Persuasive attributes of medication adherence interventions for older adults: A systematic review

BACKGROUND: Low adherence to prescribed medications leads to serious negative health consequences in older adults. Effective interventions that improve adherence are often labor-intensive and complex. However, most studies do not analyze the separate effects of the components. OBJECTIVE: Persuasive System Design (PSD) is framework that analyzes the motivations that change behavior. In this paper, we aim to apply the model to changing the pill-taking behaviors of the aging population and determine which persuasive elements in interventions drive improvement in medication adherence. METHODS: Systematic review using the databases Medline (1977 to February 2012), Cochrane library (2000 to June 2013); Cinahl (1975 to June 2013), and Psycinfo (2002 to June 2012). Inclusion criteria were experimental trials with participants' mean age >= 60 years and had medication adherence as a primary or secondary measure. RESULTS: Meta-analysis (40 studies) demonstrated a significant association of tailoring, or one-on-one counseling, with medication adherence. Interventions with simulation (showing the causal relationship between non-adherence and negative effects) and rehearsal (miming medication-taking behavior) also showed evidence for improved adherence. CONCLUSIONS: Future medication adherence interventions might be more effective if they were based on persuasive technology.