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


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)

Team Outcomes to Date

Understanding Patients' Journey to Medication Adherence (poster by Shweta Lodha, Karley Whelan, Christiana Oshotse, Hayden Bosworth, Cheryl Lin, Pikuei Tu, Leah Zullig; Judges’ Selection Runner-up at Bass Connections Showcase, April 18, 2018

Cheryl Lin, Rachel Clark, Pikuei Tu, Hayden B. Bosworth, Leah L. Zullig. “Breast cancer oral anti-cancer medication adherence: a systematic review of psychosocial motivators and barriers.” 2017. Breast Cancer Research and Treatment 165(2):247-260.

Presentation at American Public Health Association Annual Meeting (November 4-8, 2017, Atlanta, GA)

Finalist for 2017 Aetna Award for Excellence in Research

2017 Duke Health Forum—Take Our Pain Away: Patients, Practice and Policy of Opioid Epidemic, August 28, 2017


Shweta Lodha

This Team in the News

Snapshots in Civic Engagement

Bass Connections Showcase Presents Research Highlights from Durham to Malaysia

Judges’ Selection for Best Poster Goes to Team Exploring Health Needs of Refugees in Durham

From Serving Meals to Studying Patients’ Behavior, This Research Team Thrives on Collaboration

See related team, Patients' Journey to Medication Adherence (2018-2019).

Faculty/Staff Team Members

Hayden Bosworth, School of Medicine - Psychiatry & Behavior Sciences, Population Health Sciences, Medicine*
Cheryl Lin, John Hope Franklin Center for Interdisciplinary and International Studies,Duke Policy & Organizational Management Program*
Pikuei Tu, John Hope Franklin Center for Interdisciplinary and International Studies, Duke Policy & Organizational Management Program*
Leah Zullig, School of Medicine-Population Health Sciences*

Undergraduate Team Members

Shweta Lodha, Neuroscience (BS)
Christiana Oshotse, Public Policy Studies (AB)
Karley Whelan, Sociology (AB), Global Health (AB2)

Community Team Members

Laura Bayzle, The Link Group
Rachel Clark, RTI International
Rungting Tu, Management School, Shenzhen University, China

* denotes team leader