Adherence And Its Relationship To Patients Beliefs Towards Their Medicines

Medical and Health Science Project and Seminar Material

Adherence And Its Relationship To Patients Beliefs Towards Their Medicines


Abstract


This study was carried out on adherence and its relationship to patients beliefs towards their medicines using Kwuba General Hospital as a case study. The survey design was adopted and the simple random sampling techniques were employed in this study. The population size comprise of patients in Kwuba General Hospital. In determining the sample size, the researcher conveniently selected 200 respondents and 150 were validated. Self-constructed and validated questionnaire was used for data collection. The collected and validated questionnaires were analyzed using frequency tables, and mean scores. While the hypotheses were tested using Chi-square statistical tool, SPSS v23. The result of the findings reveals that patientsā€™ cultural beliefs influences their adherence to medications. The study also revealed that patientsā€™ religious beliefs influences their adherence to medications. The study also revealed that the factors which influences patients beliefs and adherence to medications includes: previous experience, expectations, other peopleā€˜s c opinions, alternate treatment. Therefore, it is recommended that patients need to be educated about their illness, symptoms and medications. Health care providers play a major role in that regard, and a collaborative care approach can facilitate the education of patients about the benefits of medications and the importance of their continuous use. And health care providers should take into account the impact of religious and cultural background on health beliefs to provide sensitive care to diverse ethnic populations to achieve better medication adherence. To mention but a few.


Table of Content


Chapter One:

Introduction

  • 1.1 Background of the Study
  • 1.2 Statement of the Problem
  • 1.3 Objective of the Study
  • 1.4 Research Questions
  • 1.5 Research Hypothesis
  • 1.6 Significance of the Study
  • 1.7 Scope of the Study
  • 1.8 Limitation of the Study
  • 1.9 Definition of Terms
  • 1.10 Organization of the Study

Chapter Two:

Review of Literature

  • 2.1 Conceptual Framework
  • 2.2 Theoretical Framework
  • 2.3 Empirical Review

Chapter Three:

Research Methodology

  • 3.1 Research Design
  • 3.2 Population of the Study
  • 3.3 Sample Size Determination
  • 3.4 Sample Size Selection Technique and Procedure
  • 3.5 Research Instrument and Administration
  • 3.6 Method of Data Collection
  • 3.7 Method of Data Analysis
  • 3.8 Validity of the Study
  • 3.9 Reliability of the Study
  • 3.10 Ethical Consideration

Chapter Four:

Data Presentation and Analysis

  • 4.1 Data Presentation
  • 4.2 Analysis of Data
  • 4.3 Answering Research Questions
  • 4.4 Test of Hypotheses

Chapter Five:

Summary, Conclusion and Recommendation

  • 5.1 Summary
  • 5.2 Conclusion
  • 5.3 Recommendation
  • References
  • APPENDIX
  • QUESTIONNAIRE

Chapter One


Introduction

1.1 Background of the Study

Chronic illness is a significant worldwide health problem, with the numbers of people affected steadily increasing. World Health Organization (WHO) data show that uncontrolled hypertension rose from 600 million people to nearly one billion from 1980 to 2008 and in a similar period the number of people with diagnosed type 2 diabetes mellitus (DMT2) rose from 108 to 422 million. 1,2.

The treatment of chronic illnesses commonly includes the long-term use of pharmacotherapy. Although medications are effective in addressing chronic illnesses, their fullbenefits are often not realized due to lack of adherence. Levels of adequate adherence to diabetes (DMT2) and hypertension (HTN) treatment regimens vary widely with estimates from 36ā€“93% for DMT2 and 30ā€“70% for HTN.3,4 Up to 50% of patients who are diagnosed with chronic obstructive pulmonary disease (COPD) fail to take medications as directed and many do not use inhalers effectively.5 Similarly, it is estimated that 30ā€“70% of asthma suffers are not adherent to preventative medications.6 The consequences of non-adherence include; significant worsening of disease, treatment failure, increased hospitalizations and increased health care costs.7

Adherence is defined as the process by which patients take their medication as prescribed8 Patientsā€™ acceptance of medical advice, including medication use, may be influenced by subjective beliefs about their health condition. Therefore, it is essential to take beliefs into account when giving health advice and/or providing medical treatment.3 It has been shown that medication adherence is multi-faceted. Factors contributing to medication adherence include illness perceptions, health literacy, self-efficacy, cognitive abilities such as memory, coping and problem-solving skills, as well as psychosocial factors such as personal and cultural beliefs related to medication taking.9

Factors of concern to patients, regarding their illness, may be conceptualized as patientsā€™ illness perceptions. Leventhal and his colleagues proposed the common-sense model of illness representation to understand the processes by which people make sense of illness.10 Illness perceptions are personal beliefs and expectations about an illness or somatic symptoms. The basic assumption underlying this model is that illness perceptions, along with ā€œcommon sense,ā€ are used in interpreting the meaning of illness or somatic symptoms, deciding on a response, and evaluating the effectiveness of the response.11

Personal beliefs about illness include both cognitive and emotional representations. Cognitive beliefs include five core domains: (1) ā€œidentityā€ describes peoplesā€™ beliefs about the label of illness and symptoms, and sets out the targets for change (such as to eliminate symptoms); (2) ā€œtimelineā€ refers to peopleā€™s perception of the duration of illness, including symptoms and recovery; (3) ā€œconsequencesā€ refers to beliefs about the seriousness of the disease and the impacts on daily life; (4) ā€œcontrolā€ refers to perceptions about the amenability of the illness to being cured, prevented or treated; and (5) ā€œcausesā€ refers to peopleā€™s perceptions of the possible causes of their condition. Emotional representations are the feelings that arise as a result of illness, such as anxiety and/or depression.12

In explaining health behaviors, social determinants such as spirituality and religiosity have been increasingly identified as impacting health and treatment.7 Though often used interchangeably, spirituality and religiosity are separate, but related, concepts. While spirituality denotes an inner freedom to engage in faith and a relationship with a Supreme Being, such as God, religion refers to the outward adherence to highly prescribed beliefs, practices and rituals related to the Supreme Being, such as church attendance and associated activities.13 Cultural beliefs, defined as ā€œa set of behavioral patterns related to thoughts, manners and actions, which members of society have shared and passed on to succeeding generationsā€ 14 may also influence the decision making of patients with chronic disease to take medication.14 Acculturation has been defined as culture change that results from continuous contact between two distinct cultural groups; it also refers to changes in an individual whose cultural group is collectively experiencing acculturation.15

Health behaviors in the self-management of chronic diseases can also be affected by both health literacy and self-efficacy.16 High health literacy, ie, ā€œthe cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand and use information in ways which promote and maintain good healthā€17 and high self-efficacy, ie, ā€œthe belief in oneā€™s capacity to organize and execute the courses of action required to manage a prospective situationā€œ17 are more likely to have better adherence to self-care tasks and medication adherence.18

Since 2006, a number of studies have been published which have examined illness perceptions conceptualized by the common sense model. Secondly, studies examining the impact of acculturation and religious beliefs on medication adherence have now also been published.

Although a number of systematic reviews on medication adherence have been conducted,12,19ā€“21 none of these has explored the relationship between medication adherence and personal and cultural beliefs of patients with chronic diseases. The chronic diseases are currently the most significant in terms of population health in first-world countries. Hence, this study seek to assess the influence of patients beliefs on their adherence towards medicines.


1.2 Statement of the Problem

Nowadays, the concept of adherence is more comprehensive and less reductionist. It implies an active involvement by the person with the chronic condition, in a not imposed way, but mutually accepted, regarding planning, implementation and execution of a therapeutic regimen. There are several factors that interfere with adherence and that makes the responsibility is shared by the person (that act on), by health professionals (that enable and facilitate the action) and by the social context (in which the action unfolds). The WHO presented a report about adherence values in various medical conditions and concluded that the adherence to long-term treatment in the general population is about 50%, being much lower in the developing countries than in Western society.7 However, there a several factors which hinders peoples adherence to medications.

Several studies showed that beliefs about medicines can be a barrier to adherence.8 Thus, patients have their own perspectives on the use of medication and make decisions based on their beliefs and experiences, and this is common among Nigerians. They weigh the risks and benefits relating to medication and they conclude their judgments, taking into account the perceived effectiveness, safety, alternatives, and value in terms of culture and outcomes for their health.

The beliefs about the behaviour are as important as the beliefs about the disease in predicting various behaviours related to health. This suggests the possibility that the interventions of change behaviour with groups of patient would be more effective, targeting beliefs about the behaviour, instead of the beliefs about the disease. In the light of the above, this study is solely focused on the correlation between patients beliefs and adherence towards medicines.


1.3 Objectives of the Study

The main focus of this study is to examine adherence and its relationship to patients beliefs towards their medicines. Specifically it seeks:

  1. To ascertain whether patientsā€™ cultural beliefs influences their adherence to medications.
  2. Ascertain whether patientsā€™ religious beliefs influences their adherence to medications.
  3. Ascertain whether patientsā€™ personal beliefs influences their adherence to medications.
  4. Identify the factors which influences patients beliefs and adherence to medications.

1.4 Research Question

The following research questions guides the study:

  1. Does patientsā€™ cultural beliefs influences their adherence to medications?
  2. Does patientsā€™ religious beliefs influences their adherence to medications?
  3. Does patientsā€™ personal beliefs influences their adherence to medications?
  4. What are the factors which influences patients beliefs and adherence to medications?

1.5 Research Hypotheses

The following null hypotheses will validate this study:

H0: Patients beliefs has no significant effect on their adherence towards their medicines.

Ha: Patients beliefs has a significant effect on their adherence towards their medicines.


1.6 Significance of the Study

The relevance of this study to health practitioners cannot be over emphasized. Basically among others it will help healthcare workers in understanding patientsā€™ pre-existing beliefs/perceptions of illness before giving new information is required. In this way, health care professionals and patients have the opportunity to recognize gaps, confusions and misconceptions in the patientā€™s perceptions. Additionally, subsequent researchers will use it as literature review. This means that, other students who may decide to conduct studies in this area will have the opportunity to use this study as available literature that can be subjected to critical review. Invariably, the result of the study contributes immensely to the body of academic knowledge with regards to adherence and its relationship to patients beliefs towards their medicines.


1.7 Scope of the Study

This study focuses on the adherence and its relationship to patients beliefs towards their medicines. The respondent for this study will be obtained from patients in Kwuba General Hospital.


1.8 Limitation of the Study

The following posed to be a constraint to the study

Financial constraint

Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).

Time constraint

The researcher will simultaneously engage in this study with other academic work. This consequently will cut down on the time devoted for the research work.

However in the midst above mentioned limitation the researcher devotedly ensured that the purpose of the study was actualized.


1.9 Definition of Terms

Adherence

Adherence is defined as the process by which patients take their medication as prescribed.

Health behaviors

Health behaviors in the self-management of chronic diseases can also be affected by both health literacy and self-efficacy


1.10 Organization of the Studies

The study is categorized into five chapters. The first chapter presents the background of the study, statement of the problem, objective of the study, research questions and hypothesis, the significance of the study, scope/limitations of the study, and definition of terms. The chapter two covers the review of literature with emphasis on conceptual framework, theoretical framework, and empirical review. Likewise, the chapter three which is the research methodology, specifically covers the research design, population of the study, sample size determination, sample size, and selection technique and procedure, research instrument and administration, method of data collection, method of data analysis, validity and reliability of the study, and ethical consideration. The second to last chapter being the chapter four presents the data presentation and analysis, while the last chapter(chapter five) contains the summary, conclusion and recommendation.


Chapter Five


Summary, Conclusions and Recommendations

5.1 Introduction

This chapter summarizes the findings on adherence and its relationship to patients beliefs towards their medicines using Kwuba General Hospital as a case study. The chapter consists of summary of the study, conclusions, and recommendations.


5.2 Summary of the Study

In this study, our focus was on adherence and its relationship to patients beliefs towards their medicines using Kwuba General Hospital as a case study. The study was specifically set to ascertain whether patientsā€™ cultural beliefs influences their adherence to medications, ascertain whether patientsā€™ religious beliefs influences their adherence to medications, ascertain whether patientsā€™ personal beliefs influences their adherence to medications, and the factors which influences patients beliefs and adherence to medications.

The study adopted the survey research design and randomly enrolled participants in the study. A total of 150 responses were validated from the enrolled participants, where all respondent are patients in Kwuba General Hospital.


5.3 Conclusions

Based on the findings of this study, the researcher made the following conclusion.

  1. Patientsā€™ cultural beliefs influences their adherence to medications.
  2. Patientsā€™ religious beliefs influences their adherence to medications.
  3. Personal beliefs influences their adherence to medications.
  4. The factors which influences patients beliefs and adherence to medications includes: previous experience, expectations, other peopleā€˜s c opinions, alternate treatment.

5.4 Recommendations

Based on the findings of the study, the following recommendations are proffered.

  1. Understanding patientsā€™ pre-existing perceptions of illness before giving new information is required. In this way, health care professionals and patients have the opportunity to recognize gaps, confusions and misconceptions in the patientā€™s perceptions.
  2. Patients need to be educated about their illness, symptoms and medications. Health care providers play a major role in that regard, and a collaborative care approach can facilitate the education of patients about the benefits of medications and the importance of their continuous use.
  3. Health care providers should take into account the impact of religious and cultural background on health beliefs to provide sensitive care to diverse ethnic populations to achieve better medication adherence.
  4. Patients with negative illness perceptions and low health literacy may benefit from practical interventions, such as psycho-educational and cognitive-behavioral interventions.
  5. Interventions focusing on illness perceptions should first consider the individualsā€™ numeracy skills by assessing in clinical settings, how well patients understand the implications of their blood sugar measurements, blood pressure results and practicalities of medication dosing, etc. Understanding the patientsā€™ numeracy skills will then allow for a more tailored approach to using simple and plain language to communicate their treatment during counseling.
  6. To improve comprehension and subsequent adherence, techniques should be tailored to the patient and context and may include using familiar language and pictures, contextualizing facts and behaviors, or providing audio or print materials.
  7. Poorer medication adherence in less acculturated patients might relate to their traditional health beliefs as well as ineffective communication with health care providers due to language barriers. Hence, migrant patients need to learn the language of countries in which they resettle. In addition, migrants may often be best able to integrate themselves into the receiving society when they receive help, encouragement and tangible support resources from members of the local community.
  8. Non-adherence should not be perceived as only the patientsā€™ responsibility. On the contrary, social factors (such as social support, economic factors, etc.), health care-related factors (eg, barriers to health care and quality of providerā€“patient communication), condition characteristics, as well as therapy-related factors (such as patient friendliness of the therapy) play an important role in addressing adherence.

Adherence And Its Relationship To Patients Beliefs Towards Their Medicines


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