169 General discussion Figure 1 A conceptual model for factors contributing to medication adherence based on a systematic review of 102 conceptual frameworks. Abbreviations: healthcare provider (HCP). Source: Peh et al. (2021) The Perceptions and Practicalities Approach (PaPA) similarly centers the patient related factors motivation and ability as core concepts of medication adherence (16). The model describes how motivation is influenced by perceptions and intentional processes, while ability is influenced by unintentional processes and practicalities. Internal or external triggers then prompt the intentional and unintentional processes, with opportunity doing the same for perceptions and practicalities. By addressing patients’ perceptions regarding the treatment and supporting the patient with the practical considerations related to adhering to the treatment, this approach aims to support adherence by affecting its essential attributes. Therefore, the authors recommend that interventions aimed at improving medication adherence should not only have a strong theoretical basis, but also consider which patients benefit most from the intervention, consider perceptual and practical barriers to adherence, tailor the intervention to an individual’s needs, and optimize the content, context, and channel of delivery (17). Building upon these recommendations, future research focusing on adherence to HBE recommendations should integrate these suggestions with the e-Exercise LBP design. Specifically, it should include evaluation of a patient’s suitability for blended treatment (18), consider patient preferences in choosing the most suitable delivery method for the intervention’s content, and continuous assessment of patient perceptions of the treatment. From medication models to adherence to HBE The common denominator between the models from pharmacology are the perceptions of the patient. Perceived susceptibility, severity, barriers, benefits, and concerns seem to 8
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