Psychosocial Predictors of Self-Efficacy Related to Self-Reported Adherence in Older Chronic Patients Dealing with Hypertension: A European Study

Figures & data

Table 1 Measures for Data Collection with Related Construct and Scores Interpretation

Measures	Construct	Scores Interpretation (↗ High, ↘ Low)
MGLS	Pharmacological adherence	↗ Scores ↗ Pharmacological adherence
ARMS	Adherence to refill medicines	↗ Scores ↘ Adherence to refill medicines
INAS	Intentional non-adherence	↗ Scores ↗ Intentional non-adherence
ASonA	Antecedents (cognitive, social, emotional and behavioral factors) and self-efficacy related to adherence	↗ Scores ↗ Higher cognitive, social and behavioral abilities and self-efficacy in adherence management
ASonA-SE	Self-efficacy related to clinical (pharmacological and non-pharmacological) adherence	↗ Scores ↗ Higher self-efficacy related to clinical adherence
BMQ-10	Beliefs (concerns and necessity) about medicines	↗ Scores ↗ Positive beliefs about medicines
CAT	Perceived physician’s communication skills	↗ Scores ↗ Doctor/patient communication
MSPSS	Perceived medication-specific social support	↗ Scores ↗ Perceived social support related to medical adherence

Abbreviations: MGLS, Morisky Green Levine Scale; ARMS, Adherence to Refills and Medications Scale; INAS, Intentional Non-Adherence Scale; ASonA, Antecedents and Self-efficacy on Adherence Schedule (ASonA-SE, Self-efficacy subscale); BMQ-10, Beliefs about Medicines Questionnaire; CAT, Communication Assessment Tool; MSPSS, Multidimensional Scale of Perceived Social Support.

Table 2 Descriptive Results of Socio-Demographic and Clinical Characteristics of the Sample

	Italian Inpatients Under Rehab (A) (n=63)	Polish Inpatients (B) (n=130)	Polish Outpatients (C) (n=265)	p*	Post Hoc	Total (n=458)
Descriptive (M±SD)
Age	76.1±6.3	71.3±10.4	72.1±6.1	<0.001	A>C, B	72.4±7.8
Weight (kg)	74.7±15.6	81.7±14.3	82.7±15.5	0.001	C, B>A	81.3±15.4
Height (m)	167.2±9.5	165.1±12.5	171.5±110.6	0.762		169.1±84.5
SBP (mmHg)	106.2±28.5	145.1±58.7	138.2±14.4	<0.001	B, C>A	136.9±36.6
DBP (mmHg)	88.6±25.3	82.1±7.2	81.1±8.2	<0.001	A>B, C	82.2±11.2
n. of chronic comorbidities	1.57±0.78	2.05±1.03	1.7±0.79	<0.001	B>C, A	1.78±0.88
n. of hypertension drugs used	1.84±0.83	2.07±1.11	2.09±0.97	0.205		1.78±0.88
Frequencies, n (%)
Gender				0.007
Male	36 (57.1)	47 (35.9)	98 (36.7)			181 (39.3)
Female	27 (42.9)	84 (64.1)	169 (63.3)			280 (60.7)
Marital status				0.104
Married, Living with a partner	34 (54.0)	90 (68.7)	161 (60.3)			285 (61.8)
Single, Divorced	29 (46.0)	41 (31.3)	106 (39.7)			176 (38.2)
Diabetes				0.077
Diabetes	24 (38.1)	62 (47.3)	95 (35.6)			181 (39.3)
No diabetes	39 (61.9)	69 (52.7)	172 (64.4)			280 (60.7)

Notes: *p-value from ANOVA for continuous variable and from X² test for categorial variables. Fischer’s LSD was used as post hoc procedure.

Abbreviations: SBP, systolic blood pressure; DBP, diastolic blood pressure.

Table 3 Mean Scores of the Sample and Comparisons Among and Between Subgroups

Measure (Range)	Italian Inpatients Under Rehab (A) (n=63, M±SD)	Polish Inpatients (B) (n=130, M±SD)	Polish Outpatients (C) (n=265, M±SD)	p*	Post Hoc	Total (n=458, M±SD)
MGLS (0–4)	3.5±0.8	1.8±1.3	2.2±1.4	<0.001	A>C>B	2.3±1.4
ARMS (14–56)	18.3±1.8	27.5±7.7	31.1±9.7	<0.001	C>B>A	28.3±9.5
INAS (22–110)	24.1±7.9	43.5±20.8	49.6±19.5	<0.001	C>B>A	44.4±20.6
ASonA (0–80)	60.7±11.2	45.3±10.2	46.7±9.8	<0.001	A>C, B	48.0±11.3
ASonA-SE (0–24)	20.7±2.4	15.7±4.7	15.8±4.5	<0.001	A>C, B	16.5±4.6
BMQ-10 (11–55)	43.1±6.2	25.6±4.9	26.2±4.9	<0.001	A>C, B	28.3±7.8
CAT (15–75)	63.6±10.6	50.2±13.2	52.3±12.1	<0.001	A>C, B	53.3±12.9
MSPSS (12–84)	68.3±14.5	59.7±16.9	58.5±16.1	<0.001	A>B, C	60.2±16.5

Notes: *p-value from the analysis of variance (ANOVA). Fischer’s LSD test was used as post hoc procedure.

Abbreviations: M, mean; SD, standard deviation; MGLS, Morisky Green Levine Scale; ARMS, Adherence to Refills and Medications Scale; INAS, Intentional Non-Adherence Scale; ASonA, Antecedents and Self-efficacy on Adherence Schedule (ASonA-SE, Self-efficacy subscale); BMQ-10, Beliefs about Medicines Questionnaire; CAT, Communication Assessment Tool; MSPSS, Multidimensional Scale of Perceived Social Support.

Table 4 Pearson’s Correlation Coefficients of All Measures

	BMQ-10	CAT	MSPSS	MGLS	INAS	ARMS	ASonA	ASonA-SE
BMQ-10	-
CAT	0.397**	-
MSPSS	0.268**	0.353**	-
MGLS	0.239**	0.03	−0.136*	-
INAS	−0.351**	−0.137**	−0.256**	0.036	-
ARMS	−0.397**	−0.213**	−0.284**	0.458**	0.366**	-
ASonA	0.52**	0.566**	0.461**	0.036	−0.232**	−0.348**	-
ASonA-SE	0.463**	0.509**	0.398**	−0.005	−0.255**	−0.334**	0.805**	-

Notes: *p<0.01, **p<0.001.

Abbreviations: BMQ-10, Beliefs about Medicines Questionnaire; CAT, Communication Assessment Tool; MSPSS, Multidimensional Scale of Perceived Social Support; MGLS, Morisky Green Levine Scale; INAS, Intentional Non-Adherence Scale; ARMS, Adherence to Refills and Medications Scale; ASonA, Antecedents and Self-efficacy on Adherence Schedule (ASonA-SE, Self-efficacy subscale).

Table 5 Results from the Multiple Regression Analysis Considering Patients’ Self-Efficacy as Dependent Variable (ASonA-SE, n=458)

Indipendent Variables	Coefficient	95% CI		p
BMQ-10	0.126	0.074	0.178	<0.001
CAT	0.114	0.085	0.144	<0.001
MSPSS	0.043	0.02	0.065	<0.001
ARMS	−0.049	−0.089	−0.009	0.017
INAS	−0.021	−0.04	−0.002	0.031
Age	−0.042	−0.098	0.014	0.14
Gender	0.346	−.0342	1.034	0.323

Abbreviations: ASonA-SE, Antecedents and Self-efficacy on Adherence Schedule – Self-efficacy subscale; BMQ-10, Beliefs about Medicines Questionnaire; CAT, Communication Assessment Tool; MSPSS, Multidimensional Scale of Perceived Social Support; ARMS, Adherence to Refills and Medications Scale; INAS, Intentional Non-Adherence Scale.

Figure 1 Model showing possible circular effect of higher levels of psychosocial and behavioral factors, self-efficacy, and clinical adherence.