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The relationship between maternal self-efficacy, compliance and outcome in a trial of vitamin D supplementation in pregnancy

Barker, M; D’Angelo, S; Ntani, G; Lawrence, W; Baird, J; Jarman, M; Vogel, C; Inskip, H; Cooper, C; Harvey, NC; et al. Barker, M; D’Angelo, S; Ntani, G; Lawrence, W; Baird, J; Jarman, M; Vogel, C; Inskip, H; Cooper, C; Harvey, NC; Papageorghiou, AT (2017) The relationship between maternal self-efficacy, compliance and outcome in a trial of vitamin D supplementation in pregnancy. Osteoporosis International, 28 (1). pp. 77-84. ISSN 0937-941X https://doi.org/10.1007/s00198-016-3721-5
SGUL Authors: Papageorghiou, Aris

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Abstract

Summary In a randomised controlled trial of vitamin D during pregnancy, we demonstrated that women with lower self-efficacy were more likely to experience practical problems with taking the trial medication and that this was associated with lower compliance and achieved 25(OH)-vitamin D concentrations. Introduction The relationship between self-efficacy (the belief that one can carry out a behaviour), compliance with study protocol and outcome was explored within a randomised, double-blind, placebo-controlled trial of vitamin D supplementation in pregnancy. Methods In the Maternal Vitamin D Osteoporosis Study (MAVIDOS) trial, women with circulating plasma 25(OH)-vitamin D of 25–100 nmol/l in early pregnancy were randomised to either 1000 IU cholecalciferol/day or matched placebo from 14 weeks until delivery. Circulating 25(OH)-vitamin D concentrations were assessed at 14 and 34 weeks’ gestation. A sequential sub-sample completed Schwarzer’s General Self-Efficacy Scale at 14 and 34 weeks and the Problematic Experiences of Therapy Scale at 34 weeks. Women were interviewed about their experiences of the trial and interview transcripts analysed thematically. Results In 203 women, those with higher self-efficacy were less likely to experience practical problems taking the study medication (odds ratio (OR) 0.81 (95 % confidence interval (CI) 0.69–0.95), p = 0.01). Over half reported practical problems associated with poorer compliance with the protocol requiring women to take the medication daily. Compliance in women who experienced practical problems was 94 % compared with 98 % for those with no problems (p < 0.001). Poorer compliance was also associated with lower concentrations of 25(OH)-D in late pregnancy in the treatment group (β = 0.54 nmol/l (95 % CI 0.18–0.89), p = 0.003). Thematic analysis suggested common difficulties were remembering to take the medication every day and swallowing the large capsules. Conclusions These findings suggest that differences in self-efficacy influence trial outcomes. Such information may help clinicians anticipate responses to routine vitamin D supplementation in pregnancy and identify those who may need more support to comply.

Item Type: Article
Additional Information: © International Osteoporosis Foundation and National Osteoporosis Foundation 2016. The final publication is available at Springer via http://dx.doi.org/10.1007/s00198-016-3721-5
Keywords: Endocrinology & Metabolism, 1103 Clinical Sciences
SGUL Research Institute / Research Centre: Academic Structure > Institute of Medical & Biomedical Education (IMBE)
Academic Structure > Institute of Medical & Biomedical Education (IMBE) > Centre for Clinical Education (INMECE )
Journal or Publication Title: Osteoporosis International
ISSN: 0937-941X
Dates:
DateEvent
1 January 2017Published
22 August 2016Published Online
21 July 2016Accepted
Publisher License: Publisher's own licence
Projects:
Project IDFunderFunder ID
17702Arthritis Research UKhttp://dx.doi.org/10.13039/501100000341
4050502589Medical Research Councilhttp://dx.doi.org/10.13039/501100000265
UNSPECIFIEDBupa Foundationhttp://dx.doi.org/10.13039/501100000355
UNSPECIFIEDNational Institute for Health Research Southampton Biomedical Research CentreUNSPECIFIED
UNSPECIFIEDUniversity of Southamptonhttp://dx.doi.org/10.13039/501100000739
289346Seventh Framework Programmehttp://dx.doi.org/10.13039/501100004963
613977Seventh Framework Programmehttp://dx.doi.org/10.13039/501100004963
URI: http://openaccess.sgul.ac.uk/id/eprint/108362
Publisher's version: https://doi.org/10.1007/s00198-016-3721-5

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