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Treatment adherence in Asthma and Attention Deficit Hyperactivity Disorder (ADHD), Personality traits, Beliefs about medication and Illness perception
Linköping University, Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences. Department of Health Science, University West, Trollhättan, Sweden.ORCID iD: 0000-0001-7367-715X
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Adherence to medication in asthma and attention deficit hyperactivity disorder (ADHD) is important because medication may prevent serious consequences, possibly with lifelong effects. Several factors have been identified that influence adherence to medication in these disorders, but the importance of personality traits, beliefs about medication and illness perception has been insufficiently explored.

The overall aim of this thesis was to study adherence to medication in asthma and ADHD, and in particular factors associated with adherence.

The participants (n=268) in Study I were recruited epidemiologically and consisted of young adults with asthma, aged 22 years (±1 year). Impulsivity and, in men Antagonism and Alexithymia were associated with low adherence among respondents with regular asthma medication (n=109).

The participants (n=35) in Study II were recruited from primary care clinics and consisted of adults (mean age 53 years). In men, Neuroticism was associated with low adherence, but Conscientiousness with high adherence. Beliefs about the necessity of medication were positively associated with adherence behaviour in women. In the total sample, a positive necessity-concern differential of beliefs predicted higher adherence.

The participants in Study III, IV (n=101) and V (n=99) were recruited from Child and Adolescent Psychiatric clinics and consisted of adolescents with ADHD on long-term ADHD medication. Study IV assessed the reliability and validity of Swedish translations of the Beliefs about Medicines Questionnaire-specific (BMQ-Specific) and Brief Illness Perception Questionnaire (B-IPQ) for use in adolescents with ADHD. Exploratory Principal Component Analysis (PCA) loadings of the BMQ-Specific items confirmed the original components, the specific-necessity and specific-concerns. The exploratory PCA for B-IPQ revealed two components; the first one, B-IPQ Consequences, captured questions regarding perceptions of the implication of having ADHD (items 1, 2, 5, 6 and 8) and the second one, B-IPQ-Control, the perceptions of the ability to manage the ADHD disorder (items 3, 4 and 7). Adherence correlated positively with BMQ-necessity-concern differential but negatively with beliefs about medication regarding concerns and side effects as well as Antagonism. Adolescents with more beliefs in the necessity, but with less concerns and side effects were less intentionally non-adherent. Adolescents with more perceptions that ADHD affected life showed less unintentional non-adherence. Negative Affectivity was associated with beliefs in the necessity of medication, but also with concern about medication and side effects. Negative Affectivity was positively associated with perceived consequences in life caused by ADHD and less control over ADHD. Hedonic Capacity was associated with less concerns about medication.

In conclusion: In asthma and ADHD, adherence was associated with personality and beliefs about medications treatment. The personality traits showed numerous associations with perception about ADHD and beliefs about asthma and ADHD medication. This thesis increases our understanding of these person-related underlying factors of non-adherence, which may enable targeted actions intended to turn non-adherence into adherence as well as to identify individuals at risk for non-adherence. The Swedish translation of BMQ-Specific and B-IPQ proved to be valid and reliable, suggesting that the scales are useful in clinical work to identify risks of low adherence and to increase knowledge about how adolescents perceive ADHD. 

Abstract [sv]

Följsamhet till läkemedelsbehandling vid astma och ADHD (attention deficit hyperactivity disorder) är viktigt eftersom optimal behandling kan förebygga allvarliga och livslånga konsekvenser. Flera faktorer som påverkar följsamhetsbeteendet har tidigare identifierats exempelvis ekonomiska faktorer, men vikten av personlighetsdrag, uppfattning om läkemedel och sjukdomsuppfattning har tidigare inte undersökts tillräckligt. Det övergripande syftet för avhandlingen var att studera följsamhet till läkemedel hos personer med astma och ADHD och i synnerhet påverkande faktorer. Avhandlingen utgörs av fem delstudier.

Personlighet kan beskrivas som grundläggande egenskaper som kännetecknar likheter och skillnader mellan individer, den så kallade egenskapsteorin. Personlighet kan beskrivas utifrån fem grundläggande personlighetsdrag: känslomässig instabilitet, utåtriktning, öppenhet, vänlighet och målmedvetenhet, den så kallade fem-faktor modellen. När det gäller uppfattning om läkemedel så vägs uppfattningen om nödvändigheten av läkemedelsbehandlingen för att kontrollera sjukdomen mot oron för läkemedlens negativa effekter-biverkningar. Följsamhetsbeteendet beror på vilken uppfattning som dominerar. Uppfattning om sjukdom påverkas bland annat av personens uppfattning om hur mycket sjukdomen påverkar personens liv och sjukdomens varaktighet.

Resultaten av denna avhandling visar att följsamheten var högre hos tonåringar med ADHD än hos vuxna med astma. Följsamheten till astma- och ADHD-medicinering var signifikant associerad med uppfattning att läkemedel var nödvändigt såväl som personlighetsdragen, särskilt antagonism. Följsamheten var inte associerad med ålder eller kön. Med anledning av att kön är relaterad till andra faktorer bör det beaktas i utredning av följsamhet till läkemedel. Personlighetsdraget känslomässig instabilitet, var relaterat till många uppfattningar om läkemedlen och sjukdomsuppfattningar. Avhandlingen visar på sambandet mellan vissa personrelaterade faktorer och följsamhet till läkemedel, hos personer med astma och ADHD. Den svenska översättningen av frågeformulären: Uppfattning om läkemedel (BMQ-Specific) och Uppfattning om ADHD (B-IPQ) visade sig ha god kvalitet för användning i kliniska utvärderingar och forskning som involverar ungdomar med ADHD.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2017. , p. 80
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1597
Keywords [en]
ADHD, adherence, asthma, beliefs about medication, illness perception, personality
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:liu:diva-142757DOI: 10.3384/diss.diva-142757ISBN: 9789176854167 (print)OAI: oai:DiVA.org:liu-142757DiVA, id: diva2:1154288
Public defence
2017-12-08, Berzeliussalen, ingång 65, Campus US, Linköping, 13:00 (English)
Opponent
Supervisors
Available from: 2017-11-02 Created: 2017-11-02 Last updated: 2017-11-02Bibliographically approved
List of papers
1. Personality, adherence, asthma control and health-related quality of life in young adult asthmatics
Open this publication in new window or tab >>Personality, adherence, asthma control and health-related quality of life in young adult asthmatics
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2009 (English)In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 103, no 7, p. 1033-1040Article in journal (Refereed) Published
Abstract [en]

Background

Striving for improved adherence and asthma control is of vital concern in today's asthma management. Several influential factors have been identified, but the importance of personality traits has been insufficiently explored. The aim was first to determine whether personality traits in young adult asthmatics are related to asthma control and health-related quality of life (HRQL), and second to examine the influences of personality traits on adherence to regular asthma medication treatment.

Methods

Young adult asthmatics, 22 years of age (n = 268) completed questionnaires. Statistical analyses were performed.

Results

The personality traits Negative Affectivity and Impulsivity correlated negatively with asthma control, whereas in women Hedonic Capacity correlated positively with asthma control. Negative Affectivity, Impulsivity, Hedonic Capacity, Alexithymia and asthma control predicted the mental dimension of HRQL. Asthma control and physical activity predicted the physical dimension of HRQL. Among respondents with regular asthma medication (n = 109), Impulsivity correlated negatively with adherence. In men, Antagonism and Alexithymia were associated with low adherence. Additionally, Alexithymia, Hedonic Capacity and Negative Affectivity showed non-linear relationships with adherence, meaning that initially increased scores on these personality traits scales were associated with increased adherence but higher scores did not increase adherence. Respondents who were prescribed a single inhaler combining ICS and LABA reported higher adherence than those with monotherapies.

Conclusion

These data suggest that personality can influence how asthma patients adhere to asthma medication treatment, and report their control and HRQL. Tools determining personality traits may be useful in the future in individualizing management of asthma patients.

Place, publisher, year, edition, pages
Elsevier, 2009
Keywords
Adherence, Asthma, Asthma control, Health-related quality of life, Personality traits, Young adults
National Category
Nursing
Research subject
NURSING AND PUBLIC HEALTH SCIENCE, Nursing science
Identifiers
urn:nbn:se:liu:diva-142758 (URN)10.1016/j.rmed.2009.01.013 (DOI)09546111 (ISSN) (ISBN)
Available from: 2009-09-21 Created: 2017-11-02 Last updated: 2017-11-02Bibliographically approved
2. The Influence of personality traits and beliefs about medicines on adherence to asthma treatment
Open this publication in new window or tab >>The Influence of personality traits and beliefs about medicines on adherence to asthma treatment
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2011 (English)In: Primary Care Respiratory Journal, ISSN 1471-4418, E-ISSN 1475-1534, Vol. 20, no 2, p. 141-147Article, review/survey (Refereed) Published
Abstract [en]

Aim:To explore the influence of personality traits and beliefs about medicines on adherence to treatment with asthma medication.

Methods:Respondents were 35 asthmatic adults prescribed controller medication. They answered questionnaires about medication adherence, personality traits, and beliefs about medicines.

Results:In gender comparisons, the personality traits “Neuroticism” in men and “adherence to medication” were associated with lower adherent behaviour. Associations between personality traits and beliefs in the necessity of medication for controlling the illness were identified. Beliefs about the necessity of medication were positively associated with adherent behaviour in women. In the total sample, a positive “necessity-concern” differential predicted adherent behaviour.

Conclusion:The results imply that personality and beliefs about medicines may influence how well adults with asthma adhere to treatment with asthma medication.

Place, publisher, year, edition, pages
The Primary Care Respiratory Society U K, 2011
Keywords
adherence, asthma, medication beliefs, personality traits, treatment
National Category
Nursing
Research subject
NURSING AND PUBLIC HEALTH SCIENCE, Nursing science
Identifiers
urn:nbn:se:liu:diva-142759 (URN)10.4104/pcrj.2011.00005 (DOI)
Available from: 2011-02-18 Created: 2017-11-02 Last updated: 2017-11-29Bibliographically approved
3. Beliefs regarding medication and side effects influence treatment adherence in adolescents with attention deficit hyperactivity disorder
Open this publication in new window or tab >>Beliefs regarding medication and side effects influence treatment adherence in adolescents with attention deficit hyperactivity disorder
2017 (English)In: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165X, Vol. 26, no 5, p. 559-571Article in journal (Refereed) Published
Abstract [en]

Adherence to attention deficit hyperactivity disorder (ADHD) treatment is important because, when untreated, it may have serious consequences with lifelong effects. In the case of adolescents on long-term medicine prescription, more knowledge is needed regarding adherence and factors influencing adherence, which was the purpose of this study. Adolescents (n = 101) on ADHD medication ≥6 months were administrated questionnaires at a monitoring appointment: Medication Adherence Report Scale (MARS), beliefs about medicines (BMQ) and the Brief Illness Perception Questionnaire (B-IPQ). Adherence was high, the mean value was 88% of the maximum MARS score, and correlated positively with the “BMQ-necessity-concerns differential” but negatively with “BMQ-concerns” and “BMQ-side effects”. Adolescents with more belief in the necessity of the medication, less concerns and less experience of side effects tended to be more adherent to medication prescription (“intentional non-adherence”), while “unintentional non-adherence” (forgetfulness) was associated with how much they perceived that their ADHD affected their lives. In a multiple regression model, the variance of MARS total (R2 = 0.21) and “intentional non-adherence” (R2 = 0.24) was explained by the “BMQ-necessity–concern differential” and “BMQ-experienced side effects”. The variance of “unintentional non-adherence” (R2 = 0.12) was explained by the “BMQ-necessity–concern differential” and “B-IPQ-consequences of ADHD”. In conclusion, adolescents on long-term medication reported good adherence, mainly influenced by more beliefs in the necessity versus concerns of the medications, less experienced side effects and more perceived consequences of ADHD. BMQ could be useful to identify risks of low adherence, which should be counteracted by partially gender-specific interventions.

Place, publisher, year, edition, pages
Springer, 2017
Keywords
Electron beam melting, IN718, microstructure, texture, hardness
National Category
Psychiatry
Identifiers
urn:nbn:se:liu:diva-132825 (URN)10.1007/s00787-016-0919-1 (DOI)000399701900007 ()27848023 (PubMedID)
Note

Funding agencies: Medical Research Council of Southeast Sweden [FORSS-466211]; "Child and Youth Studies" at the University West

Available from: 2016-11-30 Created: 2016-11-30 Last updated: 2018-04-18Bibliographically approved

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