Beyond Medication: A Cross-Sectional Study of How Sex Influences Overall Chronic Disease Adherence Behaviour Using...

Adherence research has historically focused on medication-taking behaviors. While evidence suggests that males are generally more adherent to medication regimens than females, the influence of sex on overall adherence behaviors remains unclear. We explored how sex influences a multidimensional profile of adherence beyond medication using the Generic French Adherence in Chronic Diseases Profile (GACID-P).

We conducted a cross-sectional study using data from the validation of the GACID-P. Participants were adults (>18 years) with chronic conditions attending specialist care across the Grand-Est region of France. The 25-item self-report GACID-P assesses four domains of adherence - Intention to comply with treatment, Forgetting to take medication, Healthy lifestyle, and Limitation of risk-related consumer habits - with scores ranging from 0 (worst) to 10 (best), except for forgetting, which is reverse scored. Analyses included sex-stratified comparisons, multivariable linear regression models, and multivariate analysis of variance to examine sex-based adherence patterns within and across domains.

Among 397 participants (53% male; mean age: males 57.1 ± 10.7, females 59.3 ± 11.7), domain scores indicated generally good adherence. Within domains, males had higher scores than females for Intention to comply (9.18 ± 1.15 vs 8.96 ± 1.51), less Forgetting to take medication (1.35 ± 2.42 vs 1.82 ± 2.85), more Healthy lifestyle (6.92 ± 1.95 vs 6.61 ± 2.00), while females scored higher for Limitation of risk-related consumer habits (6.15 ± 2.14 vs 5.24 ± 2.14); however, none of these differences reached statistical significance. Across domains, a multivariate analysis suggested a sex effect (Wilks' Lambda = 0.84, F(4,73) = 3.58, p=0.010), driven primarily by differences in Forgetting to take medication where males reported less forgetting than females, when adherence patterns are considered jointly across domains (F(1,76) = 10.39, p = 0.0019).

Despite the absence of statistically significant sex-based differences within individual GACID-P domains, a multivariate analysis suggested potential differences when adherence behaviors were considered jointly. While these findings should be interpreted cautiously, they support consideration of a sex-based lens to better understand adherence.