A 360-degree appraisal of the barriers to medication adherence in paediatric patients with long-term illness

  • Nafeesa Ullah

    Student thesis: Doctoral Thesis


    Research indicates that paediatric medication adherence in long-term conditions is often
    sub-optimal and can be affected by a range of developmental, social and family factors.
    However, little is known about children’s medication-taking experience. The aim of this
    research was to identify the most common barriers to adherence from the perspective of
    three different groups: the medicine-taker, the medicine giver and the healthcare
    professional (HCP). A further aim was to evaluate the role of community pharmacists in
    supporting paediatric patients with long-term medication needs.
    Study one conducted a systematic review of seven databases from January 1995 to 2016,
    yielding 18 studies that used self-report methods to identify barriers to medication
    adherence in children and adolescent, aged 5-18 years with long-term conditions. The
    common barriers were a lack of caregiver and healthcare support, medication regimen
    complexity, forgetfulness, medication side-effects and concerns about medication need and
    efficacy. Stigma was the only condition-specific adherence barrier for children and
    adolescents with HIV, all other barriers were uniform across conditions.
    Study two used a Delphi method with paediatric healthcare professionals (N=23) to
    prioritise adherence barriers in current clinical practice. Agreement was rated on a 5-point
    scale, the mean and standard deviation was used to determine consensus between
    participants to each adherence barrier. The main observed barriers to adherence were the
    need for constant reminders from caregivers to ensure medication was taken, medicationtaking
    fatigue, medication taste and increased responsibility for medication-taking. The
    results indicated that there is a variation between the barriers identified through paediatric
    self-reports and what is observed by healthcare professionals in practice.
    Study three used a retrospective questionnaire to identify caregivers (N=52) barriers to
    medication administration and their opinions of community pharmacists. Common barriers
    identified were their child’s heavy reliance on them to ensure medication was taken,
    frustration and fatigue from having to take regular medication and their child’s increased
    responsibility for medication-taking. Caregivers were generally positive about the support
    they received from the pharmacist to care for their child with long-term medication needs
    and would welcome medication reviews and information sessions with the pharmacist to
    help with their child’s adherence.
    Date of AwardOct 2017
    Original languageEnglish
    Awarding Institution
    • University of Brighton
    SupervisorAngela Macadam (Supervisor)

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