Many people face barriers to taking their medication regularly. It is estimated that between 30 and 50% of patients prescribed medication for long term conditions do not take them as prescribed. Barriers include practical difficulties (such as getting to the pharmacy or being unable to swallow medication) and/or perceptual barriers (such as lack of motivation or negative emotions). The result is poorer patient health, increased medication wastage, and investigations and prescribing that may otherwise have been avoided.
To provide the best support to help patients take their medication, their personal barrier(s) must firstly be identified. Research shows that identifying the underlying barriers is challenging for patients and practitioners. The Identification of Medication Adherence Barriers Questionnaire (IMAB-Q) was developed and validated to support patients and practitioners to identify these barriers. The IMAB-Q was developed using the stages of literature search, mapping to a theoretical framework and focus groups with people prescribed medication.
Literature searchWe searched the literature for known barriers to adherence experienced by people prescribed long-term medication. The search terms used for this scoping review are provided in Table 1.
|Medication*.ti,ab OR Drug*.ti,ab OR Medicine*.ti,ab
|Adheren*.ti,ab OR Complian*.ti,ab OR Concordan*.ti,ab OR Non-adheren*.ti,ab OR Non-complian*.ti,ab
|Barrier*.ti OR Difficult*.ti OR Problem*.ti OR Reason*.ti (NOT Tissue.ti, NOT epithelial.ti, NOT cream*.ti, NOT skin.ti, NOT platelet.ti, NOT guideline*.ti)
|1 AND 2 AND 3
|4 NOT letter, NOT editorial, NOT comment
All of the barriers identified from this literature search were organised into similar themes. This initial pool of barriers and the 17 themes to which they were organised are provided in Table 2.
Adherence barrier theme
|Beliefs about medicines
|Cognitive/memory related factors
|Changes to usual routine
|Drug and alcohol use
|Healthcare provider related factors
|Incompatibility of medicines taking with daily routine/lifestyle
|Knowledge related problems
|Medicine administration problems
|Patient preference for alternatives
Choosing traditional or herbal remedies instead of prescribed medication
|Patient related factors
|Regimen related factors
|Side effects of medicines
|Treatment related factors
Mapping to a theoretical framework
We mapped individual barriers from the literature review to one of 12 domains of the Theoretical Domains Framework. The mapping was undertaken by three experts in medication adherence and/or the Theoretical Domains Framework.
Focus groups with people prescribed medication
We invited people prescribed medication to help prevent heart disease to focus group discussions to get a better understating of the barriers to medication adherence. We presented them with the barriers identified from the literature search, organised into the domains of the Theoretical Domains Framework to stimulate discussion about the barriers to medication adherence.
Validation and clinical utility of the IMAB-Q
We tested how good the IMAB-Q is at accurately identifying a patient’s barriers to adherence and how easy it is to use in clinical practice by trialling it in community pharmacies with patients prescribed medication to help prevent heart disease. We did this by staff working in community pharmacies inviting patients to complete the IMAB-Q. A smaller sample of these patients were invited to complete the IMAB-Q twice with a two week interval to determine whether IMAB-Q when repeated provides consistent results. We will also asked pharmacists to use IMAB-Q in routine patient consultations (Medicines Use Reviews) to explore whether the IMAB-Q works in routine practice. Finally, we spoke to pharmacists who were involved in the study to find out their experiences of using the IMAB-Q. The results of this research can be found here.
The research to develop IMAB-Q was funded by the University of East Anglia and validation was funded by Pharmacy Research UK. The views expressed in this publication are those of the author(s) and not necessarily those of Pharmacy Research UK.
The full report of the IMAB-Q validation study can be found on the Pharmacy Research UK website here.
The Identification of Medication Adherence Barriers Questionnaire (IMAB-Q)
International Journal of Pharmacy Practice: Barriers to medication adherence in patients prescribed medicines for the prevention of cardiovascular disease: a conceptual framework. Read more here.