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Exploring stroke survivors’ self-efficacy in understanding and taking medication and determining associated factors: a cross-sectional study in a neurology clinic in Malaysia

Authors Appalasamy JR, Joseph JP, Seeta Ramaiah S, Quek KF, Md Zain AZ, Tha KK

Received 10 May 2019

Accepted for publication 20 July 2019

Published 28 August 2019 Volume 2019:13 Pages 1463—1475


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Johnny Chen

Jamuna Rani Appalasamy,1 Joyce Pauline Joseph,2 Siva Seeta Ramaiah,3 Kia Fatt Quek,1 Anuar Zaini Md Zain,1 Kyi Kyi Tha1

1Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia; 2Department of Neurology, Hospital Kuala Lumpur, Ministry of Health, Kuala Lumpur, Malaysia; 3Medical Department, Subang Jaya Medical Center, Sunway, Malaysia

Correspondence: Jamuna Rani Appalasamy
Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, Selangor 47500, Malaysia
Tel +60 12 325 3775

Background and aim: Evidence-based prescribing practices for stroke-preventive medication have benefited stroke survivors; however, medication-nonadherence rates remain high. Medication understanding and use self-efficacy (MUSE) has shown great importance in medication-taking behavior, but its relationship with medication nonadherence in stroke-preventive regimens lacks exploration. The aim of this study was to determine the prevalence of MUSE and its association with nonadherence causes and other potential factors among stroke survivors in Malaysia.
Methods: This cross-sectional study was conducted among 282 stroke patients who provided informed consent and were in follow-up at the Neurology Outpatient Department of Hospital Kuala Lumpur, Malaysia. The study employed a data-collection form that gathered information on sociodemographics, clinical treatment, outcome measures on MUSE, and medication-nonadherence reasons.
Results: The prevalence of poor medication understanding and use self-efficacy among stroke patients was 46.5%, of which 29.1% had poor “learning about medication” self-efficacy, while 36.2% lacked self-efficacy in taking medication. Beliefs about medicine (74.02%) was the commonest reason for medication nonadherence, followed by medication-management issues (44.8%). In the multivariate model, independent variables significantly associated with MUSE were health literacy (AOR 0.2, 95% CI 0.069–0.581; P=0.003), medication-management issues (AOR 0.073, 95% CI 0.020-0.266; P<0.001), multiple-medication issues (AOR 0.28, 95% CI 0.085–0.925; P=0.037), beliefs about medicine (AOR 0.131, 95% CI 0.032–0.542; P=0.005), and forgetfulness/convenience issues (AOR 0.173, 95% CI 0.050–0.600; P=0.006).
Conclusion: The relatively poor learning about medication and medication-taking self-efficacy in this study was highly associated with health literacy and modifiable behavioral issues related to nonadherence, such as medication management, beliefs about medicine, and forgetfulness/convenience. Further research ought to explore these underlying reasons using vigorous techniques to enhance medication understanding and use self-efficacy among stroke survivors to determine cause–effect relationships.

Keywords: medication understanding, medication taking, self-efficacy, poststroke, cross-sectional

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