Exploring motivation and confidence in taking prescribed medicines in coexisting diseases: a qualitative study
Version of Record online: 13 SEP 2013
© 2013 John Wiley & Sons Ltd
Journal of Clinical Nursing
Volume 23, Issue 3-4, pages 471–481, February 2014
How to Cite
Williams, A. and Manias, E. (2014), Exploring motivation and confidence in taking prescribed medicines in coexisting diseases: a qualitative study. Journal of Clinical Nursing, 23: 471–481. doi: 10.1111/jocn.12171
- Issue online: 28 JAN 2014
- Version of Record online: 13 SEP 2013
- Manuscript Accepted: 31 OCT 2012
- Australian Research Council Linkage Postdoctoral Fellowship. Grant Number: LP0774989
- emotional support;
- kidney disease;
- medication adherence;
- motivational interviewing;
Aims and objectives
To explore the motivation and confidence of people with coexisting diabetes, chronic kidney disease (CKD) and hypertension to take their medicines as prescribed.
These comorbidities are major contributors to disease burden globally. Self-management of individuals with these coexisting diseases is much more complicated than that of those with single diseases and is critical for improved health outcomes.
Motivational interviewing telephone calls were made with participants with coexisting diabetes, CKD and hypertension.
Patients aged ≥18 years with diabetes, CKD and systolic hypertension were recruited from outpatient clinics of an Australian metropolitan hospital between 2008–2009. An average of four motivational interviewing telephone calls was made with participants (n = 39) in the intervention arm of a randomised controlled trial. Data were thematically analysed using the modified Health Belief Model as a framework.
Participants' motivation and confidence in taking prescribed medicines was thwarted by complex medicine regimens and medical conditions. Participants wanted control over their health and developed various strategies to confront threats to health. The perceived barriers of taking recommended health action outweighed the benefits of taking medicines as prescribed and were primarily related to copious amounts of medicines.
Taking multiple prescribed medicines in coexisting diabetes, CKD and hypertension is a perpetual vocation with major psychosocial effects. Participants were overwhelmed by the number of medicines that they were required to take. The quest for personal control of health, fear of the future and the role of stress and gender in chronic disease management have been highlighted. Participants require supportive emotional interventions to self-manage their multiple medicines on a daily basis.
Relevance to clinical practice
Reducing the complexity of medicine regimens in coexisting diseases is paramount. Individualised psychosocial approaches that address the emotional needs of patients with regular follow-up and feedback are necessary for optimal chronic disease self-management.