Slide Presentation from the AHRQ 2008 Annual Conference
On September 9, 2008, Kathleen Mazor, made this presentation at the 2008 Annual Conference. Select to access the PowerPoint® presentation (460 KB).
Slide 1
The Role of Beliefs in Decisions about Medication
Kathleen Mazor, EdD
HMO Research Network (HMORN) Center for Education and Research on Therapeutics (CERT)
Meyers Primary Care Institute,
University of Massachusetts Medical School,
Fallon Community Health Plan and Fallon Clinic
Slide 2
Background
- For therapy to occur, the patient must accept the recommendation to initiate medication.
- This step is often overlooked.
- This session will focus on the role that beliefs play in patients' decisions to accept medication.
Slide 3
Three Relevant Studies
- The role of beliefs, communication and trust in a hypothetical decision.
- The role of knowledge, beliefs, communication and trust in initiating OP medications.
- Questionnaire study.
- Interview study.
Slide 4
Accepting hypertension (HTN) medication in a hypothetical situation
- 210 lay people recruited from the community.
- Questionnaire:
- Imagine yourself just diagnosed with HTN, you have this conversation with your doctor.
- Questions: would you accept medication, trust, doctor's communication, beliefs about medication and HTN.
Slide 5
Analysis
- Bivariate correlations.
- Multivariate models predicting acceptance.
Slide 6
Results: Best predictors of initiation.
- Trust in the physician.
- Perception that the physician has communicated well.
- Belief that medication is effective in treating HTN.
- Belief that doctors do not prescribe unsafe medications.
Slide 7
The diagram presents beliefs and worries and the number of patients affected by them when looking at initiating antihypertensive medication.
- Significant beliefs and worries:
- Belief that medications can effectively treat hypertension.
- Belief that doctors do not prescribe unsafe medications.
- Trust in the physician.
- Satisfaction with communication.
- Less significant beliefs and worries:
- Belief that hypertension is a very serious disease.
- Would worry about having hypertension.
- Belief that medications cause more problems than they solve.
- Would worry about medication side effects.
Slide 8
Initiation of Prescription Medication for Osteoporosis (OP)
- Women with recent bone density study meeting World Health Organization (WHO) criteria for OP, not treated in prior 6 months.
- Mailed questionnaire:
- Knowledge, beliefs, experiences.
- Electronic medical record review and pharmacy records.
Slide 9
Results
- 465 women invited to participate.
- 271 returned survey (58%).
- 57% started prescription OP treatment within 3 months of testing.
Slide 10
Women who do not start are more likely to agree.
- I can take care of my OP without medications. (26 vs 5)
- There are better ways for me to treat my OP besides medications. (45 vs 24)
- I worry about the side effects of taking OP medication. (77 vs 57)
Slide 11
Women who do not start are more likely to agree.
- Medications often cause more problems than they solve. (50 vs 31)
- I prefer not to take medications. (61 vs 43)
- Doctors are too quick to prescribe medications (46 vs 30)
- Doctors often give medication when advice would be better. (40 vs 24)
Slide 12
Women who do start are more likely to agree.
- Taking OP medication is good for me. (62 vs 37)
- Medication can effectively treat my osteoporosis. (72 vs 49)
- I worry about having OP. (72 vs 51)
Slide 13
Women who do start are more likely to agree.
- Taking OP medication can help my bones become stronger. (77 vs 58)
- Taking OP medication can help me stay independent. (66 vs 47)
- Taking OP medication can help me stay active. (66 vs 48)
Slide 14
No difference or very small difference.
- My prescriptions sometimes cost more than I can afford.
- I think OP is a very serious disease.
- I sometimes forget to take my medications on time.
- I worry about interactions between my medications.
Slide 15
Summary
- More likely to accept med if:
- Believe OP will be effective and beneficial.
- More likely to decline if:
- Believe can prevent OP otherwise.
- Distrust medication, concerned about side effects and problems.
Slide 16
Further exploration of acceptance of OP meds
- 35 in-depth qualitative interviews.
- Women age 65 and older.
- Have had bone mass density (BMD) testing.
- Meet WHO criteria for OP.
- Focus on 3 decisions: accept, decline, discontinue.
Slide 17
Preliminary Findings
- Analysis is currently underway.
Slide 18
Why women accept treatment
- Believe medication will be helpful.
- I should take something because I want to keep my bones as strong as possible.
- I was glad to take it if it was going to help.
- I don't like taking prescription drugs, but obviously since my exercise and diet was not working, I had to do it ...
Slide 19
Why women accept treatment
- Trust in their physician.
- If your doctor tells you that you have to, you more than likely listen.
- [I] took his word that this was what I should do.I do trust him. I feel comfortable and I don't think that he would lead me in the wrong direction.
Slide 20
Why women accept treatment
- Awareness of the debilitating consequences.
- I see people that do have it and the way they're bent way over due to the back problem and they're in a lot of pain and it's kind of scary. I visualize myself in five years, is that going to be me?
Slide 21
Why women decline treatment
- See medication as unnecessary.
- Like I said, I dance, I jump, I fall down, I get up, I plant, I dig, I plant, I do everything I want. Don't have a problem.
- . My bones seem to be pretty good. I've fallen a few times and I've never broken a bone. I've never broken anything.
Slide 22
Why women decline treatment
- Concerns about side effects.
- I'd rather risk a fall, which could happen tomorrow or it could happen when I'm 80, rather than take something daily that has high risks of side effects.
- There's all kinds of things that happen when you take this prescription medicine.
Slide 23
Why women decline treatment
- Concerns about medication precautions.
- But if they say, You have to stand up, or you can't lay down when you take these pills, and I'm going, What is going on here? Just how much does this involve? I don't like that... And what is this stuff anyway? Is it like plutonium? What is it? Am I going to blow up if I lay down?
- You're ingesting something that sounds pretty powerful to me... I have no problem standing, sitting, but I just even think that precaution makes me leery.
Slide 24
Why women discontinue treatment
- Experience with side effects.
- I was sick. I went down in my bed. I was vomiting, and I don't vomit.
- I had side effects from this medication.there was something in there that didn't agree with me.
- I started getting clicking of the jaw. Sort of like a lockjaw type of thing... after a month or two, I stopped taking it because of that and it went away.
Slide 25
Why women discontinue treatment
- Fear of side effects.
- ...I read an article about fosamax, something about the jaw, it could cause a big problem there... when I read that, I said, That's it, I will never take them again.
- I had heard of a friend of mine who had been taking fosamax for like ten years, she started losing her teeth. So I got kind of worried about that because that's one thing I don't want to do is lose my teeth.
Slide 26
Why women discontinue treatment
- Lack of reaction from prescriber.
- But I got sick on it. So then he said, Well never mind, just don't take anything. So that was that.
- They're overloaded and I guess with me saying I wasn't going to take it anymore he just said, Well that's your decision, abruptly, and that was that.
- In November when I went and I told her I wasn't taking it, she didn't push me or say anything. She just wrote it on my chart.
Slide 27
Conclusions
- Beliefs are important influences on decisions about medications.
- Belief in the need for the medication.
- Belief that the medication will help.
- Belief that the medication is safe; side effects unlikely or minimal.
Slide 28
Conclusions
- Don't yet fully understand how beliefs function—impact is probably not constant across people, conditions, medications.
- Don't yet know how to change beliefs.
Slide 29
Next steps.
- Better understanding of mental models.
- What affects perceptions of need?
- What affects perceptions of safety?
- What affects perceptions of benefit?
- Strategies for changing beliefs.
- For physicians.
- Print/media/Web materials.
Slide 30
References
- Mazor KM, Fischer MA and Billings-Gagliard S. Initial Acceptance of Treatment with Antihypertensive Medication: The Importance of Communication, Trust and Beliefs. Journal of Communication in Healthcare 2008. 1(3). 311-323.
- Yood RA, Mazor KM, Andrade SE, Emani S, Chan W, Kahler KH. Patients' Decisions to Initiate Therapy for Osteoporosis: The Influence of Knowledge and Beliefs. In press. Journal of General Internal Medicine (expected out online next week).
- Interview manuscript is in process.
Slide 31
Contact information
Current as of January 2009
Internet Citation:
The Role of Beliefs in Decisions about Medication. Slide Presentation from the AHRQ 2008 Annual Conference (Text Version). January 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/about/annualmtg08/090908slides/Mazor.htm
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