Nonadherence and osteoporosis treatment preferences of older women: a qualitative study.
BACKGROUND
Physicians must have an understanding of patients' medication beliefs in order to enhance medication adherence. To increase understanding, this study examined how beliefs about medication and four osteoporosis treatments influenced treatment selection and adherence.


METHODS
Six focus groups, three with 28 African Americans and one with 11 non-Hispanic white women, were conducted in English. Two groups with 16 Hispanics were conducted in Spanish. The convenience sample was recruited from senior centers and housing in lower socioeconomic geographic areas. The average age was 74.8 +/- 1.1 years.


RESULTS
Adherence was associated with recognition of the serious consequences of nonadherence, realization of the beneficial effects, and the belief that medicines are not harmful. Doubts about physicians' competence to prescribe appropriate drugs were also revealed. Women who thought they were unlikely to fracture or perceived fracture outcomes as not severe chose no treatment. If they identified a need, they weighed benefits against the attendant risks to find the best alternative among the affordable options. Price considerations eliminated raloxifene and alendronate. Consideration of side effects eliminated estrogen and raloxifene. Calcium was viewed as a low-cost, low-risk alternative. Those who could afford alendronate and who viewed its side effects as preventable preferred it. Benefit and risk assessments may have been biased by fear of cancer and thromboembolic events.


CONCLUSIONS
Women's beliefs about necessity of treatment, medication safety, cost of treatment, and treatment goals appear critical to osteoporosis treatment selection and adherence.
Unson
C G
CG
Claude Pepper Older Americans Independence Center, UConn Center on Aging, University of Connecticut Health Center, Farmington, Connecticut 06030-6147, USA. unson@uchc.edu
Siccion
E
E
Gaztambide
J
J
Gaztambide
S
S
Mahoney Trella
P
P
Prestwood
K
K
D001741:Black or African American / Q000523:psychology; D000368:Aged; D000369:Aged, 80 and over; D000739:Anecdotes as Topic; D001294:Attitude to Health; D005006:Ethnicity / Q000523:psychology*; D005260:Female; D017144:Focus Groups; D015438:Health Behavior; D006630:Hispanic or Latino / Q000523:psychology; D006801:Humans; D009511:New England; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy* / Q000523:psychology*; D010349:Patient Compliance / Q000523:psychology*; D012307:Risk Factors; D011795:Surveys and Questionnaires; D044465:White People / Q000523:psychology; D016387:Women's Health