A Scoping Literature Review of Rural Beliefs and Attitudes toward Telehealth Utilization

The purpose of this scoping literature review was to understand what is known about how the rural profile influences beliefs regarding telehealth utilization. Rural nursing theory (RNT) provided a framework for the review. Search criteria were limited to peer-reviewed studies conducted in Europe, the United States, Canada, Australia, and New Zealand. A variety of search terms related to patient telehealth perceptions generated 213 unique articles, of which 10 met the inclusion criteria. Included studies incorporated qualitative methodologies and were from Australia, Canada, Sweden, or the United States. The review highlighted four themes related to the rural profile's influence on telehealth beliefs: importance of familiar relationships, concerns with privacy and confidentiality, acceptance of limited access to care, and resourcefulness and frugality. These themes echo concepts within RNT. Nurses and other health professionals must acknowledge the rural profile's influence on a person's decision to use telehealth in order to provide optimal care.

Primary Investigation of Low Back Pain among Saudi Arabians: A Cross-Sectional Study

Low back pain (LBP) is a prevalent disease that affects all ages and is a symptom that induces immobility. Patients' beliefs may influence LBP management, and adjusting detrimental beliefs is required to improve treatment outcomes. Our aim was to evaluate the prevalence of LBP within the Saudi population and beliefs regarding LBP, physical activity, rest, imaging, and medication. People with LBP were targeted with a questionnaire containing sections on demographic information and the validated Back Beliefs Questionnaire (BBQ), in addition to questions regarding imaging, physical activity, rest and medication. A total of 651 responses were received, 559 of them (86%) experienced LBP. The most common age group was those aged 18-21 (n = 221), 80% from females. The average BBQ score was 27.8 (SD = 5.58). The majority of the respondents held the following beliefs, which are contrary to the best available evidence: back pain must be rested (77.1%) and X-rays or scans are required to gain the best medical care for LBP (73.2%). The Saudi population holds unhelpful beliefs that may affect their quality of life. Healthcare professionals working with patients with LBP have an important role in changing detrimental beliefs and behaviors about the condition.

A Survey of Australian Hospital Pharmacy Staff Knowledge, Practices, and Assessment of Animal-derived Medications

This study aims to determine the knowledge and practices of Australian hospital pharmacy staff regarding animal-derived ingredients in medications and reviewing whether commonly used medications contain animal-derived ingredients. The study surveyed 67 pharmacy staff and reviewed 20 medications. Ninety-eight percent of staff were aware patients may have religious or cultural restrictions on ingesting animal-derived products; 33% discussed this issue with patients. Information on animal-derived ingredients was readily accessible for 1.6% of medications, with information unavailable for 14%. Staff demonstrated awareness that medications may contain animal-derived ingredients, but challenges exist in discussion with patients and in accessing information on animal-derived ingredients.

Patients' Priorities for Surrogate Decision-Making: Possible Influence of Misinformed Beliefs

BACKGROUND

Many patients have three primary goals for how treatment decisions are made for them in the event of decisional incapacity. They want to be treated consistent with their preferences and values, they want their family to be involved in making decisions, and they want to minimize the stress on their family. The present paper investigates how patients' beliefs about surrogate decision-making influence which of these three goals they prioritize. Methods: Quantitative survey of 1,169 U.S. patients to assess their beliefs about surrogate decision-making, and how these beliefs influence patients' priorities for surrogate decision-making. Results: Most patients believed that families in general (68.8%) and their own family in particular (83.4%) frequently, almost always, or always know which treatments the patient would want in the event of incapacity. Patients with these beliefs were more likely to prioritize the goal of involving their family in treatment decision-making over the goal of minimizing family stress. Most patients (77.4%) also believed their family would experience significant stress from helping to make treatment decisions. However, patients' priorities were largely unchanged by this belief. Conclusions: Prior reports suggest that patients overestimate the extent to which their family knows which treatments they want in the event of decisional incapacity. The present analysis adds that these patients might be more likely to prioritize the goal of involving their family in treatment decision-making, even when this results in the family experiencing significant distress. This finding highlights that patients' misinformed beliefs about their family's knowledge might influence patients' priorities for surrogate decision-making, raising important questions for clinical practice, policy, and future research.

Supplemental data for this article is available online at https://doi.org/10.1080/23294515.2021.1983665.

Optimizing patient expectations to improve therapeutic response to medical treatment: A randomized controlled trial of iron infusion therapy

OBJECTIVES

Patient expectations have the ability to influence health outcomes and have been shown to play an important role as part of the placebo effect to influence the response to medical treatments. Increasing positive expectations have been proposed as an intervention to improve treatment response, although evidence for this to date is limited. We investigated whether a brief 10-min intervention directly targeting patient expectations prior to an iron infusion could enhance expectations and improve treatment response, in terms of patients' reported fatigue.

DESIGN

Randomized controlled trial.

METHODS

Forty-three patients diagnosed with iron deficiency anaemia were randomized to a brief expectation intervention or active control group prior to an intravenous iron infusion. Chalder Fatigue Scale scores were assessed prior to randomization and at one and four weeks.

RESULTS

The expectation intervention significantly improved patients' expectations about the effectiveness of the intravenous iron infusion, t(21) = -3.95, p = .001. While there were no significant differences between groups in fatigue at the one-week follow-up, fatigue was significantly lower in the intervention group at the four-week follow-up compared to the control group, F(1, 25) = 6.25, p = .019. This was largely influenced by a significant reduction in physical, as opposed to mental fatigue scores.

CONCLUSIONS

Boosting patients' positive expectations may be an effective way of enhancing patient response to treatment. In particular, targeting patient expectations with a brief intervention prior to medical treatments may result in a greater and longer therapeutic effect.

Different Associations of Intentional and Non-Intentional Non-Adherence Behaviors with Patient Experience with Healthcare and Patient Beliefs in Medications: A Survey of Patients with Chronic Conditions

PURPOSE

To investigate relationships between intentional and non-intentional non-adherence behaviors and patient experience with healthcare and beliefs in medications.

PATIENTS AND METHODS

This is a post hoc analysis of a cross-sectional anonymous survey distributed between May and September 2017 to patients with rheumatic disease, inflammatory bowel disease, HIV infection or diabetes mellitus from outpatient and primary care clinics in Spain. Patients answered five questions about non-adherence behaviors and completed questionnaires on their experience with healthcare (IEXPAC: Instrument to Evaluate the EXperience of PAtients with Chronic diseases) and beliefs about medicines (BMQ: Beliefs About Medicines Questionnaire).

RESULTS

Among 1530 respondents, 53% showed ≥1 non-adherence behavior; 35% had ≥1 non-intentional non-adherence behavior, and 33% had ≥1 intentional non-adherence behavior. Patients with HIV infection had the lowest frequency of intentional non-adherence behaviors. Non-intentional non-adherence was associated with patient beliefs (inversely with BMQ overall score) and patient experiences (inversely with IEXPAC Factor 3 sub-score, self-management). Intentional non-adherence was strongly associated with beliefs scores (directly with BMQ concerns and inversely with BMQ necessity sub-score) and inversely associated with HIV infection.

CONCLUSION

The different associations of intentional and non-intentional non-adherence behaviors found in this study help to understand how patient experiences and beliefs influence medical non-adherence, and in the development of strategies for reducing non-adherence.

"That Can't Be!": Perceptions of HIV and Hepatitis C Screening during Admission to an Acute Care Surgery Service

Background:

A large number of patients live with undiagnosed HIV and/or hepatitis C despite broadened national screening guidelines. European studies, however, suggest many patients falsely believe they have been screened during a prior hospitalization. This study aims to define current perceptions among trauma and emergency general surgery (EGS) patients regarding HIV and hepatitis C screening practices.

Methods:

Prospective survey administered to adult (>18 years old) acute care surgery service (trauma and EGS) patients at a Level 1 academic trauma center. The survey consisted of 13 multiple choice questions: demographics, whether admission tests included HIV and hepatitis C at index and prior hospital visits and whether receiving no result indicated a negative result, prior primary care screening. Response percentages calculated in standard fashion.

Results:

One hundred and twenty-five patients were surveyed: 80 trauma and 45 EGS patients. Overall, 32% and 29.6% of patients believed they were screened for HIV and hepatitis C at admission. There was no significant difference in beliefs between trauma and EGS. Sixty-eight percent of patients had a hospital visit within 10 years of these, 49.3% and 44.1% believe they had been screened for HIV and hepatitis C. More EGS patients believed they had a prior screen for both conditions. Among patients who believed they had a prior screen and did not receive any results, 75.9% (HIV) and 80.8% (hepatitis C) believed a lack of results meant they were negative. Only 28.9% and 23.6% of patients had ever been offered outpatient HIV and hepatitis C screening.

Conclusions:

A large portion of patients believe they received admission or prior hospitalization HIV and/or hepatitis C screening and the majority interpreted a lack of results as a negative diagnosis. Due to these factors, routine screening of trauma/EGS patients should be considered to conform to patient expectations and national guidelines, increase diagnosis and referral for medical management, and decrease disease transmission.

Transition Between Different Renal Replacement Modalities: Gaps in Knowledge and Care-The Integrated Research Initiative

Patients with end-stage kidney disease (ESKD) have different options to replace the function of their failing kidneys. The "integrated care" model considers treatment pathways rather than individual renal replacement therapy (RRT) techniques. In such a paradigm, the optimal strategy to plan and enact transitions between the different modalities is very relevant, but so far, only limited data on transitions have been published. Perspectives of patients, caregivers, and health professionals on the process of transitioning are even less well documented. Available literature suggests that poor coordination causes significant morbidity and mortality.This review briefly provides the background, development, and scope of the INTErnational Group Research Assessing Transition Effects in Dialysis (INTEGRATED) initiative. We summarize the literature on the transition between different RRT modalities. Further, we present an international research plan to quantify the epidemiology and to assess the qualitative aspects of transition between different modalities.

Patient satisfaction with information on oral anticancer agent use

Adequate information on oral anticancer agent (OACA) use is an essential element of optimal cancer care. The present study aimed to get insight into the experiences of patients with information on OACA treatment and their characteristics regarding information dissatisfaction. Patients of four Dutch university hospitals using OACA participated in this observational study and completed the Satisfaction with Information about Medicines Scale (SIMS), EORTC Quality of Life Questionnaire‐C30, Brief Illness Perception Questionnaire, and Beliefs about Medicines Questionnaire‐Specific. Logistic regression analyses were used to determine factors associated with dissatisfaction with information. Patients (n = 208) using capecitabine (35%), lenalidomide (15%), imatinib (14%), temozolomide (12%), sunitinib (11%), thalidomide (5%), dasatinib (4%), erlotinib (2%), and nilotinib (2%) participated. Information on the following SIMS‐items was inadequate: how OACA elicit their effect, how long it takes before treatment works, how to conclude that treatment is effective, the risk of side effects and its management, interference with sex life, drowsiness, interference with other medication and alcohol and what to do in case of a missed dose. Younger age, hematological malignancy, dyspnoea, positive perception of consequences of the cancer, low perception of treatment control, and indifferent attitude towards OACA were associated with dissatisfaction with information. In conclusion, a considerable number of patients would have appreciated receiving more information on specific issues relating to the consequences of OACA treatment such as the effects and side effects of OACA and the interference of treatment with various aspects of their daily life. Oncologists, hematologists, lung‐oncologists and pharmacists may reconsider the provision of information on OACA treatment.

Societal responsibility and moral hazard: How much are we willing to pay for quality-adjusted life?

Health care spending in the United States continues to rise with cancer care consuming a disproportionate amount of that spending. As the US population ages and cancer treatment options become more complex, cost containment strategies have become essential in oncology. Patient-centered decision-making will help to contain costs but requires a well-informed patient who is able to reconcile potential treatment choices with their beliefs and values. J. Surg. Oncol. 2016;114:269-274. © 2016 Wiley Periodicals, Inc.

Switching from a two-tablet regimen of tenofovir/emtricitabine and efavirenz to a one-tablet regimen may affect patients' perceptions and drug management

OBJECTIVES

Simplification of antiretroviral therapy enhances a patient's adherence but a new formulation could also lead to new adverse events and changes in daily routine. This study compared medication adherence, tolerance and satisfaction among subjects switching from a two-tablet tenofovir/emtricitabine/efavirenz regimen to a one-tablet regimen.

METHODS

Clinical and sociodemographic data were collected and three surveys were administered at month 0 (=switch), and then 1 and 4-6 months after the switch: the Beliefs about Medicines Questionnaire, the HIV-symptom index questionnaire, the Short HIV Treatment Satisfaction Questionnaire, the Swiss HIV Cohort Study (SHCS) two-item adherence questionnaire, and a questionnaire on daily combination antiretroviral therapy (cART) management. Medication adherence of a subgroup of subjects was routinely monitored using an electronic device (MEMS(™) ).

RESULTS

Eighty-eight subjects gave informed consent to participate in the study. The subjects' back-switch rate was 7% (six of 88). Subjects who did not back-switch preferred the one-tablet regimen (median = 2; IQR = 1.3-2.5; on a -3 to 3 scale), but no change in adherence was found (10 of 46 nonadherent subjects; P = 1.00). The perception of treatment necessity score decreased (P = 0.004), the efavirenz blood level increased (14%; P = 0.04), and association/dissociation of cART with food intake evolved (P = 0.01) after the switch. Subjects listed equivalent numbers of symptoms during the three visits.

CONCLUSIONS

The one-tablet regimen was preferred but the number of back-switches was not negligible. The perception of treatment necessity score decreased with the simplification of the regimen from a two-tablet to a one-tablet formulation, which could negatively impact adherence. Switching is a sensitive time in a patient's treatment life and professionals should pay particular attention to patient's perceptions of treatment during such a transition.

The influence of patient beliefs and treatment satisfaction on the discontinuation of current first-line antiretroviral regimens

OBJECTIVES

Large cohort studies have shown a high rate of first-line combination antiretroviral therapy (cART) regimen discontinuation in HIV-infected patients, attributed to characteristics of the cART regimen or toxicity.

METHODS

A cohort study of 274 patients receiving a first-line regimen was carried out. Patients' perceptions and beliefs prior to initiation were assessed using an attitude towards medication scale (0-15 points), and their satisfaction during therapy was assessed using an HIV treatment satisfaction questionnaire (HIVTSQ). Treatment discontinuation was defined as any switch in the cART regimen.

RESULTS

During 474.8 person-years of follow-up, 63 (23%) patients changed their cART regimen, mainly because of toxicity/intolerance (42; 67%). The overall rate of change was 13.2 per 100 patient-years [95% confidence interval (CI) 11.1-16.4 per 100 patient-years]. An efavirenz (EFV)-based single tablet regimen showed the highest rate of adverse events (27%), but the lowest rate of change (16%; 7.44 per 100 patient-years). Cox regression revealed a decreased hazard of first regimen termination with better initial attitude towards drugs [hazard ratio (HR) 0.76; 95% CI 0.62-0.93; P < 0.01] and higher satisfaction (HR 0.94; 95% CI 0.89-0.99; P = 0.01), and an increased hazard of termination with the presence of adverse events (HR 7.7; 95% CI 2.4-11.6; P < 0.01). One-third of patients (18 of 59; 31%) with mild/moderate adverse events (which were mainly central nervous system symptoms) continued the regimen; these patients, compared with those discontinuing therapy, showed better perception of therapy (mean score 14.4 versus 12.1, respectively; P = 0.05) and greater satisfaction during therapy (mean score 50.6 versus 44.6, respectively; P = 0.04).

CONCLUSIONS

Patients' beliefs and satisfaction with therapy influence the durability of the first antiretroviral regimen. These patient-related factors modulate the impact of mild adverse events, and could explain differences in the rate of discontinuation.

Examining the relationship between adherence and satisfaction with antidepressant treatment

BACKGROUND

Adherence to antidepressant treatment is an essential step in the management of patients with major depressive disorder, and several factors can contribute to antidepressant nonadherence. Evidence supports the hypothesis that patient treatment satisfaction will result in improved adherence; therefore, the aim of this study was to investigate the relationship between patient treatment satisfaction and adherence to antidepressants, and the role of patient beliefs toward medication in patient treatment satisfaction.

METHODS

This was an observational, nonexperimental survey of all patients attending Al Amal Psychiatric Hospital (500 beds) in Riyadh, Saudi Arabia. Medication adherence was assessed using the eight-item Morisky Medication Adherence Scale (MMAS-8), and treatment satisfaction was assessed using the Treatment Satisfaction Questionnaire for Medication (TSQM 1.4).

RESULTS

A total of 403 patients met the inclusion criteria; 50.4% were females; participant age ranged from 18 to 60 years; and 16 % of the patients reported side effects after using antidepressants. Both males and females reported high treatment satisfaction rates: - 79.21% (standard deviation [SD] 8.52) and 86.55% (SD 14.34), respectively - with statistically significant associations found for female sex, older age, and three or more physician visits per year. Adherence to antidepressants was associated with treatment satisfaction with the antidepressants, with a direct positive correlation.

CONCLUSION

The results of this study showed high treatment satisfaction scores among patients in Saudi Arabia with major depressive disorder, which correlated with adherence and patient beliefs about the necessity of treatment. This finding has improved the understanding of the role of patient beliefs, which can help caregivers and other stakeholders to improve satisfaction with antidepressants.

Racial differences in beliefs of physician prescribing practices for low-cost pharmacy options

BACKGROUND

Previous studies have reported that certain populations are sensitive to high out-of-pocket drug costs, and drug noncompliance leads to poorer health outcomes.

OBJECTIVE

Our aim was to measure patient awareness of discount pharmacy options, cost barriers to medication access, and beliefs about health care provider's use of low-cost medications.

METHODS

This cross-sectional 17-item survey was administered to patients in the emergency department of an urban trauma center in February 2011. Differences in responses by sex and race groups were assessed. A logistic regression model was created to estimate the association of sociodemographic factors and medication use with awareness of discount pharmacy options.

RESULTS

Five hundred and fifty-two surveys were analyzed. Among respondents who were prescribed medications within the past year, three fourths of patients felt comfortable asking physicians for cheaper medicines. Slightly more than half were aware of low-cost pharmacy options, and 78% of these respondents correctly listed at least one of these pharmacies. Caucasian patients were more comfortable than African American patients asking for cheaper medicines (82.5% vs. 72.2%; p < 0.05) and were more aware of low-cost prescription programs (63.9% vs. 43.5%; p < 0.001). When adjusted for insurance status and current medication use, Caucasian patients were 2.7 times more likely to name a valid discount pharmacy option compared to African Americans (95% confidence interval 1.85-4.07).

CONCLUSIONS

This study suggests populations may be more uncomfortable initiating a discussion about medication costs and selection of lower-cost alternatives. Health care providers may need to develop communication strategies in which medication cost is addressed with sensitivity and consistency.

'The body gets used to them': patients' interpretations of antibiotic resistance and the implications for containment strategies

BACKGROUND

Interventions promoting evidence based antibiotic prescribing and use frequently build on the concept of antibiotic resistance but patients and clinicians may not share the same assumptions about its meaning.

OBJECTIVE

To explore patients' interpretations of 'antibiotic resistance' and to consider the implications for strategies to contain antibiotic resistance.

DESIGN

Multi country qualitative interview study.

PARTICIPANTS

One hundred and twenty-one adult patients from primary care research networks based in nine European countries who had recently consulted a primary care clinician with symptoms of Lower Respiratory Tract Infection (LRTI).

APPROACH

Semi-structured interviews with patients following their consultation and subjected to a five-stage analytic framework approach (familiarization, developing a thematic framework from the interview questions and the themes emerging from the data, indexing, charting, and mapping to search for interpretations in the data), with local network facilitators commenting on preliminary reports.

RESULTS

The dominant theme was antibiotic resistance as a property of a 'resistant human body', where the barrier to antibiotic effectiveness was individual loss of responsiveness. Less commonly, patients correctly conceptualized antibiotic resistance as a property of bacteria. Nevertheless, the over-use of antibiotics was a strong central concept in almost all patients' explanations, whether they viewed resistance as located in either the body or in bacteria.

CONCLUSIONS

Most patients were aware of the link between antibiotic use and antibiotic resistance. The identification of the misinterpretation of antibiotic resistance as a property of the human body rather than bacterial cells could inform clearer clinician-patient discussions and public health interventions through emphasising the transferability of resistance, and the societal contribution individuals can make through more appropriate antibiotic prescribing and use.

Factors associated with the accuracy of physicians' predictions of patient adherence

OBJECTIVE

Physicians are inaccurate in predicting non-adherence in patients, a problem that interferes with physicians': (1) appropriate prescribing decisions and (2) effective prevention/intervention of non-adherence. The purpose of the current study is to investigate potential reasons for the poor accuracy of physicians' adherence-predictions and conditions under which their predictions may be more accurate.

METHODS

After the medical encounter, predictions of patient-adherence and other ratings from primary-care physicians (n=24) regarding patient-factors that may have influenced their predictions were collected. Patients (n=288) rated their agreement regarding the prescribed treatment after the encounter and reported adherence 1 month later.

RESULTS

Several factors were related to physicians' adherence-predictions, including physicians' perceptions of patient-agreement regarding treatment. However, some factors were not related to adherence and agreement-perceptions were inaccurate overall, potentially contributing to the poor accuracy of adherence-predictions. The degree to which physicians discussed treatment-specifics with the patient moderated agreement-perception accuracy but not adherence-prediction accuracy.

CONCLUSIONS

Training providers to discuss certain treatment-specifics with patients may improve their ability to perceive patient-agreement regarding treatment and may directly improve patient-adherence.

PRACTICE IMPLICATIONS

Discussing treatment-specifics with patients may directly improve adherence, but providers should not rely on these discussions to give them accurate estimates of the patients' likely adherence.

A story of maladies, misconceptions and mishaps: effective management of heart failure

Congestive heart failure (CHF) is a common chronic disease with effective therapy, yet interventions to improve outcomes have met with limited success. Though problems in self-management are suspected causes for deterioration, few efforts have been made to understand how self-management could be improved to enhance the lives of affected patients. We conducted semi-structured interviews of 19 patients with CHF treated at an urban United States hospital to elucidate their knowledge and beliefs about CHF and to understand what underlies their self-care routines. A comparison of the themes generated from these interviews with the common-sense model for self-management of illness threats, clarifies how patients' perceptions and understanding of CHF affected their behaviors. Patients had an acute model of CHF. They did not connect chronic symptoms with a chronic disease, CHF, and did not recognize that these symptoms worsened over time from their baseline of moderate, chronic distress, to a severe state that required urgent care. As a consequence, they often did not manage symptoms on a routine basis and did not, therefore, prevent or minimize exacerbations. When they worsened, many patients reported barriers to reaching their physicians and most reported seeking care primarily in an emergency room. These in depth responses elucidate how the interplay between acute and chronic models of a chronic illness effect self-management behaviors. These factors play a previously not understood role in patient's efforts to understand and manage the ever-present but symptomatically variable chronic illness that is CHF. These new concepts illustrate the tools that may be needed to effectively manage this serious and disabling illness, and suggest possible ways to enhance the self-management process and ultimately improve patients' lives.

Factors affecting adherence to asthma treatment: patient and physician perspectives

Aims

To identify important factors affecting treatment adherence of patients with asthma and to summarise this information as a guide for physicians.

Methods

Information from literature and interviews with 12 respiratory physicians (four each from France, Spain and UK) and 46 asthma patients was obtained. Factors affecting adherence to asthma treatment were identified, reviewed and a flow chart developed to indicate the relationship between key factors.

Results

Major factors influencing adherence included: the patient-physician relationship; the patient's understanding of the disease and its treatment; the patient's beliefs and perception of the disease and its treatment, and, importantly, the patient's willingness to take an active part in his/her asthma management.

Conclusion

Patient adherence to asthma can be improved, and the likelihood of treatment success increased, by paying attention to the factors that influence patients' willingness to participate in their treatment.

The relation of patient beliefs about medication to self-termination of therapy

OBJECTIVE

To examine the relation of patient beliefs about medication usage and adherence to zidovudine (ZDV) therapy in persons with AIDS.

DESIGN

Face-to-face interviews were used to determine attitudes of persons with AIDS toward ZDV and other prescribed medications, history of ZDV usage, and sociodemographics.

SETTING

A public hospital infectious disease clinic, an AIDS day care program, and an inpatient unit in a voluntary hospital where care was provided cooperatively by staff and an informal-care partner.

PATIENTS/PARTICIPANTS

One hundred forty-one people with the acquired immunodeficiency syndrome agreed to be reinterviewed as part of a longitudinal, New York City-based study examining outcomes related to quality of life. Initial recruitment procedures were to approach all active AIDS patients at each of the three sites between January and July of 1992: reinterviews, which were conducted an average of 6 months later, occurred from mid-1992 through May of 1993.

MEASUREMENTS AND MAIN RESULTS

The Zidovudine Drug Attitude Inventory was used to assess subjective feelings and attitudes concerning ZDV and prescribed medications in general. Respondents were grouped into five categories on the basis of their ZDV usage history: (1) "short-term" users (i.e., those who had been taking ZDV for 25 months or less); (2) "long-term" users (i.e., those who had been taking ZDV for more than 25 months); (3) self-terminated users; (4) doctor-terminated users; and (5) never users. Long-term users were likely to view ZDV as an illness prophylactic. In contrast, self-terminated users and never users were most likely to believe that ZDV caused adverse side effects and that medicine need not be taken as prescribed.

CONCLUSIONS

Patients' beliefs about ZDV were significantly associated with adherence-related behavior. In particular, those who had self-terminated ZDV treatment believed that taking the drug was harmful, were skeptical of its ability to prevent illness, and felt that physician's directives about medication usage in general could be disregarded. These findings highlight the importance of educating patients about ZDV and of establishing regular patient-clinician exchanges concerning patient's experience with and beliefs concerning ZDV.