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Research Article: Associations between medication beliefs and medication adherence among inpatients with chronic obstructive pulmonary disease: a cross-sectional survey

Date Published: 2026-09-16

Abstract:
Improving adherence to inhaled medication is crucial for optimal treatment outcomes and effective disease management in chronic obstructive pulmonary disease (COPD) patients. This study aimed to investigate adherence to inhaled medication and its association with medication beliefs among COPD patients in Xi’an, China. A cross-sectional study was conducted with 448 COPD inpatients recruited from two large tertiary hospitals in Xi’an, China, between May 1, 2024, and January 31, 2026. The Beliefs about Medicines Questionnaire Specific (BMQ-Specific) was used to assess inpatients’ beliefs about inhalers, and the Medication Adherence Report Scale (MARS-5) was employed to evaluate adherence to inhaled medication. Logistic regression analyses were performed to examine the associations between independent variables and medication non-adherence. Three sensitivity analyses were conducted in this study to confirm the model’s reliability. Model discrimination was assessed using ROC analysis, and internal validation was performed using 1,000 bootstrap resamples. A total of 266 (59.4%) inpatients were non-adherent to inhaled medication. Overall, 243 (54.2%) inpatients expressed strong necessity beliefs about inhaled medication, while 203 (45.3%) held strong concern beliefs. Multivariable logistic regression analysis revealed that inpatient who expressed weaker necessity beliefs about inhaled medication had 4.79-fold odds (95% CI?=?3.044–7.520; p <?0.001) of non-adherence compared with those who expressed stronger necessity beliefs. Inpatient who received dual therapy with LABA-ICS had 2.00-fold odds (95% CI?=?1.027–3.900; p =?0.042) of non-adherence compared with those who received triple therapy with LAMA-LABA-ICS, whereas inpatient who was unemployed or retired was more likely to be adherent to inhaled medication (adjusted OR 0.534 [0.320, 0.889]; p =?0.016) than those in physical labor occupations. The association between necessity beliefs and medication adherence remained statistically significant upon validation in three sensitivity analyses. The relatively low adherence to inhaled medication among inpatients with COPD in Northwestern China highlights the urgent need for effective strategies to improve adherence. These findings suggest a potential clinical implication wherein pharmacists and nurses could play a supportive role in promoting medication adherence among patients with COPD.

Introduction:
Improving adherence to inhaled medication is crucial for optimal treatment outcomes and effective disease management in chronic obstructive pulmonary disease (COPD) patients. This study aimed to investigate adherence to inhaled medication and its association with medication beliefs among COPD patients in Xi’an, China.

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