Cited by 367Medication Adherence and CompliancePharmacy and Medical PracticesPatient Safety and Medication Errors

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Medication adherence outcomes of 771 intervention trials: Systematic review and meta-analysis

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Conn, Vicki S., Ruppar, Todd M.·2017·Preventive Medicine

DOI 10.1016/j.ypmed.2017.03.008PMC PMC5467216

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Abstract

Excellent medication adherence contributes to decreases in morbidity, mortality, and health care costs. Although researchers have tested many interventions to increase adherence, results are sometimes conflicting and often unclear. This systematic review applied meta-analytic procedures to integrate primary research that tested medication adherence interventions. Comprehensive searching completed in 2015 located 771 published and unpublished intervention studies with adherence behavior outcomes. Random-effects model analysis calculated standardized mean difference effect sizes. Meta-analytic moderator analyses examined the association between adherence effect sizes and sample, design, and intervention characteristics. Analyses were conducted in 2016. A standardized mean difference effect size of 0.290 comparing treatment and control groups was calculated. Moderator analyses revealed larger effect sizes for habit-based and behavioral-targeted (vs. cognitive-focused) interventions. The most effective interventions were delivered face-to-face, by pharmacists, and administered directly to patients. Effect sizes were smaller in studies with older and homeless participants. Risks of bias were common; effect sizes were significantly lower among studies with masked data collectors and intention-to-treat analyses. The largest effect sizes were reported by studies using medication electronic event monitoring and pill count medication adherence measures. Publication bias was present. This most comprehensive review to date documented that, although interventions can increase adherence, much room remains for improvement. Findings suggest health care providers should focus intervention content on behavioral strategies, especially habit-based interventions, more so than cognitive strategies designed to change knowledge and beliefs.

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Bias in meta-analysis detected by a simple, graphical test
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BackgroundMethod
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BackgroundResultInfluential
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Result
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“Numerous reviews of adherence intervention trials across di ﬀ erent conditions, medications, and settings (Conn & Ruppar, 2017; Nieuwlaat et al., 2014; Verloo et al., 2017) have identi ﬁ ed interventions that can reduce nonadherence.”
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“Unfortunately, adherence interventions have been only partly effective [13-16].”
Background
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Background
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Primary Care Providers’ Acceptance of Pharmacists’ Recommendations to Support Optimal Medication Management for Patients with Diabetic Kidney Disease
Zullig, L. L., Jazowski, S. A., Davenport, C. A., Diamantidis, C. J., Oakes, M. M., Patel, S., Moaddeb, J., & Bosworth, H. B. (2019) · Journal of General Internal Medicine · doi:10.1007/s11606-019-05403-x · Cited by 10
Adherence management in transplantation
Geest, S. D., Ribaut, J., Denhaerynck, K., & Dobbels, F. (2020) · Elsevier eBooks · doi:10.1016/b978-0-12-817080-9.00019-1 · Cited by 9
The effect of a pharmacist consultation on pregnant women’s quality of life with a special focus on nausea and vomiting: an intervention study
Truong, M. B.-T., Ngo, E., Ariansen, H., Tsuyuki, R. T., & Nordeng, H. (2020) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-020-03472-z · Cited by 11
Understanding the Effect of a Healthcare Provider-Led Family Planning Support Intervention on Contraception use and Pregnancy Desires among Postpartum Women Living with HIV in Southwestern Uganda
Atukunda, E. C., Matthews, L. T., Musiimenta, A., Agaba, A. G., Najjuma, J. N., Lukyamuzi, E. J., Kaida, A., Obua, C., & Mugyenyi, G. R. (2021) · AIDS and Behavior · doi:10.1007/s10461-021-03380-z · Cited by 9
“Our intervention was also delivered by nurses and midwives based at the postnatal ward and clinic just like documented by previous studies [56].”
BackgroundMethod
Narrative arcs and shaping influences in long-term medication adherence
Nakata, C. C., Sharp, L. K., Spanjol, J., Cui, A. S., Izberk‐Bilgin, E., Crawford, S. Y., & Xiao, Y. (2021) · Social Science & Medicine · doi:10.1016/j.socscimed.2021.114264 · Cited by 9
Managing Medications and Medication Adherence Among US Adults During the Early Phase of the COVID-19 Pandemic
Ellis, R. J. B., Andrews, A. M., Elomba, C. D., Remy, L. M., Ruggeri, S. Y., Russell, C. L., & Ruppar, T. M. (2023) · Patient Preference and Adherence · doi:10.2147/ppa.s393749 · Cited by 9
“Habits remove the necessity of relying on memory and motivation alone, thereby improving adherence.(47,48) Additionally, the qualitative comments in our study supported this finding and respondents reported they used routines to help support taking medications, while some reported that they needed greater habit and re…”
ResultSelf-citation
Adherence to Short-course Pharmacotherapy in Adults with Irritable Bowel Syndrome
Sherwin, L. B., Deroche, C. B., Krisanabud, P., Matteson, M., Bechtold, M. L., & Ruppar, T. M. (2019) · Western Journal of Nursing Research · doi:10.1177/0193945919872419 · Cited by 9
“As noted in a comprehensive review on adherence interventions, establishment of behavioral routines are superior to cognitive interventions (Conn & Ruppar, 2017).”
BackgroundSelf-citation
Interventions Designed to Improve Adherence to Growth Hormone Treatment for Pediatric Patients and Their Families: A Narrative Review
Graham, S., Quirke‐McFarlane, S., Auyeung, V., & Weinman, J. A. (2022) · Pharmaceutics · doi:10.3390/pharmaceutics14112373 · Cited by 9
Detecting Medication-Taking Gestures Using Machine Learning and Accelerometer Data Collected via Smartwatch Technology: Instrument Validation Study
Odhiambo, C. O., Ablonczy, L., Wright, P. J., Corbett, C. F., Reichardt, S., & Valafar, H. (2023) · JMIR Human Factors · doi:10.2196/42714 · Cited by 9
“…forgetfulness, findings from a meta-analysis of medication adherence interventions among adults demonstrated that linking medication taking with existing daily routines and using behavioral strategies (eg, prompts to take medication) are the most effective approaches to promote adherence [4].”
Implementation and results of a standardized process for identifying ambulatory pharmacy clinical outcome measures
McKay, C., Vest, M., Doligalski, C. T., Summerlin, C. M., Alexander, M. D., Deyo, Z. M., Valgus, J. M., & Waldron, K. M. (2023) · American Journal of Health-System Pharmacy · doi:10.1093/ajhp/zxad056 · Cited by 8
Sorbets as Functional Food Products, Unexplored Food Matrices, Their Challenges, and Advancements
Williams, J., McKune, A. J., & Naumovski, N. (2023) · Applied Sciences · doi:10.3390/app132111945 · Cited by 12
“Non-adherence to medications is also an increasing problem in clinical and research settings [113], with a relatively large gap in the literature concerning healthcare providers and those who consume medications regularly.”
Background
Using a learning health system to understand the mismatch between medicines supply and actual medicines use among adults with cystic fibrosis
Bevan, A., Hoo, Z. H., Totton, N., Girling, C., Davids, I. R., Whelan, P., Antrobus, S., Ainsworth, J. D., Buchan, I. E., Anderson, A. J. B., et al. (2021) · Journal of Cystic Fibrosis · doi:10.1016/j.jcf.2021.09.007 · Cited by 8
Understanding reasons and factors for participation and non-participation to a medication adherence program for patients with diabetic kidney disease in Switzerland: a mixed methods study
Bandiera, C., Lam, L., Locatelli, I., Dotta-Celio, J., Duarte, D., Wuerzner, G., Pruijm, M. T., Zanchi, A., & Schneider, M. P. (2022) · Diabetology & Metabolic Syndrome · doi:10.1186/s13098-022-00898-7 · Cited by 9
“In a metaanalysis including 771 adherence studies, the effects of the interventions on medication adherence outcomes seem to be smaller in older patients compared to younger [45].”
Background
Supported self-management in asthma
Pinnock, H., McClatchey, K., & Hui, C. Y. (2023) · European Respiratory Society eBooks · doi:10.1183/2312508x.10001723 · Cited by 8
Medication adherence beliefs of U.S community pharmacists
Witry, M. J. (2017) · Research in Social and Administrative Pharmacy · doi:10.1016/j.sapharm.2017.06.006 · Cited by 8
Compliance and persistence with Alzheimer’s disease treatment: a retrospective analysis of multiregional hospital databases in Thailand
Kongpakwattana, K., Dilokthornsakul, P., Dejthevaporn, C., Pattanaprateep, O., & Chaiyakunapruk, N. (2018) · Journal of Medical Economics · doi:10.1080/13696998.2018.1534739 · Cited by 8
Satisfaction and experiences of patients taking fingolimod and involved in a pharmacy-based patient support program in Switzerland — a qualitative study
Bourdin, A., Dubois, J., Foley, R.-A., Schluep, M., Bugnon, O., & Berger, J. (2020) · BMC Health Services Research · doi:10.1186/s12913-020-05278-3 · Cited by 9
“pharmacist appears as a key actor for effective pharmacovigilance programs and to support medication adherence [19, 20].”
Background
Studies of Medication Adherence
Acri, T., & Gross, R. (2013) · doi:10.1002/9781118344828.ch20 · Cited by 8
Protocol adherence rates in superiority and noninferiority randomized clinical trials published in high impact medical journals
Bamat, N. A., Ekhaguere, O. A., Zhang, L., Flannery, D. D., Handley, S. C., Herrick, H. M., & Ellenberg, S. S. (2020) · Clinical Trials · doi:10.1177/1740774520941428 · Cited by 6
Adherence to Antihypertensive Therapy: A Systematic Review of Russian Prospective Studies from 2000 to 2019
Бочкарева, Е. В., Кронидовна, Б. Е., Ким, И. В., Васильевна, К. А., & Drapkina, O. M. (2020) · Rational Pharmacotherapy in Cardiology · doi:10.20996/1819-6446-2020-10-20 · Cited by 7
Intervention for a correct medication list and medication use in older adults: a non-randomised feasibility study among inpatients and residents during care transitions
Musawi, A. A., Hellström, L., Axelsson, M., Midlöv, P., Rämgård, M., Cheng, Y., & Eriksson, T. (2024) · International Journal of Clinical Pharmacy · doi:10.1007/s11096-024-01702-4 · Cited by 7
“Moreover, a systematic review and meta-analysis showed that adherence interventions were less effective when delivered in the participants’ homes than in other locations, such as pharmacies or clinics [46].”
Background
Enhancing Primary Adherence to Prescribed Medications through an Organized Health Status Assessment-Based Extension of Primary Healthcare Services
Harsha, N., Papp, M., Kőrösi, L., Czifra, Á., Ádány, R., & Sándor, J. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph16203797 · Cited by 7
“Such strategies have included improving the patient–physician relationship, communication, and trust; expanding and emphasizing the pharmacist role in primary healthcare [9,27,38]; increasing awareness of the patient regarding his/her disease and medications [39,40]; controlling medication-related side effects and per…”
Background
Comparing medication adherence using a smartphone application and electronic monitoring among patients with acute coronary syndrome
Giordano, N. A., Connell, K. A., French, R., Daus, M., Stephens‐Shields, A. J., Kimmel, S. E., & Riegel, B. J. (2021) · Applied Nursing Research · doi:10.1016/j.apnr.2021.151448 · Cited by 7
Randomised controlled trial targeting habit formation to improve medication adherence to daily oral medications in patients with gout
Fontanet, C. P., Choudhry, N. K., Wood, W., Robertson, T., Haff, N., Oran, R., Sears, E. S., Kim, E., Hanken, K. E., Barlev, R. A., et al. (2021) · BMJ Open · doi:10.1136/bmjopen-2021-055930 · Cited by 7
Assessment of Saudi Women’s Adherence and Experience with Venous Thromboembolism Prophylaxis after Cesarean Section Delivery Using Telemedicine Technology
Elmaghraby, D. A., Al-Bassri, Z. K., AlTuraiki, Z. A., Alsaleh, J. A., Alzuwayyid, L. S., Albanyan, N., & Almulhim, A. (2022) · Applied Bionics and Biomechanics · doi:10.1155/2022/8440789 · Cited by 7
Retracted
Codevelopment of a Text Messaging Intervention to Support Adherence to Adjuvant Endocrine Therapy in Women With Breast Cancer: Mixed Methods Approach
Green, S. M. C., French, D., Hall, L., Bartlett, Y. K., Rousseau, N. S., Raine, E., Parbutt, C., Gardner, B., ROSETA Investigators, & Smith, S. G. (2023) · Journal of Medical Internet Research · doi:10.2196/38073 · Cited by 7
“On the basis of evidence suggesting that habit interventions could be effective for improving medication adherence [38,39] and the potential for habitual medication taking to reduce forgetfulness of taking AET, SMS text messages were designed based on habit theory.”
Medication Adherence Rates in Adolescents With Eosinophilic Esophagitis Are Low and Are Associated With Health Habits
Mehta, P., Pan, Z., Zhou, W., Kwan, B. M., & Furuta, G. T. (2023) · Journal of Pediatric Gastroenterology and Nutrition · doi:10.1097/mpg.0000000000003885 · Cited by 7
“Newer research shows that habit formation interventions are the most effective way to improve adherence (17).”
Background
The positive affect, promoting Positive Engagement, and Adherence for Life (APPEAL) feasibility trial: Design and rationale.
Wilson, T. E., Massiah, C., Radigan, R., DeHovitz, J. A., Govindarajulu, U. S., Holman, S., Melendez, M., Yusuff, J., & Taylor, T. (2020) · Health Psychology · doi:10.1037/hea0000880 · Cited by 7
Lithium levels and lifestyle in patients with bipolar disorder: a new tool for self-management
Zorrilla, E. P., López-Zurbano, S., Alberich, S., BARBERO, I., López-Peña, P., García-Corres, E., Chart‐Pascual, J. P., Crespo, J. M., Dios, C. D., Balanzá‐Martínez, V., et al. (2023) · International Journal of Bipolar Disorders · doi:10.1186/s40345-023-00291-x · Cited by 6
“As stated by Conn and Ruppar (2017), healthcare professionals should use lifestyle-based interventions to implement a more personalized medicine.”
Background
5-year adherence to adjuvant endocrine treatment in Dutch women with early stage breast cancer: A population-based database study (2006–2016)
van den Biggelaar, Y., Kuiper, J. G., van der Sangen, M. J. C., Luiten, E. J. T., Siesling, S., van Herk‐Sukel, M. P. P., Voogd, A. C., & Mesters, I. (2023) · Breast Disease · doi:10.3233/bd-230024 · Cited by 6
“Sensitivity analysis using a permissible gap of 90 and 180 days, showed a 5-year persistence rate of 55.4% and 66.6%, respectively.”
Influential
Improving Assessment of Adherence Behaviors and Drivers: Targeted Literature Review and Concept Elicitation Interviews in Multiple Countries and Disease Populations
Bentley, S., Exall, E., Morgan, L., Roche, N., Khunti, K., Rossom, R., Piercy, J., Arbuckle, R., & Higgins, V. (2024) · Patient Preference and Adherence · doi:10.2147/ppa.s433662 · Cited by 6
To Improve Motivational Barriers to Retention in High Resolution Anoscopy, Patients and Providers Recommend Social and Environmental Changes: A Sequential Explanatory Mixed-Methods Pilot Study in a Federally Qualified Health Center
Kutner, B. A., Hou, B., Giguere, R., DeWitt, W., Tan, M., Rael, C. T., Radix, A. E., & Sandfort, T. G. M. (2024) · AIDS and Behavior · doi:10.1007/s10461-024-04419-7 · Cited by 6
“The association between a patient’s understanding and their belief of the necessity of medical intervention and the likelihood of adherence is widely established, at least for adherence to medication [37, 38].”
Background
Adherence to Medication in Neurogeriatric Patients: Insights from the NeuroGerAd Study
Schönenberg, A., Mühlhammer, H. M., Lehmann, T., & Prell, T. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11185353 · Cited by 5
“Although education is often discussed as an intervention method for increasing adherence [2,9], it is important to keep in mind that the education level measured in this study was not medication-specific.”
BackgroundResult
Nurse-Led Interventions to Promote Medication Adherence in Community Care: A Systematic Review
Sletvold, H., Jordan, S. E., & Olsen, R. M. (2022) · doi:10.23865/noasp.172.ch8 · Cited by 6
Health Control Beliefs and Attitude Toward Treatment in Psychiatric and Non-Psychiatric Clinical Samples
Pogány, L., & Lazáry, J. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.537309 · Cited by 6
Piloting a team-based telemedicine care for hypertension focused on Black patients
Manandhar, S., Chhetri, S., Sutton, D., Saha, A., Kaur, S., Brown, J., Williamson, J. D., Callahan, K. E., Moore, J. B., Taylor, Y. J., et al. (2025) · Pilot and Feasibility Studies · doi:10.1186/s40814-025-01656-y · Cited by 5
“These strategies can be effective in improving medication adherence [25–27].”
Self-efficacy, medical adherence and related factors in patients with diabetes
ŞAHİN, D., Ersoy, S., & Pala, E. (2021) · Family practice and palliative care · doi:10.22391/fppc.809768 · Cited by 5
Impact on patients’ compliance with medication using prepacked blisters for multidrug medical therapy: I-COMPLY Study
Shah, G. V., Erickson, J. L., Luxenburg, J., Hu, B., Reali-Sorrell, M., Lovelace, R., Pfoh, E. R., Kobaivanova, N., & Brateanu, A. (2021) · American Journal of Health-System Pharmacy · doi:10.1093/ajhp/zxab193 · Cited by 5
Association Between Cost-Saving Prescription Policy Changes and Adherence to Chronic Disease Medications: an Observational Study
Haff, N., Sequist, T. D., Gibson, T. B., Benevent, R., Sears, E. S., Chaguturu, S. K., & Lauffenburger, J. C. (2021) · Journal of General Internal Medicine · doi:10.1007/s11606-021-07031-w · Cited by 6
Motivational interviewing to support medication adherence in older patients: Barriers and facilitators for implementing in hospital setting according to healthcare professionals
Temedda, M. N., Haesebaert, J., Viprey, M., Schott, A., Dima, A. L., Papus, M., Schneider, M. P., & Novais, T. (2024) · Patient Education and Counseling · doi:10.1016/j.pec.2024.108253 · Cited by 5
Personalized Intervention to Improve Medication Adherence for Persons with Multiple Sclerosis
Neter, E., Esterkin-Hubner, E., Glass‐Marmor, L., Wolkowitz, A., Lavi, I., & Miller, A. (2024) · Patient Preference and Adherence · doi:10.2147/ppa.s455518 · Cited by 5
“15 Medication adherence interventions among PwMS are few; 17–22 the reported interventions are tailored, using either digital tools or motivational interviewing (MI), the latter delivered either via telephone or face-to-face.”
Background
Short- and Midterm Adherence to Platelet P2Y12 Receptor Inhibitors After Percutaneous Coronary Intervention With Drug-Eluting Stents
Morita, F., Wajngarten, M., Katz, M., Fernandes-Silva, M. M., Caixeta, A. M., Franken, M., Lemos, P. A., & Pesaro, A. E. P. (2020) · Journal of Cardiovascular Pharmacology and Therapeutics · doi:10.1177/1074248420926667 · Cited by 5
“Packaging that includes calendars, pill holders, the use of diaries, simplification of the therapeutic regimen, alert devices, the encouragement of self-monitoring (eg, blood pressure and blood sugar), positive reinforcement, and motivational counseling are examples of behavioral interventions that have shown good res…”
Method
A tailored intervention for illness acceptance improves adherence and quality of life in adults with haemophilia using prophylaxis
Hoefnagels, J. W., Fischer, K., Bos, R. A. T., Driessens, M. H. E., & Schrijvers, L. H. (2021) · Haemophilia · doi:10.1111/hae.14320 · Cited by 5
Therapy satisfaction and health literacy are key factors to improve medication adherence in systemic sclerosis
Matrisch, L., Graßhoff, H., Müller, A., Schinke, S., & Riemekasten, G. (2022) · Scandinavian Journal of Rheumatology · doi:10.1080/03009742.2022.2111771 · Cited by 5
“have not shown much success in other diseases (38).”
Background

Authors: Conn, V. S., & Ruppar, T. M.
Affiliations: University of Missouri (US)
Corresponding author: Conn, Vicki S.
ORCID: Conn, Vicki S.
Ruppar, Todd M.
Venue: Preventive Medicine
Publisher: Elsevier BV
Published: 2017-06
Volume: 99
Pages: 269-276
ISSN: 0091-7435 (ISSN-L)
DOI: 10.1016/j.ypmed.2017.03.008
PMC: PMC5467216
OpenAlex: W2597284704
Cited by: 367
References: 36
Citations by year: 2026: 20 · 2025: 39 · 2024: 41 · 2023: 47 · 2022: 57 · 2021: 55 · 2020: 52 · 2019: 37 · 2018: 11 · 2017: 6
FWCI: 4.87
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Preventive Medicine (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
Funders: National Institutes of Health (R01NR011990)
Topics: Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
Health Sciences › Health Professions › Pharmacy › Pharmacy and Medical Practices
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Patient Safety and Medication Errors
Keywords: medication adherence, adherence interventions, behavioral interventions, cognitive intervention, pill count, publication bias, risk of bias, older adults, homeless patients
MeSH terms: Assessment of Medication Adherence, Humans, Research Design, Bias, Drug Monitoring, Medication Adherence

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Medication adherence outcomes of 771 intervention trials: Systematic review and meta-analysis

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