Self-Reported Non-Adherence and Beliefs About Medication in a Swedish Kidney Transplant Population

Annette Lennerling*, 1, 2, Anna Forsberg2, 3
1 Transplant Institute, Sahlgrenska University Hospital, Bruna Straket 5, 6th floor, 413 45 Gothenburg, Sweden
2 Institute of Health and Care Science, The Sahlgrenska Academy at University of Gothenburg, Box 457, 405 30 Gothenburg, Sweden
3 Department of Health Sciences at Lund University, Box 157, S-221 00 Lund, Sweden

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© Lennerling and Forsberg; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Transplant Institute, Sahlgrenska University Hospital, Bruna Straket 5, 6th floor, 413 45 Gothenburg, Sweden; Tel: +4631 342 7039; E-mail:



Patients’ non-adherence to immunosuppressant treatment after organ transplantation may lead to organ failure, graft loss and death. Non-adherence among Swedish kidney transplant recipients has not previously been studied. Hence the aim of this study was to explore non-adherence among Swedish kidney transplant recipients by using self-report instruments as well as testing the hypothesis that there is a difference in self-reported symptoms, beliefs about medicine and social support between respondents with or without self reported non-adherence.

Materials and Methodology:

In the present cross sectional study 250 renal transplant recipients participated by replying to a questionnaire. Two validated instruments were included, one on beliefs about medicine (the BMQ©), the other on nonadherence (the BAASIS©).


Only 46 % never failed to follow the medical treatment with respect to taking the drugs, dosage or timing (>2 hrs from prescribed time). Timing was the most frequently reported deviation (48 %). Forty-seven patients (16 %) had failed taking at least one dose of the prescribed immunosuppressants during the past four weeks. Four individuals had reduced the prescribed doses. Only one reported taking a ‘drug holiday’. Nine participants reported stronger concerns than necessities for immunosuppressive medication. For the BMQ the necessity scores were extremely high while the scores for concern were low. Risk behaviour identified by the BAASIS had no association in risk attitudes as identified in the BMQ. The only factor relating to non-adherence was lack of social support (p=0.022).


In general adherence was high. Identification of the exceptions remains a challenge.

Keywords: The BAASIS, the BMQ, immunosuppression, kidney transplant, life-long treatment, non-adherence, self-report instruments.