A qualitative secondary data analysis of intentional and unintentional medication nonadherence in adults with chronic heart failure

Objective To explore factors contributing to intentional and unintentional medication nonadherence in adults with chronic heart failure (HF). Background Medication nonadherence is prevalent in HF but the factors contributing to it are not well understood. Methods This secondary data analysis of qualitative data explored narrative accounts about medication adherence from four previous studies (N = 112). The Necessity–Concerns–Framework derived from the Common Sense Model (CSM) of Self-Regulation guided the interpretation of themes. Results In this diverse sample (39% Black, 6% Hispanic, 63% male; mean age 59 ± 15 years), 90% reported at least intermittent nonadherence. For many (60%), missing medication was unintentional but 27% reported intentional nonadherence. Four interconnected patterns of behavior emerged: 1) rarely nonadherent, 2) frequently nonadherent, 3) intentionally nonadherent, and 4) reformed nonadherent. Misperceptions about HF, beliefs, concerns, and contextual factors contributed to both intentional and unintentional nonadherence. Conclusion Medication nonadherence is prevalent in HF and influenced by modifiable factors.