• Examining adherence to medication in patients with persistent atrial fibrillation: The role of medication beliefs, attitudes and depression.

      Taylor, Elaina C.; Hughes, Lyndsay D; O'Neill, Mark; Bennett, Peter; King's College London (Wolters Kluwer, 2020-08-07)
      This study examined whether beliefs about medicines, drug attitudes, and depression independently predicted anticoagulant and antiarrhythmic adherence (focusing on the implementation phase of nonadherence) in patients with atrial fibrillation(AF). This cross-sectional study was part of a larger longitudinal study. Patients with AF (N = 118) completed the Patient Health Questionnaire-8. The Beliefs about Medicines Questionnaire, Drug Attitude Inventory, and Morisky-Green-Levine Medication Adherence Scale (self-report adherence measure), related to anticoagulants and antiarrhythmics, were also completed. Correlation and logistic regression analyses were conducted. There were no significant differences in non-adherence to anticoagulants or antiarrhythmics. Greater concerns (r = 0.23, P = .01) were significantly, positively associated with anticoagulant nonadherence only. Depression and drug attitudes were not significantly associated with anticoagulant/antiarrhythmic adherence. Predictors reliably distinguished adherers and non-adherers to anticoagulant medication in the regression model, explaining 14% of the variance, but only concern beliefs (odds ratio, 1.20) made a significant independent contribution to prediction (χ2 =11.40, P=.02,with df = 4). When entered independently into a regression model, concerns (odds ratio, 1.24) significantly explained 10.3% of the variance (χ2 = 7.97, P = .01, with df = 1). Regressions were not significant for antiarrhythmic medication (P = .30). Specifying medication type is important when examining nonadherence in chronic conditions. Concerns about anticoagulants, rather than depression, were significantly associated with non-adherence to anticoagulants but not antiarrhythmics. Anticoagulant concerns should be targeted at AF clinics, with an aim to reduce nonadherence and potentially modifiable adverse outcomes such as stroke.
    • An illness-specific version of the revised illness perception questionnaire in patients with persistent atrial fibrillation (AF-IPQR): Unpacking beliefs about treatment control, personal control and symptom triggers

      Taylor, Elaina C; O'Neill, Mark; Hughes, Lyndsay D; Moss-Morris, Rona; King's College London (Routledge, 2017-09-11)
      This study modified the Revised Illness Perception Questionnaire (IPQ-R) in patients with persistent Atrial Fibrillation (AF). Qualitative interviews and think-aloud techniques informed modification of the IPQ-R to be specific to AF patients. Confirmatory Factor Analysis (CFA) (n=198) examined the validity of the modified IPQ-R (AF-IPQ-R). Exploratory Factor Analysis (EFA) examined the new AF-triggers scale. Construct validity examined associations between the AF-IPQ-R, quality of life (QoL) and beliefs about medicines. Test-retest and internal reliability were examined. Interviews indicated that patients viewed triggers of AF rather than initial causes of illness as more applicable. Patients believed specific behaviours such as rest could control AF. Treatment control beliefs related to pharmacological and procedural treatments. These data were used to modify the IPQ-R subscales and to develop a triggers of AF scale. CFA indicated good model fit. EFA of the triggers scale indicated 3 factors: emotional; health behaviours; and over-exertion triggers. Expected correlations were found between the AF-IPQ-R, QoL and treatment beliefs, evidencing good construct validity. The AF-IPQ-R showed sound psychometric properties. It provides more detailed specification than the IPQ-R of beliefs that may help to understand poor QoL in AF patients, and guidance for future interventions in this area.
    • 'It's like a frog leaping leaping about in your chest': Illness and treatment perceptions in patients with persistent atrial fibrillation

      Taylor, Elaina C; O'Neill, Mark; Carroll, Susan; Hughes, Lyndsay D; Moss-Morris, Rona; King's College London (Wiley, 2017-09-05)
      Persistent atrial fibrillation (AF) is an abnormal heart rhythm associated with low quality of life (QoL) and significant health-related costs. The purpose of the study was to examine patients’ illness and treatment beliefs and ways of coping with AF symptoms, to provide insight into promoting better QoL and treatment-specific management. Beliefs were explored across three procedural treatment-groups using a qualitative cross-sectional design. 30 semi-structured interviews were carried out with patients undertaking cardioversion (n=10), catheter ablation (n=11) and atrioventricular node ablation (n=9). Interviews were transcribed and analysed using inductive thematic analysis with elements of grounded theory. An overarching theme of a vicious cycle was evident, which related to perceived lack of knowledge and understanding of AF, attempts to control symptoms and negative emotional reactions to failed control attempts. This vicious cycle related to three subordinate themes (i) Unpredictability and uncertainty of AF and symptoms; (ii) Coping with symptoms through (a) avoidance (b) all-or-nothing- (c) slowing down behaviours; and (iii) Concerns and expectations about treatment. Patients outlined a need to gain control of unpredictable symptoms by monitoring and varying activity levels. These behaviours were often appraised as ineffective at controlling symptoms, leading to heightened uncertainty and increased activity-avoidance. Treatment concerns escalated with increasing number and invasiveness of procedures. Improving AF patients’ perceived understanding of their illness and treatment and promoting more effective symptom-management strategies may alleviate psychological distress and improve QoL. Themes elaborated on the Common-Sense-Model whereby patients’ beliefs about illness and treatment interact with coping behaviours.