A qualitative secondary data analysis of intentional and unintentional medication nonadherence in adults with chronic heart failure.

OBJECTIVE: To explore factors contributing to intentional and unintentional medication nonadherence in adults with chronic heart failure (HF).

BACKGROUND: Medication nonadherence is prevalent in HF but the factors contributing to it are not well understood.

METHODS: This secondary data analysis of qualitative data explored narrative accounts about medication adherence from four previous studies (N = 112). The Necessity-Concerns-Framework derived from the Common Sense Model (CSM) of Self-Regulation guided the interpretation of themes.

RESULTS: In this diverse sample (39% Black, 6% Hispanic, 63% male; mean age 59 ± 15 years), 90% reported at least intermittent nonadherence. For many (60%), missing medication was unintentional but 27% reported intentional nonadherence. Four interconnected patterns of behavior emerged: 1) rarely nonadherent, 2) frequently nonadherent, 3) intentionally nonadherent, and 4) reformed nonadherent. Misperceptions about HF, beliefs, concerns, and contextual factors contributed to both intentional and unintentional nonadherence.

CONCLUSION: Medication nonadherence is prevalent in HF and influenced by modifiable factors.