What this article is about
In brief
Nine focus groups with 65 elders and caregivers identified five proposed approaches to medication adherence: personal systems, responses to cost, medication review, community support, and medical advocates. The study gathered community ideas; it did not test whether they improve adherence.
For nursing students
Study summary
O’Quin, Semalulu, and Orom asked elders and caregivers what makes medication management difficult and what their communities could do about it. The researchers held nine focus groups with 65 participants from five communities. Participants had a mean age of 71 and were recruited through key informants using snowball sampling.
The abstract reports five groups of proposed solutions. Participants described personal systems for managing medications and approaches to cost concerns. They wanted doctors or pharmacists to review medication lists regularly so that unnecessary medicines could be removed. They also called for community-driven support and medical advocates.
These results represent participant priorities, not evidence that any proposed approach changes medication-taking behaviour. No intervention was delivered, and the study did not measure missed doses, adverse events, hospital use, or nursing-home placement after a solution was introduced.
The five themes can make a medication conversation more specific. A clinician can ask how a person currently manages medicines, whether cost creates difficulty, when the complete regimen was last reviewed, and what support the person wants. Those questions remain assessment prompts; the abstract does not establish that one strategy will work for every older adult or caregiver.
Original publication
Source abstract and study details
Read the source abstract
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.
Reviewed findings
Main findings
- Researchers conducted nine focus groups with 65 elders or caregivers from five communities; participants had a mean age of 71.
- Participants proposed five solution areas: personal systems, responses to cost concerns, regular medication review, community-driven support, and medical advocates.
- Participants regarded medication non-adherence as a community-wide issue and offered ideas they believed could work in their communities.
For teaching and learning
Education implications
- The five themes can structure medication assessment around the person’s existing system, cost concerns, medication review, and desired support.
- A request to remove unnecessary medicines should lead to review with an appropriate prescriber or pharmacist; this study did not evaluate a specific review process.
- Community support or advocacy should be explored as a participant preference, not presented as a proven adherence intervention.
For educators
Teaching and appraisal notes
This qualitative study centres solution proposals from elders and caregivers rather than evaluating a provider-designed intervention. Nine focus groups involved 65 participants from five communities, with a reported mean age of 71. Recruitment occurred through key informants and snowball sampling.
The abstract identifies five themes: personal medication-management systems, responses to cost concerns, regular review by doctors or pharmacists to remove unnecessary medicines, community-driven support, and medical advocates. The clearest appraisal distinction is between a community-endorsed proposal and an effective intervention. The study supports the former; it reports no adherence or health outcome after implementation.
The record is suitable for discussing recruitment through social networks and the transferability of qualitative findings. The abstract does not identify the five communities, report how many participants were elders versus caregivers, describe the analytic procedure, or provide participant quotations. Those omissions constrain assessment of context and interpretation without invalidating the priorities participants raised.
Critical appraisal
Limitations
- Focus groups elicited perceptions and proposed solutions; no intervention or adherence outcome was tested.
- Recruitment through key informants and snowball sampling may favour people connected to the participating community networks.
- The abstract does not identify the communities, give the elder-caregiver composition, or describe the analytic procedure, limiting assessment of transferability.
Classroom use
Discussion Questions
- How does asking participants to propose solutions change the purpose of these focus groups?
- Which perspectives might snowball recruitment through key informants include or miss?
- How would you distinguish a community-endorsed idea from an intervention supported by outcome evidence?
- What additional information about the five communities would you need before adapting one of the proposals locally?
- Which outcomes would a follow-up study need to measure to evaluate regular medication review or community support?
Source-based questions
Frequently asked questions
Who contributed the medication-management proposals?
Sixty-five elders or caregivers joined nine focus groups across five communities. Their mean age was 71.
Were these approaches tested for effectiveness?
No. The study collected perceptions and proposed solutions; it did not implement an intervention or measure a change in adherence.