The utility of the Necessity--Concerns Framework in explaining treatment non-adherence in four chronic illness groups in Italy

Chronic Illn. 2009 Jun;5(2):129-33. doi: 10.1177/1742395309102888.


Objective: To translate the Beliefs about Medicines Questionnaire (BMQ) into Italian and explore the utility of the Necessity-Concerns Framework in explaining treatment non-adherence in four chronic illness groups in Italy.

Methods: 449 patients with chronic illness (depression, asthma, diabetes and cardiac disease) were approached at outpatient clinics in Turin and asked to complete Italian translations of the BMQ and the Medication Adherence Report Scale.

Results: 427 patients consented to participate in the study. The BMQ demonstrated good internal consistency, with Cronbach's alphas of 0.78 (Necessity subscale) and 0.72 (Concerns subscale). Participants were divided into four attitudinal groups based on their responses to the BMQ: 59% Accepting (high Necessity, low Concerns), 29% ambivalent (high Necessity, high Concerns), 8% Indifferent (low Necessity, low Concerns) and 4% Skeptical (low Necessity, high Concerns). Those in the Accepting group reported the highest adherence to medication and those in the Skeptical group the lowest (p50.01).

Discussion: The BMQ has been successfully translated and validated in Italian. This study provides support for the Necessity-Concerns Framework in explaining medication non-adherence in chronic illness. Interventions that address low perceived need for treatment and concerns about potential adverse effects of treatment are likely to facilitate optimal use of medicines.

MeSH terms

  • Aged
  • Analysis of Variance
  • Chronic Disease / drug therapy
  • Chronic Disease / prevention & control*
  • Female
  • Health Status Indicators
  • Humans
  • Italy
  • Male
  • Middle Aged
  • Patient Compliance / statistics & numerical data*
  • Surveys and Questionnaires