Barriers to adherence to treatment in chronic illness - patient perspectives

Abstract

Background: Adherence to treatment is a serious financial, psychological and social issue. Researchers aimed to identify barriers to adherence, but there are only few classifications that could provide a theoretical framework for future analyses. Little data on this issue has been reported from Eastern Europe. Methods: 232 ambulatory patients (aged 13-85; M=53; SD=17.57) suffering from chronic illnesses listed perceived barriers to adherence and reported their adherence levels in a questionnaire. After preliminary analyses we decided to put their answers into 6 categories based on WHO's broad definition of health: physical (e.g. side effects), cognitive (e.g. forgetting), emotional (e.g. illness-related anxiety), material (e.g. no money), value-oriented (e.g. other things are more important) and time-related (e.g. being overworked). We asked competent judges to categorize the answers. Findings: The two most common categories were cognitive and material barriers. Compared to low adherence, patients declaring high/moderate adherence identified emotional and cognitive barriers more often and material barriers less often. Surprisingly, patients with a higher education mentioned time-related and cognitive barriers more often than other patients, while emotional barriers were mentioned most often by patients with a primary education. For all adherence levels (low/moderate/high) physical barriers were least common and cognitive barriers were most common. Discussion: The identification of perceived barriers to adherence is vital in planning to overcome low adherence. Our findings and proposed categorization of adherence barriers can serve as a theoretical framework for future analyses. The results show, that there are differences in perceived adherence barriers between patients with different characteristics