Title: Literature Review Of Functional, Educational, And Motivational Adherence Interventions
Abstract: Despite the clear benefits of high adherence, interventions aimed at improving adherence have had mixed success. This study reviewed the evidence associated with the following adherence intervention types: functional (e.g., introducing medication reminder systems), educational interventions (e.g., improving disease and adherence education), and motivational interventions (e.g., improving social support; incentivizing/reducing barriers to adherence). A prior systematic literature review on adherence interventions conducted by the Agency for Healthcare Research and Quality was updated focusing on interventions which had functional (e.g., making it easier for patients to remember medications), educational (e.g., increasing disease or adherence knowledge), or motivational (e.g., reducing financial barriers) components published up until November 2013. A total of 78 articles were reviewed. Functional interventions were the most common (63.3% of all the studies) and about two-thirds of the interventions were significant. The effects of educational interventions (appearing in 32.9% of studies) were small; approximately half of interventions showed an effect, though the non-significant interventions had smaller sample sizes (n=150 or less). Motivational interventions (10.1% of all studies) were the most consistent in their effects (all but one study reported a significant finding) but were modest with only a 2-6% increase in adherence rates. Multifaceted interventions, which most often combined functional and education components, appeared in 15.2% of studies. These interventions had the largest effect size with a third reporting at least 20% increases in adherence rates relative to controls. The results reinforce the challenge with improving adherence among patients with chronic disease. Although it is difficult to draw firm conclusions based on the heterogeneous interventions, functional interventions produced the largest changes in adherence. Motivational interventions, particularly when they are financial, had the most consistent effects, albeit small ones. However, multi-faceted interventions (combining functional and education interventions) were the most successful of all.