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Effects of medication, treatment, and behavioral beliefs on intentions to take medication in patients with familial hypercholesterolemia

  • Martin S. Hagger
    Correspondence
    Corresponding author. Health Psychology and Behavioral Medicine Research Group, School of Psychology, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth WA6845, Australia.
    Affiliations
    Health Psychology and Behavioural Medicine Research Group, School of Psychology, Curtin University, Perth, Western Australia, Australia

    Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland

    School of Applied Psychology, Griffith University, Brisbane, Australia
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  • Sarah J. Hardcastle
    Affiliations
    Health Psychology and Behavioural Medicine Research Group, School of Psychology, Curtin University, Perth, Western Australia, Australia
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  • Miao Hu
    Affiliations
    Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region
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  • See Kwok
    Affiliations
    Cardiovascular Trials Unit, The Old St Mary's Hospital, Central Manchester University Hospital NHS Foundation Trust, Manchester, UK

    Lipoprotein Research Group, Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
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  • Jie Lin
    Affiliations
    Department of Atherosclerosis, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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  • Hapizah M. Nawawi
    Affiliations
    Institute for Pathology, Laboratory and Forensic Medicine (I-PPerForM) and Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
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  • Jing Pang
    Affiliations
    School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
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  • Raul D. Santos
    Affiliations
    Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital, Preventive Medicine Centre, Cardiology Program Hospital Israelita Albert Einstein, São Paulo, Brazil
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  • Handrean Soran
    Affiliations
    Cardiovascular Trials Unit, The Old St Mary's Hospital, Central Manchester University Hospital NHS Foundation Trust, Manchester, UK
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  • Ta-Chen Su
    Affiliations
    Department of Internal Medicine and Cardiovascular Centre and College of Medicine, National Taiwan University Hospital, Taipei, Taiwan
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  • Brian Tomlinson
    Affiliations
    Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region
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  • Gerald F. Watts
    Affiliations
    School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia

    Lipid Disorders Clinic, Cardiometabolic Service, Department of Cardiology, Royal Perth Hospital, Perth, Australia
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      Highlights

      • Familial hypercholesterolemia (FH) can be appropriately managed using lipid-lowering medication.
      • Predicting patients' intentions to take medication may inform FH management interventions.
      • We tested effects of medication beliefs on intentions to take medication in FH patients.
      • Specific beliefs about taking medication and beliefs about medication overuse predicted intentions.
      • Treatment beliefs predicted medication intentions mediated by specific beliefs.

      Abstract

      Background and aims

      Although familial hypercholesterolemia (FH) can be effectively managed using cholesterol-lowering medication, patients often fall short of complete treatment adherence. Identifying the psychological factors associated with self-regulation of FH medication is important to inform interventions to maximize adherence. The aim of the present study was to test an integrated psychological model in predicting FH patients' intentions to take medication.

      Methods

      FH patients attending clinics in seven countries were invited to participate in a cross-sectional survey study. Consenting patients (N = 551) completed self-report measures of generalized beliefs about medication overuse and harms, beliefs in treatment effectiveness, specific beliefs about taking medication (attitudes, subjective norms, perceived behavioral control), and intentions to take medication. Participants also completed measures of demographic variables (age, gender, education level, income, cardiovascular disease status). Data were analysed using path analysis controlling for country and demographic variables.

      Results

      Attitudes (β = .331, p<0.001), subjective norms (β = .121, p=0.009), and beliefs about medication overuse (β = −.160, p<0.001) were significant predictors of intentions to take medication. Treatment beliefs predicted intentions indirectly (β = .088, p<0.001) through attitudes and subjective norms. There was also an indirect effect of beliefs about medication overuse on intentions (β = −.045, p=0.056), but the effect was small compared with the direct effect.

      Conclusions

      The findings indicate the importance among FH patients of specific beliefs about taking medication and generalized beliefs about medication overuse and treatment in predicting medication intentions. When managing patients, clinicians should emphasize the efficacy of taking cholesterol-lowering drugs and the importance of treatment outcomes, and allay concerns about medication overuse.

      Keywords

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