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The Pharmaceutical Journal Vol 265 No 7114 September 16, 2000
Pharmacy Practice Research
Papers presented at the British Pharmaceutical Conference, Birmingham, September 10 to 13, 2000 pR12

Factors affecting medication adherence in Saudi children

By O. Al-Omran, A. MacAdam and P. Gard

Introduction Medication non-adherence has been documented in children of all ages, for both acute and chronic illnesses.1 Many factors appear to influence adherence to treatment among children, for example, age of the child, characteristics of both the disease and regimen, and the doctor-patient relationship.2 The child's knowledge and attitude towards medicine also plays a vital role in medication adherence.3
Recent research suggests that people have their own beliefs about medicine, both to medicines they take themselves and to medicines in general.4 Studies also suggest the strong parental influence on their child's adherence or non-adherence.5
The following study will therefore examine the factors affecting children's medication adherence, including the effect of parental beliefs about medicines in general. The study was conducted in Saudi Arabia, where very little research has been carried out in this field. A subsequent identical study will be carried out in the United Kingdom to compare the behaviours and beliefs between the two very different cultures.

Method From the information obtained from the literature together with the analysis of interviews with parents of children aged between 6 and 8 years, a structured questionnaire was designed. The questionnaire was piloted among 30 parents of children in the 6-8 age range, and minor modifications were made from their comments. The first part of the questionnaire included the demographics of both the child and the parent. The second part included behavioural questions to determine which factors may affect a child's adherence to its medication. The final part included attitude questions in order to assess the parents' beliefs about medicines. Parents were asked to rate how much they agreed or disagreed with each belief statement on a five-point Likert scale. This questionnaire was then distributed, via the schools, to the parents of 800 children between the ages of 6 and 8 years. Sixteen schools in the Riyadh area were chosen at random to take part in the study, and 50 students were randomly chosen from each school.
Ethics committee approval was obtained and confidentiality was assured. The data obtained was analysed quantitatively using SPSS.

Focal points

  • This study examines the factors affecting children's medication adherence, including the effect of parental beliefs about medicines in general
  • This study was conducted in Riyadh, Saudi Arabia; 663 parents of children between the ages of 6 and 8 years took part in the study
  • Factor analysis of the items that measured parental beliefs revealed three important themes: medicines are overused in children; medicines are unsafe for children; and parents expect medicines from their GP
  • The factor analysis of the items that measure behaviours also revealed three themes: child refusal of the medicine; parental intentional non-adherence; and unintentional non-adherence
  • Statistically significant correlation existed between maternal educational level and some non-adherent behaviour (P<0.05)

Results A total of 663 parents completed the questionnaire, giving a response rate of 83 per cent. The children were 354 (53.4 per cent) females and 309 (46.6 per cent) males of mean age 6.4 years, with a standard deviation of 0.5 years.
Factor analysis of the items that measured parental beliefs revealed three important themes: medicines are overused in children; medicines are unsafe for children; and parents expect medicines from their GP. The factor analysis of the items that measured behaviour also revealed three themes: child refusal of the medicine; parental intentional non-adherence; and unintentional non-adherence.
The quantitative analysis explored the effect of the demographics on both the adherence behaviour and beliefs of the parents. There was a statistically significant correlation between maternal educational level and some non-adherent behaviour (P<0.05).

Discussion This is just a small part of a cross-cultural study of the factors affecting medication adherence in children. Our current findings suggest the importance of the child's refusal of medicine as a major factor affecting adherence; this supports previous studies in this field.3 Our study also suggests, that in the Saudi Arabian society, medicines are not viewed as harmful or unsafe, although parents do feel they are overused in children. Finally, the important role of the maternal educational level on the subsequent adherence of their children to medication may require further investigation. It will be interesting to observe the effect of the cultural differences on this issue when the same study is repeated in the United Kingdom.

School of pharmacy and biomolecular sciences, University of Brighton, Moulescoomb, Brighton, East Sussex

References

1. Matsui DM. Drug compliance in pediatric patients: clinical and research issues. Pediatr Clin North Am 1997;44: 1-15.
2. Fotheringham MJ, Sawyer MG. Adherence to recommended medical regimens in childhood and adolescence. J Paediatr Child Health 1995;31:72-8.
3. Menacker F, Aramburuzabala P, Minian N, Bush P, Bibace R. Children and medicines: what they want to know and how they want to learn. J Soc Admin Pharm 1999;16:38-49.
4. Horne R, Weinman J, Hankins M. The beliefs about medicines questionnaire: the development and evaluation of a new method for assessing the cognitive representation of medication. Psychol Health 1999;14:1-24.
5. Bush P, Iannotti R. A children's health belief model. Med Care 1990;28:69-86.