title: How do osteoporosis patients perceive their illness and treatment? Implications for clinical practice.
abstract: Non-adherence inhibits successful treatment of osteoporosis. This study used a theoretical framework to explore osteoporosis patients' cognitive and emotional representations of their illness and medication, using both interviews and drawing. We recorded some misconceptions patients have about their condition and medication which could act as barriers to treatment adherence.
  
  
  OBJECTIVE
  Despite the high efficacy of current treatments in reducing fracture risk, poor adherence is still a problem in osteoporosis. This qualitative study aims to inform the development of a psychological intervention to increase adherence through the investigation of osteoporosis patients' perceptions of their illness and medication. The self-regulation model (Leventhal) provided the framework for the study.
  
  
  METHODS
  Participants were 14 female outpatients from a London teaching hospital who suffer with osteoporosis or osteopenia. Data were collected using both semi-structured interviews and drawings. Drawings were used to elicit participants' visual representations (imagery) of their condition.
  
  
  RESULTS
  We found that patients held illness and medication beliefs that were not in accord with current scientific evidence. Interviews revealed that participants had good knowledge of what osteoporosis is, but they had low understanding of the role of medication in reducing fracture risk, various concerns about the side effects of medication, poor understanding of the causes of osteoporosis and uncertainty about how it can be controlled. Additionally, drawings elicited more information about the perceived effects of osteoporosis and emotional reactions to the condition.
  
  
  CONCLUSIONS
  Osteoporosis sufferers need a better understanding of their fracture risk and what they can do to control their condition. Concerns about medication need to be addressed in order to improve adherence, particularly in relation to the management of side effects. Since drawings of osteoporosis were found to arouse emotions, it is concluded that risk communication in osteoporosis could benefit from using visual images.
authors.affiliation: NIHR King's Patient Safety and Service Quality Research Centre, King's College London, 2 Basement, 138-142 Strand Bridge House, Strand, London WC2R 1HH, UK. sarah.besser@kcl.ac.uk
authors.forename: Sarah Jane
authors.initials: SJ
authors.lastname: Besser
authors.forename: Janet E
authors.initials: JE
authors.lastname: Anderson
authors.forename: John
authors.initials: J
authors.lastname: Weinman
mesh_terms: D000368:Aged; D001851:Bone Diseases, Metabolic / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology; D003142:Communication; D004644:Emotions; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology / Q000523:psychology; D006266:Health Education / Q000379:methods; D057220:Health Literacy; D006801:Humans; D007407:Interviews as Topic; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D010024:Osteoporosis / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology*; D010045:Outpatients / Q000523:psychology*; D010775:Photic Stimulation / Q000379:methods; D012307:Risk Factors