title: Understanding patients' adherence-related beliefs about medicines prescribed for long-term conditions: a meta-analytic review of the Necessity-Concerns Framework.
abstract: BACKGROUND
  Patients' beliefs about treatment influence treatment engagement and adherence. The Necessity-Concerns Framework postulates that adherence is influenced by implicit judgements of personal need for the treatment (necessity beliefs) and concerns about the potential adverse consequences of taking it.
  
  
  OBJECTIVE
  To assess the utility of the NCF in explaining nonadherence to prescribed medicines.
  
  
  METHODS
  We searched EMBASE, Medline, PsycInfo, CDSR/DARE/CCT and CINAHL from January 1999 to April 2013 and handsearched reference sections from relevant articles.
  
  
  METHODS
  Studies using the Beliefs about Medicines Questionnaire (BMQ) to examine perceptions of personal necessity for medication and concerns about potential adverse effects, in relation to a measure of adherence to medication.
  
  
  METHODS
  Patients with long-term conditions.
  
  
  METHODS
  Systematic review and meta-analysis of methodological quality was assessed by two independent reviewers. We pooled odds ratios for adherence using random effects models.
  
  
  RESULTS
  We identified 3777 studies, of which 94 (N = 25,072) fulfilled the inclusion criteria. Across studies, higher adherence was associated with stronger perceptions of necessity of treatment, OR = 1.742, 95% CI [1.569, 1.934], p<0.0001, and fewer Concerns about treatment, OR = 0.504, 95% CI: [0.450, 0.564], p<0.0001. These relationships remained significant when data were stratified by study size, the country in which the research was conducted and the type of adherence measure used.
  
  
  CONCLUSIONS
  Few prospective longitudinal studies using objective adherence measures were identified.
  
  
  CONCLUSIONS
  The Necessity-Concerns Framework is a useful conceptual model for understanding patients' perspectives on prescribed medicines. Taking account of patients' necessity beliefs and concerns could enhance the quality of prescribing by helping clinicians to engage patients in treatment decisions and support optimal adherence to appropriate prescriptions.
authors: Centre for Behavioural Medicine, Department of Practice and Policy, UCL School of Pharmacy, London, United Kingdom.
authors: Rob
authors: R
authors: Horne
authors: Sarah C E
authors: SC
authors: Chapman
authors: Rhian
authors: R
authors: Parham
authors: Nick
authors: N
authors: Freemantle
authors: Alastair
authors: A
authors: Forbes
authors: Vanessa
authors: V
authors: Cooper
mesh_terms: D003469:Culture; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008962:Models, Theoretical