Word Frequency and Content analysis of words used during 8482 HAART Adherence

Motivational Interviews
Susan Kamal 1, 2, Paul Nulty3, Olivier Bugnon 1, 2, Matthias Cavassini 4*, Marie P. Schneider 1, 2*
1 Community pharmacy, School of pharmaceutical sciences, University of Geneva, University of Lausanne, Switzerland
2 Community pharmacy, Department of ambulatory care & community medicine, University of Lausanne, Switzerland
Poster# 104
3 Centre for Research in Arts, Social Science, and Humanities, University of Cambridge, United Kingdom
4 Infectious Disease Service, Lausanne university hospital and University of Lausanne, Switzerland

Background Results
Motivational interviewing is a person centered approach for enhancing
Table 1 Word correlations with low adherence (less than 90%)
motivation through helping the patient explore and resolve ambivalence
to change nonadherent behavior or to maintain adherent behavior. It has Word+ context Interpretation
Pharmacists call doctors in case there is a sign of low adherence.
been reported to have a positive effect on adherence to HAART (1,2) . Reporting to Physicians “tel”
This study aims to identify the terms associated with low or high HAART The second major theme was the proposition of directly observed
therapy (D.O.T.) or pill organizers as an alternative to the electronic
adherence through a content analysis from motivational interview reports Suggesting alternative/additional methods of
monitors and stopping their use.
adherence support “D.O.T.” “pill organizers”
conducted at the community pharmacy of the Lausanne university
hospital as part of the adherence enhancing program. Pocket dosing “pocket doses” “prepare in When patients prepare their doses in advance instead of systematically

advance” “missed doses” using the electronic monitor (EM), or have a lot of missed doses, this
Methods might be a sign of low adherence.

Using text from 8428 interviews with 522 patients , we constructed a term- Travel “baggage” “border” “travel” “holiday” “ When patients travel or change routine habits (e.g. New year’s day)

frequency matrix for each patient, retaining single words, two word phrases,
and three word phrases that occurred at least ten times overall and were used
by at least six of the patients. As we have many more of these parameters
than patients, we investigated their association with adherence rate using a
regularized regression model which shrinks the coefficients of the terms.
We then conducted a close reading of the text for those terms that have the
largest estimated effects on adherence. In addition to this data-driven
approach, we studied the contexts of words through discussions with a focus
group of two pharmacists and one infectious-disease physician. Adherence
was measured using electronic monitoring.
1st of January” “ transport”
Unstable daily routine “ very variable hours”
Poly-pharmacy “appointment with Dr.” “running
nose”
associated with medication taking, it was shown to be associated with
low adherence.
When the patient medication taking was over a variable number of
hours as monitored by the EM instead of following fixed regular hours,
this was associated with lower adherence.
Patients that discussed having multiple appointments with different
specialists or reported other morbidities than HIV whether acute (e.g.
common cold or flu) or chronic (e.g. hypertension) also exhibited lower

Results adherence.

Psycho-therapy “name of psychotherapist nurse” When patients or pharmacists mentioning the name of the
The mean adherence rate for all patients was 86.8%. The analysis psychotherapy specialist or nurse, this was associated with lower
resulted in 7608 terms associated with low or high adherence. The
adherence.
average % error of the taking ratio (defined as mean adherence over
inter-visit period) prediction is 4.9%, the misclassification error of the Table 2 Word correlations with higher adherence (90% or higher)
logistic model is 13.5%. Our binary classifier was assigned a cutoff of
Word+ context Interpretation
90%. Figure 1 shows correlations with low or high adherence in
Positive reinforcement by the pharmacist “ I The strongest association with higher adherence was when the
French (original language). Tables 1 and 2 show the most clinically
significant word correlations with low or high adherence in English congratulated the patient on his/her high-level pharmacists shared encouraging statements on the patient’s adequate

(translated from original language) with their interpretations within adherence” adherence.
context. Regular intake “ very regular hours” “fixed Regular medication taking on fixed daily hours was shown to be

hours” associated with higher adherence.

Living together with someone “ my husband” “ my When patients spoke about living with a husband or a partner, or

partner” “social support” getting enough social support from close ones, this was associated

with higher adherence.

MEMS LCD usage “ When I look at the LCD When patients mentioned looking at the MEMS LCD window, and that

window it helps me remember if I took my pills it helps as a memory-aid, this was associated with higher adherence.

or not” “ the patient uses the EM as a memory

aid”

No side effects “patient reported experiencing When the patients mentioned that they were not anymore experiencing

less side effects than the previous visit” “ no side effects, this was associated with higher adherence.

more side-effects”

Figure 1 : Word cloud showing correlations with low and high adherence (In French) Gained knowledge “ the patient understood well” When patients mentioned that they understand the treatment schedule,

and that it is clear for them how they have to take their medication, this

Conclusions was associated with higher adherence.

Factors associated with high adherence included: Factors associated with low adherence included:
 Patient organization.  Patient organizational issues.
 Social support.  Psychosocial issues.
 Absence of side effects.  Co-morbidities.
 Patient literacy.  Attitude of the pharmacist: collaboration with physician.
 Attitude of pharmacist: positive feedback and support to the patients.

References
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2.Blanco JR, Caro AM, Perez-Cachafeiro S, Gutierrez F, Iribarren JA, Gonzalez-Garcia J, et al. HIV infection and aging. AIDS reviews. 2010;12(4):218-30.