dc.contributor.advisor | Russell, Cynthia L. | |
dc.contributor.author | Mahoney, Diane | |
dc.date.issued | 2019 | |
dc.date.submitted | 2019 Spring | |
dc.description | Title from PDF of title page viewed May 18, 2020 | |
dc.description | Dissertation advisor: Cynthia L. Russell | |
dc.description | Vita | |
dc.description | Includes bibliographical references (pages 113-131) | |
dc.description | Thesis (Ph.D.)--School of Nursing and Health Studies. University of Missouri--Kansas City, 2019 | |
dc.description.abstract | 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. | eng |
dc.description.tableofcontents | 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 | |
dc.format.extent | xiv, 132 pages | |
dc.identifier.uri | https://hdl.handle.net/10355/73364 | |
dc.publisher | University of Missouri -- Kansas City | eng |
dc.subject.lcsh | Infertility, Female | |
dc.subject.lcsh | Patient compliance | |
dc.subject.mesh | Medication Adherence | |
dc.subject.mesh | Infertility, Female -- drug therapy | |
dc.subject.other | Dissertation -- University of Missouri--Kansas City -- Nursing | |
dc.title | Barriers to and Facilitators of Infertility Medication Adherence: A Mixed Methods Study | eng |
dc.type | Thesis | eng |
thesis.degree.discipline | Nursing (UMKC) | |
thesis.degree.grantor | University of Missouri--Kansas City | |
thesis.degree.level | Doctoral | |
thesis.degree.name | Ph.D. (Doctor of Philosophy) | |