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Hermansson-Borrebaeck R, Andersson U, Jakobsson U, Midlöv P. Beliefs about medications when treating hypertension in primary health care: results from "PERson-centredness in hypertension management using information Technology (PERHIT)". Blood Press 2023; 32:2226736. [PMID: 37353959 DOI: 10.1080/08037051.2023.2226736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/31/2023] [Accepted: 06/09/2023] [Indexed: 06/25/2023]
Abstract
PURPOSE Hypertension is a major global health concern. Despite of efficient antihypertensive medications a low percentage of patients reach a blood pressure (BP) of <140/90. Nonadherence is a great concern in hypertension treatment and patients' beliefs about medications has been shown to have a strong impact on adherence. The objective of this study is to examine beliefs about medications and its impact on BP treatment in a group of Swedish primary healthcare patients treated for hypertension with or without an E-health platform. MATERIALS AND METHOD In a randomised unblinded controlled trial, 949 patients with hypertension from Swedish primary health care centres were included. The intervention group used a web-based system to support self-management of hypertension for eight weeks. Beliefs about medication questionnaire (BMQ) were administered to all patients at inclusion, 8-week follow up and 1-year follow up. RESULTS Data were collected from the 862 patients who completed the trial. No statistically significant difference was found in BMQ-scores between the intervention and the control group. An association between lower scores in the BMQ subsection 'General-Harm' and achieving target BP of <140/90 mmHg were noted (p = 0.021). CONCLUSION This study shows a significant association between beliefs about medication and BP levels, on hypertensive patients in the Swedish primary care setting, in only one out of four subsections of the BMQ. The intervention did not have a significant effect on changing patients' beliefs about medication. Further emphasis on patients' beliefs about medications could be useful in the clinical setting.
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Affiliation(s)
| | - Ulrika Andersson
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Ulf Jakobsson
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Patrik Midlöv
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
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Group Medical Visits Versus Usual Care for Illness Perception and Hypertension: A Randomized Pilot Study. J Healthc Qual 2023; 45:27-37. [PMID: 35976361 DOI: 10.1097/jhq.0000000000000359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
ABSTRACT Despite separate evidence regarding illness perception (IP) and group medical visits (GMVs) for hypertension, research on both is limited. Here, we have assessed and compared the effectiveness of GMVs and usual care (UC) on IP and blood pressure (BP) in patients with hypertension. This was a two-group parallel randomized controlled study with 1:1 allocation. Patients with essential hypertension on antihypertensive medication and no cognitive impairments were screened for BP control status and eligibility. A web-based program randomly assigned them to the GMV and UC groups. Group medical visits were held once a month for 3 months. Primary and secondary outcome measures included improvements in IP and BP control. Among 152 participants, 40 and 43 were assigned to the GMV and UC groups, respectively. The control group had a 9.3% dropout rate. The chronic timeline and illness coherence improved significantly in the intervention group ( p < .01). Systolic BP in the intervention group decreased significantly compared with that of the control group (Δ: -18.8 ± 18.4 mm Hg vs. Δ: -10.6 ± 12.5 mm Hg, p = .025). The participation in GMVs had a significant association with the odds of an increase in BP regulation (OR 3.8, 95% confidence interval 1.4-10.3, p = .007). Therefore, GMVs may be feasible for BP control in hypertensive patients with similar characteristics.
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Muacevic A, Adler JR, Aldharman SS, Alshathri AH, Abukhlaled JK, Alabdullah DW, Aleban S. Construct Validity and Reliability of the Arabic Version of Hypertension Knowledge-Level Scale Among Saudi Population. Cureus 2022; 14:e33182. [PMID: 36726899 PMCID: PMC9886199 DOI: 10.7759/cureus.33182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2022] [Indexed: 01/01/2023] Open
Abstract
Background Knowledgeable people are more likely to follow their treatment plan and reduce hypertension morbidity and mortality. This study aimed to construct the validity and reliability of the Arabic version of the Hypertension Knowledge-Level Scale (HK-LS) among Saudis. Methods This cross-sectional questionnaire research targets hypertensives and non-hypertensives. Cronbach's alpha and Spearman's correlation matrix analysis measured the questionnaire's construct validity. Wilcoxon rank sum tests examined HK-LS tools' discriminant validity. A p<0.05 was considered significant. Results A total of 1424 responses were received. However, the 1419 individuals were evaluated after applying exclusion criteria. About 60% of the participants were female, with the most common age groups being 18-29 years (38.5%) and 40-49 years (24.0%). A personal history of hypertension was reported by 26.1%, and a family history of hypertension by 73.3% of the subjects. Cronbach's alpha for the whole HK-LS was 0.883, suggesting that the tool was reliable. All the items of the HK-LS questionnaire were significantly correlated with each other, except for a non-significant correlation between statements two and seven (r=0.05, p=0.091). The strongest correlations were apparent between items 19 and 20 (r=0.70, p<0.0001), items one and two (r=0.64, p<0.0001), and items 18 and 19 (r=0.56, p<0.0001). However, the weakest associations were reported among items two and six (r=0.06, p<0.05), items two and nine (r=0.07, p<0.05), and items one and 19 (r=0.07, p<0.05). The discriminant validity showed that a personal history of hypertension was associated with significantly higher scores of two HK-LS subscales, including definitions and complications. In addition, the overall knowledge score was significantly higher among participants with a positive history of hypertension among family and/or friends. Conclusions The Arabic version of the HK-LS was found to be a reliable and valid tool for measuring knowledge about hypertension among the Saudi population. This reliable instrument can assist medical professionals in establishing education programs.
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Alfian SD, Annisa N, Perwitasari DA, Coelho A, Abdulah R. The role of illness perceptions on medication nonadherence among patients with hypertension: A multicenter study in indonesia. Front Pharmacol 2022; 13:985293. [PMID: 36225558 PMCID: PMC9549155 DOI: 10.3389/fphar.2022.985293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 08/29/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction: Nonadherence to antihypertensive medications is recognized as a significant cause of treatment failure. Therefore, identifying its underlying factors, particularly from the patient’s perspective, is essential for developing tailored intervention strategies. The objective of this study was to evaluate the associations between different domains of illness perception and medication nonadherence among patients with hypertension in Indonesia. Patients and methods: A multicenter cross-sectional study was conducted among patients with hypertension aged 18 years old and older who were using antihypertensive medications in the last 3 months in the community health centers in the three cities in Indonesia. The different domains of illness perception (e.g., consequences, timeline, personal control, treatment control, identity, concerns, comprehension, and emotional response) and medication nonadherence were assessed using a validated Brief Illness Perceptions Questionnaire (BIPQ) and Medication Adherence Report Scale (MARS), respectively. A logistic regression analysis was conducted to evaluate the associations between the different domains of illness perception and medication nonadherence adjusting for confounders. The odds ratios (ORs) and 95% confidence intervals (CIs) were reported. Results: A total of 440 participants were included, whom 41.8% reported nonadherence to antihypertensive medications. The majority of the participants were females (64.3%) and aged between 60 and 69 years old (39.5%). The treatment control (OR: 0.80, 95% confidence interval: 0.7–10.90), patient’s comprehension of hypertension (OR: 0.89, 95% CI: 0.820–0.97), and patient’s emotions (OR: 0.93, 95% CI: 0.88–0.99) were significantly associated with medication nonadherence. No significant associations were observed between the other domains of illness perception and medication nonadherence. Conclusion: Different dimensions of illness perception were associated with non-adherence to antihypertensive medications. Educational interventions should be developed based on patients’ perception of their illness.
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Affiliation(s)
- Sofa D. Alfian
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, Indonesia
- Drug Utilization and Pharmacoepidemiology Research Group, Center of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Jatinangor, Indonesia
- *Correspondence: Sofa D. Alfian,
| | - Nurul Annisa
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, Indonesia
- Unit Clinical Pharmacy and Community, Faculty of Pharmacy, Universitas Mulawarman, Samarinda, Indonesia
| | - Dyah A. Perwitasari
- Department of Clinical Pharmacy, Faculty of Pharmacy, Universitas Ahmad Dahlan, Yogyakarta, Indonesia
| | - Andre Coelho
- Health and Technology Research Center (H&TRC), Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa (ESTeSL), Lisbon, Portugal
| | - Rizky Abdulah
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, Indonesia
- Drug Utilization and Pharmacoepidemiology Research Group, Center of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Jatinangor, Indonesia
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Thirunavukkarasu A, Naser Abdullah Alshahrani A, Mazen Abdel-Salam D, Homoud Al-Hazmi A, Farhan ALruwaili B, Awad Alsaidan A, Narapureddy BR, Muteb AL-Ruwaili A, Ghuwayli aljabri F, Khalaf Albalawi R, Alanazi KAF. Medication Adherence Among Hypertensive Patients Attending Different Primary Health Centers in Abha, Saudi Arabia: A Cross-Sectional Study. Patient Prefer Adherence 2022; 16:2835-2844. [PMID: 36303595 PMCID: PMC9592733 DOI: 10.2147/ppa.s388365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Optimal blood pressure control is achieved by medication adherence. This will reduce the risk of associated morbidities and mortalities. The present study aimed to determine medication adherence and its associated factors among hypertensive patients attending different primary health centers (PHC) in Abha, Saudi Arabia (KSA). METHODS A cross-sectional study was conducted among ten different PHCs in Abha, KSA. Simple random sampling procedure was utilized to choose 400 participants. A structured anonymous questionnaire was used in the present study. Analysis of the data was done using the SPSS program, version 23. A logistic regression statistical test was applied to identify the independent associated factors of medication adherence. Furthermore, we have applied Spearman's test to find the correlation between overall B-IPQ score and medication adherence score. RESULTS A total of 400 hypertensive patients responded in the present survey. More than one-third of the participants (36.3%) were in the high adherence category group, while the remaining participants (63.7%) were either low or medium adherence category. The binary logistic regression analysis revealed that low and medium adherence category is significantly associated with age (adjusted odds ratio [AOR] = 0.96, 95% CI =0.93-0.99, p = 0.021), married participants (AOR = 0.42, 95% CI =0.33-0.58, p = 0.001), residing at village (AOR = 1.49, 95% CI =1.14-1.73, p = 0.038), and participants with monthly family income of 5000 to 7000 SAR (AOR = 3.06, 95% CI =1.62-5.79, p = 0.001). A negligible positive correlation was revealed between illness perception and medication adherence. CONCLUSION The present study revealed that hypertensive patients poorly adhere to their antihypertensive medications. This low adherence is significantly associated with the age, monthly income, people living in rural areas, and married participants. The present study results recommend sustained efforts to implement health education programs and awareness-raising interventions targeted at hypertensive patients.
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Affiliation(s)
- Ashokkumar Thirunavukkarasu
- Department of Community and Family Medicine, College of Medicine, Jouf University, Sakaka, Saudi Arabia
- Correspondence: Ashokkumar Thirunavukkarasu, Email
| | - Abdullah Naser Abdullah Alshahrani
- Department of Community and Family Medicine, College of Medicine, Jouf University, Sakaka, Saudi Arabia
- Department of Public Health, Asir Health Affairs, Asir Region, Saudi Arabia
| | - Doaa Mazen Abdel-Salam
- Department of Public Health and Community Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmad Homoud Al-Hazmi
- Department of Community and Family Medicine, College of Medicine, Jouf University, Sakaka, Saudi Arabia
| | - Bashayer Farhan ALruwaili
- Department of Community and Family Medicine, College of Medicine, Jouf University, Sakaka, Saudi Arabia
| | - Aseel Awad Alsaidan
- Department of Community and Family Medicine, College of Medicine, Jouf University, Sakaka, Saudi Arabia
| | - Bayapa Reddy Narapureddy
- Department of Public Health and Community Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Aliyah Muteb AL-Ruwaili
- Department of Public Health, Ministry of Health, Jouf Health Affairs, Sakaka, Aljouf, Saudi Arabia
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Al-Noumani H, Al-Harrasi M, Jose J, Al-Naamani Z, Panchatcharam SM. Medication Adherence and Patients' Characteristics in Chronic Diseases: A National Multi-Center Study. Clin Nurs Res 2021; 31:426-434. [PMID: 34287084 DOI: 10.1177/10547738211033754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Chronic diseases constitute a significant threat to health. Worldwide, medication adherence in chronic diseases remains unsatisfactory. Understanding factors affecting adherence is essential. This study examined medication adherence by characteristics of patients with chronic diseases. This cross-sectional study included 800 patients. The Adherence to Chronic Diseases Scale was used to measure adherence. Descriptive statistics and logistic regression was used to examine factors influencing medication adherence. Low adherence was found in 19.5% of the patients, 45% had medium adherence, and 35.5% had high adherence. Logistic regression showed that retired (OR 0.496, 95% CI [0.33-0.75]), having COPD (OR 0.460, 95% CI [0.32-0.67]) and duration of disease ≤5 years (OR 1.554, 95% CI [1.11-2.17]) remain independent predictors for high adherence. Mixed findings regarding the relationship between medication adherence and patients' characteristics were noticed. Patients' characteristics should be examined with the individual population when examining and attempting to improve medication adherence in clinical practice.
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Kee D, O'Conor R, Wisnivesky JP, Wolf MS, Federman AD. Patient characteristics associated with retention in an asthma self-management trial for older adults. J Asthma 2021; 59:1652-1660. [PMID: 34112032 DOI: 10.1080/02770903.2021.1941090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE New self-management interventions are being developed for older adults who suffer from worse asthma morbidity than their younger counterparts, but high rates of study drop out have hampered these efforts and there is limited literature on what factors may influence retention in behavioral intervention studies with older adults. This study analyzed illness beliefs and patient characteristics that may contribute to retention in an asthma self-management trial for older adults. METHODS This is a secondary analysis of data from a randomized controlled trial of a self-management support intervention for adults 60 years and older with persistent, uncontrolled asthma. Multivariable logistic regression was used to evaluate the association of medication and illness beliefs, and other subject characteristics with study retention, which was defined as completion of the research study interview at 6 and 12 months. RESULTS The randomized trial enrolled 388 individuals; 261 (67.3%) completed the 12-month interview. Higher perceived threat of chronic diseases relative to asthma was associated with higher study retention (OR = 1.11, 95% CI = 1.00-1.24) at 12 months. Other variables including asthma beliefs, age, cognitive function, health literacy, and asthma symptoms were not significantly associated with retention. CONCLUSIONS Concern about non-asthma chronic conditions, but no other illness beliefs, or patient characteristics, were associated with retention in an asthma self-management support intervention. Further research, including qualitative studies, is needed to better understand why patients drop out of asthma behavioral intervention studies.
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Affiliation(s)
- Dustin Kee
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rachel O'Conor
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Juan P Wisnivesky
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael S Wolf
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Alex D Federman
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Hilt AD, Hierck BP, Eijkenduijn J, Wesselius FJ, Albayrak A, Melles M, Schalij MJ, Scherptong RWC. Development of a patient-oriented Hololens application to illustrate the function of medication after myocardial infarction. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2021; 2:511-520. [PMID: 36713611 PMCID: PMC9707881 DOI: 10.1093/ehjdh/ztab053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/25/2021] [Accepted: 06/08/2021] [Indexed: 02/07/2023]
Abstract
Aims Statin treatment is one of the hallmarks of secondary prevention after myocardial infarction. Adherence to statins tends to be difficult and can be improved by patient education. Novel technologies such as mixed reality (MR) expand the possibilities to support this process. To assess if an MR medication-application supports patient education focused on function of statins after myocardial infarction. Methods and results A human-centred design-approach was used to develop an MR statin tool for Microsoft HoloLens™. Twenty-two myocardial infarction patients were enrolled; 12 tested the application, 10 patients were controls. Clinical, demographic, and qualitative data were obtained. All patients performed a test on statin knowledge. To test if patients with a higher tendency to become involved in virtual environments affected test outcome in the intervention group, validated Presence- and Immersive Tendency Questionnaires (PQ and ITQ) were used. Twenty-two myocardial infarction patients (ST-elevation myocardial infarction, 18/22, 82%) completed the study. Ten out of 12 (83%) patients in the intervention group improved their statin knowledge by using the MR application (median 8 points, IQR 8). Test improvement was mainly the result of increased understanding of statin mechanisms in the body and secondary preventive effects. A high tendency to get involved and focused in virtual environments was moderately positive correlated with better test improvement (r = 0.57, P < 0.05). The median post-test score in the control group was poor (median 6 points, IQR 4). Conclusions An MR statin education application can be applied effectively in myocardial infarction patients to explain statin function and importance.
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Affiliation(s)
- Alexander D Hilt
- Department of Cardiology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - Beerend P Hierck
- Leiden University Medical Center, Center for Innovation of Medical Education, Albinusdreef 2, 2333 ZA Leiden, The Netherlands,Leiden University, Teachers Academy, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Joep Eijkenduijn
- Faculty of Technical Medicine, Delft University of Technology, Landbergstraat 15, 2628 CE Delft, The Netherlands
| | - Fons J Wesselius
- Faculty of Technical Medicine, Delft University of Technology, Landbergstraat 15, 2628 CE Delft, The Netherlands
| | - Armagan Albayrak
- Faculty of Industrial Design Engineering, Delft University of Technology, Landbergstraat 15, 2628 CE Delft, The Netherlands
| | - Marijke Melles
- Faculty of Industrial Design Engineering, Delft University of Technology, Landbergstraat 15, 2628 CE Delft, The Netherlands,Department of Public and Occupational Health, Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1118, 1081 HV Amsterdam, The Netherlands
| | - Martin J Schalij
- Department of Cardiology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - Roderick W C Scherptong
- Department of Cardiology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands,Corresponding author. Tel: +31 71 5262020,
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Tuna S, Pakyüz SÇ. The effectiveness of planned discharge education on health knowledge and beliefs in patients with acute myocardial infarction: a randomized controlled trial. Ir J Med Sci 2021; 191:691-698. [PMID: 33728530 DOI: 10.1007/s11845-021-02601-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 03/11/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND To the best of our knowledge, no other studies investigated acute myocardial infarction patients' beliefs and knowledge level after the discharge education. AIMS The aim of the study was to investigate the effectiveness of planned discharge education on the beliefs and knowledge levels of CVD risk factors, medication compliance, dietary compliance, and individual follow-up in patients with acute myocardial infarction (AMI). METHODS A double-blind randomized controlled study was carried out with 100 AMI patients. All participants were randomly assigned to the intervention (n = 50) and control groups (n = 50). The first evaluation of all participants in both groups was on the day of discharge. Both groups were re-evaluated after 4 weeks. Patients' beliefs on medication, diet, and individual monitoring were assessed by the Beliefs about Medication Compliance Scale (BMCS), the Beliefs about Dietary Compliance Scale (BDCS), and the Beliefs about Individual Follow-up Scale (BIFS), respectively. The knowledge of CVD risk factors was questioned with the Cardiovascular Disease Risk Factors Knowledge Level (CARRF-KL) Scale. RESULTS The mean age of the patients was 59.10 ± 9.38 years in the intervention group and 58.86 ± 9.19 in the control group. After the planned discharge education, beliefs and knowledge levels of CVD risk factors, medication compliance, dietary compliance, and individual follow-up were significantly increased compared with the control group. CONCLUSION Planned discharge education had a positive effect on the knowledge level of cardiovascular diseases risk factors, drug compliance, nutritional compliance, and individual follow-up in patients with acute myocardial infarction.
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Affiliation(s)
- Serap Tuna
- Department of Elderly Care, Muğla Sıtkı Koçman University, Mugla, Turkey.
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McLoughlin A, Bennett K, Cahir C. Developing a model of the determinants of medication nonadherence in older community-dwelling patients. Ann Behav Med 2020; 53:942-954. [PMID: 30870558 DOI: 10.1093/abm/kaz004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Medication nonadherence is associated with adverse health outcomes in older populations. The aim of this study was to develop a model that describes the relationship between the determinants of nonadherence, per the World Health Organization (WHO) model of nonadherence and the necessity-concerns framework (NCF) and nonadherence in a cohort of older community-dwelling patients. A retrospective cohort study of 855 community-dwelling patients aged ≥70 years from 15 practices. Medication nonadherence was assessed by (i) medication possession ratio (MPR < 80%) and (ii) the median MPR across all drugs dispensed. Patient questionnaires, interviews, and medical records measured the determinants of nonadherence per the WHO and NCF frameworks. Confirmatory factor analysis (CFA) was undertaken to generate the model of best fit. Two structural equation models (SEM) were developed to evaluate the relationship between the WHO factors, the NCF, and nonadherence (Model 1: MPR < 80%, Model 2: median MPR). The CFA produced a reasonable fit (χ2(113) = 203, p < .001; root mean square error of approximation = 0.03; comparative fit index = 0.98, and weighted root mean square residual = 0.97) and adequate internal consistency (r = .26-.40). SEM analysis (Model 1) showed a significant direct relationship between patient-related (β = 0.45, p < .01), socioeconomic (β = 0.20, p < .01), and therapy-related factors (β = -0.27, p < .01) and nonadherence (MPR < 80%). Similar results were found for Model 2 (median MPR). There was a significant direct relationship between medication concerns (β = -0.13, p < .01) and nonadherence. Therapy-related (β = -0.04, p < .05) and patient-related factors (β = -0.06, p < .05) also had a significant mediating effect on nonadherence through medication concerns. Health care professionals need to address medication concerns and management of adverse effects in older populations to improve adherence and clinical outcomes.
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Affiliation(s)
- Affraic McLoughlin
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Kathleen Bennett
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Caitriona Cahir
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin 2, Ireland
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Kim Y, Min YH, Lee SB. Beliefs and attitudes toward endocrine therapy in patients with hormone receptor-positive breast cancer. Health Care Women Int 2020; 42:1086-1097. [PMID: 32886576 DOI: 10.1080/07399332.2020.1802460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Patients' beliefs about medications are important predictors of medication adherence; however, the relationship between patient beliefs and adjuvant endocrine therapy (AET) adherence in patients with breast cancer remains unclear. In this study, we aimed to determine the association between patient beliefs and adherence to AET. Self-reported questionnaires covering necessity beliefs (NB), concerns beliefs (CB), and adherence were completed by 210 Korean patients with breast cancer. The rate of nonadherence was determined by calculating necessity-concern (N-C) differentials and attitudinal subgroup analysis. Multivariate logistic regression analysis was performed to determine the independent impact of patient beliefs on nonadherence. Nonadherence (Morisky Medication Adherence Scale < 8) was reported in 74.3% (n = 156) of patients and predicted by a negative balance regarding AET [odds ratio (OR) = 0.89; 95% confidence interval (CI): 0.83-0.96] and strong concerns about AET such as those in the Ambivalent (OR = 5.41; 95% CI: 1.84-15.92) and Skeptical (OR = 3.48, 95% CI: 1.14-10.65) subgroups. Patient beliefs are significantly associated with adherence to AET in Korean patients with breast cancer. NB, CB, and N-C differentials may be useful intervention targets to improve medication adherence.
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Affiliation(s)
- Yonglan Kim
- Department of Nursing, Baekseok Culture University, Chungnam, Korea
| | - Yul Ha Min
- College of Nursing, Kangwon National University, Chuncheon, Korea
| | - Sae Byul Lee
- Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
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McInerney GE, Muellers K, O'Conor R, Wolf MS, Leventhal H, Wisnivesky JP, Federman AD. Concordance of patients' beliefs about chronic obstructive pulmonary disease, their comorbidities, and their medications. PATIENT EDUCATION AND COUNSELING 2020; 103:677-681. [PMID: 31761528 PMCID: PMC7138702 DOI: 10.1016/j.pec.2019.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/11/2019] [Accepted: 11/15/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To test the association of chronic obstructive pulmonary disease (COPD) illness and medication beliefs with those specific to hypertension or diabetes in patients with COPD and coexisting chronic conditions. METHODS A cross-sectional analysis of data collected from a sample of 282 adults with COPD and comorbid hypertension or diabetes recruited from primary care practices in New York, NY, and Chicago, IL. Beliefs about COPD, hypertension, and diabetes were measured using the Brief Illness Perception Questionnaire. Higher scores indicate a more adaptive view of the illness. Beliefs about medications were measured using the 10-item Beliefs about Medicines Questionnaire; higher scores on the two subscales indicate increased concerns and necessity, respectively. RESULTS In adjusted analyses, scores for COPD and hypertension as well as COPD and diabetes illness beliefs, medication necessity, and medication concern were significantly associated. CONCLUSION Patients with COPD and comorbid hypertension or diabetes have consistent beliefs about their diseases and the medications used to treat them. PRACTICE IMPLICATIONS The consistency of beliefs across conditions may help in the development of a more holistic approach to disease management in patients with COPD who have comorbid illnesses and contribute to a better understanding of the Common-Sense Model of Illness Representation.
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Affiliation(s)
| | - Kimberly Muellers
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rachel O'Conor
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Michael S Wolf
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Howard Leventhal
- Institute for Health and Department of Psychology, Rutgers University, New Brunswick, NJ, USA
| | - Juan P Wisnivesky
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Division of Pulmonary and Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alex D Federman
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Shakya R, Shrestha S, Gautam R, Rai L, Maharjan S, Satyal GK, KC B, Rai MK. Perceived Illness and Treatment Adherence to Hypertension Among Patients Attending a Tertiary Hospital in Kathmandu, Nepal. Patient Prefer Adherence 2020; 14:2287-2300. [PMID: 33244224 PMCID: PMC7685346 DOI: 10.2147/ppa.s270786] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 10/16/2020] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Hypertension (HTN) is a silent killer, accountable for life-threatening complications. An individual's illness perception may affect adherence to treatment which is crucial to prevent complications of HTN. The objective of this study was to identify illness perception and treatment adherence among patients with HTN in a tertiary hospital in Kathmandu, Nepal. METHODS Descriptive correlational study was conducted in the out-patient department of Manmohan Cardiothoracic Vascular and Transplant Center, Kathmandu Nepal. Non-probability purposive sampling was used. A face-to-face interview was conducted from September to December 2018, using a structured questionnaire that included socio-demographic variables, illness perception questionnaire (revised) and Hill bone compliance to high blood pressure therapy scale. Data analysis was done by using descriptive and inferential statistics (chi-square test, Spearman rank correlation). RESULTS Among 204 participants, 51% were male, 77% were literate, mean ± S.D. age was 60±12. About 72% experienced headache and 88% said that headache is related to HTN. Behavioural factors and psychological factors were regarded as the leading cause of HTN. Almost 63% participants believed HTN as highly threatening illness. Higher scores in timeline (acute/chronic), personal control, and treatment control revealed that patients believed HTN as a chronic disease with a higher rate of personal and treatment control. Regarding treatment adherence, the mean score was 16.58 (SD = 2.08), and only 14.7% had perfect adherence. Participants were more adherent to medication and appointment keeping rather than reduce salt intake. Duration of HTN diagnosis (p=0.027) and duration under HTN medication (p= 0.021) were found to be significantly associated with treatment adherence. There was a significant positive correlation between illness perception and treatment adherence (ρ = 0.282, p<0.01). CONCLUSION Illness perception and treatment adherence are correlated. Hence, it is beneficial to improve illness perception to achieve perfect treatment adherence. Reinforcement is essential to maintain adherence to both medications and behaviour therapy.
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Affiliation(s)
- Rajina Shakya
- Department of Nursing, Nobel College, Pokhara University, Sinamangal, Kathmandu, Nepal
- Correspondence: Rajina Shakya Email
| | - Sunil Shrestha
- Department of Pharmacy, Nepal Cancer Hospital and Research Center, Lalitpur, Nepal
- Department of Pharmaceutical and Health Service Research, Nepal Health Research and Innovation Foundation, Lalitpur, Nepal
| | - Roshani Gautam
- Maharajgunj Nursing Campus, Tribhuvan University, Institute of Medicine Maharajgunj, Kathmandu, Nepal
| | - Lalita Rai
- Maharajgunj Nursing Campus, Tribhuvan University, Institute of Medicine Maharajgunj, Kathmandu, Nepal
| | | | - Gita Kumari Satyal
- Female Surgical Ward, Department of Nursing, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Bhuvan KC
- School of Pharmacy, Monash University Malaysia, Subang Jaya47500, Selangor, Malaysia
- Bhuvan KC Email
| | - Mana Kumari Rai
- Maharajgunj Nursing Campus, Tribhuvan University, Institute of Medicine Maharajgunj, Kathmandu, Nepal
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Al-Noumani H, Wu JR, Barksdale D, Knafl G, AlKhasawneh E, Sherwood G. Health Beliefs and Medication Adherence in Omanis With Hypertension. J Cardiovasc Nurs 2019; 33:518-526. [PMID: 30130358 PMCID: PMC6179908 DOI: 10.1097/jcn.0000000000000511] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Patients' health beliefs are essential to improve medication adherence among patients with hypertension. OBJECTIVE Our objective was to examine the relationship between (1) patients' beliefs about hypertension, medication, and self-efficacy and medication adherence and (2) medication adherence and blood pressure control in Oman. METHODS This cross-sectional study included 215 participants with hypertension. Participants completed 4 questionnaires (Arabic version) to measure medication adherence, beliefs about hypertension severity, beliefs about medication, and self-efficacy. Bivariate and multivariate logistic regression was used to conduct the analyses. RESULTS Higher self-efficacy (odds ratio [OR], 2.59; 95% confidence interval [CI], 1.54-4.37), stronger beliefs about medication necessity (OR, 1.98; 95% CI, 1.21-3.23), increased age (OR, 1.06; 95% CI, 1.03-1.10), and fewer medication concerns (OR, 0.34; 95% CI, 0.20-0.57) were related to high medication adherence. Moreover, uncontrolled blood pressure was less likely in participants with high medication adherence (OR, 0.47; 95% CI, 0.24-0.93). CONCLUSIONS Patients' beliefs are important consideration to improve medication adherence. Clinically, patients' beliefs should be assessed, and strategies to improve medication adherence should incorporate beliefs as a key component to improve antihypertensive medication adherence. Patient education and counseling regarding hypertension and necessity and side effects of medications are important to maximize positive beliefs and improve medication adherence.
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Affiliation(s)
- Huda Al-Noumani
- Huda Al-Noumani, PhD, RN Assistant Professor, Department of Adult Health and Critical Care, College of Nursing, Sultan Qaboos University, Muscat, Oman. Jia-Rong Wu, PhD, RN Associate Professor, School of Nursing, University of North Carolina at Chapel Hill. Debra Barksdale, PhD, RN, FNP-BC, CNE, FAANP, FAAN Professor, School of Nursing, Virginia Commonwealth University, Richmond. George Knafl, PhD Professor, School of Nursing, University of North Carolina at Chapel Hill. Esra AlKhasawneh, PhD, RN, FAAN Associate Professor, College of Nursing, Sultan Qaboos University, Muscat, Oman. Gwen Sherwood, PhD, RN, FAAN Professor, School of Nursing, University of North Carolina at Chapel Hill
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Minja L, Cichowitz C, Knettel BA, Mahande MJ, Kisigo G, Knippler ET, Ngocho JS, Mmbaga BT, Watt MH. Attitudes Toward Long-Term Use of Antiretroviral Therapy Among HIV-Infected Pregnant Women in Moshi, Tanzania: A Longitudinal Study. AIDS Behav 2019; 23:2610-2617. [PMID: 31377894 PMCID: PMC7467083 DOI: 10.1007/s10461-019-02622-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Adherence to antiretroviral therapy (ART) during pregnancy and the postpartum period is necessary to prevent vertical HIV transmission and to secure the long-term health of an HIV-infected woman. Health behavior theory suggests that patients' attitudes towards medication can predict their medication-taking behaviour. This study sought to understand how women's attitudes towards ART changes between the pregnancy and postpartum periods, and the factors associated with these attitudes. The study enrolled 200 pregnant women living with HIV. Structured surveys were administered during pregnancy and at three and 6 months postpartum. Overall, attitudes towards ART were stable over time. More positive attitudes towards ART were associated with HIV acceptance, lower levels of depression, and lower levels of shame. Counselling interventions are needed to help HIV-infected women accept their status and reduce shameful emotions. Depression screening and treatment should be integrated into PMTCT services. This study emphasizes the importance of early attention to attitudes towards ART, in order to establish a trajectory of sustained care engagement.
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Affiliation(s)
- Linda Minja
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Cody Cichowitz
- Massachusetts General Hospital, Department of Medicine, Center for Global Health, Boston, USA
| | - Brandon A Knettel
- Duke Global Health Institute, Duke University, 310 Trent Drive, Box 90519, Durham, NC, 27708, USA
| | | | - Godfrey Kisigo
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Duke Global Health Institute, Duke University, 310 Trent Drive, Box 90519, Durham, NC, 27708, USA
| | - Elizabeth T Knippler
- Duke Global Health Institute, Duke University, 310 Trent Drive, Box 90519, Durham, NC, 27708, USA
| | - James S Ngocho
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Blandina T Mmbaga
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Duke Global Health Institute, Duke University, 310 Trent Drive, Box 90519, Durham, NC, 27708, USA
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Melissa H Watt
- Duke Global Health Institute, Duke University, 310 Trent Drive, Box 90519, Durham, NC, 27708, USA.
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Foot H, La Caze A, Baker P, Cottrell N. Better understanding the influence and complexity of beliefs on medication adherence in asthma. PATIENT EDUCATION AND COUNSELING 2019; 102:564-570. [PMID: 30413309 DOI: 10.1016/j.pec.2018.10.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 10/04/2018] [Accepted: 10/11/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE The aim was to better understand how beliefs influence medication adherence in asthma. METHODS All participants were prescribed an inhaled corticosteroid for a diagnosis of asthma. Each participant completed a survey consisting of: Beliefs about Medicines Questionnaire (BMQ), Brief-Illness Perception Questionnaire (B-IPQ) and Multi-dimensional Health Locus of Control Scale (MHLCS). Adherence to inhaled corticosteroids was elicited using the Medication Adherence Report Scale (MARS). Multiple linear regression with interaction effects was used to identify significant predictors of medication adherence and interactions between beliefs. RESULTS A total of 198 participants completed the survey. The mean(±SD) MARS score was 19.2(±4.5). A multivariable model (adjusted R2 = 0.39) predicted adherence using: age, asthma hospitalisation, timeline (B-IPQ) subscale, necessity and concern (BMQ) subscales, doctor (MHLCS) subscale and the two interaction effects (concerns [BMQ] moderated by chance [MHLCS] and treatment control [B-IPQ] moderated by understanding [B-IPQ]). CONCLUSION The findings of this study contribute to a better understanding of the role of beliefs in medication adherence in asthma. Certain beliefs meaningfully interrelate and change the relationship they have with medication adherence. PRACTICE IMPLICATIONS If these beliefs are causally related to medication adherence and can be intervened upon, the findings are useful for providing targets to personalise adherence support.
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Affiliation(s)
- Holly Foot
- School of Pharmacy, The University of Queensland, Brisbane, Australia.
| | - Adam La Caze
- School of Pharmacy, The University of Queensland, Brisbane, Australia
| | - Peter Baker
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Neil Cottrell
- School of Pharmacy, The University of Queensland, Brisbane, Australia
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Potential for physician communication to build favorable medication beliefs among older adults with hypertension: A cross-sectional survey. PLoS One 2019; 14:e0210169. [PMID: 30615656 PMCID: PMC6322726 DOI: 10.1371/journal.pone.0210169] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 12/18/2018] [Indexed: 01/01/2023] Open
Abstract
Older adults suffering from hypertension form firm medication beliefs through lifetime medication management, which significantly affect their medication adherence and treatment outcomes. Understanding whether the patient-physician communication has the potential to change medication beliefs will help design an effective communication strategy to foster favorable medication beliefs. This study aims to determine whether the patient-physician communication is associated with medication beliefs among older adults with hypertension and controls socio-demographics and clinical characteristics. Further, it examines how the association varies with two different types of medication beliefs (medication overuse and harm) for each domain of communication (informative and interpersonal). A self-administered cross-sectional survey was conducted for members of seven senior centers in a metropolitan area of the United States between August and December of 2013. A total of 211 senior members suffering from hypertension completed the questionnaire, which included the Primary Care Assessment Survey (PCAS) and the Beliefs about Medicines Questionnaire (BMQ). The former had two domains of patient-physician communication—informative and interpersonal—while the latter measured medication harm and overuse beliefs. Interpersonal patient-physician communication significantly explained the medication overuse beliefs (β = -0.28, p < 0.05), whereas neither interpersonal nor informative communication significantly explained the medication harm beliefs. Females (β = 1.29, p < 0.01) and participants with higher education (β = 2.66, p = 0.02) more strongly believed that medications are overprescribed. However, participants with low income more strongly believed that medications are harmful. Patient-physician communication, if it touches upon interpersonal aspects, has the potential to change medication overuse beliefs among older adults with hypertension. Identification of the significant factors which affect medication beliefs, will inform the design of a patient-centric communication program that fosters favorable medication beliefs among geriatric hypertensive patients.
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Mahmoodi H, Jalalizad Nahand F, Shaghaghi A, Shooshtari S, Jafarabadi MA, Allahverdipour H. Gender Based Cognitive Determinants Of Medication Adherence In Older Adults With Chronic Conditions. Patient Prefer Adherence 2019; 13:1733-1744. [PMID: 31686791 PMCID: PMC6800551 DOI: 10.2147/ppa.s219193] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 09/18/2019] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Life course gender-role traits and social stereotypes could affect the pattern of medication adherence in old age. OBJECTIVES The main purpose of this study was to investigate gender based cognitive determinants of medication adherence in a sample of older adults who suffer from at least a chronic condition. METHODS In this cross-sectional design, 455 older adults participated from five health centers in Tabriz city, Iran from June to August 2017 using a random sampling method. Next, required data about medication adherence, knowledge and beliefs about prescribed medications, perceived self-efficacy in medication adherence, illness perception, and reasons for medication non-adherence were gathered using a structured written questionnaire through face-to-face interviews with the attendees. RESULTS Low medication adherence was reported by 54.5% of the study participants. Perceived self-efficacy for medication adherence (OR = 1.04; 95% CI: 1.00, 1.08) and medication adherence reason (OR = 0.96; 95% CI: 0.92, 0.99) were two identified strong predictors of medication adherence among the studied older men. Illness perception (OR = 1.02; 95% CI: 1.00, 1.02) and beliefs toward prescribed medication (OR = 0.95; 95% CI: 0.93, 0.98) were both recognized as the significant predictors of medication adherence in the older women subgroup. CONCLUSION Gender based variations were noted regarding the medication adherence in the studied sample and attributes of cognitive function were the main pinpointed elucidating parameters for the non-conformity. The explicit cognitive processes must be considered in care provision or interventional programs that target medication adherence in older adults.
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Affiliation(s)
- Hassan Mahmoodi
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Fatemah Jalalizad Nahand
- Department of Health Education and Health Promotion, School of Public Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Abdolreza Shaghaghi
- Department of Health Education and Health Promotion, School of Public Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shahin Shooshtari
- Departments of Family Social Sciences and Community Health Sciences, University of Manitoba; St. Amant Research Centre, Winnipeg, Manitoba, Canada
| | - Mohammad Asghari Jafarabadi
- Department of Epidemiology and Biostatistics, School of Public Health, School of Public Health, Tabriz University of Medical Sciences, Tabriz, Islamic Republic of Iran
| | - Hamid Allahverdipour
- Department of Health Education and Health Promotion, School of Public Health, Tabriz University of Medical Sciences, Tabriz, Iran
- Correspondence: Hamid Allahverdipour Department of Health Education & Promotion, Faculty of Health Sciences, Tabriz University of Medical Sciences, Attar-e-Neyshabouri Street, Golgasht Street, Tabriz5165665931, IranTel +98 41 333 44 731 Email
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Oori MJ, Mohammadi F, Norouzi K, Fallahi-Khoshknab M, Ebadi A. Conceptual Model of Medication Adherence in Older Adults with High Blood Pressure-An Integrative Review of the Literature. Curr Hypertens Rev 2019; 15:85-92. [PMID: 30360745 PMCID: PMC6635648 DOI: 10.2174/1573402114666181022152313] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 10/16/2018] [Accepted: 10/16/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND Medication adherence (MA) is the most important controlling factor of high blood pressure (HBP). There are a few MA models, but they have not been successful in predicting MA completely. Thus, this study aimed to expand a conceptual model of MA based on an ecological approach. METHODS An integrative review of the literature based on theoretical and empirical studies was completed. Data source comprised: Medline (including PubMed and Ovid), ISI, Embase, Google scholar, and internal databases such as Magiran, Google, SID, and internal magazines. Primary English and Persian language studies were collected from 1940 to 2018. The steps of study included: (a) problem identification, (b) literature review and extracting studies, (c) appraising study quality, (d) gathering data, (e) data analysis using the directed content analysis, (f) concluding. RESULTS Thirty-six articles were finally included and analyzed. After analysis, predictors of MA in older adults with hypertension were categorized into personal, interpersonal, organizational, and social factors. Although the personal factors have the most predictors in sub-categories of behavioral, biological, psychological, knowledge, disease, and medication agents, social, organizational and interpersonal factors can have indirect and important effects on elderly MA. CONCLUSION There are many factors influencing MA of elderly with HBP. The personal factor has the most predictors. The designed model of MA because of covering all predictor factors, can be considered as a comprehensive MA model. It is suggested that future studies should select factors for study from all levels of the model.
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Affiliation(s)
| | - Farahnaz Mohammadi
- Address correspondence to this author at Nursing Department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; Tel: +989125003527; E-mail:
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Noone C, Dwyer CP, Murphy J, Newell J, Molloy GJ. Comparative effectiveness of physical activity interventions and anti-hypertensive pharmacological interventions in reducing blood pressure in people with hypertension: protocol for a systematic review and network meta-analysis. Syst Rev 2018; 7:128. [PMID: 30131071 PMCID: PMC6103808 DOI: 10.1186/s13643-018-0791-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 07/31/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The prevalence of hypertension is a major public health challenge. Despite it being highly preventable, hypertension is responsible for a significant proportion of global morbidity and mortality. Common methods for controlling hypertension include prescribing anti-hypertensive medication, a pharmacological approach, and increasing physical activity, a behavioural approach. In general, little is known about the comparative effectiveness of pharmacological and behavioural approaches for reducing blood pressure in hypertension. A previous network meta-analysis suggested that physical activity interventions may be just as effective as many anti-hypertensive medications in preventing mortality; however, this analysis did not provide the comparative effectiveness of these disparate modes of intervention on blood pressure reduction. The primary objective of this study is to use network meta-analysis to compare the relative effectiveness, for blood pressure reduction, of different approaches to increasing physical activity and different first-line anti-hypertensive therapies in people with hypertension. METHODS A systematic review will be conducted to identify studies involving randomised controlled trials which compare different types of physical activity interventions and first-line anti-hypertensive therapy interventions to each other or to other comparators (e.g. placebo, usual care) where blood pressure reduction is the primary outcome. We will search the Cochrane Library, MEDLINE and PsycInfo. For studies which meet our inclusion criteria, two reviewers will extract data independently and assess the quality of the literature using the Cochrane Risk of Bias Tool. Network meta-analyses will be conducted to generate estimates of comparative effectiveness of each intervention class and rankings of their effectiveness, in terms of reduction of both systolic and diastolic blood pressure. DISCUSSION This study will provide evidence regarding the comparability of two common first-line treatment options for people with hypertension. It will also describe the extent to which there is direct evidence regarding the comparative effectiveness of increasing physical activity and initiating anti-hypertensive therapy. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42017070579.
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Affiliation(s)
- C. Noone
- School of Psychology, National University of Ireland, Galway, Newcastle Road, Galway, H91 TK33 Ireland
| | - C. P. Dwyer
- School of Psychology, National University of Ireland, Galway, Newcastle Road, Galway, H91 TK33 Ireland
| | - J. Murphy
- School of Psychology, National University of Ireland, Galway, Newcastle Road, Galway, H91 TK33 Ireland
| | - J. Newell
- School of Mathematics, Statistics & Applied Mathematics, National University of Ireland, Galway, Newcastle Road, Galway, H91 TK33 Ireland
| | - G. J. Molloy
- School of Psychology, National University of Ireland, Galway, Newcastle Road, Galway, H91 TK33 Ireland
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Tan C, Hassali M, Neoh C, Saleem F, Horne R. Cultural Adaptation and Linguistic Validation of the Beliefs about Medicines Questionnaire in Malaysia. Value Health Reg Issues 2018; 15:161-168. [DOI: 10.1016/j.vhri.2017.12.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 11/29/2017] [Accepted: 12/03/2017] [Indexed: 02/08/2023]
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Park HY, Seo SA, Yoo H, Lee K. Medication adherence and beliefs about medication in elderly patients living alone with chronic diseases. Patient Prefer Adherence 2018; 12:175-181. [PMID: 29416319 PMCID: PMC5790098 DOI: 10.2147/ppa.s151263] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE The aim of this study was to assess medication adherence and its related factors among elderly people living alone with chronic diseases using a conceptual framework with the Belief about Medicines Questionnaire and the Adherence to Refills and Medication Scale-Korean version. PARTICIPANTS AND METHODS This was a cross-sectional study conducted in 3,326 elderly people living alone, who were enrolled in Seongnam Center for Home Health Care in South Korea. They completed validated questionnaires assessing their adherence and beliefs about medication in general. RESULTS In attitudinal analysis using Belief about Medicines Questionnaire, 37.0% of patients were accepting of medication (high necessity with low concerns), 49.7% were ambivalent (high necessity with high concerns), 1.9% were skeptical (low necessity with high concerns), and 11.4% were indifferent (low necessity and low concerns). In multivariable analysis, we found that adherence was related to patients' beliefs about medication; compared with patients who were accepting of medication, those in the other three attitudinal groups had significantly lower adherence (indifferent, p=0.003; skeptical, p=0.001; ambivalent, p<0.001). Also, low adherence was associated with heavy burden of drug costs (β=0.109; 95% CI 0.03, 0.19), presence of drug side effects (β=0.431; 95% CI 0.11, 0.75), dissatisfaction with medication (β=-0.626; 95% CI -0.77, -0.48), perceiving health status as poor (β=-0.151; 95% CI -0.27, -0.03), and receiving medical aid (β=0.655; 95% CI 0.42, 0.89). Gender, age group, and number of prescribed medication were not associated with medication adherence. CONCLUSION To improve medication adherence of elderly living alone, it is essential to identify barriers to adherence, including their concerns and attitudes toward medications. These factors associated with adherence should be considered in further intervention studies.
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Affiliation(s)
- Hwa Yeon Park
- Department of Family Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Community Health Research, Seongnam Center for Home Health Care, Seongnam, Republic of Korea
| | - Sin Ae Seo
- Department of Community Health Research, Seongnam Center for Home Health Care, Seongnam, Republic of Korea
| | - Hyeyoung Yoo
- Department of Community Health Research, Seongnam Center for Home Health Care, Seongnam, Republic of Korea
| | - Kiheon Lee
- Department of Family Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Community Health Research, Seongnam Center for Home Health Care, Seongnam, Republic of Korea
- Department of Family Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea
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Lemay J, Waheedi M, Al-Sharqawi S, Bayoud T. Medication adherence in chronic illness: do beliefs about medications play a role? Patient Prefer Adherence 2018; 12:1687-1698. [PMID: 30233149 PMCID: PMC6130270 DOI: 10.2147/ppa.s169236] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Several medicines are prescribed for chronic disease management; however, adherence to long-term therapy remains poor. Culture influences beliefs about medications and, ultimately, adherence to treatment. There is a paucity of data with regard to beliefs about medications in the Middle East region, and it remains to be determined how these beliefs would impact treatment adherence. OBJECTIVES To investigate the relationship between patients' beliefs about medications with self-reported adherence to treatment among a chronically ill multicultural patient population. METHODS A prospective cross-sectional study was conducted among patients treated for chronic illnesses in the Ministry of Health primary care clinics in Kuwait. Patients completed a questionnaire that consisted of questions to collect information about their health status and demographics using validated instruments: the Beliefs about Medication, Sensitive Soma Assessment Scale, and Medication Adherence Report Scale-5 items. The main outcome measures were self-reported adherence to medications, beliefs, and perceived sensitivity toward medications. RESULTS Of the 1,150 questionnaires distributed, 783 were collected - giving a response rate of 68.1%. Of the 783 patients, 56.7% were male, 73.7% were married, 53.3% were non-Kuwaitis, and 49.4% had low income (<1,000 KD/3,350 USD monthly). Patients self-reported having a cardiovascular illness (80.2%), diabetes mellitus (67.7%), respiratory disease (24.3%), or mood disorder (28.6%). Participants had a mean of two comorbid illnesses and indicated taking an average of four prescription medicines to treat them. A structural equation model analysis showed adherence to medications was negatively impacted by higher negative beliefs toward medications (beta = -0.46). Factors associated with negative beliefs toward medications included marital status (being unmarried; beta = -0.14), nationality (being Kuwaiti; beta = 0.15), having lower education level (beta = -0.14), and higher illness severity (beta = 0.15). Younger age (beta = 0.10) and higher illness severity (beta = -0.9) were independently associated with lower medication adherence. Income and gender did not influence medication adherence or beliefs about medications. The combined effect of variables tested in the model explained 24% of the variance in medication adherence. CONCLUSION Medication adherence is a complex, multifaceted issue and patient beliefs about medications contribute significantly, although partially, to adherence among a multicultural Middle Eastern patient population.
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Affiliation(s)
| | - Mohammad Waheedi
- Department of Pharmacy Practice, Faculty of Pharmacy, Kuwait University, Safat, Kuwait
| | | | - Tania Bayoud
- Department of Pharmacy Practice, Faculty of Pharmacy, Kuwait University, Safat, Kuwait
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Al-Noumani H, Wu JR, Barksdale D, Alkhasawneh E, Knafl G, Sherwood G. Relationship Between Medication Adherence and Health Beliefs Among Patients with Hypertension in Oman: Pilot study. Sultan Qaboos Univ Med J 2017; 17:e329-e333. [PMID: 29062557 DOI: 10.18295/squmj.2017.17.03.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 04/16/2017] [Accepted: 06/15/2017] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES The prevalence of hypertension (HTN) in Oman is alarmingly high and patient adherence to antihypertensive medications is inadequate. This study aimed to assess the relationship between medication adherence and health beliefs among Omani patients with HTN. METHODS This descriptive cross-sectional pilot study was conducted in December 2015 and included 45 patients with HTN recruited from four primary health centres in Al Dakhiliyah and Muscat governorates, Oman. Medication adherence and health beliefs were assessed using the Morisky Medication Adherence Scale (MMAS), Beliefs about Medicines Questionnaire, Brief Illness Perception Questionnaire and the revised Medication Adherence Self-Efficacy Scale. RESULTS The mean MMAS score was 5.3 ± 2.0, with 48.9% of patients reporting high adherence. Higher self-efficacy and stronger beliefs regarding medication necessity were significantly related to adherence (P = 0.012 and 0.028, respectively). CONCLUSION The findings of this pilot study emphasise the role of health beliefs with regards to Omani patients' adherence to antihypertensive medications.
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Affiliation(s)
- Huda Al-Noumani
- Departments of Adult Health & Critical Care, College of Nursing, Sultan Qaboos University, Muscat, Oman
| | - Jia-Rong Wu
- Department of Adult Health, School of Nursing, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Debra Barksdale
- Associate Dean of Academic Affairs, School of Nursing, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Esra Alkhasawneh
- Maternal & Child Health, College of Nursing, Sultan Qaboos University, Muscat, Oman
| | - George Knafl
- Department of Adult Health, School of Nursing, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Gwen Sherwood
- Department of Adult Health, School of Nursing, University of North Carolina, Chapel Hill, North Carolina, USA
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Barriers to Patient-Centered Care in Hypertension. Can J Cardiol 2017; 33:586-590. [DOI: 10.1016/j.cjca.2017.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Revised: 03/04/2017] [Accepted: 03/05/2017] [Indexed: 11/19/2022] Open
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Covert KL, Mardis CR, Fleming JN, Pilch NA, Meadows HB, Mardis BA, Mohan P, Posadas-Salas M, Srinivas T, Taber DJ. Development of a Predictive Model for Drug-Related Problems in Kidney Transplant Recipients. Pharmacotherapy 2017; 37:159-169. [DOI: 10.1002/phar.1886] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kelly L. Covert
- Department of Pharmacy Practice, Bill Gatton College of Pharmacy; East Tennessee State University; Johnson City Tennessee
| | - Caitlin R. Mardis
- Transplant Service Line; Medical University of South Carolina; Charleston South Carolina
| | - James N. Fleming
- Department of Pharmacy Services; Medical University of South Carolina; Charleston South Carolina
| | - Nicole A. Pilch
- Department of Pharmacy Services; Medical University of South Carolina; Charleston South Carolina
| | - Holly B. Meadows
- Department of Pharmacy Services; Medical University of South Carolina; Charleston South Carolina
| | - Benjamin A. Mardis
- Department of Pharmacy Services; Medical University of South Carolina; Charleston South Carolina
| | - Prince Mohan
- Department of Transplant Nephrology; Medical University of South Carolina; Charleston South Carolina
| | - Maria Posadas-Salas
- Department of Transplant Nephrology; Medical University of South Carolina; Charleston South Carolina
| | - Titte Srinivas
- Department of Transplant Nephrology; Medical University of South Carolina; Charleston South Carolina
| | - David J. Taber
- Department of Surgery; Medical University of South Carolina; Charleston South Carolina
- Department of Pharmacy; Ralph H. Johnson VAMC; Charleston South Carolina
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Nguyen TMU, La Caze A, Cottrell N. Validated adherence scales used in a measurement-guided medication management approach to target and tailor a medication adherence intervention: a randomised controlled trial. BMJ Open 2016; 6:e013375. [PMID: 27903564 PMCID: PMC5168495 DOI: 10.1136/bmjopen-2016-013375] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To determine if a targeted and tailored intervention based on a discussion informed by validated adherence scales will improve medication adherence. DESIGN Prospective randomised trial. SETTING 2 community pharmacies in Brisbane, Australia. METHODS Patients recently initiated on a cardiovascular or oral hypoglycaemic medication within the past 4-12 weeks were recruited from two community pharmacies. Participants identified as non-adherent using the Medication Adherence Questionnaire (MAQ) were randomised into the intervention or control group. The intervention group received a tailored intervention based on a discussion informed by responses to the MAQ, Beliefs about Medicines Questionnaire-Specific and Brief Illness Perception Questionnaire. Adherence was measured using the MAQ at 3 and 6 months following the intervention. RESULTS A total of 408 patients were assessed for eligibility, from which 152 participants were enrolled into the study. 120 participants were identified as non-adherent using the MAQ and randomised to the 'intervention' or 'control' group. The mean MAQ score at baseline in the intervention and control were similar (1.58: 95% CI (1.38 to 1.78) and 1.60: 95% CI (1.43 to 1.77), respectively). There was a statistically significant improvement in adherence in the intervention group compared to control at 3 months (mean MAQ score 0.42: 95% CI (0.27 to 0.57) vs 1.58: 95% CI (1.42 to 1.75); p<0.001). The significant improvement in MAQ score in the intervention group compared to control was sustained at 6 months (0.48: 95% CI (0.31 to 0.65) vs 1.48: 95% CI (1.27 to 1.69); p<0.001). CONCLUSIONS An intervention that targeted non-adherent participants and tailored to participant-specific reasons for non-adherence was successful at improving medication adherence. TRIAL REGISTRATION NUMBER ACTRN12613000162718; Results.
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Affiliation(s)
- Thi-My-Uyen Nguyen
- Pharmacy Australia Centre of Excellence-School of Pharmacy, The University of Queensland, Woolloongabba, Queensland, Australia
| | - Adam La Caze
- Pharmacy Australia Centre of Excellence-School of Pharmacy, The University of Queensland, Woolloongabba, Queensland, Australia
| | - Neil Cottrell
- Pharmacy Australia Centre of Excellence-School of Pharmacy, The University of Queensland, Woolloongabba, Queensland, Australia
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Barley E, Lawson V. Health psychology: supporting the self-management of long-term conditions. ACTA ACUST UNITED AC 2016; 25:1102-1107. [DOI: 10.12968/bjon.2016.25.20.1102] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Elizabeth Barley
- Professor in Health and Wellbeing, College of Nursing, Midwifery and Healthcare, University of West London
| | - Victoria Lawson
- Principal Health Psychologist, Southwark Talking Therapies Service, London
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Granados-Gámez G, Roales-Nieto JG, Gil-Luciano A, Moreno-San Pedro E, Márquez-Hernández VV. A longitudinal study of symptoms beliefs in hypertension. Int J Clin Health Psychol 2015; 15:200-207. [PMID: 30487837 PMCID: PMC6224860 DOI: 10.1016/j.ijchp.2015.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 07/20/2015] [Indexed: 11/02/2022] Open
Abstract
A longitudinal study was conducted to assess the presence of beliefs about symptoms related to hypertension and the time since diagnosis in which they appear. A randomly selected sample of hypertensive patients (67% women, mean age 53.27 years and range 20-65) was divided into four groups according to the time from diagnosis. All patients (N = 171) were interviewed at the beginning (initial assessment) and 12 months later (final assessment) and the patients (n = 75) who did not report beliefs about symptoms at the initial assessment were interviewed in a follow-up schedule. The results showed that 56% of patients reported beliefs about symptoms at the initial assessment, and this percentage increased to 77% at the final assessment (p < .001) finding significant differences between the two groups with a more recent diagnosis and the two groups of long-standing patients. Longitudinal analysis of the group with the recent diagnosis showed that the critical period for the emergence of beliefs was the first year from diagnosis. This period could be decisive in order to prevent them. Healthcare professionals should pay attention to the emergence of these beliefs, as they could negatively affect treatment adherence.
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Broadbent E, Wilkes C, Koschwanez H, Weinman J, Norton S, Petrie KJ. A systematic review and meta-analysis of the Brief Illness Perception Questionnaire. Psychol Health 2015; 30:1361-85. [DOI: 10.1080/08870446.2015.1070851] [Citation(s) in RCA: 282] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Arruda DCJD, Eto FN, Velten APC, Morelato RL, Oliveira ERAD. Fatores associados a não adesão medicamentosa entre idosos de um ambulatório filantrópico do Espírito Santo. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2015. [DOI: 10.1590/1809-9823.2015.14074] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVOS: Estimar a frequência da não adesão ao tratamento medicamentoso entre idosos acompanhados ambulatorialmente, bem como analisar seus fatores associados. METODOLOGIA: Foi conduzido estudo transversal com 263 idosos atendidos no ambulatório de especialidades médicas de um hospital filantrópico, localizado no município de Vitória-ES. Foi realizada entrevista utilizando roteiro estruturado em três blocos que contemplavam questões sociodemográficas, condições de saúde e estilo de vida e medicamentos em uso. Para verificar a não adesão ao tratamento medicamentoso, foi aplicado o instrumento de Medida de Adesão Terapêutica (MAT). Os dados foram analisados por meio do teste Qui-quadrado para variáveis categóricas. Foram consideradas significativas as variáveis com valor de p<0,05 no modelo final de regressão múltipla de Poisson. RESULTADOS: Os resultados mostraram uma frequência de não adesão ao tratamento medicamentoso de 26,7% da amostra. A não adesão ao tratamento medicamentoso nessa população se mostrou positivamente associada à ausência de vínculo empregatício anterior a aposentadoria (RP=1,12; p<0,010); presença de declínio cognitivo (RP=1,13; p<0,010) e hábitos alimentares inadequados (RP=1,12; p<0,005). CONCLUSÃO: Com o estudo, foi possível identificar os fatores associados à não adesão medicamentosa nos idosos investigados e assim contribuir para o conhecimento do perfil sociodemográfico, condições de saúde e estilo de vida e características relacionadas à utilização de medicamentos por parte dessa população.
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Affiliation(s)
| | | | | | - Renato Lírio Morelato
- Universidade Federal do Espírito Santo, Brasil; Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória, Brasil
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Odusola AO, Nelissen H, Hendriks M, Schultsz C, Wit F, Bolarinwa OA, Akande T, Agyemang C, Ogedegbe G, Agbede K, Adenusi P, Osibogun A, Stronks K, Haafkens J. How Group-Based Cardiovascular Health Education Affects Treatment Adherence and Blood Pressure Control among Insured Hypertensive Nigerians: A Pre-Test, Post-Test Study. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/wjcd.2015.57021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
'The extent to which an individual's medication-taking behaviour and/or execution of lifestyle changes, corresponds with agreed recommendations from a healthcare provider', is a highly complex behaviour, defined as adherence. However, intentional non-adherence is regularly observed and results in negative outcomes for patients along with increased healthcare provision costs. Whilst this is a consistent issue amongst adults of all ages, the burden of chronic disease is greatest amongst older adults. As a result, the absolute prevalence of intentional non-adherence is increased in this population. This non-systematic review of intentional non-adherence to medication highlights the extent of the problem amongst older adults. It notes that age, per se, is not a contributory factor in intentionally non-adherent behaviours. Moreover, it describes the difference in methodology required to identify such behaviours in contrast to reports of non-adherence in general: the use of focus groups, semi-structured, one-to-one interviews and questionnaires as opposed to pill counts, electronic medication monitors and analysis of prescription refill rates. Using Leventhal's Common-Sense Model of Self-Regulation, it emphasizes six key factors that may contribute to intentional non-adherence amongst older adults: illness beliefs, the perceived risks (e.g. dependence, adverse effects), benefits and necessity of potential treatments, the patient-practitioner relationship, inter-current physical and mental illnesses, financial constraints and pharmaceutical/pharmacological issues (poly-pharmacy/regimen complexity). It describes the current evidence for each of these aspects and notes the paucity of data validating Leventhal's model in this regard. It also reports on interventions that may address these issues and explicitly acknowledges the lack of evidence-based interventions available to healthcare practitioners. As a result, it highlights five key areas that require urgent research amongst older adults: (1) the overlap between intentional and unintentional non-adherence, particularly amongst those who may be frail or isolated; (2) the potential correlation between symptomatic benefit and intentional vs. unintentional non-adherence to medication; (3) an evaluation of the source of prescribing (i.e. a long-standing provider vs. an acute episode of care) and the patient-prescriber relationship as determinants of intentional and unintentional non-adherence; (4) the decision-making processes leading to selective intentional non-adherence amongst older adults with multiple medical problems; and (5) the development and evaluation of interventions designed to reduce intentional non-adherence, specifically addressing each of the aspects listed above.
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Affiliation(s)
- Omar Mukhtar
- Clinical Pharmacology and Therapeutics, King's Health Partners, King's College Hospital, Denmark Hill, London, SE5 9RS, UK,
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Horne R, Chapman SCE, Parham R, Freemantle N, Forbes A, Cooper V. Understanding patients' adherence-related beliefs about medicines prescribed for long-term conditions: a meta-analytic review of the Necessity-Concerns Framework. PLoS One 2013; 8:e80633. [PMID: 24312488 PMCID: PMC3846635 DOI: 10.1371/journal.pone.0080633] [Citation(s) in RCA: 737] [Impact Index Per Article: 67.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 10/04/2013] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Patients' beliefs about treatment influence treatment engagement and adherence. The Necessity-Concerns Framework postulates that adherence is influenced by implicit judgements of personal need for the treatment (necessity beliefs) and concerns about the potential adverse consequences of taking it. OBJECTIVE To assess the utility of the NCF in explaining nonadherence to prescribed medicines. DATA SOURCES We searched EMBASE, Medline, PsycInfo, CDSR/DARE/CCT and CINAHL from January 1999 to April 2013 and handsearched reference sections from relevant articles. STUDY ELIGIBILITY CRITERIA Studies using the Beliefs about Medicines Questionnaire (BMQ) to examine perceptions of personal necessity for medication and concerns about potential adverse effects, in relation to a measure of adherence to medication. PARTICIPANTS Patients with long-term conditions. STUDY APPRAISAL AND SYNTHESIS METHODS Systematic review and meta-analysis of methodological quality was assessed by two independent reviewers. We pooled odds ratios for adherence using random effects models. RESULTS We identified 3777 studies, of which 94 (N = 25,072) fulfilled the inclusion criteria. Across studies, higher adherence was associated with stronger perceptions of necessity of treatment, OR = 1.742, 95% CI [1.569, 1.934], p<0.0001, and fewer Concerns about treatment, OR = 0.504, 95% CI: [0.450, 0.564], p<0.0001. These relationships remained significant when data were stratified by study size, the country in which the research was conducted and the type of adherence measure used. LIMITATIONS Few prospective longitudinal studies using objective adherence measures were identified. CONCLUSIONS The Necessity-Concerns Framework is a useful conceptual model for understanding patients' perspectives on prescribed medicines. Taking account of patients' necessity beliefs and concerns could enhance the quality of prescribing by helping clinicians to engage patients in treatment decisions and support optimal adherence to appropriate prescriptions.
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Affiliation(s)
- Rob Horne
- Centre for Behavioural Medicine, Department of Practice and Policy, UCL School of Pharmacy, London, United Kingdom
| | - Sarah C. E. Chapman
- Centre for Behavioural Medicine, Department of Practice and Policy, UCL School of Pharmacy, London, United Kingdom
| | - Rhian Parham
- Centre for Behavioural Medicine, Department of Practice and Policy, UCL School of Pharmacy, London, United Kingdom
| | - Nick Freemantle
- Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Alastair Forbes
- Department of Internal Medicine, University College Hospital, London, United Kingdom
| | - Vanessa Cooper
- Centre for Behavioural Medicine, Department of Practice and Policy, UCL School of Pharmacy, London, United Kingdom
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