Impact of Beliefs about Medicines on the Level of Intentional Non-Adherence to the Recommendations of Elderly Patients with Hypertension

Abstract

Background: Non-adherence to pharmaceutical treatment is one of the most common causes of uncontrolled hypertension. Non-adherence may be intentional or unintentional. In the case of intentional non-adherence, it is crucial to understand the reasons behind it. The literature increasingly addresses the issue of beliefs and concerns about medication, but studies on this subject performed in a Polish population of hypertensive patients are still lacking. The aim of the study was to assess the level of intentional non-adherence among patients with hypertension, and to determine the relationship between beliefs about medication and the level of intentional non-adherence to treatment in elderly patients with hypertension. Material and methods: The study included 300 patients (106 of whom were male, mean age (SD) 71.71 (8.12) years) with hypertension, treated at a hypertension clinic. The following instruments were used: the Intentional Non-Adherence Scale (INAS) for evaluating intentional non-adherence, and the Beliefs about Medicines Questionnaire (BMQ) for evaluating patients’ beliefs and opinions regarding medication. Socio-demographic and clinical data were obtained from patients’ medical records. Results: The mean (SD) INAS score in the study was 47.28 (19.12). Patients were most concerned about the harm caused by medication, and least concerned about the necessity to take medication (mean score per item 3.49 vs. 2.14). Correlation analysis demonstrated weak correlations between BMQ and INAS: higher scores for necessity were associated with more intentional non-adherence (r = 0.174, p = 0.003), while higher scores for overuse, harm, and concerns were associated with less intentional non-adherence (respectively: r = −0.253, p < 0.001 vs. r = −0.336, p < 0.001 vs. r = −0.351, p < 0.001). In multiple-factor analysis, factors increasing the level of intentional non-adherence were elderly age (β = −0.352, p = 0.009), multimorbidity (β = −2.374, p = 0.035), and a higher BMQ concerns score (β = −1.376, p < 0.001), while being single was an independent predictor decreasing intentional non-adherence (β = 5.646, p = 0.013). Conclusions: The overall level of intentional non-adherence among patients with hypertension is moderate, but approximately one third of patients with hypertension demonstrate a high level of non-adherence. Independent determinants of intentional non-adherence include concerns, elderly age, multimorbidity, and being single.

Beliefs about Medicines and the Level of Intentional Non-Adherence to Treatment among Patients with Multiple Sclerosis Treated with First-Line Drugs

“…Our findings are in line with previous research showing the influence of beliefs about medicines on intentional non-adherence to treatment of various chronic diseases [ 9 , 30 , 37 ]. Patients with MS who had stronger beliefs that medicines in general are overused by doctors (β = 4.204, p = 0.011) more often displayed intentional non-adherence, which is in line with the results of studies conducted among patients with HIV [ 37 ].…”

“…According to the Necessity–Concerns Framework, beliefs about the necessity of taking medications and concerns about the potential side effects of medications are key beliefs that influence medication adherence [ 29 ]. Research to date has shown that beliefs about medicines have been shown to be an important factor influencing adherence [ 30 , 31 , 32 , 33 ]. Pust et al [ 28 ] has shown that first-line patients, with less necessity beliefs for treatment, are at risk of being non-adherent patients.…”

“…In our study, the mean rate of intentional non-adherence was 51.41 ± 27.83 (55.41% of patients had a low level of intentional non-adherence and 44.59% of patients had a high level of intentional non-adherence). In a study by Świątoniowska et al [ 30 ], the mean (SD) total INAS score was 47.28 (19.12) points, and 72.33% of patients had a low level of intentional non-adherence and 27.67% of patients a high level of intentional non-adherence.…”

Influence of Jamaican Cultural and Religious Beliefs on Adherence to Pharmacotherapy for Non-Communicable Diseases: A Pharmacovigilance Perspective

“…Recent systematic reviews and observational studies highlight the relevance of socio-cultural determinants on adherence to pharmacotherapy among patients living with NCDs ( Dhar et al, 2017 ; Niriayo et al, 2018 ; Swihart et al, 2018 ; Shahin et al, 2019 ; Al-Ganmi et al, 2020 ; Park et al, 2020 ; Raza et al, 2020 ; Świątoniowska-Lonc et al, 2021 ); however, the dearth of published literature suggests such awareness in pharmacovigilance processes is yet to be realized. Although poor adherence to pharmacotherapy is a common predictor of adverse drug reactions; the converse is also true ( Gellad et al, 2011 ; Adem et al, 2021 ; Elangwe et al, 2020 ) and therefore enriching pharmacovigilance processes with what is referred to as ‘the patient’s voice’ may facilitate causality analysis of adverse drug reactions ( Simon et al, 2020 ).…”

Impulsivity and Compulsivity and Their Relationship with Non-Adherence to Treatment in the Prison Population

“…Along the same lines, a meta-analysis [4] analyzing adherence in hospital and community interventions found that healthy eating habits, community support, group intervention, and knowledge of the symptomatology related to the disease being suffered are crucial elements in supporting adherence to treatment. Moreover, individual factors (such as elderly age and treatment utility beliefs) impact treatment non-adherence and affect treatment success in both chronic and acute diseases [5]. It has also been found [1,6] that non-adherence and noncompliance with homework are related to personal variables, such as impulsivity.…”