title: Medication-taking behaviours in chronic kidney disease with multiple chronic conditions: a meta-ethnographic synthesis of qualitative studies.
abstract: OBJECTIVE
  To identify behaviours associated with taking medications and medication adherence reported in qualitative studies of adults with chronic kidney disease and coexisting multiple chronic conditions.
  
  
  BACKGROUND
  To inform medication adherence interventions, information is needed to clarify the nature of the relationships between behaviours that support medication-taking and medication adherence in multiple chronic conditions.
  
  
  METHODS
  Meta-ethnographic review and synthesis.
  
  
  METHODS
  CINAHL Complete, MEDLINE and PsycINFO databases were searched. Five qualitative studies met the inclusion criteria. A meta-ethnographic approach was used for synthesis. Medication-taking behaviours were abstracted from study findings and synthesised according to the contexts in which they occur and interpreted within a new developing framework named the Medication-taking Across the Care Continuum and Adherence-related Outcomes.
  
  
  RESULTS
  Twenty categories of medication-taking behaviours occurred in three main contexts: (1) patient-provider clinical encounters, (2) pharmacy encounters and (3) day-to-day management. These behaviours are distinctly different, multilevel and interrelated. Together they represent a process occurring across a continuum.
  
  
  CONCLUSIONS
  Future medication adherence research should consider using a multilevel ecological view of medication management. Clinical practice and policy development can benefit from further understanding socio-contextual behaviours that occur across the continuum. Nurses should have greater presence in chronic disease management and be positioned to support the day-to-day home management of patients' medications.
  
  
  CONCLUSIONS
  Healthcare professionals can partner with patients to elucidate how these behaviours are enacted across the care continuum and in day-to-day management to identify opportunities to intervene on specific behaviours and promote medication adherence.
authors.affiliation: Department of Science of Nursing Care, Indiana University School of Nursing, Indianapolis, IN, USA.
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Bartlett Ellis
authors.affiliation: Department of Science of Nursing Care, Indiana University School of Nursing, Indianapolis, IN, USA.
authors.forename: Janet L
authors.initials: JL
authors.lastname: Welch
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health / Q000208:ethnology*; D019468:Disease Management; D015438:Health Behavior; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000208:ethnology* / Q000523:psychology*; D008875:Middle Aged; D000071069:Multiple Chronic Conditions / Q000188:drug therapy*; D036301:Qualitative Research; D051436:Renal Insufficiency, Chronic / Q000188:drug therapy*; D012648:Self Care / Q000523:psychology*
keywords: behaviour; chronic illness; comorbidity; compliance; medication adherence; medication management; self-management