An investigation into the beliefs about medicines using the belief about medicines questionnaire - BMQ

Abstract

Investigating beliefs about medicines has been of interest over the past years, with studies aiming to better understand theoretical reasons behind the development of such beliefs. Studies have already shown that the majority of people have negative beliefs about medicines, which might in tum have a negative effect on treatment outcomes and adherence. It is therefore important to assess beliefs about medicines since they can give insight into a better approach for having an effective health care system, with the intention of reinforcing positive beliefs in medication. This study aims to investigate whether students from different academic backgrounds hold different beliefs about medicines, and whether students' beliefs in medicines, as part of general health beliefs, differ from those of their mothers and maternal grandmothers. Medication beliefs were evaluated using the Beliefs about Medicines Questionnaire - BMQ, which is divided into two sections; BMQ-General (sub-scales: Overuse and Harm, 4 items per sub-scale) and BMQ-Specific (sub-scales: Necessity and Concerns, 5 items per sub-scale). The BMQ was first translated then validated in the Maltese language. The validation, using the Maltese BMQ, was carried out at Mater Dei Hospital, on four chronic illness groups comprising asthmatic, diabetic, cardiovascular, and depression patients, between June and September 2013. Investigation into medication beliefs of students, their mothers and grandmothers was carried out at University of Malta from October 2013 to January 2014. For the validation sample, the distribution and collection of the tool was carried out on the same day. This was also the case for the questionnaires distributed to students. Mothers' and grandmothers' questionnaires were collected a week later.

The Validation of the BMQ showed acceptable internal consistency for the harm scale (a = 0.56), the necessity scale (a = 0.73) and the concerns scale (a = 0.66), however the overuse scale gave poor internal consistency (a = 0.48) due to the item on natural remedies which posed some difficulty in the Maltese validation sample. The final solution for Principal component analysis yielded a four factor structure representing the 4 sub-scales of the BMQ, with results being comparable to previous validations carried out in different languages. Internal consistency on the students sample confirmed validity of the BMQ scales (General: Overuse a= 0.64; Harm a= 0.52; Specific: Necessity a= 0.82; Concerns a= 0.69) A total of 738 students from 14 faculties participated in the study. Investigation of the beliefs about medicines in these students revealed that 83.7% believed that doctors overprescribed medicines (Score: 14.183±3.55), whereas a total of 28.6% believed that medicines were harmful in nature (Score: 10.054±0.44). A total of 104 students self-reported having a chronic condition, with 52.4% of these students believing that medicines were necessary for their chronic condition (Score: 14.540±4.79), while 38.1% of the students had some concerns about adverse effects (Score: 12.143±5.30). There were no significant differences present between students from different faculties for the overuse scale, however significant differences were found on the harm scale. Students from the Faculty of Medicine and Surgery and the Faculty of Information and Communication Technology perceived medicines to be less harmful than students [rom other faculties (p<0.05). Predictors of medication beliefs were found to be course background, living with parents and region. Students with a scientific background were more likely to perceive medication as less overused, less harmful and be less concerned about adverse effects. Students following a course leading to a patient-oriented profession, living with their parents and residing in the Northern Harbour district, South Eastern district, Western District, and Northern district were also more likely to perceive medicines as less harmful.

Trans-generation analysis revealed that there was a gradient across medication beliefs, with younger generations having less negative views about medication when compared to the older generations. In the case of the overuse scale, significant differences were observed between students and mothers (students: 14.153±2.53; mothers±2.53, p=0.04); and students and grandmothers (students: 13.863 ±2.56; grandmothers: 14.715±2.37, p=0.00); but no significance difference was found between students' mothers and students' grandmothers, (mothers: 14.577±2.39; grandmothers: 14.715±2.38, p=O.55). Significant differences emerged on the harm scale between the students and their mothers, (students: 9.983±2.36; mothers 10.694±2.61, p=0.00); students and their grandmothers (students 9.750±2.48, grandmothers 11.476±2.80), p=0.00); and students' mothers and students' grandmothers (mothers 10.610±2.49, grandmothers 11.463±2.81,p=0.00). The Maltese version of the BMQ is a valid tool for analysis of beliefs about medicines in the Maltese population.