Psychometric properties of the Belief about Medicines Questionnaire (BMQ) in the Maltese language
Background: Investigating beliefs about medicines has been of interest over the past years, with studies aiming to better understand theoretical reasons behind development of such beliefs.
Objective: This study aimed to produce a culturally and contextually appropriate version of the Beliefs about Medicines Questionnaire (BMQ) in the Maltese language and to assess its psychometric properties.
Methods: Medication beliefs were evaluated using the BMQ which is divided into two sections: BMQ-General (sub-scales: Overuse and Harm, 4 items per sub-scale) and BMQ-Specific (sub-scales: Necessity and Concerns, 5 items per sub-scale). Following translation/back translation, the Maltese version of the BMQ was applied to patients having asthma, diabetes, cardiovascular disease or depression who attended out-patients’ clinics at the main state general hospital in Malta between June and September 2013. Cronbach’s alpha coefficient, alpha, was used to determine internal consistency of the BMQ and Principal Component Analysis using Varimax rotation with Kaiser normalisation was carried out to analyse component loading of the items on the respective sub-scales.
Results: The Maltese version of the BMQ showed acceptable internal consistency for the harm scale (alpha=0.56), the necessity scale (alpha=0.73) and the concerns scale (alpha=0.66), however the overuse scale gave poor internal consistency (alpha=0.48) due to the item on natural remedies which posed some difficulty in the Maltese sample. The final solution for Principal Component Analysis yielded a four-factor structure representing the 4 sub-scales of the BMQ, with results being comparable to previous studies out in different languages.
Conclusion: The Maltese version of the BMQ was found to have acceptable psychometric properties for the beliefs about medicines in the Maltese population.
2. Hjelm K, Berntorp K, Frid A, Aberg A, Apelqvist J. Beliefs about health and illness in women managed for gestational diabetes in two organisations. Midwifery. 2008;24(2):168-182. doi: 10.1016/j.midw.2006.12.008
3. Maclnnes J. Relationships between illness representations, treatment beliefs and the performance of self-care in heart failure: a cross-sectional survey. Eur J Cardiovasc Nurs. 2013;12(6):536-543. doi: 10.1177/1474515112473872
4. Neame R, Hammond A. Beliefs about medications: a questionnaire survey of people with rheumatoid arthritis. Rheumatology (Oxford). 2005;44(6):762-767. doi: 10.1093/rheumatology/keh587
5. Ruppar TM, Dobbels F, De Geest S. Medication beliefs and antihypertensive adherence among older adults: A pilot study. Geriatr Nurs. 2012;33(2):89-95. doi: 10.1016/j.gerinurse.2012.01.006
6. de Vries ST, Keers JC, Visser R, de Zeeuw D, Haaijer-Ruskamp FM, Voorham J, Denig P. Medication beliefs, treatment complexity, and non-adherence to different drug classes in patients with type 2-diabetes. J Psychosom Res. 2014;76(2):134-138. doi: 10.1016/j.jpsychores.2013.11.003
7. Mahler C, Hermann K, Horne R, Jank S, Haefeli WE, Szecsenyi J. Patients’ Beliefs about Medicines in a primary care setting in Germany. J Eval Clin Pract. 2012;18(2):409-413. doi: 10.1111/j.1365-2753.2010.01589.x
8. Belendez Vazquez M, Mijares AH, Horne R. Evaluacion de las creencias sobre el tratamiento: validez y flabilidad de la version espanola del Beliefs about Medicines Questionnaire. Int J Clin Health Psychol. 2007;7(3):767-779.
9. Tordera MP, Moragon EM, Fuster AB, Bayo AL, Císcar CP. Spanish asthma patients’ beliefs about health and medicines: validation of 2 questionnaires. Arch Bronconeumol. 2009;45(5):218-223. doi: 10.1016/j.arbres.2008.06.006
10. De las Cuevas C, Santana AR, Perez LP, Lorenzo MG, Ramos JP, Sanz EJ. Adaptation and validation study of the Beliefs about Medicines Questionnaire in psychiatric outpatients in a community mental health setting. Hum Psychopharmacol. 2011;26(2):140-146. doi: 10.1002/hup.1185
11. Argentero P, Torchio E, Tibaldi G, Horne R, Clatworthy J, Munizza C. [The beliefs about drug treatment. The Italian version of the BMQ (the Beliefs about Medicines Questionnaire): its validity and applicability]. Epidemiol Psichiatr Soc. 2010;19(1):86-92.
12. Salgado T, Marques A, Geraldes L, Benrimoj S, Horne R, Fernandez-Llimos F. Cross-cultural adaptation of the Beliefs about Medicines Questionnaire into Portuguese. Sao Paulo Med J. 2013;131(2):88-94. doi: 10.1590/S1516-31802013000100018
13. Jonsdottir H, Friis S, Horne R, Pettersen KI, Reikvam A, Andreassen OA. Beliefs about medications: measurement and relationship to adherence in patients with severe mental disorders. Acta Psychiatr Scand. 2009;119(1):78-84. doi: 10.1111/j.1600-0447.2008.01279.x
14. Jorgensen TM, Andersson KA, Mardby AC. Beliefs about medicines among Swedish pharmacy employees. Pharm World Sci. 2006;28(4):233-238.
15. Andersen M, Eldberg K, Foged A, Søndergaard J. Generisk substitution. Indflydelse på medicinbrugernes tryghed og komplians. Copenhagen: Forskningsenheden for Almen Praksis, Institut for Sundhedstjenesteforskning, Syddansk Universitet; 2009. Available at: http://www.ft.dk/samling/20081/almdel/suu/bilag/704/738838.pdf (accessed 2016 Oct 24).
16. Fall E, Gauchet A, Izaute M, Horne R, Chakroun N. Validation of the French version of the Beliefs about Medicines Questionnaire (BMQ) among diabetes and HIV patients. Eur Rev Appl Psychol. 2014;64(6):335-343. doi: 10.1016/j.erap.2014.08.005
17. International Test Commission. International Test Commission Guidelines for Translating and Adapting Tests. 2010. Available at: http://www.psyktestbarn.no/cms/ptb_mm.nsf/lupgraphics/ITC%20guidelines.pdf/$file/ITC%20guidelines.pdf (accessed 2016 Oct 24).
18. Wild D, Grove A, Martin M, Eremenco S, McElroy S, Verjee-Lorenz A, Erikson P; ISPOR Task Force for Translation and Cultural Adaptation.Principles of Good Practice for the Translation and Cultural Adaptation Process for Patient-Reported Outcomes (PRO) Measures: Report of the ISPOR Task Force for Translation and Cultural Adaptation. Value Health. 2005;8(2):94-104.
19. Hambleton RK, Merenda P, Spielberger C, eds. Adapting educational and psychological tests for cross-cultural assessment. New Jersey: Lawrence Erlbaum Associates; 2005.
20. Zenisky AL, Hambleton RK. Developing test score reports that work: The process and best practices for effective communication. Educ Meas Issues Pract. 2012;31(2):21-26. doi: 10.1111/j.1745-3992.2012.00231.x
21. Horne R, Weinman J, Hankins M. The beliefs about medicines questionnaire: The development and evaluation of a new method for assessing the cognitive representation of medication. Psychol Health. 1999;14(1):1-24. doi: 10.1080/08870449908407311
22. Tavakol M, Denick R. Making sense of Cronbach’s alpha. Int J Med Educ. 2011;2:53-55. doi:10.5116/ijme.4dfb.8dfd
23. Granas AG, Nørgaard LS, Sporrong SK. Lost in translation? Comparing three Scandinavian translations of the Beliefs about Medicines Questionnaire. Patient Educ Couns. 2014;96(2):216-221. doi: 10.1016/j.pec.2014.05.010
24. Tsianou K, Tsipouras MG, Giannakeas N, Skamnelos A, Katsanos KH, Tatsioni A, Karvounis EC, Tsianos V, Tzallas AT, Vlcek J. Beliefs about Medicines Questionnaire (BMQ) for inflammatory bowel disease patients in Greece. Is it useful? Eur J Pers Cent Healthc. 2016;4(1):187-195.
25. George D, Mallery P. SPSS for Windows step by step: A simple guide and reference. 4th ed. Boston: Allyn and Bacon; 2003.
26. Gliem JA, Gliem RR. Calculating, interpreting, and reporting Cronbach’s alpha reliability coefficient for Likert-type scales. Ohio: Ohio State University; 2003. Available at: https://scholarworks.iupui.edu/bitstream/handle/1805/344/gliem+&+gliem.pdf?sequence=1 (accessed 2016 Oct 24).
27. Henson RK. Understanding internal consistency reliability estimates: A conceptual primer on coefficient alpha. Meas Eval Couns Dev. 2001;34(3):177-189.
28. Streiner DL. Starting at the beginning: an introduction to coefficient alpha and internal consistency. J Pers Assess. 2003;80(1):99-103.
29. Cinar M, Cinar FI, Acikel C, Yilmaz S, Çakar M, Horne R, Simsek I. Reliability and validity of the Turkish translation of the Beliefs about Medicines Questionnaire (BMQ-T) in patients with Behcet’s. Clin Exp Rheumatol. 2016;34(6 Suppl 102):S46-S51.
30. Jimenez K, Vargas C, Garcia K, Guzman H, Angulo M, Billimek J. Evaluating the validity and reliability of the Beliefs about Medicines Questionnaire in low-income, Spaninsh-speaking patients with diabetes in the United States. Diabetes Educ. 2017;43(1):114-124. doi: 10.1177/0145721716675740
31. Savona Ventura C. Maltese medical folklore man and the Herpetofauna in Malta: A review. Maltese Med J. 1990;2(1):41-43.
32. Kraft K. Complementary/Alternative Medicine in the context of prevention of disease and maintenance of health. Prev Med. 2009;49(2-3):88-92. doi: 10.1016/j.ypmed.2009.05.003
33. Hanna LA, Hall M, McKibbin K. Pharmacy students’ knowledge, attitudes, and use of complementary and alternative medicines. Curr Pharm Teach Learn. 2013;5(6):518-525. doi: 10.1016/j.cptl.2013.07.018
34. Du X. A Brief Introduction of Skopos Theory. Theory and Practice in Language Studies. 2012;2:2189-2193.
The authors hereby transfer, assign, or otherwise convey to Pharmacy Practice: (1) the right to grant permission to republish or reprint the stated material, in whole or in part, without a fee; (2) the right to print pr epublish copies for free distribution or sale; and (3) the right to republish the stated material in any format (electronic or printed). In addition, the undersigned affirms that the article described above has not previously been published, in whole or part, is not subject to copyright or other rights except by the author(s), and has not been submitted for publication elsewhere, except as communicated in writing to Pharmacy Practice with this document.
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC-BY-NC-ND) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.