Abstract
Purpose :
Adherence to long-term glaucoma medication is often poor. Current interventions to improve adherence have had limited success due to lack of robust theoretical underpinning.
The study aim was to explore factors influencing patients’ medication adherence using qualitative interviews and applying the Theoretical Domains Framework (TDF) of behaviour change.
Methods :
Participants from UK glaucoma clinics, prescribed one or more IOP-lowering eyedrop, were purposively sampled, to aim for a representative sample. One-to-one semi-structured interviews were conducted via Zoom, audio recorded and transcribed verbatim. Data were organised using NVivo 12 and analysed using the TDF to investigate personal, sociocultural and environmental factors influencing patient adherence to glaucoma medication. Interview transcripts were analysed using deductive and inductive thematic analysis. Key barriers to adherence were mapped to evidence-based Behaviour Change Techniques (BCTs) to identify potential strategies to improve medication adherence.
Results :
Thirteen participants were interviewed (Table 1). Nine TDF domains were particularly salient regarding medication adherence (Table 2). Key barriers to adherence fall within three TDF domains: Memory, Attention and decision processes (forgetfulness), Skills (lack of physical ability/poor vision), and Environmental Context and Resources (lifestyle changes, unavailability of eyedrops, issues with healthcare system). Enablers included: Knowledge (sufficient understanding of glaucoma and treatment), Behavioural Regulation (developing a routine), Skills (ability to order ongoing eyedrop supplies), Beliefs about capabilities (confidence in ability to use eyedrops), Beliefs about consequences (believe eyedrops necessary), Goals (not wanting to lose sight) and Social Influences (positive influences). Potential BCTs to improve medication adherence included Instruction on how to perform behaviour, Information about health consequences, Behavioural practice/rehearsal, Prompts/cues, Social support, Restructuring the physical environment and Adding objects to the environment.
Conclusions :
Adherence to glaucoma medication is complex and affected by multiple factors. The theory-driven determinants identified can inform development of behaviour change interventions that seek to improve adherence behaviour and prevent avoidable sight loss.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.