title: Immunosuppressant nonadherence in heart, liver, and lung transplant patients:  associations with medication beliefs and illness perceptions.
abstract: BACKGROUND
  Nonadherence to immunosuppressant medication is a significant problem among solid organ transplant recipients. Previous research suggests that patients' perceptions about their medications may be a better predictor of nonadherence than demographic factors. This study aimed to further investigate the role of patients' perceptions about their transplant and medication beliefs in nonadherence.
  
  
  METHODS
  This was a cross-sectional observational study. Participants were 87 heart, 46 lung, and 193 liver transplant patients. All surviving heart, lung, and liver transplant patients from Auckland City Hospital and Greenlane Hospital older than 16 years who had received their transplant at least 3 months before study commencement were mailed questionnaires. Standardized self-report measures were used to assess illness perceptions, medication beliefs, and adherence.
  
  
  RESULTS
  Nonadherent patients had lower perceptions about the necessity of medication, weaker beliefs that medication could prevent rejection, and higher concerns about its harms, than adherers. Nonadherers perceived that their transplant and immunosuppressant medication caused more symptoms and were more distressed about symptoms than adherers; they understood their transplant less, perceived their transplant had a larger impact on their lives, affected them more emotionally, and caused greater concern, than patients who were more adherent. A regression model that included these perceptions and demographic variables correctly classified 71% of patients as adherent or nonadherent.
  
  
  CONCLUSIONS
  The perceptions that patients hold about their transplant and medications are associated with adherence to immunosuppressant medications. Future research could investigate whether a psychologic intervention could change patients' perceptions to improve adherence.
authors.affiliation: Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
authors.forename: Mary
authors.initials: M
authors.lastname: Kung
authors.forename: Heidi E
authors.initials: HE
authors.lastname: Koschwanez
authors.forename: Liz
authors.initials: L
authors.lastname: Painter
authors.forename: Val
authors.initials: V
authors.lastname: Honeyman
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Broadbent
mesh_terms: D003430:Cross-Sectional Studies; D003469:Culture; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control*; D006085:Graft Survival; D016027:Heart Transplantation / Q000523:psychology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016031:Liver Transplantation / Q000523:psychology*; D016040:Lung Transplantation / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology*; D010465:Perception; D011795:Surveys and Questionnaires
chemical_list: D007166:Immunosuppressive Agents