Patient Education for Long Term Adherence
Main Article Content
Abstract
The success of patients with chronic disorders in effective management is reflected in the poor adherence rates reported for various regimen components, including medication taking, exercise, dietary regimen, among others. A major function of nursing is the education of patients on care management. Research shows that this education primarily focuses on knowledge, with less attention given to the development of behaviors which would support continuation of treatments over time. Conceptualizing adherence to treatment as a habit building process has shown promise in supporting adherence. While there is the need for ongoing research, there is a body of evidence to support the development of adherence through habit building. Models of habit building exist to inform the nurse educator. It is recommended that the education of the nurse include the process of developing habits and habit strength to inform the education of patients on regimen management.
Keywords:
Patient education, Adherence, Habit building, Nurse delivered patient education
Article Details
How to Cite
DUNBAR-JACOB, Jacqueline.
Patient Education for Long Term Adherence.
Medical Research Archives, [S.l.], v. 13, n. 7, july 2025.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/6632>. Date accessed: 05 dec. 2025.
doi: https://doi.org/10.18103/mra.v13i7.6632.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. Chowdhury, S. R., Das, D. C., Sunna, T. C., Beyene, J., & Hossain, A. (2023). Global and regional prevalence of multimorbidity in the adult population in community settingts: A systematic review and meta-analysis. eClinical Medicine, 57:101860. Doi: 10.1016/j.eclinm.2023.101860
2. Cea-Calvo, L., Marin-Jimenez, I., de Toro, J., Fuster-RuizdeApodaca, M. J., Fernandez, G., Sanchex-Vega, N., & Orozco-Beltran, D. (2019). Current Medical Research and Opinion, 36(2):293-300. https://doi.org/10.1080/03007995.2019.1676539
3. Youngster, L., Gelernter, R., Klainer, H., Paz, H., Kozer, E., & Goldman, M. (2022). Electronically monitored adherence to short-term antibiotic therapy in children. Pediatrics, 150 (6): e2022058281. https://doi.org/10.1542/peds.2022-058281
4. Almomani, B. A., Hijazi, B. M., Awwad, O., & Khasawneh, R. A. (2022). Prevalence and predictors of non-adherence to short-term antibiotics: A population-based survey. PLOS One, https://doi.org/10.1371/journal.pone.0268285
5. Garcia-Hermoso, A., Lopez-Gil, J. F., Ramirez-Velex, R., Alonso-Martinez, A. M., Izquierdo, M., & Ezzatvar, Y. (2022). Adherence to aerobic and muscle-strengthening activities guidelines: a systematic review and meta-analysis of 3.3 million participants across 32 countries. British Journal of Sports Medicine. 57(4), https://doi.org/10.1136/bjsports-2022-106189
6. Saida, T. G. R. H., Sorensen, T. J., & Langberg, H. (2017). Long-term exercise adherence after public health training in at-risk adults. Annals of Physical Medicine and Rehabilitation, 60(4): 237-243. Doi: 10.1016/j.rehab.2017.02.006
7. Mellen, P. B., Gao, S. K., Vitolins, M. Z., & Goff, D. C. (2008). Deteriorating dietary habits among adults with hypertension: DASH dietary accordance, NHANES 1988-1994 and 1999-2004. Archives of Internal Medicine, 168(3): 308-314. https://Doi:10.1001/archinternmed.2007.119
8. 8.Shim, J. S., Heo, J. E., & Kim, H. C. (2020). Factors associated with dietary adherence to the guidelines for prevention and treatment of hypertension among Korean adults with and without hypertension. Clinical Hypertension. 26, 5 https://doi.org/10.1186/s40885-020-00138-y
9. 9.Arad, M., Goli, R., Parizad, N., Vahabzadeh, D., & Baghaei, R. (2021). Do the patient education program and nurse-led telephone follow-up improve treatment adherence in hemodialysis patients? A randomized controlled trial. BMC Nephrology. 22, 119 https://doi.org/10.1186/s12882-021-02319-9
10. 10.Albiladi, R. A. M., Ajlabri, K. A., Alrowatai, B. A., Alsuhimi, M. M., Alamri, A. S., Alharbi, R. A. A., Alharbi, S. S. A., & Aljabri, B. A. (2023). Nurse-led interventions to enhance adherence to chronic medication. International Journal for Scientific Research. 2(11), 312-325. https://doi.org/10.59992/IJSR.2023.v2n11p13
11. 11.Ampofo, A. G., Khan, E., & Ibitoye, M. B. (2020). Understanding the role of educational interventions on medication adherence in hypertension: A systematic review and meta-analysis. Heart & Lung. 49(5), 537-547, https://doi.org/10.1016/j.hrtlng.2020.02.039
12. Walter, W. G. (1925). Habit training for mental patients. Occupational Therapy & Rehabilitation, 4(4), 235-240.
13. Wilson, S. C. (1929). Habit training for mental cases. Occupational Therapy & Rehabilitation. 8(3), 189-109.
14. Badawy, S. M., Shah, R., Beg, U., & Heneghan, M. B. (2020). Habit strength, medication adherence, and habit-based mobile health interventions across chronic medical conditions: Systematic review. Journal of Medical Internet Research. 22(4):e17883 Doi: 10.2196/17883
15. Demirci, E., Tuzun, E., Un, A, F, asonmez, T. G., & Varol, O. (2025). From occasional to steady: Habit formation insights from a comprehensive fitness study. Computers and Society, arXiv:2501.01779
16. Pironet, A., Phillips, L. A., & Vrijens, B. (2025). Correlation between objective habit metrics and objective medication adherence: Retrospective study of 15,818 participants from clinical studies. Interactive Journal of Medical Research. 14:e63987, Doi: 10.2196/63987
17. Stroebele-Benschop, N., Dieze, A., & Hilsendegen, C. (2018). Students’ adherence to dietary recommendations and their food consumption habaits. Nutrition and Health, 24(2), 75-81. https://doi.org/10.1177/0260106018772946
18. 18.Ma, H., Wang, A., Pei, R., & Piao, M. (2023). Effect of habit formation interventions on physical activity habit strength: Meta-analysis and meta-regression. International Journal of Behavioral Nutrition and Physical Activity. 20, 109. https://doi.org/10.1186/s12966-023-01493-3
19. 19.Singh, B., Murphy, A., Maher, C., & smith, A. E. (2024). Time to form a habit: A systematic review and meta-analysis of health beahviour habit formation and its determinants. Healthcare. 12(23), 2488. https://doi.org/10.3390/healthcare12232488
20. 20.Akash, M. S. & Chowdhury, S. (2025). Small changes, big impact: A mini review of habit formation and behavioral change principles. World Journal of Advanced Research and Reviews. 26(01), 3098-3106. Doi: https://doi.org/10.30574/wjarr.2025.26.1.1333
21. 21.Gardner, B., Rebar, A. L., & Lally, P. (2022). How does habit form? Guidelines for tracking real-world habit formation. Cogent Psychology. 9(1). https://doi.org/10.1080/23311908.2022.2041277
22. 22.Simonsmeier, B. A., Flaig, M., Simacek, T. & Schneider, M. (2020). What sixty years of research says about the effectiveness of patient education on health: a second order meta-analysis. Health Psychology Review. 16(3), 450-474. https://doi.org/10.1080/17437199.2021.1967184
23. 23.Murray, J. M. & Escola, G. S. (2020). Remembrance of things practiced with fast and slow leawrning in cortical and subcortical pathways. Nature Communications, 11, 6441. https://doi.org/10.1038/s41467-020-19788-5
24. 24.Wang, S., Liu, K., Tang, S., Wang, G., Qi, Y., & Chen, Q. (2025). Interventions to improve patient health education competence among nursing personnel: A scoping review. Nurse Education in Practice. 83, 104258. https://doi.org/10.1016/j.nepr.2025.104258
25. 25.Rice, H., Say, R., & Betihavas, V. (2018). The effect of nurse-led education on hospitalization, readmission, quality of life and cost in adults with heart failure. A systematic. Patient Education and Counseling. 101(3), 363-374. https://doi.org/10.1016/j.pec.2017.10.002
26. 26.Celio, J., Ninane, F., Bugnon, O., & schneider, M. P. 2018). Pharmacist-nurse collaborations in medication adherence-enhancing interventions: A review. Patient Education and Counseling. 101(7), 1175-1192. https://doi.org/10.1016/j.pec.2018.01.022
27. 27.Alanzi, A. M., Al Guhani, M. F., Althobity, S. a., Alharthi, M. D. Alotaibi, S. D., & Al Ghamdi, F. A., (2024). The role of health education among nurses in promoting medication adherence: Strategies and outcomes. Journal of Healthcare Sciences. 4(12), JOHS2024001014. http://dx.doi.org/10.52533/JOHS.2024.41251
28. 28.Shi, W., Ghisi, G. l. M., Zhang, L., Hyun, K., Pakosh, M., & Gallagher, R. (2022). Systematic review, meta-analysis and meta-regression to determine the effects of patient education on health behaviour change in adults diagnosed with coronary heart disease. Journal of Clinical Nursing, 32(15-16), 5300-5327. https://doi.org/10.1111/jocn.16519
29. 29.Gardner, B., Aarden, M. A., Brown, D., Even, F. F., Green, J., Hamilton, K., Hankonen, N., Inauen, J., Keller, J., Kwasnicka, D., Labudek, S., Marien, H., Masaryk, R., McCleary, N., Mullan, B. A., Neter, E., Orbell, S., Potthoff, S., & Lally, P. (2021). Developing habit-based health behavior change interventions: twenty-one questions to guide future research. Psychology & Health, 38(4), 518-540. https://doi.org/10.1080/08870446.2021.2003362
2. Cea-Calvo, L., Marin-Jimenez, I., de Toro, J., Fuster-RuizdeApodaca, M. J., Fernandez, G., Sanchex-Vega, N., & Orozco-Beltran, D. (2019). Current Medical Research and Opinion, 36(2):293-300. https://doi.org/10.1080/03007995.2019.1676539
3. Youngster, L., Gelernter, R., Klainer, H., Paz, H., Kozer, E., & Goldman, M. (2022). Electronically monitored adherence to short-term antibiotic therapy in children. Pediatrics, 150 (6): e2022058281. https://doi.org/10.1542/peds.2022-058281
4. Almomani, B. A., Hijazi, B. M., Awwad, O., & Khasawneh, R. A. (2022). Prevalence and predictors of non-adherence to short-term antibiotics: A population-based survey. PLOS One, https://doi.org/10.1371/journal.pone.0268285
5. Garcia-Hermoso, A., Lopez-Gil, J. F., Ramirez-Velex, R., Alonso-Martinez, A. M., Izquierdo, M., & Ezzatvar, Y. (2022). Adherence to aerobic and muscle-strengthening activities guidelines: a systematic review and meta-analysis of 3.3 million participants across 32 countries. British Journal of Sports Medicine. 57(4), https://doi.org/10.1136/bjsports-2022-106189
6. Saida, T. G. R. H., Sorensen, T. J., & Langberg, H. (2017). Long-term exercise adherence after public health training in at-risk adults. Annals of Physical Medicine and Rehabilitation, 60(4): 237-243. Doi: 10.1016/j.rehab.2017.02.006
7. Mellen, P. B., Gao, S. K., Vitolins, M. Z., & Goff, D. C. (2008). Deteriorating dietary habits among adults with hypertension: DASH dietary accordance, NHANES 1988-1994 and 1999-2004. Archives of Internal Medicine, 168(3): 308-314. https://Doi:10.1001/archinternmed.2007.119
8. 8.Shim, J. S., Heo, J. E., & Kim, H. C. (2020). Factors associated with dietary adherence to the guidelines for prevention and treatment of hypertension among Korean adults with and without hypertension. Clinical Hypertension. 26, 5 https://doi.org/10.1186/s40885-020-00138-y
9. 9.Arad, M., Goli, R., Parizad, N., Vahabzadeh, D., & Baghaei, R. (2021). Do the patient education program and nurse-led telephone follow-up improve treatment adherence in hemodialysis patients? A randomized controlled trial. BMC Nephrology. 22, 119 https://doi.org/10.1186/s12882-021-02319-9
10. 10.Albiladi, R. A. M., Ajlabri, K. A., Alrowatai, B. A., Alsuhimi, M. M., Alamri, A. S., Alharbi, R. A. A., Alharbi, S. S. A., & Aljabri, B. A. (2023). Nurse-led interventions to enhance adherence to chronic medication. International Journal for Scientific Research. 2(11), 312-325. https://doi.org/10.59992/IJSR.2023.v2n11p13
11. 11.Ampofo, A. G., Khan, E., & Ibitoye, M. B. (2020). Understanding the role of educational interventions on medication adherence in hypertension: A systematic review and meta-analysis. Heart & Lung. 49(5), 537-547, https://doi.org/10.1016/j.hrtlng.2020.02.039
12. Walter, W. G. (1925). Habit training for mental patients. Occupational Therapy & Rehabilitation, 4(4), 235-240.
13. Wilson, S. C. (1929). Habit training for mental cases. Occupational Therapy & Rehabilitation. 8(3), 189-109.
14. Badawy, S. M., Shah, R., Beg, U., & Heneghan, M. B. (2020). Habit strength, medication adherence, and habit-based mobile health interventions across chronic medical conditions: Systematic review. Journal of Medical Internet Research. 22(4):e17883 Doi: 10.2196/17883
15. Demirci, E., Tuzun, E., Un, A, F, asonmez, T. G., & Varol, O. (2025). From occasional to steady: Habit formation insights from a comprehensive fitness study. Computers and Society, arXiv:2501.01779
16. Pironet, A., Phillips, L. A., & Vrijens, B. (2025). Correlation between objective habit metrics and objective medication adherence: Retrospective study of 15,818 participants from clinical studies. Interactive Journal of Medical Research. 14:e63987, Doi: 10.2196/63987
17. Stroebele-Benschop, N., Dieze, A., & Hilsendegen, C. (2018). Students’ adherence to dietary recommendations and their food consumption habaits. Nutrition and Health, 24(2), 75-81. https://doi.org/10.1177/0260106018772946
18. 18.Ma, H., Wang, A., Pei, R., & Piao, M. (2023). Effect of habit formation interventions on physical activity habit strength: Meta-analysis and meta-regression. International Journal of Behavioral Nutrition and Physical Activity. 20, 109. https://doi.org/10.1186/s12966-023-01493-3
19. 19.Singh, B., Murphy, A., Maher, C., & smith, A. E. (2024). Time to form a habit: A systematic review and meta-analysis of health beahviour habit formation and its determinants. Healthcare. 12(23), 2488. https://doi.org/10.3390/healthcare12232488
20. 20.Akash, M. S. & Chowdhury, S. (2025). Small changes, big impact: A mini review of habit formation and behavioral change principles. World Journal of Advanced Research and Reviews. 26(01), 3098-3106. Doi: https://doi.org/10.30574/wjarr.2025.26.1.1333
21. 21.Gardner, B., Rebar, A. L., & Lally, P. (2022). How does habit form? Guidelines for tracking real-world habit formation. Cogent Psychology. 9(1). https://doi.org/10.1080/23311908.2022.2041277
22. 22.Simonsmeier, B. A., Flaig, M., Simacek, T. & Schneider, M. (2020). What sixty years of research says about the effectiveness of patient education on health: a second order meta-analysis. Health Psychology Review. 16(3), 450-474. https://doi.org/10.1080/17437199.2021.1967184
23. 23.Murray, J. M. & Escola, G. S. (2020). Remembrance of things practiced with fast and slow leawrning in cortical and subcortical pathways. Nature Communications, 11, 6441. https://doi.org/10.1038/s41467-020-19788-5
24. 24.Wang, S., Liu, K., Tang, S., Wang, G., Qi, Y., & Chen, Q. (2025). Interventions to improve patient health education competence among nursing personnel: A scoping review. Nurse Education in Practice. 83, 104258. https://doi.org/10.1016/j.nepr.2025.104258
25. 25.Rice, H., Say, R., & Betihavas, V. (2018). The effect of nurse-led education on hospitalization, readmission, quality of life and cost in adults with heart failure. A systematic. Patient Education and Counseling. 101(3), 363-374. https://doi.org/10.1016/j.pec.2017.10.002
26. 26.Celio, J., Ninane, F., Bugnon, O., & schneider, M. P. 2018). Pharmacist-nurse collaborations in medication adherence-enhancing interventions: A review. Patient Education and Counseling. 101(7), 1175-1192. https://doi.org/10.1016/j.pec.2018.01.022
27. 27.Alanzi, A. M., Al Guhani, M. F., Althobity, S. a., Alharthi, M. D. Alotaibi, S. D., & Al Ghamdi, F. A., (2024). The role of health education among nurses in promoting medication adherence: Strategies and outcomes. Journal of Healthcare Sciences. 4(12), JOHS2024001014. http://dx.doi.org/10.52533/JOHS.2024.41251
28. 28.Shi, W., Ghisi, G. l. M., Zhang, L., Hyun, K., Pakosh, M., & Gallagher, R. (2022). Systematic review, meta-analysis and meta-regression to determine the effects of patient education on health behaviour change in adults diagnosed with coronary heart disease. Journal of Clinical Nursing, 32(15-16), 5300-5327. https://doi.org/10.1111/jocn.16519
29. 29.Gardner, B., Aarden, M. A., Brown, D., Even, F. F., Green, J., Hamilton, K., Hankonen, N., Inauen, J., Keller, J., Kwasnicka, D., Labudek, S., Marien, H., Masaryk, R., McCleary, N., Mullan, B. A., Neter, E., Orbell, S., Potthoff, S., & Lally, P. (2021). Developing habit-based health behavior change interventions: twenty-one questions to guide future research. Psychology & Health, 38(4), 518-540. https://doi.org/10.1080/08870446.2021.2003362