title: Nonadherence to the medical regimen after lung transplantation: A systematic review.
abstract: This study reports on the first systematic review focused on lung transplant recipients (LTRs) and provides evidence regarding 1) prevalence of nonadherence to the post-transplant medical regimen; 2) risk factors for nonadherence; 3) impact of adherence-promoting interventions; and 4) transplant-related clinical outcomes of nonadherence in LTRs. Following the PRISMA guidelines, a literature search of 5 databases was conducted, yielding 30 relevant articles. Findings suggested that nonadherence rates varied greatly across regimen components and were not consistently associated with any single risk factor. Effect sizes in terms of correlation coefficients for adherence-promoting interventions ranged from .05 to .45. Mortality rates did not significantly differ by adherence levels. Major limitations across studies were weak methodologies for measuring nonadherence and small sample sizes. This review underscores the need for more rigorous and extensive studies of risk factors and clinical outcomes of nonadherence and for large-scaled theory-based trials to examine adherence-promoting interventions in LTRs.
authors.affiliation: New York University School of Medicine, Center for Healthful Behavior Change, United States. Electronic address: lu.hu@nyumc.org.
authors.forename: Lu
authors.initials: L
authors.lastname: Hu
authors.affiliation: University of Pittsburgh School of Nursing, Department of Health and Community Systems, United States.
authors.forename: Jennifer H
authors.initials: JH
authors.lastname: Lingler
authors.affiliation: University of Pittsburgh School of Nursing, Department of Health and Community Systems, United States.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Sereika
authors.affiliation: University of Pittsburgh School of Nursing, Department of Health and Community Systems, United States.
authors.forename: Lora E
authors.initials: LE
authors.lastname: Burke
authors.affiliation: University of Pittsburgh Medical Center Community Provider Services, United States.
authors.forename: Donna Kaltenbaugh
authors.initials: DK
authors.lastname: Malchano
authors.affiliation: University of Pittsburgh School of Nursing, Department of Acute and Tertiary Care, United States.
authors.forename: Annette
authors.initials: A
authors.lastname: DeVito Dabbs
authors.affiliation: University of Pittsburgh School of Medicine, Department of Psychiatry, United States.
authors.forename: Mary Amanda
authors.initials: MA
authors.lastname: Dew
mesh_terms: D002985:Clinical Protocols; D006801:Humans; D016040:Lung Transplantation; D010349:Patient Compliance; D011184:Postoperative Period; D012307:Risk Factors
keywords: Lung transplant; Nonadherence; Post-transplant medical regimen; Self-management; Systematic review