title: 'When you are homeless, you are not thinking about your medication, but your food, shelter or heat for the night': behavioural determinants of homeless patients' adherence to prescribed medicines.
abstract: OBJECTIVE
  This study aimed to explore behavioural determinants of homeless patients' adherence to prescribed medicines using Theoretical Domains Framework (TDF).
  
  
  METHODS
  A qualitative study using semi-structured, face-to-face interviews.
  
  
  METHODS
  Participants were recruited from a homelessness primary healthcare centre in Aberdeen, United Kingdom (UK). Face-to-face interviews were audio-recorded and transcribed verbatim. Thematic analysis of the interview data was conducted using the Framework Approach based on the Theoretical Domains Framework. National Health Service ethical and Research and Development (R&D) approval was obtained.
  
  
  RESULTS
  Twenty-five patients were interviewed, at which point data saturation was achieved. A total of 13 out of 14 Theoretical Domains Framework domains were identified that explained the determinants of adherence or non-adherence to prescribed medicines. These included: 'beliefs about consequences' (e.g. non-adherence leading to poor health); 'goals' of therapy (e.g. being a 'normal' person with particular reference to methadone adherence); and 'environmental context and resources' (e.g. stolen medicines and the lack of secure storage). Obtaining food and shelter was higher priority than access and adherence to prescribed medicines while being homeless.
  
  
  CONCLUSIONS
  Behavioural determinants of non-adherence identified in this study were mostly related to participants' homelessness and associated lifestyle. Results are relevant to developing behaviour change interventions targeting non-adherent homeless patients and to the education of healthcare professionals serving this vulnerable population.
authors.affiliation: School of Pharmacy, College of Medical and Dental Sciences, Sir Robert Aitken Institute for Medical Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK. Electronic address: v.paudyal@bham.ac.uk.
authors.forename: V
authors.initials: V
authors.lastname: Paudyal
authors.affiliation: School of Pharmacy and Life Sciences, Robert Gordon University, Riverside East, Garthdee Road, Aberdeen, AB10 7GJ, UK. Electronic address: k.m.maclure@rgu.ac.uk.
authors.forename: K
authors.initials: K
authors.lastname: MacLure
authors.affiliation: Marywell Health Care Centre, NHS Grampian, 90 College Street, Aberdeen, AB11 6FD, UK. Electronic address: carol.buchanan2@nhs.net.
authors.forename: C
authors.initials: C
authors.lastname: Buchanan
authors.affiliation: Marywell Health Care Centre, NHS Grampian, 90 College Street, Aberdeen, AB11 6FD, UK. Electronic address: liz.wilson3@nhs.net.
authors.forename: L
authors.initials: L
authors.lastname: Wilson
authors.affiliation: Aberdeen City Health & Social Care Partnership, Summerfield House, Eday Rd Aberdeen, AB15 6RE, UK. Electronic address: joan.macleod@nhs.net.
authors.forename: J
authors.initials: J
authors.lastname: Macleod
authors.affiliation: School of Pharmacy and Life Sciences, Robert Gordon University, Riverside East, Garthdee Road, Aberdeen, AB10 7GJ, UK. Electronic address: d.stewart@rgu.ac.uk.
authors.forename: D
authors.initials: D
authors.lastname: Stewart
mesh_terms: D000328:Adult; D005260:Female; D006703:Ill-Housed Persons / Q000523:psychology* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D055553:Prescription Drugs / Q000627:therapeutic use; D036301:Qualitative Research; D006113:United Kingdom
chemical_list: D055553:Prescription Drugs
keywords: Adherence; Behaviours; Homeless; Prescription medicines; Theoretical Domains Framework (TDF); Vulnerable patients