The Necessity-Concerns Framework: a Multidimensional Theory Benefits from Multidimensional Analysis |
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Authors: | L Alison Phillips PhD Michael A Diefenbach PhD Ian M Kronish MD Rennie M Negron MPH Carol R Horowitz MD |
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Institution: | 1. The George Washington University, Washington, DC, 20052, USA 2. Mount Sinai School of Medicine, New York, NY, 10029, USA 3. Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, 10032, USA
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Abstract: | Background Patients’ medication-related concerns and necessity-beliefs predict adherence. Evaluation of the potentially complex interplay of these two dimensions has been limited because of methods that reduce them to a single dimension (difference scores). Purpose We use polynomial regression to assess the multidimensional effect of stroke-event survivors’ medication-related concerns and necessity beliefs on their adherence to stroke-prevention medication. Methods Survivors (n?=?600) rated their concerns, necessity beliefs, and adherence to medication. Confirmatory and exploratory polynomial regression determined the best-fitting multidimensional model. Results As posited by the necessity-concerns framework (NCF), the greatest and lowest adherence was reported by those necessity weak concerns and strong concerns/weak Necessity-Beliefs, respectively. However, as could not be assessed using a difference-score model, patients with ambivalent beliefs were less adherent than those exhibiting indifference. Conclusions Polynomial regression allows for assessment of the multidimensional nature of the NCF. Clinicians/Researchers should be aware that concerns and necessity dimensions are not polar opposites. |
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