual rehabilitation management, (2) acceptance and commitment therapy (ACT), or (3) control. A positive outcome was defined as RTW or increased employability. The outcome was considered negative if the (part-time) wage was reduced or ceased, or if there was an indication of decreased employability. The outcome was measured one year after entry in the project and analyzed using binary and multinomial logistic regressions. Results: Participants in the multidisciplinary team group reported having RTW odds ratio (OR) 3.31 (95% CI 1.39-7.87) compared to the control group in adjusted models. Participants in the ACT group reported having increased employability OR 3.22 (95% CI 1.13-9.15) compared to the control group in adjusted models. Conclusions: This study of vocational rehabilitation in mainly female patients on long-term sick leave due to mental illness and/or chronic pain suggests that multidisciplinary team assessments and individually adapted rehabilitation interventions increased RTW and employability. Solely receiving the ACT intervention also increased employability.

Keywords
return-to-work, vocational rehabilitation, multidisciplinary rehabilitation, chronic pain, mental illness, sick leave
National Category
Occupational Health and Environmental Health Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-372458 (URN)10.3390/ijerph15112424 (DOI)000451640500098 ()30384498 (PubMedID)
Funder
Swedish Social Insurance Agency
Available from: 2019-01-07 Created: 2019-01-07 Last updated: 2019-01-07Bibliographically approved
Andersén, Å., Larsson, K., Lytsy, P., Berglund, E., Kristiansson, P. & Anderzén, I. (2018). Strengthened General Self-Efficacy with Multidisciplinary Vocational Rehabilitation in Women on Long-Term Sick Leave: A Randomised Controlled Trial. Journal of occupational rehabilitation, 28(4), 691-700
Open this publication in new window or tab >>Strengthened General Self-Efficacy with Multidisciplinary Vocational Rehabilitation in Women on Long-Term Sick Leave: A Randomised Controlled Trial
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2018 (English)In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 28, no 4, p. 691-700Article in journal (Refereed) Published
Abstract [en]

Purpose To investigate the effects of two vocational rehabilitation interventions on self-efficacy, for women on long-term sick leave ≥ 1 year due to chronic pain and/or mental illness. Methods This study uses data from a randomised controlled trial consisting of two phases and comprising 401 women on long-term sick leave. They were allocated to either (1) a multidisciplinary team assessment and multimodal intervention (TEAM), (2) acceptance and commitment therapy (ACT), or (3) control group. Data were collected through repeated measurements from self-reported questionnaires before intervention, 6 and 12 months later and registry data. Data from measurements of general self-efficacy, sociodemographics, anxiety and depression were analysed with linear regression analyses. Results During the intervention period, the women in the TEAM group’s self-efficacy mean increased from 2.29 to 2.74. The adjusted linear regression model, which included group allocation, sociodemographics, self-efficacy pre-treatment, anxiety and depression showed increased self-efficacy for those in the TEAM intervention at 12 months (B = 0.25, 95% CI 0.10–0.41). ACT intervention had no effect on self-efficacy at 12 months (B = 0.02, 95% CI − 0.16 to 0.19). The results in the adjusted model also showed that higher self-efficacy at pre-treatment was associated with a higher level of self-efficacy at 12 months (B = 0.68, 95% CI 0.54–0.81). Conclusion A multidisciplinary team assessment and multimodal intervention increased self-efficacy in women on sick leave for an extremely long time (mean 7.8 years) who had a low mean level of self-efficacy prior to inclusion. Thus, self-efficacy needs to be addressed in vocational rehabilitation.

Keywords
Chronic pain, Mental illness, Multidisciplinary rehabilitation, Self-efficacy, Sick leave, Vocational rehabilitation, Women
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-339109 (URN)10.1007/s10926-017-9752-8 (DOI)000450856600011 ()29318421 (PubMedID)
Funder
Swedish Social Insurance AgencySwedish Association of Local Authorities and RegionsVårdal Foundation
Available from: 2018-01-16 Created: 2018-01-16 Last updated: 2019-01-22Bibliographically approved
Berglund, E., Westerling, R. & Lytsy, P. (2017). Housing Type and Neighbourhood Safety Behaviour Predicts Self-rated Health, Psychological Well-being and Frequency of Recent Unhealthy Days: A Comparative Cross-sectional Study of the General Population in Sweden. Planning practice + research, 32(4), 444-465
Open this publication in new window or tab >>Housing Type and Neighbourhood Safety Behaviour Predicts Self-rated Health, Psychological Well-being and Frequency of Recent Unhealthy Days: A Comparative Cross-sectional Study of the General Population in Sweden
2017 (English)In: Planning practice + research, ISSN 0269-7459, E-ISSN 1360-0583, Vol. 32, no 4, p. 444-465Article in journal (Refereed) Published
Abstract [en]

This study aimed at analysing associations among housing type, neighbourhood safety behaviour, self-rated health (SRH), psychological well-being and unhealthy days in the general population. From 2004 to 2013, 90,845 Swedes completed a questionnaire about their health, number of days with poor health, psychological well-being, housing type, and whether they refrained from going out based on perception of neighbourhood safety. People not living in private housing and those who did not go out for safety reasons reported lower SRH and psychological well-being and higher frequency of recent unhealthy days and days without work capacity due to poor health.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2017
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-342425 (URN)10.1080/02697459.2017.1374706 (DOI)000423904900006 ()
Funder
Stiftelsen Olle Engkvist Byggmästare
Available from: 2018-02-20 Created: 2018-02-20 Last updated: 2018-03-16Bibliographically approved
Berglund, E., Westerling, R. & Lytsy, P. (2017). Social and health-related factors associated with refraining from seeking dental care: A cross-sectional population study. Community Dentistry and Oral Epidemiology, 45(3), 258-265
Open this publication in new window or tab >>Social and health-related factors associated with refraining from seeking dental care: A cross-sectional population study
2017 (English)In: Community Dentistry and Oral Epidemiology, ISSN 0301-5661, E-ISSN 1600-0528, Vol. 45, no 3, p. 258-265Article in journal (Refereed) Published
Abstract [en]

Background: Social inequities are considered to affect healthcare utilization, whereas less is known about the factors associated with refraining from seeking dental care. This study aimed to investigate whether people with no social support, long-term illness, caregiver burden and low socioeconomic status (SES) refrained from seeking dental care in higher proportion than the general Swedish population.

Methods: This study used cross-sectional questionnaire data from repeated nationwide health surveys during 2004-2013 of a total of 90 845 people. The questionnaire included questions on demographic characteristics, social support, long-term illness, caregiving burden, SES and dental care-seeking behaviour. Descriptive statistics, chi-square tests, correlation analyses and logistic regressions were used to investigate associations between independent variables and dental care-seeking behaviour.

Results: In the total sample, 15.1% of respondents reported refraining from seeking dental care. Having no emotional social support or having no instrumental social support was separately associated with reporting refraining from seeking dental care in adjusted multivariate models (odds ratio [OR] 1.26, 95% confidence interval [CI] 1.18-1.34 and OR: 1.89, 95% CI: 1.67-2.13, respectively). Having a long-term illness was associated with refraining from seeking dental care in adjusted models (adjusted OR: 1.43, 95% CI: 1.35-1.51). Furthermore, being an informal caregiver was associated with refraining from seeking dental care (adjusted OR: 1.15, 95% CI: 1.07-1.23). Low SES was associated with higher refraining from seeking dental care; the strongest association was with having financial problems (adjusted OR: 3.57, 95% CI: 3.19-4.00). Interaction effects were found between education level and SES, and between social support and long-term illness, and the outcome.

Conclusions: The findings in this study imply that having no social support, having long-term illness, being informal caregiver or having financial problems are factors associated with reporting refraining from seeking dental care, on a population basis.

Keywords
dental care utilization, health-seeking behaviour, informal caregiving, social support, socioeconomic status
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-317519 (URN)10.1111/cdoe.12284 (DOI)000400790900009 ()28169442 (PubMedID)
Available from: 2017-03-15 Created: 2017-03-15 Last updated: 2017-06-20Bibliographically approved
Berglund, E., Lytsy, P. & Westerling, R. (2016). Active Traveling and Its Associations with Self-Rated Health, BMI and Physical Activity: A Comparative Study in the Adult Swedish Population. International Journal of Environmental Research and Public Health, 13(5), Article ID 455.
Open this publication in new window or tab >>Active Traveling and Its Associations with Self-Rated Health, BMI and Physical Activity: A Comparative Study in the Adult Swedish Population
2016 (English)In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 13, no 5, article id 455Article in journal (Refereed) Published
Abstract [en]

Active traveling to a daily occupation means that an individual uses an active way of traveling between two destinations. Active travel to work or other daily occupations offers a convenient way to increase physical activity levels which is known to have positive effects on several health outcomes. Frequently used concepts in city planning and regional planning today are to create environments for active commuting and active living. Even then, little research has focused on traveling modes and subjective health outcomes such as self-rated health (SRH). This study aimed to explore and investigate associations between travel mode and health-related outcomes, such as self-rated health (SRH), body mass index (BMI) and overall physical activity, in an adult population in Sweden. A cross-sectional study was conducted in a randomly selected population-based sample (n = 1786, age 45-75 years); the respondents completed a questionnaire about their regular travel mode, demographics, lifestyle, BMI and SRH. Chi-square tests and logistic regressions found that inactive traveling was associated with poor SRH, a greater risk of obesity or being overweight and overall physical inactivity. In addition, lifestyle factors, such as choice of food and smoking habits, were associated with SRH, BMI and overall physical activity.

Keywords
active travel, commuting, self-rated health, BMI, physical activity, planning
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-299511 (URN)10.3390/ijerph13050455 (DOI)000377256900012 ()
Available from: 2016-07-22 Created: 2016-07-22 Last updated: 2017-11-28Bibliographically approved
Berglund, E., Westerling, R., Sundstrom, J. & Lytsy, P. (2016). Treatment effect expressed as the novel Delay of Event measure is associated with high willingness to initiate preventive treatment - A randomized survey experiment comparing effect measures. Patient Education and Counseling, 99(12), 2005-2011
Open this publication in new window or tab >>Treatment effect expressed as the novel Delay of Event measure is associated with high willingness to initiate preventive treatment - A randomized survey experiment comparing effect measures
2016 (English)In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 99, no 12, p. 2005-2011Article in journal (Refereed) Published
Abstract [en]

Objectives: This study aimed to investigate patients' willingness to initiate a preventive treatment and compared two established effect measures to the newly developed Delay of Events (DoE) measure that expresses treatment effect as a gain in event-free time. Methods: In this cross-sectional, randomized survey experiment in the general Swedish population, 1079 respondents (response rate 60.9%) were asked to consider a preventive cardiovascular treatment. Respondents were randomly allocated to one of three effect descriptions: DoE, relative risk reduction (RRR), or absolute risk reduction (ARR). Univariate and multivariate analyses were performed investigating willingness to initiate treatment, views on treatment benefit, motivation and importance to adhere and willingness to pay for treatment. Results: Eighty-one percent were willing to take the medication when the effect was described as DoE, 83.0% when it was described as RRR and 62.8% when it was described as ARR. DoE and RRR was further associated with positive views on treatment benefit, motivation, importance to adhere and WTP. Conclusions: Presenting treatment effect as DoE or RRR was associated with a high willingness to initiate treatment. Practice implications: An approach based on the novel time-based measure DoE may be of value in clinical communication and shared decision making.

Keywords
Preventive measures, Adherence, Decision-making, Treatment outcome, Randomized, Survey experiment
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:uu:diva-315088 (URN)10.1016/j.pec.2016.07.028 (DOI)000391223200012 ()27499030 (PubMedID)
Funder
Swedish Society of Medicine
Available from: 2017-02-08 Created: 2017-02-08 Last updated: 2019-03-11Bibliographically approved
Berglund, E., Lytsy, P. & Westerling, R. (2015). Health and wellbeing in informal caregivers and non-caregivers: a comparative cross-sectional study of the Swedish a general population. Health and Quality of Life Outcomes, 13, Article ID 109.
Open this publication in new window or tab >>Health and wellbeing in informal caregivers and non-caregivers: a comparative cross-sectional study of the Swedish a general population
2015 (English)In: Health and Quality of Life Outcomes, ISSN 1477-7525, E-ISSN 1477-7525, Vol. 13, article id 109Article in journal (Refereed) Published
Abstract [en]

Background: Informal caregiving by relatives is a great resource for individuals as well as for society, but the caregiving role is associated with health problems for the caregiver. This study aimed to compare caregivers' self-rated health, number of recent days with poor health and psychological wellbeing with that of non-caregivers in a general Swedish population. Methods: From 2004 to 2013, 90,845 Swedish people completed a postal questionnaire about their health, number of recent days with poor health during last month, psychological wellbeing and if they were performing caregiving or not. Descriptive statistics, chi-square analysis, ANOVA, logistic regressions and negative binomial regression models were used to investigate associations between being a caregiver or not and health and wellbeing. Negative binomial regression was used to assess the relation between caregiver status and recent days with poor health or functioning. Results: Eleven percent reported having a caregiving role. Caregivers reported poorer self-rated health compered to non-caregivers, also in adjusted models; odds ratio (OR): 1.07 with a 95 % confidence interval (CI): 1.01-1.13. Caregivers also reported lower psychological wellbeing compared to non-caregivers; OR: 1.22, CI: 1.15-1.30. Caregiving status was associated with more recent days with poor physical health and more recent days with poor mental health. Conclusions: This study suggests that caregivers have worse perceptions in self-rated health and psychological wellbeing compared with non-caregivers, indicating that the role of caregiver is adversely associated with health. This association also appears in terms of reporting days of poor health in the last month. The underlying mechanism of these associations, including the potential detrimental health effects of being a caregiver, needs to be investigated in longitudinal studies.

Keywords
Self-rated health, Wellbeing, Informal caregiving, Population health
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-260837 (URN)10.1186/s12955-015-0309-2 (DOI)000358564100002 ()26216099 (PubMedID)
Available from: 2015-08-25 Created: 2015-08-25 Last updated: 2017-12-04Bibliographically approved
Berglund, E., Lytsy, P. & Westerling, R. (2014). The influence of locus of control on self-rated health in context of chronic disease: a structural equation modeling approach in a cross sectional study. BMC Public Health, 14, 492
Open this publication in new window or tab >>The influence of locus of control on self-rated health in context of chronic disease: a structural equation modeling approach in a cross sectional study
2014 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 14, p. 492-Article in journal (Refereed) Published
Abstract [en]

Background: Self-rated health is a robust predictor of several health outcomes, such as functional ability, health care utilization, morbidity and mortality. The purpose of this study is to investigate and explore how health locus of control and disease burden relate to self-rated health among patients at risk for cardiovascular disease. Methods: In 2009, 414 Swedish patients who were using statins completed a questionnaire about their health, diseases and their views on the three-dimensional health locus of control scale. The scale determines which category of health locus of control - internal, chance or powerful others - a patient most identifies with. The data was analyzed using logistic regression and a structural equation modeling approach. Results: The analyses showed positive associations between internal health locus of control and self-rated health, and a negative association between health locus of control in chance and powerful others and self-rated health. High internal health locus of control was negatively associated with the cumulative burden of diseases, while health locus of control in chance and powerful others were positively associated with burden of diseases. In addition, age and education level had indirect associations with self-rated health through health locus of control. Conclusions: This study suggests that self-rated health is positively correlated with internal locus of control and negatively associated with high locus of control in chance and powerful others in patients at high risk for cardiovascular disease. Furthermore, disease burden seems to be negatively associated with self-rated health.

Keywords
Self-rated health, Locus of control, Chronic disease, Cardiovascular disease, Diseases burden, Logistic regressions, Path model, SEM
National Category
Public Health, Global Health, Social Medicine and Epidemiology Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-229526 (URN)10.1186/1471-2458-14-492 (DOI)000338374900001 ()
Available from: 2014-08-12 Created: 2014-08-11 Last updated: 2017-12-05Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-6937-4025

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