Sociological Factors Contributing To Medication Non-adherence

Introduction

Osterberg et al (2005) define medication non-adherence is a voluntary or involuntary failure to adhere to treatment recommendations given by a medical practitioner, taking less or more medication than is prescribed, discontinuing medication before the end of the prescribed dosage, or taking medication at the wrong time. The main aim of this essay is to explore the sociological factors that contribute to medication non-adherence through the lens of concepts and theories of doctor-patient relations. Therefore, the essay will focus on three major concepts of adherence, non-adherence and concordance, with specific reference to epilepsy. Therefore, the essay will explore the intentional and non-intentional behaviours that affect antiepileptic drug adherence as well as factors hindering the achievement of concordance.

Adherence, Non-Adherence and Concordance

Patients may find it relatively easy to intentionally or unintentionally stop taking medication or take them incorrectly. This act is termed as ‘non-adherence,’ which is mostly experienced in situations where patients are on more than one medication (NICE, 2009). None-adherence may occur due to many reasons, some of them being medical side effects or lack of proper understanding of treatment.

Adherence, also termed as compliance refers to the patient’s decision to follow the prescription directions properly and to adhere to every instruction given by the prescriber. This implies that a compliant patient takes medication in the proper dosage, at the prescribed time of the day within the prescribed intervals and with proper adherence to advised food and nutritional intake (Eatock & Baker, 2007).

Concordance refers to the shared decision-making between the patient and a healthcare professional (Johnbull et al 2011). According to Dabis et al (2008), it occurs during the consultation process. Recently, concordance has been conceptualised differently from compliance and adherence because it focuses mainly on the consultation process as opposed to patient behaviour. Chapman et al (2014) assert that concordance is an essential concept in pharmacy because it creates an environment within which patients interact with healthcare professionals to enhance medication adherence.

Adherence, Non-Adherence and Concordance among Epileptics

The prevalence of antiepileptic drug (AED) non-adherence globally is alarming. According to (Faught et al 2009; Johnbull et al 2011), AED non-adherence was estimated to be at 26% and 67% in the USA and Nigeria respectively. Besides, the study by Dabis et al (2008) explored the prevalence of AED non-adherence drug non-adherence in North Carolina and found 39% AED non-adherence levels, with a higher prevalence rate of 43% among the elderly. In the UK, a primary care study by Chapman et al (2014) found that AED non-adherence was at 36.4% and that the patients under multiple drug treatment showed higher rates of non-adherence. Similar studies have been conducted in Finland and revealed that 34% of Finish epileptics fail to adhere to medications, with higher non-adherence levels experienced among smokers and alcoholics.

Research has found various voluntary and involuntary reasons for AED non-adherence. For instance, a recent study by Getnet et al (2016) found that epileptics who were buying AEDs were more likely to be non-adherence to medication than those who received the drugs for free. In an attempt to explain this finding, Getnet et al (2016) asserted that being a long-term illness; patients would feel bored with buying medication for long periods and consequently end up failing to adhere to medications. The findings by Getnet et al (2016) have been supported by several other studies such as Mbuba et al (2012) that explored AED non-adherence in Kenya and found that constantly buying AEDs was one of the most significant cause for AED non-adherence. The findings by Getnet et al (2016) were not only on patients becoming bored with buying AEDs but also on health information. With this regard, Getnet et al (2016) found that patients without adequate information about epilepsy, drug side effects and treatment durations were more likely to be non-compliant compared to those who had such information. Similar observations were made by El-Shamaa (2013) who noted that unless epileptic patients are exposed to sufficient information about epilepsy and its treatments, they are more likely to stop medication after the seizure has been controlled of whenever they experience any medication side effects.

Existing research has also attributed AED non-adherence to lack of social support given to patients. For instance, the study by El-Shamaa (2013) concluded that epileptics who receive little or inadequate social support are more likely to be non-adherent to AEDs compared to their counterparts receiving adequate social support. Chapman et al (2014) assert that social support from family, friends and colleagues is a vital aspect of epileptic care because it enhances patient-centred care through people who are closest to the patient. Therefore, failure to receive adequate social support contributes to poor identification of factors that may contribute to non-adherence, as well as lack of encouragement by close associates to be compliant. Shallcross et al (2015) found that positive patient perception of social support was positively correlated to adherence, a finding that has also been supported by Getnet et al (2016).

Research by Eatock & Baker (2007), Virag et al (2012) and Getnet et la (2019) have all found stigma to be a contributing factor towards non-adherence. For instance, results by Getnet et al (2016) the chances of AED non-adherence increased among patients who had perceived stigma as compared to those who had no perceived stigma. Eatock & Baker (2007) had similar findings but explained further that the physical act of constantly taking medications contributed to increased levels of stigma because it keeps reminding them that they are epileptic and therefore try to reduce pill-taking as much as possible. Perceived stigma is one of the significant factors that negatively impact on the life of epileptics. Fanta et al (2015) even observe that perceived stigma, among all types of stigma, negatively impacts epileptic patients because it causes stress and restricts them from participating in normal societal activities. In a study by Baker et al (2000) perceived stigma emanates from the belief that epilepsy is contagious, or from injuries occurring during seizure attacks. The physical deformities and scars may cause another stigma or lead to the existence of a new one. Patients may, therefore, seize to take medication so that people around them may not know that the scars emanated from epilepsy-related injuries.

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