Heller, MK; (2017) The role of medication beliefs in side effects. Doctoral thesis , UCL (University College London).

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Abstract

The experience (or mere anticipation) of side effects influences patients’ beliefs about specific treatment and pharmaceuticals in general. In this thesis I postulate that beliefs about medication may also contribute to side effect reporting. Five studies were conducted to test this hypothesis and to explore putative underlying mechanisms. The majority of studies examining the relationship between medication beliefs and side effect reporting are cross-sectional, precluding inferences about the direction of the relationship. I present evidence from a prospective study showing that baseline medication beliefs predict side effect reporting in a large multinational sample of women initiating bone-loss treatment. The claim that non-pharmacological factors like medication beliefs can influence side effect reporting is supported by research on the nocebo effect (side effects to placebo). A sham trial was conducted showing that medication beliefs predict symptom reporting and attribution of symptoms as side effects in healthy volunteers taking Modafinil placebo. Many symptoms that are frequently listed as side effects are also common in patients randomized to placebo and un-medicated healthy volunteers. Using an analogue scenario I demonstrate that people with more negative beliefs about medication are more likely to misattribute a common symptom as a side effect. A related analogue study explored whether pre-existing beliefs about medication act as schemas that bias the way people process information about side effects. I show that individuals with more negative beliefs about pharmaceuticals recall and recognize fewer side effects from a patient leaflet, spend less time reading side effect information and are consequently more likely to attribute an unlisted symptom as a side effect. Finally, I present findings from a feasibility study of interventions to modify unhelpful medication beliefs in order to reduce side effect attribution. Together these findings confirm the importance of medication beliefs in side effect reporting and point to possible intervention strategies.

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