Utilization of the Beliefs about Medicine Questionnaire and Prediction of Medication Adherence in China: A Systematic Review and Meta-Analysis

Background: Beliefs about medicines have been proposed as a strong determinant of medication adherence. It has been widely assessed using a Belief about Medicines Questionnaire (BMQ) for 20 years outside of China. Objectives: To investigate the use of the BMQ in China, and to evaluate the association between beliefs about medicines and medication adherence in the Chinese population. Methods: A systematic review of studies published before February 2019 was performed in PubMed, EMBASE, PsycINFO, CNKI and WANFANG DATA. Any quantitative study that measured Chinese adults' medicine beliefs using BMQ translations was included. Random-effects meta-analysis with 95% confidence interval (CI) was used to test the correlations between BMQ-Specific components (Necessity Belief or Concerns or their differential scores) and medication adherence. Results: Fifty-eight eligible articles (n = 12,595) were identified with sample sizes ranged from 48 to 967. Three meta-analyses (n = 17, 18 & 19) containing total 22 studies were performed. Adherence was significantly correlated with necessity beliefs (pooled correlation coefficient = 0.32, 95% CI: 0.21, 0.43), concerns (−0.35, 95% CI: −0.42, −0.28), and the necessity-concerns differential score (0.25, 95% CI: 0.15, 0.36). There was significant heterogeneity between studies for necessity beliefs (I2 = 93%, p < .001), concerns (I2 = 83%, p < .001) and differential score (I2 = 95%, p < .001). Conclusion: The BMQ appears to be a reliable tool for assessing medication beliefs in the Chinese population. Chinese people's specific medicine beliefs about medicines were significantly correlated with medication adherence. The Necessity-Concerns Framework was suggested as a useful conceptual model to explain Chinese patients' medication adherence.