Patients' Journey to Medication Adherence (2018-2019)


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 amounting to $290 billion a year.

Medication nonadherence is a prevalent issue worldwide and across all socioeconomic groups, yet existing intervention programs have been only moderately effective, and long-term results are often less than satisfactory. Improving patient adherence is critical in raising healthcare quality, leveling health disparities and containing costs for the individuals and the health system. The issue requires more public attention and further research to understand and target the motivators and barriers influencing people’s decisions and actions.

Project Description

This Bass Connections project aims to provide richer insights into patient psychology and cognition, in order to help bridge the gaps in clinical research for more optimal medication adherence and improved health outcomes.

The project has three focus areas: 

  • Uncovering patients’ insights and thought processes regarding illness, treatment and relationship with physicians. The team will investigate how patients cope with the externalities of having to manage a prescribed regimen, their involvement in shared decision-making and attitudes about nonadherence, such as self-rationalization, frustration and desired autonomy.
  • Examining health equity and cultural differences in self-perceptions and value of medication. Qualitative results gathered during the 2017-18 project will help shape a large scale international comparative study—one survey will be conducted in the U.S. with a parallel survey in Asia.
  • Implementing a longitudinal study to capture the fluctuations of patients’ feelings and behavior related to medication and how these factors influence adherence over time.

The results will help strengthen identification tools for noncompliance risk screening and in designing future intervention programs, providing evidence and recommendations for medical professionals, policymakers and researchers as well as health-related industries.

Anticipated Outcomes

Preliminary results used for grant proposals; study findings disseminated through group-authored conference presentation(s) and peer-reviewed publication(s)


Summer 2018 – Summer 2019  

  • Summer 2018: (off campus) Continuing students are encouraged to revise their individual papers or collaborate on the team paper to get ready for journal submission; may elect to do an internship domestically or overseas to shadow and investigate the impacts of healthcare system and policies on medical practice and patient behavior (faculty will help identify sponsor organizations and local mentors). New students will start background research and literature review; complete online IRB training modules.
  • Fall 2018: Team building, group training on research methodology and data analysis software; continue literature review; mini lectures by invited field experts (throughout the year); collectively design participant screener, interview discussion guide and survey; complete IRB proposal; start longitudinal studies; first stage of data analysis and drafting manuscript; on campus or conference presentation of preliminary findings
  • Spring 2019: Continue longitudinal study; conduct international study, compare results; second stage of data analysis; collaboratively write manuscript; external grant proposal
  • Summer 2019: Manuscript revision for journal submission; students may travel domestically or overseas to examine the effects of care delivery models and public policies on health outcomes (optional with support from DukeEngage or other funding)

Team Outcomes to Date

Cheryl Lin, Rachel Clark, Pikuei Tu, Rungting Tu, Ya-Jung Hsu, Hsiao-Ching Nien. 2019. “The disconnect in hepatitis screening: participation rates, awareness of infection status, and treatment-seeking behavior.” Journal of Global Health 9(1)

Patient-Physician Communication and Medication-Taking Behaviors of Rheumatoid Arthritis Patients  (poster by Ian Levitan, Hayden Bosworth, Cheryl Lin, Pikuei Tu, Leah Zullig, presented at Bass Connections Showcase, Duke University, April 17, 2019)

2018 Duke Health Forum: Health Equity MattersWhat Has Worked?, August 27, 2018

This Team in the News

“Invisible” Illnesses: Exploring Medication Adherence from the Patient’s Perspective

See earlier related team, Patients’ Journey to Medication Adherence (2017-2018)

Health worker holding prescription pills

Team Leaders

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

/undergraduate Team Members

  • Carolyn Huynh, Neuroscience (BS)
  • Ian Levitan, Biology (BS)
  • En-Hua Wang, Neuroscience (AB)

/zcommunity Team Members

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