Beyond Prescription Adherence: The Influence of Medication Beliefs and Perceived Treatment Necessity onLong-Term Disease Management

Abstract

Medication adherence that is a well-recognized as key determinant of treatment adherence in chronic illness, but adherence alone only explains part of the variance in chronic illness management. This research aimed at assessing the impact of beliefs towards medications and treatment necessity on chronic illness management without considering adherence behavior among individuals on constant medications. An analytic cross-sectional study design was done among 294 individuals with either type-2 diabetes mellitus and/or hypertension attending medical outpatient departments selected through consecutive sampling technique. Beliefs about the medication was assessed using Beliefs about Medicines Questionnaire (BMQ-Specific), adherence using five-item Medication Adherence Report Scale (MARS- 5), and disease control using target levels of glycated hemoglobin and blood pressure. Data were analysed through descriptive statistics, the chi-square test, multivariate logistic regression and mediation analysis using SPSS version 26.0. The means for necessity and concern were 18.9 ± 3.5 and 14.6 ± 3.9, while 63.3% of the subjects had high adherence and 55.1% had controlled disease. The frequency of controlled disease dropped from 74.0% in patients with accepting attitudes to 26.3% in those with skeptical attitudes (χ² = 34.82, p < 0.001). Increased perceived necessity was found to decrease the probability of uncontrolled disease (adjusted OR per SD = 0.62; 95% CI 0.46–0.83; p = 0.001), while increased treatment concerns were positively correlated with this outcome. The addition of belief-related variables improved the Nagelkerke R² by 0.17 and the area under the ROC curve by 0.11. The role of adherence as mediator of beliefs' impact on disease control was confirmed by explaining 31.4% of this association. Medication beliefs and perceived treatment necessity are important factors in long-term disease management in addition to adherence.