Impact of Health Belief on Medication Adherence among Patients with Chronic Diseases in Erbil City

Abstract

Background and Objectives: Adherence to long-term medication is influenced not only by clinical instructions or drug availability but also by patients’ beliefs about medicines and lifestyle practices within a specific social context. The Necessity–Concerns Framework is widely cited to explain adherence, yet empirical studies validating it in Iraq and the wider Middle East remain limited. This study assessed the relationship of medication-related beliefs with adherence among adults with chronic diseases in Erbil, Iraq.

Method: This cross-sectional study included 377 adults diagnosed with at least one chronic conditions who attended tertiary hospitals or private outpatient clinics. Adherence was measured using the Medication Adherence Report Scale (MARS-5), and beliefs about medicines were assessed using the Beliefs about Medicines Questionnaire–Specific (BMQ-S). Statistical analysis included Spearman correlation and logistic regression.

Results: The overall adherence rate was 72.4%. Participants expressed strong necessity beliefs (mean 4.3 ± 0.8) and relatively low concern levels (mean 2.1 ± 0.9). Adherence correlated positively with necessity beliefs (ρ = 0.326, p < 0.001) and negatively with concerns (ρ = −0.366, p < 0.001). Regular physical activity (OR = 7.75), employment (OR = 2.56), and older age (OR = 1.04) predicted better adherence, whereas polypharmacy, cigarette smoking, and herbal medicine use predicted poorer adherence.

Conclusion: Medication adherence among patients with chronic diseases in Erbil is driven by the interplay of medication beliefs and healthy daily behaviors. Strong necessity beliefs encourage medicine use. Pharmacist-led interventions should therefore include belief-focused counseling and simplification of treatment regimens for long-term disease control.