Attitudes and beliefs about, medication, as well as satisfaction with medications, are also important covariates of nonadherence; an example of self-report measures addressing these construct is the Drug Attitude Inventory44 and the Brief Evaluation of Medications Attitudes and Beliefs.45 Another useful assessment, tool is the AIDS Clinical Trials Group’s Adherence Measure,“46 which includes a set of questions about
reasons for nonadherence. Gathering the individual’s perspective about what causes nonadherence behaviors can be essential to formulating an intervention strategy. Risk factors for nonadherence There are multiple and interacting risk factors for medication nonadherence, Inhibitors,research,lifescience,medical with Inhibitors,research,lifescience,medical no single profile for high risk for nonadherence. Conceptually, these can be divided into patient-related, medication-related, and providerrelated risk factors.47 Most research has been focused on patient-related risk factors.48 Among patient characteristics that appear to be risk factors for nonadherence, the strongest support appears to be for comorbid substance use, younger age, lower education level, and cognitive impairment. Additionally, attitudinal factors, particularly the denial of the need for medications/severity of the illness appear to
account for a substantial proportion of variance in adherence.49 In the Apoptosis Compound Library Health Beliefs Model, an Inhibitors,research,lifescience,medical individual is likely to engage in a behavior, such as adherence, if they believe their condition is severe enough to warrant, treatment, if the perceived benefits of treatment outweigh the drawbacks, Inhibitors,research,lifescience,medical and if cues to action are provided to initiate and maintain the behavior. It is likely that these factors change over the course of the illness. In the early stages, acceptance of the illness is lower and avoidance coping is higher,50 potentially accounting for the relationship found between younger age and worse adherence. In our work with older adults, we have hypothesized that cognitive impairment and
increasing medication burden may heighten the importance of cues to action in maintaining adherence.51 Medication-related risk factors are less clear, Inhibitors,research,lifescience,medical with some studies finding that higher rates of side effects, and greater medication burden (ie, more medication and/or more frequent, dosing) related to worse adherence whereas some have found no association or the inverse.52-53 Interestingly, in a large cross-national European survey, fears about future side Adenylyl cyclase effects (eg, fear of toxicity) or dependence on medication were more related to nonadherence than were experienced side effects, which were rarely endorsed a reason for stopping medications.54 Provider-related predictors of adherence include the quality of the therapeutic alliance and satisfaction with care provided.48 Factors involved in the alliance would include the degree of agreement between in terms of treatment outcomes and importance of side effects.