Medication Management Frameworks in the Context of Self-Management: A Scoping Review

Figures & data

Table 1 Characteristics of Included Articles (n=39)

Author (Year)	Country	Objective	Method Study Design	Participants	Sample Size	Key Findings
Alsalman and Smith (2013)^Citation60	United States	To critique adherence concepts and terminology To present a new medication-taking behaviour framework To identify future applications of the new framework	Neither^† Review	NR	N/A	The framework emphasizes a patient-centred approach and highlights current challenges with medication-taking data
Archiopoli, et al (2016)^Citation30	United States	To analyze the impact of a model consisting of communicative factors, health behaviour factors and medication self-efficacy on medication adherence	Quantitative Cross-sectional study	People living with HIV	334	Patient-provider communication is positively associated with medication self-efficacy Medication self-efficacy is positively associated with adherence
Bartlett Ellis and Welch (2017)^Citation61	United States	To identify behaviours associated with medication-taking and medication adherence that have been reported in qualitative studies	Neither Meta-ethnographic qualitative literature review	Adults with chronic kidney disease and multiple co-existing chronic conditions	108 (total across all included studies)	Medication-taking and medication adherence behaviours were identified in 3 contexts: patient-provider clinical encounters; pharmacy encounters; and day-to-day management
Beusterien et al (2008)^Citation45	United States	To explore factors and medication characteristics that impact medication adherence	Qualitative Descriptive	People living with HIV	35	Six themes related to medication adherence were identified: regimen complexity/medication features; lifestyle fit; emotional impacts; side effects; effectiveness; and communication
Blalock (2011)^Citation62	United States	To explain how behavioural science theories may enhance the quality of medication use among prescription medication users	Neither Review	NR	N/A	The quality of research on medication use could be improved with an ecological model focused on medication self-management
Bright and Stanton (2018)^Citation31	United States	To expand and test a model of adherence that involves approach-oriented coping strategies	Quantitative Longitudinal	Women with breast cancer receiving their first endocrine therapy treatment	130	Support for depressive symptoms and social factors are importance considerations for medication adherence
Brown et al (2012)^Citation46	United States	To explore factors that help atrial fibrillation patients take medications as prescribed To develop a model of the medication adherence process	Qualitative Descriptive	Persons living with atrial fibrillation	38	The model integrates the patient voice and displays many factors and complexities with medication adherence
Coleman et al (2014)^Citation47	South Africa	To explore medication adherence and propose a mobile phone medication adherence monitoring framework	Qualitative Case study	Elderly people living in retirement villages	12	A high percent of elderly people are non-adherent The monitoring framework could improve adherence by sending and escalating reminders
Corneli et al (2016)^Citation57	South Africa and Kenya	To explore reasons for medication non-adherence and factors impacting decisions not to adhere	Mixed Method Exploratory cross-sectional study	Women who participated in the FEM-PrEP trial	Qualitative: 88 Quantitative: 224	Reasons for medication non-adherence were grounded in 5 areas: individual factors; trial characteristics and study pill regimen; patient–provider relationship; clinical setting; and the disease
de Guzman et al (2013)^Citation32	Philippines	To develop and test and medication adherence model relative to numerous factors	Quantitative Cross-sectional study	Older adults	325	Factors related to medication adherence are connected and solutions should be multi-faceted
DiIorio et al (2004)^Citation34	United States	To analyze a psychosocial model of medication self-management	Quantitative Repeated measures	Adults with epilepsy	320^‡	Medication self-management is impacted by psychosocial factors (social support, stigma)
Fransen et al (2009)^Citation35	Netherlands	To examine factors that determine patients’ adherence to short-term treatment	Quantitative Prospective observational study	Adults with dyspepsia using short-term proton pump inhibitor treatment	347	Medication adherence was affected by concerns with medications, limited social support, lower self-efficacy, increased complaints and beliefs that complaints could not be changed
Ghose et al (2019)^Citation48	United States	To examine how a transitional housing program for women recently released from incarceration impacts medication adherence	Qualitative Grounded theory	Women with HIV released from incarceration	43	Housing initiated processes (empowerment, cognitive and emotional re-engagement, health-seeking behaviours) that improved adherence
Gifford and Groessl (2002)^Citation63	United States	To propose a framework and discuss components of a program for the self-management of chronic HIV disease	Neither Review	People living with HIV	N/A	Key components of a self-management program include: goal setting; planning; communication; information seeking; and symptom management
Goh et al (2017)^Citation64	Singapore	To identify factors affecting adherence and evaluate the association of the factors with adherence	Neither Systematic review	Rheumatic patients	N/A	Five main categories related to adherence were identified: patient factors; therapy factors; condition factors; health system factors; and social/economic factors
Guy et al (2018)^Citation36	United States	To identify the association between adherence, emotional support seeking and active coping	Quantitative Cross-sectional study	Young African American men who have sex with men who have HIV	49	Emotional support seeking was significantly associated with adherence through active coping
Koh et al (2018)^Citation49	Singapore	To explore factors affecting medication adherence	Qualitative Descriptive	Persons living with atherosclerotic cardiovascular disease	20	Factors affecting medication adherence included: complex regimens; lack of support; perceived seriousness of condition; and cost
Lau et al (2017)^Citation38	China	To examine factors impacting medication adherence using structural equation modeling	Quantitative Exploratory cross-sectional study	Older Chinese community-dwelling adults	593	Improved medication adherence was associated with fewer chronic diseases; more medication categories; lower fear of sharing scores; and higher willingness to share and self-care agency scores
Li et al (2007)^Citation65	United States	To describe a theoretical framework for antihypertensive medication compliance	Neither Review	Chinese immigrants with hypertension	N/A	The framework was built on four constructs: motivation; cultural health perceptions; modifying factors; and cultural health activities
McCann et al (2008)^Citation66	Australia	To present a model for medication adherence self-efficacy for chronic mental illness	Neither Review	Individuals with chronic mental illness	N/A	Medication adherence is multidimensional and includes factors related to self-efficacy, relationships, and social, psychological and environmental support
Mickelson et al (2016)^Citation50	United States	To describe and analyze the medication management of older adults with heart failure using the macrocognitive workflow framework	Qualitative Descriptive	Older adults with heart failure	61	Macrocognitive processes affected medication management and were often collaborative
Nantha et al (2019)^Citation58	Malaysia	To create an integrated behavioural model for diabetic medication compliance	Mixed Method Protocol Cross-sectional study	Adults with type 2 diabetes	Study 1: Expecting 20 interviews, 10 for focus groups Study 2: Expecting 200	N/A
Newman-Casey et al (2013)^Citation67	United States	To review educational interventions, identify their effect on glaucoma medication adherence and how they use Health Behaviour Theory	Neither Systematic Review	Glaucoma	N/A	There are limited high quality studies using education for glaucoma medication adherence
Paterson et al (2018)^Citation41	Canada	To examine the relationship between medication adherence and depressive symptoms, self-efficacy, problem solving and neurocognitive abilities	Quantitative Cross-sectional study	Renal transplant recipients	211	Problem solving and self-efficacy were positively associated with medication adherence
Piette et al (2006)^Citation68	United States	To present a conceptual framework to understand influencing factors on responses to medication costs	Neither Review	Chronically ill patients	N/A	Medication costs are impacted by patient and clinician characteristics, type of medication, and the health system
Roe et al (2009)^Citation52	Israel	To explore reasons people with serious mental illness stop taking prescription medication	Qualitative Descriptive	Serious mental illness	7	Medication non-adherence is contextual and based on subjective experiences
Schafheutle et al (2018)^Citation54	United Kingdom	To describe strategies for medication-taking following hospital discharge To identify members of one’s social network involved in medication-taking strategies	Qualitative Descriptive	Chronic obstructive pulmonary disease	12	Strategies for medication-taking did not change from pre-hospitalization Social networks assisting with medication-taking were: family and healthcare professionals
Schrijvers et al (2014)^Citation55	Netherlands	To describe the adherence process from the patients’ perspective	Qualitative Grounded Theory	Hemophilia	21	Adherence was impacted by: acceptance of hemophilia; feelings and fearing symptoms; understanding of hemophilia and prophylaxis; and behavior
Simoni et al (2006)^Citation43	United States	To test a model of adherence among inner-city HIV-positive patients on antiretroviral therapy	Quantitative Longitudinal Evaluation	HIV-Positive Men and Women on Antiretroviral Therapy	136	Baseline adherence self-efficacy predicted patients’ self-reported adherence
Swanlund et al (2008)^Citation56	United States	To explore medication self-management among older adults	Qualitative Descriptive	Community-dwelling older adults	19	Self-management capability is positively impacted by: living orderly and aging well
Weaver et al (2005)^Citation44	United States	To study and test a stress and coding model of factors associated with adherence and HIV viral load	Quantitative Secondary analysis of a longitudinal randomized trial	Adults with HIV	322	Adherence is predicted by avoidance-oriented coping, which is impacted by social support and negative mood
Saslo (2007)^Citation53	United States	To observe the culture of living with HIV and its impact on adherence to care plans	Qualitative Ethnography	Adults with HIV	6	Adherence was impacted by: literacy; fear; disease; and policies
Qu et al (2018)^Citation42	China	To examine adherence to pre-exposure prophylaxis To identify if information, motivation and behavioural skills are significantly associated with adherence To explore objective factors for non-adherence to pre-exposure prophylaxis To describe factors of non-adherence for future interventions	Quantitative Secondary analysis of randomized placebo-controlled trial	Men who have sex with men (at risk of contracting HIV)	331	Adherence was not associated with social psychological factors in the model
O’Brien (2014)^Citation59	United States	To identify factors associated with medication adherence and non-adherence To describe medication self-management processes	Mixed Method Descriptive explanatory study	Older adults	268	Assistance from caregivers positively impacted medication adherence
Mondesir et al (2019)^Citation51	United States	To explore influences on medication adherence using the World Health Organization Multidimensional Adherence Model	Qualitative Descriptive	Adults with coronary heart disease	18	Adherence was impacted by factors related to the: patient; social and economic; therapy; and health system
Messina et al (2016)^Citation40	United States	To examine motivational constructs for non-medical use of pain relievers, stimulants and sedatives/tranquilizers	Quantitative Cross-sectional study	Undergraduate students	1016	Non-medical use of pain relievers, stimulants and sedatives/tranquilizers may be driven by self-treatment and recreational use
MacDonell et al (2016)^Citation39	United States	To test a model of medication adherence, specific to social cognitive factors	Quantitative Cross-sectional study	Ethnic and racial minority HIV-positive youth	2213	Adherence was positively associated with higher self-efficacy and readiness Adherence was negatively associated with substance use and psychological symptoms
Kekwaletswe et al (2017)^Citation37	South Africa	To duplicate and build on a multicomponent model of antiretroviral therapy adherence	Quantitative Cross-sectional study	HIV positive people taking antiretroviral therapy	304	Adherence was associated with: reduced depression; reduced alcohol use; and higher self-efficacy beliefs
Dehn (2010)^Citation33	United States	To clarify the association of adherence to cystic fibrosis treatments to numerous factors	Quantitative Descriptive and correlational	Adults with cystic fibrosis	173	Adherence was significantly associated with: problem-focused coping and physician partnership

Notes: ^† The article was not original research (ie, qualitative, quantitative or mixed methods). ^‡ Three participants were excluded from all analyses (incomplete assessments or withdrawal post-baseline).

Abbreviations: NR, not reported; N/A, not applicable; HIV, human immunodeficiency virus.

Figure 1 PRISMA flow diagram of included articles.

Table 2 Framework Characteristics

Author (Year)	Name of Framework/Model	Description	Target Population	New or Adapted Framework
Alsalman and Smith (2013)^Citation60	Medication-Taking Behavior	A framework describing all medication-taking behaviours (how, when and how much patients take prescribed medications) using new concepts and measures	NR	New
Archiopoli, et al (2016)^Citation30	Mediating Model	A model examining the relationship between behavioural health factors and interpersonal communication factors with medication self-efficacy and medication adherence	People living with HIV	New
Bartlett Ellis and Welch (2017)^Citation61	Medication-taking across the care continuum and adherence-related outcomes	A framework to organize medication-taking behaviours within clinical encounters, pharmacy encounters and day-to-day management	Adults with chronic kidney disease and multiple coexisting chronic conditions	New
Beusterien et al (2008)^Citation45	Patient reported adherence diagram	A framework illustrating the relationship of themes (emotional impact, communication, effectiveness, side effects, lifestyle fit and regimen complexity/medication features) that have an influence on adherence to therapy	People living with HIV	New
Blalock (2011)^Citation62	Proposed ecological framework for medication self-management	A framework based on an ecological model identifying goals at 5 levels (patient, family, providers, system and social policy/government regulations) that impact medication use and self-management	NR	Adapted
Bright and Stanton (2018)^Citation31	Stress and coping model of endocrine therapy adherence	A model that incorporates social support, coping and depressive symptoms to test their influence on adherence	Women with breast cancer receiving their first endocrine therapy treatment	New
Brown et al (2012)^Citation46	Conceptual model of adherence to oral anticoagulants	A model outlining the adherence process to oral anticoagulants (includes contextual factors, knowledge, motivation, habit formation, self-efficacy and adherence)	Persons living with atrial fibrillation	New
Coleman et al (2014)^Citation47	Mobile phone adherence monitoring framework (MPAMF)	A mobile health framework for medication self-efficacy among elderly individuals, with an adherence monitoring system	Elderly people living in retirement villages	New
Corneli et al (2016)^Citation57	Conceptual model illustrating factors related to non-adherence in FEM-PrEP	A model of commonly reported factors related to non-adherence	Women who participated in the Preexposure Prophylaxis Trial for HIV Prevention among African Women (FEM-PrEP)	Adapted
de Guzman et al (2013)^Citation32	Emerging model of medication adherence	A structural equation model identifying the relationships that have a positive effect on medication adherence (behavioural attitude, perceived behavioral control, subjective norm)	Older adults	New
DiIorio et al (2004)^Citation34	Modified model of epilepsy self-management for medications	A model of epilepsy self-management for medications that includes personal, social and provider-specific variables	Adults with epilepsy	Adapted
Fransen et al (2009)^Citation35	Theoretical model: determinants of patient adherence	A theoretical model of patient-related factors impacting adherence to short-term proton pump inhibitor treatment	Adults with dyspepsia using short-term proton pump inhibitor treatment	Adapted
Ghose et al (2019)^Citation48	Housing’s effect on adherence	A conceptual framework that includes subjective and material processes and examines how housing affects advances in antiretroviral adherence	Women with HIV released from incarceration	Adapted
Gifford and Groessl (2002)^Citation63	HIV disease self-management	A conceptual framework for understanding and categorizing determinants of HIV disease self-management and health outcomes	People living with HIV	Adapted
Goh et al (2017)^Citation64	Hand model of medication adherence in rheumatic factors	A model of five categories of factors that affect medication adherence	Rheumatic patients	Adapted
Guy et al (2018)^Citation36	Mediation model	A model examining the association between active coping, emotional support seeking and treatment adherence	Young African American men who have sex with men who have HIV	Adapted
Koh et al (2018)^Citation49	Integration of WHO framework of adherence and Levesque’s framework for health care access	A framework for understanding how system, social, economic and patient related factors impact medication adherence	Persons living with atherosclerotic cardiovascular disease	Adapted
Lau et al (2017)^Citation38	Structural equation model of five-dimensional factors on medication adherence among older adults	A hypothetical model of medication adherence that incorporates healthcare team, patient, disease, therapy and socioeconomic related factors	Older Chinese community-dwelling adults	Adapted
Li et al (2007)^Citation65	Modified sick role behaviour model	A model consisting of four constructs to predict their impact on medication compliance	Chinese immigrants with hypertension	Adapted
McCann et al (2008)^Citation66	Self-efficacy model of medication adherence	A model of medication adherence that consists of five core factors and contextual influences	Individuals with chronic mental illness	New
Mickelson et al (2016)^Citation50	Macrocognitive workflow of medication management	A model outlining the macrocognitive workflow of medication management and includes artifacts, actors and actions	Older adults with heart failure	Adapted
Nantha et al (2019)^Citation58	Integrated behavioural model of medication compliance	An integrated behavioural model of medication compliance that incorporates external variables, indirect and direct determinants	Adults with type 2 diabetes	Adapted
Newman-Casey et al (2013)^Citation67	Model of glaucoma medication adherence	A conceptual model of medication adherence that includes components of knowledge, barriers to adherence and perceived stress	Glaucoma	New
Paterson et al (2018)^Citation41	Model of adherence by renal transplant recipients	A model that examines the impact of sociodemographics, neurocognitive abilities, depressive symptoms, self-efficacy and problem solving on medication adherence	Renal transplant recipients	New
Piette et al (2006)^Citation68	Framework for understanding chronically ill patients’ medication cost problems	A framework consisting of factors that impact cost-related medication non-adherence	Chronically ill patients	New
Roe et al (2009)^Citation52	Process of choosing not to take medication	A model of the steps involved in the decision to stop taking medication	Serious mental illness	New
Schafheutle et al (2018)^Citation54	Medication work	A framework describing types of medication work that patients with chronic obstructive pulmonary disease use post-discharge	Chronic obstructive pulmonary disease	Applied Cheraghi-Sohi et al’s medication work framework
Schrijvers et al (2014)^Citation55	Model of adherence to prophylaxis in hemophilia	A model to describe factors impacting adherence to prophylaxis	Haemophilia	New
Simoni et al (2006)^Citation43	Model of social support and adherence	A cognitive-affective model of adherence to highly active antiretroviral therapy and the impact of social support	HIV-Positive Men and Women on Antiretroviral Therapy	New
Swanlund et al (2008)^Citation56	Medication self-management model	A model for predicting one’s self-management capability and the overall successful or unsuccessful self-management of a medication regimen	Community-dwelling older adults	New
Weaver et al (2005)^Citation44	Stress and coping model of medication adherence	A model of latent factors and indicators of latent factors that affect adherence to highly active antiretroviral therapy	Adults with HIV	New
Saslo (2007)^Citation53	Saslo’s model for adherence to HIV treatment	A model of HIV treatment adherence that includes themes related to fear, trust, self-worth, finances, literacy and disease	Adults with HIV	New
Qu et al (2018)^Citation42	Information motivation behaviour skills model of medication adherence behavior	A model that examines the relationship between knowledge, behaviour and motivation and their impact on adherence rate	Men who have sex with men (at risk of contracting HIV)	Adapted
O’Brien (2014)^Citation59	Conceptual framework	A framework that incorporates contextual factors (risk and protective) and self-management processes to examine their effect on medication adherence	Older adults	Adapted
Mondesir et al (2019)^Citation51	World Health Organization multidimensional adherence model	A model based on the five factors of the World Health Organization’s adherence model	Adults with coronary heart disease	Applied the World Health Organization Multidimensional Adherence Model
Messina et al (2016)^Citation40	3 Models: 1. Non-medical use of pain relievers 2. Non-medical use of tranquillizers and sedatives 3. Non-medical use of stimulants	Three models that incorporate latent constructs impacting the non-medical use of pain relievers, tranquilizers and sedatives and stimulants	Undergraduate students	New
MacDonell et al (2016)^Citation39	Model of medication adherence	A model of medication adherence that incorporates social and cognitive factors	Ethnic and Racial Minority HIV-Positive Youth	New
Kekwaletswe et al (2017)^Citation37	Structural equation model among HIV positive people taking antiretroviral therapy	A model of latent and measured variables on adherence to antiretroviral therapy	HIV positive people taking antiretroviral therapy	Adapted
Dehn (2010)^Citation33	Adapted health belief model	An adapted model to examine the relationship between sociodemographic characteristics, modifying factors and treatment adherence	Adults with cystic fibrosis	Adapted

Abbreviations: NR, not reported; HIV, human immunodeficiency virus.

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