Understanding different beliefs held by adherers, unintentional nonadherers, and intentional nonadherers: application of the Necessity-Concerns Framework

J Psychosom Res. 2008 Jan;64(1):41-6. doi: 10.1016/j.jpsychores.2007.05.004.


Objective: The objective of this study was to explore beliefs about medicines, using the Necessity-Concerns Framework, of patients who report adherence, unintentional nonadherence, and intentional nonadherence.

Method: This study performed a cross-sectional survey of patients starting a new medication for a chronic condition. Self-reported adherence was assessed via telephone interview. The Necessity-Concerns Framework was operationalized using the Beliefs About Medicines Questionnaire, which assesses beliefs about the necessity of and concerns with taking medications.

Results: Intentional nonadherers, compared to adherers, had lower perceptions of the necessity of their new medication and higher levels of concerns about taking it. Conversely, unintentional nonadherers were not significantly different from adherers. Intentional nonadherers were more likely to rate their concerns as high relative to their need for treatment than both adherers and unintentional nonadherers.

Conclusion: When patients start a new medication for a chronic condition, intentional nonadherers hold beliefs significantly different from those of adherers and unintentional nonadherers. These findings have implications for practice in helping clinicians to reduce this type of nonadherence.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Attitude to Health
  • Chronic Disease / drug therapy*
  • Chronic Disease / psychology
  • Culture*
  • England
  • Female
  • Health Surveys
  • Humans
  • Intention*
  • Male
  • Middle Aged
  • Patient Compliance / psychology*
  • Surveys and Questionnaires
  • Treatment Refusal / psychology*