Table 2.

Characteristics of included studies.

Study Reference	Country	Design/Method	Population	Sample Size	Sample Characteristics	Analysis	Research Question
Ahlstedt Karlsson et al. (2019) [33]	Sweden	Focus group	Women treated with Tamoxifen after breast cancer surgery	25	Median age: 62 years (range 42–80); 92% Married/co-habiting, 8% Single; 40% Retired; 60% Employed full or part time	Content analysis	To explore women's experiences with HT
Bedi (2018) [26]	USA	Focus group	Hormone receptor-positive breast cancer survivors under age 64 who had been prescribed ET since 2000; 50% on Tamoxifen, 41% on Aromatase Inhibitors, and 9% had switched.	22	Median age: 52 years when first prescribed ET (Range: 37–63 years); 64% Caucasian, 23% African American, and 14% Other Race; 18% High School Diploma, 14% Associate Degree, 41% Bachelors' Degree, 18% Post-Baccalaureate Degree, And 9% Preferred Not to Answer	Grounded theory	To understand from the survivor perspective which modifiable factors could have the greatest impact on the likelihood of HT continuation
Bluethmann et al. (2017) [34]	USA	Mixed method - interview	Breast cancer survivors who were prescribed adjuvant hormone therapy (i.e., Tamoxifen or AI).	27	Mean Age: 57 Years (Range = 49–86 Years); 27 Non-Hispanic White, 1 Non-Hispanic Black, 2 Hispanic; 22 Married, 8 Other; 4 High School Diploma, 5 Some College Or Technical School, 15 Bachelor's Degree, 6 Graduate Degree	Grounded theory	To describe survivors' reported appraisal and management of medication-related side effects and deconstruct survivors' decisions to initiate, discontinue, or maintain adjuvant hormone therapy.
Brauer et al. (2016) [38]	USA	Interview	Early-stage breast cancer, age 65 years and older taking AI	27	Mean age: 73.3 years (range 66–91); 4 Divorced, 1 Never married, 12 Married or living as married, 9 Widowed, 1 Separated;	Grounded theory	To explore how survivors of breast cancer made decisions about persisting with AIs, including specific challenges as well as attempts to manage them.
					7 High school diploma, 2 Some College, 9 Bachelor's Degree, 3 Some Graduate School, 6 Graduate Degree
Brett et al. (2018) [27]	UK	Interview	Women who had been prescribed adjuvant hormone therapy, 19 Tamoxifen, 4 AI and 9 switched, 2–4 years following their diagnosis of breast cancer.	32	Adherers	Framework analysis	Identify the factors that influence whether women adhere to or do not adhere to adjuvant hormone therapy
					median age: 59 (Range 37–77)
					15 (79%) Married, 1 (5%) Single, 3 (16%) Separated - Widow;
					1 (5%) O′ O” level, GCSE, or equivalent, 16 (84%) College or university degree, 2 (11%) Postgraduate qualification;
					Non-adherers
					median age: 64 (Range 53–76);
					10 (77%) Married, 2 (15%) Single, 1 (8%) Separated;
					9 (69%) College or university degree, 4 (31%) Postgraduate qualification
Cahir et al. (2015) [39]	Ireland	Interview	Women with stage I-III breast cancer prescribed adjuvant hormonal therapy purposively sampled by their medication taking behaviour at two cancer centres.	31	Mean age 51 years (SD ± 10);	Thematic analysis	To investigate influences on adjuvant hormonal therapy Medication Taking Behaviour in women with stage I–III breast cancer.
					7 Single, 24 Married/cohabiting;
					Employed: 16 Yes, 15 No
Cheng et al. (2017) [28]	China	Interview	Breast cancer survivors (<5 years after diagnosis)	19	Mean age: 54 years (range 41–65 years); 95% of the participants were unemployed or retired	Content analysis	Reveal Breast Cancer Survivor's views and experiences of self-management in extended survivorship
Harrow et al. (2014) [29]	UK	Interview	Women who had been prescribed tamoxifen or aromatase inhibitors (anastrozole or letrozole) and had been taking this medication for 1–5 years	30	Ages: <50 years 2 (7%), 50–64 years 15 (50%), ≥65 years 12 (40%), age unknown 1 (3%);	Constant comparison method applied within the framework approach	Women's experiences of taking adjuvant hormone therapy; their understandings and reasons for taking or not taking medication and the factors which influenced adherence or non-adherence and the information and support they received or desired.
					3 (10%) premenopausal, 7 (23%), perimenopausal, 17 (57%), postmenopausal, 3 (10%) unknown
Humphries et al. (2018) [35]	Canada	Interviews and focus groups	Women aged 18 years or older, diagnosed with hormone receptor-positive breast cancer, had a first adjuvant hormone therapy prescription for early breast cancer within the last two years and sufficient fluency in French. 19 Tamoxifen, 3 Letrozole, and 21 Anastrozole	43	Ages: ≤49: 6, 50–59: 17, 60–69: 10, ≥70: 10;	Thematic Analysis	Identify women's attitudinal, normative, and control beliefs regarding adjuvant hormone therapy adherence that could be targeted by an intervention offered in the community pharmacy setting.
					2 Primary school, 8 Secondary school, 14 College, 19 University
Iacorossi et al. (2018) [36]	Italy	Interview	Women aged between 44 and 75 years, diagnosed with breast cancer, who were being treated with endocrine therapy mainly Tamoxifen.	27	Median Age: 52 years, mean: 55.9 years, (range: 44–75 years);	Framework Analysis	To explore the experiences of adherence to hormone therapy in women with breast cancer.
					5 Single, 15 Married, 5 Divorced, 2 Widowed
Lambert et al. (2018) [37]	Canada	Interview	Women diagnosed with HR + stage I to III breast cancer, without a prior cancer diagnosis, recurrence of breast cancer, or secondary cancer diagnosis (excluding non-melanoma skin cancer), who had completed primary cancer treatment, were fluent in English, aged 18–79 years at diagnosis, and prescribed Adjuvant Hormone Therapy.	22	Ages: 45–60 years 11 (50%), 60–79 years 11 (50%)	Thematic Analysis	To explore breast cancer survivors' experiences and perspectives of adjuvant hormone therapy use to describe how personal, social, and structural factors influence adjuvant hormone therapy persistence.
Mao et al. (2013) [25]	USA	Mixed method – online forum posts	Posts collected from breast cancer message boards between February 2002 and May 2010.	12 different breast cancer message boards	Data on sample not collected.	Content Analysis	To evaluate the volume and frequency of AI-associated side effects reported on internet message boards.
Moon et al. (2017) [30]	UK	Interview	Breast cancer survivors who had been prescribed tamoxifen	32	Mean age: 55 years (range: 36 to 77, SD = 10.6); 16 Post-Menopausal, 5 Pre-Menopausal, 5 Perimenopausal, 6 Unsure; 24 White, 5 Black British, 2 Asian/Asian British, 1 Mixed	Thematic Analysis	To elicit abroad understanding of women's lived experiences of tamoxifen, their motivation to adhere to treatment and identify reasons for non-adherence and non-persistence, in their own words.
Pieters et al. (2019) [40]	USA	Interview	Women aged at least 65 years old, started an AI for loco-regional (Stage I, II or III) breast cancer 4–36 months prior to enrolment and were in charge of taking their own medications.	54	Mean age: 73.3 years (range = 66–91);	Thematic Analysis	To describe and compare how women treated for primary early-stage breast cancer either persisting or not persisting with an AI received, interpreted, and acted upon AI-related information.
					44 White, 3 Latina, 3 Japanese, 2 Chinese, 1 Korean, 1 African American; 24 Married, 2 Never married, 16 Widowed, 10 Divorced, 2 Separated;
					9 High School Graduate, 7 Some College, 19 College Graduate, 5 Some Graduate School, 14 Graduated Grad School; Household Income: 14: $21k-$40,999, 8: $41k-60,999, 13: $61k-80,999, 5: $81k-100,999, 12: >$101k
Van Londen et al. (2014) [31]	USA	Focus group	Breast cancer survivors, aged 50 years or older, with Adjuvant Hormone Therapy-related symptoms	14	Mean age: 58.8 years (SD: 6.7); 100% Caucasian; 79% Married; 21% Employed, 79% Not Working (retired, disabled, not able to find a job)	Thematic Analysis	To explore survivors' recollection of the conversation with the medical oncologist about starting Adjuvant Hormone Therapy, experiences with Adjuvant Hormone Therapy-related symptoms, Adjuvant Hormone Therapy-related symptom management, challenges to taking Adjuvant Hormone Therapy, and views about how Adjuvant Hormone Therapy-related symptoms might be better managed.
Wells et al. (2016) [32]	USA	Interview	Underserved breast cancer survivors at a comprehensive cancer centre in the south eastern United States.	25	Mean age: 59.92 (Range 46–71 years; SD = 6.82);	Content Analysis	To evaluate the barriers and facilitators to taking anti-hormonal medications among medically and historically underserved breast cancer survivors within the first five years post chemotherapy, radiation, and/or definitive surgery.
					(15 = no, 10 = yes) Hispanic/Latina, 13 White, 7 African American, 1 Asian, 4 other; 4 Single, 8 Married, 11 Separated, 2 Widowed;
					11 Not Currently Employed, 8 Part-Time, 6 Full-Time