Exploring Patient Beliefs and Medication Adherence in the Mediterranean Context: A Cross-Sectional Study in Patients with Cardiovascular Diseases and Cardiometabolic Disorders in Greece—The IACT-Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Scope
2.2. Setting
2.3. Sample
2.4. Eligibility Criteria
2.5. Bioethics
2.6. Measurements
2.7. Socio-Demographic Characteristics
2.8. Anthropometric Characteristics
2.9. Clinical Characteristics-Cardiometabolic Disease/Risk Factors
2.10. Medication Adherence
2.11. General Views and Beliefs Regarding the Therapeutic Protocol
2.12. Statistical Analysis
3. Results
3.1. Patients’ Demographic, Socioeconomic and Clinical Characteristics
3.2. Patients’ Beliefs/Views about Their Prescribed Therapeutic Protocol
3.3. Impact of Patients’ Beliefs on Level of Medication Adherence
4. Discussion
4.1. Non-Adherence Levels among Patients with CVD and/or Cardiometabolic Disorders
4.2. Importance of Patients’ Beliefs/Views
5. Limitations
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Total Sample (N = 1988) | Perfect Adherence (N = 1018) | Poor Adherence (N = 970) | p-Value | |
---|---|---|---|---|
Demographic and Socioeconomic Characteristics | ||||
Nationality | ||||
Greek | 1961 (98.6) | 1012 (99.4) | 949 (97.8) | 0.002 |
Other | 27 (1.4) | 6 (0.6) | 21 (2.2) | |
Sex | ||||
Male | 808 (40.6) | 406 (39.9) | 402 (41.4) | 0.479 |
Female | 1180 (59.4) | 612 (60.1) | 568 (58.6) | |
Age [Mean (SD); years] | 63.9 (13.4) | 64.2 (12.9) | 63.5 (13.9) | 0.213 |
Level of education | ||||
Primary education | 351 (17.7) | 161 (15.8) | 190 (19.6) | 0.001 |
Secondary education | 985 (49.6) | 545 (53.5) | 440 (45.4) | |
Higher- Tertiary education | 651 (32.8) | 312 (30.6) | 339 (35.0) | |
Occupation | ||||
Employed/Freelance | 1225 (61.6) | 692 (68.0) | 533 (54.9) | <0.001 |
Unemployed/Retired | 763 (38.4) | 326 (32.0) | 437 (45.1) | |
Marital status | ||||
Married/ Cohabitation | 1328 (66.8) | 709 (69.6) | 619 (63.8) | 0.006 |
Other (Single, Widowed, Divorced) | 660 (33.2) | 309 (30.4) | 351 (36.2) | |
Annual income | ||||
Less than 18,000 euros | 1402 (70.5) | 748 (73.5) | 654 (67.4) | 0.003 |
More than 18,000 euros | 586 (29.5) | 270 (26.5) | 316 (32.6) | |
Clinical characteristics | ||||
Body Mass Index [Mean (SD); kg/m2] | 27.8 (4.0) | 27.8 (4.0) | 27.9 (4.1) | 0.411 |
Have you been diagnosed with: | ||||
Coronary artery disease | 352 (17.7) | 178 (17.5) | 174 (17.9) | 0.791 |
Stroke | 126 (6.3) | 71 (7.0) | 55 (5.7) | 0.233 |
Hypertension | 1141 (57.4) | 518 (50.9) | 623 (64.2) | <0.001 |
Type II diabetes | 370 (18.6) | 179 (17.6) | 191 (19.7) | 0.228 |
Type I diabetes | 64 (3.2) | 33 (3.2) | 31 (3.2) | 0.954 |
Hypercholesterolaemia | 735 (37.0) | 260 (25.5) | 475 (49.0) | <0.001 |
Hypertriglyceridemia | 354 (17.8) | 150 (14.7) | 204 (21.0) | <0.001 |
Obesity | 251 (12.6) | 117 (11.5) | 134 (13.8) | 0.119 |
Non- alcoholic Fatty liver disease | 115 (5.8) | 42 (4.1) | 73 (7.5) | 0.001 |
Kidney Disease | 120 (6.0) | 69 (6.8) | 51 (5.3) | 0.155 |
Perfect Adherence (N = 1018) | Poor Adherence (N = 970) | p-Value | ||
---|---|---|---|---|
Doctors prescribe too many medicines? | Agree | 114 (11.2) | 163 (16.8) | <0.001 |
I am not sure/Disagree | 904 (88.8) | 807 (83.2) | ||
The people taking medicines should stop the therapeutic protocol every once in a while? | Agree | 45 (4.4) | 69 (7.1) | 0.010 |
I am not sure/Disagree | 973 (95.6) | 901 (92.9) | ||
Medicines perform more harm than good? | Agree | 50 (4.9) | 46 (4.7) | 0.860 |
I am not sure/Disagree | 968 (95.1) | 924 (95.3) | ||
Most medicines are addictive? | Agree | 134 (13.2) | 152 (15.7) | 0.111 |
I am not sure/Disagree | 884 (86.8) | 818 (84.3) | ||
Alternative therapies are better compared to drugs | Agree | 53 (5.2) | 77 (7.9) | 0.014 |
I am not sure/Disagree | 965 (94.8) | 893 (92.1) | ||
I prefer to take medicines rather than restrict my diet and my lifestyle? | Agree | 104 (10.2) | 198 (20.4) | <0.001 |
I am not sure/Disagree | 914 (89.8) | 772 (79.6) | ||
I am willing to change my habits rather than take medications | Disagree | 72 (7.1) | 114 (11.8) | <0.001 |
I am not sure/Agree | 946 (92.9) | 856 (88.2) | ||
Both the use of medicines and lifestyle changes are necessary for an effective treatment | Disagree | 19 (1.9) | 19 (2.0) | 0.881 |
I am not sure/Agree | 999 (98.1) | 951 (98.0) | ||
I believe that changes in my lifestyle portray an important role in the course of my health | Disagree | 10 (1.0) | 22 (2.3) | 0.023 |
I am not sure/Agree | 1008 (99.0) | 948 (97.7) | ||
I use alternative treatments (herbal medicines or supplements) without informing my doctor | Agree | 55 (5.4) | 68 (7.0) | 0.137 |
I am not sure/Disagree | 963 (94.6) | 902 (93.0) |
Negative Beliefs/Views (N = 870) | Positive Beliefs/Views (N = 1118) | p-Value | |
---|---|---|---|
Demographic and Socioeconomic Characteristics | |||
Nationality | |||
Greek | 845 (97.1) | 1116 (99.8) | <0.001 |
Other | 25 (2.9) | 2 (0.2) | |
Sex | |||
Male | 330 (37.9) | 478 (42.8) | 0.030 |
Female | 540 (62.1) | 640 (57.2) | |
Age [Mean (SD); years] | 65 (14.7) | 63 (12.3) | <0.001 |
Level of education | |||
Primary education | 237 (27.3) | 114 (10.2) | <0.001 |
Secondary education | 346 (39.8) | 639 (57.2) | |
Higher- Tertiary education | 286 (32.9) | 365 (32.6) | |
Occupation | |||
Employed/Freelance | 336 (38.6) | 889 (79.5) | <0.001 |
Unemployed/Retired/ Student | 534 (61.4) | 229 (20.5) | |
Marital status | |||
Married/Cohabitation | 508 (58.4) | 820 (73.3) | <0.001 |
Other (Single, Widowed, Divorced) | 362 (41.6) | 298 (26.7) | |
Yearly income | |||
Less than 18,000 euros | 601 (69.1) | 801 (71.6) | 0.213 |
More than 18,000 euros | 269 (30.9) | 317 (28.4) | |
Clinical characteristics | |||
Body Mass Index [Mean (SD); kg/m2] | 27.9 (4.5) | 27.8 (3.6) | 0.459 |
Have you been diagnosed with: | |||
Hypertension | 579 (66.6) | 562 (50.3) | <0.001 |
Type II diabetes | 216 (24.8) | 154 (13.8) | <0.001 |
Type I diabetes | 41 (4.7) | 23 (2.1) | <0.001 |
Hypercholesterolaemia | 475 (54.6) | 260 (23.3) | <0.001 |
Increased triglycerides levels | 219 (25.2) | 135 (12.1) | <0.001 |
Obesity | 129 (14.8) | 122 (10.9) | 0.009 |
Coronary artery disease | 175 (20.1) | 177 (15.8) | 0.013 |
Stroke | 38 (4.4) | 88 (7.9) | 0.001 |
Kidney Disease | 43 (4.9) | 77 (6.9) | 0.071 |
Non- alcoholic Fatty liver disease | 76 (8.7) | 39 (3.5) | <0.001 |
Odds Ratio | 95% Confidence Interval | p-Value | |
---|---|---|---|
Negative beliefs/ views towards treatment (Ref.: Positive) | 2.73 | 2.28–3.28 | <0.001 |
I believe that changes in my lifestyle portray an important role in the course of my health (Ref.: I am not sure/ Agree) | 2.34 | 1.10–4.97 | 0.027 |
I prefer to take medicines rather than restrict my diet and my lifestyle (Ref.: I am not sure/ Disagree) | 2.25 | 1.75–2.91 | <0.001 |
I am willing to change my habits rather than take medications (Ref.: I am not sure/ Agree) | 1.75 | 1.28–2.38 | <0.001 |
The people taking medicines should stop the therapeutic protocol every once in a while (Ref.: I am not sure/ Disagree) | 1.66 | 1.13–2.44 | 0.011 |
Doctors prescribe too many medicines (Ref.: I am not sure/ Disagree) | 1.60 | 1.24–2.07 | <0.001 |
Alternative therapies are better compared to drugs (Ref.: I am not sure/ Disagree) | 1.57 | 1.09–2.25 | 0.014 |
I use alternative treatments (herbal medicines or supplements) without informing my doctor (Ref.: I am not sure/ Agree) | 1.32 | 0.92–1.91 | 0.138 |
Most medicines are addictive (Ref.: I am not sure/ Disagree) | 1.23 | 0.95–1.58 | 0.112 |
Both the use of medicines and lifestyle changes are necessary for an effective treatment (Ref.: I am not sure/ Agree) | 1.05 | 0.55–2.00 | 0.881 |
Medicines perform more harm than good (Ref.: I am not sure/ Disagree) | 0.96 | 0.64–1.45 | 0.860 |
Odds Ratio | 95% Confidence Interval | p-Value | |
---|---|---|---|
Total Sample | 2.73 | 2.28–3.28 | <0.001 |
Stratified by: | |||
Sex | |||
Males | 1.27 | 0.87–1.85 | 0.214 |
Females | 2.51 | 1.98–3.17 | <0.001 |
Level of education | |||
Primary education | 1.57 | 0.90–2.73 | 0.110 |
Secondary education | 3.14 | 2.06–4.77 | <0.001 |
Higher/Tertiary education | 1.46 | 1.07–1.99 | 0.017 |
Occupation | |||
Employed/Freelance | 2.15 | 1.43–3.23 | <0.001 |
Unemployed/ Retired/ Student | 1.62 | 1.19–2.22 | 0.002 |
Marital status | |||
Married/Cohabitation | 1.49 | 1.01–2.19 | 0.045 |
Other (Single, Widowed, Divorced) | 2.08 | 1.52–2.84 | <0.001 |
Yearly income | |||
Less than 18,000 euros/year | 2.23 | 1.50–3.32 | <0.001 |
More than 18,000 euros/year | 1.56 | 1.12–2.16 | 0.008 |
Established CVD (CHD or stroke) | |||
Yes | 3.42 | 2.32–5.05 | <0.001 |
No | 0.75 | 0.48–1.16 | 0.198 |
Number of clinical risk factors * | |||
None | 1.79 | 0.60–5.34 | 0.298 |
One (1) | 1.00 | 0.54–1.86 | 0.993 |
Two (2) | 1.36 | 0.67–2.78 | 0.396 |
At least three (3) | 1.91 | 1.11–3.30 | 0.019 |
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Belitsi, V.; Tsiampalis, T.; Kouvari, M.; Kalantzi, V.; Androutsos, O.; Bonoti, F.; Panagiotakos, D.B.; Kosti, R.I. Exploring Patient Beliefs and Medication Adherence in the Mediterranean Context: A Cross-Sectional Study in Patients with Cardiovascular Diseases and Cardiometabolic Disorders in Greece—The IACT-Study. Life 2023, 13, 1880. https://doi.org/10.3390/life13091880
Belitsi V, Tsiampalis T, Kouvari M, Kalantzi V, Androutsos O, Bonoti F, Panagiotakos DB, Kosti RI. Exploring Patient Beliefs and Medication Adherence in the Mediterranean Context: A Cross-Sectional Study in Patients with Cardiovascular Diseases and Cardiometabolic Disorders in Greece—The IACT-Study. Life. 2023; 13(9):1880. https://doi.org/10.3390/life13091880
Chicago/Turabian StyleBelitsi, Vasiliki, Thomas Tsiampalis, Matina Kouvari, Vasiliki Kalantzi, Odysseas Androutsos, Fotini Bonoti, Demosthenes B. Panagiotakos, and Rena I. Kosti. 2023. "Exploring Patient Beliefs and Medication Adherence in the Mediterranean Context: A Cross-Sectional Study in Patients with Cardiovascular Diseases and Cardiometabolic Disorders in Greece—The IACT-Study" Life 13, no. 9: 1880. https://doi.org/10.3390/life13091880
APA StyleBelitsi, V., Tsiampalis, T., Kouvari, M., Kalantzi, V., Androutsos, O., Bonoti, F., Panagiotakos, D. B., & Kosti, R. I. (2023). Exploring Patient Beliefs and Medication Adherence in the Mediterranean Context: A Cross-Sectional Study in Patients with Cardiovascular Diseases and Cardiometabolic Disorders in Greece—The IACT-Study. Life, 13(9), 1880. https://doi.org/10.3390/life13091880