To fully understand the issue, we need to recognise a patient’s non-adherence drivers, know what these are formed by, and understand how patients view themselves within the context of their medicine routine.
In the past when addressing non-adherence, intervention work often focused on doctors providing information to patients and the effect of this on the patient. But information provision alone is not enough to ensure patients remember, especially if it doesn’t address reasons for intentionally not taking a medicine (Jackson et al, 2014).
In the last decade there’s been a push to describe and classify the wide range of techniques that can change behaviour. The COM-B model of behaviour is one of the most widely applied and user-friendly tools to describe what influences a behaviour. It also suggest how someone might go about changing the causes of this behaviour (Byrne-Davis, et al., 2018). Using the COM-B model to describe adherence to medication and determinants of adherence provided a good fit (Jackson et al, 2014).
The behaviour (B) is determined by three main categories: Capability (C), Opportunity (O) and Motivation (M). Capability, the ability to take the medication, perhaps, fits the classic ‘not remembering’ category best as it describes both physical (e.g., the pills are hard to swallow) and psychological factors (e.g., not being able to remember). Opportunity, relates to all elements outside ourselves that affect adherence (e.g., not having the funds to pay for medication, or the necessary social support) – whilst Motivation taps into psychological factors that influence us, for instance emotions, or concerns around the effectiveness of treatment). Capability and Opportunity can also influence Motivation, and vice versa (Michie et al, 2011; Jackson et al 2014). So, patients who view medicines as ‘unimportant’, may also be more likely to forget.