The challenges of assessing patients' medication beliefs: a qualitative study

Rachael J Thorneloe,Christopher E.M Griffiths,Lis Cordingley,Darren M Ashcroft

doi:10.1186/s12913-017-2020-y

Rachael J Thorneloe, Christopher E.M Griffiths + Show 2 more

Open Access

https://doi.org/10.1186/s12913-017-2020-y

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Abstract

BackgroundAn estimated 50% of patients do not take their medication as prescribed, with medication adherence associated with adverse outcomes and higher costs of care. The Necessity-Concerns Framework identified individual’s beliefs about their medication as playing a key role in adherence, and UK Clinical Adherence Guidelines recommend eliciting and incorporating individual’s perceptions of their medication within the consultation. 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.MethodsWe examined the challenges of assessing medication beliefs using the BMQ in 20 people with a complex relapsing-remitting condition recruited from community sources. Data were collected from people with psoriasis; a patient group characterised by complex medication regimens, which include therapies that are applied topically, phototherapy/photochemotherapy, and therapies that are administered orally or via subcutaneous or intravenous injections. Semi-structured cognitive interviews were undertaken, with responses coded using established schedules and analysed using Content analysis.ResultsIndividual’s beliefs about their condition specific therapies were not accurately captured by the BMQ. Medication beliefs as expressed during ‘real-time’ completion of the BMQ were underestimated, or failed to be captured, by the corresponding scores given by participants.There was mismatch between the terminology used in the scale and individuals perceptions of their condition and the complexity of its management and treatment outcomes. Currently the BMQ cannot represent beliefs about medicines underuse, even though some individuals with psoriasis viewed access to therapies as overly restrictive. Some the BMQ items were misinterpreted in part due to ambiguous item wording or due to misreading by participants.ConclusionsThis is the first study to identify general and condition-specific difficulties experienced by individuals completing the BMQ in ‘real time’. The main implication of this research is the need to develop condition-specific versions of the BMQ in order that this important instrument can capture the full range of medication beliefs in individuals living with a complex relapsing-remitting condition. Access to condition-specific versions could significantly increase our understanding of beliefs which facilitate or reduce medication adherence.

Highlights

An estimated 50% of patients do not take their medication as prescribed, with medication adherence associated with adverse outcomes and higher costs of care
“I’m going to say uncertain about that and again because it really depends on what type of medicine you are talking about and what you are using it for.” [P4, general concerns Q17 ‘Most medicines do more harm than good’, item response ‘uncertain’, score 3/5]. This qualitative study examined the extent to which the Beliefs about Medicines Questionnaire (BMQ) is suitable for assessing condition-specific medication beliefs, using psoriasis as a suitable exemplar of a complex condition characterised by relapsing-remitting symptoms and considerable medication challenges
Whilst the BMQ has been a major contribution to the assessment of medication beliefs, this study has identified limitations of its use in complex Long-term condition (LTC)

Summary

Introduction

An estimated 50% of patients do not take their medication as prescribed, with medication adherence associated with adverse outcomes and higher costs of care. High levels of adherence is a crucial component of effective selfmanagement for many people living with long-term conditions (LTCs) and viewed as one of the key mediators between medical practice and clinical outcomes. The World Health Organisation [3] views non-adherence as an important public health concern, with implications for treatment response [4], mortality [5], and additional healthcare costs, including increased number of hospital admissions and appointments, wasted resources, disease progression and need for more aggressive medications [1, 6]

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