Barriers, facilitators, and interventions for medication adherence across chronic conditions with the highest non-adherence rates: a scoping review with recommendations for intervention development

Abstract

Medication non-adherence (MNA) constitutes a complex health problem contributing to increased economic burden and poor health outcomes. The Medication Adherence Model (MAM) supports that numerous processes are involved in medication adherence (MA). Based on the MAM and guidelines of the World Health Organization (WHO), this scoping review aimed to identify the barriers and facilitators associated with MA, and the behavioral health interventions and techniques among chronic conditions presenting with high non-adherence rates (asthma, cancer, diabetes, epilepsy, HIV/AIDS, and hypertension). PubMed, PsycINFO, and Scopus databases were screened, and 243 studies were included. A mixed methods approach was used to collate the evidence and interpret findings. The most commonly reported barriers to MA across conditions were younger age, low education, low income, high medication cost, side effects, patient beliefs/perceptions, comorbidities, and poor patient–provider communication. Additionally, digitally delivered interventions including components such as medication and condition education, motivational interviewing (MI), and reinforcement and motivational messages led to improvements in MA. This review highlights the importance of administrating multicomponent interventions digitally and personalized to the patients’ individual needs and characteristics, responding to the adherence barriers faced. This is the first review examining and synthesizing evidence on barriers and facilitators to MA and behavioral health interventions used for improving MA across chronic conditions with the highest non-adherence rates and providing recommendations to researchers and clinicians. Stakeholders are called to explore methods overcoming barriers identified and developing effective multicomponent interventions that can reduce the high rates of MNA.

Combined Use of Web-Based and In-Person Education on Ill Health Self-management Skills in Adults With Bipolar Disorder: Protocol for a Mixed Methods Study

“…Previous data support difficulty in impulse control [ 25 ], and high rates of substance use [ 26 ] and nonadherence to pharmacotherapy [ 27 ] in people diagnosed with BD, which are all linked to increased relapse rates and decreased quality of life [ 4 , 5 ]. Thus, interventions, mainly psychotherapeutic, toward addressing these issues need to be further explored [ 28 ]; the combination of in-person and web-based interventions is highly recommended for effective management of symptoms [ 29 ]. Other studies support that performance of ill health self-management skills is associated with one’s self-perception about the health-related locus of control and related health literacy level [ 30 , 31 ].…”

Evaluation of online, publicly available cancer‐related educational and self‐management resources for symptom management

“…Medication adherence (taking medication as prescribed) is influenced by a number of factors including socioeconomic status and condition‐related factors (e.g., longer treatment), 40 some of which are more easily modifiable. Specifically, modifiable barriers include not having received condition‐ and treatment‐related information (particularly discussion of side‐effects), lack of family support, and health illiteracy 41 . Educational resources may help address these by including information directed towards family members, providing reliable evidence‐based information, addressing the reasons for treatment (and consequences of non‐treatment) as well as using accessible language and avoiding medical jargon 41 .…”

“…Specifically, modifiable barriers include not having received condition‐ and treatment‐related information (particularly discussion of side‐effects), lack of family support, and health illiteracy 41 . Educational resources may help address these by including information directed towards family members, providing reliable evidence‐based information, addressing the reasons for treatment (and consequences of non‐treatment) as well as using accessible language and avoiding medical jargon 41 . Furthermore, several factors previously addressed in this study, such as a high reading grade level and low reliability, may exacerbate medication non‐adherence.…”

Frequency of Iatrogenic Sexual Dysfunction Associated with Antihypertensive Compounds

“…Antihypertensive drugs are frequently associated with undesirable side effects that reduce patient quality of life, compromising adherence to treatment. Hypertension, similar to other chronic diseases, has been reported to be associated with poor adherence to treatment [3].…”