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My patient cannot remember their pills. Or can they?

Why do people ‘forget’ to take medication? At first glance it might be down to memory capacity or distraction. Of course, for some patients this is the case but we are more likely to forget things we don’t understand or that don’t seem important to us. For some patients it might even be easier to talk about forgetting than to admit to a healthcare professional that they aren’t sure about a treatment. Sometimes, it is worth looking beyond forgetting to explore other reasons patients don’t take their medication as prescribed.

To fully understand the issue, we need to recognise a patient’s non-adherence drivers, know what these are formed by, and understand how patients view themselves within the context of their medicine routine.

In the past when addressing non-adherence, intervention work often focused on doctors providing information to patients and the effect of this on the patient. But information provision alone is not enough to ensure patients remember, especially if it doesn’t address reasons for intentionally not taking a medicine (Jackson et al, 2014).

In the last decade there’s been a push to describe and classify the wide range of techniques that can change behaviour. The COM-B model of behaviour is one of the most widely applied and user-friendly tools to describe what influences a behaviour. It also suggest how someone might go about changing the causes of this behaviour (Byrne-Davis, et al., 2018). Using the COM-B model to describe adherence to medication and determinants of adherence provided a good fit (Jackson et al, 2014).

The behaviour (B) is determined by three main categories: Capability (C), Opportunity (O) and Motivation (M). Capability, the ability to take the medication, perhaps, fits the classic ‘not remembering’ category best as it describes both physical (e.g., the pills are hard to swallow) and psychological factors (e.g., not being able to remember). Opportunity, relates to all elements outside ourselves that affect adherence (e.g., not having the funds to pay for medication, or the necessary social support) – whilst Motivation taps into psychological factors that influence us, for instance emotions, or concerns around the effectiveness of treatment). Capability and Opportunity can also influence Motivation, and vice versa (Michie et al, 2011; Jackson et al 2014). So, patients who view medicines as ‘unimportant’, may also be more likely to forget.

Understanding what factors are most important to the patient offers appropriate fuel for a tailored intervention.

Understanding what factors are most important to the patient offers appropriate fuel for a tailored intervention. It allows the focus to shift from ‘providing the patient with information’ to ‘empowering the patient to make their own informed decisions’. The latter could involve correcting misinformation or offering new insights but is not limited by it. The major difference is the involvement of the patient in the process – and ultimately changing behaviour.

So next time your patient ‘forgets’ to take their medicine, look beyond their memory.

Byrne-Davis, L., Hart, J. & Bull, E., 2018. Policy @ Manchester Blogs. [Online]
Available at: https://blog.policy.manchester.ac.uk/posts/2018/04/just-because-i-can-doesnt-mean-i-will-behavioural-science-and-translating-professional-change-into-practice/
[Accessed 9 March 2022].
Jackson, C., Eliasson, L., Barber, N. & Weinman, J. (2014) Applying COM-B to medication adherence. A suggested framework for research and interventions. The European Health Psychologist, 6 (1), 7-17.
Michie, S., van Stralen, M. M., & West, R. (2011) The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implement Science, 6, 42. doi:10.1186/1748-5908-6-42

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Tess  van Leeuwen

Tess van Leeuwen

Digital Lead

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