Mapping modifiable determinants of medication adherence in bipolar disorder (BD) to the theoretical domains framework (TDF): a systematic review

Asta Ratna Prajapati, Alexandra Dima, George Mosa, Sion Scott, Fujian Song, Jonathan Wilson, Debi Bhattacharya

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Abstract

Background

Around 40% of people with bipolar disorder (BD) are non-adherent to medication leading to relapse, hospitalisation and increased suicide risk. Limited progress in addressing non-adherence may be partly attributable to insufficient understanding of the modifiable determinants of adherence that require targeting in interventions. We synthesised the modifiable determinants of adherence in BD and map them to the theoretical domains framework (TDF).

Method

We searched CINAHL, Cochrane Library, Embase, LILACS, Medline, PsychINFO and PubMed until February 2020. We included studies reporting modifiable determinants of adherence in BD. Two reviewers independently screened studies, assessed quality, extracted modifiable determinants and mapped them to TDF.

Results

We included 57 studies involving 32 894 participants. Determinants reported by patients spanned 11 of the 14 TDF domains compared to six domains represented by clinician/researcher. The TDF domains most commonly represented (% and example) in studies were: ‘Environmental context and resources’ (63%, e.g. experiencing side effects), ‘Beliefs about consequences’ (63%, e.g. beliefs about medication effects), ‘Knowledge’ (40%, e.g. knowledge about disorder), ‘Social influences’ (33%, e.g. support from family/clinicians), ‘Memory, attention and decision processes’ (33%, e.g. forgetfulness), ‘Emotion’ (21%, e.g. fear of addiction) and ‘Intentions’ (21%, e.g. wanting alternative treatment). ‘Intentions’, ‘Memory, attention and decision processes’ and ‘Emotion’ domains were only reported by patients but not clinicians.

Conclusions

Clinicians may be underappreciating the full range of modifiable determinants of adherence and thus not providing adherence support reflective of patients' needs. Reporting of modifiable determinants in behavioural terms facilitates developing theory-based interventions to address non-adherence in BD.
Original languageEnglish
Pages (from-to)1082-1098
Number of pages17
JournalPsychological Medicine
Volume51
Issue number7
Early online date19 May 2021
DOIs
Publication statusPublished - May 2021

Keywords

  • Adherence
  • barriers and facilitators
  • bipolar disorder
  • compliance
  • theoretical Domains Framework

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