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Mapping Modifiable Determinants of Medication Adherence in Bipolar Disorder (BD) to the Theoretical Domains Framework (TDF): A Systematic Review
44 Pages Posted: 16 Jul 2020More...
Background: Around 40% of patients with bipolar disorder (BD) are non-adherent to prescribed medication leading to relapse, hospitalisation and increased risk of suicide. Lack of progress in addressing medication non-adherence may be partly attributable to the limited understanding of the modifiable determinants of adherence that should be targeted by interventions. We aimed to synthesise the modifiable determinants of medication adherence in BD and map them to the Theoretical Domains Framework (TDF).
Method: We searched CINAHL, Cochrane Library, Embase, LILACS, Medline, PsychINFO, PubMed in Feb 2020 using search terms "Treatment Adherence and Compliance", “Bipolar Disorder” and "Psychotropic Drugs". We included qualitative and quantitative primary studies reporting modifiable determinants of medication adherence in BD. Two reviewers independently screened retrieved studies, extracted modifiable determinants of adherence and coded them to the TDF. The study protocol was registered with PROSPERO [CRD42018096306] and published in the BMJ Open [ http://dx.doi.org/10.1136/bmjopen-2018-026980 ].
Findings: We included 57 studies involving 32894 participants. A majority of studies (n=50) explored modifiable determinants from the perspectives of patients but none included carers. Clinicians reported a narrow range of modifiable determinants, eight themes of determinants mapped to seven TDF domains, compared to 33 themes reported by patient studies covering 11 TDF domains. The TDF domains represented in the greatest number of studies were ‘Environmental context and resources’ (67% of studies) and ‘Beliefs about consequences’ (62%). Examples of the determinants mapped to these domains include the experience of side effects (49% of studies) and beliefs about positive/negative effects of medication (36%). Only patient studies reported the ‘Memory, attention and decision process’ and ‘Emotion’ domains. These domains included modifiable determinants such as forgetfulness (31% of studies) and fear of addiction (20%).
Interpretation: The review highlights that clinicians may be underappreciating the full range of modifiable determinants and thus may not be providing the adherence support reflective of patients’ need. Since each TDF domain has been linked to behavior change techniques (BCTs) this study provides foundation for the development of an adherence tool for clinicians to provide tailored BCTs to support adherence.
Funding Statement: Asta Ratna Prajapati is funded by Health Education England / National Institute for Health Research (NIHR), (Clinical Doctoral Research Fellowship) (NIHR reference number: ICA-CDRF-2017-03-054) for this research project.
Declaration of Interests: None.
Keywords: Medication Adherence; bipolar disorder; reasons of non-adherence; Barriers and facilitators; compliance
Suggested Citation: Suggested Citation