SOCIAL ECOLOGICAL APPROACHES TO HEALTH REGIMEN ADHERENCE IN CHRONIC CONDITIONS Syllabus
Course Learning Objectives
Upon successfully completing this course, students will be able to:
- Assess medical adherence among persons living with specific chronic health conditions
- Describe a social ecological framework of health regimen adherence, including influences at the individual, dyadic (patient-formal caregiver and patient-informal caregiver relationship), and social network levels.
- Identify correlates to medical adherence at the individual, dyadic, and social network levels
- Identify theory-based components of adherence interventions for various populations or health conditions
Course DescriptionAddresses social approaches to promoting sustained adherence to health regimens among persons living with chronic conditions. Addresses prescribed use of medications, lifestyle changes, and retention in healthcare over time among persons living with HIV/AIDS, hypertension, and other chronic conditions. Enables students to: (1) assess adherence to health regimens, (2) identify correlates of adherence at the individual, interpersonal, and social network levels, and (3) assess major approaches and components of medical adherence interventions, and their linkage to theories of behavior change. Explores social factors impacting vulnerable populations’ medical adherence and health disparities, drawing examples from both domestic and international contexts.
Intended AudienceGraduate students and clinicians interested in social approaches to promoting medical adherence.
Methods of AssessmentJournal article critique (individual assignment), proposed intervention & evaluation (small group assignment), oral presentation of group project, and class participation
Additional Faculty Notes:
ASSIGNMENTS & EVALUATION
Assignment #1 (30% of grade): Written journal article critique (individual assignment).
Each student will submit a written critique (3-4 pages) of a peer-reviewed journal article regarding a medical adherence intervention or methodologies for assessing medical adherence (e.g., measures or methods). For the text, please use 12 point font and double space, with 1 inch margins and a uniform reference format. The following are some suggested aspects of the article to consider in your presentation (not necessarily in the order in which you will present it).
- Rationale: What is the reason/purpose of the intervention/article; why do the investigators/authors (or you) think it’s important?
- Theories or conceptual models of behavior and health: Note: these may be explicit or implicit. How do the investigators/authors appear to understand behavior and health, or ways/mechanisms to affect behavior and health?
- Methods: Give a brief overview of the study design and methods.
- Findings: What were the major findings of the study?
- Conclusions: What are the conclusions that the investigators/authors draw from the study/paper?
- Potential implications: What do the investigators/authors (or you) suggest are the potential implications of the study to public health, theory/understanding of behavior or health, or to health/public policy?
- Praise and questions: What was good about the intervention/article? What are some questions you have about the intervention/article? What was left unclear?
- Critique of article: How adequate do you think the evidence is to support the investigators'/authors' conclusions? ThHow adequately do you think this approach, conceptual basis, study design, or methods address this issue/public health problem? Use information from the article and from other literature.
Grades for assignment #1 will be based upon completeness of the critique (per 8 suggested points, as applicable) and use of literature (references) to support your assertions.
Assignment #2 (30% of grade): Written proposal of an adherence intervention and evaluation plan (small group assignment).
Students working in pairs (unless otherwise approved by course instructors) will submit an overview of a proposed medical adherence intervention for a vulnerable population and a plan for evaluating it (6-8 pages). The proposal should also include a brief description of a proposed formative study (i.e., a qualitative or quantitative observational study) to inform the development or refinement of the proposed intervention; this can address gaps in the literature on aspects of the intervention design or measurement.
Proposals should include a brief description of the proposed observational study; and a brief description of the proposed intervention study design, study population, measures (independent/predictor and outcome variables), major components of the intervention, and literature to support them. The proposal could build on a prior intervention in the literature, or an existing intervention you are familiar with. If you base the proposal on a prior intervention, please clarify what innovations in the intervention and evaluation you are proposing and why (citing literature to support these modifications). For the text, please use 12 point font and double space, with 1 inch margins and a uniform reference format.
Grades for assignment #2 will be based on the degree to which groups consider prior literature on the topic (e.g., interventions, measures, and aspects of relevance regarding the vulnerable population of focus [however defined]). You are encouraged to consider potentially feasible intervention approaches within the context of a population with challenges accessing or optimally engaging in healthcare.
Assignment #3 (30% of grade): Group presentation of proposed intervention (small group assignment).
Each group from assignment #2 will present a 10-15 minute presentation (with a maximum of 12 PowerPoint slides) of the group’s proposed intervention and evaluation plan, its fit to the vulnerable study population of focus, and major ways the proposed study addresses current gaps in the literature regarding intervention and measurement of this population’s medical adherence.
Grades for this assignment will be based on quality of oral presentation, equal participation of each student, use of slides, and keeping within the time limitations.
Classroom attendance and participation (10% of grade)
Grades for this will be based on attendance and actively exchanging questions and ideas.
Please see the course Session for a full list of dates and items for this course.
Academic Ethics Code
Students enrolled in the Bloomberg School of Public Health of The Johns Hopkins University assume an obligation to conduct themselves in a manner appropriate to the University's mission as an institution of higher education. A student is obligated to refrain from acts which he or she knows, or under the circumstances has reason to know, impair the academic integrity of the University. Violations of academic integrity include, but are not limited to: cheating; plagiarism; knowingly furnishing false information to any agent of the University for inclusion in the academic record; violation of the rights and welfare of animal or human subjects in research; and misconduct as a member of either School or University committees or recognized groups or organizations.
Pedagogical Approach: The course is designed to facilitate student learning by active engagement in group problem solving around medical adherence. The instructors will facilitate students’ understanding of real world complexities and social influences on medical adherence. Students will be introduced to resources of potential utility in assessing adherence, and in designing and evaluating adherence interventions for a variety of chronic conditions and social contexts.
·Attendance & participation: Attendance and participation in all class sessions is expected for satisfactory completion of the course. Participation includes actively exchanging questions and ideas. If unable to attend a class session, the student is expected to notify the instructors prior to the class session by email.
·Submission of written assignments: Papers are to be uploaded onto CoursePlus in the indicated folder/link by the due date and time. Only in rare circumstances, and with prior approval, will assignments be accepted after the due date.
·Use of cell phones/laptops during class: Due to their adverse effects on concentration and participation, students are asked to refrain from the use of cell phones or laptops during class time, with the exception of using laptops for writing notes.
·Modes of communication: Students can contact the instructors at their email addresses listed. Because the course is co-led by two instructors, it is requested that email communication be addressed to both instructors to enhance communication.
Course readings: The assigned readings for each class are available on the CoursePlus website (http://courseplus.jhsph.edu) under the “Class materials and resources” tab and the “On-line library” link for the course. Students are expected to be prepared at each class to engage in discussion of the required reading in terms of its explicit or implicit theoretical basis, methodology or approach, and findings. Recommended readings are provided for those who want to read further on a topic, but are not required for appropriate participation.
Group work guidelines: Small-group discussions in class will be assigned throughout the course to facilitate more in-depth group learning on topics of focus. As in classroom participation, students are expected to actively exchange questions and ideas.
Source guidelines: In paper assignments, please cite all sources. It is permissible to cite unpublished articles, blogs, listserves, etc., but be sure to cite the sources. Any citation format, e.g., ICMJE (www.icmje.org), APA, AMA, is permissible as long as it is used consistently throughout the paper.
Grades will be determined as follows:
Journal article critique
Proposed intervention & evaluation (small group assignment)
Oral presentation of group project
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