title: Discrepancies between beliefs and behavior: a prospective study into immunosuppressive medication adherence after kidney transplantation.
abstract: BACKGROUND
  Nonadherence to immunosuppressive medication after kidney transplantation is a behavioral issue and as such it is important to understand the psychological factors that influence this behavior. The aim of this study was to investigate the extent to which goal cognitions, illness perceptions, and treatment beliefs were related to changes in self-reported immunosuppressive medication adherence up to 18 months after transplantation.
  
  
  METHODS
  Interviews were conducted with patients in the outpatient clinic 6 weeks (T1; n=113), 6 months (T2; n=106), and 18 months (T3; n=84) after transplantation. Self-reported adherence was measured using the Basel Assessment of Adherence to Immunosuppressive Medications Scale Interview. Psychological concepts were measured using the Brief Illness Perceptions Questionnaire, Beliefs about Medicines Questionnaire, and questions on the importance of adherence as a personal goal, conflict with other goals, and self-efficacy for goal attainment.
  
  
  RESULTS
  Nonadherence significantly increased over time to 31% at T3. Perceived necessity of medication, perceived impact of transplant on life (consequences) and emotional response to transplantation significantly decreased over time. Participants who reported low importance of medication adherence as a personal goal were more likely to become nonadherent over time.
  
  
  CONCLUSIONS
  Illness perceptions can be described as functional and supportive of adherence which is inconsistent with the pervasive and increasing nonadherence observed. There appears therefore to be a discrepancy between beliefs about adherence and actual behavior. Promoting (intrinsic) motivation for adherence goals and exploring the relative importance in comparison to other personal goals is a potential target for interventions.
authors.affiliation: 1 Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands. 2 Department of Psychiatry, Erasmus Medical Center, Rotterdam, the Netherlands. 3 Departments of Internal Medicine and Hospital Pharmacology, Erasmus Medical Center, Rotterdam, the Netherlands.
authors.forename: Emma K
authors.initials: EK
authors.lastname: Massey
authors.forename: Mirjam
authors.initials: M
authors.lastname: Tielen
authors.forename: Mirjam
authors.initials: M
authors.lastname: Laging
authors.forename: Reinier
authors.initials: R
authors.lastname: Timman
authors.forename: Denise K
authors.initials: DK
authors.lastname: Beck
authors.forename: Roshni
authors.initials: R
authors.lastname: Khemai
authors.forename: Teun
authors.initials: T
authors.lastname: van Gelder
authors.forename: Willem
authors.initials: W
authors.lastname: Weimar
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D003071:Cognition; D003469:Culture; D004644:Emotions; D005260:Female; D006040:Goals; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control* / Q000523:psychology; D006085:Graft Survival / Q000187:drug effects*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D007407:Interviews as Topic; D016030:Kidney Transplantation / Q000009:adverse effects / Q000523:psychology*; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D010361:Patients / Q000523:psychology*; D010465:Perception; D011446:Prospective Studies; D020377:Self Efficacy; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents