A phenomenological investigation of patients' lived experiences of medicines adherence: a novel perspective for future intervention development

Abstract

Approximately 50% of medications are not used as prescribed, this phenomenon is known as non-adherence. The literature concerning this phenomenon focuses on reasons medicines are not taken, dissecting experiences to identify mechanisms that act as barriers and facilitators to using medicines as prescribed. Theoretical frameworks and models have been developed that conceptualise the phenomenon, enabling interventions to be established to improve medicines use. However these interventions have yet to demonstrate sustainable improvements in adherence. A novel perspective of the adherence phenomenon may direct future intervention development that will lead to improved adherence.
This project evaluated current literature concerning the adherence phenomenon; concluding that a largely ‘biomedical perspective’ had been taken to understanding patients’ medicines use and that further work was needed that approached the phenomenon from with a novel outlook. A systematic review and thematic synthesis was conducted of evidence that, through phenomenological methods, rejected previously held beliefs and concluded that adherence was experienced by patients as an interaction between the patient’s and the medicine’s identity. The systematic review identified a gap in the literature that described adherence from patients’ lived experiences across different disease states.
Using phenomenology, empirical research included forty-one interviews that explored patients’ experiences of medicines use across five disease areas, namely cardiovascular disease, gout, chronic obstructive pulmonary disease, cancer and diabetes. This uncovered a novel description of the phenomenon as a construct of social interaction between the patient, their product and wider society (embodied as family and friends, healthcare professionals, the media and policy). Three focus groups were conducted to validate these findings and locate patients’ perspectives of interventions within this novel description. Analyses from these focus groups identified that current adherence interventions represented micro-social interactions between the patient and the product, with few interventions developed that utilise patients’ interactions with wider society. These works are synthesised to present new directions for future intervention development that might seek to utilise patients’ interactions with friends, family, healthcare professionals and policy to improve adherence.