Author Type

Undergraduate Student

Publication Date

Winter 3-11-2026

Document Type

Article

Executive Summary

An Individualized Approach to Medication Adherence and Safety for a Community Recovering from Addiction

Adherence to prescribed medications is essential for the effective treatment and prevention of medical conditions. A study conducted in British Columbia, Canada, estimated that 50% of patients worldwide do not take their medications as prescribed (Zeitouny et al., 2023). Further, having substance use disorder can increase this risk (Mehdinia et al., 2020). Research with patients who are affected by polypharmacy found that pillboxes can support medication adherence (FarzanehRad et al., 2024). With these statistics in mind, our nursing student team developed a leadership project around pillbox usage to improve medication adherence within a community of individuals at differing stages of addiction recovery. Our team also provided education regarding the use of medication logs, reminders, and contacting providers with medication questions.

Background

The organization we collaborated with is located in Washington state, serving between 75 and 125 individuals per day, as reported by a staff member (Personal communication, February 15, 2026). Individuals who access services at this agency site report being in various stages of recovery from substance use or behavioral disorders and have access to community resources such as housing and free transportation.

To better understand the needs of our organization’s community, our team performed both a windshield survey and informal interview surveys. During the windshield survey, we observed that the surrounding area is well developed but consists primarily of commercial buildings and workplaces, with relatively few visible community support resources. Access to services such as health education, medication education, and social support appears limited. Along with this, utilizing informal interviews with participants from the organization provided insight into their specific challenges with medication adherence. Many participants reported polypharmacy and chronic health conditions, psychosocial stressors, and limited health literacy, all of which can contribute to challenges with consistent medication use. In addition, many individuals are in recovery from substance use disorders, a factor that has been associated with lower medication adherence (Mehdinia et al., 2020). These combined factors increase the risk for difficulty following prescribed medication regimens. Based on these findings, we identified the nursing diagnosis of ineffective medication adherence (Doenges et al., 2019).

Scholarly literature shows similar findings to our assessments. A study conducted in 2020 among older adults found that 57.14% of participants in the intervention group had poor medication adherence due to polypharmacy. However, after receiving education on pillbox use, the incidence of impaired medication adherence reduced to just 11.4% (Mehdinia et al., 2020). Additionally, in a separate small-scale primary study, 49% of participants found it helpful to keep a medication log to discuss concerns with providers (Mortelmans & Dilles, 2024). Both studies informed our decision to provide pillboxes and educational materials that encourage medication adherence and provide guidance on communicating effectively with healthcare providers about medications. Another mixed-methods descriptive study assessed providers' and patients’ thoughts on the effect of medication list implementation (Garfield et al., 2020). The participants reported improved accuracy of medication reconciliation, identification of potential drug interactions, and increased communication between patients and doctors regarding medication regimens.

Project Description

Our project was guided by the Transtheoretical Model of Behavior Change (Raihan & Cogburn, 2023), which recognizes that individuals move through varying stages of readiness when modifying health behaviors. The intervention was designed to meet participants at their current stage and to support progression toward consistent medication adherence by advancing through the steps of the model.

To gather data, we created a survey, asking 5 “yes” or “no” questions to assess participants’ ability to adhere to medications. The survey scores range from zero to five, with a higher score indicating stronger medication adherence. We set up an informational table where participants were asked pre-survey questions and provided with educational materials covering medication adherence strategies and tips for effective communication with healthcare providers. Due to the nature of our population, we did not collect demographic data to protect participants’ privacy. Follow-up discussions and surveys were conducted one week later to assess the project's efficacy. Project success was evaluated based on self-reported increases in medication adherence and mean survey results.

Outcomes

During our project implementation, we distributed pillboxes and educational flyers to 24 participants, whose average pre-survey score was 3 out of 5. In the post-survey, data was collected from 10 returning participants, revealing an average score of 3.3 out of 5. Eight of the 10 participants reported using the pillboxes consistently within the last week. Although a small change, this indicates an improvement in medication adherence. All participants reported that using a pillbox made them feel less overwhelmed with their medication regimens and helped them remember to take them as prescribed. Thus, we were able to meet our objectives of increasing medication adherence and safety, with all pillbox users reporting stronger adherence in the week-long period following the intervention.

Conclusion

When evaluating the effectiveness of our project, we identified several opportunities to improve sustainability and overall impact. Further recommendations include gathering informational data based on a research-approved survey, using a larger sample size, and implementing long-term follow-ups with participants. These strategies may demonstrate a deeper impact on medication adherence and are more representative of the diverse population.

Despite limitations in sample size and longevity of the project, our team met our goal to provide resources that bolster medication adherence among those who attend the organization. Our intervention was well-received, and a majority of participants reported a positive outcome from our project. With sustainability in mind, we left our supplies and resources at the agency to facilitate community member’s engagement with this project. Through this project, we aimed to support sustained improvement in the community’s ability to manage medications effectively by increasing awareness, providing education, and encouraging the use of strategies that promote medication adherence.

References

Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2019). Nursing diagnosis manual: Planning, individualizing, and documenting client care (6th ed.). F. A. Davis Company.

FarzanehRad, A., Allahbakhshian, A., Gholizadeh, L., Khalili, A. F., & Hasankhani, H. (2024). Randomized comparison of the effects of tailored text messaging versus pillbox organizers on medication adherence of heart failure patients. BMC Cardiovascular Disorders, 24, 244. https://doi.org/10.1186/s12872-024-03884-1

Garfield, S., Furniss, D., Husson, F., Etkind, M., Williams, M., Norton, J., Ogunleye, D., Jubraj, B., Lakhdari, H., & Franklin, B. D. (2020). How can patient‑held lists of medication enhance patient safety? A mixed‑methods study with a focus on user experience. BMJ Quality & Safety, 29(9), 764–773. https://doi.org/10.1136/bmjqs-2019-010194

Mehdinia, A., Loripoor, M., Dehghan, M., & Heidari, S. (2020). The effect of pillbox use on medication adherence among elderly patients: A randomized controlled trial. International Electronic Journal of Medicine, 9(1), 38–43. https://doi.org/10.34172/iejm.2020.07

Mortelmans, L., & Dilles, T. (2024). The development and evaluation of a medication diary to report problems with medication use. Heliyon, 10(4), Article e26127. https://doi.org/10.1016/j.heliyon.2024.e26127

Raihan, N., & Cogburn, M. (2023). Stages of change theory. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK556005/

Seraphine Zeitouny, Cheng, L., Wong, S. T., Tadrous, M., McGrail, K., & Law, M. R. (2023). Prevalence and predictors of primary nonadherence to medications prescribed in primary care. Canadian Medical Association Journal, 195(30), E1000–E1009. https://doi.org/10.1503/cmaj.221018

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