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.
University of Texas Health Science Center at Houston, Houston, TX, USA.
Anna
A
Xu
University of Tromsø, Tromsø, Norway.
Taridzo
T
Chomutare
University of Texas Health Science Center at Houston, Houston, TX, USA.
Sriram
S
Iyengar
D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D009664:Norway; D010353:Patient Education as Topic / Q000379:methods*; D010565:Persuasive Communication; D016032:Randomized Controlled Trials as Topic; D016903:Drug Monitoring
Systematic review; older adults; persuasive technology