A meta-analysis of cognitive-based behaviour change techniques as interventions to improve medication adherence

Easthall, C., Song, Fujian and Bhattacharya, D. (2013) A meta-analysis of cognitive-based behaviour change techniques as interventions to improve medication adherence. BMJ Open, 3 (8). ISSN 2044-6055

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Abstract

Objective To describe and evaluate the use of cognitive-based behaviour change techniques as interventions to improve medication adherence. Design Systematic review and meta-analysis of interventions to improve medication adherence. Data sources Search of the MEDLINE, EMBASE, PsycINFO, CINAHL and The Cochrane Library databases from the earliest year to April 2013 without language restriction. References of included studies were also screened to identify further relevant articles. Review methods We used predefined criteria to select randomised controlled trials describing a medication adherence intervention that used Motivational Interviewing (MI) or other cognitive-based techniques. Data were extracted and risk of bias was assessed by two independent reviewers. We conducted the meta-analysis using a random effects model and Hedges’ g as the measure of effect size. Results We included 26 studies (5216 participants) in the meta-analysis. Interventions most commonly used MI, but many used techniques such as aiming to increase the patient's confidence and sense of self-efficacy, encouraging support-seeking behaviours and challenging negative thoughts, which were not specifically categorised. Interventions were most commonly delivered from community-based settings by routine healthcare providers such as general practitioners and nurses. An effect size (95% CI) of 0.34 (0.23 to 0.46) was calculated and was statistically significant (p?<?0.001). Heterogeneity was high with an I2 value of 68%. Adjustment for publication bias generated a more conservative estimate of summary effect size of 0.21 (0.08 to 0.33). The majority of subgroup analyses produced statistically non-significant results. Conclusions Cognitive-based behaviour change techniques are effective interventions eliciting improvements in medication adherence that are likely to be greater than the behavioural and educational interventions largely used in current practice. Subgroup analyses suggest that these interventions are amenable to use across different populations and in differing manners without loss of efficacy. These factors may facilitate incorporation of these techniques into routine care.

Item Type: Article
Additional Information: This article has a correction. Please see: BMJ Open 2014;4 doi:10.1136/bmjopen-2013-002749corr1 This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/
Faculty \ School: Faculty of Science > School of Pharmacy
Faculty of Medicine and Health Sciences > Norwich Medical School
Faculty of Science
Depositing User: Pure Connector
Date Deposited: 18 Sep 2013 05:15
Last Modified: 24 Jul 2019 18:51
URI: https://ueaeprints.uea.ac.uk/id/eprint/43293
DOI: 10.1136/bmjopen-2013-002749

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