Table 2

Topics of patients’ disclosures of adherence problems, grouped by patient-oriented adherence barrier

Topic of adherence problem disclosure (number of patients disclosing this topic)Recognised when patients’ problem disclosure includes information about:Type of patient-oriented adherence barrier and non-adherence risk according to the PAPA framework18 Illustrative examples of patients’ problem disclosures*
Healthcare systems-related barrier
(n=4) 		… external practical problems stemming from the healthcare system, for example, prescribing errors, unavailability of medications on the market.Practical factor (eg, ability and resources), associated with risk of unintentional non-adherence.

  • Patient is worried she has used the wrong dose due to different information in the discharge letter and pharmacy label.

  • Patient reports being unable to fill prescription.

Limited ability to organise intake of medications in use
(n=8) 		… forgetting to take medications or having limited ability or resources to organise their medications on a regular basis.Practical factor (eg, ability and resources), associated with risk of unintentional non-adherence.

  • Patient reports being unable to dispense own medications.

  • Patient forgets to take medications.

Limited ability to recall or recognise medications in use
(n=11) 		… inability to recall or recognise which medications they are using, as evident in inability to report that information during consultations.Practical factor (eg, ability and resources), associated with risk of unintentional non-adherence.

  • Patient is unable to report medication intake in accordance with prescribed regimen.

  • Patient reports he does not recognise the medication the doctor is talking about.

Negative stance to medications
(n=10) 		… reduced motivation to take medications as prescribed (eg, wants to change, discontinuing).Perceptual factor (eg, beliefs and motivation), associated with risk of intentional non-adherence.

  • Patient reports symptoms he thinks are adverse effects and wants to reduce medications he believes are unnecessary.

  • Patient has discontinued medication.

Negative experience with medications
(n=21) 		… negative experiences after using medications (eg, adverse drug reactions), but without mentioning a reduced motivation to adhere.Perceptual factor (eg, beliefs and motivation), associated with risk of intentional non-adherence.

  • Patient reports adverse effects.

  • Patient reports lack of effect of medication.

Concerns or worries about medications
(n=8) 		… concerns or worries about benefits or preferences about their medications in use.Perceptual factor (eg, beliefs and motivation), associated with risk of intentional non-adherence.

  • Patient is worried about having (too) many medications.

  • Patient is unsure why she needs medication.

  • *Full overview of the 62 red flag-topic descriptions is provided in online supplemental file 2

  • PAPA, Perceptions and Practicalities Approach.