https://doi.org/10.4081/monaldi.2026.3852
A correlational study to assess the levels of adherence to treatment, illness perception and acceptance of illness in patients with coronary artery disease attending the outpatient departments at a tertiary care hospital
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Published: 15 June 2026
Coronary artery disease (CAD) continues to be a major global health burden, and its effective management depends on optimal treatment adherence, realistic illness perception, and adequate acceptance of illness. However, evidence examining these psychosocial and behavioral factors remains limited. This study assessed treatment adherence, illness perception, and acceptance of the illness and explored their associations among CAD patients. A descriptive correlational cross-sectional study was conducted among 250 CAD patients selected through convenience sampling. Data were collected using standardized tools: the Morisky Medication Adherence Scale (MMAS-8), the Brief Illness Perception Questionnaire (IPQ-B), and the Acceptance of Illness Scale (AIS) with the relative ranges (MMAS-8: 0-8, IPQ-B: 0-80, AIS: 8-40). Descriptive statistics (mean, standard deviation, frequency, and percentage) were used to summarize the data, Pearson’s correlation was applied to examine relationships among variables, and the chi-square test was used to assess associations between outcome variables and selected sociodemographic factors. Treatment adherence was predominantly low (59%), with a mean score of 5.69±1.58. Illness perception scores indicated that most participants (82%) experienced a high perceived illness threat (mean = 54.93±8.78). Acceptance of illness was moderate in 57.6% of participants, with a mean score of 25.09±6.07. A weak but statistically significant positive correlation was observed between acceptance of illness and treatment adherence (r=0.245, p<0.001). Illness perception showed no significant relationship with other variables. Significant associations were identified between treatment adherence and socioeconomic status (χ²=19.97, p=0.003); acceptance of illness and educational status (p<0.001), physical activity (χ²=12.98, p=0.011), and past medical history (χ² =29.51, p=0.003); and illness perception with socioeconomic status (χ²=16.18, p=0.013) and area of residence (χ²=16.88, p=0.002). CAD patients showed low treatment adherence, high perceived illness threat, and moderate illness acceptance. Strengthening patient education, addressing illness perceptions, and enhancing psychological support may improve adherence and long-term disease management.
Downloads
Bodkhe S, Jajoo SU, Jajoo UN, et al. Epidemiology of confirmed coronary heart disease among population older than 60 years in rural central India-A community-based cross-sectional study. Indian Heart J 2019;71:39-44. DOI: https://doi.org/10.1016/j.ihj.2019.01.002
GBD 2017 Causes of Death Collaborators. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018;392:1736-88. DOI: https://doi.org/10.1016/S0140-6736(18)32203-7
Goyal A, Yusuf S. The burden of cardiovascular disease in the Indian subcontinent. Indian J Med Res 2006;124:235-44.
Dugunchi F, Mudgal SK, Marznaki Z, et al. Levels of adherence to treatment, illness perception and acceptance of illness in patients with coronary artery disease - descriptive and correlational study. BMC Cardiovasc Disord 2024;24:171. DOI: https://doi.org/10.1186/s12872-024-03827-w
Gardezi SKM, Aitken WW, Jilani MH. The impact of non-adherence to antihypertensive drug therapy. Healthcare 2023;11:2979. DOI: https://doi.org/10.3390/healthcare11222979
Cheng C, Donovan G, Al-Jawad N. The use of technology to improve medication adherence in heart failure patients: a systematic review of randomised controlled trials. J Pharm Policy Pract 2023;16:81. DOI: https://doi.org/10.1186/s40545-023-00582-9
Hagger MS, Orbell S. The common sense model of illness self-regulation: a conceptual review and proposed extended model. Health Psychology Rev 2021;16:347-77. DOI: https://doi.org/10.1080/17437199.2021.1878050
Al-Sutari M, Khraisat O. Illness perceptions as predictive factors for anxiety and depressive symptoms among patients with coronary heart disease. Health Psychol Res 2025;13:133564. DOI: https://doi.org/10.52965/001c.133564
Gauro P, Thaniwattananon P, Kritpracha C. Illness perception predicting cardiovascular health behaviors among patients with ischemic heart disease in Nepal: a descriptive cross-sectional study. JNMA J Nepal Med Assoc 2020;58:884-8. DOI: https://doi.org/10.31729/jnma.5426
Ihm SH, Kim KI, Lee KJ, et al. Interventions for adherence improvement in the primary prevention of cardiovascular diseases: expert consensus statement. Korean Circ J 2022;52:1-33. DOI: https://doi.org/10.4070/kcj.2021.0226
Mobini S, Allahbakhshian A, Shabanloei R, Sarbakhsh P. Illness perception, self-efficacy, and medication adherence in patients with coronary artery disease: a path analysis of conceptual model. SAGE Open Nurs 2023;9:23779608231171772. DOI: https://doi.org/10.1177/23779608231171772
Rashidi A, Kaistha P, Whitehead L, Robinson S. Factors that influence adherence to treatment plans amongst people living with cardiovascular disease: a review of published qualitative research studies. Int J Nurs Stud 2020;110:103727. DOI: https://doi.org/10.1016/j.ijnurstu.2020.103727
Prakash DD, Lucas A, Jayaraman S, et al. Medication adherence, self-efficacy, and attitude toward the management of coronary artery disease among elderly with coronary artery disease. J Indian Acad Geriatrics 2025;21:94-9. DOI: https://doi.org/10.4103/jiag.jiag_4_25
Dhande P, Gonarkar S. Medication adherence and its determinants in myocardial infarction patients: an Indian scenario. J Clin Prev Cardiol 2016;5:2-8. DOI: https://doi.org/10.4103/2250-3528.183983
Haley WE, Gilbert ON, Riley RF, et al. The association between Self-Reported Medication Adherence scores and systolic blood pressure control: a SPRINT baseline data study. J Am Soc Hypertens 2016;10:857-64.e2. DOI: https://doi.org/10.1016/j.jash.2016.08.009
Basu S, Poole J. The Brief Illness Perception Questionnaire. Occup Med 2016;66:419-20. DOI: https://doi.org/10.1093/occmed/kqv203
Piotrkowska R, Kruk A, Krzemińska A, et al. Factors determining the level of acceptance of illness and satisfaction with life in patients with cancer. Healthcare 2023;11:1168. DOI: https://doi.org/10.3390/healthcare11081168
Pluta A, Sulikowska B, Manitius J, et al. Acceptance of illness and compliance with therapeutic recommendations in patients with hypertension. Int J Environ Res Public Health 2020;17:6789. DOI: https://doi.org/10.3390/ijerph17186789
Bilondi SS, Noghabi AD, Aalami H. The relationship between illness perception and medication adherence in patients with diabetes mellitus type II: illness perception and medication adherence. J Prev Med Hyg 2022;62:E966-71. DOI: https://doi.org/10.21203/rs.3.rs-426152/v1
Janković S, Stojisavljević D, Janković J, et al. Association of socioeconomic status measured by education, and cardiovascular health: a population-based cross-sectional study. BMJ Open 2014;4:e005222. DOI: https://doi.org/10.1136/bmjopen-2014-005222
Syed Shamsuddin SM, Ahmad N, Radi MFM, Ibrahim R. The role of illness perception in the physical activity domain of health-promoting lifestyle among patients with non-communicable diseases: a systematic review. PLoS One 2024;19:e0311427. DOI: https://doi.org/10.1371/journal.pone.0311427
Kołtuniuk A, Pytel A, Kulik A, Rosińczuk J. The role of disease acceptance, life satisfaction, and stress perception on the quality of life among patients with multiple sclerosis: a descriptive and correlational study. Rehabil Nurs 2021;46:205-13. DOI: https://doi.org/10.1097/RNJ.0000000000000288
Mai Q, Xu S, Hu J, et al. The association between socioeconomic status and health-related quality of life among young and middle-aged maintenance hemodialysis patients: multiple mediation modeling. Front Psychiatry 2023;14:1234553. DOI: https://doi.org/10.3389/fpsyt.2023.1234553
Mudgal SK, Ranjan A, Patidar V, et al. Quality of life, compliance with treatment, and challenges among patients undergoing cardiac intervention. Monaldi Arch Chest Dis 2025;95:3178. DOI: https://doi.org/10.4081/monaldi.2024.3178
Schutt-Cerdan JA, Marcelo-Lluen YE, Oblitas-Guerrero SM, et al. Socioeconomic factors associated with non-adherence to antihypertensive treatment among older adults affiliated to the "pension 65" program in Peru. Patient Prefer Adherence 2025;19:1717-29. DOI: https://doi.org/10.2147/PPA.S523651
Yoon S, Kwan YH, Yap WL, et al. Factors influencing medication adherence in multi-ethnic Asian patients with chronic diseases in Singapore: a qualitative study. Front Pharmacol 2023;14:1124297. DOI: https://doi.org/10.3389/fphar.2023.1124297
Ethics Approval
How to Cite
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.