Intentionality in adherence to long-term therapies. Results from an online survey of 3,001 patients with cardio-metabolic pathologies in France

Figures & data

Table 1 Univariate Analysis of the Absence of Intentional Nonadherence

Do you sometimes deliberately not take your medication?
Never (n = 1778 out of 2022 nonadherent patients) (87.9%)		Test-value	P
Have you ever stopped taking your treatment because, on some days, you feel your treatment is doing more harm than good?	No	18.38	<0.0001
Did you forget to take your medication this morning?	No	12.51	<0.0001
If you are concerned, how many times do you need to take an injection?	Injectable: No	11.16	<0.0001
Have you run out of medication since the last visit?	No	9.32	<0.0001
Has your doctor or pharmacist advised you about proper nutrition?	No	7.81	<0.0001
Have you experienced side effects from your medication(s)?	No	7.41	<0.0001
What is your vision of the benefit of your medication?	Beneficial	7.20	<0.0001
How old are you?	53–70	7.01	<0.0001
Are you currently employed? (several possibilities given)	No	6.77	<0.0001
When was this (these) condition(s) diagnosed? Hypertension	> 6 months	6.76	<0.0001
Which of the following people support you in taking your medication(s) correctly? Nurse	Not concerned	6.50	<0.0001
How many times per day must you take medication for this (these) condition(s)? Hypertension	Once daily	6.24	<0.0001
How many tablets or capsules (by mouth) do you take per day for this/these condition(s)? Hypertension	One	5.97	<0.0001
When you sometimes do not take your medication, can you give the reason why?	No	5.96	<0.0001
When you sometimes do not take your medication, can you give the reason why?	Never	5.96	<0.0001
To what extent do you feel your GP understands problems with your treatment?	Understands	5.88	<0.0001
Have you ever not taken your medication because you had a memory lapse on certain days?	No	5.83	<0.0001
Do you have other tricks for taking your medication every day?	No	5.69	<0.0001
To what extent do you feel that your GP takes your needs into account?	Takes into account	5.49	<0.0001
“I do a physical activity because I am used to doing it.”	Disagree	5.46	<0.0001
What disease(s) do you suffer from?	Hypertension	5.29	<0.0001
Generally speaking, when you are in the habit of doing something, do you stick to it?	Yes	4.95	<0.0001
Has your pharmacist advised you to be physically active on a regular basis?	No	4.78	<0.0001
Which of the following people support you in taking your medication(s) correctly? Friends	Not concerned	4.50	<0.0001
Do you think you have too much medication to take?	No	4.44	<0.0001
Q46 Which of the following people support you in taking your medication(s) correctly? Children	Not concerned	4.42	<0.0001
How old are you?	70 and more	3.81	<0.0001
Are side effects one reason you do not take your medication regularly?	Disagree	3.48	<0.0001
Which of the following people support you in taking your medication(s) correctly? Spouse	Not concerned	3.41	<0.0001
Has your doctor or pharmacist advised you about proper nutrition?	No	3.35	<0.0001
Do you share a medical condition(s) with a family member(s)?	No	3.22	0.0006
Do you follow their advice?	No	2.89	0.0019
“I take my medication because I’m used to taking it.”	Agree	2.87	0.0020
How many tablets or capsules (by mouth) do you take per day for this/these condition(s)? Hypercholesterolemia	One	2.80	0.002
To what extent would you say there is a relationship of trust between you and your specialist?	Trust	2.71	0.003
To what extent do you feel involved in decisions about your treatment?	Involved	2.62	0.004
Would you say that your relationship with your doctor influences whether you are taking your medications correctly?	Disagree	2.51	0.005
To what extent do you feel adequately informed about your pathology(ies)?	Informed	2.25	0.012
To what extent do you feel your specialist understands problems with your treatment?	Understands	2.1395	0.016
How many times per day must you take medication for this (these) condition(s)? Hypercholesterolemia	Once daily	2.13	0.016

Notes: Determinants, in descending order of significance, of the response “never” to the question: Do you sometimes deliberately not take your medication?

Table 2 Univariate Analysis of the Effect of Habit

How much do you agree with the following statement about taking your medication? “I take my medication because I am used to taking it.”
Fully agree (n = 1325, 44.15%)
		Test-value	P
Do you sometimes deliberately not take your medication?	Never	10.84	<0.0001
Have you ever stopped taking your treatment because, on some days, you feel your treatment is doing more harm than good?	No	7.60	<0.0001
What is your vision of the benefit of your medication?	Beneficial	7.54	<0.0001
Have you ever taken your medication later than usual?	No	5.41	<0.0001
Generally speaking, when you are in the habit of doing something, do you stick to it?	Yes	5.31	<0.0001
“I do a physical activity because I am used to doing it.”	Agree	5.24	<0.0001
Have you ever not taken your medication because you had a memory lapse on certain days?	No	5.04	<0.0001
Adherent/nonadherent	Adherent	4.95	<0.0001
To what extent do you feel adequately informed about your pathology(ies)?	Informed	4.90	<0.0001
Did you forget to take your medication this morning?	No	4.60	<0.0001
To what extent do you feel your GP understands problems with your treatment?	Understands	4.57	<0.0001
To what extent do you feel that your GP takes your needs into account?	Takes into account	4.54	<0.0001
To what extent do you feel adequately informed about your medication(s)	Informed	4.40	<0.0001
When was this (these) condition(s) diagnosed? Hypertension	More than 6 months	4.03	<0.0001
What disease(s) do you suffer from (several possibilities given, Hypertension, Cholesterol, Type 2 Diabetes, None of these)?	Hypertension	3.90	<0.0001
When you sometimes do not take your medication, can you give the reason why?	I can	3.87	<0.0001
When you sometimes do not take your medication, can you give the reason why?	I cannot	3.75	<0.0001
When was this (these) condition(s) diagnosed? Diabetes	More than 6 months	3.45	<0.0001
To what extent would you say there is a relationship of trust between you and your GP?	Trust	3.42	<0.0001
What disease(s) do you suffer from?	Diabetes	3.33	<0.0001
How many tablets or capsules (by mouth) do you take per day for this/these condition(s)? Hypertension	More than one tablet	3.28	0.0005
To what extent do you feel involved in decisions about your treatment?	Involved	3.10	0.0009
How old are you?	53 and more	3.07	0.0010
How many times per day must you take medication for this (these) condition(s)? Hypertension	More than once daily	2.97	0.0014
How many times per day must you take medication for this (these) condition(s)? Diabetes	More than once daily	2.88	0.0019
Have you experienced side effects from your medication(s)?	No	2.77	0.0027
How many times per day must you take medication for this (these) condition(s)? Hypertension	Once daily	2.64	0.0041
Are you currently employed?	No	2.60	0.0046
How many times per day must you take medication for this (these) condition(s)? Hypercholesterolemia	Once daily	2.52	0.0057
How many times per day must you take medication for this (these) condition(s)? Diabetes	Once daily	2.52	0.0057
How many tablets or capsules (by mouth) do you take per day for this/these condition(s)? Hypertension	One tablet	2.37	0.0088
Have you run out of medication since the last visit?	No	2.02	0.021

Notes: Determinants, in descending order of significance, of the response “fully agree” to the question: How much do you agree with the following statement about taking your medication: I take my medication because I am used to taking it.

Figure 1 Multiple Correspondence Analysis. A: Age A1≥ 53/A2<53 years; B: Adherence B1 Adherent/ B2 Nonadherent; C: Do you deliberately not take your medication? C1 Never/C2 other answer; D: Experienced adverse effects D1 No/D2 Yes; E: Generally speaking, when you have got into the habit of doing something, do you stick to it? E1 Yes/E2 No; F: To what extent do you feel involved in decisions about your treatment? F1: Fully/F2: other answer; G: To what extent would you say there is a relationship of trust between you and your GP? G1: Fully /G2: other answer: H: To what extent would you say there is a relationship of trust between you and your specialist? H1: Fully/H2: other answer; I: “I take my medication because I‘m used to taking it.” I1: Fully agree/I2: other answer.

Figure 2 A novel model of patient adherence in taking medications. According to this model, it is possible to improve medication adherence by promoting the use of the habit (1, unintentional adherence), by playing on the nature of the treatment (2). Physician attitudes make the patient feel involved in decisions and has trust in the physician (3). These two factors combat intentional nonadherence (4). Finally, the attitudes of the physician are associated with the presence of a nocebo effect of the drug which also favors the occurrence of intentional nonadherence (5). The effect of age on trusting the doctor could form a facet of the well-known influence of age on adherence (6).