William R Nardi1, Eric B Loucks2, Stacey Springs3, Don Operario4, Ian M Kronish5, Brandon A Gaudiano6, Shufang Sun7. 1. Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States. Electronic address: william_nardi@brown.edu. 2. Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States; Department of Epidemiology, Brown University School of Public Health, Providence, RI, United States; Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, RI, United States. Electronic address: eric_loucks@brown.edu. 3. Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI, United States. Electronic address: stacey_springs@brown.edu. 4. Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States; Department of Epidemiology, Brown University School of Public Health, Providence, RI, United States. Electronic address: don_operario@brown.edu. 5. Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, NY, New York, United States. Electronic address: ik2293@cumc.columbia.edu. 6. Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States; Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, United States; Psychosocial Research Program, Butler Hospital, Providence, RI, United States; Providence VA Medical Center, Providence, RI, United States. Electronic address: brandon_gaudiano@brown.edu. 7. Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States. Electronic address: shufang_sun@brown.edu.
Abstract
OBJECTIVE: Inadequate medication adherence is a significant limitation for achieving optimal health outcomes across chronic health conditions. Mindfulness-based interventions (MBIs) have been increasingly applied to promote medical regimen adherence as MBIs have been shown to improve patient-level barriers to adherence (i.e., depressive symptoms, cognitive impairment, stress). The purpose of this review is to investigate the state of research regarding MBIs targeting medication adherence in chronic illnesses and to identify evidence gaps to inform future studies. METHODS: The search reviewed 5 databases (e.g., PubMed, PsycINFO, Embase, CINAHL, Proquest Thesis/Dissertations) to identify trials that quantitatively evaluated the effect of MBIs on medication adherence. Study abstracts and full texts were screened identifying eligible studies, and findings were summarized using a narrative synthesis. RESULTS: A total of 497 studies were reviewed; 41 were eligible for full text review and 9 were included in narrative synthesis: seven were RCTs and two were pre-post designs. Study quality varied, with five rated moderate or high risk for bias. Clinical populations tested included living with HIV (k = 3), cardiovascular disease (k = 3), psychological disorders (k = 2), and men who underwent a radical prostatectomy (k = 1). Four studies found significant improvements in medication adherence, however only two of these studies had low risk of bias. CONCLUSIONS: Research on MBI's for medication adherence is developing, but the effectiveness of MBIs remains unclear due to the nascent stage of evidence and methodological limitations of existing studies. Researchers should prioritize rigorous experimental designs, theory-driven investigations of behavioral mechanisms, and the use of objective measurements of adherence.
OBJECTIVE: Inadequate medication adherence is a significant limitation for achieving optimal health outcomes across chronic health conditions. Mindfulness-based interventions (MBIs) have been increasingly applied to promote medical regimen adherence as MBIs have been shown to improve patient-level barriers to adherence (i.e., depressive symptoms, cognitive impairment, stress). The purpose of this review is to investigate the state of research regarding MBIs targeting medication adherence in chronic illnesses and to identify evidence gaps to inform future studies. METHODS: The search reviewed 5 databases (e.g., PubMed, PsycINFO, Embase, CINAHL, Proquest Thesis/Dissertations) to identify trials that quantitatively evaluated the effect of MBIs on medication adherence. Study abstracts and full texts were screened identifying eligible studies, and findings were summarized using a narrative synthesis. RESULTS: A total of 497 studies were reviewed; 41 were eligible for full text review and 9 were included in narrative synthesis: seven were RCTs and two were pre-post designs. Study quality varied, with five rated moderate or high risk for bias. Clinical populations tested included living with HIV (k = 3), cardiovascular disease (k = 3), psychological disorders (k = 2), and men who underwent a radical prostatectomy (k = 1). Four studies found significant improvements in medication adherence, however only two of these studies had low risk of bias. CONCLUSIONS: Research on MBI's for medication adherence is developing, but the effectiveness of MBIs remains unclear due to the nascent stage of evidence and methodological limitations of existing studies. Researchers should prioritize rigorous experimental designs, theory-driven investigations of behavioral mechanisms, and the use of objective measurements of adherence.
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