Financial Barriers
- High out-of-pocket costs for medications, specialist consultations, and follow-up care
- Lack of subsidised treatment or insurance coverage
Education and Health Literacy
- Low levels of education may limit understanding of treatment importance
- Poor health literacy can lead to misinterpretation of prescription instructions
Employment and Time Constraints
- Irregular work schedules or lack of sick leave may interfere with follow-up or daily dosing
Access to Healthcare Services
- Geographical and logistical barriers to accessing clinics or pharmacies
- Long waiting times or transportation difficulties

Healthcare Provision
- Limited availability, accessibility, or efficiency of services
- Inadequate system integration for coordinated care
Care Continuity and Provider Communication
- Fragmented care due to involvement of multiple specialists, risking conflicting advice
- Poor prescriber follow-up leads to missed opportunities to assess adherence, monitor side effects, or adjust treatment
Prescriber–Patient Relationship
- Lack of clear communication, trust, or shared decision-making may reduce adherence

Nature of the Disease
- Intermittent or asymptomatic diseases (e.g., hypertension) may lead to premature discontinuation
- Chronic diseases require long-term adherence with less immediate feedback
Perceived Severity
- Patients may undervalue therapy if symptoms are mild or absent
- Conversely, those with severe or complex conditions may feel overwhelmed
Type of Condition
- Adherence is generally higher in acute conditions with visible outcomes compared to chronic conditions with delayed benefits

Beliefs and Attitudes
- Mistrust in medications, fear of dependency, or doubts about efficacy
Cognitive Impairment
- Memory issues or misunderstanding due to age or mental health conditions
Mental Health and Motivation
- Depression, anxiety, or apathy reduce motivation for self-care
Social Support
- Isolation may hinder adherence; strong support networks improve it

Complexity of Regimen
- Polypharmacy or complex instructions (e.g., refrigeration, timing) increase burden
Side Effects
- Even mild adverse effects can discourage continued use
Duration of Therapy
- Long-term treatment may cause “treatment fatigue”
Dosing Frequency
- More frequent dosing (e.g., captopril 2–3 times/day) is associated with lower adherence than once-daily options (e.g., lisinopril)

Strategies to Improve Medication Adherence

Cognitive Behavioural Therapy (CBT)
- Helps address dysfunctional thoughts, improve self-efficacy, and manage symptoms
Structured Counselling
- Targeted sessions to explore barriers and reinforce positive behaviour change
Motivational Interviewing
- Encourages patients to explore and resolve ambivalence toward adherence

Pharmacist-led Interventions
- Medication reviews, dose simplification, adherence counselling
Webster Packs / Dose Administration Aids
- Organize medications by day and time to reduce confusion
Electronic Aids and Reminders
- Apps, SMS alerts, or smart pillboxes to prompt timely medication intake
Deprescribing and Pill Burden Reduction
- Regular medication review to remove unnecessary drugs
- Use of fixed-dose combinations and long-acting formulations

Regular Monitoring and Review
- Adjust doses based on tolerability and therapeutic response
- Manage side effects proactively with adjunct therapies or alternatives
Address Mental and Emotional Barriers
- Acknowledge fears, stigma, and patient concerns (especially in adolescents or mental health populations)

Telemedicine
- Virtual consultations reduce the need for in-person visits
Remote Monitoring
- Real-time tracking of BP, glucose, etc., enables timely intervention
Mobile Health (mHealth) Applications
- Provide reminders, symptom tracking, educational content, and progress feedback

Family Involvement
- Family members can assist with medication reminders and emotional support
Community Support Groups
- Peer support for chronic illness can reduce isolation and promote shared experiences

Personalised Medicine
- Use pharmacogenomics to tailor medications and minimize side effects
Shared Decision-Making
- Align treatment plans with patient preferences, lifestyle, and values to enhance engagement

Medication Non-compliance / Non-adherence