Barriers to medication adherence in sickle cell disease: A comprehensive theory-based evaluation using the COM-B...

Area of Science:

• Hematology
• Pharmacology
• Patient Adherence Research

Background:

• Sickle cell disease (SCD) impacts over 100,000 Americans, causing pain episodes and acute chest syndrome.
• Hydroxyurea is effective in reducing SCD complications, but low patient adherence limits its benefit.

Purpose of the Study:

• To investigate barriers to hydroxyurea adherence in patients with SCD.
• To assess the relationship between identified barriers and hydroxyurea adherence levels.

Main Methods:

• A cross-sectional study enrolled patients with SCD and their caregivers using hydroxyurea.
• Data collected included demographics, visual analog scale (VAS) for adherence, and the Disease Management and Barriers Interview (DMI)-SCD, mapped to the Capability, Opportunity, Motivation, and Behavior (COM-B) model.

Main Results:

• 63% of patients and 75% of caregivers reported low and high hydroxyurea adherence, respectively, via VAS.
• Caregivers identified physical opportunity (cost) and reflective motivation (SCD perceptions) as key barriers.
• Patients reported psychological capability (forgetfulness) and reflective motivation as primary barriers.
• A significant negative correlation was found between the number of barriers and adherence scores for both patients (r=-.53, p=.01) and caregivers (r=-.28, p=.05).

Conclusions:

• Fewer barriers correlate with higher hydroxyurea adherence in SCD.
• Understanding specific barriers is crucial for developing targeted interventions to improve medication adherence and patient outcomes.