Understanding variations in determinants of medicationadherence to inform a tailored intervention: the case ofstatin adherence

他汀类药物可降低“坏”胆固醇水平，阻止或减缓心血管疾病(CVD)的进展。他汀类药物的依从性与心血管疾病事件(例如心脏病发作/中风)以及死于心血管疾病或任何原因的风险较低相关(Martin-Ruiz 2018；Vrecer 2003)。然而，两年后，只有大约25%的患者按处方服用他汀类药物(Brown 2011)。尽管如此，对他汀类药物依从性的心理决定因素或有效他汀类药物干预的行为成分分类的研究相对缺乏。拟议的博士将使用行为科学方法以及定性和定量方法来确定不同患者群体和个人之间不坚持的决定因素如何不同。这将为设计一种可扩展的依从性干预措施提供信息，该干预措施根据个人需求量身定做。这种一刀切的方法可以解决服药的各种障碍。该项目将由伦敦帝国理工学院和Hammersmith and Fulham Partnership(由5家全科医生组成的全科医生伙伴关系)合作，建立在该团队现有研究的基础上。博士学位的第一阶段将使用各种方法调查患者群体和个人的依从性决定因素，所有这些都基于理论域框架：行为预测者的综合框架。我们正在进行的关于他汀类药物依从性的心理决定因素的调查的第二次分析将测试这些因素在不同的群体中有何不同，例如，服用多种药物的人，有心血管疾病事件的人，少数民族。一项访谈研究将评估依从性和非依从性患者的依从性决定因素，以及个体之间的模式。此外，还将对他汀类药物依从性决定因素进行系统回顾，并对他汀类药物依从性干预措施进行回顾，并使用行为改变技术分类学对干预措施进行分类。学生将把所有这些发现映射到不同群体中的依从性决定因素，以及解决每个依从性障碍的相应技术。第二阶段将在阶段1发现的基础上，设计一项量身定制的干预措施，以解决不同的决定因素。干预措施将通过研讨会与不同的患者、临床医生、行为科学家和设计师共同设计。干预将是可扩展的，并根据每个患者的特定需求而量身定做，例如，根据患者特征和报告的障碍，通过各种干预组件进行调整。先导性和可行性研究将评估招募是否可行，试验过程是否顺利，干预是否可接受。将检查干预对依从性的影响，以及患者组之间的差异。访谈和调查将调查患者和临床医生对干预的意见，以及可能的改进。博士的发现将为随后的干预全面试验提供信息。

Statins lower levels of 'bad' cholesterol, and stop or slowthe progression of cardiovascular disease (CVD). Statinadherence is associated with lower risk of CVD events (e.g.heart attack/stroke), and death from CVD or any cause(Martin-Ruiz 2018; Vrecer 2003). However, after two years,only around 25% of patients take statins as prescribed(Brown 2011).Despite this, there is a relative lack of research intopsychological determinants of statin adherence, orcategorisations of the behavioural components of effectivestatin interventions. The proposed PhD will use behaviouralscience approaches and qualitative and quantitativemethods to identify how determinants of non-adherencediffer between different patient groups and betweenindividuals. This will inform the design of a scalableadherence intervention, tailored to individual needs. Thisalternative to a one-size-fits-all approach can addressvarying barriers to taking medications.The project will be a collaboration between ImperialCollege London and Hammersmith and Fulham Partnership(a GP Partnership of 5 GP practices), building on existingresearch from this team.The first stage of the PhD will investigate determinants ofadherence across patient groups and individuals, using avariety of methods, all based on the Theoretical DomainsFramework: a comprehensive framework of behaviouralpredictors. Secondary analysis of our ongoing survey onpsychological determinants of statin adherence will testhow these differ in different groups, e.g. those on manymedications, those who have had a CVD event, ethnicminorities. An interview study will assess adherencedeterminants in adherent and non-adherent patients, andthe patterns seen across individuals. This will be complemented by a systematic review of statin adherencedeterminants, and a review of statin adherenceinterventions, with intervention components categorisedusing the Behaviour Change Techniques Taxonomy.The student will map all these findings to identifyadherence determinants across different groups, andcorresponding techniques to address each adherencebarrier.The second stage will design a tailored intervention toaddress the varying determinants, building on stage 1findings. The intervention will be co-designed usingworkshops with diverse patients, clinicians, behaviouralscientists and designers. The intervention will be scalable,and tailored to specific needs of each patient e.g. through apathway of intervention components, based on patientcharacteristics and reported barriers. A pilot and feasibilitystudy will assess whether recruitment is feasible, trialprocesses run smoothly, and the intervention is acceptable.The effect of the intervention on adherence will beexamined, along with differences between patient groups.An interview and survey will investigate patient andclinician views on the intervention, and potentialimprovements. The PhD findings will inform a subsequentfull trial of the intervention.