Background: Non-adherence to immunosuppressive medications is an important cause of allograft loss after kidney transplant. To examine factors influencing medication adherence in adult kidney transplant patients, we performed a qualitative study and performed depth interviews in adherent as well as non-adherent patients.

Methods: We interviewed 18 subjects who were identified as being non-adherent by the Immunosuppressive Therapy Adherence Scale (ITAS), a self-administered adherence measure (ITAS scores <9). For comparison purposes, we interviewed 9 additional patients who were identified as being adherent by ITAS score (ITAS scores >11). The face-to-face interviews ranged in duration from 36 to 116 minutes (mean 58 minutes) and followed a structured interview guide. This guide included questions and probes about patients' transplant experiences; medication-taking behaviors (past and present); use of tools and reminders; descriptions of any missed doses; and advice they would give others regarding transplant medication-taking. Interview transcripts were analyzed using a qualitative, grounded theory approach by a multidisciplinary team that included a qualitative researcher, health psychologist, epidemiologist, and transplant physician.

Results: Among the kidney transplant recipients whom we interviewed, knowledge of the importance of medication adherence was common. Most patients, even those with low ITAS scores, described themselves as adherent. Having routines and the use of tools and reminders were important for maintaining adherence. These tools and reminders included pillboxes, visual cues, and alarms. Variations in patient routines (e.g. weekends, travel, going out with friends) contributed to non-adherence. Emotional and psychological issues, such as depression and anxiety, also impaired adherence, though mostly at higher levels of severity. Patients appeared to be more successful in maintaining medication adherence when they approached any lapses in adherence as opportunities to problem-solve and to learn. Patients with lower adherence tended to be more acquiescent and passive in their responses to missed doses.

Conclusion: Future research should explore the use of interventions that encourage transplant recipients to adopt a problem-solving approach to lapses in medication adherence.

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