Aldosari, Mohammed
(2021)
Medicines adherence in children.
PhD thesis, University of Nottingham.
Abstract
Poor medicines adherence in children is one of the common problems in the health care system. Knowing the medicines adherence rate in individual children is important to understand the consequences of non-adherence. Different factors can contribute to poor adherence such as forgetting, lack of understanding about the treatment or disease, age of child, socioeconomic status, medicines schedule and taste. Strategies that target these factors may improve medicines adherence. This research explores methods of measuring medicines adherence and the barriers and facilitators to medicines adherence in children with diverse diseases.
A systematic review of measures of medicines adherence in children was conducted. Six databases were searched to identify studies published in the last ten years and therefore to focus on the methods recently used to assess medicines adherence in children. Inclusion criteria were original research studies measuring medicines adherence in children. Only 31 articles met the inclusion criteria and were included. The review identified seven methods which had been used to measure adherence; self-report, Electronic Monitoring Devices (EMD), dose count, canister weight, plasma level, checking medical records or pharmacy refill data, and contact by mobile phone. Currently, no gold standard method to measure adherence to medicines in children exists as each method has its own advantages and disadvantages.
A systematic review of the barriers and facilitators to medicines adherence in children was also conducted. Six databases were searched to identify the most common barriers and facilitators in the last ten years. Inclusion criteria were original research studies with stated objectives of identifying barriers and/or facilitators of medicines adherence in children. This review identified 177 articles that met the inclusion criteria. Reported barriers included forgetfulness, weak patient-provider relationships, stigma and discrimination, drug regimen complexity and lack of support from families. Factors reported to facilitate adherence include linking of medicine taking with daily life routines, using reminders to avoid forgetfulness, a higher level of caregivers and parental education and good communication between healthcare professionals, patients and parents.
Based on the findings from the two systematic reviews, two exploratory studies were conducted to measure medicines adherence in children in Saudi Arabia and the UK, and to explore the barriers to and facilitators of medicines adherence in these children. After confirming eligibility for inclusion in the two studies, the patients and their parents or guardians were asked to participate in the studies. The researcher provided them with written and verbal information about the study in age-appropriate language. In both studies, the patient or parent/guardian were asked to answer all questions in the Beliefs about Medicines Questionnaire (BMQ) and our own designed questionnaire, in order to measure medicines adherence and explore the barriers to and facilitators of medicines adherence in children. One hundred children and their parents/guardians were recruited for each study. The study conducted in Saudi Arabia found substantial agreement between the study’s two adherence measurement methods of self-report and Medication possession ratio (MPR) calculation. Additionally, this study identified that changes in daily routine, many doses each day, unpleasant medicine taste and fear of side effects were the most common barriers to medicines adherence. Using reminders, implementing a scheduled routine for taking medicines, measures to address poor taste, pain caused by administration or taking big tablets, and adequate family support were the most common facilitators for medicine adherence in children.
The study conducted in the UK found changes in daily routine, poor medicine taste, many doses each day, and being busy were the most common barriers to medicine adherence. This study similarly found that using reminders, measures to address poor taste, pain caused by administration or taking big tablets, following a scheduled routine for taking medicines, and family support were the most common facilitators in children’s medicine adherence. Both studies found a statistically significant association between the participants’ beliefs about medicines and adherence rates and between adherence rates and the education level of the patients’ parents. However, there was no statistically significant association between adherence rates, age and gender in either study.
This project contributes to the field of medicines adherence in children by confirming that there is currently no gold standard method of measuring it, but that there is good agreement between the two adherence measurements of MPR and self-report. Additionally, parental education level and BMQ differential scores are factors significantly associated with medicines adherence. In addition, this project highlights the most common barriers to and facilitators of medicines adherence in children with diverse diseases in children’s hospitals in Saudi Arabia and the UK.
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