METHODS: We searched PubMed, Embase, CINAHL, PsycINFO, Cochrane and PROSPERO (inception to 08/2022) to identify systematic reviews on factors influencing ET adherence. Abstracted determinants were mapped to the World Health Organization\'s dimensions of adherence. Reviews were quality appraised and overlap assessed.
RESULTS: Of 5732 citations screened, 17 reviews were eligible (9 quantitative primary studies; 4 qualitative primary studies; 4 qualitative or quantitative studies) including 215 primary papers. All five WHO dimensions influenced ET non-adherence: The most consistently identified non-adherence determinants were patient-related factors (e.g. lower perceived ET necessity, more treatment concerns, perceptions of ET \'cons\' vs. \'pros\'). Healthcare system/healthcare professional-related factors (e.g. perceived lower quality health professional interaction/relationship) were also important and, to a somewhat lesser extent, socio-economic factors (e.g. lower levels of social/economic/material support). Evidence was more mixed for medication-related and condition-related factors, but several may be relevant (e.g. experiencing side-effects, cost). Potentially modifiable factors are more influential than non-modifiable/fixed factors (e.g. patient characteristics).
CONCLUSIONS: The evidence-base on ET adherence determinants is extensive. Future empirical studies should focus on less well-researched areas and settings. The determinants themselves are numerous and complex in indicating that adherence support should be multifaceted, addressing multiple determinants.
方法:我们搜索了PubMed,Embase,CINAHL,PsycINFO,Cochrane和PROSPERO(从08/2022开始)确定影响ET依从性的因素的系统评价。抽象的决定因素被映射到世界卫生组织的依从性维度。对评论进行了质量评估和重叠评估。
结果:在筛选的5732篇引文中,17篇评论符合条件(9篇定量主要研究;4篇定性主要研究;4篇定性或定量研究),包括215篇主要论文。所有五个WHO维度都影响ET不依从性:最一致的非依从性决定因素是患者相关因素(例如,较低的感知ET必要性,更多的治疗问题,对ET\'cons\'的看法与\'pros\')。医疗保健系统/医疗保健专业相关因素(例如,感知质量较低的健康专业互动/关系)也很重要,在较小的程度上,社会经济因素(例如,社会/经济/物质支持水平较低)。关于药物相关和病情相关因素的证据更加混杂,但其中一些可能是相关的(例如经历副作用,成本)。潜在可修改因素比不可修改/固定因素(例如患者特征)更有影响力。
结论:关于ET依从性决定因素的证据是广泛的。未来的实证研究应该集中在研究较少的领域和环境上。决定因素本身是众多而复杂的,表明坚持支持应该是多方面的,解决多个决定因素。