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Meta-Analysis
. 2013 Dec 2;8(12):e80633.
doi: 10.1371/journal.pone.0080633. eCollection 2013.

Understanding patients' adherence-related beliefs about medicines prescribed for long-term conditions: a meta-analytic review of the Necessity-Concerns Framework

Rob Horne  1 , Sarah C E Chapman, Rhian Parham, Nick Freemantle, Alastair Forbes, Vanessa Cooper
Affiliations
Meta-Analysis

Understanding patients' adherence-related beliefs about medicines prescribed for long-term conditions: a meta-analytic review of the Necessity-Concerns Framework

Rob Horne et al. PLoS One. .

Abstract

Background: Patients' beliefs about treatment influence treatment engagement and adherence. The Necessity-Concerns Framework postulates that adherence is influenced by implicit judgements of personal need for the treatment (necessity beliefs) and concerns about the potential adverse consequences of taking it.

Objective: To assess the utility of the NCF in explaining nonadherence to prescribed medicines.

Data sources: We searched EMBASE, Medline, PsycInfo, CDSR/DARE/CCT and CINAHL from January 1999 to April 2013 and handsearched reference sections from relevant articles.

Study eligibility criteria: Studies using the Beliefs about Medicines Questionnaire (BMQ) to examine perceptions of personal necessity for medication and concerns about potential adverse effects, in relation to a measure of adherence to medication.

Participants: Patients with long-term conditions.

Study appraisal and synthesis methods: Systematic review and meta-analysis of methodological quality was assessed by two independent reviewers. We pooled odds ratios for adherence using random effects models.

Results: We identified 3777 studies, of which 94 (N = 25,072) fulfilled the inclusion criteria. Across studies, higher adherence was associated with stronger perceptions of necessity of treatment, OR = 1.742, 95% CI [1.569, 1.934], p<0.0001, and fewer Concerns about treatment, OR = 0.504, 95% CI: [0.450, 0.564], p<0.0001. These relationships remained significant when data were stratified by study size, the country in which the research was conducted and the type of adherence measure used.

Limitations: Few prospective longitudinal studies using objective adherence measures were identified.

Conclusions: The Necessity-Concerns Framework is a useful conceptual model for understanding patients' perspectives on prescribed medicines. Taking account of patients' necessity beliefs and concerns could enhance the quality of prescribing by helping clinicians to engage patients in treatment decisions and support optimal adherence to appropriate prescriptions.

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Conflict of interest statement

Competing Interests: The authors have performed consultancy for Nycomed, Takeda, B Braun, Shire, Warner Chilcott, Abbott, MSD, and the university spin out consultancy company, Spoonful of Sugar of which RH is a shareholder; RH has undertaken speaker engagements with honoraria for pharmaceutical companies, RH has received consultancy payments from pharmaceutical companies related to the use of the BMQ in industry sponsored studies. There are no other relationships or activities that could appear to have influenced the submitted work. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials.

Figures

Figure 1
Figure 1. Selection process for study inclusion.
Figure 2
Figure 2. Forest plot of effect sizes for BMQ Necessity and medication adherence.
Figure 3
Figure 3. Forest plot of effect sizes for BMQ Concerns and medication adherence.
Figure 4
Figure 4. Funnel plot for BMQ Necessity and medication adherence.
Figure 5
Figure 5. Funnel plot for BMQ Concerns and medication adherence.
See this image and copyright information in PMC

References

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    1. World Health Organisation (2003) Adherence to Long-term Therapies: Evidence for Action. Geneva: World Health Organisation.
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