Determinants of Treatment Adherence Among Older Adults with Multimorbidity: A Literature Review Grounded in Social Cognitive Theory, the Health Action Process Approach, and Structural Equation Modelling
DOI:
https://doi.org/10.5281/zenodo.21126965Keywords:
Multimorbidity, Older adults, Treatment adherence, Social cognitive theory, Health action process approach, Structural equation modelling, Medication literacy, Self-efficacyAbstract
Multimorbidity — the coexistence of two or more chronic conditions within an individual — has emerged as one of the most pressing public health challenges of the twenty-first century, particularly among ageing populations. Treatment adherence, a critical determinant of therapeutic outcomes, remains persistently suboptimal in this population, with non-adherence rates ranging from 25% to 76% across diverse clinical contexts. This literature review synthesises current evidence on the determinants of treatment adherence among older adults with multimorbidity through the integrative lens of three complementary theoretical frameworks: Social Cognitive Theory (SCT), particularly its Triadic Reciprocal Determinism (TRD) component; the Health Action Process Approach (HAPA); and Structural Equation Modelling (SEM). Empirical evidence on key psychosocial determinants — including medication literacy, inner strength, social support, and self-efficacy — is critically examined. The review identifies significant gaps in the existing literature, particularly the scarcity of studies that simultaneously model these constructs within a unified framework applied specifically to older adults with multimorbidity, and proposes directions for future research and intervention development.
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