Adherence to pharmacological treatment of non-malignant chronic pain: The role of illness perceptions and medication beliefs

The objective was to identify the degree to which illness perceptions and medication beliefs explain variations in reported adherence to medication prescribed for the treatment of non-malignant chronic pain and to test the applicability of an extended version of the self-regulatory model to the chronic pain population. A cross-sectional design included 217 clinic patients completing validated questionnaires assessing their illness perceptions, medication beliefs and reported adherence to medication. Perceptions of illness (pain) as chronic, uncontrollable and unremitting were associated with greater adherence, fewer medication concerns and a belief that treatment was necessary. Structural equation modelling supports an extended SRM for chronic pain. It suggests that patients holding perceptions of serious consequences of pain and high emotion levels have more concerns about medication and are less adherent. Perceptions of serious illness consequences are also associated with stronger beliefs about the necessity of medicines and greater adherence. Beliefs about illness and medication are associated with adherence to treatment in chronic pain and this can be explained by an extended SRM. Results are preliminary and require replication. Further studies should explore the role that emotion has on coping strategies in chronic pain. Interventions should focus on altering unhelpful beliefs that reduce adherence.     

Assessing theoretical predictors of long-term medication adherence: Patients’ treatment-related beliefs,experiential feedback and habit development

Patient non-adherence to medication is a pervasive problem that contributes to poor patient health and high healthcare costs. Basic research and interventions have focused thus far on behaviour initiation factors, such as patients’ illness and treatment beliefs. This paper proposes two processes that occur after behaviour initiation that are theorised to contribute to prediction of long-term medication adherence: ‘coherence’ of patients’ beliefs from experiences with treatment and habit development. Seventy-one hypertensive patients reported their treatment-related beliefs, experiences related to treatment efficacy and medication-taking habit strength in a baseline interview. Patients then used an electronic monitoring pill bottle for approximately one month. Patients’ medication habit-strength was the strongest predictor of all adherence measures, explaining 6–27% incremental variance in adherence to that explained by patients’ treatment-related beliefs. Patients’ beliefs and experiences did not predict overall adherence, even for patients with ‘weaker’ habits. However, patients’ experiences were found to predict intentional non-adherence and habit strength was found to predict unintentional adherence. Practitioners may assess patients’ medication-taking habits to get an initial view of their likely adherence to long-term medications. Future research should assess the current theoretical predictions in a hypertension inception sample and in populations with symptomatic conditions.     

Partners’ representations of diabetes as mediators between patients’ representations and adherence to self-care behaviors,in type 2 diabetes

The purpose of this study was to analyze partners’ representations of diabetes as mediators between patients’ illness representations and adherence to all self-care behaviors, in recently diagnosed type 2 diabetes (T2DM) patients. The sample included 340 patients and their respective partners. The instruments used were: Revised Summary of Diabetes Self-Care Activities (RSDSCA); Medication Adherence Report Scale (MARS); and the Brief Illness Perception Questionnaire (Brief-IPQ). A mediational effect of partners’ representation of diabetes consequences was found between the same patients’ representations and exercise, foot care, and self-monitoring of blood glucose. Partners’ representations of personal and treatment control, were mediators between the same partners’ representations and self-monitoring of blood glucose. No partners’ representations mediated patients’ representation and adherence to medication or diet . This study emphasized partners’ representations on patient’s adherence to exercise, foot care and monitoring of blood glucose, in recent diagnosed T2DM patients. Interventions to promote adherence in T2DM should promote convergence between patients and partners’ diabetes representations. This study provides some evidence for the need to treat T2DM within the dyad to improve adherence, starting after the diagnosis.     

Medication beliefs and structural barriers to treatment adherence among people living with HIV infection

Background: People living in poverty face multiple structural challenges to medication adherence including lack of transportation, inadequate housing and food insecurity. The degree to which individuals’ motivations to remain adherent may overcome structural barriers has received limited attention.

Purpose: To examine whether medication necessity and concerns beliefs predict antiretroviral therapy (ART) adherence over and above structural adherence barriers associated with poverty.

Methods: People living with HIV in a southern US city (N = 942) completed computerised interviews, an objective measure of adherence and HIV viral suppression obtained from medical records. Hierarchical logistic regression models were constructed to examine demographic and illness characteristics, structural barriers, mental health, substance use and medication necessity and concerns beliefs as predictors of ART adherence.

Results: In multivariable models, current drug use and medication necessity and concerns beliefs predicted treatment adherence over and above demographic, health, mental health and structural factors.

Conclusions: Medication beliefs are proximal and powerful motivating factors that predict adherence. Adherence interventions should directly address medication beliefs in developing strategies to manage barriers facing people with HIV living in poverty.     

The Illness Perceptions and Treatment Beliefs of Individuals with Severe Haemophilia and their Role in Adherence to Home Treatment

The majority of individuals in the UK with severe haemophilia treat themselves at home with clotting factor. The aim of this study was to examine patient's beliefs about their haemophilia, their beliefs regarding treatment with clotting factor and to assess whether relationships existed between these factors and adherence to home treatment. Patient beliefs were assessed by posting individuals with severe haemophilia A and B ( n = 104) the Illness Perceptions Questionnaire (IPQ) and the Beliefs about Medicines Questionnaire (BMQ). The final analysis was based on 65 questionnaires yielding a response rate of 63%. Adherence to the frequency and to the amount of each clotting factor dose was assessed for individuals treating prophylactically and the amount of each clotting factor dose for those only treating 'on-demand'. Adherence scores were calculated by comparing individual patient treatment records with recommended regimens. Regression analysis indicated that perceptions of illness identity and treatment necessity explained a significant amount of the variance in adherence to frequency of prophylactic infusions and that illness identity was associated with the adherence to the amount of each prophylactic dose. Further regression analysis also showed that the amount of each dose of clotting factor administered on-demand was associated with perceptions regarding the necessity of treatment. Analysis with a combined measure of adherence to dose amount indicated that patients treating on-demand or with prophylaxis who under treated, recorded significantly lower perceptions of illness consequence than individuals who were fully adherent or who over-treated. The results suggest that assessing illness perceptions, especially beliefs regarding identity , consequence and necessity of treatment, may play a valuable role in identifying which individuals are least likely to adhere to treatment.     

Emotion and adherence to treatment in people with asthma: An application of the emotional Stroop paradigm

This study explored whether an emotional Stroop paradigm might represent an appropriate means of assessing individuals' emotional representations of asthma. In addition, the opportunity was taken to investigate whether emotional representations of asthma, as assessed by this method, were associated with adherence to inhaled preventative medication. An asthma Stroop task was devised which comprised three sets of stimuli: asthma symptom words, general negative words, and neutral words. Three groups of participants were compared on their performance on this task: individuals with asthma, individuals without asthma, and individuals without asthma who had been primed about the condition. It was found that individuals with asthma experienced significantly more interference when colour‐naming the asthma symptom words, but not when colour‐naming the general negative words. Furthermore, their performance on the asthma Stroop task was associated with self‐reported adherence levels. Specifically, individuals who reported the highest and lowest levels of adherence displayed more interference when colour‐naming the asthma symptom words than individuals with intermediate levels of adherence. It is concluded that the emotional Stroop paradigm might provide an objective and sensitive means of assessing individuals’ emotional representations of illness. Additionally, it is proposed that emotional responses to illness should be assessed and included in research designed to explain health behaviours and, furthermore, that such research should not assume that any relationship between emotional representations and health behaviours will be linear.     

Ask and ye shall receive: behavioural specificity in the accuracy of subjective memory complaints

A cross‐sectional sample of adults completed an extensive set of cognitive tasks and a set of questionnaires measuring depressive affect, memory complaint, and other variables. During an interview about their prescribed medications, the participants also reported whether they were having problems remembering to take the medication as prescribed (an everyday prospective memory problem). Their medication adherence at home was then monitored for one month using pill bottles which microelectronic caps. Cognitive tasks correlated with memory complaints, as measured by the Memory Functioning Questionnaire, but not with problems in remembering to take medications. The highest correlations were with a free recall task. Conversely, reported problems with medication adherence during the interview had good predictive validity for subsequent adherence problems, but not for cognitive tasks, including a measure of prospective memory. Depressive affect was related to both the questionnaire and the interview complaints about medication adherence, but a structural equation model showed that the relationships of cognition and medication adherence to the different memory complaints were independent of depressive affect. The results are interpreted in terms of a behavioural specificity hypothesis, which states that adults' self‐reports of memory problems are valid when they focus directly on specific memory‐related behaviours in everyday contexts. Copyright © 2000 John Wiley & Sons, Ltd.     

Coping with adverse drug events in patients with heart failure: Exploring the role of medication beliefs and perceptions

This study describes coping strategies that patients with heart failure (HF) use to manage adverse drug events (ADEs). The included coping strategies were social support seeking, information seeking, non-adherence and taking alleviating medication. The role of beliefs about medication and ADE perceptions in explaining these coping strategies was assessed using the Self-Regulation Model. We performed a cross-sectional study including 250 HF patients who experienced an ADE. Patients completed validated questionnaires assessing their coping strategies, ADE perceptions and medication beliefs. Social support (60%) and information seeking (32%) were the most commonly used strategies to cope with ADEs. Non-adherence was reported by 7% of the patients. Multivariate linear regression analysis showed that demographics, clinical factors and medication beliefs explained only a small amount of the variance in coping strategies, whereas ADE perceptions explained a substantial amount of variance. Path analysis showed that patients' perceptions about the timeline, consequences and controllability of ADEs by the health care provider were directly related to their coping behaviour. The effect of patients' medication beliefs on their coping strategies was consistent with mediation through their ADE perceptions. Our results support the value of the Self-Regulation Model in understanding patients' coping behaviour with regard to ADEs.     

The Beliefs About Medication Scale: Development, Reliability, and Validity

The purpose of the study was to develop and evaluate a psychometrically sound health belief measure, the Beliefs About Medication Scale (BAMS) that can be used with adolescent chronic illness populations whose prescribed treatment includes oral medication. One hundred and thirty-three adolescents (age 11–18 years) with asthma (n = 60), HIV (n = 31), or inflammatory bowel disease (n = 42) completed the BAMS and, along with their parent, a self-report medication interview. A confirmatory factor analysis supported the hypothesized subscales of Perceived Threat, Positive Outcome Expectancy, Negative Outcome Expectancy, and Intent to Adhere to treatment. The subscales evidenced good internal consistency and 3-week test-retest reliability. Univariate and multivariate analyses demonstrated that the health belief constructs accounted for 22% of the variance in medication adherence beyond demographic and illness characteristics. The study provides preliminary evidence of the reliability and validity of a theoretically based measure of health beliefs for adolescents. The BAMS may be a useful tool to evaluate the psychological barriers to adherence that place teenagers at risk for nonadherence.     

Electronic monitoring and counseling to improve medication adherence

Electronic caps, pill caps that record the date and time of pill bottle opening provide an objective measure of adherence to prescribed medication. A promising intervention to improve adherence, cue-dose training, involves reviewing patients' pill cap-generated reports concerning their medication-taking and offering individualized recommendations for remembering to take medications at specific times of day. In this preliminary study, 79 patients prescribed the antihyperglycemic medication metformin had adherence assessed during a 4-week baseline period. Adherence, defined as proportion of prescribed doses taken within a predetermined 4-h window, was measured using electronic MEMS caps. Those who had less than 80% baseline adherence (n = 33) were randomly assigned to either receive 4 months of cue-dose training (n = 16) or to a control group (n = 17). Cue-dose training was associated with significantly better adherence to metformin (mean improvement of 15%). The effects of cue-dose training on adherence to other antihyperglycemic medication did not reach statistical significance. Glycosylated hemoglobin (a measure of blood sugar control) did not differ between groups. Data from nine patients who reviewed pill cap-generated data with their primary care providers suggested that both patients and providers found the discussion moderately helpful and not at all uncomfortable.     

Coping with adverse drug events in patients with heart failure: Exploring the role of medication beliefs and perceptions

This study describes coping strategies that patients with heart failure (HF) use to manage adverse drug events (ADEs). The included coping strategies were social support seeking, information seeking, non-adherence and taking alleviating medication. The role of beliefs about medication and ADE perceptions in explaining these coping strategies was assessed using the Self-Regulation Model. We performed a cross-sectional study including 250 HF patients who experienced an ADE. Patients completed validated questionnaires assessing their coping strategies, ADE perceptions and medication beliefs. Social support (60%) and information seeking (32%) were the most commonly used strategies to cope with ADEs. Non-adherence was reported by 7% of the patients. Multivariate linear regression analysis showed that demographics, clinical factors and medication beliefs explained only a small amount of the variance in coping strategies, whereas ADE perceptions explained a substantial amount of variance. Path analysis showed that patients’ perceptions about the timeline, consequences and controllability of ADEs by the health care provider were directly related to their coping behaviour. The effect of patients’ medication beliefs on their coping strategies was consistent with mediation through their ADE perceptions. Our results support the value of the Self-Regulation Model in understanding patients’ coping behaviour with regard to ADEs.     

An exploratory study on the development of beliefs about symptoms as signals of arterial hypertension

An exploratory study on the development of beliefs about symptoms as signals of arterial hypertension. In spite of hypertension is known as an asymptomatic health problem, most of the people with such a diagnosis are convinced of experiencing very specific symptoms associated to specific changes in blood pressure (BP). In addition, such beliefs may affect treatment adherence. Previous studies have shown that hypertensive patients use the information they considered right about BP symptoms to regulate the type of decisions they follow in adhering to treatment. The aim of this study is to explore specific variables related with the formation of beliefs about symptoms in a sample of 171 hypertensive patients. Results show that 81,3% of the patients perceived specific symptoms related to changes in hypertension as well as that variables related with the development of these beliefs were mostly: (1) the presence of symptoms during the diagnosis process, (2) the occurrence of hypertensive crisis, and (3) the information provided by others concerning the relationships between symptoms and BP changes. The importance of paying attention to the beliefs of specific symptoms as well as to the circumstances related with the formation process of such beliefs is discussed.     

Depression and medication adherence among breast cancer survivors: bridging the gap with the theory of planned behaviour

Evidence suggests that more depressed breast cancer patients will less likely adhere to treatment plans. This study presents evidence that the theory of planned behaviour mediates the relation between depression and intentions to adhere to treatment plans and between depression and lack of adherence to medication regime. Two hundred and thirteen women undergoing breast cancer treatment participated in this study. Measures of depressive symptoms and planned behaviour variables were collected at the first time point; measures of medication adherence were collected at the second time point. Structural equation models were utilised to fit the data to the proposed models. Depressive symptoms were significantly correlated to both intentions and medication adherence. In support of hypotheses, the relation between depressive symptoms and treatment intention was mediated by attitudes towards health maintenance plans. The relation between depressive symptoms and medication adherence was fully mediated by the planned behaviour process. Conditions under which treatment intentions and perceptions of control in adhering to treatment were most related to medication adherence were elucidated. The results point to avenues for interventions to increase medication adherence among breast cancer patients. Manipulating attitudes and perceptions of control towards treatment plans will potentially serve to increase medication adherence.     

Illness perceptions and self efficacy beliefs in adolescents and young adults with insulin dependent diabetes mellitus

Abstract

The study examined the role of illness perceptions and self-efficacy in diabetic regimen adherence and metabolic control among young patients with Insulin Dependent Diabetes Mellitus (IDDM). Sixty-four outpatients with Insulin Dependent Diabetes completed measures of illness perceptions, generalised and diabetes specific self-efficacy and a self-report measure of adherence. Metabolic control (HbAlc) was also assessed. Control, identity and consequences components of illness perceptions were significantly correlated with self-efficacy expectancies. Control beliefs were consistently associated with self-reported adherence across all treatment aspects and accounted for 39% of the predicted variance in total adherence. The associations of the other psychological predictors examined, varied depending on the regimen area. Multiple regression analysis showed that 30.8% of the variance in HbAlc assays was explained by patients' diabetes specific self-efficacy, consequences and identity. Our findings suggest that patients' beliefs are useful predictors of physiological and behavioural outcomes in diabetes self-management and should thus be the focus of routine clinical assessments and future interventions.     

Secondary Beliefs: A Mediator between Illness Representations and Coping Behavior in Arthritis Sufferers

The aim of the current study was to investigate the factors of secondary beliefs and illness representations, and their relationship with particular coping strategies used in the management of arthritis, and more specifically, if secondary beliefs, as defined in Rational Emotive Behavioral Therapy (REBT), mediated the relationship between illness representations and coping, as outlined by the Self-Regulatory Model (SRM). A sample of 63 arthritis sufferers aged between 32.0 and 100.1 years was recruited. Participants were asked to complete three questionnaires: Ways of Coping Questionnaire (WOCQ); revised Illness Perception Questionnaire (IPQ-R); Secondary Beliefs Scale (SBS). Analyses revealed that all eight coping strategies measured were significantly related to one or more illness representation, lending support to the SRM. Furthermore, secondary beliefs were found to mediate the relationship between illness representations and coping for three of the strategies measured: confrontive coping, accepting responsibility and seeking social support, while they also appeared to be directly related to the escape-avoidance strategy. Therefore, support for the REBT model was also evidenced. Overall, these results have highlighted the importance of cognitive factors in influencing coping behavior, a finding that could prove useful when designing interventions aiming to promote beneficial coping in arthritis sufferers.     

Measuring the effectiveness of psychoeducation on adherence,depression, anxiety and stress among patients with diagnosis of schizophrenia. a control trial

Despite evidence of the impact of depression and stress on attitudes towards medication in general medical pathology regimens, little is known of the effects of depression and stress on attitudes towards medication in schizophrenia. This study explores the effects of a hope-based psychoeducation on attitudes towards medication, depression, anxiety and stress, and predictors of attitudes towards medication. The participants in the study (n = 29) were randomly allocated to either the psychoeducation group or the control group. Results from the psychoeducation group revealed that attitudes towards medication were significantly improved and anxiety was significantly reduced. Given the small sample, which was recruited from among patients of a day mental health centre, findings should be interpreted tentatively. Being longer in pharmacotherapy, having experienced fewer occurrences of hospitalisation, and being less depressed predicted positivity towards medication. Patients in the control group did not exhibit significant change in any of the studied variables. Findings were interpreted in the light of research on stigma and insight into illness, and add modestly to literature arguing for the importance of patients’ retention of hope, empowerment and sense of control over illness. This study proposed that psychoeducation is an appropriate intervention to address a wide range of factors that compound adherence to medication and patients’ symptoms, such as patients’ interpretations of causal models, their sense of hope and control over the illness, and their insight into illness and self-stigma.

     

Temporomandibular Disorder in Brazilian Patients: A Preliminary Study

The objective of the current study was to evaluate disease-related beliefs, adherence to treatment, quality of life, coping strategies and cognitive status in a group of Brazilian patients with Temporomandibular Disorder (TMD). Thirty patients were evaluated with a semi-directed interview, the Coping Strategies Inventory, and a Mini-Mental State Examination. Although half (50%) of the patients had known their diagnosis long term, 40% of the sample were not correctly following proposed treatment. All patients had a similar pattern of pain behavior related to TMD, while disease-related beliefs, quality of life and coping strategies were variable. Expectations about treatment also had significant association with treatment adherence. The findings of this study suggest that a more thorough understanding of individual differences in TMD is warranted.