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

他汀类药物降低“坏”胆固醇水平，阻止或减缓心血管疾病（CVD）的进展。他汀类药物依从性与CVD事件（例如心脏病发作/卒中）和CVD或任何原因导致的死亡风险降低相关（Martin-Ruiz 2018; Vrecer 2003）。然而，两年后，只有约25%的患者按处方服用他汀类药物（Brown 2011）。尽管如此，仍相对缺乏关于他汀类药物依从性的心理学决定因素或有效他汀类药物干预的行为成分分类的研究。拟议的博士学位将使用行为科学的方法和定性和定量的方法，以确定如何决定不遵守不同的患者群体和个体之间的差异。这将为设计一个可扩展的、针对个人需求的领导力干预提供信息。这个替代方案可以解决服用药物的各种障碍。该项目将是帝国学院伦敦和哈默史密斯和富勒姆合作的一个合作项目（一个全科医生伙伴关系的5全科医生的做法），建立在现有的研究从这个团队。博士的第一阶段将调查的决定因素ofadherence跨患者群体和个人，使用各种方法，所有基于理论领域框架：a comprehensive全面framework框架of behaviouralpredictors行为预测.对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进行的二次分析将证明这些决定因素在不同的人群中有何不同，例如，接受多种药物治疗的人群、发生过心血管事件的人群、少数民族人群。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，以及个体间观察到的模式。这将通过对他汀类药物依从性决定因素的系统回顾和对他汀类药物依从性干预措施的回顾来补充，其中干预措施的组成部分使用行为改变技术分类法进行分类。学生将绘制所有这些发现，以确定不同群体的依从性决定因素，并采用相应的技术来解决每个依从性障碍。第二阶段将设计一个量身定制的干预措施来解决不同的决定因素，建立在第一阶段的发现上。干预措施将通过与不同患者、临床医生、行为科学家和设计师的研讨会共同设计。干预将是可扩展的，并根据每位患者的具体需求量身定制，例如，根据患者特征和报告的障碍，通过干预组件的途径。初步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。干预对依从性的影响将被检查，沿着患者组之间的差异。访谈和调查将调查患者和临床医生对干预的看法，以及潜在的改进。博士研究结果将为干预措施的全面试验提供信息。

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.