Beliefs about medicines questionnaire (BMQ) Horne, Weinman, Hankins, () Psychology and Health, 14, BMQ –Specific. Your views about medicines. This paper presents a novel method for assessing cognitive representations of medication: the Beliefs about Medicines Questionnaire (BMQ). The BMQ-Specific assesses representations of medication prescribed for personal use and the BMQ-General assesses beliefs about medicines in general.

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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.

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. Medication beliefs were evaluated using the BMQ which is divided into two sections: Necessity and Concerns, 5 items per sub-scale. The final solution for Principal Component Analysis yielded a four-factor structure representing the 4 sub-scales of mfdicines BMQ, with results being comparable to previous studies out in different languages.

The Maltese version of the BMQ was found to have acceptable psychometric properties for the beliefs about medicines in the Maltese population. Medicines are vital components which are needed to maintain and improve health, however, they may still be perceived as unsafe, expensive, and unavailable, and on most occasions, are not taken properly.

The Belief about Medicines Questionnaire BMQdeveloped by Professor Robert Horne and colleagues, as a method for assessing cognitive representations of medication, was validated for use in patients suffering from common chronic diseases. When using a psychometric instrument in a different language to that in which it has been original constructed, it needs to be appropriately translated, taking into consideration cross-cultural issues, conceptual equivalence and it needs to possess adequate psychometric properties.

The principle aim of this study was therefore, to produce a culturally and contextually appropriate version of the BMQ in the Maltese language and to assess its psychometric properties. The BMQ consists of an item questionnaire which assesses medication beliefs in general medkcines in specific conditions allowing for the medicijes of the overall perceptions of medication in general BMQ—Generalas well as perceptions of medication in more definite situations such as chronic illnesses BMQ —Specific.

The BMQ-General comprises 8 items which are subdivided into two sub-scales. The General-Harm sub-scale assesses beliefs about how questionnaire medicines are and the General-Overuse sub-scale addresses the concept of over-prescription of medication by doctors who place too much trust in them. The items are scored on a 5 point Likert scale with scores ranging from 4 to The BMQ-Specific comprises 10 items which are sub-divided into two sub-scales. Specific-Concerns scale assesses perceptions of the likelihood of adverse reactions as a consequence of taking the prescribed abut.

Higher scores in the General-Harm and General-Overuse scales represent an overall negative perception of medication. Procedure as per Wild et al. Four different chronic illness groups were selected based on those selected by Horne et al. The physicians were briefed about the aims of the study, the BMQ itself and the target number of patients to be recruited.

All consultants accepted to participate.

Beliefs about Medicines Questionnaire (BMQ)

The patients selected were those with a confirmed diagnosis of asthma, diabetes, depression or cardiovascular disease. For the purpose of the present questkonnaire, only the Maltese version was used. Inclusion criteria for patients were: Maltese nationality; taking medication for their condition for at least two months; and being 18 years of age and over.

Qestionnaire were informed that the study was on a voluntary basis, that all information would be kept confidential, and that the information would only be handled by the principal investigator and would not be accessible to the hospital staff. The questionnaire was self-administered. A target sample size of patients per disease group was established.

This was based on the sample sizes used by Horne et al. Patients were recruited through the outpatient clinics, of the main general hospital, in Malta, between July and September Consecutive patients were approached until the target of patients per chronic illness group was achieved.

The principal investigator asked the patients for a few minutes of their time, explained to them that she was conducting a study on the beliefs about medicines and asked them if they would be kind enough to fill in the questionnaire.


She explained that this was not meddicines test, that there were no correct or incorrect answers. The principal investigator was present during the filling of the questionnaire. The questionnaire was collected and checked on completion. Principal Component Analysis PCA using Varimax rotation with Kaiser normalisation was carried out to analyse component loading of the items on the respective sub-scales.

This was done for both the General and Specific sub-scales. Since the original English version presents a 4-component structure, PCA was conducted with restriction to 4 components. A total of patients were approached in order to recruit the necessary patients per chronic illness group.

The demographics for the study subjects are presented in Table 2. There were no statistically significant differences between the groups. Cronbach alpha values are presented in Table 3.

All questiknnaire fall within the range obtained by the original study 21with the exception of the General-Overuse scale. This scale presented some anomalies with respect to the internal consistency. During the analysis of alpha, items G4 Natural remedies are safer than medicines and G8 If doctors had more time with patients they would prescribe fewer medicines resulted in unexpectedly lower values.

Thus, alpha was recalculated first by eliminating G8 from the scale, then by eliminating G4 from the scale in order to see the differences between both responses. Recalculated Cronbach alpha values belief are shown mfdicines Table 4. Table 5 shows reliability results for this study. Cronbach alpha values obtained for different chronic medicinex groups within the Maltese population. Principal component analysis with Varimax rotation confirmed the original four factor structure Table 6 and Table 7 explaining Both items G4 and G3 loaded on two components, component 1 overuse and component 4 concernswith G4 having a higher loading on component 4.

Item G2 loaded on component 1 overuse despite the item belonging to the Harm sub-scale. Items G5 and G6 loaded on component 2 harm. Principal component analysis using varimax rotation with Kaiser Normalisation. Due to the nature of the items loading, component 1 was identified as the General-overuse scale, queshionnaire the items developed as representative of the overuse scale, G1, G4, G7, G8 all loaded on component 1.

Component 2 was identified as the General-harm scale with items G5 and G6, two items that were originally developed for this scale, questionnaird high loadings for this questionnaure items geliefs as representative of scale include G2, G3, G5, G6. In the qeustionnaire of the BMQ-Specific items, S1, S3, S4, S7 and S10 loaded all on component 3 necessityconfirming this as the Specific-necessity scale, as all items correspond to the items developed as representative of this scale.

Items S2, S3 and S9 loaded on component 4 concerns with S6 and S8 having higher loadings on component 2 harm rather than component 4 concerns. Due to the nature of the items loaded on component 4, this was identified as the Specific-concerns sub-scale items developed as representative of abkut scale include S2, S5, S6, S8, S9.

To further confirm factor loading, PCA was then carried out on the items in each sub-scale in order to verify that mediclnes items in each sub-scale were loading on one component. In each case one component was extracted.

Due to the items loading on different components, PCA was conducted with restriction of up to four factors, by loading each item on its respective component, as was done in the Portuguese study. Principal component analysis carried out on individual sub-scales to confirm factor loading.

This is the believs study to assess psychometric properties quesyionnaire the BMQ in the Maltese language. Significant care was taken during the translation process, engaging professional academic translators of the Maltese medicinea together with healthcare professionals highly proficient in both the Maltese and English language.

This was done to ensure a translation which was linguistically, culturally and contextually appropriate thereby avoiding the pitfalls described in the paper highlighting issues identified in the three Scandinavian versions of the BMQ. The level of education of most of the participants in Malta was similar to the Portuguese version where the majority of patients had completed elementary school and with the original BMQ where the majority of participants had a secondary level of education.


Therefore, patients with different levels of education should be targeted differently when counselling patients about their medicines. Age was also comparable to the other studies. Internal consistency and reliability for these sub-scales were also comparable to the other studies with the closest values being those reported in the Greek version used to study patients with inflammatory bowel disease.

By convention, acceptable internal consistency is proven by obtaining values of alpha that are over 0. However, alpha is very dependent on the number of items in a test, which might result in a reduced value of alpha. Reason for this low internal consistency remains unclear.

Low alpha values could be indicative of certain items on the general overuse scale not measuring the same concept. Psychometric evaluation was further investigated through inter-item correlation, a measure of reliability. As shown in Table 4item G4 Natural remedies are safer than medicines showed non-significant correlations with the other items G1 Doctors use beliefa many medicines and G7 Doctors place too much trust on medicineswhereby item G8 If doctors had more time with patients they would prescribe fewer medicines had the lowest correlation with item G4 when compared to items Beliefw and Meficines.

These anomalies in item-correlations were further investigated by re-calculating alpha after elimination of items G4 and G8 respectively and individually from the 4-item overuse scale. Recalculated alpha values are presented in Table 4. A recalculated alpha value of 0.

Psychometric properties of the Belief about Medicines Questionnaire (BMQ) in the Maltese language

It was clear at this point that G4 was the item that was mostly inconsistent with the rest of the items on the general overuse scale. This could be indicative of the item being relatively unstable in the overuse scale. At this stage, a potential modification was considered on the overuse scale, where G4 would be eliminated from the scale.

However, this was not done as the recalculated alpha value of 0. Therefore, the minor improvement from this potential alteration would not justify the structural equivalence between the Maltese and English versions of the questionnaire. Irrespective of chronic illness and age, low alpha values in the Maltese study are thought to be related to the concept of natural remedies being relatively new and thereby misunderstood by the cohort.

When comparing alpha values obtained for the Maltese study with other studies carried out 79 – 121621242930 Table 9 it was noted that despite the notion that alpha values of 0. Internal consistency values for the German study 7 and the Spanish studies 910 were all above 0. However, Mahler et al. In the Spanish study by De las Cuevas et al.

The sub-scales in the French version also demonstrated good internal consistency with alpha values in the range of 0. Comparisons of Internal consistency alpha values obtained in the Maltese study with the original and others published in different languages.

Item loadings Table 6 and Table 7showed a varied outcome with items from one sub-scale loading elsewhere. Similar loadings were observed in other studies. In the case of the Specific-concerns factor, all items loaded on the concerns factor, however items S6 My medicines are a mystery to me and S8 My medicines disrupt my life gave higher loadings on the General harm factor.

In the development of the BMQ, during confirmatory factor analysis, S6 had a loading of 0. After conducting PCA with restriction to two factors, item S6 loaded on two components, with a loading of 0. However, elimination of item S6 gave only minor gains with respect to the internal consistency of the tool.

The same reasoning was applied for this study. Due to the items loading on different components, PCA was conducted with restriction to four factors, by loading each item on its respective component, as was done in the Portuguese study 12 as presented in Table 8.