ABSTRACT

The study determined the collective influence of illness perception and

medication beliefs on the adherence to antihypertensive drugs prescribed to the adult

population in Brgy. Puting Kahoy, Silang, Cavite. The researchers interviewed the

samples and used three questionnaires to obtain the illness perception, medication beliefs

and adherence toward antihypertension medication of the constituents. These

questionnaires were, the Brief Illness Perception Questionnaire (BIPQ), Beliefs about

Medicines Questionnaire (BMQ) and the Morisky Medication Adherence Scale

(MMAS). collected 61 usable samples. The study utilized a correlational research design

to analyze the data. It revealed that 90.2% of the samples had low adherence.
“THE INFLUENCE OF ILLNESS PERCEPTION AND MEDICATION

BELIEFS TOWARDS THE ADHERENCE OF ADULT RESIDENTS

PRESCRIBED WITH ANTI-HYPERTENSIVE DRUGS IN BARANGAY

PUTING KAHOY, SILANG, CAVITE”

Presented to
College of Medicine
Adventist University of the Philippines

In Partial Fulfillment
Of the requirements for the Degree
Doctor of Medicine

Christopher Dale G. Chua

Nim Franzio A. Salazar II
Eimarlouyd P. Mansaguiton
Julienne Rowelie A. Sanchez
December 13, 2017
 CHAPTER I

INTRODUCTION

Ischemic heart disease and stroke are the biggest killers in the world, accounting for

more than 15 million deaths in 2015. These diseases have remained the leading causes of

death worldwide for the past 15 years. Cardiovascular diseases account for most NCD

deaths, or 17.7 million people annually, followed by cancers (8.8 million), respiratory

diseases (3.9million), and diabetes (1.6 million). The rise of these NCDs has primarily

caused by four major risks factors: tobacco use, physical inactivity, the harmful use of

alcohol and unhealthy diets. These behaviors lead to four key metabolic and/or

physiological changes: raised blood pressure, overweight/obesity, hyperglycemia and

hyperlipidemia. In terms of attributable deaths, the leading NCD risk factor globally is

hypertension, accounting for 19% of worldwide deaths [ CITATION GBD16 \l 13321 ].

Worldwide prevalence of hypertension is estimated to cause millions of premature

deaths averaging around 330 million in the developed world and 640 million in the

developing world. It is estimated that by the year 2025, there will be 1.56 billion adults

living with high blood pressure[CITATION WHO14 \l 1033 ]. In the Philippines,

cardiovascular diseases are the leading non-communicable disease with hypertension

being the highest risk factor, ranks 3rd in the leading causes of morbidity in the year

2010, 2011, and 2012 having 345,412, 303,612, and 512,604 in number respectively

[CITATION The15 \l 1033 ].

There are over 101.6 million Filipinos living in the Philippines today with Southern

Tagalog having the largest in number[ CITATION The15 \l 1033 ]. In Cavite, more

specifically there are over 3 Million people and over 213,000 (NSO, 2014). The
consequence of this large population, is that a larger population would demand a bigger

need for healthcare facilities and services.

Moreover, the number of people with uncontrolled hypertension has increased to

around 1 billion worldwide in the past three decades. As a result, the effective control of

hypertension has become a priority for global health policy and, with growing interest in

the prevention and control of noncommunicable diseases (NCDs). It is vital that health-

care systems deliver appropriate interventions for tackling high blood pressure.

Therefore, control of hypertension is paramount in primary as well as secondary

prevention of cardiovascular disease [ CITATION Raj14 \l 13321 ].

Prescribing medicines is one of the basic medical management of most chronic

noncommunicable diseases, like hypertension. However, almost half of this medication is

not taken seriously and as directed, resulting to greater negative outcomes for patients

and society. Where prescriptions are appropriate, this level of nonadherence has

potentially serious consequences, both for the patients, in terms of not gaining health with

increased morbidity and mortality, and for the health care systems, in terms of increased

hospital admissions, increased wasted resources, and increased use of services [ CITATION

Hor13 \l 13321 ].

Despite the availability of effective treatments, studies have shown that in many

countries, less than 25% of patients treated for hypertension achieve optimum blood

pressure and medication non-adherence has been cited as the primary cause of lack of

hypertension control [ CITATION Edu03 \l 13321 ]. Medication Nonadherence is defined as

the failure to adhere to medication instructions, either intentionally or unintentionally

[ CITATION Raj14 \l 13321 ] . The causes of non-adherence can be intentional (patients’

preferences, motivations and beliefs) or unintentional (patients’ skills and capacity). It is

a complex behavioral process and it is affected by many factors such as patients’

individual character, patient–physician relationship, and the nuances and intricacies of the

health care system [ CITATION RajNay14 \l 1033 ]. It seems that patient’s decision-making

capacity, in terms of their adherence to their prescribed medication, is more often

determined by the way in which they think of the necessity of their medication in relation

to their concerns about the side effects [ CITATION Hor13 \l 13321 ] . According to a WHO

report on adherence to long term therapies, patients who did not adhere to their

antihypertensive medications were 4.5 times more likely to have more serious

complications compared to those who did [ CITATION Edu03 \l 13321 ].

Several studies have enumerated the benefits of controlling hypertension, which

resulted to a significant reduction of associated risk of stroke, coronary heart disease,

congestive heart failure, and consequently, mortality. However, studies evaluating data

from those with hypertension-obtained from various sources such as national survey data,

epidemiologic studies, ambulatory care practices, and high-risk patients—report a

varying rate of hypertension control ranging from 29% to 50%. Despite the numerous

advances in the development of anti-hypertensive medicines, it has also been shown that

noncompliance toward medication is also one of the common causes of uncontrolled

hypertension, resulting in failure to decrease its prevalence [ CITATION Raj14 \l 13321 ].

Outlining the variables that affect or regulate the appearance and/or the change of

adherence behaviors is the first step to develop strategies to facilitate and improve their

implementation and maintenance [ CITATION Gar12 \l 1033 ]. The ability of patients to

adhere to treatment plans is frequently compromised by more than one barrier. These
include: the social and economic factors, the health care team/system, the characteristics

of the disease, disease therapies and patient-related factors. Belief was identified as one

of the patient-related factors that interact with in ways not yet fully understood to

influence adherence behavior [ CITATION Edu03 \l 1033 ]. Interventions to optimise

adherence tend to be more effective if they are personalized to the needs of the individual

taking account of the perceptions of the treatment as well as practical abilities and

resources that enable or impede their adherence [ CITATION Hor13 \l 1033 ].

In our setting, the Filipino people are known to have diverse religions, cultures and

beliefs which, in various ways, affects the health of the people. Beliefs are vital

components that a health care provider must consider in providing care and treatment to a

patient. The beliefs and attributions that people hold can influence their health by

affecting their behavior, or more directly by affecting a physiological system [CITATION

Bro13 \l 1033 ]. These sets of belief can be considered as one of the leading factors

affecting nonadherence of patients to their medication regimen. Specific to hypertension,

fear of hypertensive complications, desire to control blood pressure, and faith in

physician are the primary documented reasons for treatment adherence, while

misunderstanding of the condition, perceived improvement in health, worsening of

health, general disapproval of medications, and concern over side effects are primary

documented reasons for treatment nonadherence.

Increasing the success of adherence interventions may have a far greater impact

on the health of the population than any improvement in specific medical treatments

[ CITATION Edu03 \l 1033 ] , therefore, understanding the influence of individual beliefs and
perceptions on medication adherence is vitally important to augment the global success of

unique and effective treatment plans for each individual.

Significance of the Study

This study will be significant for the people with chronic illness as well as physicians

so that effective interventions can be developed to address questions, doubts about the

necessity for treatment, concerns about adverse effects, as well as fears regarding the

patents’ treatment regimens in order to enhance adherence. Knowledge of the factors that

can affect the common Filipino adult’s decisions when taking medicine can enable

physicians to take into account the beliefs of their patients in order to assure the

adherence of their patients to take their prescribed medicine regimens seriously.

Moreover, this study will redound to the benefit of the society considering that

medication adherence can improve the rate at which disease can be cured.

Objectives of the study

General Objective: To determine the collective influence of illness perception

and medication beliefs on the adherence to antihypertensive drugs prescribed to the adult

population in Brgy. Puting Kahoy, Silang, Cavite.

Specific Objectives

1. To determine the individual influence of medication beliefs on the medication

adherence of adult residents in Brgy. Puting Kahoy, who have been prescribed

and have been taking hypertension medicines for at least 1 month.

 2. To determine the individual influence of illness perception on the medication

adherence of adult residents of Brgy. Puting Kahoy, who have been prescribed

and have been taking hypertension medicines, regarding their hypertension.

Population:

Population will consist residents of Barangay Puting Kahoy, Silang, Cavite, ages

18 and above, prescribed or taking hypertensive medicines.

 CHAPTER II

REVIEW OF LITERATURE

Illness Perception

How one views his illness matters in determining one’s health outcomes. This

specific view was termed, “illness perception” and has been found out to be playing a

huge role in a patient’s decision on their health according to several studies which will be

discussed below.

Illness Perceptions has been defined as the organized cognitive representations or

beliefs that patients have about their illness. These perceptions have been found to be

important determinants of behavior and have been associated with a number of important

outcomes, such as treatment adherence and functional recovery[CITATION Pet07 \l 1033 ].

This concept originated from research into the communication of health threats by

Leventhal et al. in which he developed the Common-sense model (CSM) which aims to

describe the process by which individuals respond to a perceived health threat. This

model proposes that situational stimuli generate both cognitive and emotional

representations of the illness or health threat [CITATION Bro06 \l 1033 ]. In addition, the

theory describes a parallel response model in which people process emotional responses

to illness and cognitive representations of illness relatively independently. These

cognitions and emotional responses provide motivation for people to take specific

behaviors to regulate their emotions and improve the outcome of the illness. Following

adaption of these procedures, people appraise the effect on the illness and the self-system,

and this can result in changes to their cognitive representations and emotional responses

in a feedback loop[CITATION Bro15 \l 1033 ].

It has also been found out that the way patients structure their perceptions of

illness has a consistent pattern. Illness Perception researches identified five components:

the identity component which includes the name of the illness and the range of symptoms

they viewed to be associated with the disease; the consequences of which the patient

believes as the expected effects and outcome of the illness for the patient and the family;

the cause which are the patient’s personal ideas about the cause of the illness; the

timeline on which the patient believed how long his/her illness would last; and lastly, the

cure or control which is the extent to which the patient believe that they can recover from

or control the illness[CITATION Bro06 \l 1033 ]. Two important aspects have also been

noted by Petrie et.al in this model: First is the patient’s beliefs about their condition

usually varies from those who are treating them. Second, is that the patient’s perception

varies widely even amongst patients with the same medical condition.[CITATION Pet07 \l

1033 ].

The Brief Illness Perception Questionnaire (BIPQ)

The importance of illness perceptions in medical conditions can be seen in on-

going and researches during the past years and has eventually sparked the development of
several objective measurements. The Illness Perception Questionnaire (IPQ) is a widely

used multifactorial pencil-and-paper questionnaire assessing the five cognitive illness

representations on a five-point Likert scale. The Revised Illness Perception Questionnaire

(IPQ-R) is a revised and extended version of the IPQ which added 4 more items and new

subscales including the emotional representation. The Brief Illness Perception

Questionnaire (BIPQ) is a very short and simple measure of illness perception that has an

alternative format from the IPQ and IPQ-R [CITATION Bro06 \l 1033 ]. In contrast to the

more traditional method of constructing dimensions, the Brief IPQ uses one single item

on a scale from 0 to 10 to assess each dimension, where higher scores indicate stronger

perceptions along that dimension. The items include 5 items assessing cognitive illness

representations: perceived consequences, timeline (acute-chronic), amount of perceived

personal control, treatment control, identity (symptoms); 2 items assessing emotional

representations: concern about the illness and emotional representation; and one item

assessing illness comprehensibility which is coherence of the illness. The last item

assesses causal perceptions by asking patient to list the three most likely cause for their

illness[CITATION Bro15 \l 1033 ]. Such responses can be grouped into categories such as

stress, lifestyle, hereditary, etc., determined by the particular illness studied, and

categorical analysis can then be performed. The word ‘illness’ was used in the most

general version of the questionnaire but is possible to be replaced with the name of a

particular illness. Similarly, the word ‘treatment’ can be replaced by a particular

treatment[CITATION Bro06 \l 1033 ].

The original evaluation of BIPQ found that it demonstrated good psychometric

properties, including concurrent, predictive and discriminant validity. It showed similar

associations with medication beliefs, disease severity and quality of life as previous

research with other illness perception measures. Since its publication, it has been widely

used in several researches and journals in different countries. A meta-analysis of the

BIPQ showed its versatile measurement having been used in different illness populations

in 36 countries across many continents with participants ranging from 8 to 80 years old. It

was validated in translated version in 4 different languages and was also used for

validating new measures[CITATION Bro15 \l 1033 ]

Several studies have utilized the BIPQ in analyzing illness in correlation with

adherence to medication. One study by Broadbent et.al showed association on diabetic

patients’ medication adherence and illness perceptions such as lower perceived

consequences of diabetes, higher personal control, lower distress, and fewer

symptoms[CITATION Bro11 \l 1033 ]. Another study done by Petricek et.al in patients with

type 2 diabetes showed their illness perception was associated with the degree of control

established over certain cardiovascular risk factors. In addition, significantly better

adherence to the recommended lifestyle was associated with higher degree of personal

control over the illness, and better illness understanding [CITATION Pet09 \l 1033 ]. In a

cross-sectional study done by Rajpura and Nayak, they intended to assess the collective

influence of illness perceptions, medication beliefs, and illness burden on medication

adherence on elderly people suffering from hypertension utilized the BIPQ together with

the MMAS and the BMQ. The study concluded that threatening views of illness and

stronger beliefs regarding necessity of medications contribute substantially to positive

medication adherence. Majority of the participants, rank-ordered stress as the number 1

perceived cause of their hypertension, followed by lifestyle, and heredity[CITATION Raj14 \l

1033 ].

Medication beliefs

The Merriam-Webster Dictionary defines beliefs as the conviction of truth to a

statement or reality of some phenomenon especially when based on examination of

evidence. In this case, the phenomenon is about medication. So, it can be said that

medication beliefs are the conviction of a person towards the medication that is

prescribed to them as well as finding out the factors that affect them.

AlHweiti in his study, aimed to find the factors regarding health beliefs that aided

or hampered patients from complying with their medication. The author also comes to

say that beliefs are the strongest predictors of adherence. In his study, he gave out

questionnaires called the BMQ or the Beliefs about Medication Questionnaire to assess

the patients’ medical beliefs like benefit of the medicine or its harmful ness. The study

consisted of 664 patients selected whose answers were analyzed. Adherence, on the other

hand, was assessed using the 8-item Morisky Medication Adherence Scale (MMAS-8),

assisted by an interviewer.

They found that the majority of patients with chronic disease reported low

adherence to medications and reported a perception of medication information

inadequacy. He points it out to the fact that more complex disease, needed complex

medication as well and one that not everybody and can adhere to. In the study, he

emphasizes on the fact that proper education should be given to the patients to ensure a

better rate of adherence and iron-out any misconceptions that patients may have
regarding their medicines. Furthermore, beliefs tend to be fixed over time unless an

intervention was made. Education is one of the proven intervention to change beliefs and

there is evidence that targeting patient’s specific beliefs can improve such adherence

[CITATION Abd14 \l 1033 ].

Moreover, AlHewiti, in his study, said that the impact of beliefs on adherence varies.

This is according to the culture of each person. One of the motivations for their study is

that they didn’t know how their patients view the adequacy of the information given to

them about their medications by their physicians and how could this possibly influence

their beliefs and adherence. Hence, the final aim of their study is to estimate adherence to

long-term therapies among patients with chronic diseases and to examine the relationship

between adherence, beliefs about medications, and patients’ perception about the

adequacy of medication information [CITATION Abd14 \l 1033 ]

In a study by Abad et al., they describe the traditional beliefs of Filipinos and they

concluded that religious beliefs have a bearing in affecting a person’s willingness to

discuss with their condition. To pregnant women, folk beliefs can influence the

physician’s communication regarding genetic defects to infants in childbirth. According

to them, “A patient may be dissatisfied with their counselling session, and this may likely

lead to poor adherence to the recommended medical care and negative health outcomes.”

In a study by Horne et. Al. in which they reviewed over 200 journals regarding

beliefs and medication, they found out that most studies would have a group with the

least medication concerns and those are the groups that tend to have a higher rate of

adherence and those with more concerns were shown to be less adherent to medications.
According to them, “Our findings show that many patients harbour significant,

unresolved doubts and concerns about prescribed treatment suggesting a fault-line

between patients’ and prescribers’ cultural perceptions of the treatment.” They also go on

to say that for some patients, non-adherence of for them an informed choice. [ CITATION

Hor13 \l 1033 ]

A study by Lin et.al, shows the medication adherence rate of elderly

hypertensives in Tainan City in Southern Taiwan was 57.6%. The factors associated with

good adherence include: male gender, lower daily dose frequency, lower monthly

income, belief in the efficacy of medications, and absence of ADR in the past 6 months.

They concluded that treating elderly with hypertensives is better when prescribing long-

acting drugs, avoiding the occurrence of adverse drug reactions, and educate them to

understand and appreciate the beneficial effects of antihypertensive treatment on their

health[CITATION Lin07 \l 1033 ].

A study by Ungari et. al. reiterates the importance of professional/patient

interaction, trust in the doctor and health professionals' attitude toward users. It

corroborates the need for greater emphasis on patient education regarding hypertension as

well as organization of permanent education courses for training of health professionals,

addressing the correct use of medications, knowledge sharing, modifying beliefs and

attitudes toward treatment and helping patients understand their health conditions.

Although it emphasizes the pharmacist as a key element in improving hypertensive

patients' adherence to treatment by providing direct pharmaceutical attention. The

pharmacist is a professional who is in a position of constant contact with patients,

enabling the provision of information about the prescribed medications, the disease and
its complication while optimizing the medication therapy as a health maintenance

practice. [CITATION Ung10 \l 1033 ]

A study by Gadkari, implicates that unintentional non-adherence does not appear to

be random and is predicted by medication beliefs, chronic disease, and socio-

demographics. The data suggests that the importance of unintentional non-adherence may

lie in its potential prognostic significance for future intentional non-adherence. Health

care providers may consider routinely inquiring about unintentional non-adherence in

order to proactively address patients’ suboptimal medication beliefs before they choose to

discontinue therapy all together [CITATION Gad12 \l 1033 ].

Beliefs about Medications Questionnaire (BMQ)

The Beliefs about Medicines Questionnaire was developed to understand people’s

perceptions about medicines and their adherence (or non-adherence) to prescribed

medication regimes. It comprises 2 scales: Specific Beliefs and General Beliefs. The

Specific Beliefs scale is further divided into 2 subscales: Specific “Necessity” Beliefs and

Specific “Concern” Beliefs. General Beliefs is divided into General “Harm” Beliefs and

General “Overuse” Beliefs [CITATION Por10 \l 1033 ].

Individual medication concerns were assessed by the Specific Concern Beliefs

component. The Specific Necessity Beliefs subscale assesses the beliefs of individuals

about the necessity of their medications, where having a strong necessity belief translates

into higher medication adherence. The General Harm score signifies the degree of an

individual’s beliefs that his or her medications are harmful; therefore, a lower General

Harm score means higher medication adherence. The General Overuse scores signifies
the degree of an individual’s belief that his or her physician overprescribes medication;

therefore, a lower General Overuse score means higher medication adherence. All 18

items on the scale utilize a 5-point Likert scale. The first 10 items evaluate attitudes about

the necessity of, and the level of concern about, the medication the patient is currently

taking. The next 8 questions are about general attitudes toward medicines. Scale scores

are computed from the sum of answers to all the relevant questions [CITATION Abd14 \l

1033 ].

Beliefs can have an effect against concerns, e.g. patients continue their medications

knowing that it is essential for their health regardless of the adverse effects. However,

concerns would cause (a) intentional non-adherence especially when patients

discontinued taking the medication due to the adverse effects, and (b) unintentional non-

adherence occurs when a patient wants to adhere but does not have the means to

continue. Some examples, include lack of financial means to purchase or has difficulty in

remembering the schedule to take. Many studies had used the BMQ to quantify Necessity

Beliefs and Concerns to investigate relationship between beliefs and adherence to

patients. However, the succeeding studies had their own variations when it comes to the

cultural backgrounds or values. They found out that necessity and concern beliefs had

less association with adherence. Therefore, with this study it is possible to elicit at least

one Filipino culture or value that could be a factor for this study.[ CITATION Hor13 \l 1033 ]

According to Horne, individuals with greater specific concerns with their medications

had become more distrustful and thus more non-adherent. It was observed that

perceptions about illness, perceived illness burden, and beliefs about medication jointly

played a significant role in the prediction of medication adherence. Positive beliefs

regarding medications are also crucial for shaping adherence behavior of elderly

hypertensive individuals. Interventions and programs aimed at building adherence in

elderly hypertension patients need to recognize the value and importance of patient

perceptions of illness and medications in shaping adherence behavior [CITATION Raj14 \l

1033 ].

Adherence

“Non-adherence” has been defined in the literature as a patient’s passive failure

to follow a prescribed therapeutic regimen. The same principle applies to dietary

regimens, screening tests, and lifestyle modifications. Non- adherence to medication has

profound implications on the patient as well as on doctor-patient relationships and

interactions, plans of care, and the healthcare system. Without taking medications

prescribed by their doctors, the patient will not benefit from the medication, adequate

drug serum levels will not be achieved, and the medication itself will not be an effective

therapeutic intervention. In addition, physicians may erroneously interpret the inadequate

disease control as indicating a need for more medication and thus potentially over-

prescribing. Thus, non-adherence can lead the patient to a higher health care and drugs

utilization, putting the patient at risk for more complications [CITATION Sye09 \l 1033 ].
 CHAPTER III

METHODOLOGY

The methods and procedures that were used in the study will be discussed in the

chapter, this includes: the research design, population and sampling, inclusion and

exclusion criteria, data gathering procedures, instrumentation, statistical treatment of the

data, and the scope and limitations of the study.

Research Design

The study utilized a correlational research design in order to examine the factors

relating to the, illness perception, beliefs about medication, and medication adherence of

the population and their correlation with each other.

Sampling Method

A cross-sectional survey research design, utilizing a convenience sample and a

battery of self-administered surveys was adopted to address the study objective.

Inclusion and Exclusion Criteria

 Inclusion criteria includes: study participants were required to be at least 18 years

old, residing in Brgy. Puting Kahoy, Silang, Cavite, diagnosed with hypertension, were

prescribed by their physicians at least 1 anti-hypertensive medication to be taken daily,

and was takimg it for at least 1 month. Exclusion criteria includes: study participants who

refused to further continue the survey, failed to complete the questionnaire, failed to

answer the much-needed questions due to the inability to understand spoken words

caused by hearing loss, and severe visual impairment hindering reading.

Data Collection Procedure

The study was approved by the research defense panel and was given the consent

from the AUP College of Medicine Dean, the college ethics board chairman. The study

was guided accordingly regarding the ethical considerations. The researchers were

properly recommended to the University Research Center and were approved to conduct

the said study inside and outside the university. The questionnaires were also given a

translation and localization to fit the constituents of the community involved.

A cross-sectional interviewer-assisted survey was conducted among hypertensive

people of Barangay Puting Kahoy. Respondents were assessed through house and office

visitation inside the Adventist University of the Philippines and from the Puting Kahoy

community. People who were known to have a chronic disease and were taking

maintenance medications, were considered initially eligible for the study. Among the

assessed individuals, each was asked if they have met the inclusion criteria. Respondents

who met the inclusion criteria above were asked properly to participate in the study.

- 70 met the inclusion criteria

80 assessed for
inclusion criteria
Inclusion Criteria:
- 18 years and not older than 70
- Must be taking hypertensive
medication (no restriction)
prescribed by a physician
 70 met the inclusion criteria
- 3 refused to further participate
- 1 failed to answer needed
questions
66 eligible respondents

- 5 incomplete data

61 included in analysis

Figure 1. Flowchart indicating the selection process of

After obtaining the

informed consent, respondents

were asked to fill the questionnaires and were assisted by the interviewers/researchers if

they had encountered difficulty in understanding some questions. Care was taken not to

be judgmental during the interview in order to avoid social desirability bias (Figure 1).

Study Instruments

The survey consisted of a collection of instruments that measured the dependent

variable—medication adherence—and its association with the independent variables of

beliefs about medications and illness perception. Survey questionnaires were formally

translated in order to address the language barrier and to ensure the readability of the

questionnaires.

The researchers assessed age, gender, educational level (no formal education, primary

studies, secondary studies, university studies) and financial capability of the respondents.

For evaluation purposes, medications were divided into the common groups of anti-
hypertensive drugs, number of antihypertensive drugs, and number of medications. The

survey also recorded how long patients had received anti-hypertensive treatments.

The questionnaire consisted of three parts: Beliefs about Medicines Questionnaire

(BMQ), Morisky Medication Adherence Scale-8 (MMAS-8), and Brief Illness Perception

Questionnaire-revised (BIPQ-r). The survey measures the independent variables of

illness perception and beliefs about medications associated to the dependent variable of

medication adherence. To ensure reliability of the questionnaire, pilot testing was

conducted.

Beliefs about Medicines Questionnaire (BMQ)

An 18 item-questionnaire, used to measure the respondents’ beliefs on their

medications, divided into two parts: first, the BMQ-General which measured

respondents’ attitudes to medicines in general. It has two sub-scales, with each sub-scale

consisting of four items. The first, the General-overuse sub-scale measures respondents’

beliefs about the extent to which medicines are overused or over-prescribed by doctors.

The second subscale, the General-harm sub-scale assesses beliefs about the harmfulness

of medicines. Secondly, the BMQ-Specific scale has two sub-scales and assesses

respondents’ beliefs about prescribed medicines that they are currently using for specific

conditions, for example, hypertension, diabetes or asthma. Items are scored using a 5-

point Likert scale. Higher scores indicate stronger beliefs about the corresponding

concepts in each sub-scale.

Morisky Medication Adherence Scale (MMAS-8)

An 8-item scale used to identify the level of medication adherence of the subject.

Mainly, this is concerned with the implementation of treatment by the patient. The

barriers to proper treatment that it aims to identify are factors that include forgetfulness,

medication taking behavior, and partly what they feel about the medication. To classify

subjects, results are divided into low, medium and high adherence. Questions will be

asked with two options for the answers. A “Yes” answer will be equivalent to 0 point.

While a “No” has the equivalent score of 1. Unlike the BMQ, a lower score indicates a

higher adherence to the medication. The score of 0 would indicate a high level of

adherence, 1-2 indicates medium adherence, and 3-8 indicates low adherence.

According to Di Bonaventura et al, it is a reliable and a valid instrument to assess

non-adherence to medication at least when it comes to assessing the medication

adherence of patients with type 2 diabetes. The data collection method was validated by

Nguyen et al and also said that it was reliable enough for the study of osteoporosis.

[ CITATION Dib12 \l 1033 ]

Brief Illness Perception Questionnaire (BIPQ)

This instrument assessed the study participant’s perception of hypertension. It

contains a 9-item scale where each item is a condensed version of the nine sub-scales of

the original Illness Perception Questionnaire (IPQ). Each scale is rated from 0-10, while

the ninth item required participants to rank their perceived cause of illness from 1-3 such

as “Lifestyle,” “Stress,” or “Heredity” where higher composited on BIPQ interpreted to a

more threatening view of the illness.

Scope and Limitations

For the scope and limitations, the researchers performed a maximum variation

purposive sampling in order to have a diverse set of hypertensive adults as well as to be

more flexible in obtaining the sample. The study did not take into account the beliefs and

adherence for other comorbidities and the associated medicines. As well as the ethnicity

or region of origin of the sample and the corresponding cultural background regarding

medicines. The study focused solely on the illness perception, medication beliefs and

medication adherence of hypertension only.

CHAPTER IV

RESULTS AND DISCUSSION

Among the 70 questionnaires that were distributed in the study site, only 61

responded during the study period, accounting all to be eligible and were included for the

final analysis. The researchers arranged for the data to be treated by a statistician who in

turn, analyzed the data using SPSS. The respondent’s characteristics are shown in Table

1.

Table 1

Study Participant Characteristics 22-39 8.2 5

40-65 57.4 35
Characteristic Percentag Frequenc >66 32.8 20
s e (%) y (n=61) Civil Status
Gender Single 13.1 8
Male 34.4 21 Married 70.5 43
Female 65.6 40 Widowed 11.5 7
Age Occupation
 None 47.5 29 Others 4.9 3
Professionals 18.0 11 Educational level
Service 16.4 10 High School 32.8 20
Workers College 21.3 13
Religion Post-Graduate 23.0 14
RC 32.8 20
SDA 55.7 34
 Medication Used
ARB 19.6 12
Ca Channel
Blocker 31.5 19
Beta-Blockers 13.1 8
Gross monthly Income
Less than 5000 23.0 14
10000 - 20000 16.4 10
Greater than 36.1 22
20000
Source of Monthly Income
Salary 42.6 26
Pension 14.8 9
Relatives 11.5 7
Age Diagnosed with Hypertension
22 - 29 13.1 8
40 - 65 73.8 45
66 and older 11.5 7
Number of Other Medical Conditions
1 illness 65.6 40
2 illnesses 26.2 16
3 illnesses 8.2 5
Illnesses in Conjunction with
Hypertension
None 16.4 10
DM 21.3 13
Cardiovascular 31.1 19
Duration of Use
1 - 5 years 24.6 15
5 - 10 years 29.5 18
> 10 years 21.3 13
Number of Anti-Hypertensive
Medications
1 65.6 40
2 26.2 16
3 8.2 5
a
Only top 3 major findings per demographic variable are reported in the table. Complete table is in the
Appendix A.
b
RC= Roman Catholic, SDA= Seventh-day Adventist, DM= Diabetes Mellitus, ARB= Angiotensin Receptor
Blocker

The respondents were mostly from ages 40-65 years old which comprised an

estimated average of 55.2% of the entire sample where more than half were female, and

32.8% (n=20) of the respondents, at least, attended high school. In addition, 65.6%

(n=40) among them had only 1 medical illness. Heart problem (31.1%, n=19) was the

most common disease among the respondents followed by Diabetes (21.3%, n=13). Most

of the respondents (73.8%, n=45) were diagnosed with hypertension between the ages of

40-65 years old. As for the number of anti-hypertensive medications they used, most of

the samples took only 1 anti-hypertensive medication (65.6%, n=40) which commonly

was a Calcium Channel Blocker (31.5%, n=16). A total of 90.2% (n=55) of the

respondents answered “no” to all of the 8 items of MMAS (Table 2), meaning that

majority of the population in Brgy. Puting Kahoy had low levels of medication-taking

behavior.

Table 2

Descriptive Statistics for Morisky Medication Adherence Scale

Range
MMAS Results Score Percentage (%) Frequency
Low <6 90.2 55
Medium 6–8 9.8 6
High 8 0.0 0
Total   100.0 61
Interpretation: The lower the Morisky’s composite score, the lower the medication adherence; the higher
the composite score, the higher the medication adherence. According to Morisky et al., 0 = high
medication adherence; 1, 2 = medium medication adherence; 3, 4 = low medication adherence.
For the reliability study of the questionnaires the researchers obtained 32 samples

and gave them questionnaires with a follow-up interview procedure as stated in the

previous chapter. The reliability study showed that all of the questionnaires were valid.
The requirement of the test needed that at least a result of 0.5 to be considered valid. A

higher result yielded better reliability. First, with BMQ Specific, which had 10 items, the

Cronbach’s alpha coefficient yielded a result of 0.502. BMQ General which had 8 items,

yielded a Cronbach’s alpha of 0.575. As for the MMAS questionnaire, the original

validation study had a Cronbach’s alpha of 0.687 [ CITATION Raj14 \l 1033 ] which was 0.1

off of that of the original. Although, since it did exceed the minimum value of 0.5 then it

is still considered to be reliable. BIPQ, which had 7 items analyzed yielded a Cronbach’s

alpha of 0.586. The last item was not included in the reliability due to the nature of the

question. Wherein the interviewees simply had to list down the top three reasons as to

why they had Hypertension.

A standard multiple regression analysis shown on Table 3 was conducted to

assess the collective influence of illness perceptions and medication beliefs on the

medication adherence of the study sample. BIPQ composite scores indicating illness

perceptions of study participants; and BMQ subscale composite scores (specific concern,

specific necessity, general harm, general overuse) indicating beliefs about medication

were regressed on the MMAS composite score, the dependent variable. The linear

combination of BMQ and BIPQ composite scores was significantly related to medication

adherence, F (5,55) = 4.54, p =.001. The multiple correlation coefficient was .292,

indicating that approximately 54% of the variance of the medication adherence can be

accounted for by the linear combination of medication beliefs and illness perception.

Table 3

Multiple Linear Regression Model to Assess the Collective Influence of Beliefs and
Illness Perception Towards Adherence

Model B Standard Beta t Sig.

 Error
(Constant) .716 .114 6.269 .000
Illness Perception
BIPQ composite -.032 .018 -.224 -1.762 .084
scores
Beliefs about
Medication
Specific Concern .024 .021 .159 1.145 .257
Specific Necessity .024 .018 .153 1.315 .194
General Overuse -.011 0.25 -.055 -.438 .663
General Harm -.080 0.23 -.462 -3.425 .001
a
Model fit statistics: R2=0.292; r=0.54; F=4.54. Correlation is significant at 0.05, 2 tailed
B = values for the regression equation for predicting the dependent variable from the independent
variable; BIPQ- Brief Illness Perception Questionnaire; F= statistic; r = correlation between the observed
and predicted values of dependent variables; sig= significance; t= statistic.

Beliefs about Antihypertensive Medications.

To assess the study participants’ beliefs about their hypertensive medications and

their influence on medication adherence, Pearson’s correlation analysis was performed

between BMQ subscale composite scores and MMAS composite scores. As shown in

Table 4, a weak negative correlation (r = -0.138, P = 0.014) was observed between

specific concern scores and medication adherence, indicating that individuals with strong

concerns about their medications tend to have lower medication adherence. A weak

positive and significant correlation (r = 0.312, P = 0.014) was observed between specific

necessity scores and medication adherence, indicating that individuals with strong beliefs

that their medications are necessary for them tend to have higher medication adherence.

A weak negative and significant correlation (r = -0.207, P = 0.109) was observed

between general harm scores and medication adherence, indicating that individuals with

strong beliefs that medications are harmful to them tend to have lower medication

adherence. A moderate negative correlation (r = -0.503, P =0.000) was observed between

general overuse scores and medication adherence, indicating that individuals with strong
beliefs that their physicians overprescribe their medications, and fear of medication

overuse, tend to have lower medication adherence.

Table 4
Correlation between Medication Adherence and Beliefs about Medication
Variables BMQ- BMQ- BMQ- BMQ- MMAS
Specific Specific General General
Concern Necessity Overuse Harm
BMQ-Specific R 1 .210 .531** .490** -.138
Concern Sig. .105 .000 .000 .289
N 61 61 61 61 61
BMQ- Specific R .210 1 .061 -.130 .312*
Necessity Sig. .105 .642 .318 .014
N 61 61 61 61 61
BMQ- General R .531** .061 1 .441** -.207
Overuse Sig. .000 .642 .000 .109
N 61 61 61 61 61
BMQ- General R .490** -.130 .441** 1 -.503**
Harm Sig. .000 .318 .000 .000
N 61 61 61 61 61
MMAS R -.138 .312* -.207 -.503** 1
Sig. .289 .014 .109 .000
N 61 61 61 61 61
**. Correlation is significant at the 0.01 level (2-tailed)
*. Correlation is significant at the 0.05 level (2-tailed)
BMQ- Beliefs about Medication; MMAS- Morisky Medical Adherence Scale; R- Pearson’s correlation;
Sig.- Significance level

Illness Perception and Medication Adherence.

In order to assess the influence of perceptions of illness on the medication

adherence of the study sample, Pearson’ correlation analysis was also performed between

the BIPQ composite scores and the MMAS composite scores. Table 5 depicts a negative

and significant correlation (r = -.281, P = 0.028) between medication adherence illness

perceptions, suggesting that higher scores on the BIPQ scale (meaning more threatening

view of illness) would translate into lower levels of medication adherence. Table 6 shows

that the majority of the participants (n = 24, 40.7%) rank-ordered stress as the number 1
perceived cause of their hypertension, followed by unhealthy diet (n = 11, 18.6%), and

heredity (n = 6, 10.2%).

Table 5

Correlation between Medication Adherence and Illness Perception

Variables MMAS BIPQ

MMAS R 1 -.281*
Sig. 0.028
N 61 61
BIPQ R -.281* 1
Sig. 0.028
N 61 61
*Correlation is significant at the 0.05 level (2-tailed)
MMAS- Morisky Medication Adherence Scale; BIPQ-Brief Illness Perception Questionnaire; R-Pearson’s
Correlation; Sig.-Significant level

Table 6

Leading Perceived Cause of Hypertension

Cause** Frequency Percentage

Stress 24 40.7
Unhealthy Diet 11 18.6
Heredity 6 10.2
**Only top 3 major causes were reported in the table

This study which was done in Barangay Puting Kahoy, Silang, Cavite provided

insights into how beliefs about medicines and perceptions about their own illnesses

influence the medication adherence, specifically in hypertension. Positive beliefs

regarding medications are important for molding adherence behavior of adult

hypertensive individuals. Stronger beliefs that their medications are necessary for them

contribute significantly to positive medication adherence. On the other hand, negative

beliefs about their medications are also equally important to consider. Stronger beliefs

that their medications are harmful to them contribute significantly, however, to negative

medication adherence. Our results are very similar to another study conducted on elderly
hypertensive individuals. It showed that positive beliefs regarding medications are also

crucial for shaping medication adherence behavior. It was found out also that individuals

with greater specific concerns with their medications had become more distrustful and

thus more became non-adherent. Moreover, another study by Horne et al., they also

found out that necessity and concern beliefs had less association with adherence.

[ CITATION Hor13 \l 13321 ]; However, in our study, beliefs about specific concerns and

general overuse did not reach statistical significance.

Another interesting significant finding in our study showed that the more

threatening illness perceptions lead to lower medication adherence. This finding

somehow contradicts mostly to the outcomes of other related studies. In one instance, a

previous study of Petricek et.al in patients with type 2 diabetes, they have found out that

significantly higher adherence to the recommended lifestyle was associated with higher

degree of personal control over the illness, and better illness understanding.[] Meaning, if

there is greater perception and understanding of their own illnesses, there will be

favorable and better outcomes in following a treatment regimen. Moreover, another

previous study had found out that the majority of patients with chronic disease reported

low adherence to medications and reported a perception of medication information

inadequacy. [] However, there is one study about assessing the adherence of patients

diagnosed with asthma and COPD, resulted the same with our findings that there was

significant negative correlation between total MMAS-8 and BIPQ scores.[] This finding

can explain the variation of results with different studies.

In assessing medication adherence using the MMAS, the majority of our study

participants exhibited low medication adherence patterns, few exhibited medium

adherence score, while none had exhibited high adherence rates. Low adherence rates

within our study sample can be attributed to multiple factors, however, it is not included

in our objectives to find the difference between the demographical profiles of a

hypertensive adult and medication adherence. Although reviewed literature sufficiently

demonstrates that beliefs about medication and illness perceptions significantly affect

medication compliance in chronic disease conditions in the general population [ CITATION

Jig14 \l 13321 ], different variables such as the demographical profiles and the cultural

differences of each individual was poorly documented and correlated with adherence.

Previous literatures noted that two important aspects have been found out with

regards to the differences of medication adherence: first is the patient’s beliefs about their

condition usually varies from those who are treating them. Second, is that the patient’s

perception varies widely even amongst patients with the same medical condition.

[CITATION Pet07 \l 1033 ]. Programs and different interventions designed at improving

adherence in adult hypertensive patients need to know the value and importance of

beliefs about medicines and patient perceptions of illness in shaping adherence behavior.

And education remained to be one of the proven interventions to change beliefs and there

is evidence that targeting patient’s specific beliefs can improve such adherence [CITATION

Abd14 \l 1033 ].

CHAPTER V
 CONCLUSION

In conclusion, we have assessed that the prevalence of low adherence among

adults with hypertension in Barangay Puting Kahoy, Silang, Cavite, is somehow alarming

and it was observed that perceptions about illness and beliefs about medication mutually

played a significant part in the prediction of medication adherence. Based on reviewed

literatures, the perspective of a patient towards medication adherence is gaining

significance over a provider’s insistence on a patient’s adherence with written or oral

instructions to take medications. While adherence to medication is necessary, an

assessment of the factors contributing to lack of adherence is important in identifying the

reason leading to low adherence and resulting therapeutic failure. Understanding these

factors could help refine future medical interventions not by prescribing the appropriate

antihypertensive drugs but also ensuring that they are taken at the right time, amount, and

frequency. It may also be designed at increasing medication adherence in adult

hypertensive patients by incorporating beliefs about medications and perception of illness

in order to achieve desired patient outcomes.

Therefore, discussing medications adherence and beliefs with the patients is vital

and should be a part of the usual clinical care of chronic diseases as improving medicine

taking behavior may have a far greater impact on clinical outcomes than improvement in

treatment, especially in hypertensive patients.

RECOMMENDATIONS
 The following are recommendations as possible ways to improve the study. The

study sample size is a target number of respondents rather than a set requirement.

Increasing the number of sample size increases also the reliability and validity of the

questionnaire. Interviewing the study participants rather than letting the participants

answer the questionnaire themselves is better to ensure that no item in the questionnaire

are unanswered.

It will be very significant to future studies if the demographical profiles of

respondents will be included. This could probably explain the cultural differences and

may be a determining factor as well, towards better adherence.

The study participants are specifically residents from Puting Kahoy. The study

can be replicated in other barangays or the entire Silang municipality considering that

current study setting is an academic community and thus may yield different results

compared to other communities.

 INDEX

Appendix A

Study Demographics

Percenta Frequen
Medicatio ge cy
n Used (%) (n=61)
ARB 19.6 12
Ca
Channel
Blocker 31.5 19
Beta-
Blockers 13.1 8
a-
adrenergi
c agonist 1.6 1
ACE
Inhibitor 9.8 6
Unrecalle
d 8.1 5
ARB &
CCB 4.9 3
ARB &
AAA 1.6 1
ARB &
ACEi 3.3 2
ARB, CCB
& BB 1.6 1
ARB, CCB,
& AAA 1.6 1
CCB &
AAA 3.3 2

Cause of Illness as Claimed by the Frequenc

Patient Percent (%) y
Stress 31.8 49
Diet 20.8 32
Lifestyle 12.3 19
Genetics 12.3 19
Fatigue 11.2 17
Comorbid Diseases 4.5 7
Physical Inactivity 3.9 6
Hormonal 1.9 3
 Aging 1.3 2
Total 100 154

Appendix B

Reliability Statistical Treatment Results

BMQ Specific
Reliability Statistics

Cronbach's Cronbach's N of Items

Alpha Alpha Based on
Standardized
Items

.502 .506 10

Item Statistics

Mean Std. Deviation N

bmq1 2.8750 1.28891 32

bmq2 3.0625 1.41279 32
bmq3 2.7813 1.28852 32
bmq4 2.8125 1.17604 32
bmq5 2.5313 1.29476 32
bmq6 3.0000 1.29515 32
bmq7 2.9375 1.31830 32
bmq8 3.5625 1.21649 32
bmq9 2.9375 1.38977 32
bmq10 3.6875 1.25563 32

Inter-Item Correlation Matrix

 bmq1 bmq2 bmq3 bmq4 bmq5 bmq6 bmq7 bmq8 bmq9

bmq1 1.000 -.208 .566 .452 .022 -.367 .603 .231 -.0
bmq2 -.208 1.000 -.116 -.187 .352 .123 -.032 .392 .6
bmq3 .566 -.116 1.000 .589 .111 -.058 .334 .060 -.2
bmq4 .452 -.187 .589 1.000 .089 -.296 .325 -.149 -.2
bmq5 .022 .352 .111 .089 1.000 -.154 -.037 .419 .4
bmq6 -.367 .123 -.058 -.296 -.154 1.000 -.491 -.123 -.0
bmq7 .603 -.032 .334 .325 -.037 -.491 1.000 .284 -.0
bmq8 .231 .392 .060 -.149 .419 -.123 .284 1.000 .4
bmq9 -.077 .626 -.206 -.284 .449 -.090 -.073 .479 1.0
bmq10 .513 -.098 .156 .309 -.113 -.476 .514 .034 -.2

Item-Total Statistics

Scale Mean if Scale Variance Corrected Item- Squared Cronbach's

Item Deleted if Item Deleted Total Correlation Multiple Alpha if Item
Correlation Deleted

bmq1 27.3125 23.448 .441 .654 .400

bmq2 27.1250 25.339 .230 .546 .469
bmq3 27.4063 24.443 .354 .552 .429
bmq4 27.3750 26.758 .203 .508 .478
bmq5 27.6563 25.007 .303 .384 .446
bmq6 27.1875 35.254 -.411 .483 .643
bmq7 27.2500 24.258 .355 .546 .427
bmq8 26.6250 23.726 .456 .465 .400
bmq9 27.2500 26.258 .170 .621 .489
bmq10 26.5000 27.161 .143 .497 .495

Scale Statistics

Mean Variance Std. Deviation N of Items

30.1875 30.609 5.53253 10

BMQ General

Reliability Statistics
 Cronbach's Cronbach's N of Items
Alpha Alpha Based on
Standardized
Items

.575 .580 8

Item Statistics

Mean Std. Deviation N

bmq11 2.7188 1.30098 32

bmq12 2.7188 1.32554 32
bmq13 3.5625 1.26841 32
bmq14 2.2188 1.23744 32
bmq15 2.8438 1.27278 32
bmq16 3.5000 1.36783 32
bmq17 2.4375 1.26841 32
bmq18 2.5625 1.16224 32

Inter-Item Correlation Matrix

bmq11 bmq12 bmq13 bmq14 bmq15 bmq16 bmq17 bmq18

bmq11 1.000 .121 .255 .120 -.086 .009 .194 -.105

bmq12 .121 1.000 .270 .334 .069 .133 -.174 .148
bmq13 .255 .270 1.000 .453 .396 .130 -.098 .304
bmq14 .120 .334 .453 1.000 .514 .448 -.145 .517
bmq15 -.086 .069 .396 .514 1.000 .083 -.356 .279
bmq16 .009 .133 .130 .448 .083 1.000 .074 .386
bmq17 .194 -.174 -.098 -.145 -.356 .074 1.000 -.150
bmq18 -.105 .148 .304 .517 .279 .386 -.150 1.000

Item-Total Statistics

Scale Mean if Scale Variance Corrected Item- Squared Cronbach's

Item Deleted if Item Deleted Total Correlation Multiple Alpha if Item
Correlation Deleted

bmq11 19.8438 22.846 .138 .185 .587

bmq12 19.8438 21.491 .245 .190 .554
bmq13 19.0000 19.161 .494 .337 .471
bmq14 20.3438 17.652 .680 .578 .406
bmq15 19.7188 21.822 .237 .433 .556
bmq16 19.0625 20.125 .347 .281 .519
bmq17 20.1250 26.694 -.156 .206 .667
bmq18 20.0000 20.774 .390 .347 .510

Scale Statistics

Mean Variance Std. Deviation N of Items

22.5625 26.254 5.12387 8

MMAS

Case Processing Summary

N %

Valid 32 100.0
a
Cases Excluded 0 .0

Total 32 100.0

a. Listwise deletion based on all variables in the

procedure.

BIPQ
Reliability Statistics

Cronbach's Cronbach's N of Items

Alpha Alpha Based on
Standardized
Items

.586 .507 7

Inter-Item Correlation Matrix

mmas1 mmas2 mmas3 mmas4 mmas5 mmas6 mmas7

mmas1 1.000 .327 .130 .192 -.123 .226 -.251

mmas2 .327 1.000 .532 .354 -.266 .449 .301
mmas3 .130 .532 1.000 .281 -.095 .583 .157
mmas4 .192 .354 .281 1.000 -.260 .469 .098
mmas5 -.123 -.266 -.095 -.260 1.000 -.362 -.340
mmas6 .226 .449 .583 .469 -.362 1.000 .284
mmas7 -.251 .301 .157 .098 -.340 .284 1.000

Item-Total Statistics

Scale Mean if Scale Variance Corrected Item- Squared Cronbach's

Item Deleted if Item Deleted Total Correlation Multiple Alpha if Item
Correlation Deleted

mmas1 4.4063 8.959 .163 .293 .587

mmas2 3.9688 6.160 .601 .467 .424
mmas3 3.6875 5.964 .574 .472 .427
mmas4 3.8438 6.910 .390 .262 .514
mmas5 4.2813 10.725 -.384 .244 .711
mmas6 3.7188 5.886 .619 .525 .408
mmas7 3.2813 7.886 .160 .338 .604

Scale Statistics

Mean Variance Std. Deviation N of Items

4.5313 9.547 3.08988 7

Reliability Statistics

Cronbach's Cronbach's N of Items

Alpha Alpha Based on
Standardized
Items

.644 .662 8

Item Statistics

Mean Std. Deviation N

bipq1 4.8125 3.08417 32

bipq2 5.8750 3.18008 32
bipq3 6.3438 2.77790 32
bipq4 6.9063 2.44104 32
bipq5 4.7813 2.51106 32
bipq6 6.6563 3.02260 32
bipq7 7.4688 2.34155 32
bipq8 5.4375 3.06844 32

Inter-Item Correlation Matrix

bipq1 bipq2 bipq3 bipq4 bipq5 bipq6 bipq7 bipq8

bipq1 1.000 .178 -.342 .045 .315 .481 .218 .104

bipq2 .178 1.000 -.137 .231 .231 .311 .116 .016
bipq3 -.342 -.137 1.000 .324 -.072 -.147 .307 -.109
bipq4 .045 .231 .324 1.000 .081 .061 .601 .419
bipq5 .315 .231 -.072 .081 1.000 .504 .325 .494
bipq6 .481 .311 -.147 .061 .504 1.000 .347 .298
bipq7 .218 .116 .307 .601 .325 .347 1.000 .312
bipq8 .104 .016 -.109 .419 .494 .298 .312 1.000

Scale Statistics

Mean Variance Std. Deviation N of Items

48.2813 145.886 12.07833 8

Appendix C
Statistical Treatment of the Data Including Regression Analysis
 1. To determine the individual influence of medication beliefs on the medication

adherence of adult residents in Brgy. Puting Kahoy, who have been prescribed

and have been taking hypertension medicines for at least 1 month.

N 61 61 61

**. Correlation is significant at the 0.01 level (2-tailed).

*. Correlation is significant at the 0.05 level (2-tailed).

Descriptive Statistics

Mean Std. Deviation N

MMAS .4734 .21178 61

Illness Perception 6.3934 1.47370 61

Correlations

MMAS Illness
Perception

Pearson Correlation 1 -.061

MMAS Sig. (2-tailed) .641

N 61 61
Pearson Correlation -.061 1

Illness Perception Sig. (2-tailed) .641

N 61 61
 Variables Entered/Removeda

Model Variables Variables Method

Entered Removed

BMQ General, . Enter

1 b
BMQ Specific

a. Dependent Variable: MMAS

b. All requested variables entered.

Model Summary

Model R R Square Adjusted R Std. Error of the

Square Estimate

1 .355a .126 .096 .20136

a. Predictors: (Constant), BMQ General, BMQ Specific

ANOVAa

Model Sum of Squares df Mean Square F Sig.

Regression .339 2 .170 4.184 .020b

1 Residual 2.352 58 .041

Total 2.691 60

a. Dependent Variable: MMAS

b. Predictors: (Constant), BMQ General, BMQ Specific

Coefficientsa

Model Unstandardized Coefficients Standardized t Sig. 95.0% Confidence

Coefficients Interval for B

B Std. Error Beta Lower Upper

Bound Bound

(Constant) .092 .143 .642 .523 -.194 .378

1 BMQ Specific .047 .049 .138 .977 .333 -.050 .145

BMQ General .083 .044 .267 1.894 .063 -.005 .171

a. Dependent Variable: MMAS

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