Association between non-adherence behaviors, patients’ experience with healthcare and beliefs in medications: a survey of patients with different chronic conditions

Figures & data

Table 1. Prevalence of non-adherence behaviors in chronic diseases.

	All patients (n = 1,530)	Rheumatic disease (n = 336)	IBD (n = 322)	HIV infection (n = 442)	DM (n = 430)	p-Value
At least one non-adherence behavior, n (%)	812 (53.1)	188 (56.0)	179 (55.6)	189 (42.8)	257 (59.8)	<.001
Forgetfulness in taking medication (skipping doses), n (%)	496 (32.4)	96 (28.6)	117 (36.2)	140 (31.6)	143 (33.3)	.199
Taking medication at unscheduled hours, n (%)	89 (5.8)	19 (5.6)	18 (5.5)	22 (5.0)	31 (7.1)	.588
Stopping medication when feeling well, n (%)	90 (5.9)	34 (10.1)	21 (6.5)	11 (2.5)	25 (5.7)	<.001
Stopping medication if it makes the patient feel unwell, n (%)	418 (27.3)	111 (33.0)	91 (28.3)	55 (12.5)	160 (37.2)	<.001
Stopping medication after reading the patients’ information leaflet, n (%)	179 (11.7)	39 (11.5)	27 (8.4)	30 (6.8)	83 (19.4)	<.001

Abbreviations. DM, Diabetes mellitus; HIV, Human immunodeficiency virus; IBD, Inflammatory bowel disease.

Table 2. Overall IEXPAC and Factor scores in patients with or without non-adherence behaviors, and the proportion of patients giving always/mostly responses to individual IEXPAC items.

	All patients	Patients with ≥1 non-adherence behavior	Patients without non-adherence behavior	p-Value
IEXPAC and Factors, mean (SD)
IEXPAC overall score	6.0 (1.9)	5.8 (1.9)	6.2 (1.9)	< .001
Factor 1: Productive interactions score (items 1, 2, 5, and 9)	8.0 (2.2)	7.8 (2.2)	8.3 (2.2)	< .001
Factor 2: New relational model score (items 3, 7, and 11)	2.0 (2.3)	2.1 (2.2)	2.0 (2.3)	.193
Factor 3: Self-management score (items 4, 6, 8, and 10)	7.1 (2.3)	6.8 (2.3)	7.4 (2.3)	<.001
IEXPAC items	Always/mostly responses (%)			p-Value
1. They respect my lifestyle	81.5	78.9	84.3	.007
The professionals who care for me listen to me and ask me about my needs, habits and preferences to adapt my treatment and care plan
2. They are coordinated to offer good health care to me	69.1	66.1	72.5	.008
Health and social care services are coordinated to improve my wellbeing and quality of life in my environment (family, neighborhood, town).
3. They help me to get information from the internet	15.0	16.0	13.8	.233
The professionals who care for me inform me about trustful webpages and internet forums that I can consult to know my disease better, its treatment and the consequences they may have on my life.
4. Now I can take care of myself better	80.8	76.2	86.1	<.001
I feel that my confidence in my ability to take care of myself, manage my health problems and keep my autonomy has improved.
5. They ask me and help me to follow my treatment plan	79.5	76.1	83.3	.001
I regularly review adherence to my treatment and care plan with the professionals who care for me.
6. We set goals for a healthy life and better control my illness	69.8	65.8	74.3	<.001
I’ve been able to agree with the professionals who care for me on specific objectives regarding diet, physical exercise and medication to get better control of my health problems.
7. I can use the internet and my mobile phone to consult my medical records	7.2	6.4	8.0	.241
I can consult my clinical record, tests results, programmed visits and access to other services through the internet or the mobile app of my health service.
8. They make sure that I take medication correctly	75.8	71.8	80.3	<.001
The professionals who care for me review with me all of the medication I take, how I take it and how it suits me.
9. They worry about my welfare	84.1	82.9	85.6	.151
The professionals who care for me are concerned with my quality of life and I feel they are committed to my wellbeing.
10. I have been informed on health and social resources that can help me	41.3	39.1	43.8	.067
The professionals who care for me inform me about health and social resources available in my neighbourhood or town that I can use to improve my health problems and take better care of myself.
11. They encourage me to talk to other patients	14.7	15.2	14.3	.647
The professionals who care for me invite me to participate in patients groups to share information and experiences on how to care for ourselves and improve our health.
Respond to the following statement only if you have been admitted to the hospital in the last 3 years
12. They care about me when I come home after being in the hospital	30.5	31.0	30.1	.783
After hospital discharge, they have called or visited me at home to see how I was and what care I needed.

Figure 1. Frequency of at least one non-adherence behavior by quartiles (Q) of IEXPAC experience scores. Quartiles of IEXPAC overall score: Q1: <4.77; Q2: 4.77–6.36; Q3: 6.36–7.27; Q4: >7.27. Quartiles of Factor 1 (productive interactions) score: Q1: <6.87; Q2: 6.87–8.75; Q3: 8.75–10.0; Q4: >10.0. Quartiles of Factor 2 (new relational model) score: Q1: 0; Q2: 0–1.66; Q3: 1.66–3.33; Q4: >3.33. Quartiles of Factor 3 (patient self-management) score: Q1: <5.62; Q2: 5.62–7.50; Q3: 7.50–8.75; Q4: >8.75. p-Values denote linear trend.

Table 3. Overall Beliefs about Medicines Questionnaire (BMQ), Necessity and Concerns Scale scores in patients with or without non-adherence behaviors, and the proportion of patients giving strongly agree/agree responses to individual BMQ items.

	All	Patients with ≥ 1 non- adherence behavior	Patients without non- adherence behavior	p-Value
BMQ and factors, mean (SD)
BMQ overall score	6.6 (6.3)	5.2 (6.1)	8.2 (6.3)	<.001
Necessity Scale score	21.0 (4.1)	20.4 (4.3)	21.8 (3.8)	<.001
Concerns Scale score	14.4 (4.6)	15.1 (4.3)	13.5 (4.8)	<.001
	Strongly agree/agree (%)			p-Value
Necessity Scale
My health, at present, depends on my medicines	84.8	81.1	88.9	<.001
My life would be impossible without my medicines	75.7	70.7	81.3	<.001
Without my medicines, I would be very ill	78.9	74.6	83.7	<.001
My health, in the future, will depend on my medicines	81.3	77.2	85.9	<.001
My medicines protect me from becoming worse	87.7	86.1	89.6	.037
Concerns Scale
Having to take my medicines worries me	44.4	51.1	36.8	<.001
I sometimes worry about the long-term effects of my medicines	61.4	65.0	57.4	.003
My medicines are a mystery to me	26.6	27.4	25.6	.446
My medicines disrupt my life	16.2	18.2	13.8	.020
I sometimes worry about becoming too dependent on my medicines	33.7	38.4	28.4	<.001

Figure 2. Frequency of at least one non-adherence behavior by quartiles (Q) of BMQ beliefs in medicines scores. Quartiles of BMQ overall score: Q1: <2; Q2: 2–6; Q3: 6–11; Q4: >11. Quartiles of Necessity Scale score: Q1: <19; Q2: 19–21; Q3: 21–25; Q4: >25. Quartiles of Concerns Scale score: Q1: <11; Q2: 11–15; Q3: 15–18; Q4: >18. p-Values denote linear trend.

Table 4. Multivariate analyses of variables associated with the presence of ≥1 non-adherence behavior.

Variable	Model 1 (IEXPAC and BMQ overall scores)		Model 2 (IEXPAC and BMQ sub-scores)
	OR (95% CI)	p-Value	OR (95% CI)	p-Value
Age (1-year increment)	0.99 (0.98–1.00)	.219	0.99 (0.98–1.01)	.476
Gender (female versus male)	1.09 (0.83–1.43)	.558	1.12 (0.84–1.49)	.448
Chronic condition: DM (versus HIV infection)	2.17 (1.43–3.29)	<.001	2.29 (1.47–3.56)	<.001
Chronic condition: IBD (versus HIV infection)	1.26 (0.86–1.85)	.244	1.19 (0.80–1.77)	.398
Chronic condition: rheumatic disease (versus HIV infection)	1.21 (0.81–1.81)	.349	1.16 (0.77–1.76)	.485
Needing to take medication 3–4 times per day (versus 1–2 times per day)	1.34 (0.98–1.83)	.069	1.29 (0.93–1.79)	.135
Number of different medicines (1-unit increment)	0.95 (0.91–1.00)	.071	0.96 (0.91–1.01)	.095
IEXPAC, overall score (1-unit increment)	0.98 (0.91–1.05)	.516
IEXPAC Factor 1: productive interactions score (1-unit increment)			1.08 (0.98–1.18)	.146
IEXPAC Factor 2: new relational model score (1-unit increment)			1.07 (1.00–1.14)	.064
IEXPAC Factor 3: self-management score (1-unit increment)			0.87 (0.79–0.96)	.007
BMQ, overall score (1-unit increment)	0.93 (0.91–0.95)	<.001
BMQ Necessity score (1-unit increment)			0.93 (0.90–0.97)	<.001
BMQ Concerns score (1-unit increment)			1.08 (1.04–1.11)	<.001

Abbreviations. BMQ, Beliefs about Medicines Questionnaire; CI, Confidence interval; DM, Diabetes mellitus; HIV, Human immunodeficiency virus; IBD, Inflammatory bowel disease; IEXPAC, Instrument to Evaluate the Experience of Patients with Chronic diseases; OR, Odds ratio.