# ‘‘That's just part of having a transplant, that's the price you pay” Patient-reported facilitators and barriers to immunosuppressant medication adherence among transplant recipients: a qualitative study

## TL;DR

This study explores why transplant patients struggle to follow their medication rules and suggests ways to help them stick to their treatment long-term.

## Contribution

The study identifies patient-reported facilitators and barriers to immunosuppressant adherence and maps them to the ABC Taxonomy for intervention guidance.

## Key findings

- Psychological support and peer interactions influence medication adherence.
- Practical strategies like alarms and pillboxes are recommended to improve adherence.
- The Persistence phase of the ABC Taxonomy highlights the need for psychological support to maintain long-term adherence.

## Abstract

It is estimated that 1 in 5 organ transplant patients fail to properly adhere to their immunosuppressant medication. Interventions for good adherence lack efficacy, and challenges to developing interventions tailored to individual patient needs remain. This study explored patient-reported facilitators and barriers to immunosuppressant medication adherence, and patient-recommended strategies to support good adherence. The findings were mapped to the ABC Taxonomy for medication adherence to provide a framework to guide future intervention development.

Semi-structured interviews were held with heart, lung, liver and kidney transplant recipients (n = 16) who were taking prescribed immunosuppressant medication for a minimum of 6 months post-transplant. Inductive thematic analysis was conducted to identify key themes.

Themes identified were: (1) the psychological processes impacting medication adherence, including lack of post-transplant psychological support, peer support from fellow transplant recipients and reflecting on health improvements following transplantation; (2) the practicalities of adhering to medication, including in-hospital medication training, routine implementation, managing domestic and social responsibilities and side effect experiences; and (3) patient-recommended strategies to facilitate medication adherence among newly transplanted patients, including mobile apps and alarms, visual reminders and pillboxes. The Persistence phase of the ABC Taxonomy represented intentional non-adherence related barriers to longer-term medication adherence, with emphasis on the importance of accessing psychological support to promote lifelong adherence.

Themes mapped to the ABC Taxonomy for medication adherence highlighted that future interventions should focus on intentionally non-adherent patients and address the complex physical, cognitive and emotional themes influencing longer-term persistence to the immunosuppressant medication regimen.