Women and men report different behaviours in, and reasons for medication non-adherence: a nationwide Swedish survey
Objectives: The aim of the present study was to analyse gender differences in self-reported non-adherence (NA) to prescribed medication in the Swedish general population. We aimed to study unintentional and intentional NA as well as the reasons given for NA.
Methods: A questionnaire was mailed to a cross-sectional, random, national sample of people aged 18-84 years in Sweden (n=7985). The response rate was 61.1% (n=4875). The questionnaire covered use of prescription drugs, NA behaviour and reasons for NA.
Results: Use of prescription drugs was reported by 59.5% (n=2802) of the participants, and 66.4% (n=1860) of these participants did not adhere to the prescribed regimen. No overall gender differences in reporting NA were found. However, when analysing the various types of NA behaviour and the reasons for NA, different gender patterns emerged. Men were more likely to report forgetting [OR=0.77 (95%CI 0.65:0.92)], changing the dosage [OR=0.64 (95%CI 0.52:0.79)] and that they had recovered [14.3%, (OR=0.71 (95%CI 0.56:0.90)] as a reason. In contrast, more women than men reported filling the prescription but not taking the drug [OR=1.25 (95%CI 1.02:1.54)] and reported the development of adverse drug reactions (ADRs) [OR=1.89 (95%CI 1.37:2.59)] as a reason more commonly. The gender differences remained, in most cases, after controlling for confounders such as age, socioeconomic factors, medical problems and attitudes toward drugs.
Conclusions: Women and men have different patterns of NA behaviour and different reasons for NA. Therefore, if adherence is to be improved, a wide knowledge of all the reasons for NA is required, along with an understanding of the impact of gender on the outcomes.
2. Vermeire E, Hearnshaw H, Van Royen P, Denekens J. Patient adherence to treatment: three decades of research. A comprehensive review. J Clin Pharm Ther. 2001;26(5):331-342.
3. Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353(5):487-497.
4. DiMatteo MR. Variations in patients' adherence to medical recommendations: a quantitative review of 50 years of research. Med Care. 2004;42(3):200-209.
5. Burnier M. Medication adherence and persistence as the cornerstone of effective antihypertensive therapy. Am J Hypertens. 2006;19(11):1190-1196.
6. Haynes RB, Ackloo E, Sahota N, McDonald HP, Yao X. Interventions for enhancing medication adherence. Cochrane Database Syst Rev. 2008(2):CD000011.
7. Lehane E, McCarthy G. Intentional and unintentional medication non-adherence: A comprehensive framework for clinical research and practice? A discussion paper. Int J Nurs Stud. 2007;44:1468-1477.
8. Horne R. Representations of medication and treatment: advances in theory assessment. In: Petrie KJ, Weinman J, editors. Perceptions of health and illness. Chur (Switzerland):Harwood; 1997. p. 155-188.
9. Wilke T, Müller S, Morisky DE. Toward identifying the causes and combinations of causes increasing the risks of nonadherence to medical regimens: combined results of two German self-report surveys. Value Health. 2011;14(8):1092-100.
10. Horne R, Weinman J. Patients’ beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness. J Psychosom Res. 1999;47:555.567.
11. Horne R, Weinman J. Self regulation and self management in asthma: exploring the role of illness perceptions and treatment beliefs in explaining non-adherence to preventer medication. Psychology and Health. 2002;17(1):17-32.
12. Donovan JL, Blake DR. Patient non-compliance: deviance or reasoned decision-making? Soc Sci Med. 1992:34(5);507-513.
13. Demyttenaere K, Enzlin P, Dewe W, Boulanger B, De Bie J, De Troyer W, Mesters P. Compliance with antidepressants in a primary care setting, 1: Beyond lack of efficacy and adverse events. J Clin Psychiatry. 2001;62(22):30-33.
14. Pound P, Britten N, Morgan M, Yardley L, Pope C, Daker-White G, Campbell R. Resisting medicines: a synthesis of qualitative studies of medicine taking. Soc Sci Med. 2005;61(1):133-155.
15. Bull SA, Hu XH, Hunkeler EM, Lee JY, Rowland CR, Williamson TE, Schwab JR, Hurt SW. Discontinuation of use and switching of antidepressants: influence of patient-physician communication. JAMA. 2002;288(11):1403-1409.
16. Applebaum AJ, Richardson MA, Brady SM, Brief DJ, Keane TM. Gender and other psychosocial factors as predictors of adherence to highly active antiretroviral therapy (HAART) in adults with comorbid HIV/AIDS, psychiatric and substance-related disorder. AIDS Behav. 2009;13(1):60-65.
17. Verbrugge LM. Gender and health: an update on hypotheses and evidence. J Health Soc Behav. 1985;26(3):156-182.
18. Courtenay WH. Constructions of masculinity and their influence on men’s well-being: a theory of gender and health. Soc Sci Med. 2000;50(10):1385-1401.
19. Isacson D, Bingefors K. Attitudes towards drugs--a survey in the general population. Pharm World Sci. 2002;24(3):104-110.
20. Horne R, Graupner L, Frost S, Weinman J, Wright SM, Hankins M. Medicine in a multi-cultural society: the effect of cultural background on beliefs about medication. Soc Sci Med. 2004;59(6):1307-1313.
21. Chan CD, Shrank WH, Cutler D. Patient, physician, and payment predictors of statin adherence. Med Care. 2010;48:196-202.
22. Granger BB, Ekman I, Granger CB, Ostergren J, Olofsson B, Michelson E, McMurray JJV, Ysuf S, Pfeffer MA, Swedberg K. Adherence to medication according to sex and age in the CHARM programme. Eur J Heart Fail. 2009:11(11):1092-1098.
23. Beardon PH, McGilchrist MM, McKendrick AD, McDevitt DG, MacDonald TM. Primary non-compliance with prescribed medication in primary care. BMJ. 1993;307(6908):846-848.
24. Puskas CM, Forrest JI, Parashar S, Salters KA, Cescon AM, Kaida A, Miller CL, Bangsberg DR, Hogg RS. Women and vulnerability to HAART non-adherence: a literature review of treatment non-adherence by gender from 2000 to 2011. Curr HIV/AIDS Rep. 2011;8(4):277-287.
25. Nahon S, Lahmek P, Saas C, Durance C, Olympie A, Lesgourgues B, Gendre JP. Socioeconomic and psychological factors associated with nonadherence to treatment in inflammatory bowel disease patients: results of the ISSEO survey. Inflamm Bowel Dis. 2011;17(6):1270-1276.
26. Hankivsky O. Women’s health, men’s health, and gender and health: implications of intersectionality. Soc Sci Med. 2012;74:1712-1720.
27. Statistics Sweden. Living conditions. Appendix 13. Technical report for surveys conducted during 1984-1989. Surveys of Living Conditions. Örebro: SCB-Tryck, 1992.
28. Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986;24(1):67-74.
29. Vetting the ethics of research involving humans. Available from: http://www.epn.se/start/startsida.aspx (accessed 6th April 2012).
30. Hawthorne AB, Rubin G, Ghosh S. Review article: medication non-adherence in ulcerative colitis – strategies to improve adherence with mesalazine and other maintenance therapies. Aliment Pharmacol Ther. 2008;27:1157-1166.
31. Demyttenaere K, Enzlin P, Dewe W, Boulanger B, De Bie J, De Troyer W, Mesters P. Compliance with antidepressants in a primary care setting, 2: the influence of gender and type of impairment. J Clin Psychiatry. 2001;62(22):34-37.
32. Culig J, Leppée M, Boskovic J, Eric M. Determining the difference in medication compliance between the general patient population and patients receiving antihypertensive therapy: a case study. Arch Pharm Res. 2011;34(7):1143-1152.
33. Bulloch AGM, Patten SB. Non-adherence with psychotropic medications in the general population. Soc Psychiat Epidemiol. 2010;45:47-56.
34. Abhijit SG, McHorney CA. Unintentional non-adherence to chronic prescription medications: How unintentional is it really? BMC Health Serv Res. 2012;12:98.
35. Phatak HM, Thomas J. Relationship between beliefs about medications and nonadherence to prescribed chronic medication. Ann Pharmacother. 2006;40(10):1737-42.
36. DiMatteo MR, Haskard KB, Williams SL. Health beliefs, disease severity, and patient adherence. A meta-analysis. Med Care. 2007;45(6):521-528.
37. Clifford S, Barber N, Horne R. Understanding different beliefs held by adherers, unintentional nonadherers, and intentional nonadherers: Application of the Necessity-Concerns Framework. J Psychosom Res. 2008;64(1):41-46.
38. Ajzen I. Nature and operation of attitudes. Annu Rev Psychol. 2001;52:27-58.
39. Petty RE, Wegener DT, Fabrigar LR. Attitudes and attitude change. Annu Rev Psychol. 1997;48:609-647.
40. Mardby AC, Akerlind I, Jorgensen T. Beliefs about medicines and self-reported adherence among pharmacy clients. Patient Educ Couns. 2007;69(1-3):158-164.
41. Janz NK, Becker MH. The Health Belief Model: a decade later. Health Educ Q. 1984;11(1):1-47.
42. Harrison JA, Mullen PD, Green LW. A meta-analysis of studies of the health belief model with adults. Health Educ Res. 1992;7:107-116.
43. Isacson D, Johansson L, Bingefors K. Nationwide survey of subjectively reported adverse drug reactions in Sweden. Ann Pharmacother. 2008;42(3):347-353.
44. Tran C, Knowles SR, Liu BA, Shear NH. Gender differences in adverse drug reactions. J Clin Pharmacol. 1998;38:1003-1009.
45. Harris RZ, Benet LZ, Schwartz JB. Gender effects in pharmacokinetics and pharmacodynamics. Drugs. 1995;50:222-239.
46. Koren G, Klein N. Bias against negative studies in newspaper reports of medical research. JAMA. 1991;266(13):1824-1826.
47. Petersen I, Gilbert RE, Evans SJ, Man SL, Nazareth I. Pregnancy as a major determinant for discontinuation of antidepressants: an analysis of data from the Health Improvement Network. J Clin Psychiarty. 2011;72(7):979-985.
48. Einarson A, Selby P, Koren G. Abrupt discontinuation of psychotropic drugs during pregnancy: fear of teratogenic risk and impact of counselling. J Psychiatry Neurosci. 2001;26(1):44-48.
49. Eggen AE. Pattern of drug use in a general population – prevalence and predicting factors: The Tromsø study. Int J Epidemiol. 1994;23:1262-1272.
50. Lim PC, Lim K. Evaluation of a pharmacist-managed diabetes medication therapy adherence clinic. Pharm Pract (Internet). 2010;8(4):250-254.
51. Van Wijk BL, Klungel OH, Heerdink ER, de Boer A. Effectiveness of interventions by community pharmacists to improve patient adherence to chronic medication: a systematic review. Ann Pharmacother. 2005;39(2):319-328.
52. Nkansah N, Mostovetsky O, Yu C, Cheng T, Beney J, Bond CM, Bero L. Effect of outpatient pharmacists' non-dispensing roles on patient outcomes and prescribing patterns. Cochrane Database Syst Rev. 2010;7(7):CD000336.
53. Chumney EC, Robinson LC. The effects of pharmacist interventions on patients with polypharmacy. Pharm Pract (Internet). 2006;4(3):103-109.
54. Fikri-Benbrahim N, García-Cárdenas V, Sáez-Benito L, Gastelurrutia MA, Faus MJ. Adherence: a review of education, research, practice and policy in Spain. Pharm Pract (Internet). 2009;7(3):125-138.
55. Södergård B. Adherence to treatment: what is done in Sweden? Practice, education and research. Pharm Pract (Internet). 2008;6(4):171-177.
56. Rickles NM, Brown TA, McGivney MS, Snyder ME, White KA. Adherence: a review of education, research, practice, and policy in United States. Pharm Pract (Internet). 2010;8(1):1-17.
57. Schneider MP, Krummenacher I, Figueiredo H, Marquis J, Bugnon O. Adherence: a review of education, research, practice and policy in Switzerland. Pharm Pract (Internet). 2009;7(2):63-73.
58. Haugbølle LS, Herborg H. Adherence to treatment: practice, education and research in Danish community pharmacy. Pharm Pract (Internet). 2009;7(4):185-194.
59. Bell JS, Enlund H, Vainio K. Medication adherence: a review of pharmacy education, research, practice and policy in Finland. Pharm Pract (Internet). 2010;8(3):147-161.
60. Herborg H, Haugbølle LS, Sørensen L, Rossing C, Dam P. Developing generic, individualised adherence programme for chronic medication users. Pharm Pract (Internet). 2008;6(3):148-157.
61. Clifford S, Garfield S, Eliasson L, Barber N. Medication adherence and community pharmacy: a review of education, policy and research in England. Pharm Pract (Internet). 2010;8(2):77-88.
62. Clifford S, Barber N, Elliot R, Hartley E, Horne R. Patient centered advice is effective in improving adherence to medicines. Pharm World Sci. 2006;28:165-170.
63. Rubio-Valera M, Serrano-Blanco A, Magdalena-Belío J, Fernández A, García-Campayo J, Pujol MM, del Hoyo YL. Effectiveness of pharmacist care in the improvement of adherence to antidepressants: a systematic review and meta-analysis. Ann Pharmacother. 2011;45(1):39-48.
64. Wamala S, Merlo J, Bostrom G, Hogstedt C, Agren G. Socioeconomic disadvantage and primary non-adherence with medication in Sweden. Int J Qual Health Care. 2007;19(3):134-140.
65. Rickles NM, Svarstad BL. Relationships between multiple self-reported nonadherence measures and pharmacy records. Res Social Adm Pharm. 2007;3(4):363-377.
66. Garber MC, Nau DP, Erickson SR, Aikens JE, Lawrence JB. The concordance of self-report with other measures of medication adherence: a summary of the literature. Med Care. 2004;42(7):649-652.
The authors hereby transfer, assign, or otherwise convey to Pharmacy Practice: (1) the right to grant permission to republish or reprint the stated material, in whole or in part, without a fee; (2) the right to print pr epublish copies for free distribution or sale; and (3) the right to republish the stated material in any format (electronic or printed). In addition, the undersigned affirms that the article described above has not previously been published, in whole or part, is not subject to copyright or other rights except by the author(s), and has not been submitted for publication elsewhere, except as communicated in writing to Pharmacy Practice with this document.
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC-BY-NC-ND) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.