4 patient barriers in talking about adherence

#1 Not wanting to disappoint

We’ve all been there, rather than answering a question honestly we tell a white lie. At the dentist when we’re asked if we’ve flossed (“Of course!”) or when our employer requests we take on more work despite a heavy workload (“Not a problem!”), most people want to please.

There can be many reasons for giving the “desired” answer but ultimately this can lead to worse health outcomes. Assuring a patient that your clinic is a safe space where they can speak freely, may put a patient at ease.

#2 Acting on the defence

Have you ever been confronted in a very direct way? Did it make you want to “scratch back”? A direct confrontation can cue a defensive response as not many people like to be told off. It can also compromise a relationship as it dismisses the opportunity of having a mutually informed conversation.

When asking a patient: “Have you taken your medication?” this may come across as too confrontational. It can create a skewed relationship in which a patient feels uncomfortable disclosing, and an adherence issue, therefore, goes unnoticed. Instead, a more open-phrased question like “Can you tell me a little bit about how you’re getting on with your medicines?” may be better suited.

#3 Lack of motivation

Patients can have direct or indirect bad experiences around healthcare, some of which may be deeply rooted into a belief system. This can lead to motivational issues around medication and a reluctance to talk.

Healthcare professionals can help patients open-up by empowering them through shared decision making. This offers patients the chance to take back some control, making them feel heard/seen and sets the scene for a productive relationship. (Polinski, et al., 2014)

#4 Factors outside the patient’s control

Aside from internal barriers, aspects outside of the patient’s control can also inform their willingness to talk. Tricky topics like social pressure, a lack of social support or stigmas around a health condition can affect how willing a patient is to talk (Hamilton, et al., 2022) For example, in some cultural communities the stigma around a disease, like HIV, is so strong patients may struggle to disclose problems around taking medicine in social situations.

Being mindful of different circumstances can aid how we prescribe. And being aware a patient may feel embarrassment or reluctance to talk about adherence because of external factors. Offering reassurance, and non-judgemental support, signposting patients to support groups, and - where possible - offering alternatives can all aid better adherence. (d'Ancona & Weinman, 2021)

1. d'Ancona, G., & Weinman, J. (2021). Improving adherence in chronic airways disease: are we doing it wrongly? Breathe, 1-12.

2. Hamilton, J., Blanco, E., Selek, S., Wirfel, K., Bernstam, E., Velligan, D., . . . Roberts, K. (2022). Patient and Provider Perspectives on Medication Non-adherence Among Patients with Depression and/or Diabetes in Diverse Community Settings – A Qualitative Analysis. Patient Preference and Adherence, 1581-1594.

3. OECD. (2018). Investing in medication adherence improves health outcomes and health system efficiency: Adherence to medicines for diabetes, hypertension, and hyperlipidaemia . OECD.

4. Polinski, J., Kesselheim, A., Frolkis, J., Wescott, P., Allen-Coleman, C., & Fischer, M. (2014). A matter of trust: patient barriers to primary medication adherence. Health Education Research, 755-763