Development of a novel instrument for assessing intentional non-adherence to official medical recommendations (iNAR-12): a sequential mixed-methods study in Serbia

Abstract

ObjectivesWe aimed to (1) develop a novel instrument, suitable for the general population, capturing intentional non-adherence (iNAR), consisting of non-adherence to prescribed therapy, self-medication and avoidance of seeking medical treatment; (2) differentiate it from other forms of non-adherence, for example, smoking; and (3) relate iNAR to patient-related factors, such as sociodemographics, health status and endorsement of irrational beliefs (conspiratorial thinking and superstitions) and to healthcare-related beliefs and experiences ((mis)trust and negative experiences with the healthcare system, normalisation of patient passivity).DesignТо generate iNAR items, we employed a focus group with medical doctors, supplemented it with a literature search and invited a public health expert to refine it further. We examined the internal structure and predictors of iNAR in an observational study.SettingData were collected online using snowball sampling and social networks.ParticipantsAfter excluding those who failed one or more out of three attention checks, the final sample size was n=583 adult Serbian citizens, 74.4% female, mean age 39.01 years (SD=12.10).Primary and secondary outcome measuresThe primary, planned outcome is the iNAR Questionnaire, while smoking was used for comparison purposes.ResultsFactor analysis yielded a one-factor solution, and the final 12-item iNAR Questionnaire had satisfactory internal reliability (alpha=0.72). Health condition and healthcare-related variables accounted for 14% of the variance of iNAR behaviours, whereas sociodemographics and irrational beliefs did not additionally contribute.ConclusionsWe constructed a brief yet comprehensive measure of iNAR behaviours and related them to health and sociodemographic variables and irrational beliefs. The findings suggest that public health interventions should attempt to improve patients' experiences with the system and build trust with their healthcare practitioners rather than aim at specific demographic groups or at correcting patients’ unfounded beliefs.Study registrationThe design and confirmatory analyses plan were preregistered (https://osf.io/pnugm).

Tracking variations in daily questionable health behaviors and their psychological roots: a preregistered experience sampling study

“…iNAR-12 3 is a 12-item self-report checklist assessing intentional non-adherence to official medical recommendations. Participants are presented with a list of situations reflecting non-adherence and asked to respond to whether those situations ever happened to them on a binary scale (0 - No, 1 - Yes).…”

“…magical beliefs about health, and belief in medical conspiracy theories) will emerge as the best predictors of TCAM (as observed in 10 ) (H5). We expected the relation of iNAR to irrational beliefs to be positive as well, but weaker compared to the relation of the TCAM-irrational beliefs (H6 3 , 10 ). Finally, we expected iNAR to correlate negatively with trust in healthcare professionals and positively with mistrust in the healthcare system (H7; e.g.…”

“…Although there is less evidence, there are indications that an irrational mindset can also be predictive of certain aspects of non-adherence to medical recommendations, especially intentional non-adherence. Self-medicating, changing the prescribed treatment, and avoiding checkups were shown to be positively, albeit weakly related to conspiratorial thinking and superstitious beliefs 3 . Similarly, people more prone to medical conspiracy theories more often avoided health and dental checkups 23 .…”

“…Psychologically, unintentional non-adherence which can be due to a lack of socio-economic or cognitive resources is not as relevant as intentional non-adherence (iNAR), i.e. a patient deciding to ignore or modify medical advice either by changing the dosage or length of medication, avoiding scheduled check-ups or deciding to self-medicate 3 . A previous study showed that participants, on average, intentionally decided not to follow almost half of the medical recommendations at some point in their lifetime 3 .…”

“…a patient deciding to ignore or modify medical advice either by changing the dosage or length of medication, avoiding scheduled check-ups or deciding to self-medicate 3 . A previous study showed that participants, on average, intentionally decided not to follow almost half of the medical recommendations at some point in their lifetime 3 .…”