Effects of medication, treatment, and behavioral beliefs on intentions to take medication in patients with familial hypercholesterolemia

Martin S Hagger; Sarah J Hardcastle; Miao Hu; See Kwok; Jie Lin; Hapizah M Nawawi; Jing Pang; Raul D Santos; Handrean Soran; Ta-Chen Su; Brian Tomlinson; Gerald F Watts

doi:10.1016/j.atherosclerosis.2018.06.010

Effects of medication, treatment, and behavioral beliefs on intentions to take medication in patients with familial hypercholesterolemia

Atherosclerosis. 2018 Oct:277:493-501. doi: 10.1016/j.atherosclerosis.2018.06.010.

Authors

Martin S Hagger¹, Sarah J Hardcastle², Miao Hu³, See Kwok⁴, Jie Lin⁵, Hapizah M Nawawi⁶, Jing Pang⁷, Raul D Santos⁸, Handrean Soran⁹, Ta-Chen Su¹⁰, Brian Tomlinson³, Gerald F Watts¹¹

Affiliations

¹ Health Psychology and Behavioural Medicine Research Group, School of Psychology, Curtin University, Perth, Western Australia, Australia; Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland; School of Applied Psychology, Griffith University, Brisbane, Australia. Electronic address: [email protected].
² Health Psychology and Behavioural Medicine Research Group, School of Psychology, Curtin University, Perth, Western Australia, Australia.
³ Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region.
⁴ Cardiovascular Trials Unit, The Old St Mary's Hospital, Central Manchester University Hospital NHS Foundation Trust, Manchester, UK; Lipoprotein Research Group, Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK.
⁵ Department of Atherosclerosis, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
⁶ Institute for Pathology, Laboratory and Forensic Medicine (I-PPerForM) and Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia.
⁷ School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia.
⁸ Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital, Preventive Medicine Centre, Cardiology Program Hospital Israelita Albert Einstein, São Paulo, Brazil.
⁹ Cardiovascular Trials Unit, The Old St Mary's Hospital, Central Manchester University Hospital NHS Foundation Trust, Manchester, UK.
¹⁰ Department of Internal Medicine and Cardiovascular Centre and College of Medicine, National Taiwan University Hospital, Taipei, Taiwan.
¹¹ School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia; Lipid Disorders Clinic, Cardiometabolic Service, Department of Cardiology, Royal Perth Hospital, Perth, Australia.

PMID: 30270090
DOI: 10.1016/j.atherosclerosis.2018.06.010

Abstract

Background and aims: Although familial hypercholesterolemia (FH) can be effectively managed using cholesterol-lowering medication, patients often fall short of complete treatment adherence. Identifying the psychological factors associated with self-regulation of FH medication is important to inform interventions to maximize adherence. The aim of the present study was to test an integrated psychological model in predicting FH patients' intentions to take medication.

Methods: FH patients attending clinics in seven countries were invited to participate in a cross-sectional survey study. Consenting patients (N = 551) completed self-report measures of generalized beliefs about medication overuse and harms, beliefs in treatment effectiveness, specific beliefs about taking medication (attitudes, subjective norms, perceived behavioral control), and intentions to take medication. Participants also completed measures of demographic variables (age, gender, education level, income, cardiovascular disease status). Data were analysed using path analysis controlling for country and demographic variables.

Results: Attitudes (β = .331, p<0.001), subjective norms (β = .121, p=0.009), and beliefs about medication overuse (β = -.160, p<0.001) were significant predictors of intentions to take medication. Treatment beliefs predicted intentions indirectly (β = .088, p<0.001) through attitudes and subjective norms. There was also an indirect effect of beliefs about medication overuse on intentions (β = -.045, p=0.056), but the effect was small compared with the direct effect.

Conclusions: The findings indicate the importance among FH patients of specific beliefs about taking medication and generalized beliefs about medication overuse and treatment in predicting medication intentions. When managing patients, clinicians should emphasize the efficacy of taking cholesterol-lowering drugs and the importance of treatment outcomes, and allay concerns about medication overuse.

Keywords: Beliefs about medicines; Common sense model; Hyperlipidemia; Illness perceptions; Theory of planned behavior.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Anticholesteremic Agents / adverse effects
Anticholesteremic Agents / therapeutic use*
Biomarkers / blood
Cholesterol, LDL / blood*
Cross-Sectional Studies
Down-Regulation
Female
Health Knowledge, Attitudes, Practice*
Humans
Hyperlipoproteinemia Type II / blood
Hyperlipoproteinemia Type II / diagnosis
Hyperlipoproteinemia Type II / drug therapy*
Hyperlipoproteinemia Type II / psychology
Intention*
Male
Medication Adherence*
Middle Aged
Models, Psychological
Risk Assessment
Self Care*
Treatment Outcome

Substances

Anticholesteremic Agents
Biomarkers
Cholesterol, LDL