Patients' Journey to Medication Adherence (2017-2018)


It is estimated that by 2020, three-fourths of death in the world will be attributed to chronic diseases. While there have been great advancements in medications, the health benefits cannot be realized if patients do not take their medications as prescribed. In the U.S., about half of the 3.2 billion prescriptions dispensed annually are not taken as instructed, leading to 125,000 preventable deaths and wasted medical expenditure of $290 billion a year.

Taking medication may appear straightforward and routine. Yet for some patients, it may be an emotional struggle, a daily reminder of the illness they have to endure and the accompanying impediments that complicate their decisions and actions to follow doctors’ orders. Many studies have investigated the demographic, psychosocial or disease/therapy-related factors associated with medication nonadherence, with limited impact. More research is needed on the interactions of the variables, changes in patients’ perception and behavior over time and cross-cultural effects.

Project Description

The main objective of this Bass Connections project is to gain richer insights into patient disincentives and motivators for more optimal medication adherence. The project will focus on better understanding patients’ feelings and thought processes regarding medication use via focus groups and qualitative interviews.

This work will include examining self-efficacy, social support, patient-provider relationship and financial burden. Team members will also learn how patients cope with the externalities of having a prescription and their attitudes about nonadherence behavior, such as self-rationalization, frustration or desired autonomy. Another focus is on studying cultural differences in the perceptions and value of medication and interpretation of doctors’ orders that influence patients’ behavior via an international comparative study.

Field practitioners and/or executives from the relevant industries and public agencies will be invited to share their knowledge and contribute to the multifaceted learning of the team. The team will also discuss policy implications regarding healthcare quality, insurance payment system, pharmaceutical innovation and pricing as well as government welfare models.

Anticipated Outcomes

Strengthened identification and segmentation tools for nonadherence risk screening; evidence and recommendations for better patient engagement for medical professionals, policy makers and the pharmaceutical and insurance industries; preliminary results used for other grant proposals; dissemination of study results through one or more group-authored conference presentations and peer-reviewed publications

Student Opportunities

Student team members are encouraged to develop subprojects using either primary or secondary data to probe deeper into one or more of the related constructs of their particular interest. Undergraduates may have opportunities to travel overseas in the summer (with the support of DukeEngage) to investigate the impacts of healthcare systems and policies on patient behavior and medication outcome. A Ph.D. student or postdoc may serve as project manager.

Cross-level and peer evaluations will be performed periodically to ensure group learning and project progress. Students will be evaluated on their initiatives, acquisition and application of research skills, efforts and commitment to teamwork and contribution to collective learning.


Fall 2017 – Summer 2018

  • Fall 2017: Conduct literature review; field expert mini seminars; plan focus groups and interviews; complete IRB; collect data; summarize and discuss qualitative findings; design subprojects individually or in pairs; campus or conference presentation of preliminary results
  • Spring 2018: Draft manuscript of qualitative study; design quantitative survey; translate questionnaire for parallel international study; conduct multi-part data collection in the US and one or more countries; compare and analyze data; submit for conference presentation and/or publication
  • Summer 2018: Paper revisions; prepare for longitudinal study; travel overseas to investigate the impacts of healthcare system and policies on patient behavior (optional for students with the support of DukeEngage independent program)


Independent study credit available for fall and spring semesters; summer funding

Faculty/Staff Team Members

Hayden Bosworth, School of Medicine - Psychiatry & Behavior Sciences*
Cheryl Lin, International Studies and Markets & Management*
Pikuei Tu, Duke Policy & Organizational Management Program*
Leah Zullig, Medical Center - Duke Cancer Institute*

Community Team Members

Laura Bayzle, The Link Group
Rungting Tu, Management School, Shenzhen University, China

* denotes team leader