Use of the transtheoretical model in medication adherence: A systematic review

Hyllore Imeri; Jennifer Toth; Austin Arnold; Marie Barnard

doi:10.1016/j.sapharm.2021.07.008

Use of the transtheoretical model in medication adherence: A systematic review

Res Social Adm Pharm. 2022 May;18(5):2778-2785. doi: 10.1016/j.sapharm.2021.07.008. Epub 2021 Jul 15.

Authors

Hyllore Imeri¹, Jennifer Toth², Austin Arnold³, Marie Barnard⁴

Affiliations

¹ Department of Pharmacy Administration, School of Pharmacy, University of Mississippi, University, MS, USA. Electronic address: himeri@go.olemiss.edu.
² Department of Pharmacy Administration, School of Pharmacy, University of Mississippi, University, MS, USA. Electronic address: jtoth@go.olemiss.edu.
³ Department of Pharmacy Administration, School of Pharmacy, University of Mississippi, University, MS, USA. Electronic address: adarnol1@go.olemiss.edu.
⁴ Department of Pharmacy Administration, School of Pharmacy, University of Mississippi, University, MS, USA. Electronic address: mbarnard@olemiss.edu.

PMID: 34275751
DOI: 10.1016/j.sapharm.2021.07.008

Abstract

Background: Medication nonadherence is an important public health issue that has individual and system-level implications. Nonadherence can lead to negative health outcomes and illness, which in turn produce increased healthcare costs for both the individual and system. The transtheoretical model of change (TTM) can be a useful basis for interventions, as it can identify patients' current stages of change and guide them from nonadherence to adherence.

Objective: The objective of this systematic review was to determine the utilization of the TTM to predict or improve medication adherence in patients with chronic conditions.

Methods: A systematic review of current literature was conducted to obtain an overview of the use of TTM-informed interventions for medication adherence in chronic conditions. PubMed, Embase, PsycInfo and CINAHL databases were searched in July 2020. The methodological quality of the studies was evaluated using the Downs and Black checklist. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed for data extraction, analysis, and reporting.

Results: Ten studies were included in the final data synthesis of this review. Eight of the reviewed studies supported the utility of TTM to predict or improve medication adherence in patients with chronic conditions, while two studies did not find any significant improvement in medication adherence after using a TTM-based intervention. The Downs and Black checklist revealed the overall methodological quality of the included studies to be fair [mean (SD) = 16.3 (4.5) of a possible maximum score of 28].

Conclusion: This systematic review provides an overview of the utility of TTM in predicting and improving medication adherence in patients with chronic conditions. Although TTM-based interventions in patients with low or moderate medication adherence were effective, there were few studies identified, suggesting the need for further research.

Keywords: Chronic conditions; Medication adherence; Social and behavioral theory; Stages of change; Systematic review; Transtheoretical model.

Publication types

Review
Systematic Review

MeSH terms

Chronic Disease
Humans
Medication Adherence*
Transtheoretical Model*