Elsevier

Ophthalmology

Volume 117, Issue 5, May 2010, Pages 903-908
Ophthalmology

Original article
Intentional and Unintentional Nonadherence to Ocular Hypotensive Treatment in Patients with Glaucoma

Presented as a poster at: Association for Research in Vision and Ophthalmology Annual Meeting, May 2009, Fort Lauderdale, Florida.
https://doi.org/10.1016/j.ophtha.2009.10.038Get rights and content

Objective

To determine the rate of intentional and unintentional nonadherence in glaucoma patients and to identify associations between adherence behavior and patients' beliefs.

Design

Cross-sectional study.

Participants

One hundred thirty-one glaucoma patients using topical eye drops for at least 6 months.

Methods

Interviewer-administered surveys.

Main Outcome Measures

Self-reported adherence and beliefs about glaucoma and its treatment were assessed using the Reported Adherence to Medication scale, the Brief Illness Perception Questionnaire, and the Beliefs about Medicines–Specific Questionnaire.

Results

Overall, 59 (45%) participants reported some degree of nonadherence, among whom 39 (66.1%) reported unintentional nonadherence (e.g., forgetting), 10 (16.9%) reported intentional nonadherence (deliberate nonadherence), and 10 (16.9%) reported both forms of nonadherence. Compared with adherers, nonadherers were significantly younger, were less likely to have other nonocular health conditions or to use medicines other than their eye drops, and reported lower belief in the necessity of eye drops for glaucoma (P<0.05). Degree of unintentional nonadherence was associated with lower belief in necessity of eye drops, whereas degree of intentional nonadherence was associated with concerns about eye drops.

Conclusions

Strategies aimed at improving adherence in glaucoma patients need to address both intentional and unintentional dimensions. Interventions focused on eliciting and addressing patients' beliefs and concerns about their eye drops require evaluation.

Financial Disclosure(s)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Section snippets

Study Design

This was a hospital-based, cross-sectional study of patients receiving ophthalmic care at a public tertiary ophthalmic hospital. Consecutive patients were recruited from specialist glaucoma clinics and, on providing informed consent, volunteered to participate in an interviewer-administered survey. Ethical approval was obtained from the Royal Victorian Eye and Ear Hospital's Human Research and Ethics Committee, and the study was conducted in accordance with the Declaration of Helsinki.

Participant Inclusion and Exclusion Criteria

Sample Characteristics and Self-Reported Adherence

The sample was aged between 17 and 91 years, with a mean of 67.7 years (standard deviation [SD], 13.56 years). Among participants, 61.1% were male. Participants had been using eye drops for glaucoma for an average of 8.67 years (range, <1–43 years). A total of 72 (55%) participants reported to be fully adherent. Of the 59 (45%) who reported nonadherence, 39 (66.1%) reported unintentional nonadherence only. Ten participants (16.9%) reported intentional nonadherence, and 10 participants (16.9%)

Discussion

This study revealed that both intentional and unintentional nonadherence is a problem for glaucoma patients. Although unintentional nonadherence is most common, one third of nonadherers report intentional nonadherence, and nonadherers may exhibit both intentional and unintentional nonadherence. Overall, nonadherence was more likely in younger patients and those without other chronic health problems requiring medication. Adherers held a stronger belief in the necessity for eye drops than

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  • Cited by (0)

    Manuscript no. 2009-675.

    Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

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