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. 2019 Jan 9;21(1):e10421. doi: 10.2196/10421

Table 1.

Theoretical constructs and behavioral strategies associated with improved medication adherence extracted from the quantitative reviews.

Authors (year) TCa and BSb Evidence summary
Broekmans et al (2009) [33]

  • Medication-related concerns (TC)

  • Poor patient-physician communication and satisfaction (TC)

  • Concerns about side effects were a significantc correlate of lower MAd in k=1. Fewer concerns about withdrawal were a significantc correlate of lower MA (k=1).

  • Poor patient-physician communication and satisfaction were a significantc correlate of lower MA (k=1).
Conn et al (2009) [36]

  • Coping with side effects (BS)

  • Stimulus to take medication (BS)

  • Self-monitoring of symptoms related to medications (BS)

  • Providing succinct written instructions (BS)

  • Adding side-effect management as a moderator to a multiple-moderator model significantlye improved the model (beta=.60).

  • Interventions, including a stimulus to take medication were more effective at improving MA (ESf 1.06) than interventions without these cues (ES 0.30).

  • Interventions that directed participants to self-monitor symptoms related to medications (including symptom improvement from taking medications and medication side effects) were more effective (ES 1.18) at improving MA than interventions that lacked this component (ES 0.30).

  • Interventions with succinct written instructions achieved better effects on MA (ES 0.61) than studies without succinct written instructions (ES 0.29).
Conn et al (2015a) [37]

  • No TC or BS associated with MA

  • N/Ag
Conn et al (2015b) [38]

  • No TC or BS associated with MA

  • N/A
Conn et al (2016) [39]

  • Habit analysis (BS)

  • Prompts or cues (BS)

  • Habit-focused interventions in which participants’ daily habits were linked to taking medications were more effective at increasing MA relative to interventions that lacked this component (0.57 vs 0.22e).

  • Studies that used prompts or cues for taking medications had larger ES than studies that did not (0.50 vs 0.23c).
Conn et al (2017) [40]

  • Habit analysis (BS)

  • Moderation analysis showed that interventions that included habit analysis were more effective (d=0.37) at improving MA than interventions that did not (d=0.28).
Cutrona et al (2010) [41]

  • Reinforcement and reminding (BS)

  • The majority of k=16 showed small effects of reinforcement and reminding on MA, whereas k=3 yielded large effects.
Devine et al (1995) [42]

  • Self-monitoring of medications (BS)

  • Self-monitoring of symptoms related to medications (BS)

  • Increasing health-related knowledge through education (BS)

  • Effect size values on MA by type of treatment were monitoring medications (d=0.43), monitoring blood pressure (d=0.37), and education (d=0.81).
Dew et al (2007) [43]

  • Social support (BS)

  • Poorer social support was significantly associated with greater nonadherence (ES 0.10, CI 0.03-0.26c) from k=11.
Farmer et al (2015) [26]

  • Self-monitoring of medications (BS)

  • Overall, 3 of 6 self-monitoring trials observed significantc improvements in MA.
Fogarty et al (2002) [34]

  • Social support (BS)

  • Scheduling demands (TC)

  • Regimen complexity (TC)

  • Social support was statistically significantly associated with MA in 1 of 4 papers and 1 of 8 abstracts.

  • A total of 2 of 15 abstracts and 2 of 5 papers reported a significantc association between scheduling demands and MA.

  • Overall, 2 of 17 abstracts and 3 of 4 studies reported a significant association between regimen complexity and MA. In total, 2 of 4 of these found the direction of the association to be as expected; more complex regimens were associated with decreased MA.
Holmes et al (2014) [44]

  • Self-efficacy (TC)

  • Perceived barriers (TC)

  • Perceived adverse effects (TC)

  • Perceived benefits (TC)

  • Perceived severity (TC)

  • Perceived susceptibility (TC)

  • Attitude (TC)

  • Intention (TC)

  • Perceived behavioral control (TC)

  • Necessity beliefs (TC)

  • Medication-related concerns (TC)

  • Self-efficacy was a significantc predictor of MA in 7 of 7 studies of sociocognitive theory, 6 of 6 studies of self-regulation theory, and 4 of 6 studies of social support theory.

  • Perceived barriers were significantlyc associated with MA in 11 of 17 studies.

  • Perceived adverse effects were significantlyc associated with MA in 4 of 5 studies.

  • Perceived benefits were significantlyc associated with MA in 5 of 11 studies.

  • Perceived severity was significantlyc associated with MA in 3 of 7 studies.

  • Perceived susceptibility was significantlyc associated with MA in 3 of 6 studies.

  • Attitude was significantlyc associated with MA in 2 of 5 studies.

  • Intention was significantlyc associated with MA in 2 of 5 studies.

  • Perceived behavioral control was significantlyc associated with MA in 2 of 4 studies.

  • Necessity beliefs were significantlyc associated with MA in 7 of 8 studies.

  • Medication-related concerns were significantlyc associated with MA in 7 of 8 studies.
Kahwati et al (2016) [45]

  • Self-efficacy (TC)

  • Attitude (TC)

  • Increasing health-related knowledge through education (BS)

  • Motivational interviewing (BS)

  • Enhancing self-efficacy was identified as individually sufficient for improving MA (consistency 90%).

  • Improving attitude was identified as individually sufficient for improving MA (consistency 90%).

  • Increasing knowledge was a necessary individual BCT for improved MA; it was present in 31 of 34 studies (consistency 91%).

  • Motivational interviewing was identified as close to the consistency threshold for an individually sufficient technique for improving MA (consistency 78%).
Ruppar et al (2015) [46]

  • No TC or BS associated with MA

  • N/A
Schedlbauer et al (2010) [47]

  • Reinforcement and reminding (BS)

  • In total, 4 of 6 studies reported statisticallyc improved MA following reminders in the form of written postal material (k=1), regular telephone calls (k=2), and a simple calendar reminder of medication taking (k=1).
Simoni et al (2006) [48]

  • Interactive discussion of cognitions, motivations, and expectations about adherence (BS)

  • Interactive discussion of cognitions, motivations, and expectations about MA, ES 1.62 (CI 1.21-2.03; k=14) versus no discussion ES 0.99 (CI 0.55-1.79; k=4).
Takiya et al (2004) [49]

  • Prompts or cues (BS)

  • Increasing health-related knowledge through education (BS)

  • Beeper: 1 of 1 study reported significant improvement in MA, ES 0.09 (CI −0.15 to 0.31c).

  • Phone reminder: 1 of 1 study reported significant improvement in MA, ES 0.03 (CI −0.09 to 0.15c).

  • Increasing health-related knowledge through education: 2 of 3 studies reported significant improvement in MA, ES 0.18 (CI −0.11 to 0.44c), 0.03 (CI −0.26 to 0.30c).
Teeter et al (2014) [50]

  • Motivational interviewing (BS)

  • Overall, 6 of 9 studies reported statistically significantc differences between intervention and control groups for change in MA.
Thorneloe et al (2013) [51]

  • Patient satisfaction with their treatment (TC)

  • k=1 reported patients being too busy or fed up was associated with reduced MA.
Xu et al (2014) [52]

  • Tailoring care plan (BS)

  • Tailoring was the most common persuasive attribute; 76% of interventions that successfully improved MA included tailoring versus 33% of interventions in which MA did not improvee (the number of included studies that incorporated tailoring was not reported).
Zomahoun et al (2015) [53]

  • Coping with side effects (BS)

  • Interventions in which cope with side effects was applied had a pooled SMDh of 0.64 (95% CI 0.31-0.96) versus 0.02 (95% CI −0.25 to 0.28) for those who did not (the subgroup differencese).

aTC: theoretical construct.

bBS: behavioral strategy.

cP<.05.

dMA: medication adherence.

eP<.01.

fES: effect size.

gN/A: not applicable.

hSMD: standard mean difference.