Social context, the struggle with uncertainty, and subjective risk as meaning-rich constructs for explaining HBP noncompliance

Proulx, Michelle; Leduc, Nicole; Vandelac, Louise; Grégoire, Jean‐Pierre; Collin, Johanne

doi:10.1016/j.pec.2007.05.014

Cited by 15 publications

(24 citation statements)

References 29 publications

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“…With occasional episodes of unintentional non-adherence, patients may be testing a medication’s effectiveness or gauging symptom status without the medication. Others have suggested that reports of forgetfulness in taking medications may be a proxy for reduced motivation [67], having doubts about the prescribed therapy [68], or having low perceived need for the medication [29,69]. Our analyses support these interpretation as all three medication beliefs scales were significantly associated with reports of forgetfulness, carelessness, and any unintentional non-adherence.…”

Section: Discussionsupporting

confidence: 79%

Unintentional non-adherence to chronic prescription medications: How unintentional is it really?

Gadkari

McHorney

2012

BMC Health Serv Res

323

231

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BackgroundUnintentional non-adherence has been characterized as passively inconsistent medication-taking behavior (forgetfulness or carelessness). Our objectives were to: (1) study the prevalence and predictors of unintentional non-adherence; and (2) explore the interrelationship between intentional and unintentional non-adherence in relation to patients’ medication beliefs.MethodsWe conducted a cross-sectional survey of adults with asthma, hypertension, diabetes, hyperlipidemia, osteoporosis, or depression from the Harris Interactive Chronic Illness Panel. The analytic sample for this study included 24,017 adults who self-identified themselves as persistent to prescription medications for their index disease. They answered three questions on unintentional non-adherence (forgot, ran out, being careless), 11 questions on intentional non-adherence, and three multi-item scales assessing perceived need for medication (k = 10), perceived medication concerns (k = 6), and perceived medication affordability (k = 4). Logistic regression was used to model predictors of each unintentional non-adherence behavior. Baron and Kenny’s regression approach was used to test the mediational effect of unintentional non-adherence on the relationship between medication beliefs and intentional non-adherence. Bootstrapping was employed to confirm the statistical significance of these results.ResultsFor the index disease, 62% forgot to take a medication, 37% had run out of the medication, and 23% were careless about taking the medication. Common multivariate predictors (p < .001) of the three behaviors were: (1) lower perceived need for medications; (2) more medication affordability problems; (3) worse self-rated health; (4) diabetes or osteoporosis (relative to hypertension); and (5) younger age. Unique statistically-significant predictors of the three behaviors were: (a) ‘forgot to take medications’ - greater concerns about the index medication and male gender; (b) ‘run out of medications’ - non-white race, asthma, and higher number of total prescription medications; (c) ‘being careless’ - greater medication concerns. Mediational tests confirmed the hypothesis that the effect of medication beliefs (perceived need, concerns, and affordability) on intentional non-adherence is mediated through unintentional non-adherence.ConclusionsFor our study sample, unintentional non-adherence does not appear to be random and is predicted by medication beliefs, chronic disease, and sociodemographics. The data suggests that the importance of unintentional non-adherence may lie in its potential prognostic significance for future intentional non-adherence. Health care providers may consider routinely inquiring about unintentional non-adherence in order to proactively address patients’ suboptimal medication beliefs before they choose to discontinue therapy all together.

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Section: Discussionsupporting

confidence: 79%

Unintentional non-adherence to chronic prescription medications: How unintentional is it really?

Gadkari

McHorney

2012

BMC Health Serv Res

323

231

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“…The manner in which women logistically and socially managed anastrozole therapy was consistent with research examining medication-taking for patients with chronic conditions [4, 6, 32, 33]; however, in our study, mutual-medication taking went beyond social support or reminding or assisting patients with their medications [4]. Rather, it included a partnership with a spouse in the physical taking of anastrozole that was part of her daily routine.…”

Section: Discussionsupporting

confidence: 73%

“Keeping the Boogie Man Away”: Medication Self-Management among Women Receiving Anastrozole Therapy

Wickersham

Happ

Bender³

2012

Nursing Research and Practice

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The oral hormonal agent anastrozole improves clinical outcomes for women with breast cancer, but women have difficulty taking it for the five-year course. The unique medication-taking experiences related to self-management of anastrozole therapy for women with early stage breast cancer are not known. Our purpose was to describe the medication-taking experiences for postmenopausal women with early stage breast cancer who were prescribed a course of anastrozole therapy. Twelve women aged 58 to 67 years, midway through therapy, participated in audio-recorded interviews. Women's medication-taking experiences involved a belief in their importance and an imperative to take anastrozole. We found that women's side effect experiences, particularly menopausal symptoms, were significant, but only one woman stopped anastrozole due to side effects. Medication-taking included routinization interconnected with remembering/forgetting and a storage strategy. Some women noted a mutual medication-taking experience with their spouse, but most felt taking anastrozole was something they had to do alone. Our results provide insight into the way some women with early stage breast cancer manage their hormonal therapy at approximately the midpoint of treatment. Next steps should include examinations of patient-provider communication, potential medication-taking differences between pre- and postmenopausal women, and the effects of medication-taking on clinical outcomes.

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“…The characteristics and unique physical makeup of individual patients were reported as more important in determining the effect of medication than compliance. In Proulx et al . (2007) participants who engaged in different forms of irregular medication practices steadfastly maintained that their actions were legitimate based on their experiences and beliefs, and the information they possessed.…”

Section: Resultsmentioning

confidence: 99%

“…In Rogers et al (1998), the everyday medication practices of schizophrenia patients were found to reflect a policy context which stresses the need to survey and control the behaviour of people living in the community and the wider meanings and symbolic significance which schizophrenia has for patients in their everyday lives. For Proulx et al . (2007), three broad groups of subjective meanings: stress and living conditions, doubt, and subjective risk, explain respondents’ failure to take blood‐pressure‐lowering medication regularly.…”

Section: Introductionmentioning

confidence: 99%

Beliefs and practices about antiretroviral medication: a study of poor urban Kenyans living with HIV/AIDS

Izugbara

Wekesa

2011

Sociology Health & Illness

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Interest in medication-taking as a social behaviour is growing. Drawing on qualitative data, this study interrogates beliefs and practices related to antiretroviral therapy (ART) use among urban poor Kenyan people living with HIV ⁄ AIDS (PLWHA). Responding PLWHA relied on a range of ingenious strategies to remember to take their medications but did not necessarily perceive compliance with medical instructions as key to treatment efficacy. They also believed that compliance can even hurt some patients. PLWHA relied on both compliance and non-compliance to seek social acceptance, maintain a reputation of being healthy, dispel rumours about one's status, and minimise economic vulnerability. Compliance was further used to mark gratitude to supportive caregivers and providers, and non-compliance to appraise the efficacy of other treatments which promise permanent cure. The medication-taking practices of poor Kenyan PLWHA reflect their struggles with deprived livelihoods and stigma.

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Social context, the struggle with uncertainty, and subjective risk as meaning-rich constructs for explaining HBP noncompliance

Cited by 15 publications

References 29 publications

Unintentional non-adherence to chronic prescription medications: How unintentional is it really?

Unintentional non-adherence to chronic prescription medications: How unintentional is it really?

“Keeping the Boogie Man Away”: Medication Self-Management among Women Receiving Anastrozole Therapy

Beliefs and practices about antiretroviral medication: a study of poor urban Kenyans living with HIV/AIDS

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