Illness Representation and Medication Adherence of Patients with Chronic Kidney Disease

Abstract

Chronic kidney disease (CKD) places a high personal and economic burden globally on individuals, families, and society. Although kidney protective medications slow the progression of CKD to end stage kidney disease, adherence to these medications is inadequate. The primary purposes of this study are to: 1) describe the illness and treatment beliefs of CKD patients in stage 3 guided by the Common Sense M model (CSM); and 2) examine the relationship of those beliefs with adherence to renal protective medications, ACE-I. Secondary purposes of this study include determining adherence levels of ACE-I among patients with CKD stage 3; examining relationships between individual and clinical characteristics with patient beliefs and medication adherence with ACE-I; and examining the relationship between the Medication Adherence Report Scale (MARS) and the Medication Possession Ratio (MPR). Using a descriptive cross-sectional design, a convenience sample of 92 individuals with Stage 3 CKD was obtained from a Midwestern VA medical center. Data were collected through self-administered mailed surveys and medical record reviews. Data analyses were performed using descriptive statistics, correlation, t-tests and ANOVA. Seventeen symptoms experienced were perceived as related to CKD by at least one respondent with most reporting legs/feet swelling (n=31). Top perceived cause of CKD was aging (60%). Revised Illness Perception Questionnaire (IPQ-R) items were scored from 1 to 5 with higher scores indicating perceptions of higher personal and treatment control of chronic, cyclical illness with serious consequences and negative emotional reactions. In this study, the CKD timeline was perceived as a long-term chronic rather than short-term acute condition (M = 3.8), with minimal cyclical exacerbations (M = 2.7), and moderate severity of consequences (M = 3.1). Respondents perceived having both, but more personal control than treatment control of CKD (M = 3.5 v 3.2). Participants did not perceive CKD as related to a great negative emotional response (M = 2.8). Illness Representations were not found to be significantly correlated with self-reported medication adherence. Medication adherence levels by self-report (M = 4.8 [5 = perfect adherence]) and pharmacy refill records (73% had perfect refill ratio of 1:1) reveal highly adherent levels among this sample.