Abstract
Purpose
The aim of this review is to cohere evidence on the knowledge, attitudes and beliefs of patients and carers regarding medication adherence. Medication adherence refers to “the extent to which the patient’s action matches the agreed recommendations”. Medication adherence is vital in preventing, managing and curing illnesses and, hence, is linked with positive health outcomes.
Methods
A search was conducted using the following databases: CINAHL, Embase, PubMed and Web of Knowledge from inception to November 2013. Titles and abstracts were screened for inclusion in the review according to pre-defined inclusion and exclusion criteria. Studies were assessed for quality, and data were extracted into a data extraction form. Results were analysed thematically.
Results
The final results included 34 articles. Eight analytical themes were identified: (i) beliefs and experiences of medicines, (ii) family support and culture, (iii) role of and relationship with health-care practitioners, (iv) factors related to the disease, (v) self-regulation, (vi) communication, (vii) cost and (viii) access. The theme, “beliefs and experiences of medicines”, was present in 33 studies, with many discussing the influence that side effects have on medication adherence.
Conclusions
There are a number of variables that impact upon the knowledge, attitudes and beliefs of patients and carers regarding medication adherence. This review presents an overview of the analytical themes which offers the opportunity to examine interventions and their relative efficacies to increase medication adherence.
Similar content being viewed by others
References
Osterberg L, Blaschke T (2005) Adherence to medication. N Engl J Med 353(5):487–497. doi:10.1056/NEJMra050100
NICE (2009) Medicines adherence: involving patients in decisions about prescribed medicines and supporting adherence
Brown MT, Bussell JK (2011) Medication adherence: WHO cares? Mayo Clin Proc Mayo Clin 86(4):304–314. doi:10.4065/mcp.2010.0575
Simpson SH, Eurich DT, Majumdar SR, Padwal RS, Tsuyuki RT, Varney J, Johnson JA (2006) A meta-analysis of the association between adherence to drug therapy and mortality. BMJ 333(7557):15. doi:10.1136/bmj.38875.675486.55
Cramer JA, Roy A, Burrell A, Fairchild CJ, Fuldeore MJ, Ollendorf DA, Wong PK (2008) Medication compliance and persistence: terminology and definitions. Value Health 11(1):44–47. doi:10.1111/j.1524-4733.2007.00213.x
Miller NH, Hill M, Kottke T, Ockene IS, FtEPo C (1997) The multilevel compliance challenge: recommendations for a call to action: a statement for healthcare professionals. Circulation 95(4):1085–1090. doi:10.1161/01.cir.95.4.1085
DiMatteo MR (2004) Variations in patients’ adherence to medical recommendations: a quantitative review of 50 years of research. Med Care 42(3):200–209
Sabate E (ed) (2003) Adherence to long-term therapies: evidence for action. The World Health Organisation, Geneva http://www.who.int/chp/knowledge/publications/adherence_report/en/. Accessed 12 June 2014
Matthes J, Albus C (2014) Improving adherence with medication: a selective literature review based on the example of hypertension treatment. Deutsches Arzteblatt Int 111(4):41–47. doi:10.3238/arztebl.2014.0041
Kripalani S, Yao X, Haynes RB (2007) Interventions to enhance medication adherence in chronic medical conditions: a systematic review. Arch Intern Med 167(6):540–550. doi:10.1001/archinte.167.6.540
United Nations DoEaSA, Population Division (2009) World population prospectus: the 2008 Revision, Highlights, Working paper No. ESA/P/WP.210, New York; United Nations.
Chummun H, Boland D (2013) How patient beliefs affect adherence to prescribed medication regimens. Br J Nurs 22(5):270–276, Mark Allen Publishing
Critical Appraisal Skills Programme (CASP). Qualitative research: appraisal tool. 10 questions to help you make sense of qualitative research. In. Oxford: Public Health Resource Unit; 2006. p. 1–4. http://media.wix.com/ugd/dded87_951541699e9edc71ce66c9bac4734c69.pdf). Accessed 20 July 2014
Tong ASP, Craig J (2007) Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care 19(6):349–357
Badger F, Nolan P (2006) Concordance with antidepressant medication in primary care. Nurs Stand 20(52):35–40 (Royal College of Nursing (Great Britain): 1987)
Beune EJ, Haafkens JA, Agyemang C, Schuster JS, Willems DL (2008) How Ghanaian, African-Surinamese and Dutch patients perceive and manage antihypertensive drug treatment: a qualitative study. J Hypertens 26(4):648–656. doi:10.1097/HJH.0b013e3282f4d20b
Beusterien KM, Davis EA, Flood R, Howard K, Jordan J (2008) HIV patient insight on adhering to medication: a qualitative analysis. AIDS Care 20(2):244–252. doi:10.1080/09540120701487666
Bollini P, Tibaldi G, Testa C, Munizza C (2004) Understanding treatment adherence in affective disorders: a qualitative study. J Psychiatr Ment Health Nurs 11(6):668–674. doi:10.1111/j.1365-2850.2004.00780.x
Boyle E, Chambers M (2000) Medication compliance in older individuals with depression: gaining the views of family carers. J Psychiatr Ment Health Nurs 7(6):515–522. doi:10.1046/j.1365-2850.2000.00356.x
Chambers JA, O’Carroll RE, Hamilton B, Whittaker J, Johnston M, Sudlow C, Dennis M (2011) Adherence to medication in stroke survivors: a qualitative comparison of low and high adherers. Br J Health Psychol 16(3):592–609. doi:10.1348/2044-8287.002000
Chang Y-T, Tao S-G, Lu C-L (2013) Qualitative inquiry into motivators for maintaining medication adherence among Taiwanese with schizophrenia. Int J Ment Health Nurs 22(3):272–278. doi:10.1111/j.1447-0349.2012.00864.x
Dolovich L, Nair K, Sellors C, Lohfeld L, Lee A, Levine M (2008) Do patients’ expectations influence their use of medications? Qualitative study. Can Fam Physician 54(3):384–393
Donovan JL, Blake DR (1992) Patient non-compliance: deviance or reasoned decision-making? Soc Sci Med 34(5):507–513
Ersek M, Kraybill BM, Du Pen A (1999) Factors hindering patients’ use of medications for cancer pain. Cancer Pract 7(5):226–232
Gordon K, Smith F, Dhillon S (2007) Effective chronic disease management: patients’ perspectives on medication-related problems. Patient Educ Couns 65(3):407–415. doi:10.1016/j.pec.2006.09.012
Granger BB, McBroom K, Bosworth HB, Hernandez A, Ekman I (2013) The meanings associated with medicines in heart failure patients. Eur J Cardiovasc Nurs 12(3):276–283
Gusdal AK, Obua C, Andualem T, Wahlstrom R, Tomson G, Peterson S, Ekstrom AM, Thorson A, Chalker J, Fochsen G (2009) Voices on adherence to ART in Ethiopia and Uganda: a matter of choice or simply not an option? AIDS Care 21(11):1381–1387. doi:10.1080/09540120902883119
Henriques MA, Costa MA, Cabrita J (2012) Adherence and medication management by the elderly. J Clin Nurs 21(21/22):3096–3105. doi:10.1111/j.1365-2702.2012.04144.x
Lehane E, McCarthy G, Collender V, Deasy A (2008) Medication-taking for coronary artery disease—patients’ perspectives. Eur J Cardiovasc Nurs 7(2):133–139
Lewis LM, Askie P, Randleman S, Shelton-Dunston B (2010) Medication adherence beliefs of community-dwelling hypertensive African Americans. J Cardiovasc Nurs 25(3):199–206. doi:10.1097/JCN.0b013e3181c7ccde
Orr A, Orr D, Willis S, Holmes M, Britton P (2007) Patient perceptions of factors influencing adherence to medication following kidney transplant. Psychol Health Med 12(4):509–517
Rifkin DE, Laws MB, Rao M, Balakrishnan VS, Sarnak MJ, Wilson IB (2010) Medication adherence behavior and priorities among older adults with CKD: a semistructured interview study. Am J Kidney Dis 56(3):439–446. doi:10.1053/j.ajkd.2010.04.021
Roberson MHB (1992) The meaning of compliance: patient perspectives. Qual Health Res 2(1):7–26
Rushworth GF, Cunningham S, Mort A, Rudd I, Leslie SJ (2012) Patient-specific factors relating to medication adherence in a post-percutaneous coronary intervention cohort. Int J Pharm Pract 20(4):226–237. doi:10.1111/j.2042-7174.2011.00185.x
Russell CL, Kilburn E, Conn VS, Libbus MK, Ashbaugh C (2003) Medication-taking beliefs of adult renal transplant recipients. Clin Nurse Spec: J Adv Nurs Pract 17(4):200–210
Sacajiu G, Raveis VH, Selwyn P (2009) Patients and family care givers’ experiences around highly active antiretroviral therapy (HAART). AIDS Care 21(12):1528–1536. doi:10.1080/09540120902923113
Sand AM, Harris J, Rosland JH (2009) Living with advanced cancer and short life expectancy: patients’ experiences with managing medication. J Palliat Care 25(2):85–91
Stewart DW, DePue J, Rosen RK, Bereolos N, Goldstein MG, Tuitele J, Nu’usolia O, McGarvey ST (2013) Medication-taking beliefs and diabetes in American Samoa: a qualitative inquiry. Transl Behav Med 3(1):30–38
Tolmie EP, Lindsay GM, Kerr SM, Brown MR, Ford I, Gaw A (2003) Patients’ perspectives on statin therapy for treatment of hypercholesterolaemia: a qualitative study. Eur J Cardiovasc Nurs 2(2):141–149
Unson CG, Siccion E, Gaztambide J, Gaztambide S, Mahoney Trella P, Prestwood K (2003) Nonadherence and osteoporosis treatment preferences of older women: a qualitative study. J Wom Health (Larchmt) 12(10):1037–1045. doi:10.1089/154099903322643965
van Geffen EC, Hermsen JH, Heerdink ER, Egberts AC, Verbeek-Heida PM, van Hulten R (2011) The decision to continue or discontinue treatment: experiences and beliefs of users of selective serotonin-reuptake inhibitors in the initial months—a qualitative study. Res Soc Adm Pharm 7(2):134–150. doi:10.1016/j.sapharm.2010.04.001
Van Tam V, Pharris A, Thorson A, Alfven T, Larsson M (2011) “It is not that I forget, it’s just that I don’t want other people to know”: barriers to and strategies for adherence to antiretroviral therapy among HIV patients in Northern Vietnam. AIDS Care 23(2):139–145. doi:10.1080/09540121.2010.507741
Verbeek-Heida PM, Mathot EF (2006) Better safe than sorry—why patients prefer to stop using selective serotonin reuptake inhibitor (SSRI) antidepressants but are afraid to do so: results of qualitative study. Chronic Illn 2(2):133–142
Vermeire E, Hearnshaw H, Van Royen P, Denekens J (2001) Patient adherence to treatment: three decades of research. Compr Rev J Clin Pharm Ther 26(5):331–342. doi:10.1046/j.1365-2710.2001.00363.x
Wrubel J, Moskowitz JT, Richards TA, Prakke H, Acree M, Folkman S (2005) Pediatric adherence: perspectives of mothers of children with HIV. Soc Sci Med 61(11):2423–2433. doi:10.1016/j.socscimed.2005.04.034
Wu J-R, Moser DK, Lennie TA, Peden AR, Chen Y-C, Heo S (2008) Factors influencing medication adherence in patients with heart failure. Heart Lung 37(1):8–16. doi:10.1016/j.hrtlng.2007.02.003, 16.e11
Sidat M, Fairley C, Grierson J (2007) Experiences and perceptions of patients with 100 % adherence to highly active antiretroviral therapy: a qualitative study. AIDS Patient Care STDs 21(7):509–520
Viktil KK, Blix HS, Moger TA, Reikvam A (2007) Polypharmacy as commonly defined is an indicator of limited value in the assessment of drug-related problems. Br J Clin Pharmacol 63(2):187–195. doi:10.1111/j.1365-2125.2006.02744.x
Lehane E, McCarthy G, Collender V, Deasy A (2008) Medication-taking for coronary artery disease—patients’ perspectives. Eur J Cardiovasc Nurs 7(2):133–139. doi:10.1016/j.ejcnurse.2007.08.003
Vermeire E, Van Royen P, Coenen S, Wens J, Denekens J (2003) The adherence of type 2 diabetes patients to their therapeutic regimens: a qualitative study from the patient’s perspective. Pract Diabetes Int 20(6):209–214
Bajramovic J, Emmerton L, Tett SE (2004) Perceptions around concordance—focus groups and semi-structured interviews conducted with consumers, pharmacists and general practitioners. Health Expect 7(3):221–234. doi:10.1111/j.1369-7625.2004.00280.x
European Council Policy makers Debate. An EU response to medication non-adherence. Brussels, 2010
Ponieman D, Wisnivesky JP, Leventhal H, Musumeci-Szabo TJ, Halm EA (2009) Impact of positive and negative beliefs about inhaled corticosteroids on adherence in inner-city asthmatic patients. Annal Allergy Asthma Immunol: Off Publ Am Coll Allergy Asthma Immunol 103(1):38–42. doi:10.1016/s1081-1206(10)60141-x
McKillop G, Joy J (2013) Patients’ experience and perceptions of polypharmacy in chronic kidney disease and its impact on adherent behaviour. J Ren Care 39(4):200–207. doi:10.1111/j.1755-6686.2013.12037.x
Dibonaventura M, Gabriel S, Dupclay L, Gupta S, Kim E (2012) A patient perspective of the impact of medication side effects on adherence: results of a cross-sectional nationwide survey of patients with schizophrenia. BMC Psychiatr 12:20. doi:10.1186/1471-244x-12-20
Vik SA, Maxwell CJ, Hogan DB (2004) Measurement, correlates, and health outcomes of medication adherence among seniors. Ann Pharmacother 38(2):303–312. doi:10.1345/aph.1D252
Vlasnik JJ, Aliotta SL, DeLor B (2005) Medication adherence: factors influencing compliance with prescribed medication plans. Case Manag 16(2):47–51. doi:10.1016/j.casemgr.2005.01.009
Stone VE, Hogan JW, Schuman P, Rompalo AM, Howard AA, Korkontzelou C, Smith DK (2001) Antiretroviral regimen complexity, self-reported adherence, and HIV patients’ understanding of their regimens: survey of women in the her study. J Acquir Immune Defic Syndr 28(2):124–131, 1999
Golin CE, Liu H, Hays RD, Miller LG, Beck CK, Ickovics J, Kaplan AH, Wenger NS (2002) A prospective study of predictors of adherence to combination antiretroviral medication. J Gen Intern Med 17(10):756–765
Murphy DA, Sarr M, Durako SJ, Moscicki AB, Wilson CM, Muenz LR (2003) Barriers to HAART adherence among human immunodeficiency virus-infected adolescents. Arch Pediatr Adolesc Med 157(3):249–255
Munger MA, Van Tassell BW, LaFleur J (2007) Medication nonadherence: an unrecognized cardiovascular risk factor. MedGenMed: Medscape Gen Med 9(3):58
Claxton AJ, Cramer J, Pierce C (2001) A systematic review of the associations between dose regimens and medication compliance. Clin Ther 23(8):1296–1310. doi:10.1016/S0149-2918(01)80109-0
Ogedegbe G, Harrison M, Robbins L, Mancuso CA, Allegrante JP (2004) Barriers and facilitators of medication adherence in hypertensive African Americans: a qualitative study. Ethn Dis 14(1):3–12
Zedler BK, Kakad P, Colilla S, Murrelle L, Shah NR (2011) Does packaging with a calendar feature improve adherence to self-administered medication for long-term use? A systematic review. Clin Ther 33(1):62–73. doi:10.1016/j.clinthera.2011.02.003
Marshall S, Sahm L, McCarthy S (2012) Health literacy in Ireland: reading between the lines. Perspect Public Health 132(1):31–38
Ngoh LN (2009) Health literacy: a barrier to pharmacist-patient communication and medication adherence. J Am Pharm Assoc: JAPhA 49(5):e132–e146. doi:10.1331/JAPhA.2009.07075, quiz e147-139
Horne R, Weinman J (1999) Patients’ beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness. J Psychosom Res 47(6):555–567. doi:10.1016/S0022-3999(99)00057-4
Hsu J, Price M, Huang J, Brand R, Fung V, Hui R, Fireman B, Newhouse JP, Selby JV (2006) Unintended consequences of caps on Medicare drug benefits. N Engl J Med 354(22):2349–2359
Mojtabai R, Olfson M (2003) Medication costs, adherence, and health outcomes among Medicare beneficiaries. Health Aff 22(4):220–229
Balkrishnan R (1998) Predictors of medication adherence in the elderly. Clin Ther 20(4):764–771
Ferguson C, Inglis SC, Newton PJ, Midleton S, Macdonald PS, Davidson PM (2003) Atrial fibrillation and thromboprophylaxis in heart failure: the need for patient-centered approaches to address adherence. Vasc Health Risk Manag 9:3–11. doi:10.2147/VHRM.S39571
Barry M Heerey A, Feely J (2000) Drug reimbursement in Ireland IMJ; 93(3): 71–72 http://www.ncpe.ie/wp-content/uploads/2012/04/Drug-Reimbursement-in-Ireland-Attachment1.pdf. Accessed 26 June 2014
Hennessy J (2012) Primary care reimbursement service: statistical analysis of claims and payments 2012. Health Service Executive http://www.hse.ie/eng/staff/PCRS/PCRS_Publications/PCRSannreport12.pdf. Accessed 26 June 2014
O’Driscoll D, Ryan J, Brogan C, Henman M (2009) The DUMP campaign. Irish Pharm 11(5):19–22
Dickson M, Gagnon JP (2004) Key factors in the rising cost of new drug discovery and development. Nat Rev Drug Discov 3(5):417–429
Beattie J (2007) People with cardiovascular disease identified 5 areas of medication-related problems that influenced adherence and informed decision making. Evid Based Nurs 10(4):127. doi:10.1136/ebn.10.4.127
Acknowledgments
MK would like to acknowledge the assistance of Professor John Browne, University College Cork, Ireland who teaches PG7016, a postgraduate module in Systematic Reviews in the Health Sciences. This module was very helpful in the completion of this review.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kelly, M., McCarthy, S. & Sahm, L.J. Knowledge, attitudes and beliefs of patients and carers regarding medication adherence: a review of qualitative literature. Eur J Clin Pharmacol 70, 1423–1431 (2014). https://doi.org/10.1007/s00228-014-1761-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00228-014-1761-3