Non-adherence to immunosuppressive medication in renal transplant recipients within the scope of the Integrative Model of Behavioral Prediction: a cross-sectional study.

Background: Non-adherence to immunosuppressive medication is strongly associated with poor outcomes. Identifying the factors influencing it is a first step in developing adherence interventions. This study's objective was to investigate the prevalence of self-reported and collaterally-reported non-adherence to immunosuppressives, and, based on the Integrative Model of Behavioral Prediction, to explore the association between non-adherence, intention to adhere, attitudes, norms and self-efficacy.
Methods: This cross-sectional study included a convenience sample of 114 renal transplant recipients in follow-up care, one to five yr post-transplant. Non-adherence was measured by self-reports and collateral reports. Factors of the Integrative Model of Behavioral Prediction were assessed using a self-report questionnaire.
Results: Self-reports showed non-adherence of 23.7%; collateral reports showed 3.8%; and a combination of the two showed 26.4%. Logistic regression analysis showed that the attitude "Not all immunosuppressive drugs are necessary to prevent rejection" was less frequent in patients with higher intentions to adhere, with an odds ratio (OR) of 0.05 (95% CI 0.01-0.50). The barrier of "Forgetfulness/Interruption of daily routine" was associated with non-adherence, with an OR of 3.74 (95% CI 1.55-9.03).
Conclusions: Forgetfulness is the most powerful barrier against adherence. Intention to adhere plays a minor role in non-adherence in renal transplant recipients.