Determining the causes of drug nonadherence in patients with kidney transplantation

The study was conducted descriptively to determine the reasons for medication nonadherence in patients who underwent kidney transplantation. The population of the study consisted of all patients (N=450) followed in the Organ Transplant Outpatient Clinic of a private university hospital. The sample included 120 patients aged between 18-65, who had undergone transplantation at least 3 months prior, were literate, had no sensory/hearing impairments, were willing to participate in the study, and provided informed consent. Data collection tools included the "Patient Information Form," the "Adherence Scale with Knowledge (ASK-20)" and the "Medication Adherence Report Scale-5 (MARS-5)" to evaluate medication adherence, and the "Quality of Life Scale-5 Dimensions (EQoL-5D-3L)" to assess quality of life. Data analysis was performed using descriptive, relational, and comparative statistics with IBM SPSS® 22.0. The mean MARS-5 score for kidney transplant patients was found to be 23.16±2.83, with 37.5% exhibiting medication nonadherence. The mean EQoL-5D-3L VAS score was 79.5±8.43 (min=40, max=90). A negative significant correlation was found between MARS-5 and EQoL-5D-3L (r=-0.203; p<0.05). It was determined that 59.2% of the patients were male, 69.2% were married, with an average age of 40.50±11.92 years, and the average time since transplantation was 17.3±15.61 months. As age (r=-0.210; p<0.05), number of children (r=-0.270; p<0.05), and over time transplantation increased, MARS-5 scores decreased (r=-0.313; p<0.001). The ASK-20 scale, which had undergone language and content validity, was found unsuitable for factor analysis in the construct validity step, as the Kaiser-Meyer-Olkin test value was below 0.50 (0.314). This study identified that increases in age (p<0.05) and time since transplantation (p<0.001) were associated with increased medication nonadherence. Male gender, being married, having children, being retired post-transplant, having a caregiver for medication use, missing appointments due to transportation issues/neglect/forgetfulness, not knowing their medications, and discontinuing medications were found to be influential variables affecting medication nonadherence. Additionally, it was determined that as medication adherence increased, quality of life improved. In conclusion, it is recommended that education given to patients be repeated at frequent intervals and that individual counseling be provided by identifying the difficulties experienced in medication use. To enhance the permanence of education on medication adherence and thereby improve quality of life, it is suggested to plan nursing interventions accordingly.