title: Adherence and barriers to H. pylori treatment in Arctic Canada.
abstract: BACKGROUND
  Helicobacter pylori infection is an emerging health concern to some northern Canadian Aboriginal communities and their clinicians. Clinicians in the north perceive H. pylori infection to be a major clinical problem because they find H. pylori infection in many patients evaluated for common stomach complaints, leading to frequent demand for treatment, which often fails. Moreover, public health authorities identified the need for information to develop locally appropriate H. pylori control strategies. We described adherence and identified barriers to completing treatment among H. pylori-positive participants in a community-based project inspired by local concerns about H. pylori infection risks.
  
  
  METHODS
  In 2008, 110 H. pylori-positive participants (diagnosed by a breath test, histopathology and/or culture) of the Aklavik H. pylori project were randomised to standard-of-care or sequential treatment. We ascertained adherence by interviewing participants using a structured questionnaire. We estimated adherence frequencies as the proportion of participants who reported taking either 100% of doses (perfect adherence) or ≥80% of doses (good adherence). To compare the proportion with perfect or good adherence in subgroups, we report proportion differences and 95% confidence intervals (CI).
  
  
  RESULTS
  Of 87 participants who were interviewed, 64% reported perfect adherence and 80% reported good adherence. We observed more frequent perfect adherence for: standard therapy (67%) versus sequential (62%); males (76%) versus females (52%); participants 40-77 years (79%) versus 17-39 (50%). Proportion differences were 5% (CI: -15, 25) for standard versus sequential therapy; 23% (CI: 4, 43) for male versus female; and 29% (CI: 10, 48) for 40-77 versus 15-39 years for perfect adherence. Of the 29 participants who reported poor adherence (<80% of doses taken), the following barriers to treatment were reported: changed mind about taking treatment (24%), consumption of alcoholic beverages (18%), nausea (18%), forgetfulness (12%), stomach pain (12%), difficulty in swallowing pills (6%), no reason (6%) or bad taste of the pills (6%).
  
  
  CONCLUSIONS
  This analysis suggests that adherence to treatment for eliminating H. pyori infection may vary by regimen and may be influenced by socio-demographic factors. These findings add to the small body of evidence pertaining to adherence to H. pylori treatment in Arctic Aboriginal communities. On-going research in additional northern Canadian communities will accumulate data for developing recommendations to improve adherence for treatment to eliminate H. pylori infection.
authors.affiliation: Department of Public Health Sciences, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Megan
authors.initials: M
authors.lastname: Lefebvre
authors.affiliation: Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Hsiu-Ju
authors.initials: HJ
authors.lastname: Chang
authors.affiliation: Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Amy
authors.initials: A
authors.lastname: Morse
authors.affiliation: Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Sander Veldhuyzen
authors.initials: SV
authors.lastname: van Zanten
authors.affiliation: Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Karen Jean
authors.initials: KJ
authors.lastname: Goodman
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D001110:Arctic Regions / Q000453:epidemiology; D002170:Canada / Q000453:epidemiology; D004359:Drug Therapy, Combination; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy / Q000208:ethnology*; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D007407:Interviews as Topic; D004930:Inuit / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D054328:Proton Pump Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D017678:Sex Distribution; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D000900:Anti-Bacterial Agents; D054328:Proton Pump Inhibitors
keywords: Aboriginal health; Helicobacter pylori; cancer; circumpolar regions; peptic ulcers