Intentional and unintentional medication non-adherence in African Americans: Insights from the Jackson Heart Study

Mentz, Robert J.; Greiner, Melissa A.; Muntner, Paul; Shimbo, Daichi; Sims, Mario; Spruill, Tanya M.; Banahan, Benjamin F.; Wang, Wei; Mwasongwe, Stanford; Winters, Karen; Correa, Adolfo; Curtis, Lesley H.; O’Brien, Emily C.

doi:10.1016/j.ahj.2018.03.007

Cited by 15 publications

(13 citation statements)

References 23 publications

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“…16 Factors that underlying their decisions vary from experiencing adverse effects 17 to their perceptions of the need for the prescribed treatment. 18 The concept of intentionality has been used to examine treatment nonadherence among individuals living with a variety of chronic conditions, including coronary heart disease, [19][20][21] glaucoma, 22 kidney disease, 23 hypertension, 20,24 epilepsy, 25 and diabetes. 21,24 This research has led to tailored interventions, with mixed results, and recommendations that focus on intentional and unintentional nonadherence.…”

Section: Introductionmentioning

confidence: 99%

Intentional and unintentional nonadherence to hydroxyurea among people with sickle cell disease: a qualitative study

et al. 2020

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Hydroxyurea is an efficacious treatment for sickle cell disease (SCD), but adoption is low among individuals with SCD. The objective of this study was to examine barriers to patients’ adherence to hydroxyurea use regimens by using the intentional and unintentional medication nonadherence framework. We interviewed individuals with SCD age 15 to 49.9 years who were participants in the Sickle Cell Disease Implementation Consortium (SCDIC) Needs Assessment. The intentional and unintentional medication nonadherence framework explains barriers to using hydroxyurea and adds granularity to the understanding of medication adherence barriers unique to the SCD population. In total, 90 semi-structured interviews were completed across 5 of the 8 SCDIC sites. Among interviewed participants, 57.8% (n = 52) were currently taking hydroxyurea, 28.9% (n = 26) were former hydroxyurea users at the time of the interview, and 13.3% (n = 12) had never used hydroxyurea but were familiar with the medication. Using a constructivist grounded theory approach, we discovered important themes that contributed to nonadherence to hydroxyurea, which were categorized under unintentional (eg, Forgetfulness, External Influencers) and intentional (Negative Perceptions of Hydroxyurea, Aversion to Taking Any Medications) nonadherence types. Participants more frequently endorsed adherence barriers that fell into the unintentional nonadherence type (70%) vs intentional nonadherence type (30%). Results from this study will help SCD health care providers understand patient choices and decisions as being either unintentional or intentional, guide tailored clinical discussions regarding hydroxyurea therapy, and develop specific, more nuanced interventions to address nonadherence factors.

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Section: Introductionmentioning

confidence: 99%

Intentional and unintentional nonadherence to hydroxyurea among people with sickle cell disease: a qualitative study

et al. 2020

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“…This assumption is supported by the fact that especially therapy- and disease-related influencing factors, which are related to the symptomatic patients, were inconsistent. Moreover, none of the included SRs distinguishes intentional (conscious decision not to take medication) and unintentional adherence (forget to take medication); however, it strongly stands to reason that the influencing factors can depend on the underlying reasons for non-adherence [45]. Additional sources of inconsistency that we could not control for were different definitions and measurements of influencing factors (e.g., socioeconomic status) and even more adherence measures (e.g., self-reported vs. electronic monitoring, > 90% of pills taken vs. > 80% vs. mean intake).…”

Section: Discussionmentioning

confidence: 99%

Medication adherence influencing factors—an (updated) overview of systematic reviews

2019

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Background Non-adherence negatively affects the efficacy, safety and costs of therapies. Non-adherence is a multifactorial problem. This systematic review (SR) of SRs (overview) aims to identify factors that can influence the adherence of adult patients with chronic physical diseases. Methods We performed a systematic literature search in MEDLINE and Embase on June 13, 2018. We included SRs on the factors that can influence adherence in adult patients taking oral medications for treating physical chronic diseases. Two reviewers independently selected studies according to pre-defined inclusion criteria. Two reviewers independently assessed the risk of bias with the ROBIS tool. Data were extracted in standardized tables previously piloted by one reviewer and verified by a second reviewer. We synthesized data in tables in a structured narrative manner. Results We included 21 SRs on eight different conditions. We rated eight SRs to be at low risk of bias and 13 to be at high risk of bias. Although higher education, employment, higher financial status and marriage/partnership mostly showed a positive effect on adherence, the impact was unclear because of the high uncertainty of the underlying evidence. The evidence indicates that socioeconomic status and social support might have a positive impact on adherence and that belonging to an ethnic minority might have a negative impact on adherence. Therapy-related factors (e.g., intake regime) and disease-related factors (e.g., duration) mostly showed no impact on adherence. Analysis of gender showed inconsistent results. Age might have a concave relation to adherence, i.e., adherence is lowest in very young and very old people. Depression has a negative impact on adherence. Impacts of other mental and physical comorbidities were uncertain. Co-payments (any or higher) have a negative impact on adherence. In contrast, the impacts of medication costs and insurance status were uncertain. Conclusion This overview analyses factors that might impact adherence to oral therapies in adult patients with physical chronic diseases. Our overview suggests that there is a social gradient in adherence. However, for most factors, the evidence was not conclusive due to the risk of bias, inconsistency or imprecision. Electronic supplementary material The online version of this article (10.1186/s13643-019-1014-8) contains supplementary material, which is available to authorized users.

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“…Therapy-related factors relate to the drug regime or an individual drug, involving factors ranging from cost, side effects to dosing regime and ease of use. Some strong determinants of non-adherence are complicated drug regime, polypharmacy, experiencing side effects, the need to cut tablets, frequent change of drug regime and specific types of medications such as anti-arrhythmic and antiasthmatic drugs (Gautério-Abreu et al, 2016;Ingersoll & Cohen, 2008;Lam et al, 2007;Mansur et al, 2008;Mentz et al, 2018;Park et al, 2018;Roy et al, 2017). On the other hand, condition-related factors represent disease-specific concerns or problems encountered by patients.…”

Section: Backg Rou N Dmentioning

confidence: 99%

Prevalence and predictors of medication non‐adherence among older community‐dwelling people with chronic disease in Singapore

Chew

Lee

Lim

et al. 2021

Journal of Advanced Nursing

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Aims: To determine the prevalence and predictors of medication non-adherence among older community-dwelling people with at least one chronic disease in Singapore.Design: A single-centre cross-sectional study. Methods:The study was conducted in the largest tertiary public hospital in Singapore between May 2019 and December 2019. The community nurses of the hospital recruited a total of 400 community-dwelling older people aged ≥60 years old, who were diagnosed with at least one chronic disease and prescribed with at least one long-term medication. Medication non-adherence was assessed using the self-report 5-item Medication Adherence Report Scale, operationalized as a score of <25. A list of potential factors of medication non-adherence was structured based on the World Health Organization five-domain framework and collected using a self-report questionnaire.Results: Sixty percent (n = 240) of our participants were non-adherent to their medication regime. Older people who smoked (OR 2.89, 95% CI 1.14-7.33), perceived their medication regime as being complicated (OR 2.54, 95% CI 1.26-5.13), felt dissatisfied with their regime (OR 2.50, 95% CI 1.17-5.31), did not know the purpose of all their medications (OR 2.56, 95% CI 1.42-4.63) and experienced side effects (OR 3.32, 95% CI 1.14-9.67) were found to be predictive of medication non-adherence. Conclusion:Medication adherence was found to be poor in community-dwelling older people in Singapore. The predictors identified in this study can help guide healthcare professionals in identifying older people who are at risk of medication non-adherence and inform the development of interventions to improve adherence. Impact: Medication non-adherence, especially in the older population with chronic diseases, constitutes a serious problem as it undermines the efforts to reduce morbidity and mortality associated with the underlying chronic diseases. To improve adherence, our findings propose the importance of assessing the older person's treatment satisfaction, which includes examining the aspects of side effects, effectiveness and convenience. Additionally, we highlight the need to address the older person's medication knowledge deficit.

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Intentional and unintentional medication non-adherence in African Americans: Insights from the Jackson Heart Study

Cited by 15 publications

References 23 publications

Intentional and unintentional nonadherence to hydroxyurea among people with sickle cell disease: a qualitative study

Intentional and unintentional nonadherence to hydroxyurea among people with sickle cell disease: a qualitative study

Medication adherence influencing factors—an (updated) overview of systematic reviews

Prevalence and predictors of medication non‐adherence among older community‐dwelling people with chronic disease in Singapore

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