A Qualitative Study On Barriers And Facilitators And Strategies To Improve Adherence To Antidepressants Among Outpatients With Major Depressive Disorder
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Date
2017-01
Authors
Ho, Siew Ching
Journal Title
Journal ISSN
Volume Title
Publisher
Universiti Sains Malaysia
Abstract
Major depressive disorder (MDD) is associated with a high rate of relapse
and recurrence. One of the major challenges in treating MDD is patients’ nonadherence
to medication. The objectives aimed: (1) to explore the barriers and
facilitators of patients’ adherence to antidepressants among outpatients with MDD;
(2) to identify strategies that aimed to improve adherence from the perspective of
various stakeholders. A qualitative study using semi-structured and individual indepth
interviews was conducted in phase I of the study. Thirty participants were
purposively sampled from different ethnicities to achieve maximum variation in
sampling, and data were collected until it reached thematic saturation. Interviews
were conducted using a validated topic guide and responses were audio-tape
recorded, transcribed verbatim, checked, and analysed using the grounded theory
approach. In phase II, a Delphi survey involving 20 panellists from physicians,
pharmacists, and nurses/medical assistant; was conducted to validate a list of
strategies that aimed to improve patients’ adherence. Panellists completed tworounds
of self-administered questionnaires to obtain a group consensus for the
strategies identified. Results from phase I showed that 40 different themes and subthemes
were identified which were conceptually divided into two distinct categories
related to barriers and facilitators to adherence. The barriers were: patient-specific
barriers (sub-categorised into erroneous beliefs, forgetfulness, negative attitudes, and
lack of knowledge), medication-specific barriers (side effects, pill burden, treatment
duration, and costs), healthcare provision and system, social-cultural barriers (lack of
support, barriers related to religion and cultural beliefs, and stigma), and logistic
barriers.
Description
Keywords
Barriers and facilitators and strategies to improve adherence , antidepressants among outpatients with major depressive disorder