# Development of a behavioural theory-based New Medicine Service toolkit for community pharmacists to promote medication adherence

## TL;DR

This paper describes the development of a toolkit for pharmacists to help patients stick to new medications for heart and metabolic conditions.

## Contribution

A new behavioral theory-based toolkit was developed to address medication adherence barriers in patients with cardiometabolic conditions.

## Key findings

- A short form of the NMS toolkit was created with 14 most challenging nonadherence reasons identified by patients.
- Eighty-four percent of pharmacist interventions were deemed applicable in daily practice according to the Delphi study.
- The toolkit integrates 10 TDF-14 domains and 18 behavioral change techniques to address nonadherence.

## Abstract

Adherence to newly prescribed cardiometabolic medications is low. It is crucial to develop personalized behavioural interventions to address patients’ specific medication adherence barriers.

The aim of this study was to develop a behavioural theory-based New Medicine Service (NMS) toolkit for use by community pharmacists in Türkiye to identify and address reasons for nonadherence in patients newly started on medications for hypertension, diabetes, or dyslipidemia.

This multistage study used a literature search, expert panel, cognitive interviews, and survey with patients to identify reasons for nonadherence to include in the Turkish DOSE Nonadherence Scale. A short form of the toolkit was generated by asking the patients to select the most challenging reasons for nonadherence. To identify relevant pharmacist interventions, the theoretical domains framework (TDF-14) (v2) domains related to reasons for nonadherence were identified and matched with behavioural change techniques (BCTs). To assess the applicability of the proposed pharmacist interventions in daily practice, an online survey of community pharmacists was conducted using a modified Delphi study.

The final list of reasons for nonadherence consisted of 31 items, of which 14 identified as most challenging by patients were selected for inclusion in the short form of the NMS toolkit. For the full 31 reasons, ten domains of TDF-14 and 18 BCTs were selected. In the Delphi study (response rate: 83.3%), 68 of the 81 (84.0%) pharmacist interventions were found to be applicable, corresponding to 15 BCTs.

The behavioural theory-based NMS toolkit was developed for use by community pharmacists to identify and address reasons for nonadherence in patients newly started on medications to manage hypertension, diabetes, or dyslipidemia. This toolkit will assist community pharmacists in developing personalized interventions to overcome nonadherence problems in patients who are newly starting medications. Future studies should be conducted to assess the impact of this new toolkit on patients' medication adherence levels and clinical outcomes.

The online version contains supplementary material available at 10.1007/s11096-025-01959-3.