This qualitative study sought to ex

This qualitative study sought to explore facilitators and barriers to adherence to multiple
medications among low-income patients with comorbid chronic physical and mental health
conditions.The 50 focus group participants identified personal/contextual and health system
factors as major impediments to adherence to multiple medications. These factors included
medication side effects, fear of harm from medication, fear of dependence on medication,
complex instructions, suboptimal communications with doctor, suspicion about doctors' and
pharmaceutical companies' motives in prescribing medication, and the high cost of medications.
Participants also identified motivators, both internal (self-initiated) and external (initiated by
family,doctor,support groups), to ensure adherence to multiple medications.These motivators
included self-discipline, sense of personal responsibility,faith,support from family members and
doctors, and focused health education and self-management support.Three themes emerged
that enhanced understanding of the complexity of adherence to multiple medications: (1)
reaching one's own threshold for medication adherence, (2) lack of shared information and
decision making, and (3) taking less than the prescribed medication. Further analysis of the
data revealed that the patients perceived a lack of shared decision making in the management
of their comorbid chronic conditions and their medication regimen.