The psychological factors in adherence to osteoporosis medication : an exploration and intervention development

• Main Author: Besser, Sarah Jane
• Format: Dissertation
• Language: English
• Published: King's College London (University of London) 2014

The ultimate aim of this six study research programme was to develop and evaluate an intervention to promote medication adherence for osteoporosis patients. Mixed methods were used, with a combination of qualitative, quantitative and interventional approaches. Each study involved the investigation of the psychological factors which contributed to adherence to osteoporosis medication. In addition to data collection through interviews and questionnaires, participants were asked to draw how they visualized their osteoporosis. This research drew on Leventhal’s Self-Regulation Model (Leventhal et al, 1984) and Witte’s Extended Parallel Process Model (Witte, 1992). The first three studies explored the role of psychological factors in osteoporosis medication adherence. The following factors were found to be related to adherence: concerns about medication (studies 1 and 3), motivation (study 3) and self-efficacy (study 3). Further, study 2 suggested that misconceptions about osteoporosis may also contribute to treatment non-adherence. Study 4 tested the psychological impact of the intervention materials. The drawing element of the research indicated that drawing the condition enabled patients to express their emotional response it (study 2). Findings from the first four studies led to the design of a theory-based psychological intervention. The intervention comprised: psycho-education, motivational interviewing and plan-setting and was tailored to the needs of each individual. Medication adherence increased for seven of the eight study participants. Post-intervention, patients reported increased understanding of osteoporosis, a greater perceived need for medication and a stronger belief that osteoporosis medication could reduce the risk of osteoporotic fractures. Further, the evaluation suggested that the tailored element of the intervention was largely responsible for the increases in adherence (study 6). The key findings were that i) osteoporosis patients have misconceptions about their bone health and their medication ii) psychological factors are related to osteoporosis medication adherence iii) creating a drawing of osteoporosis may elicit an emotional response to the condition and iv) a psychological intervention has the potential to increase adherence to osteoporosis medication. Further research with a larger sample is required to assess the intervention’s effectiveness.