An exploration of adherence and persistence in overactive bladder and other long-term conditions

Ali, Mahmood (2023) An exploration of adherence and persistence in overactive bladder and other long-term conditions. Doctoral thesis (PhD), Manchester Metropolitan University.

Preview

Available under License Creative Commons Attribution Non-commercial No Derivatives. Download (6MB) | Preview

Abstract

Background and aims Overactive bladder is a common, bothersome, and chronic condition associated with symptoms of urinary urgency, incontinence, increased daytime micturition frequency and nocturia. Despite exerting a significant burden on quality of life, adherence, and persistence behaviours with OAB are particularly poor in comparison with other long-term conditions. The aims of the present work were to explore themes relating to medicine-taking behaviours in OAB and other long-term conditions and to suggest ways to improve them. Methods A systematic literature review was undertaken to understand the current landscape of qualitative work exploring adherence and persistence with OAB patients. A qualitative study involving 1:1 semi-structured interviews was conducted with OAB patients to explore the context and drivers for adherence and persistence behaviours using thematic analysis. A comparative analysis was then undertaken with qualitative papers exploring medicinetaking behaviours in a chronic bowel condition, type II diabetes, and multimorbidity to explore the themes identified in the OAB study for convergence and divergence in other conditions and to contextualise the learnings from the former study. Results The systematic literature review revealed a gap in the literature of qualitative exploration of adherence and persistence behaviours in OAB patients. The OAB study found a range of drivers for non-adherent behaviours including a perceived lack of treatment efficacy, side effects, unclear instructions, and drug and condition hierarchies, as well as the rich context within which these themes sit. The comparative analysis study supported the findings of the OAB study demonstrating evidence of key themes transcending across conditions, including a perceived lack of treatment efficacy and side effects, as well as nuances associated with the OAB experience. Conclusions The present work has identified key drivers for non-adherent behaviours in OAB patients and sets out a number of recommendations categorised within the World Health Organisation’s 5 dimensions of adherence. These include addressing the poor understanding and illness perception of OAB by patients and others, by improving the provision and availability of information, as well as the work of patient support groups; scrutiny on the support within primary care to OAB patients before and after diagnosis; and the encouragement of realistic expectations of the condition and treatment with mindful use of prescriber’s language at the point of prescribing. The present work has further highlighted the utility of conceptual models of adherence such as COM-B and the NCF in understanding medicine-taking behaviours in the context of OAB.