title: The role of irrational thought in medicine adherence: people with diabetic kidney disease.
abstract: OBJECTIVE
  This paper is a report of a study conducted to examine how irrational thinking affects people's adherence to multiple medicines prescribed to manage their diabetic kidney disease.
  
  
  BACKGROUND
  Approximately 50% of people are non-adherent to their prescribed medicines and the risk of non-adherence escalates as the number of prescribed medicines increases. Adherence to prescribed medicines can slow disease progression in diabetic kidney disease.
  
  
  METHODS
  A descriptive exploratory design was used. In-depth interviews were conducted with 23 participants recruited from a nephrology outpatient clinic in Australia in 2007. Data were analysed using a 'framework' method.
  
  
  RESULTS
  Participants' mean age was 59 years, they had approximately six chronic conditions in addition to their diabetic kidney disease and were prescribed a median of ten medicines daily. Two major themes of irrational thinking--heuristics and denial--and subthemes were identified. Heuristics contributed to inaccurate risk assessment and biases affecting rational judgement concerning medicines, whereas denial was used to enhance coping necessary to manage this complex health condition.
  
  
  CONCLUSIONS
  Participants underestimated their health risks because they had been taking medicines for many years and preferred not to dwell on their ill health. A large amount of irrational thinking was related to maintaining the emotional strength necessary to manage their comorbid conditions as best they could. Regular assessment and support of medicine adherence throughout the disease course is necessary to avert the development of counterproductive heuristics and denial affecting medicine adherence.
authors.affiliation: School of Nursing and Social Work, The University of Melbourne, Carlton, Australia. afw@unimelb.edu.au
authors.forename: Allison F
authors.initials: AF
authors.lastname: Williams
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Manias
authors.forename: Rowan
authors.initials: R
authors.lastname: Walker
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D000553:Ambulatory Care; D001315:Australia; D002908:Chronic Disease; D003657:Decision Making; D003717:Denial, Psychological; D003928:Diabetic Nephropathies / Q000150:complications / Q000188:drug therapy* / Q000523:psychology; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D019338:Polypharmacy; D036301:Qualitative Research; D011788:Quality of Life; D013850:Thinking