Metrics details. The Beliefs about Medicines Questionnaire BMQ is widely used to assess medication beliefs, however, given the condition-specific nature of some self-management regimens, it is unknown whether this tool is able to fully capture beliefs about more complex medication regimens. We examined the challenges of assessing medication beliefs using the BMQ in 20 people with a complex relapsing-remitting condition recruited from community sources. Semi-structured cognitive interviews were undertaken, with responses coded using established schedules and analysed using Content analysis.
|Published (Last):||13 December 2016|
|PDF File Size:||1.68 Mb|
|ePub File Size:||8.85 Mb|
|Price:||Free* [*Free Regsitration Required]|
Neame, A. To investigate beliefs about medications held by people with rheumatoid arthritis RA , what factors are related to these specific medication beliefs, and whether these beliefs influence adherence. The design was a cross-sectional postal questionnaire survey of people with RA.
The Beliefs about Medicines Questionnaire was used to assess beliefs about the necessity of medication and concerns about it. Questionnaires were mailed to out-patients with RA. The response rate was Most However, The overall necessity score mean Concerns scores for non-adherent participants mean Most people with RA have positive beliefs about the necessity of their medication.
However, levels of concern are high and associate with helplessness and non-adherence. The Beliefs about Medicines Questionnaire may identify people at risk of poor adherence and provide a focus for patients to discuss their beliefs, providing opportunities to improve adherence. Beliefs and attitudes about illness influence adherence to treatment [ 1 , 2 ]. In fact, beliefs about medicines predict adherence more strongly than sociodemographic or clinical factors [ 2 ].
Non-adherence may result in unnecessary health costs, investigations, changes in treatment, morbidity and mortality [ 5 ]. Investigating medication beliefs is especially important in rheumatoid arthritis RA as it is a chronic disease, and people are usually advised to take potentially toxic drugs, including non-steroidal anti-inflammatory drugs NSAIDs and disease-modifying anti-rheumatic drugs DMARDs , which may be only partially effective.
Being able to identify people with RA at risk of medication non-adherence could assist in the design and appropriately timed delivery of interventions to increase adherence, thus improving health status and reducing costs. There is a relative paucity of information regarding the medication beliefs held by people with RA. Two recent studies have investigated these. Berry et al. Perceived benefits of medication were primarily reduction of pain, stiffness and swelling, and perceived risks were primarily side-effects and becoming dependent on drugs.
Although existing patients perceived their medications to be significantly more risky than did new patients, these concerns were still only at modest levels.
Participants expressed strong concerns about taking their medications, particularly with regard to potential toxicity and long-term effects. This study emphasized the tension experienced by people with RA with respect to the importance of their medication and their concerns about it.
Social cognition theories of health behaviour e. Self-regulatory theory also emphasizes that treatment perceptions and illness representations influence medication adherence [ 8 ]. These theories propose that people undertake a cost—benefit analysis, considering whether their beliefs about the necessity of medications for maintaining health outweigh their concerns about the potential adverse effects of taking them.
It has been validated for use in patients with chronic illnesses and has been shown to predict adherence to treatment amongst other groups, e. People with strong beliefs in the necessity of taking medication to maintain their health were found to be more adherent to treatment, and those with higher levels of concern about medication, commonly about the dangers of dependence and long-term side-effects, were more likely to be non-adherent [ 2 ].
The aims of this study were to use the BMQ to investigate the beliefs about medications held by people with RA. We also investigated what factors are related to these specific medication beliefs, and whether these beliefs influence adherence to drug treatments. Scores obtained for individual items within both scales are summed. Thus, total scores for the Necessity and Concerns Scales range from 5 to Higher scores indicate stronger beliefs. This differential can be thought of as the cost—benefit analysis for each patient, for whom costs concerns are weighed against their perceived benefits necessity beliefs [ 2 ].
These are age, gender, highest educational level achieved and current employment status. Self-reported duration of RA was recorded. Higher scores indicate greater levels of helplessness.
Participants responded on a five-point scale strongly disagree to strongly agree. This consists of 11 items assessing general knowledge about RA and drug treatments. A percentage score is calculated. The questionnaire was piloted with 10 out-patients with RA and subsequently modified to improve clarity.
The database was sorted in alphabetical order by surname and the first people were selected. Freepost envelopes were provided for return of the questionnaires. The LREC required all replies to be anonymous, and so no reminders to non-respondents could be sent. Data were analysed using SPSS v Data distributions were normal and therefore parametric analysis was conducted. Bivariate correlations were used to examine the associations of concerns scores and necessity scores with the variables of interest sociodemographic, disease-related, DMARD-related and knowledge of RA.
Partial correlations were used to further examine these associations with the remaining variables held constant. For nominal variables e. Three hundred and forty-four of questionnaires were returned, a response rate of Some respondents did not complete every questionnaire item. Non-respondents were similar to the total sample mailed in terms of age and gender.
The median disease duration was The mean mHAQ score was 1. The mean fatigue VAS was The mean RAI score was The mean RA knowledge score was The majority of the sample Medication was considered important for both the maintenance of current health and for future health.
However, overall Another area of concern was becoming dependent upon medications There was much less concern about the inconveniences and disruption to life's routines associated with taking anti-rheumatic drugs or not having sufficient information about these. The mean necessity score of For 51 For 23 7. The mean necessity score for women Correlations between necessity scores and other variables are shown in Table 2.
There was no association between the necessity score and the sociodemographic variables of age or level of formal education. Greater levels of pain, fatigue and physical disability mHAQ were associated with greater belief in the necessity of arthritis medications. Necessity scores also correlated positively with a sense of greater helplessness RAI. Longer disease duration, longer DMARD treatment duration and greater numbers of DMARDs taken were all associated with greater belief in the necessity of medications, although the first two of these correlations were very weak.
There was no correlation between knowledge about RA and necessity scores. Associations of study variables with Beliefs about Medicines Specific Necessity scores. Concerns scores for men mean Correlations of concerns scores with other variables are shown in Table 3. There was a very weak negative association with age, older people tending to report less concern. There was also a very weak negative correlation between level of formal education and concerns, more highly qualified people having lower concerns scores.
Higher pain and fatigue scores were associated with greater levels of concern about taking medications. There was a moderate positive correlation between mHAQ score and concerns score. The correlation between concerns scores and RAI was strong, even when the three medications-related components of this index were omitted.
Those who reported having had adverse effects from treatment had higher concerns scores mean There was no association between knowledge about RA and concerns scores. Associations of study variables with Beliefs about Medicines Specific Concerns scores. Factors significantly associated with a positive necessity—concerns differential were a lower RAI score i.
However, concerns scores of the adherent group mean Knowledge scores for those who reported not taking their medications as directed mean The main finding of our study was that three-quarters of people with RA have positive beliefs about the necessity of their medication.
However, strong concerns about potential adverse effects, particularly long-term effects, were also expressed by almost half the respondents. In comparison with other chronic illness groups, the average necessity score was similar to that observed among asthmatic, renal dialysis and oncology patients [ 2 ]. The average concerns score was similar to that of asthmatic patients, and notably higher than that for renal dialysis, oncology and cardiac patients [ 2 ]. Two previous studies of medication beliefs of patients with rheumatological conditions also found that participants expressed strong concerns about potential adverse consequences of treatment [ 6 , 7 ].
We found that the greater the number of DMARDs patients had taken, the greater their concerns about medications, even after adjusting for pain, fatigue and disability.
However, belief in the necessity of arthritis medication also positively correlated with the number of DMARDs taken and this association also remained after adjustment.
To our knowledge, only one previous study has used the BMQ to assess medication beliefs among patients with RA. Skingle investigated whether current beliefs were associated with past decisions to reject starting DMARDs [ 16 ]. The group who had rejected DMARDs had significantly greater concerns scores, but necessity scores did not differ from those who had started treatment. This is the first study of people with RA that examines potential associations of medication beliefs assessed using the BMQ.
Psychometric properties of the Belief about Medicines Questionnaire (BMQ) in the Maltese language
Identifying factors associated with adherence is of great value in clinical practice. The objective of this study was to investigate medication adherence, beliefs about medicines held by people with chronic illness and whether beliefs influence medication adherence. The study was carried out at primary health care clinic of the Palestinian Medical Military Services in Nablus, Palestine. The beliefs about medicines questionnaire was used to assess beliefs and Morisky medication adherence scale was used to assess adherence. A total of patients were interviewed. Most participants
The challenges of assessing patients' medication beliefs: a qualitative study
Msida Malta. Post-Doctoral Researcher. Senior Lecturer. Msida, Malta.
Beliefs about Medicines Questionnaire (BMQ)