In brief
Focus groups with 65 elders and caregivers (mean age 71) across five communities identified five solutions to improve medication adherence: personal systems, cost strategies, regular medication review, community support, and medical advocates.
What this article is about
Quick Answer
Focus groups with 65 elders and caregivers (mean age 71) across five communities identified five solutions to improve medication adherence: personal systems, cost strategies, regular medication review, community support, and medical advocates.
Student takeaways
Key Takeaways
- Nine focus groups with 65 elder and caregiver participants (mean age 71) across five communities generated five community-endorsed solution themes for improving medication adherence.
- Participants described personal systems, such as individually developed routines and reminder strategies, as a primary way they try to overcome barriers to taking medications correctly.
- Cost was identified as a significant barrier, with participants proposing a range of solutions to address the financial burden of managing multiple medications.
- Participants wanted more regular medication review by doctors or pharmacists specifically aimed at eliminating medications that were no longer necessary.
- Participants expressed a desire for community-driven support systems and the use of medical advocates to help manage medications and communicate with providers.
Student summary
Why This Research Matters
Medication mismanagement among older adults is not a small problem. It is a leading reason older people end up in emergency departments or move into nursing homes, and it happens often enough that researchers consider it a public health issue rather than just a personal one. Instead of asking doctors or pharmacists what should be done about it, O'Quin, Semalulu, and Orom (2015) asked the people living the problem: elders and the family members or friends who care for them. Their reasoning was simple. Elders and caregivers are the ones managing pill bottles, refills, side effects, and confusing schedules every day, so they are well positioned to know what actually helps and what does not.
The researchers ran nine focus groups across five different communities, involving 65 participants with an average age of 71. People were recruited through key informants using snowball sampling, meaning trusted community contacts identified initial participants, who then helped identify others. This approach is common in community-based qualitative research because it builds trust and reaches people who might not respond to a cold recruitment flyer.
During the focus groups, participants were not just asked to describe problems. They were asked to propose solutions, and the researchers organized what they heard into five themes. First, participants talked about personal systems, things like pill organizers, calendars, reminder routines, or habits tied to daily activities, that individuals build for themselves to stay on track. Second, cost came up repeatedly. Participants described a range of ways they try to manage the financial burden of medications, from splitting pills to seeking assistance programs. Third, many wanted more regular medication reviews by physicians or pharmacists, specifically to catch and remove medications that were no longer necessary. This reflects a common real-world problem: prescriptions pile up over years of specialist visits, and no one steps back to ask whether all of them are still needed. Fourth, participants expressed a desire for community-driven support systems, informal or semi-formal networks of neighbours, peers, or local organizations that could help with reminders, transportation to pharmacies, or general encouragement. Fifth, participants raised the idea of medical advocates, someone who could accompany or represent an elder in conversations with providers, helping ensure questions get asked and instructions are understood.
What makes this study noteworthy is not that any single theme is groundbreaking on its own. Pill organizers and pharmacist reviews already exist in many care models. What is valuable is that the ideas came directly from the people who would use them, which gives these solutions a kind of grassroots credibility. When elders and caregivers describe a problem and propose their own fix, health educators and program designers have more confidence that an intervention built around that idea will actually be used, not just tolerated.
For nursing students, this study is a useful reminder that medication adherence is rarely just about whether a patient understands instructions. It is shaped by cost, by the sheer number of prescriptions a person is carrying, by whether they have someone to lean on, and by whether the health system makes it easy or hard to ask questions. A nurse who only reviews a medication list without asking about affordability, daily routines, or whether the patient has support at home is missing several of the barriers this study's participants raised themselves.
It is also worth remembering the limits of this kind of research. This was a qualitative study built on focus group discussion, not a clinical trial testing whether these five solution types actually reduce missed doses or hospitalizations. The sample was drawn from five specific communities and skewed toward older participants willing to attend a focus group, so the themes may not capture every older adult's experience, particularly those who are more isolated or who did not participate. Still, the study offers a useful, community-grounded starting point for thinking about medication adherence interventions, and it models an approach nursing programs increasingly value: asking the people affected by a problem what they think would help before designing a solution for them.
Source abstract
Study Overview
Medication mismanagement is a growing public health concern, especially among elders. Annually, it is a major contributor to emergency hospitalization and nursing home placement. Elders and their caregivers, as healthcare consumers and stakeholders in this issue, are uniquely qualified to inform strategies to improve medication adherence. We conducted a qualitative study to ascertain caregiver and elder perceptions of barriers to medication management and to identify community-derived solutions to improve medication management. Nine focus groups (N = 65, mean age = 71) were conducted with caregivers or elders from five communities. Participants were recruited by key informants utilizing snowball sampling methodology. The following themes were identified in the participant-recommended proposed solutions improving medication adherence: (i) use of personal systems to overcome barriers to medication adherence, (ii) various solutions to address cost concerns, (iii) the need for regular review of medications by doctors or pharmacists to eliminate unnecessary medications, (iv) desire for community-driven support systems, and (v) using medical advocates. Elders and caregivers recognized medication non-adherence as a community-wide issue and were eager to offer solutions they thought would work in their communities. These solutions can lend credibility to strategies currently being developed/utilized and offer innovative recommendations for future interventions.
Evidence appraisal
Main Findings
- Nine focus groups with 65 elder and caregiver participants (mean age 71) across five communities generated five community-endorsed solution themes for improving medication adherence.
- Participants described personal systems, such as individually developed routines and reminder strategies, as a primary way they try to overcome barriers to taking medications correctly.
- Cost was identified as a significant barrier, with participants proposing a range of solutions to address the financial burden of managing multiple medications.
- Participants wanted more regular medication review by doctors or pharmacists specifically aimed at eliminating medications that were no longer necessary.
- Participants expressed a desire for community-driven support systems and the use of medical advocates to help manage medications and communicate with providers.
Practice transfer
Clinical Relevance
- Nurses should ask patients about cost and affordability directly, since financial barriers to medication adherence may not surface unless specifically raised, according to this study's participants.
- Routine medication reconciliation, reviewing a patient's full list to identify medications that may no longer be needed, aligns with what participants themselves requested and may support adherence.
- Encouraging or helping patients build personal reminder systems (pill organizers, routines tied to daily habits) reflects a strategy elders and caregivers already value and use.
- Nurses can support informal caregiver involvement and community resources as legitimate parts of a medication management plan, not just supplemental extras.
- The concept of a medical advocate suggests nurses should consider whether patients have someone to help them ask questions and understand instructions during appointments, and support that role when present.
Faculty notes
Educational Relevance
This study by O'Quin, Semalulu, and Orom (2015), published in Health Education Research, is a useful teaching example of participatory, community-based qualitative research applied to a persistent clinical problem: medication non-adherence among older adults. Rather than surveying providers or reviewing chart data, the researchers positioned elders and their caregivers as the experts on the barriers and potential solutions, conducting nine focus groups (N = 65, mean age 71) across five communities. Participants were recruited through key informants using snowball sampling, a method well suited to reaching community members through trusted intermediaries, though one that also introduces selection effects worth discussing with students.
The analysis produced five solution-oriented themes rather than a simple list of barriers: personal adherence systems, cost-mitigation strategies, provider-led medication review to eliminate unnecessary prescriptions, community-driven support systems, and the use of medical advocates. Framing findings as elder- and caregiver-generated "solutions" rather than only "barriers" is itself a notable methodological choice, and instructors can use it to discuss the difference between deficit-based and asset-based approaches to health education research.
For teaching purposes, this article works well in courses covering health education, community health nursing, gerontological nursing, or qualitative research methods. It illustrates how focus group methodology can surface practical, implementable ideas rather than abstract theory, and how snowball sampling functions in hard-to-reach or dispersed populations such as community-dwelling older adults and informal caregivers. It also offers a concrete example of thematic analysis applied to solution-generation rather than problem description, which can prompt discussion about how coding decisions shape which themes emerge.
Instructors should guide students to distinguish source-supported claims, the five themes and the study's design details as reported in the abstract, from broader supplementary context about medication adherence in older adults generally (such as polypharmacy trends or the cost burden of prescription drugs), which is well documented elsewhere but not the direct subject of this particular study's data.
Discussion should also address the study's limits. As a qualitative study, the findings describe perceived barriers and community-endorsed solution categories; they do not establish that implementing any of these five approaches reduces missed doses, adverse events, or hospitalizations. The sample, while reasonably sized for qualitative work, was drawn from five specific communities, and the demographic and clinical characteristics of participants (comorbidities, medication regimen complexity, caregiving relationship type) are not detailed in the abstract, which limits how far instructors can generalize the findings without access to the full text. The article is paywalled beyond the abstract, so faculty relying on open-access review should note that methodological detail (interview guide, coding process, saturation criteria) could not be independently verified for this summary.
Used well, this article helps students connect a health education research design to direct clinical implications: prompting nurses to ask about affordability, regimen complexity, and available support before assuming non-adherence reflects poor understanding or motivation, and to consider medication reconciliation and advocacy roles as concrete, patient-endorsed interventions rather than provider-imposed ones. For Canadian students, the participant-driven call for regular medication review dovetails with medication reconciliation at care transitions, a Required Organizational Practice under Accreditation Canada, which frames medication list review and deprescribing as a system-level safety expectation rather than an optional courtesy.
Critical appraisal
Limitations
- This is a qualitative focus group study; it identifies perceived barriers and community-endorsed ideas but does not test whether any of the five solution types actually improves adherence outcomes.
- The sample of 65 participants was drawn from only five communities using snowball sampling, which may not represent the views of older adults or caregivers outside those networks.
- Snowball sampling through key informants can introduce selection bias, since participants are connected through existing social ties and may share similar views or circumstances.
Classroom use
Discussion Questions
- Why might asking elders and caregivers to propose solutions, rather than only describe barriers, change the kind of information a study collects?
- How could snowball sampling through key informants affect who is represented, and who might be missing, from this study's findings?
- What questions could a nurse ask during a routine visit to uncover whether cost is affecting a patient's medication adherence?
- How does the theme of 'personal systems' compare to adherence strategies you have seen used in clinical practice or with your own family members?
- What role could a nurse play in supporting the 'medical advocate' concept described by participants?
- Why is it important for medication reviews to focus specifically on eliminating unnecessary medications, rather than only checking for correct dosing?
- How might a community-driven support system for medication management actually be organized in a rural versus an urban setting?
- What are the risks of generalizing these five themes to all older adults, given the study's sample and design?
- How would you design a follow-up study to test whether one of these five community-generated solutions actually reduces missed doses or hospitalizations?
- In what ways does this study model a patient-centred or community-based approach to health education research, compared to a provider-designed intervention?
Knowledge check
Quiz
1. What was the primary aim of this study?
- To test a new medication reminder app with older adults
- To ascertain caregiver and elder perceptions of barriers to medication management and identify community-derived solutions
- To measure hospitalization rates linked to medication errors
- To compare adherence rates between different pharmacy chains
Rationale: The abstract states the researchers 'conducted a qualitative study to ascertain caregiver and elder perceptions of barriers to medication management and to identify community-derived solutions to improve medication management.'
2. How many focus groups and participants were involved in the study?
- Five focus groups with 30 participants
- Nine focus groups with 65 participants
- Twelve focus groups with 100 participants
- Three focus groups with 20 participants
Rationale: The abstract states: 'Nine focus groups (N = 65, mean age = 71) were conducted with caregivers or elders from five communities.'
3. What recruitment method was used to enroll participants?
- Random digit dialing
- Convenience sampling at hospitals
- Snowball sampling via key informants
- Online survey recruitment
Rationale: The abstract states: 'Participants were recruited by key informants utilizing snowball sampling methodology.'
4. Which of the following was NOT listed as one of the five participant-recommended solution themes?
- Use of personal systems to overcome barriers
- Solutions to address cost concerns
- Increasing the number of medications prescribed
- Desire for community-driven support systems
Rationale: The abstract's five themes are personal systems, cost solutions, regular medication review to eliminate unnecessary medications, community-driven support systems, and medical advocates. Increasing prescriptions is the opposite of the theme calling for elimination of unnecessary medications.
5. According to the study, what did participants want regarding review of their medications?
- Less frequent contact with pharmacists
- Regular review by doctors or pharmacists to eliminate unnecessary medications
- Automatic refills without provider oversight
- A reduction in the number of pharmacies they use
Rationale: The abstract identifies 'the need for regular review of medications by doctors or pharmacists to eliminate unnecessary medications' as one of the five themes.
6. What is a 'medical advocate,' as referenced in the study's themes?
- A government policy addressing drug pricing
- A person who helps an elder navigate medication management and provider communication
- A pharmaceutical company representative
- An electronic health record system
Rationale: The abstract lists 'using medical advocates' as one of the five solution themes elders and caregivers proposed, referring to individuals who support medication-related communication and decision-making.
7. What did the study conclude about how elders and caregivers viewed medication non-adherence?
- As a purely individual failing with no community relevance
- As a community-wide issue they were eager to help address
- As a problem best left entirely to physicians
- As a rare occurrence not worth discussing
Rationale: The abstract states: 'Elders and caregivers recognized medication non-adherence as a community-wide issue and were eager to offer solutions they thought would work in their communities.'
8. What research design did this study use?
- Randomized controlled trial
- Qualitative study using focus groups
- Retrospective cohort chart review
- Cross-sectional survey
Rationale: The abstract describes the work as 'a qualitative study' conducted through nine focus groups, not a trial, chart review, or survey.
9. Why is a limitation of this study relevant to how nursing students should interpret its findings?
- Because the study proves all five solutions reduce hospitalizations
- Because it is a qualitative study of a specific sample, so findings describe perceptions and community-endorsed ideas rather than tested outcomes
- Because the study included no real participants
- Because the findings apply equally to all countries and populations
Rationale: As a qualitative focus group study drawn from five communities, the findings reflect participant perceptions and proposed solutions; the abstract does not report outcome data testing whether the solutions reduce missed doses or hospitalizations.
10. What value do the authors suggest these community-derived solutions offer?
- They replace the need for any further research on medication adherence
- They can lend credibility to current strategies and offer recommendations for future interventions
- They prove that community input is unnecessary for intervention design
- They eliminate the need for pharmacist involvement in care
Rationale: The abstract states these solutions 'can lend credibility to strategies currently being developed/utilized and offer innovative recommendations for future interventions.'
Study cards
Flashcards
What public health problem does this study address?
Medication mismanagement among elders, a major contributor to emergency hospitalization and nursing home placement.
What type of study design was used?
A qualitative study using focus groups.
How many focus groups were conducted, and with how many participants?
Nine focus groups with 65 participants.
What was the mean age of participants?
71 years.
How many communities did participants come from?
Five communities.
How were participants recruited?
By key informants using snowball sampling methodology.
What is snowball sampling?
A recruitment method where initial participants or contacts help identify additional participants through their social networks.
Name the five participant-recommended solution themes.
Personal systems, cost solutions, regular medication review to eliminate unnecessary medications, community-driven support systems, and medical advocates.
What does the 'personal systems' theme refer to?
Individually developed strategies, like reminder routines or organizers, that elders use to overcome barriers to taking medications correctly.
What barrier does the 'cost concerns' theme address?
The financial burden of managing and paying for medications.
Who did participants want to conduct regular medication reviews?
Doctors or pharmacists, specifically to eliminate unnecessary medications.
What is a 'community-driven support system' in this study's context?
An informal or community-based network that helps elders manage medications, such as peer or neighbourhood support.
What is a 'medical advocate' as described by participants?
A person who helps an elder communicate with providers and manage medication-related decisions.
How did participants view medication non-adherence?
As a community-wide issue, not just an individual problem.
What did the authors say these community-derived solutions could offer?
Credibility to existing strategies and innovative recommendations for future interventions.
In what journal and year was this study published?
Health Education Research, 2015 (Volume 30, Issue 2).
Why is asking elders and caregivers for solutions (not just barriers) methodologically notable?
It generates asset-based, practical ideas rather than only a list of problems, which can improve buy-in for future interventions.
What is one key limitation of this study's sample?
It was drawn from only five communities using snowball sampling, which may limit generalizability and introduce selection bias.
What clinical action does the 'medication review' theme suggest nurses and prescribers should take?
Regularly reviewing patients' full medication lists to identify and eliminate medications that are no longer necessary.
Does this study test whether the five proposed solutions actually reduce missed doses or hospitalizations?
No, it is a qualitative study identifying perceived barriers and community-endorsed ideas, not an outcomes trial.
Search-ready answers
Frequently asked questions
What is this study about?
It is a qualitative study examining barriers to medication management among older adults and identifying solutions proposed by elders and their caregivers themselves, published in Health Education Research (2015).
How many people participated in the study?
Sixty-five people participated across nine focus groups, with a mean age of 71, drawn from five different communities.
How were participants found for the focus groups?
Participants were recruited through key informants using snowball sampling, meaning trusted community contacts helped identify participants who then helped identify others.
What are the five solutions elders and caregivers suggested for improving medication adherence?
Personal systems for staying organized, cost-related solutions, regular medication review by doctors or pharmacists to remove unnecessary medications, community-driven support systems, and use of medical advocates.
Why does cost matter for medication adherence in older adults?
Participants in this study identified cost as a significant barrier and proposed various solutions to address it, though the abstract does not detail every specific cost strategy discussed.
What does 'eliminating unnecessary medications' mean in this context?
Participants wanted doctors or pharmacists to periodically review their full medication lists and stop prescriptions that were no longer needed, a practice related to medication reconciliation.
Is this study a clinical trial that proves these solutions work?
No. It is a qualitative focus group study that identifies participant-perceived barriers and community-endorsed solution ideas; it does not test outcomes like reduced missed doses or hospitalizations.
How can nurses use these findings in practice?
Nurses can ask about cost barriers directly, support patients' personal reminder systems, participate in medication reconciliation, and recognize the value of caregiver and community support and advocacy roles.
What is a limitation of this study's findings?
The sample came from only five communities recruited via snowball sampling, and the abstract does not report detailed demographics, so findings may not generalize to all older adults or caregivers.
Where was this study published and who wrote it?
It was published in Health Education Research, Volume 30, Issue 2 (2015), authored by O'Quin, Semalulu, and Orom.