In summary, my hypotheses regarding the effects of conflicting information and the information seeking behavior of vasculitis patients were partially supported. Table 7.1 summarizes the results for each research question. For the first research question, I correctly hypothesized that a majority of patients would report receiving conflicting information; 51.3% of patients received conflicting information about at least one aspect of their medications. As described in Chapter 5, the percentage of patients receiving conflicting information varied considerably (16.6% to 35.5%) depending on the specific medication topic. Patients were most likely to receive conflicting information about the severity of medication side effects (35.5%) and treatment duration (30.7%) and were least likely to receive conflicting information about how to take their medications correctly (16.6%).
The second research question, which was addressed in Chapter 5, explored the relationships between conflicting information, adherence support, adherence self-efficacy, outcome expectations for medications, and medication adherence. The first hypothesis was not supported; adherence self-efficacy did not mediate the effect of conflicting information on medication adherence. Instead, conflicting information had a direct positive association with nonadherence such that patients who received more conflicting information were more nonadherent than patients who received less conflicting information. In contrast, the second
hypothesis was supported; adherence self-efficacy did mediate the effect of adherence support on medication adherence. Specifically, more support from the physician increased patient self-efficacy, which in turn decreased nonadherence.
Similar to the first hypothesis for research question #2, the hypothesis for research question #3 also was incorrect; outcome expectations for medications did not mediate the relationship between conflicting information and medication adherence. The relationship between outcome expectations and adherence support from the physician also was insignificant.
As hypothesized in research question #4, there was a strong positive relationship between adherence self-efficacy and medication adherence. In fact, this relationship remained significant even after controlling for patient demographic and clinical
characteristics such as age, gender, race, education, and time since last flare. This finding was unsurprising given the extensive literature base that has documented a positive
relationship between self-efficacy and health-promoting behaviors (Marks et al, 2005;Brus, 1999; Burge, 2005; Lorig et al, 1989; Lorig & Holman, 1993).
In contrast to our hypothesis for research question #5, outcome expectations were significantly positively correlated with medication nonadherence, meaning that patients with more positive outcome expectations for medications were more nonadherent. Chapter 5 addresses some of the possible reasons I found a significant relationship that was in the opposite direction of what was hypothesized.
Chapter 6 presents the results for the remaining three research questions, which focused on the information-seeking behaviors of vasculitis patients during the past year. The hypotheses for research question #6 were partially supported; the physician was the primary
source of medication information for patients. However, the Internet, not the pharmacist, was the second most commonly used information source. Although I hypothesized that patients would frequently consult pharmacists because they are “professional” sources of medication information, patients only consulted them rarely to sometimes during the past year. Contrary to my expectations, other patients with vasculitis (in the form of support groups) were fairly frequently used sources of medication information for patients. Family members, on the other hand, were not commonly consulted sources for medication information, which was in line with my hypothesis. Last, I posited that patients would not use their spouses often as sources of medication information. This hypothesis was partially supported because female patients rated their spouse as their least used information source. However, male patients rated their spouse as their third most used information source. Because of the magnitude of this gender difference, it is unproductive to discuss spouses as information sources in a global manner.
The hypotheses for the seventh research question regarding perceived credibility also were partially supported by the study data. Patients rated physicians as their most trusted source for medication information followed by the Internet. I had speculated that pharmacists also would be rated as a highly credible source; however, patients rated them at
approximately the same credibility level as other vasculitis patients, around 6.5 on a 9-point scale. As expected, family members other than the spouse were rated among the least credible sources of medication information. Male and female patients differed in their
perceptions of spouse credibility, with male patients rating their spouse as fairly credible and female patients rating them as the least credible of six sources. Again, the magnitude of this difference limits the ability to discuss an overall result for spouse credibility.
source use. As alluded to earlier, there were substantial differences in which sources male and female vasculitis patients consulted. I hypothesized that female patients would obtain medication information more frequently than male patients. Moreover, I posited that females would consult their family and friends for medication information more often than males. Indeed, female patients used eight of the twelve information sources more frequently than male patients. However, only two source differences were statistically significant, with women obtaining information from the Internet and medication package inserts more than men. Contrary to my hypothesis, women did not use family and friends as information sources more often than men. Unexpectedly, men consulted their spouses and nurses more frequently than women. However, it was the magnitude of the gender difference in spouse use that was most striking, with men using their spouse as an information source much more frequently than women.
Table 7.1: Support for research questions and hypotheses16:
RQ Hypothesis Support for
Hypotheses Specific aim #1
RQ1 H1.1: A majority of patients will report receiving
conflicting information about some aspect of their vasculitis medications.
Supported
Specific aim #2
RQ2 H2.1: Adherence self-efficacy will partially mediate the
relationship between conflicting information and
medication nonadherence such that receipt of conflicting information will decrease adherence self-efficacy which, in turn, will increase medication nonadherence.
H2.2: Adherence self-efficacy will partially mediate the
relationship between adherence support and medication nonadherence such that more adherence support will increase self-efficacy which, in turn, will decrease medication nonadherence.
Partially supported Adherence self-efficacy mediated the
relationship between social support and medication
RQ Hypothesis Support for Hypotheses RQ3 H3.1: Outcome expectations will partially mediate the
relationship between conflicting information and
medication nonadherence such that receipt of conflicting information will lead to less positive outcome expectations for medication which, in turn, will increase medication nonadherence.
H3.2: Outcome expectations will partially mediate the
relationship between adherence support and medication nonadherence such that receipt of adherence support will lead to more positive outcome expectations for medication which, in turn, will decrease medication nonadherence.
Not supported
RQ4 H4.1: Adherence self-efficacy will be significantly,
negatively associated with medication nondherence for vasculitis patients.
Supported
RQ5 H5.1: Outcome expectations will be significantly,
negatively associated with medication nondherence for vasculitis patients. Not supported Outcome expectations were positively associated with nonadherence Specific aim #3
RQ6 H6.1: The physician will be the primary source of
medication information followed by the pharmacist and the Internet.
H6.2: The spouse/partner, family member, and person
living with vasculitis will not be major sources of medication information for patients.
Partially supported The physician and the Internet were
frequently used sources and family members were not.
Specific aim #4
RQ7 H7.1: Physicians and pharmacists will be perceived as the
most credible sources of medication information followed by the Internet, persons living with vasculitis,
spouses/partners, and family members.
Partially supported The physician was perceived as the most credible source. Specific aim #5
RQ8 H8.1: Female patients will obtain medication information
more frequently than male patients.
H7.2: Female patients will use family and friends as
medication information sources more often than male patients.
Partially supported Women obtained medication information more frequently than men.