Self-Reported Adherence to Cholesterol-Lowering Medication in Patients with Familial Hypercholesterolaemia: The Role of Illness Perceptions
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Background: The objectives of this study are to describe levels of adherence to cholesterol-lowering medication and to identify predictors of adherence in patients with familial hypercholesterolaemia (FH).
Design: Descriptive questionnaire study.
Methods:: 336 adults patients with FH attending one of five outpatient lipid clinics in South East England underwent a clinical assessment by a nurse and completed a questionnaire. The questionnaire assessed self-reported adherence to cholesterol-lowering medication, anxiety, depression, and patient perceptions of heart disease.
Results:: Overall, participants reported high levels of medication adherence, although 63% reported some level of non-adherence. Total medication adherence (never deviating from the regimen) was more likely to be reported by older participants, those with no formal educational qualifications, those with a personal history of cardiovascular disease, those with a lower total cholesterol level, and those with a greater difference between untreated cholesterol levels and current cholesterol levels. The illness perceptions associated with reported total adherence were lower perceived risk of raised cholesterol, perceiving greater control over FH, and perceiving genes and cholesterol to be important determinants of a heart attack. Emotional state was not associated with medication adherence. In logistic regression analysis, predictors of total medication adherence were having personal history of cardiovascular disease, having no formal qualifications, and perceiving genes to be important determinants of a heart attack.
Conclusions: Both clinical factors and patients’ illness perceptions were associated with self-reported cholesterol-lowering medication adherence. The association with illness perceptions was small and many of these associations may be a consequence, rather than a cause, of greater adherence. Given this, intervention strategies aimed at helping patients’ to establish routines for medication taking may be more effective in increasing adherence than interventions designed to alter perceptions related to taking statins.
Key Wordsfamilial hypercholesterolaemia patient nonadherence risk reduction behaviour self efficacy
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- 2.Scandinavian Simvastatin Survival Study Group. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: The Scandinavian Simvastatin Survival Study (4s). Lancet 1994;344:1383–1389.Google Scholar
- 4.Umans-Eckenhausen MAW, Defesche JC, van Dam MJ, Kastelelein JJP. Long-term compliance with lipid-lowering medication after genetic screening for familial hypercholesterolemia. Arch Int Med 2003;163:65–68.Google Scholar
- 5.Myers LB, Midence K, eds. Adherence to Treatment in Medical Conditions. London: Harwood Academic Publishers, 1998.Google Scholar
- 6.Erikson M, Hadell K, Holme I, et al. Compliance with and efficacy of treatment with pravastatin and cholestyramine: A randomised study of lipid-lowering in primary care. J Intern Med 1998;243:373–380.Google Scholar
- 7.Avorn J, Monette J, Lacour A, et al. Persistence of use of lipid-lowering medications: A cross-national study. JAMA 279:1458–1462.Google Scholar
- 8.Petrie KJ, Weinman JA, eds. Perceptions of Health and Illness: Current Research and Applications. London: Harwood Academic Publishers, 1997.Google Scholar
- 9.Meyer D, Leventhal H, Gutmann M. Common-sense models of illness: The example of hypertension. Health Psychol 1995;4:115–135.Google Scholar
- 13.Marteau TM, Senior V, Humphries SE, et al. Psychological impact of genetic testing for Familial Hypercholesterolemia with a previously aware population: A randomized controlled trial. AJMG 2004:128:285–293.Google Scholar
- 14.Rose GA, Blackburn H, Gillum RF, et al. Cardiovascular Survey Methods, 2nd ed. Geneva: World Health Organisation, 1982.Google Scholar
- 15.Moss Morris R, Weinman J, Petrie KJ, et al. The Revised Illness Perception Questionnaire (IPQ-R). Psychology and Health 2002;17:1–16.Google Scholar
- 18.Rudd P. The measurement of compliance: medication taking. In: Krasnegor NA, Epstein LH, Johnson SB, et al, eds. Developmental Aspects of Health Compliance Behavior. Hillsdale, New Jersey: Lawrence Erlbaum 1993:185– 213.Google Scholar
- 20.Sheeran P. Intention-behaviour relations: A conceptual and empirical review. In Hewstone M, Stroebe W, eds. European Review of Social Psychology (in press);11.Google Scholar
- 21.Sheeran P, Orbell S. Implementation intentions and repeated behaviour: Augmenting the predictive validity of the theory of planned behaviour. European Journal of Social Psychology 1999;29:349–369.Google Scholar