Improving Medication Adherence: Moving from Intention and Motivation to a Personal Systems Approach

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Medication adherence theories

For the past 30 years, medication adherence theoretical approaches have primarily focused on understanding and changing the psychology of the person taking medications. Altering attitudes and beliefs are the focal concepts of these theories. The Theory of Planned Behavior has been used to examine the person’s beliefs and attitudes toward medication taking.7 According to this theory, behavior is a function of one’s intention to perform the behavior. Intention is affected not only by the attitude

Medication adherence interventions

Medication adherence interventions have targeted the older adult and medication taking largely through efforts to change knowledge, attitudes and beliefs, and associated behavior.21, 22 Although most medication adherence studies do not report any theoretical underpinning, they typically attempt to enhance intention and knowledge through education (verbal, written, Internet), attitude and motivation through counseling (to change negative thoughts about medications), and associated behavior

A paradigm shift

Thomas Kuhn,33 in his book The Structure of Scientific Revolutions, notes that knowledge development in science does not progress in a linear or continuous manner but instead periodically goes through revolutions called paradigm shifts. During these shifts, development of a scientific field undergoes transformation.

Kuhn suggests that there are 3 stages of development of science33: prescience, normal science, and revolutionary science. In prescience, the field has no central paradigm, and

Personal systems approach

“To Err is Human,” the Institute of Medicine’s landmark report on improving hospital safety, suggests moving away from blaming the individual and, instead, making the desired behavior more likely to occur by removing environmental barriers.34 Strategies have been implemented in health care organizations not only at the level of large systems and the community to improve health care delivery but also at the personal systems level as part of the efforts to improve health outcomes.35, 36, 37, 38

Future trends in medication adherence in older adults

Testing and implementing personal systems interventions to improve medication adherence are certainly accompanied by other advances. Medication adherence guidelines for older adults are currently available for use by health care providers.54 Publication of RCTs to test interventions to improve medication adherence in older adults has progressively increased over the past few decades.21 Concomitantly, the number of meta-analyses and medication adherence guidelines are also growing.24, 55

Summary

We review the theories and interventions used to attempt improvement in older adults’ medication adherence behavior. Using Kuhn’s model, we propose a paradigm shift in behavior change intervention toward a novel medication adherence intervention that focuses on tapping into the personal system in which the individual functions to change medication-taking behavior that moves away from focusing on personal characteristics, motivation, and intention. We discuss the evidence that has tested this

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  • Cited by (22)

    • A concept analysis of routines for improving health behaviors

      2023, International Journal of Nursing Sciences
    • Oral Agents for Cancer Treatment: Effective Strategies to Assess and Enhance Medication Adherence

      2017, Nursing Clinics of North America
      Citation Excerpt :

      The third step involves tracking medication adherence data either electronically or by pill counts at office visits. Evaluating these data and reassessing changes that were made and that were effective is the fourth and final step in this personal systems approach.21,22 For patients taking OAC, each step in this process should occur at each office or clinic visit, and if patients are found to have missed doses routines should be modified to optimize adherence.

    • Medication adherence in older adults: The pillbox half full

      2014, Nursing Clinics of North America
      Citation Excerpt :

      These investigators concluded that there is a need for a paradigm shift to a personal systems approach that focuses more on the individual in the environment. Building on the work of Alemi and colleagues23 regarding continuous self-improvement and systems thinking, the investigators define personal systems change as “a process of systematically improving individual systems through collaboratively shaping routines, involving supportive others in routines, and using medication self-monitoring to change and maintain behavior.”19( p274) Theories can help practitioners be holistic in researching the etiology of nonadherence and to know how to intervene more effectively.

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    The authors have nothing to disclose.

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