Title: Psycho-Social Determinants and Strategies for Facilitating Adherence to a Complex Medication Regimen in Cancer Treatment
Description: Medication adherence in individuals taking multiple medications has received little research attention, despite its importance in clinical treatment and its relevance to achieving optimal health outcomes. With the growth of the aging population and prevalence of chronic diseases, adherence to multiple medication regimens has become a critical issue. This project, consisting of three related studies, investigated medication adherence of cancer patients who received an allogeneic hematopoietic cell transplant (alloHCT) and whose conditions require adherence to complex, multiple medication regimens for prolonged periods of time. The Information-Motivation-Behavioral Skills (IMB) model was the theoretical framework for the study. This model posits that well-informed, highly motivated individuals have better adherence behaviors. In addition to having optimal information and motivation, patients also need to develop the appropriate behavioral skills to maximize the value of information, motivation and aid adherence.

Thus, within this framework, the link between information, motivation, and adherence is mediated by behavioral skills. Using the IMB model, the aim of this project was to examine different approaches to facilitating medication adherence after transplant. The first study used a mixed-methods approach to examine the feasibility of using an electronic pillbox for assessing adherence to multiple medications. The second study utilized patient interview data to assess the link between social support and adherence to multiple medications. The third study also used patient interview data to identify adherence determinants and strategies that patients used after transplant. The results of the first study show that even though some features of the electronic pillbox need to be modified, it is feasible to use it to facilitate medication adherence for patients after transplant. The second study demonstrated the importance of social support from lay caregivers, such as spouse and family members, as well as healthcare providers, for adherence tasks after transplant.

Lay caregivers provided emotional and practical support, whereas healthcare providers were the main source of informational and medical support. The third study identified various determinants that facilitated and hindered medication adherence. The study also suggests practical lessons for adherence to multiple medications. Collectively, the findings provide a foundation for developing intervention approaches for this particular patient population.