Skepticism and pharmacophobia toward medication may negatively impact adherence to psychiatric medications: a comparison among outpatient samples recruited in Spain, Argentina, and Venezuela

Abstract

BackgroundCultural differences in attitudes toward psychiatric medications influence medication adherence but transcultural studies are missing. The objective of this study was to investigate how attitudes and beliefs toward psychotropic medications influence treatment adherence in psychiatric outpatients in Spain, Argentina, and Venezuela.MethodsA cross-sectional, cross-cultural psychopharmacology study was designed to assess psychiatric outpatients’ attitudes toward their prescribed medication. Patients completed the Drug Attitude Inventory – 10 Item (DAI-10), the Beliefs about Medicines Questionnaire – Specific Scale (BMQ-Specific), the Sidorkiewicz adherence tool, and sociodemographic and clinical questionnaires. The study included 1,291 adult psychiatric outpatients using 2,308 psychotropic drugs from three Spanish-speaking countries, the Canary Islands (Spain) (N=588 patients), Argentina (N=508), and Venezuela (N=195).ResultsThe univariate analyses showed different mean scores on the DAI-10 and the BMQ – Necessity and Concerns subscales but, on the other hand, the percentages of non-adherent and skeptical patients were relatively similar in three countries. Argentinian patients had a very low level of pharmacophobia. Multivariate analyses (logistic regression and chi-squared automatic interaction detector segmentation) showed that pharmacophobia in general and skepticism about specific medications (high concern about adverse reactions and low belief in their necessity) were associated with non-adherence. Pharmacophobia was the major factor associated with non-adherence (Spain and Venezuela) but when pharmacophobia was rare (Argentina), skepticism was the most important variable associated with non-adherence.ConclusionPsychiatric patients’ attitudes and beliefs about their psychiatric treatment varied in these three Spanish-speaking countries, but pharmacophobia and skepticism appeared to play a consistent role in lack of adherence.

The necessity‐concern framework in the assessment of treatment adherence of psychiatric patients and the role of polypharmacy in a Spanish sample

“…Adherence to every prescribed psychiatric drug was assessed using the Spanish validated version of the Sidorkiewicz adherence tool (De las Cuevas et al, ; Sidorkiewicz, Tran, Cousyn, Perrodeau, & Ravaud, ). This five‐item self‐report questionnaire with two or three possible answers is illustrated with practical examples and pictographs to help patients recognize their various medication behaviors for each psychiatric drug prescribed.…”

“…In our experience, this was a major problem, because psychiatric patients appear to adhere differently to the various psychiatric medications prescribed to them and exhibit diverse medication‐taking behaviors for the various drugs used. In 2016, Sidorkiewicz et al proposed a self‐report instrument for assessing adherence for each individual drug in patients undergoing long‐term therapy; the instrument would facilitate the analysis of the relationship between polypharmacy and treatment adherence (De las Cuevas et al, ).…”

A Clinimetric Approach for Improving the Measurement of Pharmacophobia with Replication in Two Other Samples

“…The aim of this research in the 3 previously studied samples [8] is to improve the DAI-10 scoring system by using a clinimetric plan including 6 successive steps: (1) eliminating 2 confusing items from the DAI-10, (2) performing an exploratory factor analysis of the 8 remaining items to rate 2 factors (liking and disliking medications) in the 3 sample groups, (3) testing based on improved internal consistency of the 2 new subscales versus the DAI-10 in the 3 sample groups, (4) identifying clinimetric pharmacophobic patients (high in disliking and low in liking medications), (5) identifying patients with consistently poor adherence, and (6) testing within the 3 samples for more accurate prediction of nonadherence using the new clinimetric definition of pharmacophobia versus the old definition of pharmacophobia.…”

“…This cross-sectional, cross-cultural pharmacopsychology study included a total of 1,320 psychiatric outpatients recruited on the Canary Islands (Spain), Mendoza (Argentina), and Mérida (Venezuela) and has been described previously [8]. Two scales were used: the Spanish validated version of the DAI-10 and the Spanish version of the validated Sidorkiewicz instrument [6] to assess treatment adherence for each individual drug taken by a patient.…”

“…When comparing the clinimetric and old definitions, the phi coefficient and the OR of the clinimetric definition tended to be lower in the Venezuelan sample but were higher, as predicted, in the Spanish sample and the Argentinian sample. In our published analysis of the Argentinian sample [8], the prevalence of pharmacophobia was rare (9%) and had a limited effect as a predictor of poor adherence (OR = 2.17; 95% confidence interval 1.63–2.88), while the clinimetric definition provided a prevalence of 27% and an OR of 8.43 (95% confidence interval 4.94–14.4). As the 95% confidence intervals do not overlap, the clinimetric OR is significantly better than the OR using the old pharmacophobic definition.…”