Patients' perspectives on medication adherence feedback interventions for managing long-term medications: a systematic review of qualitative evidence.

Abstract

Introduction: Optimising medication usage is a worldwide challenge. While numerous feedback interventions have been developed to address this issue, understanding patients' perspectives on the use of such interventions to optimise adherence provides opportunities for successful development and implementation.

Aim: To synthesise qualitative evidence on patients' views on medication adherence feedback interventions to support adherence behaviour.

Method: CINAHL, EMBASE, MEDLINE, PsycINFO, and PubMed were systematically searched from database inception to February 2023 with searches updated to February 2025. Additionally, Google Scholar was used to identify any potentially relevant grey literature or supplementary sources. Eligible studies included qualitative or mixed-methods research that explored adult patients' perspectives on medication adherence feedback interventions for long-term conditions, specifically those aimed at self-management within community settings. The review was conducted according to ENTREQ and reported following PRISMA guidelines. Study quality was appraised using the Mixed Methods Appraisal Tool (MMAT). Data were extracted and analysed using thematic synthesis, with findings presented narratively.

Results: Of the 1270 studies screened, 11 met the inclusion criteria and evaluated participants' views on therapeutic drug monitoring and digital adherence interventions across conditions including asthma, human immunodeficiency virus (HIV), coronary heart disease, hypertension, type 2 diabetes, and opioid use disorder. Three themes were identified; balancing support and autonomy in feedback interventions, maintaining patient-provider relationship and enhancing engagement through tailored design. Interventions were considered acceptable when they were easy to use, offered users control over personal data, incorporated audio-visual cues, and provided emotional or motivational support. Trust and shared decision-making between patients and providers facilitated uptake, while tailored interventions were considered essential for supporting engagement.

Conclusion: Medication adherence feedback interventions are acceptable, however further improvements will enhance user engagement and optimise adherence. Future research should prioritise co-designed interventions that address user needs, improve patient-provider communication, deliver accurate adherence feedback, and support cost-effective scalability.