A research adherence to medical treatments among adults in Cyprus

This dissertation describes an investigation into non adherence to medical treatments among the Cypriot population. The research establishes and operates empirically a dynamic conceptual framework for understanding this issue, from the patient’s perspective, based upon the Health Decision Model.

The primary objective was to find out on which grounds health decisions are taken and which factors relate to the decision to adhere. In doing so, adherence, intention to adhere and self regulation patterns were examined within and across short term, long term and non medication treatments. In the same way, the relationship of adherence/non adherence was examined with factors of an intrapersonal and an interpersonal origin and with factors confined to the disease and the regimen. The secondary objective was to find out which of the above factors are the best predictors of adherence and whether there is a consistency and an interdependency in adherence across treatments.

Information was collected from 200 adult Cypriots either by interview or by post using a tailored self-report questionnaire. The data were analyzed descriptively and quantitatively. Reliability and validity issues were examined.

On a micro analysis, findings indicate that long medication treatments had the highest score of adherence ( at least 70%) while non medication treatments had the lowest (at most 50%). For short and long medication treatments, intentional non adherence varied from 25-37% over the total sample, while for non medication treatments this was at a lower extent (21-34%). More than 50% of the adherent respondents were also intentional adherents opting for an outcome efficacy. Findings confirm that adherence is not a matter of" yes or no" but of "more or less" and that intentional non adherence is a response to treatment in the context of everyday life.

A focus upon the relationship of adherence / non adherence with potential factors across treatments, showed that side effects from medication, the satisfaction with the communication with the doctor and the method of data collection were more predominant variables for short treatments. The communication with the doctor, the certainty about the effectiveness of medication and the susceptibility to a disease were indicative for long treatment. For non medication treatment the age and the place of permanent residence were predominant. The characteristics of the adherent / non adherent respondents appeared to rotate around an "old" and a "new" generation respectively.

On a macro analysis, factors of an intrapersonal and an interpersonal behaviour origin revealed a higher extent of significant relationships with adherence than factors referring to the disease and the treatment regimen. An investigation of the issue of consistency in adherence across one or more treatments revealed that around 40% of the respondents always adhered, 20% never adhered and the remaining 40% did not show consistency in their adherence across different treatment regimens. Within this framework, a series of logistic regression analyses were performed across treatments distinguishing adherence from non adherence and developing significant models with acceptable prediction accuracy, applicable for each type. Focusing upon the issue of interdependency, it was found that the inclusion of adherence for long treatment as an independent variable in logistic regression analysis, increased the prediction of adherence for short and non medication treatments.

An overall implication of the research conceptual framework is that adherence is not a static but a dynamic decision and that all potential factors, as originally pointed by the Health Decision Model, are important.