title: Exploring motivation and confidence in taking prescribed medicines in coexisting diseases: a qualitative study.
abstract: OBJECTIVE
  To explore the motivation and confidence of people with coexisting diabetes, chronic kidney disease (CKD) and hypertension to take their medicines as prescribed.
  
  
  BACKGROUND
  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.
  
  
  METHODS
  Motivational interviewing telephone calls were made with participants with coexisting diabetes, CKD and hypertension.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: School of Nursing and Midwifery, Monash University Health Sciences, Frankston, Vic., Australia.
authors.forename: Allison
authors.initials: A
authors.lastname: Williams
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Manias
mesh_terms: D000368:Aged; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000188:drug therapy; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy; D007676:Kidney Failure, Chronic / Q000150:complications / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D009042:Motivation; D055553:Prescription Drugs; D036301:Qualitative Research
chemical_list: D055553:Prescription Drugs
keywords: comorbidities; diabetes; emotional support; hypertension; kidney disease; medication adherence; motivational interviewing; self-management