Department of Psychology, University of Cyprus, Nicosia, Cyprus.
Department of Applied Health Research, UCL, London.
Transl Behav Med. 2020 Dec 31;10(6):1390-1398. doi: 10.1093/tbm/ibaa118.
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.
药物不依从（MNA）是一个复杂的健康问题，导致经济负担增加和健康状况恶化。药物依从性模型（MAM）支持许多过程与药物依从性（MA）有关。本研究基于 MAM 和世界卫生组织（WHO）的指南，旨在确定与 MA 相关的障碍和促进因素，以及在高不依从率的慢性疾病（哮喘、癌症、糖尿病、癫痫、HIV/AIDS 和高血压）中使用的行为健康干预措施和技术。筛选了 PubMed、PsycINFO 和 Scopus 数据库，共纳入了 243 项研究。采用混合方法来整理证据并解释研究结果。在各种疾病中，最常报道的 MA 障碍包括年龄较小、教育程度低、收入低、药物费用高、副作用、患者信念/认知、合并症和患者与提供者之间的沟通不畅。此外，数字化交付的干预措施，包括药物和病情教育、动机访谈（MI）以及强化和激励信息等组成部分，可改善 MA。本综述强调了根据患者的个体需求和特征，以数字化方式管理多组分干预措施并对其进行个性化的重要性，以应对所面临的依从性障碍。这是第一项审查和综合了有关改善高不依从率慢性疾病的 MA 和行为健康干预措施的障碍和促进因素的证据，并为研究人员和临床医生提供了建议。利益相关者应探索克服已确定障碍的方法，并开发能够降低 MNA 高发生率的有效多组分干预措施。
