Exploring barriers and facilitators to medication adherence among geriatric patients with polypharmacy: a qualitative study using the theoretical domains framework

Background and Need for the Study

Medication adherence is critical for managing chronic diseases in older adults; however, nonadherence is common, especially among those with polypharmacy. In India, the contributing factors include low health literacy, financial constraints, caregiver dependence, cultural beliefs, and irregular access to medicines. Although prior studies have identified some barriers, the deeper behavioural, social, and systemic determinants remain poorly understood, particularly from the patient and provider perspectives. The Theoretical Domains Framework (TDF) offers a structured, evidence based approach to explore these influences across the cognitive, behavioural, social, and environmental domains. Its application in the Indian geriatric context can yield culturally relevant insights to guide targeted and sustainable interventions that improve adherence in this vulnerable population.

Objectives

To identify and map barriers and facilitators influencing medication adherence among older adults with polypharmacy in India, incorporating perspectives from both patients and healthcare providers, using TDF as the analytical framework.

Methods

A qualitative study will be conducted over a six-month period (September 2025 to February 2026) in the Department of General Medicine, Justice K.S. Hegde Charitable Hospital, Mangaluru, with participants drawn from both urban and rural healthcare settings. Geriatric patients (over 60 years) taking five or more chronic medications will be recruited purposively, alongside healthcare providers involved in their care. Approximately 15 to 20 patients and 5 to 8 healthcare providers will be interviewed until thematic saturation is reached.

Data Analysis

Thematic analysis will be conducted using the TDF domains as the coding framework. Two independent researchers will code the data collected. Discrepancies in coding will be resolved through discussion, and if an agreement cannot be reached, a third researcher will make the final decision. To ensure methodological rigour, we will use investigator triangulation (involving multiple researchers in analysis), data source triangulation (drawing on patient interviews, provider interviews, and case records), and maintain a detailed audit trail documenting coding and analytical decisions

Expected Outcome

This study is expected to generate a rich, domain specific understanding of the cognitive, behavioural, social, and environmental factors influencing medication adherence. Comparative analysis will highlight both shared and unique determinants between patients and providers, with particular attention to culturally relevant facilitators and modifiable barriers that can be addressed through targeted interventions in the future.

Conclusion

By applying the TDF to the Indian geriatric polypharmacy context, this study will fill a critical evidence gap in the literature. The findings will provide actionable insights to inform the design of targeted, context sensitive, and sustainable interventions that strengthen medication adherence, thereby contributing to improved therapeutic outcomes and quality of life among India’s aging population.