medication adherence

Medication adherence is a key factor in controlling chronic diseases, particularly diabetes and high blood pressure. We aimed to describe the level of medication adherence of patients with diabetes or high blood pressure in urban and rural areas in Morocco and to identify the factors associated with medication non-adherence.

A cross-sectional study was conducted from August 1, 2019 to January 30, 2020, among participants recruited from primary health centers in Morocco. The Girard questionnaire was used to measure medication adherence, and bivariate and multivariate analyses were done using SPSS software.

A total of 502 patients were recruited with a majority of women (70.5%). According to the Girard questionnaire, a minority of our patients had a good adherence to medication (11.8%), less than half had a low adherence (38.4%), and half were non-adherent (50%). The factors associated with medication non-adherence for patients with diabetes were: living in rural areas, being overweight, taking antidiabetic oral drugs, and suffering from dyslipidemia. Concerning the patients with high blood pressure, medication non-adherence was higher among patients with dyslipidemia, overweight patients, and those who benefited from a free treatment. For patients suffering from both, the associated factors of non-adherence were taking oral drugs, a multi-therapy of anti-hypertensive drugs, and shorter diabetes duration.

This study highlighted several matters concerning medication adherence among patients with chronic diseases. Healthcare professionals should encourage and help their patients to take their medications.

Polypill or fixed-dose combination has been recognized as an effective secondary prevention strategy for patients with cardiovascular disease (CVD). This study aimed to evaluate the effectiveness of the polypill on one-year medication adherence, patient satisfaction, and lipid profile control in patients with ST-elevation myocardial infarction (STEMI). This was an open-label, multicentric, randomized clinical trial study of STEMI patients who were prescribed a polypill (Aspirin 81 mg, Atorvastatin 40 mg, Metoprolol Succinate 47.5 mg, and Valsartan 40 mg) versus usual care (continued with separate medications) for secondary prevention. The primary outcome was to compare one-year medication adherence between groups. Other outcomes included comparing patient satisfaction and lipid profile after 12 months of follow-up, as well as identifying predictor factors of medication adherence. Of 624 STEMI participants, 289 patients were treated with the polypill (79.2% male; mean age 61.67 ± 8.54 years), and 335 patients received usual care (82.7% male; mean age 62.10 ± 9.63 years). After one-year follow-up, no significant differences were detected between groups regarding medication adherence (p-value = 0.351) and cholesterol levels (p-value = 0.808). The polypill strategy was associated with increased patient satisfaction and better control of LDL-C (p-value = 0.043) and HDL-C (p-value < 0.001). Patients with a history of chronic kidney disease (OR: 13.392; p-value = 0.001), cerebrovascular disease (OR: 4.577; p-value = 0.011), and higher waist circumference (OR: 1.01; p-value = 0.002) demonstrated a lower probability of medication adherence. In contrast, in-hospital complications such as arrhythmia (OR: 0.039; p-value = 0.010), bleeding (OR: 0.034; p-value = 0.007), and higher ejection fraction (OR: 0.965; p-value = 0.002) were associated with a higher probability of medication adherence. In STEMI patients, participants treated with polypills were more satisfied and showed better lipid profile control. However, a longer follow-up duration is needed to examine the effectiveness of the polypill on medication adherence in this subgroup.

Diabetes mellitus is a chronic situation requiring effective self-management and medicinal medication adherence to save complications and improve patient consequences. Despite its significance, many patients struggle with those factors, which are influenced by different factors and health literacy. The study aimed to investigate the association between diabetes self-management and medication adherence among diabetic patients.

A cross-sectional descriptive study was conducted at Babylon Diabetes and Endocrinology Center, Iraq, from September 2024 to February 2025. Three hundred twenty-eight diabetic patients were recruited using convenience sampling. The data collection process used included the Diabetes Self-Management Questionnaire and Medication Adherence Report Scale, each tested as a tool. Data were analyzed through descriptive and inferential statistical approaches, with Pearson correlation and regression analysis performed to explore the relationships between variables.

Participants exhibited moderate self-management (63.1%) and high medication adherence (58.8%). A statistically significant correlation was determined between diabetes self-management and medication adherence (r=0.622; p<0.001). Regression analysis indicated that superior self-management substantially predicted higher adherence. Age, gender, education, and earnings were recognized as influencing factors (p<0.05).

There is a moderate level of diabetes management and good adherence to treatment in Babylon province, Iraq, that vary globally due to factors such as access to healthcare, socioeconomic status, and education.

Epilepsy is a common chronic neurological disorder in paediatrics. Most of the children with epilepsy do not properly adhere to medication regimen which leads to a lack of control over seizure and increased mortality and morbidity rate in these patients.

This study was conducted with aim to evaluate the effect of parent training and telephone follow-up on adherence to the medication program of children with epilepsy.

This quasi-experimental study was conducted with participation of 72 parents of children with epilepsy who were referred to Besat Hospital of Hamadan in 2019-2021. The samples were assigned to two experimental and control groups by using random block permutation. During the first 24 hours of admission, the participants completed the researcher-made medication adherence questionnaire. A face-to-face training program and follow-up by phone were provided for the experimental group and no intervention for the control group. The questionnaire was also completed after two months. Data were analysed using SPSS software (version 22). p<0.05 was considered statistically significant.

After the intervention, the control group showed a non-significant increase of 47.10±15.07 in medication adherence (p>0.05). However, the intervention group experienced a significant increase of 88.83±4.68 in medication adherence (p<0.001).

Implications for Practice: 

Parental education and telephone follow-up can be recommended as an independent action in nursing care services to improve medication adherence in children with epilepsy.

Tuberculosis is still a significant global health challenge, particularly in developing countries. This study aimed to evaluate the impact of the TB SEHAT application on medication adherence among pulmonary tuberculosis patients in Jambi City. 

This quasi-experimental study employed a one-group pre-test-post-test design with a control group, comprising two groups; an intervention group that received TB SEHAT app-based education and a medication reminder program, and a control group that received standard care from medication supervisors. Each group included 37 participants, selected through simple random sampling. Data collection was done from May 13 to August 30, 2024, within the service area of the Putri Ayu Health Center. Data analysis was performed by SPSS 23.

Following the use of the TB SEHAT application, the mean adherence to anti-tuberculosis drugs was 127.30±5.22 on the TB Medication Adherence Scale. In contrast, the mean adherence in the group receiving standard treatment supervision was 121.41±6.43. An analysis of covariance indicated a significant difference in adherence between the TB SEHAT application and standard treatment groups (p=0.001).

The TB SEHAT application effectively improves adherence to anti-tuberculosis drugs in patients with pulmonary tuberculosis.

This study aimed to explore the impact of telemedicine on self-care behaviors, medication adherence, vital signs, and the frequency of hospital visits following discharge in patients who experienced brain complications due to COVID-19 and were admitted to the ICU. In this semi-experimental study, we conducted research with a convenience sample of 120 patients, 60 in the intervention group (telemedicine) and 60 in the control group, who were hospitalized in the ICU for COVID-19-related brain complications at Imam Reza Hospital in Tabriz, Iran, from March 1, 2022, to December 1, 2023. We assessed self-care using a COVID-19 self-care questionnaire, medication adherence with the Morisky Medication Adherence Scale (MMAS), and monitored vital signs and the number of hospital visits post-discharge. Comparisons were made between the two groups after the intervention. The findings indicated significant improvements in self-care behaviors (P=0.003), medication adherence (P=0.048), stability of vital signs (P<0.05), and a reduction in the number of hospital visits (P=0.014) for patients in the intervention group compared to those in the control group. The implementation of telemedicine has shown promising results in enhancing self-care practices, improving medication adherence, stabilizing vital signs, and decreasing the frequency of hospital visits after discharge among ICU patients with brain complications related to COVID-19.

 Medication adherence (MA) is a crucial factor in effectively managing hypertension (HTN). Southeast Asia (SEA) is one of the regions with a significant burden of HTN. Understanding MA among patients with HTN is vital to identifying gaps and potential strategies to enhance its use and effectiveness for this region. However, little is known about MA among this population. This review study aimed to identify MA strategies implemented in previous studies on older people with HTN in SEA.

 This scoping review was conducted from 2013 to 2023 by searching the Global Medicus Index, PubMed, ScienceDirect, EBSCO, CINAHL, Wiley, Garuda, and Google Scholar and grey literature to identify the aims of this paper using keyword variations such as “elderly” OR “older people” AND “hypertension” OR “Hypertensive” OR high blood pressure” AND “medication adherence” OR “medication compliance” AND “southeast Asia”. Three reviewers independently examined the results, and the extracted data were then organized, categorized, and summarized.

 Out of 742 studies reviewed, 16 met the criteria and were included in this review. The evidence indicated that MA rates among older people with HTN in several countries in SEA were considered poor, with various reasons for non-adherence. Family support and level of knowledge were found to be the most common supportive factors for MA. Some studies demonstrated negative perceptions toward medication, with previous reviews reporting the use of herbal medicine as self-treatment due to fear of side effects of prescribed medications.

 The level of adherence to prescribed medication among older people is considered low in the reviewed studies. The main reasons for non-adherence are negative perceptions toward prescribed medication, which were also expressed in some studies. Moreover, various efforts were made by individuals to improve their adherence to medication use.

Promoting adherence to treatment and self-efficacy in patients with coronary artery diseases helps to improve patient outcomes. The present study was conducted to explain the effectiveness of interventions based on information, motivation, and behavioral skills model on treatment adherence and self-efficacy in patients with coronary artery diseases.

This explanatory-sequential study was conducted on patients with coronary artery diseases in Shiraz, Iran. First, a quasi-experimental study was conducted on 112 patients who were randomly assigned to two intervention and control groups. The intervention consisted of ten motivational training sessions that were designed based on Information, Motivation, and Behavioral Skills (IMBS) model and continued with six months of telephone follow-up and counseling. Data were collected before, three months, and six months after the end of the intervention. Then, in the second phase, a qualitative study including 20 in-depth interviews with 18 participants from the intervention group was conducted. The data were analyzed by deductive and inductive qualitative content analysis. Finally, quantitative findings were explained with the help of qualitative findings.

The findings showed that the mean score of treatment adherence, medication adherence, and self-efficacy in the intervention group was significantly higher than the control group 3 and 6 months after the intervention (p<0.001). The results of the qualitative phase of the study also showed that the four main categories include receiving targeted information, encouragement to care, gained self-efficacy/doubt in care, and improvement/non-improvement of treatment adherence behaviors can explain quantitative phase results.

The results showed that receiving training with effective methods, strengthening the support system, self-confidence and positive attitudes about care, and promoting self-management and proper management of emotional distress contributed to the effectiveness of the interventions. However, receiving conflicting information, limited financial resources, and the inability to face challenges were among the obstacles to strengthening self-efficacy and adherence to treatment.

This study aimed to investigate whether transdiagnostic treatment as well as acceptance and commitment therapy (ACT) could improve treatment adherence and alleviate gastrointestinal symptoms plus perceived stress in patients suffering from irritable bowel syndrome.

Research has shown that people with chronic diseases often have negative attitudes toward medications, especially when they also have psychiatric disorders. This, along with the complex dosing requirements and inadequate knowledge about medication adherence among irritable bowel syndrome patients, can affect the treatment efficacy.

A randomized clinical trial was conducted using a pre-test-post-test design. The statistical population included patients with irritable bowel syndrome referring to Taleghani Hospital in Tehran between winter 2021 and spring 2022. Convenience sampling was used to select 30 individuals, with 15 people assigned to each group. Two types of psychotherapy were provided online and individually to the participants. The desired treatments were given to the transdiagnostic treatment and ACT groups in eight weekly sessions of 45-60 minutes.

There was no significant difference between the transdiagnostic treatment pre-test and ACT regarding perceived stress, medication adherence, and gastrointestinal symptoms (P>0.05). There was no significant difference either between the transdiagnostic treatment and ACT post-test. However, there was a significant difference between the pre-test and post-test phases of ACT regarding adherence, gastrointestinal symptoms, plus perceived stress (P<0.05) and transdiagnostic treatment regarding gastrointestinal symptoms (P<0.05).

Specialists may use transdiagnostic treatment and ACT as effective psychological treatments to alleviate gastrointestinal symptoms and perceived stress, thereby increasing treatment adherence in patients with irritable bowel syndrome.

 Diabetes is considered one of the most arduous chronic diseases emotionally and behaviorally. This disease is an integral part of the patient’s lives, and not paying attention to the psychological stress stemming from it, not only leads to the occurrence of psychological symptoms and frustration, but also influences self-care behaviors, such as blood sugar control, proper use of medicines, and medication regimen adherence.

 This study was conducted to determine the relationship between psychological stress and medication regimen adherence in patients with type 2 diabetes.

 This descriptive-correlational study was conducted on 101 patients referring to diabetes clinics affiliated with Zanjan University of Medical Sciences in 2023. Sampling was carried out using the convenience sampling method. A demographic characteristics questionnaire, the Problems Areas in Diabetes-5 (PAID-5) Scale, and the Mo risky Medication Adherence Scale-8 (MMAS-8) were used to collect data. Data were analyzed using descriptive statistics, the Mann-Whitney U test, the Kruskal-Wallis test, and Spearman’s test, with SPSS-26 software.

 In the present research, 68.3% of the participants were female and 31.7% were male. The mean (standard deviation) stress score was 9.579 (7.448). Also, 58.4% of the participants had a stress score of ≥8, indicating high psychological stress. The mean (standard deviation) of medication adherence was 6.054 (1.874), which based on the findings, 43.6% had a poor adherence score. Spearman’s correlation coefficient showed an inverse and significant statistical relationship between psychological stress and medication adherence (p =0.002, r=-0.307).

 According to the results, the higher the psychological stress of diabetic patients, the lower their medication adherence. It is suggested that targeted interventions should be designed to manage psychological stress and improve medication adherence in diabetic patients.

Children with epilepsy need sustained drug treatment to achieve optimal and desired health outcomes. However, non-adherence to drug treatment is a common cause of adverse health outcomes in this population. This study aimed to investigate the relationship between caregivers' beliefs about antiepileptic drug therapy and adherence to medication in children and adolescents with epilepsy.

This correlational and cross-sectional study was conducted on 151 caregivers of children and adolescents with epilepsy aged between 2 months and 19 years old referred to the neurology clinic for epilepsy in Children's Hospital of Bandar Abbas, Iran. Data collection tools included demographic and general questionnaires; the Medication Adherence Report Scale (MARS) to assess medication adherence and the Beliefs about Medication Questionnaire (BMQ) for assessing the pharmaceutical beliefs of caregivers.

Using quantile regression, there was no significant relationship between medication adherence and caregiver belief in the necessity of medications to control a child's epilepsy (P=0.38) and concern about the medications' side effects and efficacy (P=0.24). However, 47.7 % of caregivers reported full medication adherence.

Education about awareness of how to use and the effects of antiepileptic drugs is essential. By taking these actions, it is expected to increase medication adherence and following this, more appropriate control of epilepsy in children and adolescents.

The aim of this study was to investigate the role of psychological variables in medication adherence in OCD. 

This descriptive and correlational study was carried out at Tehran Institute of Psychiatry in Tehran. The statistical population of the present study includes all OCD patients referred to the Tehran Institute of Psychiatry. The participants were selected by available sampling method. The patients completed the demographic questionnaire, Yale Brown Obsessive-Compulsive Disorder Scale-Second Edition (Y-BOCS-II), Vancouver Obsessional Compulsive Inventory (VOCI), Medication Adherence Rating Scale (MARS), Drug Attitude Questionnaire (DAI-10), Multidimensional Scale of Perceived Special Support (MSPSS), Coping strategies scale of Lazarus and Folkman (WOCQ), and Temperament and Character Inventory (TCI). Multiple Linear Regression (MLR) was used to analyze the data. 

The variable of education status (r=0.18) had a positive relationship and the variable of hospitalization history (r=-0.26) had a negative relationship with medication adherence. Medication adherence is only negatively associated with obsessive thoughts (r=- 0.18, r=-0.20). Duration of drug use (r=0.27), attitude to treatment (r=0.25) and social support (r=0.54) had a positive relationship with medication adherence. Among the various dimensions of temperament and character, four dimensions of harm avoidance (r=-0.29), reward dependence (r=-0.44), persistence (r=-0.20) and self-transcendence (r=0.32) had a significant correlation with medication adherence. Variables of social support, reward dependence, persistence, harm avoidance and education status had the highest regression effect on medication adherence. 

Medication adherence is one of the behaviors that predicts successful treatment and reduces the negative side effects and severity of the OCD.