Role of emotion and cognition in medication adherence of older women

Objective: This exploratory study investigated the relative importance of emotion and cognition in medication adherence decision-making. Medication adherence potentially involves strong emotions involving the efficacy of medications. Methods: Eighty-nine older women (Mean age=74.6(±8.0) years; 41% white, 45% African-American and 4% other groups) were recruited from senior centers. Participants rated, using the Communication via Analytic and Syncretic Cognition (CASC) Scale, the emotions they feel when taking their most important medication. They reported adherence rates and rated their beliefs about their medications and outcomes of non-adherence. Results: Respondents were taking an average of 5.3(±2.9) prescribed medications for an average of 7.1±8.2 years. Most frequently mentioned medications were for hypertension, (47.2%), diabetes (11.2%), heart conditions (11.2%) and hyperlipidemia (9.0%). Factor analysis of the CASC scale resulted in two factors: a) positive emotions (M=4.6±1.4, 11 items, Cronbach alpha=.88) and negative emotions (16 items, M=1.3±.82, Cronbach alpha=.95). Factor analysis of cognitive items resulted in one factor representing high level of knowledge about one's medication (6 items, M=5.8±1.2, Cronbach alpha=.81). Positive emotions were significantly associated with self-reported adherence (r=.30, p<.01) and with the belief that adherence to physician's instructions is beneficial to health (r =.32, p<.01). Cognitive factors were positively related to the belief that altering dosage without physician knowledge is harmful (r =.21, p<05). Conclusions: Positive emotions are related to beliefs about adherence benefits and self-reported adherence rates more strongly than cognitive factors tested. This suggests that emotional factors can indeed affect decisions to adhere to medications. Further research is warranted in this important area.