Evaluating the Validity and Reliability of the Beliefs About Medicines Questionnaire in Low-Income,Spanish-Speaking Patients With Diabetes in the United States
Restricted accessResearch articleFirst published online February, 2017
Evaluating the Validity and Reliability of the Beliefs About Medicines Questionnaire in Low-Income,Spanish-Speaking Patients With Diabetes in the United States
The purpose of this study was to examine the reliability and validity of a Spanish version of the Beliefs about Medicines Questionnaire (BMQ) as a measure to evaluate beliefs about medications and to differentiate adherent from nonadherent patients among low-income Latino patients with diabetes in the United States.
Methods
Seventy-three patients were administered the BMQ and surveyed for evidence of medication nonadherence. Internal consistency of the BMQ was assessed by Cronbach’s alpha along with performing a confirmatory factor analysis. Criterion validity was assessed by comparing mean scores on 3 subscales of the BMQ (General Overuse, General Harm, and Specific Necessity–Concerns difference score) between adherent patients and patients reporting nonadherence for 3 different reasons (unintentional nonadherence, cost-related nonadherence, and nonadherence due to reasons other than cost) using independent samples t tests.
Results
The BMQ is a reliable instrument to examine beliefs about medications in this Spanish-speaking population. Construct validity testing shows nearly identical factor loading as the original construct map. General Overuse scores were significantly more negative for patients reporting each reason for nonadherence compared with their adherent counterparts. Necessity–Concerns difference scores were significantly more negative for patients reporting nonadherence for reasons other than cost compared with those who did not report this reason for nonadherence.
Conclusion
The Spanish version of the BMQ is appropriate to assess beliefs about medications in Latino patients with type 2 diabetes in the United States and may help identify patients who become nonadherent to medications for reasons other than out-of-pocket costs.
Get full access to this article
View all access options for this article.
References
1.
American Diabetes Association. Summary of revisions to the 2014 clinical practice recommendations. Diabetes Care. 2014;37(suppl 1):S4.
2.
HoPMRumsfeldJSMasoudiFA. Effect of medication nonadherence on hospitalization and mortality among patients with diabetes mellitus. Arch Intern Med. 2006;166(17):1836-1841.
3.
EgedeLELynchCPGebregziabherM. Differential impact of longitudinal medication non-adherence on mortality by race/ethnicity among veterans with diabetes. J Gen Intern Med. 2013;28(2):208-215.
4.
EgedeLEGebregziabherMHuntKJ. Regional, geographic, and ethnic differences in medication adherence among adults with type 2 diabetes. Ann Pharmacother. 2011;45(2):169-178.
5.
OsterbergLBlaschkeT. Adherence to medication. N Engl J Med. 2005;353(5):487-497.
6.
Ngo-MetzgerQSorkinDHBillimekJGreenfieldSKaplanSH. The effects of financial pressures on adherence and glucose control among racial/ethnically diverse patients with diabetes. J Gen Intern Med. 2012;27(4):432-437.
7.
BillimekJAugustKJ. Costs and beliefs: understanding individual- and neighborhood-level correlates of medication nonadherence among Mexican Americans with type 2 diabetes. Health Psychology. 2014;33(12):1602-1605.
8.
MishraSIGioiaDChildressSBarnetBWebsterRL. Adherence to medication regimens among low-income patients with multiple comorbid chronic conditions. Health Soc Work. 2011;36(4):249-258.
9.
SteinerJF. Rethinking adherence. Ann Intern Med. 2012;157(8): 580-585.
10.
KimCJSchlenkEAKimDJKimMErlenJAKimSE. The role of social support on the relationship of depressive symptoms to medication adherence and self-care activities in adults with type 2 diabetes. J Adv Nurs. 2015;71(9):2164-2175.
11.
SilvermanJKriegerJKieferMHebertPRobinsonJNelsonK. The relationship between food insecurity and depression, diabetes distress and medication adherence among low-income patients with poorly-controlled diabetes. J Gen Intern Med. 2015;30(10):1476-1480.
12.
UrsemCJBosworthHBShelbyRAHwangWAndersonRTKimmickGG. Adherence to adjuvant endocrine therapy for breast cancer: importance in women with low income. J Womens Health. 2015;24(5):403-408.
13.
WilliamsDRMohammedSALeavellJCollinsC. Race, socioeconomic status, and health: complexities, ongoing challenges, and research opportunities. Ann N Y Acad Sci. 2010;1186:69-101.
14.
VoilsCIMaciejewskiMLHoyleRH. Initial validation of a self-report measure of the extent of and reasons for medication nonadherence. Med Care. 2012;50(12):1013-1019.
15.
UnniEFarrisKB. Determinants of different types of medication non-adherence in cholesterol lowering and asthma maintenance medications: a theoretical approach. Patient Educ Couns. 2011;83(3):382-390.
16.
SafranDGNeumanPSchoenC. Prescription drug coverage and seniors: findings from a 2003 national survey. Health Aff (Millwood). 2005;Suppl Web Exclusives:W5.152-W5.166.
17.
LowryKPDudleyTKOddoneEZBosworthHB. Intentional and unintentional nonadherence to antihypertensive medication. Ann Pharmacother. 2005;39(7-8):1198-1203.
18.
ParkLGHowie-EsquivelJChungMLDracupK. A text messaging intervention to promote medication adherence for patients with coronary heart disease: a randomized controlled trial. Patient Educ Couns. 2014;94(2):261-268.
19.
HuangHLLiYCChouYC. Effects of and satisfaction with short message service reminders for patient medication adherence: a randomized controlled study. BMC Med Inform Decis Mak. 2013;13:127.
20.
OvbiageleBJenkinsCPatelS. Mobile health medication adherence and blood pressure control in recent stroke patients. J Neurol Sci. 2015;358(1-2):535-537.
21.
KirkmanMSRowan-MartinMTLevinR. Determinants of adherence to diabetes medications: findings from a large pharmacy claims database. Diabetes Care. 2015;38(4):604-609.
22.
ChoudhryNKBykovKShrankWH. Eliminating medication copayments reduces disparities in cardiovascular care. Health Aff (Millwood). 2014;33(5):863-870.
23.
HaJFLongneckerN. Doctor-patient communication: a review. Ochsner J. 2010;10(1):38-43.
24.
WeinerSJSchwartzASharmaG. Patient-centered decision making and health care outcomes: an observational study. Ann Intern Med. 2013;158(8):573-579.
25.
WeinerSJKellyBAshleyN. Content coding for contextualization of care: evaluating physician performance at patient-centered decision making. Med Decis Mak. 2014;34(1):97-106.
26.
FischerMAStedmanMRLiiJ. Primary medication non-adherence: analysis of 195,930 electronic prescriptions. J Gen Intern Med. 2010;25(4):284-290.
27.
SteinerJFHoPMBeatyBL. Socio-demographic and clinical characteristics are not clinically useful predictors of refill adherence in patients with hypertension. Circ Cardiovasc Qual Outcomes. 2009;2(5):451-457.
28.
Andersson SundellKJönssonAK. Beliefs about medicines are strongly associated with medicine-use patterns among the general population. Int J Clin Pract. 2016;70(3):277-285.
29.
DriesenaarJADe SmetPAvan HultenRNoordmanJvan DulmenS. Cue-responding behaviors during pharmacy counseling sessions with patients with asthma about inhaled corticosteroids: potential relations with medication beliefs and self-reported adherence. Health Commun. 2016;31(10):1266-1275.
30.
SchoenthalerADe La CalleFBarrios-BarriosM. A practice-based randomized controlled trial to improve medication adherence among Latinos with hypertension: study protocol for a randomized controlled trial. Trials. 2015;16:290.
31.
SofianouAMartynenkoMWolfMS. Asthma beliefs are associated with medication adherence in older asthmatics. J Gen Intern Med. 2013;28(1):67-73.
32.
LopezM. Increasing medication adherence among HIV+ Hispanics: a culturally tailored application of the imb model. Poster presented at: 141st APHA Annual Meeting; November 2-6, 2013; Boston, MA.
33.
HorneRChapmanSCParhamRFreemantleNForbesACooperV. Understanding patients’ adherence-related beliefs about medicines prescribed for long-term conditions: a meta-analytic review of the Necessity-Concerns Framework. PloS One. 2013;8(12):e80633.
34.
De las CuevasCRivero-SantanaAPerestelo-PerezLGonzalez-LorenzoMPerez-RamosJSanzEJ. Adaptation and validation study of the Beliefs about Medicines Questionnaire in psychiatric outpatients in a community mental health setting. Hum Psychopharmacol. 2011;26(2):140-146.
35.
Beléndez-VázquezMHernández-MijaresAHorneRWeinmanJ. Assessment beliefs about treatment: validity and reliability of the Spanish version of the Beliefs about Medicines Questionnaire. Int J Clin Health Psychol. 2007;7(3):767-779.
36.
Perpiñá TorderaMMoragónEMFusterABBayoALCíscarCP. Spanish asthma patients’ beliefs about health and medicines: validation of 2 questionnaires. Arch Bronconeumol. 2009; 45(5):218-223.
37.
BillimekJGuzmanHAnguloMA. Effectiveness and feasibility of a software tool to help patients communicate with doctors about problems they face with their medication regimen (EMPATHy): study protocol for a randomized controlled trial. Trials. 2015;16:145.
38.
HorneRWeinmanJHankinsM. The Beliefs about Medicines Questionnaire: the development and evaluation of a new method for assessing the cognitive representation of medication. Psychol Health. 1999;14(1):1-24.
39.
SweilehWMZyoudSHAbu Nab’aRJ. Influence of patients’ disease knowledge and beliefs about medicines on medication adherence: findings from a cross-sectional survey among patients with type 2 diabetes mellitus in Palestine. BMC Public Health. 2014;14:94.
40.
KreyenbuhlJLeithJMedoffDR. A comparison of adherence to hypoglycemic medications between type 2 diabetes patients with and without serious mental illness. Psychiatry Res. 2011;188(1):109-114.
41.
AflakseirA. Role of illness and medication perceptions on adherence to medication in a group of Iranian patients with type 2 diabetes. J Diabetes. 2012;4(3):243-247.
42.
KaplanSHBillimekJSorkinDHNgo-MetzgerQGreenfieldS. Reducing racial/ethnic disparities in diabetes: the Coached Care (R2D2C2) project. J Gen Intern Med. 2013;28(10):1340-1349.
43.
MårdbyACAkerlindIJörgensenT. Beliefs about medicines and self-reported adherence among pharmacy clients. Patient Educ Couns. 2007;69(1-3):158-164.
44.
MårdbyACAkerlindIHedenrudT. Different development of general beliefs about medicines during undergraduate studies in medicine, nursing and pharmacy. Patient Educ Couns. 2009;75(2):283-289.
45.
ArcuryTASuerkenCKGrzywaczJGBellRALangWQuandtSA. Complementary and alternative medicine use among older adults: ethnic variation. Ethn Dis. 2006;16(3):723-731.
46.
BriesacherBAGurwitzJHSoumeraiSB. Patients at-risk for cost-related medication nonadherence: a review of the literature. J Gen Intern Med. 2007;22(6):864-871.
