The use of telephone counselling to improve medicine beliefs and adherence among hospital out-patients in Hong Kong

Kin Fai Wan

    Research output: ThesisDoctoral Thesis


    At present, there are many government-funded adherence detection, or improvement intervention services that target improving medicine beliefs and adherence among older patients in Hong Kong; however, they are expensive, time-consuming, and not satisfactorily effective. This is the case even though various methods have been developed in an attempt to effectively and quickly identify potential medicine non-believers or non-adherers, with specifically designed interventions for improving quality of patient care in global public hospital environments have also been carried out. This context identified the gap for the present study to address.

    In the baseline study conducted in the Outpatients Pharmacy Department, Ruttonjee Hospital, Hong Kong (OPD), patients were invited to complete a questionnaire consisting of demographic questions, a ‘beliefs about medicines’ questionnaire (BMQ), social desirability bias or response (SDR) scale, and self-rated health (SRH) scale. Patients in the baseline study, who were regarded as subjectively non-adherent (through their responses to designed questions) and satisfied the selection criteria, were recruited to participate in a 12-months’ telephone counselling (intervention) study. They were then issued a computer-generated identification code in sealed envelopes and divided into intervention and control cohorts for further investigation. For the intervention cohorts, patients received 10-15 minutes telephone counselling every 3 to 4 months, and patients in both cohorts received the usual counter counselling service when collecting their regular medicines at the OPD. The BMQ-specific (BMQ-s) was administered after each telephone counselling session. Data collected was statistically analysed by appropriate modelling, for example, various logistic regression models (LgRs). The impact of the intervention on patient’s adherence or their beliefs about medicines and the influence of predicted variables of interest (adherence, BMQ, SRH and SDR) or demographic characteristics were analysed by various LgRs.

    Main Findings
    From the baseline study of 698 patients, LgRs revealed that older (aged over 61) male participants, who considered their general health to be good or better were more likely to be strong believers in medicines, compared to younger (under 45 years of age) females who regarded their general health to be fair or worse (OR = 4.73-5.84; 1.42-1.82; 1.53-1.83, respectively; p < .05). Furthermore, LgR demonstrated that middle-aged (45-61 years of age) male patients who were taking more than two regular medicines for 5 years or longer, were more likely to be subjectively adherent when compared to younger females (under 45 years of age) who were taking two regular medicines for less than 5 years (OR = 1.99-2.20; 1.422; 1.36-1.37; 1.32-1.36, respectively; p < .05). Logistic regression models also revealed that overall SRH was significantly associated with medicine-specific beliefs, and subjective adherence was negatively associated with medicine-general beliefs (OR = 1.53; 2.34; 0.66, respectively; p < .05). These associations suggested that SRH opens new opportunities for quickly identifying potentially non-adherent patients. Overall, the results suggested there was no significant SDR tendency on the reporting of dependent variables (i.e., subjective adherence; SRH plus medicine general and specific beliefs), and thus instrumental reliability was confirmed.
    Compared to the baseline, and after 12 months of the telephone intervention study, regardless of whether participants were in the control (N=197) or intervention (N=193) cohorts, medicine adherers, believers, and patients who considered their health was good or better at baseline, were more likely to remain in the same corresponding categories (OR = 16.06; 111.10; 23.88, respectively; p < .001; CI = 95%). Also, the overall mean medicine-specific beliefs score for patients in the intervention cohort significantly increased, while this score in the control cohort did not change significantly. Furthermore, a number of logistic regression models confirmed that patients in the intervention cohort were more likely to become medicine believers compared to those in the control cohort after 12 months of receiving the intervention (OR = 2.12-4.76; p < .001; CI = 95%).
    At the end of the study, LgR re-affirmed that medicine-specific beliefs, expressed in necessity – concern differentials (NCD) was significantly associated with subjective health, expressed in SRH (OR = 3.01; p < .01; CI = 95%), and this substantiated the hypothesis in the baseline study that SRH opens new opportunities for prompt screening of potentially non-adherent patients.
    Logistic regression models confirmed that young-old (62-77 years of age) patients at baseline were more likely to be objectively adherent and strong believers at the end of the intervention (OR = 8.27; 4.82, p < .01; .05, respectively, CI = 95%). After 12 months of intervention, patients with non-hesitant attitudes were found very unlikely to modify their belief attitudes to an in-favour attitude (medicine believers) compared to those with hesitant medicine attitudes (OR = 0.16; p < .001; CI = 95). In addition, concerns in the BMQ-specific theme was reaffirmed to be a predominant factor affecting patients’ beliefs towards medicines.

    The 12-month telephone pharmacy counselling service successfully converted a significant proportion of medicine non-believers into believers by the end of the study. While younger females (under 45 years of age) taking two regular medicines for less than 5 years were at higher risk of being sceptical and non-adherent to their medicines, middle-aged and young-old patients with hesitant attitudes were more likely to benefit most from our telephone counselling service. Furthermore, self-rated health (SRH) was confirmed as a tool offering the prompt identification of potentially non-adherent patients. If an intervention aimed at reducing the concerns of higher-risk patients (higher risk of being medicine sceptics or non-adherent) was designed, it is predicted that it would be more likely to produce a positive outcome within a shorter period of time.
    Original languageEnglish
    QualificationDoctor of Philosophy
    Awarding Institution
    • Charles Sturt University
    • Ball, Patrick, Principal Supervisor
    • Jackson, David, Co-Supervisor
    • Maynard, Gregg, Co-Supervisor
    Publication statusPublished - 2022


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