Yang Chen, Lee Diana Tze Fan, Wang Xiuhua, Chair Sek Ying
The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
Xiangya Nursing School of Central South University, Changsha, China.
Gerontologist. 2023 May 9;63(4):637-647. doi: 10.1093/geront/gnac069.
Suboptimal medication adherence is prevalent in older adults with multimorbidity. However, intervention programs for enhancing adherence in this population are limited. This study describes the development process of a medication self-management program for older adults with multimorbidity.
We adopted the first 4 steps of the intervention mapping to develop the program: (1) needs assessment, including a literature review, a systematic review, and a cross-sectional study; (2) development of program outcomes and objectives; (3) selection of theory-based intervention methods and practical applications; and (4) development of the program.
We conducted a needs assessment to identify factors affecting medication adherence among older adults with multimorbidity and created a logic model of the adherence problem in Step 1. In Step 2, we developed the specific program outcomes and objectives and then selected adherence information, personal motivation, social motivation, behavioral skills, and treatment experiences as modifiable and important targets that needed to change in this program. In Step 3, we chose several theory-based methods and strategies for practical applications. We finally created a nurse-led medication self-management program in Step 4. Feedback from relevant stakeholders refined the intervention protocol and materials.
The newly developed medication self-management program incorporated theory and evidence from literature and empirical studies with the engagement of multiple stakeholders, making it a contextually and culturally appropriate intervention. This study provides insights into strategies for geriatrics health care professionals to support medication self-management among older adults with multimorbidity.
药物治疗依从性欠佳在患有多种疾病的老年人中普遍存在。然而，针对提高这一人群依从性的干预项目有限。本研究描述了一项针对患有多种疾病的老年人的药物自我管理项目的开发过程。
我们采用干预映射的前4个步骤来开发该项目：（1）需求评估，包括文献综述、系统综述和横断面研究；（2）制定项目结果和目标；（3）选择基于理论的干预方法和实际应用；（4）开发项目。
我们进行了需求评估，以确定影响患有多种疾病的老年人药物治疗依从性的因素，并在第1步中创建了依从性问题的逻辑模型。在第2步中，我们制定了具体的项目结果和目标，然后选择依从性信息、个人动机、社会动机、行为技能和治疗经历作为该项目中需要改变的可改变且重要的目标。在第3步中，我们选择了几种基于理论的方法和策略用于实际应用。我们最终在第4步中创建了一个由护士主导的药物自我管理项目。相关利益相关者的反馈完善了干预方案和材料。
新开发的药物自我管理项目将文献和实证研究中的理论与证据相结合，并让多个利益相关者参与其中，使其成为一个符合背景和文化的适当干预措施。本研究为老年保健专业人员支持患有多种疾病的老年人进行药物自我管理的策略提供了见解。
