Cited by 39Medication Adherence and ComplianceBehavioral Health and InterventionsHealth Policy Implementation Science

A systematic review of the inclusion of mechanisms of action in NIH-funded intervention trials to improve medication adherence

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Edmondson, Donald, Falzon, Louise, Sundquist, Kevin J., Julian, Jacob, Meli, Laura, Sumner, Jennifer A., Kronish, Ian M.·2018·Behaviour Research and Therapy

Abstract

Medication nonadherence contributes to morbidity/mortality, but adherence interventions yield small and inconsistent effects. Understanding the mechanisms underlying initiation and maintenance of adherence could improve interventions. The National Institutes of Health (NIH) support adherence research, but it is unclear whether existing NIH-funded research incorporates mechanisms. We conducted a systematic review to determine the proportion of NIH-funded adherence trials that have tested hypothesized mechanisms of intervention effects. We included randomized and quasi-randomized NIH-funded trials with medication adherence in adults as the primary outcome. Studies were identified by searching electronic databases from inception to 6/2016, references, and clinicaltrials.gov. Two of 18 (11%) NIH-funded trials tested a hypothesized mechanism of an intervention's effect on medication adherence. Another 44 studies with medication adherence as a secondary outcome were described in protocol form, and are either ongoing or never published results, but none mentioned mechanism tests. Overall, 3% of NIH-funded trials with adherence as an outcome conducted, or plan to conduct, tests of behavior change mechanisms. These results mirror previous findings that very few studies of behavior change interventions actually test the mechanism by which the intervention is hypothesized to improve health behaviors. We must understand mechanisms if we are to improve the effectiveness of interventions.

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  1. Nasseh K Frazee SG Visaria J Vlahiotis A Tian Y 2012 Cost of medication nonadherence associated with diabetes, hypertension, and dyslipidemia American Journal of Pharmacy Benefits 4 2 e41 e47

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Authors
Edmondson, D., Falzon, L., Sundquist, K. J., Julian, J., Meli, L., Sumner, J. A., & Kronish, I. M.
Affiliations
Columbia University Irving Medical Center (US)
Corresponding author
Edmondson, Donald
Venue
Behaviour Research and Therapy
Publisher
Elsevier BV
Published
2018-02
Volume
101
Pages
12-19
ISSN
0005-7967 (ISSN-L)
OpenAlex
W2761901593
Cited by
39
References
49
Citations by year
2026: 4 · 2025: 2 · 2024: 2 · 2023: 3 · 2022: 7 · 2021: 2 · 2020: 15 · 2019: 3 · 2018: 1
FWCI
0.87
Type
journal article
Language
en
Open access
Locations
  • Behaviour Research and Therapy (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • NIH
  • National Institutes of Health
  • National Institute on Aging (U24AG052175)
Topics
  • Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
  • Social Sciences › Psychology › Applied Psychology › Behavioral Health and Interventions
  • Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
Keywords
medication adherence, mechanism of action, behaviour change interventions, adherence interventions, intervention effectiveness
MeSH terms
Humans, National Institutes of Health (U.S.), Research Support as Topic, United States, Randomized Controlled Trials as Topic, Drug Monitoring

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