The review found that multifaceted interventions , addressing several non-adherence factors , were comparatively more effective in improving medication adherence and glycaemic target in patients with T2D than single strategies .
However , interventions with similar components and those addressing similar non-adherence factors demonstrated mixed results , making it difficult to conclude on effective intervention strategies to promote adherence .
Educational strategies have remained the most popular intervention strategy , followed by behavioural , with affective components becoming more common in recent years .
There is a noticeable shift in the literature from using single to multifaceted intervention strategies addressing a range of factors impacting adherence to medications .
BACKGROUND Poor adherence to anti-diabetic medications contributes to suboptimal glycaemic control in patients with type 2 diabetes ( T2D ) .
A range of interventions have been developed to promote anti-diabetic medication adherence .
However , there has been very little focus on the characteristics of these interventions and how effectively they address factors that predict non-adherence .
In this systematic review we assessed the characteristics of interventions that aim ed to promote adherence to anti-diabetic medications .
Framework for design and evaluation of complex interventions to improve health
R and omised controlled trials are widely accepted as the most reliable method of determining effectiveness , but most trials have evaluated the effects of a single intervention such as a drug . Recognition is increasing that other , non-pharmacological interventions should also be rigorously evaluated.1 - 3 This paper examines the design and execution of research required to address the additional problems result ing from evaluation of complex interventions —that is , those “ made up of various interconnecting parts.”4 The issues dealt with are discussed in a longer Medical Research Council paper ( www.mrc.ac.uk/complex_packages.html ) . We focus on r and omised trials but believe that this approach could be adapted to other design s when they are more appropriate . # # # # Summary points Complex interventions are those that include several components The evaluation of complex interventions is difficult because of problems of developing , identifying , documenting , and reproducing the intervention A phased approach to the development and evaluation of complex interventions is proposed to help research ers define clearly where they are in the research process Evaluation of complex interventions requires use of qualitative and quantitative evidence There are specific difficulties in defining , developing , documenting , and reproducing complex interventions that are subject to more variation than a drug . A typical example would be the design of a trial to evaluate the  benefits of specialist stroke units .  Such a trial would have to consider the expertise of various health professionals as well as investigations , drugs , treatment guidelines , and arrangements for discharge and follow up . Stroke units may also vary in terms of organisation , management , and skill mix . The active components of the stroke unit may be difficult to specify , making it difficult to replicate the intervention . The box gives other examples of complex interventions . # # # # Examples of complex interventions Service delivery and organisation : Stroke units Hospital at home Interventions directed at health professionals ' behaviour : Strategies for implementing guidelines Computerised decision support Community interventions : Community
The review found that multifaceted interventions , addressing several non-adherence factors , were comparatively more effective in improving medication adherence and glycaemic target in patients with T2D than single strategies .
However , interventions with similar components and those addressing similar non-adherence factors demonstrated mixed results , making it difficult to conclude on effective intervention strategies to promote adherence .
Educational strategies have remained the most popular intervention strategy , followed by behavioural , with affective components becoming more common in recent years .
There is a noticeable shift in the literature from using single to multifaceted intervention strategies addressing a range of factors impacting adherence to medications .
BACKGROUND Poor adherence to anti-diabetic medications contributes to suboptimal glycaemic control in patients with type 2 diabetes ( T2D ) .
A range of interventions have been developed to promote anti-diabetic medication adherence .
However , there has been very little focus on the characteristics of these interventions and how effectively they address factors that predict non-adherence .
In this systematic review we assessed the characteristics of interventions that aim ed to promote adherence to anti-diabetic medications .