Different Associations of Intentional and Non-Intentional Non-Adherence Behaviors with Patient Experience with Healthcare and Patient Beliefs in Medications: A Survey of Patients with Chronic Conditions

Figures & data

Table 1 Prevalence of Non-Adherence Behaviors in Chronic Diseases

	All Patients (n = 1530)	Rheumatic Diseases (n = 336)	IBD (n = 322)	HIV Infection (n = 442)	DM (n = 430)	Overall p-value
At least one non-adherence behavior, n (%)	812 (53.1)	188 (56.0)	179 (55.6)	189 (42.8)	257 (59.8)	<0.001
At least one non-intentional non-adherence behavior, n (%)	533 (35.1)	104 (31.1)	124 (38.6)	148 (33.9)	157 (36.8)	0.182
Forgetfulness in taking medication (skipping doses), n (%)	496 (32.4)	96 (28.6)	117 (36.2)	140 (31.6)	143 (33.3)	0.199
Taking medication at unscheduled hours, n (%)	89 (5.8)	19 (5.6)	18 (5.5)	22 (5.0)	31 (7.1)	0.588
At least one intentional non-adherence behavior, n (%)	505 (33.2)	130 (38.9)	110 (34.3)	78 (17.8)	187 (43.8)	<0.001
Stopping medication when feeling well, n (%)	90 (5.9)	34 (10.1)	21 (6.5)	11 (2.5)	25 (5.7)	<0.001
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)	<0.001
Stopping medication after reading the patients’ information leaflet, n (%)	179 (11.7)	39 (11.5)	27 (8.4)	30 (6.8)	83 (19.4)	<0.001

Abbreviations: DM, diabetes mellitus; HIV, human immunodeficiency virus; IBD, inflammatory bowel disease.

Figure 1 Frequency of non-adherence behaviors (non-intentional, intentional or mixed) in the different patient cohorts. Data are shown as percentages.

Figure 2 Frequency of non-adherence behaviors (non-intentional, intentional or mixed) by (A) quartiles of experience score (IEXPAC) and (B) quartiles of overall Beliefs in Medicines (BMQ) score. Data are shown as percentages. Quartiles of IEXPAC overall score: Q1: <4.77; Q2: 4.77–6.36; Q3: 6.36–7.27; Q4: >7.27. Quartiles of BMQ overall score: Q1: <2; Q2: 2–6; Q3: 6–11; Q4: >11.

Table 2 IEXPAC Results Stratified by: Adherent Patients, Patients with Only Non-Intentional Non-Adherence Behaviors, Patients with Only Intentional Non-Adherence Behaviors, and Patients with Both Non-Intentional and Intentional Non-Adherence Behaviors (Mixed)

IEXPAC Overall and Factors Scores	Adherent	Non-Adherent			Overall p-value
		Non-Intentional	Intentional	Mixed
	Mean (SD)
IEXPAC overall score	6.2 (1.9)	5.9 (1.9)**	5.9 (1.8)*	5.8 (1.8)**	0.004
Factor 1	8.3 (2.2)	7.8 (2.2)**	7.9 (2.1)**	7.8 (2.1)***	<0.001
Factor 2	2.0 (2.3)	2.2 (2.2)	2.0 (2.1)	2.2 (2.3)	0.414
Factor 3	7.4 (2.8)	6.7 (2.4)***	6.9 (2.3)**	6.7 (2.1)***	<0.001
IEXPAC items^a	Always/mostly responses (%)				p-value
1. They respect my lifestyle	84.3	79.4	77.2**	79.7	0.039
2. They are coordinated to offer good healthcare to me	72.5	65.5*	67.1	65.2*	0.054
3. They help me to get information from the internet	13.8	15.8	14.3	17.9	0.470
4. Now I can take care of myself better	86.1	80.5*	76.2***	71.1***	<0.001
5. They ask me and help me to follow my treatment plan	83.3	75.8**	77.5*	74.7**	0.006
6. We set goals for a healthy life and better control my illness	74.3	60.7***	70.9	65.8*	<0.001
7. I can use the internet and my mobile phone to consult my medical records	8.0	8.3	4.2*	6.0	0.148
8. They make sure that I take medication correctly	80.3	73.2*	73.9*	67.0***	<0.001
9. They worry about my welfare	85.6	82.7	84.7	80.7	0.297
10. I have been informed on health and social resources that can help me	43.8	38.9	37.6	41.1	0.262
11. They encourage me to talk to other patients	15.2	16.0	13.4	13.5	0.775
12. They care about me when I come home after being in the hospital	30.1	30.2	30.5	32.3	0.970

Notes: *p<0.05 versus adherent group; **p<0.01 versus adherent group; ***p<0.001 versus adherent group. ^aSee methods section for details of IEXPAC items.

Table 3 BMQ Results Stratified by: Adherent Patients, Patients with Only Non-Intentional Non-Adherence Behaviors, Patients with Only Intentional Non-Adherence Behaviors, and Patients with Both Non-Intentional and Intentional Non-Adherence Behaviors (Mixed)

BMQ Overall and Sub-Scales Scores	Adherent	Non-Adherent			Overall p-value
		Non-Intentional	Intentional	Mixed
	Mean (SD)
BMQ overall score	8.2 (6.3)	6.9 (6.1)**	5.4 (5.7)***	3.0 (5.7)***	<0.001
Necessity scale score	21.8 (3.8)	21.1 (3.8)*	20.6 (4.4)***	19.3 (4.3)***	<0.001
Concerns scale score	13.5 (4.8)	14.1 (4.5)	15.2 (4.1)***	16.2 (3.9)***	<0.001
Necessity scale	Strongly agree/agree (%)				p-value
My health, at present, depends on my medicines	88.9	84.7	82.3**	75.6***	<0.001
My life would be impossible without my medicines	81.3	75.0 *	74.2*	60.9***	<0.001
Without my medicines, I would be very ill	83.7	80.0	74.7**	67.2***	<0.001
My health, in the future, will depend on my medicines	85.9	80.3*	78.0**	71.7***	<0.001
My medicines protect me from becoming worse	89.6	87.8	88.3	81.5**	0.014
Concerns scale	Strongly agree/agree (%)				p-value
Having to take my medicines worries me	36.8	45.6*	52.3***	57.1***	<0.001
I sometimes worry about the long-term effects of my medicines	57.4	59.5	67.7**	67.9**	0.003
My medicines are a mystery to me	25.6	25.4	24.7	31.8	0.242
My medicines disrupt my life	13.8	15.4	15.2	25.6***	<0.001
I sometimes worry about becoming too dependent on my medicines	28.4	31.3	39.8**	44.9***	<0.001

Notes: *p<0.05 versus adherent group; **p<0.01 versus adherent group; ***p<0.001 versus adherent group.

Table 4 Multivariate Analysis

A. Variables Related to Only Non-Intentional Non-Adherence Behaviors
Model 1 (IEXPAC and BMQ overall scores)	OR (95% CI)	p-value
Age (1-year increment)	0.98 (0.96–0.99)	<0.001
Needing to take medication 3–4 times per day (versus 1–2 times per day)	1.57 (1.08–2.27)	0.018
BMQ, overall score (1-unit increment)	0.96 (0.94–0.90)	0.01
Model 2 (IEXPAC and BMQ sub-scores)	OR (95% CI)	p-value
Age (1-year increment)	0.98 (0.97–0.99)	0.006
IEXPAC Factor 3: self-management score (1-unit increment)	0.90 (0.84–0.96)	0.003
B. Variables related to only intentional non-adherence behaviors
Model 1 (IEXPAC and BMQ overall scores)	OR (95% CI)	p-value
Chronic condition: DM (versus HIV infection)	4.35 (2.47–7.66)	<0.001
Chronic condition: IBD (versus HIV infection)	2.58 (1.39–4.79)	0.003
Chronic condition: rheumatic diseases (versus HIV infection)	3.38 (1.87–6.13)	<0.001
BMQ, overall score (1-unit increment)	0.93 (0.90–0.96)	<0.001
Model 2 (IEXPAC and BMQ sub-scores)	OR (95% CI)	p-value
Chronic condition: DM (versus HIV infection)	4.46 (2.49–7.99)	<0.001
Chronic condition: IBD (versus HIV infection)	2.34 (1.23–4.44)	0.01
Chronic condition: rheumatic diseases (versus HIV infection)	3.39 (1.85–6.24)	<0.001
BMQ Necessity score (1-unit increment)	0.94 (0.89–0.98)	0.008
BMQ Concerns score (1-unit increment)	1.08 (1.04–1.13)	<0.001
C. Variables related to mixed behaviors
Model 1 (IEXPAC and BMQ overall scores)	OR (95% CI)	p-value
Chronic condition: DM (versus HIV infection)	2.99 (1.75–5.11)	<0.001
Chronic condition: IBD (versus HIV infection)	1.48 (0.81–2.69)	0.203
Chronic condition: rheumatic diseases (versus HIV infection)	0.98 (0.52–1.86)	0.951
BMQ, overall score (1-unit increment)	0.87 (0.83–0.90)	<0.001
Model 2 (IEXPAC and BMQ sub-scores)	OR (95% CI)	p-value
Chronic condition: DM (versus HIV infection)	3.44 (1.96–6.05)	<0.001
Chronic condition: IBD (versus HIV infection)	1.60 (0.85–3.00)	0.144
Chronic condition: rheumatic diseases (versus HIV infection)	0.98 (0.50–1.93)	0.965
BMQ Necessity score (1-unit increment)	0.87 (0.82–0.91)	<0.001
BMQ Concerns score (1-unit increment)	1.17 (1.12–1.23)	<0.001

Notes: The variables in the model were age (numerical), gender (male and female), background disease (HIV infection as reference, DM, IBD, rheumatic disease), number of medicines per day (numerical), number of times per day medication was taken (3–4 times a day versus 1–2 times a day), and overall IEXPAC and BMQ scores (Model 1) or IEXPAC and BMQ sub-scores (Model 2) (in both cases numerical, with score increments of 1 unit).

Abbreviations: DM, diabetes mellitus; HIV, human immunodeficiency virus; IBD, inflammatory bowel disease.