A screening instrument to identify ulcerative colitis patients with the high possibility of current non-adherence to aminosalicylate medication based on the Health Belief Model: a cross-sectional study

BMC Gastroenterology

Noriko Yamamoto-Mitani³  Reiko Kunisaki⁵  Shin Maeda⁶  Ryoichi Suzuki²  Naoki Yoshimura¹  Masakazu Nishigaki³  Makoto Tanaka⁴  Aki Kawakami⁶ 

[1] Department of Gastroenterology, Social Insurance Central General Hospital, 3-22-1 Hyakuninn-cho, Shinjyuku-ku 169-0073, Tokyo, Japan;Kannai Suzuki Clinic, 3-28 Onoue-cho, Naka-ku 231-0028, Yokohama, Japan;Department of Adult Nursing, Graduate school of Medicine the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku 113-0033, Japan;Department of Advanced Clinical Nursing, Graduate School of Medicine, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku 113-0033, Tokyo, Japan;Inflammatory Bowel Disease Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku 232-0024, Yokohama, Japan;Department of Gastroenterology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku 236-0004, Yokohama, Japan

关键词: Screening;    Health belief model;    Aminosalicylates;    Medication adherence;    Ulcerative colitis;   

Others  :  1121727
DOI  :  10.1186/s12876-014-0220-z

 received in 2014-09-03, accepted in 2014-12-11,  发布年份 2014

【 摘 要 】

Background

Non-adherence to aminosalicylates is observed among 30% to 45% of patients with ulcerative colitis and increases the risk of relapse. The Health Belief Model is a theoretical model that could offer a broader perspective to improve patients’ self-medication adherence. This study aimed to develop a screening instrument based on the Health Belief Model to screen patients with ulcerative colitis who had a high possibility of current non-adherence to aminosalicylates. The study was also designed to allow examination of factors of non-adherence.

Methods

A multicenter, cross-sectional study was conducted in outpatients diagnosed with ulcerative colitis and prescribed aminosalicylates. Non-adherence was defined as taking less than 80% of the prescribed dose. We hypothesized that there was a significant relationship between current aminosalicylate non-adherence and five components of the HBM: beliefs about taking aminosalicylates, disease characteristics, medication characteristics, abdominal symptoms, and sociodemographic characteristics. A logistic regression model was applied and the coefficients converted to a numeric scores in order to develop a screening instrument which could reliably discriminate non-adherent and adherent subjects.

Results

Non-adherence was observed in 127 (29.6%) of the 429 enrolled subjects. Lower perceptions of belief in taking aminosalicylates, absence of visible bleeding, eight daily tablets or less taken, and no concomitant use of thiopurines were related to non-adherence. We then developed a screening instrument comprising 22 items. When the cut-off point was set at 60, the instrument showed 85.0% sensitivity and 69.2% specificity with an area under the curve of 0.84 (95% confidence interval = 0.79–0.91).

Conclusions

The instrument appeared to be reliable for identifying patients with a high possibility of current non-adherence to aminosalicylates. Further, the instrument may provide useful information for detecting patients with a high possibility of current non-adherence and for assessing factors of non-adherence. On the other hand, we need to evaluate disease activity more strictly and examine whether it is included in the screening instrument in the future.

【 授权许可】

   
2014 Kawakami et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

【 参考文献 】

• [1]Dignass A, Lindsay JO, Sturm A, Windsor A, Colombel JF, Allez M, D'Haens G, D'Hoore A, Mantzaris G, Novacek G, Oresland T, Reinisch W, Sans M, Stange E, Vermeire S, Travis S, Van Assche G: Second European evidence-based consensus on the diagnosis and management of ulcerative colitis part 2: current management. J Crohns Colitis 2012, 6:991-1030.
• [2]Ford AC, Achkar J-P, Khan KJ, Kane SV, Talley NJ, Marshall JK, Moayyedi P: Efficacy of 5-aminosalicylates in ulcerative colitis: systematic review and meta-analysis. Am J Gastroenterol 2011, 106:601-616.
• [3]Kawakami A, Tanaka M, Nishigaki M, Naganuma M, Iwao Y, Hibi T, Sanada H, Yamamoto-Mitani N, Kazuma K: Relationship between non-adherence to aminosalicylate medication and the risk of clinical relapse among Japanese patients with ulcerative colitis in clinical remission: a prospective cohort study. J Gastroenterol 2013, 48:1006-1015.
• [4]Jackson CA, Clatworthy J, Robinson A, Horne R: Factors associated with non-adherence to oral medication for inflammatory bowel disease: a systematic review. Am J Gastroenterol 2010, 105:525-539.
• [5]Kane S, Huo D, Aikens J, Hanauer S: Medication nonadherence and the outcomes of patients with quiescent ulcerative colitis. Am J Med 2003, 114:39-43.
• [6]Khan N, Abbas AM, Bazzano LA, Koleva YN, Krousel-Wood M: Long-term oral mesalazine adherence and the risk of disease flare in ulcerative colitis: nationwide 10-year retrospective cohort from the veterans affairs healthcare system. Aliment Pharmacol Ther 2012, 36:755-764.
• [7]Trindade AJ, Morisky DE, Ehrlich AC, Tinsley A, Ullman TA: Current practice and perception of screening for medication adherence in inflammatory bowel disease. J Clin Gastroenterol 2011, 45:878-882.
• [8]Haynes BR, Ackloo E, Sahota N, McDonald PH, Yao X: Interventions for enhancing medication adherence.Cochrane Database Sys Rev 2010:1-159
• [9]Rosenstock IM: Historical origins of the health belief model. Health Educ Monogr 1974, 2:328-335.
• [10]Becker MH, Maiman LA: Sociobehavioral determinants of compliance with health and medical care recommendations. Med Care 1975, 13:10-24.
• [11]Janz NK, Becker MH: The health belief model: A decade later. Health Educ Q 1984, 11:1-47.
• [12]DiMatteo MR, Haskard KB, Williams SL: Health beliefs, disease severity, and patient adherence: a meta-analysis. Med Care 2007, 45:521-528.
• [13]Harvey JN, Lawson VL: The importance of health belief models in determing self-care behaviour in diabetes. Diabet Med 2009, 26:5-13.
• [14]Gao X, Nau DP, Rosenbluth SA, Scott V, Woodward C: The relationship of disease severity, health beliefs and medication adherence among HIV patients. AIDS Care 2000, 12:387-398.
• [15]Carpenter CJ: A meta-analysis of the effectiveness of health belief model variables in predicting behavior. Health Commun 2010, 25:661-669.
• [16]Horne R, Weinman J, Hankins M: The Beliefs about Medicines Questionnaire (BMQ); the development and evaluation of a new methos for assessing the cognitive representation of medication. Psychol Health 1999, 14:1-14.
• [17]Horne R, Parham R, Driscoll R, Robinson A: Patients' attitudes to medicines and adherence to maintenance treatment in inflammatory bowel disease. Inflamm Bowel Dis 2009, 15:837-844.
• [18]Selinger CP, Eaden J, Jones DB, Katelaris P, Chapman G, McDonald C, Smith P, Lal S, Leong RW, McLaughlin JAR: Modifiable factors associated with nonadherence to maintenance medication for inflammatory bowel disease. Inflamm Bowel Dis 2013, 19:2199-2206.
• [19]Horne R, Chapman SC, Parham R, Freemantle N, Forbes AVC: Understanding patients' adherence-related beliefs about medicines prescribed for long-term conditions: a meta-analytic review of the Necessity-Concerns Framework. PLoS One 2013, 8:e80633.
• [20]Trindade AJ, Ehrlich A, Kornbluth A, Ullman TA: Are your patients taking their medicine? Validation of a new adherence scale in patients with inflammatory bowel disease and comparison with physician perception of adherence. Inflamm Bowel Dis 2011, 17:599-604.
• [21]Brooks CM, Richards JM, Kohler CL, Soong SJ, Martin B, Windsor RA, Bailey WC: Assessing adherence to asthma medication and inhaler regimens: a psychometric analysis of adult self-report scales. Med Care 1994, 32:298-307.
• [22]Horne R, Weinman J: Self-regulation and self-management in asthma: exploring the role of illness perceptions and tratment beliefs in explaining non-adherence to preventer medication. Psychol Health 2002, 17:17-32.
• [23]Thompson K, Kulkarni J, Sergejew AA: Reliability and validity of a new medication adherence rating scale (MARS) for the psychoses. Schizophr Res 2000, 42:241-247.
• [24]Horne R, Weinman J: Patients' beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness. J Psychosom Res 1999, 47:555-567.
• [25]Knobel H, Alonso J, Casado JL, Collazos J, Gonzalez J, Ruiz I, Kindelan JM, Carmona A, Juega J, Ocampo A, Group GS: Validation of a simplified medication adherence questionnaire in a large cohort of HIV-infected patients: the GEEMA Study. AIDS 2002, 16:605-613.
• [26]Morisky DE, Ang A, Krousel-Wood M, Ward HJ: Predictive validity of a medication adherence measure in an outpatient setting. J Clin Hypertens 2008, 10:348-354.
• [27]Kane S, Becker B, Harmsen WS, Kurian A, Morisky DE, Zinsmeister AR: Use of a screening tool to determine nonadherent behavior in inflammatory bowel disease. Am JGastroenterol 2012, 107:154-160.
• [28]Simoni JM, Kurth AE, Pearson CR, Pantalone DW, Merrill JO, Frick PA: Self-report measures of antiretroviral therapy adherence: A review with recommendations for HIV research and clinical management. AIDS Behav 2006, 10:227-245.
• [29]Bland JM, Altman DG: Measuring agreement in method comparison studies. Stat Methods Med Res 1999, 8:135-160.
• [30]Kawakami A, Tanaka M, Ochiai R, Naganuma M, Iwao Y, Hibi T, Kazuma K: Difficulties in taking aminosalicylates for patients with ulcerative colitis. Gastroenterol Nurs 2012, 35:24-31.
• [31]Sullivan LM, Massaro JM, D'Agostino RB Sr: Presentation of multivariate data for clinical use: The Framingham Study risk score functions. Stat Med 2004, 23:1631-1660.
• [32]Rosenstock IM, Strecher VJ, Becker MH: Social learning theory and the Health Belief Model. Health Educ Q 1988, 15:175-183.
• [33]Funnell MM, Brown TL, Childs BP, Haas LB, Hosey GM, Jensen B, Maryniuk M, Peyrot M, Piette JD, Reader D, Siminerio LM, Weinger K, Weiss MA: National Standards for diabetes self-management education. Diabetes Care 2011, 34(Suppl 1):S89-S96.
• [34]Nguyen GC, LaVeist TA, Harris ML, Datta LW, Bayless TM, Brant SR: Patient trust-in-physician and race are predictors of adherence to medical management in inflammatory bowel disease. Inflamm Bowel Dis 2009, 15:1233-1239.
• [35]Wood DA, Kotseva K, Connolly S, Jennings C, Mead A, Jones J, Holden A, De Bacquer D, Collier T, De Backer G, Faergeman O, Group ES: Nurse-coordinated multidisciplinary, family-based cardiovascular disease prevention programme (EUROACTION) for patients with coronary heart disease and asymptomatic individuals at high risk of cardiovascular disease: a paired, cluster-randomised controlled trial. Lancet 2008, 371:1999-2012.
• [36]Garber MC, Nau DP, Erickson SR, Aikens JE, Lawrence JB: The concordance of self-report with other measures of medication adherence: a summary of the literature. Med Care 2004, 42:649-652.