The necessity-concerns framework: a multidimensional theory benefits from multidimensional analysis

Ann Behav Med. 2014 Aug;48(1):7-16. doi: 10.1007/s12160-013-9579-2.

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.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Health Knowledge, Attitudes, Practice*
  • Humans
  • Male
  • Medication Adherence / psychology*
  • Medication Adherence / statistics & numerical data
  • Middle Aged
  • Models, Psychological*
  • Regression Analysis
  • Stroke / drug therapy*
  • Stroke / psychology*
  • Survivors / psychology