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4 patient barriers in talking about adherence

A patient not discussing adherence issues, doesn’t necessarily signal blue skies. Research suggests at least 50% of patients is non-adherent to their medication, yet adherence is rarely discussed. (OECD, 2018) Alongside more systematic solutions, effective communication may offer respite. What are some of the patient barriers to be mindful of when talking about adherence?

#1 Not wanting to disappoint

We’ve all been there, rather than answering a question honestly we tell a white lie. At the dentist when we’re asked if we’ve flossed (“Of course!”) or when our employer requests we take on more work despite a heavy workload (“Not a problem!”), most people want to please.

There can be many reasons for giving the “desired” answer but ultimately this can lead to worse health outcomes. Assuring a patient that your clinic is a safe space where they can speak freely, may put a patient at ease.

#2 Acting on the defence

Have you ever been confronted in a very direct way? Did it make you want to “scratch back”? A direct confrontation can cue a defensive response as not many people like to be told off. It can also compromise a relationship as it dismisses the opportunity of having a mutually informed conversation.

When asking a patient: “Have you taken your medication?” this may come across as too confrontational. It can create a skewed relationship in which a patient feels uncomfortable disclosing, and an adherence issue, therefore, goes unnoticed. Instead, a more open-phrased question like “Can you tell me a little bit about how you’re getting on with your medicines?” may be better suited.

In some cultural communities the stigma around a disease, like HIV, is so strong patients may struggle to disclose problems around taking their medicines.

#3 Lack of motivation

Patients can have direct or indirect bad experiences around healthcare, some of which may be deeply rooted into a belief system. This can lead to motivational issues around medication and a reluctance to talk.

Healthcare professionals can help patients open-up by empowering them through shared decision making. This offers patients the chance to take back some control, making them feel heard/seen and sets the scene for a productive relationship. (Polinski, et al., 2014)

#4 Factors outside the patient’s control

Aside from internal barriers, aspects outside of the patient’s control can also inform their willingness to talk. Tricky topics like social pressure, a lack of social support or stigmas around a health condition can affect how willing a patient is to talk (Hamilton, et al., 2022) For example, in some cultural communities the stigma around a disease, like HIV, is so strong patients may struggle to disclose problems around taking medicine in social situations.

Being mindful of different circumstances can aid how we prescribe. And being aware a patient may feel embarrassment or reluctance to talk about adherence because of external factors. Offering reassurance, and non-judgemental support, signposting patients to support groups, and - where possible - offering alternatives can all aid better adherence. (d'Ancona & Weinman, 2021)

  1. d'Ancona, G., & Weinman, J. (2021). Improving adherence in chronic airways disease: are we doing it wrongly? Breathe, 1-12.
  2. Hamilton, J., Blanco, E., Selek, S., Wirfel, K., Bernstam, E., Velligan, D., . . . Roberts, K. (2022). Patient and Provider Perspectives on Medication Non-adherence Among Patients with Depression and/or Diabetes in Diverse Community Settings – A Qualitative Analysis. Patient Preference and Adherence, 1581-1594.
  3. OECD. (2018). Investing in medication adherence improves health outcomes and health system efficiency: Adherence to medicines for diabetes, hypertension, and hyperlipidaemia . OECD.
  4. Polinski, J., Kesselheim, A., Frolkis, J., Wescott, P., Allen-Coleman, C., & Fischer, M. (2014). A matter of trust: patient barriers to primary medication adherence. Health Education Research, 755-763

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John  Weinman

John Weinman

Professor of Psychology as applied to Medicines

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