How do osteoporosis patients perceive their illness and treatment? Implications for clinical practice
Non-adherence inhibits successful treatment of osteoporosis. This study used a theoretical framework to explore osteoporosis patients' cognitive and emotional representations of their illness and medication, using both interviews and drawing. We recorded some misconceptions patients have about their condition and medication which could act as barriers to treatment adherence.
Despite the high efficacy of current treatments in reducing fracture risk, poor adherence is still a problem in osteoporosis. This qualitative study aims to inform the development of a psychological intervention to increase adherence through the investigation of osteoporosis patients' perceptions of their illness and medication. The self-regulation model (Leventhal) provided the framework for the study.
Participants were 14 female outpatients from a London teaching hospital who suffer with osteoporosis or osteopenia. Data were collected using both semi-structured interviews and drawings. Drawings were used to elicit participants' visual representations (imagery) of their condition.
We found that patients held illness and medication beliefs that were not in accord with current scientific evidence. Interviews revealed that participants had good knowledge of what osteoporosis is, but they had low understanding of the role of medication in reducing fracture risk, various concerns about the side effects of medication, poor understanding of the causes of osteoporosis and uncertainty about how it can be controlled. Additionally, drawings elicited more information about the perceived effects of osteoporosis and emotional reactions to the condition.
Osteoporosis sufferers need a better understanding of their fracture risk and what they can do to control their condition. Concerns about medication need to be addressed in order to improve adherence, particularly in relation to the management of side effects. Since drawings of osteoporosis were found to arouse emotions, it is concluded that risk communication in osteoporosis could benefit from using visual images.
KeywordsAdherence Emotions Illness perceptions Medication beliefs Visual representations
This article presents independent research commissioned by the National Institute for Health Research. The views expressed in this publication are those of the authors and not necessarily those of the NHS, NIHR or the Department of Health. We would like to thank Dr. Amelia Moore, the expert patients who assisted the study design, Dr. Alastair Ross, Dr. Nao Kadote, Dr. Kellie Thompson and Dr. Angus Ramsay for validation of data coding.
Conflicts of interest
- 5.Haynes R et al (2002) Interventions for helping patients to follow prescriptions for medications. Cochrane Database Syst Rev (2):CD000011Google Scholar
- 6.O'Donohue WT, Levensky ER (2006) Promoting treatment adherence: a practical handbook for health care providers. Sage Publications Inc, Thousand Oaks, p 458Google Scholar
- 9.Horne R et al (2005) Concordance, adherence and compliance in medicine taking. Report for the National Co-ordinating Centre for the NHS service delivery and organisation R & D (NCCSDO), pp 1–372Google Scholar
- 10.Petrie K, Weinman J (eds) (1997) Perceptions of health and illness. Current research and applications. Harwood Academic Publishers, Singapore, pp 1–17, Introduction to the perceptions of health and illnessGoogle Scholar
- 15.Leventhal H et al (1997) Illness representations: theoretical foundations. In: Petrie KJ, Weinman JA (eds) Perceptions of health and illness. Current research and applications. Harwood Academic, London, pp 19–45Google Scholar
- 17.Horne R (2003) Treatment perceptions and self regulation. In: Routledge (ed) The self regulation of health and illness behaviour. Taylor and Francis Group, London, pp 138–155Google Scholar
- 23.Ritchie J, Spencer L et al (2003) Carrying out qualitative analysis. Carrying out qualitative analysis in qualitative research in practice. Sage, LondonGoogle Scholar