Sample Quotations Depicting the Subthemes Associated with Each Major Theme Influencing Primary Statin Nonadherence
| Major Themes and Associated Subthemes | Sample Quotes |
|---|---|
| Desire for Alternative Treatments | |
| Lifestyle changes (diet and exercise) | “I actually informed my doctor that I wasn’t gonna take it, but he can prescribe it to me first, but I wanted to go to changing my diet first to see if that would help.” [FG5:P1] |
| Dietary supplements/alternative treatments | “I think if you look up a bunch of your herbs, herbs that you can eat…that will also help. Natural herbs.” [FG6:P1] |
| Risks | |
| Risks of statins worry patients | |
| Side effects and interactions | “I don’t [want to] have liver and kidney problems, and muscle cramp[s], and all those crazy side effects.” [FG5:P4] |
| Worsening of existing problems | “Some of my friends and…me, I have asthma. They had took statin and they had more symptoms. It worsened their lung functions… yeah, it made it worse. Worsened their lungs.” [FG6:P3] |
| Creating new medical problems | “The last thing I wanted to do was to get type 2 diabetes while trying to lower my cholesterol. So it just seemed counterproductive.” [FG9:P1] |
| Causing addiction or dependency | “I didn’t know if this is something that you can get addicted to or something like that.” [FG6:P4] |
| Perceptions of Good Health | |
| Too healthy or young to start a statin | “Made me feel old, you know. I always thought statins would be for older people like, retirees, versus someone in their forties.” [FG3:P2] |
| Good family history | “My mother had the same lipid profile I have, and they wanted to put her on a statin. And I think she did it for a while, but—without it, though, she hit 93.” [FG1:P3] |
| Cholesterol slightly high or not that high | “I’m not that over the scale that I should have to be taking [a statin]… I’m only 8 points over.” [FG2:P4] |
| Correctable reason for high cholesterol | “My cholesterol was just over the normal, and I had lost my mother so I gained some weight…” [FG3:P5] |
| High cholesterol is genetic | “I heard my family mention that they also have the same issue with the high cholesterol. They were told that it was genetic and basically they were told that it didn’t matter if they took the medication…Basically, the medication wasn’t going to help. So I figure if it’s a genetic thing, why even take the medication?” [FG10:P1] |
| Benefits—uncertainty about benefits | |
| Scientific evidence not definitive | “The other key point from that [JAMA] article was that there was not as strong evidence that it really…that everybody would really need it even though it was being recommended under the new guidelines.” [FG7:P6] |
| Risk calculator does not look at people as individuals | “We’re being treated by a medical profession that sees us sort of as a statistic. I mean, statistically speaking, you have a 10% chance of having a cardiac event in the next blah-blah-blah. And we’re not all the same.” [FG1:P4] |
| Link between cholesterol and CVD is uncertain | “It’s not really clear how important is it to take statins, despite having a so-called high level of bad cholesterol.” [FG2:P1] |
| Cholesterol cutoffs for treatment are arbitrary | “I’m not going to take [a statin] for what could be just an arbitrary number.” [FG4:P5] |
| Statins do not cure | “We have to make changes in our life…Medication is not a cure. It’s just a Band Aid.” [FG4:P7] |
CVD, Cardiovascular disease.