Relationships Between Beliefs about Medications and Nonadherence to Prescribed Chronic Medications

Department of Pharmacy Practice, Purdue University, ウェストラファイエット, Indiana, United States
Annals of Pharmacotherapy (Impact Factor: 2.06). 11/2006; 40(10):1737-42. DOI: 10.1345/aph.1H153
Source: PubMed


Medication beliefs of patients with a specific medical condition have been associated with nonadherence to drugs used to treat that condition. However, associations between medication beliefs and nonadherence of individuals on chronic, multiple medications have not been studied.
To investigate associations between patients' medication beliefs and nonadherence to chronic drug therapy.
A cross-sectional, self-administered survey of patients waiting to see pharmacists at an outpatient pharmacy in a primary care clinic was conducted. Participants' medication beliefs were assessed using the Beliefs about Medicines Questionnaire, and nonadherence was assessed using the Morisky Medication Adherence Scale. Pearson correlation analysis was used to assess bivariate associations between medication beliefs and nonadherence. Regression was used to assess relative strength of associations between various medication beliefs and nonadherence and also to assess the significance of the interactions between those beliefs and nonadherence.
There were positive bivariate associations between specific concerns about medications (p < 0.001), perceived general harmful effects of medications (p < 0.001), and perceived overprescribing of medications by physicians (p < 0.001) and medication nonadherence. When relative strength of associations between each medication belief and nonadherence was assessed, while controlling for other medication beliefs, specific-necessity (p = 0.02) and specific-concerns (p = 0.01) exhibited significant negative and positive associations with nonadherence, respectively. All two-way interactions between variables in the model were insignificant. A model consisting of age, total number of drugs used, and medication beliefs, that is, specific-necessity, specific-concerns, general-overuse, and general-harm, accounted for 26.5% of variance. Medication beliefs alone explained 22.4% of variation in nonadherence to chronic drug therapy.
Patients' medication beliefs explained a significant portion of variation in medication nonadherence.

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Available from: Hemant Phatak, Jun 13, 2014
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    • "Intentional nonadherence as a behavior can be viewed in the context of theories of reasoned action and planned behavior, where individual's beliefs about certain behaviors are strong predictors of behavioral intention [8]. Therefore, holding positive beliefs about medications is a prerequisite for intentional adherence [9, 10]. Unintentional nonadherence such as forgetfulness, on the other hand, was considered to be due to regimen complexity; nevertheless, it has also been found to be influenced by beliefs [11]. "
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    ABSTRACT: Objectives. To assess adherence to long-term medications among patients in family medicine clinics and to evaluate relationship between adherence, beliefs about medications, medication information adequacy, and other factors. Methods. Interviewer assisted survey was conducted to assess adherence using the 8-item Morisky Medication Adherence Scale (MMAS-8), beliefs about medications using beliefs about medicine questionnaire (BMQ), and the patients' perception of medication information adequacy. Results. Of the 408 participants, 56.9% reported low adherence. Pearson's bivariate correlation showed positive association between MMAS-8 score and BMQ-specific necessity (r = 0.526 P < 0.001) and the perceived information adequacy (r = 0.568 P < 0.001), and there was negative association between adherence score and BMQ specific concerns, general overuse, and harm (r = -0.647, -0.466, and -0.663, resp.) (P < 0.001). Multivariable analysis revealed that age, number of medications, number of medical conditions, specific necessity and concerns beliefs, general harm beliefs, and perceived adequacy of medication information were independent predictor of adherence. Furthermore, specific beliefs explain 27.7% of the variance in adherence, while medication information adequacy explains 32.3% of the variance in adherence. Conclusion. The prevalence of low adherence among patients on long-term medications is high and it is related to negative beliefs about medications and to inadequate information given to patients about their medications.
    Full-text · Article · Feb 2014
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    • "Of the modifiable factors, beliefs about a drug and treatment convenience or complexity are important predictors of non-adherence [7] [8] [9] [10]. Within the belief domain it is relevant to distinguish between concern and necessity beliefs [11]. Concern beliefs are about the adverse consequences of taking a drug, whereas necessity beliefs are about the positive effects of a drug on someone's health [12]. "
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    ABSTRACT: To assess the relationship of patients' medication beliefs and treatment complexity with unintentional and intentional non-adherence for three therapeutic groups commonly used by patients with type 2 diabetes. Survey data about adherence (Medication Adherence Report Scale) and beliefs about medicines (Beliefs about Medicines Questionnaire) were combined with prescription data from the Groningen Initiative to ANalyse Type 2 diabetes Treatment (GIANTT) database. Patients were classified as being adherent, mainly unintentional non-adherent, or partly intentional non-adherent per therapeutic group (glucose-, blood pressure-, and lipid-lowering drugs). Treatment complexity was measured using the Medication Regimen Complexity Index, which includes the dosage form, dosing frequency and additional directions of taking the drug. Analyses were performed using Kruskal-Wallis and Mann-Whitney U-tests. Of 257 contacted patients, 133 (52%) returned the questionnaire. The patients had a mean age of 66years and 50% were females. Necessity beliefs were not significantly different between the adherers, mainly unintentional non-adherers, and partly intentional non-adherers (differences smaller than 5 points on a scale from 5 to 25). For blood pressure-lowering drugs, patients reporting intentional non-adherence had higher concern beliefs than adherers (8 point difference, P=0.01). Treatment complexity scores were lower for adherers but similar for mainly unintentional and partly intentional non-adherers to glucose- and blood pressure-lowering drugs. Treatment complexity was related to non-adherence in general. Beliefs about necessity were not strongly associated with non-adherence, while patients' concern beliefs may be associated with intentional non-adherence. However, the role of these determinants differs per therapeutic group.
    Full-text · Article · Feb 2014 · Journal of psychosomatic research
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    • "These attitudes, which reflect evaluation of the object (i.e. the drug) as good or bad, harmful or beneficial38, are thought to influence behavior and, consequently, adherence.39 A belief that medication is harmful has been associated with decreased adherence35,40, and our study confirmed that a negative attitude toward drugs seemed to be connected with NA. In previous studies, women were more frequently found to be negative about drugs than men were14,19,20 and it seems reasonable to assume that a negative attitude toward drugs would be associated with poor adherence. "
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    ABSTRACT: The aim of the present study was to analyse gender differences in self-reported non-adherence (NA) to prescribed medication in the Swedish general population. We aimed to study unintentional and intentional NA as well as the reasons given for NA. A questionnaire was mailed to a cross-sectional, random, national sample of people aged 18-84 years in Sweden (n=7985). The response rate was 61.1% (n=4875). The questionnaire covered use of prescription drugs, NA behaviour and reasons for NA. Use of prescription drugs was reported by 59.5% (n=2802) of the participants, and 66.4% (n=1860) of these participants did not adhere to the prescribed regimen. No overall gender differences in reporting NA were found. However, when analysing the various types of NA behaviour and the reasons for NA, different gender patterns emerged. Men were more likely to report forgetting [OR=0.77 (95%CI 0.65:0.92)], changing the dosage [OR=0.64 (95%CI 0.52:0.79)] and that they had recovered [14.3%, (OR=0.71 (95%CI 0.56:0.90)] as a reason. In contrast, more women than men reported filling the prescription but not taking the drug [OR=1.25 (95%CI 1.02:1.54)] and reported the development of adverse drug reactions (ADRs) [OR=1.89 (95%CI 1.37:2.59)] as a reason more commonly. The gender differences remained, in most cases, after controlling for confounders such as age, socioeconomic factors, medical problems and attitudes toward drugs. Women and men have different patterns of NA behaviour and different reasons for NA. Therefore, if adherence is to be improved, a wide knowledge of all the reasons for NA is required, along with an understanding of the impact of gender on the outcomes.
    Full-text · Article · Oct 2012
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