Matching Adherence Interventions to Patient Determinants Using the Theoretical Domains Framework

Abstract

Introduction: Despite much research, interventions to improve medication adherence report disappointing and inconsistent results. Tailored approaches that match interventions and patient determinants of non-adherence were seldom used in clinical trials. The presence of a multitude of theoretical frameworks and models to categorize interventions and patient determinants complicated the development of common categories shared by interventions and determinants. We retrieved potential interventions and patient determinants from published literature on medication adherence, matched them like locks and keys, and categorized them according to the Theoretical Domains Framework (TDF).Methods: We identified the most relevant literature reviews on interventions and determinants in a pragmatic literature search, extracted all interventions and determinants, grouped similar concepts to umbrella terms and assigned them to TDF categories. All steps were finalized in consensus discussion between the authors.Results: Sixteen articles (5 with determinants, 11 with interventions) were included for analysis. We extracted 103 interventions and 42 determinants that we divided in 26 modifiable and 16 unmodifiable determinants. All interventions and modifiable determinants were matched within 11 categories (Knowledge; Skills; Social/professional role and identity; Beliefs about capabilities; Beliefs about consequences; Intentions; Memory, Attention and decision processes; Environmental context and resources; Social influences; Emotion; and Behavioral regulation).Conclusion: In published trials on medication adherence, the congruence between interventions and determinants can be assessed with matching interventions to determinants. To be successful, interventions in medication adherence should target current modifiable determinants and be tailored to the unmodifiable determinants. Modifiable and unmodifiable determinants need to be assessed at inclusion of intervention studies to identify the patients most in need of an adherence intervention. Our matched categories may be useful to develop interventions in trials that investigate the effectiveness of adherence interventions.

Association between non-adherence behaviors, patients’ experience with healthcare and beliefs in medications: a survey of patients with different chronic conditions

“…The use of good, targeted information to reduce patients' concerns about medications, and close supervision from the clinical team to promote patient selfmanagement, may be particularly beneficial in such conditions. Thus, while the requirement for addressing modifiable risk factors for non-adherence in clinical practice is well recognized 26 , the current study emphasizes the importance of reducing patients' concerns about medication whilst also reinforcing the need for patients to continue with their medication. As there is no optimal method to measure non-adherence in routine clinical practice, we defined five non-adherence behaviors based on physician and patient input.…”

Promoting adherence in adolescents and young adults with cancer to optimize outcomes: A developmentally oriented narrative review

“…The following section presents a new framework for conceptualizing adherence in AYAs, developed through the integration of developmental considerations into existing theoretical conceptualizations of adherence‐influencing factors (Figure ). To create this framework, key dimensions of adherence for AYAs were identified through a literature review of factors influencing adherence among AYAs with cancer.…”

A systematic review of factors affecting adherence to malaria chemoprophylaxis amongst travellers from non-endemic countries

“…The results of this review have implications for clinicians who may be able to improve adherence rates of malaria prophylaxis. Many previous attempts at adherence interventions have been unsuccessful, perhaps due to being developed without a sound theoretical basis, lacking a tailored approach matching interventions and individual determinants of non-adherence, and focusing solely on provision of information [9,46]. Research has therefore moved on to models focusing on patients' beliefs, abilities and motivations [9].…”

“…One example of this is the Capability, Opportunity and Motivation (COM-B) model of behaviour [10], suggesting that behaviour is influenced by the interaction between capability, opportunity and motivation-and, importantly, that behaviour could be modified by targeting these three factors. Allemann et al [46] developed a list of modifiable determinants of adherence (such as knowledge, beliefs about capabilities, beliefs about consequences, intentions, and memory, among others) and suggested that such determinants should be assessed and matched to appropriate interventions. It is important that future interventions aimed at improving adherence should be personalized, targeting the causes of non-adherence per individual, and should apply the COM-B model rather than simply providing information to patients.…”