Barriers to and Facilitators of Infertility Medication Adherence: A Mixed Methods Study
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Background. Infertility treatment protocols require women to engage in self management of their prescribed medication regimens, yet adherence to infertility medication schedules have been suboptimal. No prior research has investigated barriers to and facilitators of infertility medication adherence (MA) that could assist in the development of effective interventions to overcome medication non-adherence (MNA). Purpose. The purpose of this study was to assess barriers to and facilitators of infertility MA among women undergoing infertility treatment. This study was approved by the University of Missouri-Kansas City Institutional Review Board (IRB) and followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Setting. The study setting was a reproductive medicine and infertility clinical practice serving women who reside in urban, suburban, and rural communities. Methods. Supported by Ajzen and Fishbein’s Reasoned Action Model, a convergent mixed methods design was conducted to correlate women’s perceived barriers to and facilitators of infertility MA. Women in a convenience sample were interviewed and completed questionnaires at study onset followed by one to two subsequent months of electronically monitored medication-taking using the Medication Event Management System® (MEMS). Results. The total sample consisted of 30 participants, of which 18 (60%) participants used the MEMS® with infertility medication-taking. The overall median infertility adherence MA score was 0.98 with a range of .75 to 1.00. The median adherence score of women who were considered non-adherent (n=9) was 0.90, and those who were considered adherent (n=9) was 1.00. MA scores significantly (r = -.49, p= 0.020) increased when the total MA barrier scores decreased. Women with a higher MA total barrier scores had significantly (p= 0.019) lower MA scores compared to women with lower total barrier scores. Women who were adherent to their infertility medication regimen had a significantly (p= 0.009) higher probability to report a positive view on treatment success compared to women who were not adherent. Women who lived in urban and rural communities had a significantly (p= 0.010) higher probability to report a positive view regarding treatment success compared to women who lived in suburban communities. Caucasian and African American women had a significantly (p= 0.049) higher probability to report feelings of self blame for experiencing infertility compared to Asian, Hispanic, and Native American women. Women who had experienced two to three prior failed treatment cycles had a significantly (p= 0.047) higher probability to report feelings of emotional distress compared to women who had experienced zero to one prior failed cycle. Women with children had a significantly (p= 0.015) lower probability to report having a supportive partner compared to women who were childless. There were no significant relationships found between the reported MA facilitators and infertility MA scores. Conclusion. These study findings offer new insight about this unique population that could impact the future of clinical practice. This study serves as a framework to foster ongoing scientific discovery including new interventional studies aimed at optimizing infertility MA.
Table of Contents
Introduction -- Review of Literature -- Theoretical framework and methodology -- Results -- Discussion -- Appendix A. Fishbein and Ajzen’s ReasonedAction Model -- Appendix B. Letter of support -- Appendix C. Demographic Questionnaire -- Appendix D. ASK-20 Adherence Barrier Survey -- Appendix E. Permission to Use ASK-20 Adherence Barrier Survey -- Appendix F. Interview Guide -- Appendix G. Medication Event Monitoring System -- Appendix H. Medication Event Monitoring System Diary -- Appendix I. Deferment of Human Subjects Review to UMKC IRB -- Appendix J. Medication Event Monitoring System Follow-Up Telephone Calls
Ph.D. (Doctor of Philosophy)