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The Necessity-Concerns Framework: a Multidimensional Theory Benefits from Multidimensional Analysis

  • Original Article
  • Published:
Annals of Behavioral Medicine

Abstract

Background

Patients’ medication-related concerns and necessity-beliefs predict adherence. Evaluation of the potentially complex interplay of these two dimensions has been limited because of methods that reduce them to a single dimension (difference scores).

Purpose

We use polynomial regression to assess the multidimensional effect of stroke-event survivors’ medication-related concerns and necessity beliefs on their adherence to stroke-prevention medication.

Methods

Survivors (n = 600) rated their concerns, necessity beliefs, and adherence to medication. Confirmatory and exploratory polynomial regression determined the best-fitting multidimensional model.

Results

As posited by the necessity-concerns framework (NCF), the greatest and lowest adherence was reported by those necessity weak concerns and strong concerns/weak Necessity-Beliefs, respectively. However, as could not be assessed using a difference-score model, patients with ambivalent beliefs were less adherent than those exhibiting indifference.

Conclusions

Polynomial regression allows for assessment of the multidimensional nature of the NCF. Clinicians/Researchers should be aware that concerns and necessity dimensions are not polar opposites.

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References

  1. Kravitz RL, Melnikow J. Medical adherence research: time for a change in direction? Medical Care. 2004; 42: 197-199.

    Article  PubMed  Google Scholar 

  2. Haynes RB, Ackloo E, Sahota N, McDonald HP, Yao X. Interventions for enhancing medication adherence. Cochrane Database of Systematic Reviews 2008: CD000011. doi:10.1002/14651858.CD000011.pub3.

  3. Horne R, Weinman J. Patients’ beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness. J Psychosom Res. 1999; 47: 555-67.

    Article  CAS  PubMed  Google Scholar 

  4. Horne R, Weinman J. Self-regulation and self-management in asthma: exploring the role of illness perceptions and treatment beliefs in explaining non-adherence to preventer medication. Psychol Health. 2002; 17: 17-32.

    Article  Google Scholar 

  5. Gonzalez JS, Penedo FJ, Llabre MM, et al. Physical symptoms, beliefs about medications, negative mood, and long-term HIV medication adherence. Ann Behav Med. 2007; 34(1): 46-55.

    Article  PubMed  Google Scholar 

  6. Horne R, Buick D, Fisher M, Leake H, Cooper V, Weinman J. Doubts about necessity and concerns about adverse effects: identifying the types of beliefs that are associated with non-adherence to HAART. Int J STD AIDS. 2004; 15: 38-44.

    Article  PubMed  Google Scholar 

  7. Bucks RS, Hawkins K, Skinner TC, Horn S, Seddon P, Horne R. Adherence to treatment in adolescents with cystic fibrosis: the role of illness perceptions and treatment beliefs. J Ped Psychol. 2009; 34: 893-902.

    Article  Google Scholar 

  8. Llewellyn CD, Miners AH, Lee CA, Harrington C, Weinman J. The illness perceptions and treatment beliefs of individuals with severe haemophilia and their role in adherence to home treatment. Psychol Health. 2003; 18: 185-200.

    Article  Google Scholar 

  9. Horne R, Sumner S, Jubraj B, Weinman J, Taube D. Haemodialysis patients’ beliefs about treatment: implications for adherence to medication and diet/fluid restrictions. Int J Pharm Practice. 2001; 9: 169-75.

    Article  Google Scholar 

  10. Ross S, Walker A, MacLeod MJ. Patient compliance in hypertension: role of illness perceptions and treatment beliefs. J Human Hypertens. 2004; 18: 607-13.

    Article  CAS  Google Scholar 

  11. Aikens JE, Nease DE, Nau DP, Klinkman MS, Schwenk TL. Adherence to maintenance-phase antidepressant medication as a function of patient beliefs about medication. Ann Fam Med. 2005; 3: 23-30.

    Article  PubMed Central  PubMed  Google Scholar 

  12. O’Carroll R, Whittaker J, Hamilton B, Johnston M, Sudlow C, Dennis M. Predictors of adherence to secondary preventive medication in stroke patients. Ann Behavioral Med. 2011; 41: 383-90.

    Article  Google Scholar 

  13. Rothwell PM, Algra A, Amarenco P. Medical treatment in acute and long-term secondary prevention after transient ischemic attack and ischemic stroke. Lancet. 2011; 377: 1681-92.

    Article  PubMed  Google Scholar 

  14. Horne R, Weinman J, Hankins M. The beliefs about medicines questionnaire: the development and evaluation of a new method for assessing the cognitive representation of medication. Psychol Health. 1999; 14: 1-24.

    Article  Google Scholar 

  15. Cacioppo JT, Berntson GG. Relationship between attitudes and evaluative space: a critical review, with emphasis on the separability of positive and negative substrates. Psych Bull. 1994; 115(3): 401-423.

    Article  Google Scholar 

  16. Cacioppo JT, Gardner WL, Berntson GG. Beyond bipolar conceptualizations and measures: the case of attitudes and evaluative space. Personality Soc Psychol Rev. 1997; 1: 3-25.

    Article  CAS  Google Scholar 

  17. Gardner WL, Cacioppo JT. Multi-gallon blood donors: why do they give? Transfusion. 1995; 35: 795-8.

    Article  CAS  PubMed  Google Scholar 

  18. Mann DM, Ponieman D, Leventhal H, Halm EA. Predictors of adherence to diabetes medications: the role of disease and medication beliefs. J Behav Med. 2009; 32: 278-84.

    Article  PubMed  Google Scholar 

  19. Tibaldi G, Clatworthy J, Torchio E, Argentero P, Munizza C, Horne R. The utility of the Necessity-Concerns Framework in explaining treatment non-adherence in four chronic illness groups in Italy. Chronic Illn. 2009; 5(2): 129-33.

    Article  PubMed  Google Scholar 

  20. Clatworthy J, Bowskill R, Parham R, Rank T, Scott J, Horne R. Understanding medication non-adherence in bipolar disorders using a Necessity-Concerns Framework. J Affective Disorders. 2009; 116(1–2): 51-5.

    Article  Google Scholar 

  21. Menckeberg TT, Bouvy ML, Bracke M, et al. Beliefs about medicines predict refill adherence to inhaled corticosteroids. J Psychosom Res. 2008; 64(1): 47-54.

    Article  PubMed  Google Scholar 

  22. Maxwell SE, Delaney HD. Bivariate median splits and spurious statistical significance. Psychological Bulletin. 1993; 113: 181-90.

    Article  Google Scholar 

  23. Edwards JR. Alternatives to difference scores: polynomial regression analysis and response surface methodology. In: Drasgow F, Schmitt NW, eds. Advances in measurement and data analysis. San Francisco: Jossey-Bass; 2002: 350-400.

    Google Scholar 

  24. Edwards JR. The study of congruence in organizational behavior research: critique and proposed alternative. Org Beh Human Decision Proc. 1994; 58: 51-100.

    Article  Google Scholar 

  25. Phillips LA. Congruence research in behavioral medicine: methodological review and demonstration of an alternative methodology. J Beh Med. 2013; 36(1): 61-74. doi:10.1007/s10865-012-9401-9.

    Article  Google Scholar 

  26. Shanock LR, Baran BE, Gentry WA, Pattinson SC, Heggestad ED. Polynomial regression with response surface analysis: a powerful approach for examining moderation and overcoming limitations of difference scores. J Business Psychol. 2012; 25: 543-54.

    Article  Google Scholar 

  27. Edwards JR. Ten difference score myths. Org Research Meth. 2001; 4: 264-86.

    Google Scholar 

  28. [Masked for review]. Peer education for secondary stroke prevention in inner-city minorities: design and methods of the prevent recurrence of all inner-city strokes through education randomized controlled trial. Contemp Clin Trials. 2013 (in press).

  29. Morisky DE, Ang A, Krousel-Wood M, Ward H. Predictive validity of a medication adherence measure for hypertension control. J Clin Hypertens. 2008; 10(5): 348-54.

    Article  Google Scholar 

  30. Aiken LS, West SG. Multiple regression: testing and interpreting interactions. Newbury Park: Sage; 1991.

    Google Scholar 

  31. Petrie KJ, Perry K, Broadbent E, Weinman J. A text message programme designed to modify patients’ illness and treatment beliefs improves self-reported adherence to asthma preventer medication. Br J Health Psychol. 2012; 17(1): 74-84.

    Article  PubMed  Google Scholar 

  32. Edwards JR, Harrison RV. Job demands and worker health: three-dimensional reexamination of the relationship between person-environment fit and strain. J Appl Psychol. 1993; 78: 628-48.

    Article  CAS  PubMed  Google Scholar 

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Conflict of Interest

The authors have no conflict of interest to disclose

Funding

National Institute on Minority Health and Health Disparities [#5P60MD000270] and the National Center for Advancing Translational Sciences [UL1TR000067].

Author information

Authors and Affiliations

  1. The George Washington University, Washington, DC, 20052, USA

    L. Alison Phillips Ph.D

  2. Mount Sinai School of Medicine, New York, NY, 10029, USA

    Michael A. Diefenbach PhD, Rennie M. Negron MPH & Carol R. Horowitz MD

  3. Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, 10032, USA

    Ian M. Kronish MD

Authors
  1. L. Alison Phillips Ph.D
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  2. Michael A. Diefenbach PhD
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  3. Ian M. Kronish MD
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  4. Rennie M. Negron MPH
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  5. Carol R. Horowitz MD
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Correspondence to L. Alison Phillips Ph.D.

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Phillips, L.A., Diefenbach, M.A., Kronish, I.M. et al. The Necessity-Concerns Framework: a Multidimensional Theory Benefits from Multidimensional Analysis. ann. behav. med. 48, 7–16 (2014). https://doi.org/10.1007/s12160-013-9579-2

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  • DOI: https://doi.org/10.1007/s12160-013-9579-2

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