title: Factors influencing medication knowledge and beliefs on warfarin adherence among patients with atrial fibrillation in China.
abstract: OBJECTIVE
  Warfarin is often used for ischemic stroke prevention in patients with atrial fibrillation (AF), but the factors affecting patient adherence to warfarin therapy have not been fully understood.
  
  
  METHODS
  A cross-sectional survey was conducted in AF patients undergoing warfarin therapy at least 6 months prior to the study. The clinical data collected using questionnaires by phone interviews included the following: 1) self-reported adherence measured by the Morisky Medication Adherence Scale-8©; 2) beliefs about medicines surveyed by Beliefs about Medicines Questionnaire (BMQ); and 3) drug knowledge as measured by the Warfarin Related Knowledge Test (WRKT). Demographic and clinical factors associated with warfarin adherence were identified using a logistic regression model.
  
  
  RESULTS
  Two hundred eighty-eight patients completed the survey and 93 (32.3%) of them were classified as nonadherent (Morisky Medication Adherence Scale-8 score <6). Major factors predicting warfarin adherence included age, cardiovascular disorders, WRKT, and BMQ; WRKT and BMQ were independently correlated with adherence to warfarin therapy by multivariate logistic regression analysis. Adherents were more likely to have greater knowledge scores and stronger beliefs in the necessity of their specific medications ([odds ratio {OR} =1.81, 95% confidence interval {CI} =1.51-2.15] and [OR =1.17, 95% CI =1.06-1.29], respectively). Patients with greater concerns about adverse reactions and more negative views of general harm were more likely to be nonadherent ([OR =0.76, 95% CI =0.69-0.84] and [OR =0.82, 95% CI =0.73-0.92], respectively).
  
  
  CONCLUSIONS
  BMK and WRKT are related with patient behavior toward warfarin adherence. BMQ can be applied to identify patients at increased risk of nonadherence.
authors.affiliation: Department of Pharmacy.
authors.forename: Shujuan
authors.initials: S
authors.lastname: Zhao
authors.affiliation: Department of Pharmacy.
authors.forename: Hongwei
authors.initials: H
authors.lastname: Zhao
authors.affiliation: Department of Cardiovascular Medicine, People's Hospital of Henan Province, Zhengzhou, Henan, People's Republic of China.
authors.forename: Xianpei
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Cardiovascular Medicine, People's Hospital of Henan Province, Zhengzhou, Henan, People's Republic of China.
authors.forename: Chuanyu
authors.initials: C
authors.lastname: Gao
authors.affiliation: Department of Pharmacy.
authors.forename: Yuhua
authors.initials: Y
authors.lastname: Qin
authors.affiliation: Department of Pharmacy.
authors.forename: Haixia
authors.initials: H
authors.lastname: Cai
authors.affiliation: Department of Pharmacy.
authors.forename: Boya
authors.initials: B
authors.lastname: Chen
authors.affiliation: Department of Pharmacy.
authors.forename: Jingjing
authors.initials: J
authors.lastname: Cao
keywords: INR; MMAS-8©; anticoagulation control; beliefs about medicine; warfarin