Centre for Behavioural Medicine, Department of Policy and Practice, The School of Pharmacy, University of London, and Brighton University Hospital, National Health Service Trust, The Lawson Unit, United Kingdom.
To test the utility of the necessity-concerns framework in predicting highly active antiretroviral therapy (HAART) uptake and adherence.
This was a prospective follow-up study. Consecutive patients who were not currently receiving HAART were referred by their HIV physician. Immediately after a recommendation of HAART, patients completed the Beliefs about Medicines Questionnaire assessing their perceptions of personal necessity for HAART and concerns about potential adverse effects. The influence of these beliefs on the decision to accept or decline HAART and adherence 12 months later were assessed.
One hundred fifty-three participants were given a recommendation of HAART, and 136 (88.9%) returned completed questionnaires. Thirty-eight participants (28%) initially rejected the treatment offer. Uptake of HAART was associated with perceptions of personal necessity for treatment (odds ratio [OR]=7.41, 95% confidence interval [CI]: 2.84 to 19.37) and concerns about potential adverse effects (OR=0.19, 95% CI: 0.07 to 0.48). There was a significant decline in adherence over time. Perceived necessity (OR=2.19, 95% CI: 1.02 to 4.71) and concerns about adverse effects (OR=0.45, 95% CI: 0.22 to 0.96), elicited before initiating HAART, predicted subsequent adherence. These associations were independent of clinical variables and depression.
The necessity-concerns framework is a useful theoretic model for understanding patient perspectives of HAART and predicting uptake and adherence, with implications for the design of evidence-based interventions.
"Beliefs about medication have been linked to adherence in several chronic diseases, including kidney disease and cancer (Horne & Weinman, 1999), asthma (Horne & Weinman, 2002), heart disease (Wray, Waters, Radley-Smith, & Sensky, 2006), hypertension (Ross, Walker, & MacLeod 2004), HIV (Gauchet, Tarquinio, & Fischer, 2007; Horne, Cooper, Gellaitry, Date, & Fisher, 2007) and diabetes (Broadbent, Donkin, & Stroh, 2011). Patients' assessment of specific prescribed medicines is strongly related to adherence , particularly how they rate their need for the treatment (necessity beliefs) versus their concerns about the potential negative effects of taking it (Horne et al., 2007). Furthermore, these specific beliefs are influenced by more general social beliefs about pharmaceutics as a class of treatment (Horne, Parham, Driscoll, & Robinson, 2009). "
"The quantitative study design of Umeed and the fact that we measured mental health at a single time-point means that the mechanisms for the relationship between psychological factors and service use outcomes are unclear. Further observational, qualitative research is necessary to explore how mental health fits into the complex networks of concerns (stigma, illness/treatment beliefs etc.) that have been found to influence treatment-related behaviours and outcomes [36,37]. "
[Show abstract][Hide abstract] ABSTRACT: Background
Successful linkage to care is increasingly recognised as a potentially important factor in determining the success of Antiretroviral Therapy treatment programmes. However, the role of psychological factors during the early part of the continuum of care has so far been under-investigated. The objective of the Umeed study was to evaluate the impact of Common Mental Disorder (CMD), hazardous alcohol use and low cognitive functioning upon attendance for post-test counselling and linkage to care among people attending for HIV-testing in Goa, India.
The study was a prospective cohort design. Participants were recruited at the time of attending for testing and were asked to complete a baseline interview covering sociodemographic characteristics and mental health exposures. HIV status, post-test counselling (PTC) and Antiretroviral Treatment (ART) Centre data were extracted from clinical records.
Among 1934 participants, CMD predicted non-attendance for PTC (adjusted OR = 0.51, 0.21-0.82). There was tentative evidence of an association between hazardous alcohol use and non-attendance for PTC (adjusted OR = 0.69, 0.45-1.02). There was no evidence of an association between CMD caseness and attendance for ART. However, post-hoc analyses showed an association between increasing symptoms of CMD and non-attendance.
Although participation rates were high (86%), non-participation was a possible source of bias. Cognitive tests had not been previously validated in a young population in Goa. The context in which cognitive testing took place may have contributed to the high prevalence of low scores. Findings suggest the need to move towards a broader conceptualisation of the interrelationship between mental health and HIV. It may be important to consider the impact of symptoms of depression and anxiety at every stage of the continuum of care, including immediately after diagnosis and when initiating contact with treatment services.
"The BMQ has been translated and validated in many European languages      and has proved suitable to measure patients' beliefs in medicines in a German primary care setting . In addition, it has been shown that BMQ-specific scores represent strong predictors of adherence to the treatment of a range of diseases such as asthma, mental disorders, rheumatoid arthritis, heart, renal diseases, depression, diabetes, AIDS, hypertension and haemophilia            . The aim of this study was the cultural adaptation of the Beliefs about Medicines Questionnaire into the Greek language and its validation for use in primary healthcare patients in Greece. "
[Show abstract][Hide abstract] ABSTRACT: Objective: Cultural adaptation and validation of the Beliefs about Medicines Questionnaire in Primary Health Care patients in Greece. Methods: For the assessment of the psychometric properties of the Greek version of the Beliefs about Medicines Questionnaire, 150 chronic patients visiting primary healthcare settings throughout the island of Crete, Greece, were recruited. They all completed both BMQ-general and BMQ-specific scales of the BMQ version which was previously culturally adapted and translated into the Greek language. Results: The subscales of the Beliefs about Medicines Questionnaire demonstrated adequate internal consistency with Cronbach's alphas of 0.852 for Specific Necessity, 0.763 for Specific Concern, 0.784 for General Harm and 0.676 for General Overuse. On both parts of the BMQ, the inter-item correlations were found to be sufficient. Factor analysis revealed identical patterns for all questions between the Greek and the original scales. Conclusion: The Greek Version of the Beliefs about Medicines Questionnaire is a valid and reliable instrument for evaluating patients' beliefs about medicines in primary healthcare in Greece. Further research is needed in order to study the relationship between beliefs about medication and non-adherence to medications.
A Degli Antoni, L E Weimer, V Fragola, A Giacometti, F Sozio
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