Haemodialysis patients' beliefs about treatment: implications for adherence to medication and fluid-diet restrictions

Abstract

Objectives — To assess haemodialysis patients' beliefs about treatment and to investigate which beliefs correlate with adherence to medication and fluid‐diet restrictions. Methods — Forty‐seven haemodialysis patients receiving intermittent hospital haemodialysis completed questionnaires assessing their beliefs about medication and fluid‐diet restrictions. Key findings — Adherence rates varied between and within patients, and were related to specific treatment beliefs in a logically consistent way. Reported intentional non‐adherence to medication correlated with concerns about the potential adverse effects of renal medication. Low adherence to fluid‐diet restrictions (assessed by inter‐dialysis weight gain) was associated with the personal belief that the restrictions were too strict. Most patients (90 per cent) agreed that medicines prescribed for their renal condition were necessary for maintaining health. However, 32 per cent harboured concerns about their medication, arising from beliefs about the potential for dependence, long‐term effects, or disruption of life. Concerns about renal medication correlated with more general beliefs that medicines as a whole are harmful, addictive poisons which are overused by doctors. Although specific treatment beliefs (medication or fluid‐diet restrictions) were related to specific adherence behaviours, these two areas of beliefs and behaviours were unrelated. Conclusions — Patients' perceptions of treatment merit further study. Eliciting and addressing patients' perceptions of treatment may be a target for pharmaceutical care and a foundation for partnership in medicine‐taking.

Profiling patient attitudes to phosphate binding medication: A route to personalising treatment and adherence support

“…This finding, which supports an association between beliefs about PBM and poor adherence, is consistent with studies which have explored this relationship in other chronic illness groups (e.g. Aikens et al, 2005;Horne et al, 2001;Horne and Weinman, 2002;Horne et al, 2004;Horne et al, 2007;Horne et al, 2009;Hunot et al, 2007). Furthermore, the creation of attitudinal groups based on patient's beliefs about PBM offered further insight into the relationship between treatment beliefs and adherence behaviour.…”

“…A systematic review of studies investigating the prevalence and causes of nonadherence to PBM (Karamanidou et al, 2008) revealed that reports of nonadherence to PBM range from 22-74%, and that associations between demographic and clinical factors and nonadherence to PBM are limited, with younger age being the only consistent predictor of poor adherence to PBM (Bame et al, 1993;Boyer et al, 1990;Horne et al, 2001). A further finding of this review was that whilst psychosocial predictors of adherence (e.g.…”

“…The utility of the NCF in explaining adherence to treatment has been shown in a variety of chronic illness groups including HIV , cardiovascular disease , asthma (Horne and Weinman, 2002), depression (Aikens et al, 2005;Hunot et al, 2007), and inflammatory bowel disease . While associations between treatment beliefs and nonadherence have previously been explored in the context of renal disease (Butler et al, 2004;Horne et al, 2001), there is an overall paucity of research exploring the beliefs that patients with CKD hold specifically about phosphate binding agents, and the role of these beliefs in adherence behaviour. A recent study by Wileman et al (2011), however, reported from a sample of 76 patients, an association between beliefs held specifically about PBM and nonadherence, whereby doubts about personal need for PBM were associated with self-reported intentional ATTITUDES TO PBM 6 nonadherence to PBM and increased concerns about PBM were associated with higher serum phosphate levels.…”

The necessity–concerns framework predicts adherence to medication in multiple illness conditions: A meta-analysis

“…Of the papers relating beliefs about medicines to a measure of medication adherence, some report only necessity beliefs are correlated to medication adherence [19,21,22,[35][36][37][38] while others have found only concern beliefs to be correlated to medication adherence [30,[39][40][41][42][43]. In some studies, the necessity-concerns differential was shown to have a stronger correlation with adherence than necessity or concern beliefs alone [4,20,44,45].…”

Exploring the relationship between health beliefs and medication adherence in individuals with asthma

“…[141][142][143] Of the papers correlating beliefs about medicines to a measure of medication adherence, some report only the necessity subscale is correlated to medication adherence 131,133,134,[144][145][146][147] while others have found only the concern subscale to be correlated to medication adherence. 139,[148][149][150][151][152] In some studies, the necessity-concerns differential was shown to have a stronger correlation with adherence than necessity or concerns alone. 109,132,153,154 From these findings, it is unclear whether each of these scales -necessity, concerns and the necessity-concern differential -correlate with adherence on a population level.…”