MEDICATION NON-ADHERENCE OF KIDNEY TRANSPLANT PATIENTS IN SINGAPORE: A MIXED-METHODS APPROACH

Abstract

The study used a mixed-methods approach to identify factors associated with unintentional and intentional non-adherence, and overall adherence of kidney transplant patients (KTPs) in Singapore. One-hundred and eighty-two KTPs were recruited, of which seventeen were interviewed. Unintentional non-adherence was associated with employment, and high emotional distress symptoms. Intentional non-adherence was associated with longer periods on dialysis before transplantation, and higher stress symptoms. Overall adherence was associated with higher beliefs relative to concerns about medication. Qualitative findings highlight immunosuppressants and blood tests as important aspects of KTPs’ medication regimen. Side effects and cost of treatment were identified by KTPs as primary concerns about their medication regimen, while the disruption of treatment routines were underlined as barriers to adherence. Alarm systems and reminders, routinisation, and personal motivators were highlighted as facilitators to adherence. KTPs were averse to taking alternative medication due to distrust of its efficacy, and more receptive towards taking supplements to boost their immune system, or for aesthetic purposes. Qualitative data explained how busy schedules and emotional distress from side effects may have contributed to quantitative findings, and identified additional predictors that may better explain adherence.