Qualitative Experience with an Adherence Promotion Intervention Among Individuals with Bipolar Disorder: What Is Helpful and Unhelpful?

Background and Objectives: Pharmacotherapy is a first-line treatment for bipolar disorder (BD), although half of individuals report suboptimal medication adherence. Medication adherence enhancement programs that are brief, person-specific, and remotely delivered may be an effective adjunct to treatment. The aim of this study was to qualitatively assess what individuals with BD who participated in a Customized Adherence Enhancement (CAE) program found most helpful and unhelpful about this program, focusing on elements most generalizable to medication adherence promotion. Materials and Methods: n = 14 participants with BD from the intervention arm of a randomized effectiveness trial of CAE vs. enhanced treatment–as-usual participated in one-on-one virtual, semi-structured interviews. Interviews were recorded, transcribed, and summarized using thematic content analysis to identify themes reflecting what was helpful and unhelpful about the program. Results: Participants identified six main themes reflecting impactful aspects of the medication adherence promotion program: practical tools (e.g., worksheets), self-awareness (e.g., identification of triggers), psychoeducation/content (e.g., specific CAE modules), emotional distress (e.g., difficult emotions arose during sessions), format (e.g., pros/cons of virtual format), and interventionist factors (e.g., rapport). Conclusions: Results provide participant-identified useful aspects of a remotely delivered, adjunctive medication adherence promotion program for individuals in treatment for BD in public-sector settings. Strategies for improvement and scale-up of the program include ensuring sufficient technologic and emotional support throughout the program. Future studies may investigate the longer-term impact of such interventions with multiple stakeholder input and consideration of diverse populations, settings, and cultural contexts.